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You pull up to an address at an apartment complex where you’ve been called around midnight for a “behavioral emergency.” The police are on the scene, and they’ve cleared you to come in.

There are so many flashing colored lights, it’s hard to see what’s going on at first. But that’s a short-lived mystery. One of the officers opens the rear door of a cruiser, and two others half-drag, half-dodge the kicks of a big man who emerges from the back seat. He’s about six-four and weighs 300, and he looks pissed. He’s wearing a spit shield, and his wrists are cuffed behind him. He’s clothed in jeans but shirtless, and that’s about right for the weather.

You decide to leave your gear right where it is for the moment, and just see what’s going on. A young cop tells you the man’s name is Daniel. He’s 31, he’s HBD, and he’s been living with his mom. Earlier a neighbor saw him smack her in the face hard enough to knock her down. Big as he is, the neighbor jumped a fence and opened a can of whup-ass on him. His nose and mouth are bloody. He smells like a brewery. He’s protesting the neighbor’s actions, one moment crying pathetically and the next spitting his bloody oral secretions and lunging at anybody who gets close to him. You’ve heard a lot of cussing in your career. But no kidding, this guy has the foulest, most limited vocabulary you’ve ever heard.

You, the cops and the engine company wrestle him to the cot and restrain him face-up, with the cuffs still in place behind him. (He doesn’t like that, and he recommends some anatomically impossible strategies for all of you.) You apply an O2 mask over the spit shield, administer IM benzos, and transport with two firefighters aboard and a cop following you. During transport, you ask him what he’s had to drink and if he’s taken any medicines. He calls you a “stupid c---,” and threatens to find you and assault you sexually as soon as he gets out of the restraints. And as soon as they’re within range, he extends that offer to an ED nurse as well.

Two days later, his mom calls your chief. She says he’s just been released from jail. He’s complained to her that, during transport, one of the medics acted inappropriately toward him. She says he was hyperventilating and the medic wouldn’t give him an inhaler. And worst of all, prior to offloading at the hospital, a female medic was covering him with a sheet and remarked, “we need to cover up your man-boobs.” That, she says, was degrading and unprofessional.  

Q. Next to politics, this is one of the worst things about EMS. Since when is an inhaler indicated for hyperventilation? It wasn’t a medic who made the “man-boobs” comment, and even that wasn’t used in a derogatory context. But this is a complaint nonetheless, and it will become part of my employment history. Most of all, we weren’t the offenders, here. This guy was spitting blood at all of us throughout our contact with him. His verbal assault on us never abated. I know there’s nothing we can do but tolerate this kind of abuse. But why should have to endure it, and then be penalized for it? That’s simply unfair.

A. You’re right, it’s not fair. We don’t necessarily owe people what they want. We owe them what they need, if that’s even possible. It sounds like this fellow’s neighbor had the best prescription for his behaviors. As for the complaint, most good EMS systems do track them as critical quality indicators.   But there are warranted complaints and unwarranted ones. That’s an important distinction, and it needs to be considered by whoever does your investigations.

Q. In our organization, a complaint’s a complaint. They’re tracked, not investigated. How do we get across to our administration the fact that some people’s behaviors are simply unmanageable?

A. That’ll be easier if your chiefs have ever worked in the field, and just need a little reminder. It’ll be harder if, not. You can tell them what we did when we recontacted this kid’s mom with follow-up.

We told her our crews don’t always get the respect they deserve, and there’s not much we can do about that. But our women don’t have to tolerate being called what this medic was called. We told her, if her son wanted to come by the station and apologize to the crew, that might be a good idea.

(No sign of him yet.)

Thom Dick has been involved in EMS for more than 40 years, 23 of them as a full-time EMT and paramedic in San Diego County. He is the quality care coordinator for Platte Valley Ambulance Service, a community-owned, hospital-based 9-1-1 provider in Brighton, CO. Thom is also a member of the EMS World editorial advisory board. E-mail

Thom is the author of People Care: Perspectives & Practices for Professional Caregivers. The recently released 2nd edition of this classic text includes seven new features: Death notification skills; suicide intervention strategies; safe procedures for defusing and, when necessary, restraining violent people; cases intended to illustrate the lessons of People Care; and strategies for reconceptualizing burnout and managing it as a balance issue. Click here to order.


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