Case of the Month
August 2005

28-year-old male - abnormal behavior

At 1026 hours Aid 2 is dispatched to a report of a 28-year-old male acting strangely. During the response the dispatcher updates the dispatch adding that the patient is lying unresponsive on the kitchen floor-he is breathing, his eyes are open, and his color is good.

You are met at the curb by the patient's fiancé who is very upset because she has never seen him act this way. She states he is "just lying there and won't answer." She states found him like this and adds that he "trashed the family room." The crew asks if there are weapons in the house and she says "no."

She reports that he has no medical history, takes no medications and he does not use recreational drugs. She says, "He is a really great guy, but he has been under a lot of pressure at work lately."

Due to the damage to the family room your crew decides to call for police back up. When the police arrive you go inside to investigate. You find the patient on the floor, face down, legs slightly spread and arms folded under his head. His eyes are open but he does not look at you. His breathing is unremarkable and his color looks good.

As you reach down to pinch his earlobe (noxious stimulus) the patient jumps to his feet and assumes a defensive posture. Your crew steps back and the officer says, "Hey, we're just here to help you." The patient then bolts out of the house. You immediately update the dispatch center of the situation.

With the help of a neighbor your crew determines that he has run to a huge, nearby park. You do not pursue further and report this information. You return to the initial scene.

The fiancé now reports that the patient had one "outbreak" of violence ten years prior, but nothing since. "He does get upset sometimes and hits a wall or throws something, but never at another person," she says. It is also discovered that he is a seventh degree black belt in karate.

In the house you find no signs of drug use, no signs of bleeding or trauma, and no other clues. The patient's truck is parked with the wheels on the curb, which is not normal. With the police present the truck is searched, but nothing found. Having no patient and no other follow-up work to do, your crew returns to quarters. The police will contact the fire department if the patient is found.

The lesson learned from this case: Patients who act irrational are capable of demonstrating even more bizarre and aggressive behavior. You must always approach a scene with safety foremost in your mind. EMTs tend to want to help everybody, but you must keep yourself safe. It doesn't take much to provoke some patients and you can quickly become the target of an assault. Attempting to find a medical reason for this patient's behavior is a secondary to safety of the scene, crew, and patient!

Some tips:

When approaching a situation that involves bizarre or aggressive behavior, make sure you have the appropriate resources (personnel, etc). If the patient is breathing fine and has good color, as in this case, it is very appropriate to wait for the police.

Survey the scene for hazards . As you approach a patient you should look around to for any potential threats. This includes weapons are anything that can become a weapon, for example, scissors, a piece of pipe, or a letter opener.

Don't corner the patient . People are much more likely to feel threatened and react if they feel trapped. It is not our job to restrain a patient unless asked to do so by the police. Give the patient an "out."

Always have an escape plan that has two routes to safety. As you enter a scene look to see how you can escape if needed. Do not present a threatening posture or confrontational attitude.

If your patient leaves the scene, follow at a safe distance, if at all . This may make the patient feel "hunted" if you follow too closely.and he or she may go on the offensive. The police have the training and tools for perusing and confining these patients. It's best not to take the chance alone.