The EMS crew’s safety is of paramount importance. Do not approach a potentially dangerous patient without law enforcement presence on scene.
After obtaining preliminary history, do not unnecessarily antagonize a psychologically-unstable patient. You should ask permission to conduct a quick physical examination and then give the patient his “own space” while continuing to observe enroute to medical facility.
You should ALWAYS consider whether the patient has any weapons on him/her. If so, relay your concerns to law enforcement. If necessary, request that an officer accompany the EMS crew in the ambulance during transport.
In the case of a violent or physically-threatening patient AND you anticipate transporting the patient for medical evaluation, you may consider:
a. KETAMINE 1 mg/kg IV/IO or 4 mg/kg IM or 5 mg/kg IN
OR
b. MIDAZOLAM (Versed) 2.5mg-5mg IV or 5mg IV max of 10mg
If chemical sedation is utilized, monitor airway closely enroute.
If the patient is transported in handcuffs, an officer is required to accompany the patient.
Any patient in restraints during transport must have his airway monitored at all times.
If the patient voices suicidal or homicidal ideations, notify law enforcement.
If patient refuses treatment or transportation for mental evaluation, EMS providers do NOT have the legal authority to provide care UNLESS the patient is in law enforcement custody for mental evaluation. Contact law enforcement for assistance.