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Patient Care

Nasty Little Kids

You're summoned to a holding cell at the police station for a 16-year-old kid who's been the topic of considerable radio traffic. His mom called police to her home, where he'd returned after being out all night. He was agitated, throwing furniture and generally destroying the place. Police arrived and detained him, then called Dad at another residence. Per PD dispatch, Dad says he can't control his son, who is therefore the PD's problem. After taking him into custody and failing to communicate with him, the police suspect he's ingested something. And, of course, that's why you're invited.

You're a seasoned medic, but you're impressed. This kid has the worst case of potty-mouth you've ever heard. He clearly has no respect for his parents, the police, you or anyone else. He has a wide-ranging offensive vocabulary in at least two languages. He's invoking Satan. He's suggesting, in florid detail and the most guttural of terms, the degree of native intelligence and at least one detailed sexual maneuver for every person in the room. And if that's not enough, he spits. He bites. And he will not shut that busy mouth, even to inhale. He's even attempting to defecate something he wants you to ingest.

Q. This kid didn't grow his disrespect overnight. He's an animal, he's not over 18, and he really is the parents' responsibility. They should be shouldering the consequences for his behavior. They belong here, and they should be forced to witness this.

A. Hard to say what the parents have already been through, but if this is about drugs, you may all be seeing someone the parents have never met. And even if it's not about drugs, some kids eventually defy their parents' best efforts to raise them as good people. About the best any parent can do is provide a good example, good advice, and good boundaries. Tragically, some kids simply reach a point when they refuse to honor any of those things.

Q. I was raised to respect others, especially those in positions of authority. It's really hard for me to tolerate people who treat me with this kind of disrespect. This is verbal assault, plain and simple. All I do is help people. I shouldn't have to tolerate this. When I encounter people who treat me this way, I'm seriously tempted to retaliate.

A. Ah, but you're smarter than that. You lay one finger on this kid, and he can get himself an attorney for free. He's got nothing to lose, and nothing better to do than work the system. He can be driving your car and parking in your garage, only they won't be yours anymore. He has lots of defenses: He's a minor, it was the drugs, temporary insanity, permanent insanity, he's just a dumb kid with a big mouth and you're supposed to know better. You touch him once, step outside that role of a caregiver, and you forfeit your defense.

Q. So, what? We're just supposed to tolerate this kind of treatment from people's dirty little brats? I'm sorry, but that's just not right.

A. It may not be right, but it's part of the job. Caregivers of all descriptions tolerate it every day, and a plaintiff's attorney will have no trouble proving that in court.

Q. But how? Practically speaking, how do you just let this little bridge troll demean you, your life, your work, and your human dignity without getting angry enough to smack him?

A. It's easier if you're in an ALS system, because there's usually no hurry to transport people like him. You can medicate him and wait for the meds to deescalate his behaviors. In a BLS system you can put a spit shield (and an oxygen mask) on him and then restrain him. You can wear hearing protection, so he doesn't seem so noisy.

But meds or no meds, teach yourself to see him as damaged goods—as though, at least temporarily, the part of him that should be communicating clearly and thoughtfully is incapacitated so he can't interact normally. He may just be a nasty little jerk, or he may not. In either case, you're a professional, and he's not going to own you.

There's another technique you may find useful, especially if you do this for a living. Try to imagine someone you love more than anyone in the whole world and keep them in the back of your mind throughout the call. Try to see yourself protecting them from this patient.

It's a strategy that can elevate you above those behaviors and make you immune to them.

Thom Dick is the quality care coordinator for Platte Valley Ambulance Service, a community-owned, hospital-based 9-1-1 provider in Brighton, Colo. Thom is also a member of EMS World's editorial advisory board. Reach him at

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