On Being Assaulted

Those of you who read my Twitter feed will have had a preview to today's post.

The night before last I was attacked at work. Thankfully my injuries were limited to bruises and scratches, however I have been incapacitated by muscle strain. Let me explain.

We were sent to a man who was unconscious in the street, we arrived a few seconds before the police to find him collapsed in the road. It was obvious that someone had given him a good beating as his face was like a split fruit. Big cuts, large lumps, swollen lip – whoever had hit him had really gone to town on his face.

He seemed mildly disorientated so we quickly got him on our trolley and into the back of the ambulance. We checked him out to make sure that he didn't have any stab wounds – it's a bit of a hazard round my way, especially considering not all stabbings get reported by the media.

The police tried to get some details off him, but he said he was in too much pain, so we told them that we would meet them down at the hospital where he might be a bit more cooperative.

His behaviour was a little 'off', he'd been drinking, but was possibly showing signs of concussion or maybe something more serious.

I got into the front of the ambulance and started towards hospital.

Within seconds the man was up and swinging his fists at my crewmate, slamming on the handbrake I ran round to the back of the ambulance and managed to restrain him.

His confusion seemed to have become more severe, he couldn't remember what had happened to him and he kept repeating the same questions. Every so often he would look at his hands, see the blood and start asking us why we had hit him.

He alternated between calm and very agitated, he kept refusing to go to hospital and kept fighting us to get out.

Here is were we get into the thorny issue of Consent and Capacity. I can't kidnap people off the street, not if they have Capacity (the understanding to refuse).

However in the case of someone who cannot understand the consequences of refusing treatment and may have life or limb threatening injuries then I can try to 'force' them to go to hospital. For example, someone hit by a car who has a serious brain injury causing them to fight us off may be dragged off to hospital as they don't have the Capacity to refuse.

Needless to say, it's not something that I like doing.

What we were worried about with this patient was that he had been beaten so hard that he had a bleed on his brain, it was this which could have been causing his strange behaviour and which could prove fatal. He wasn't able to understand the consequences of what was happening to him, nor of what would happen if he didn't have treatment – he was having trouble remembering his name let alone anything more complicated.

He needed to go to hospital and in our opinion he didn't have the Capacity to refuse.

Unfortunately the police had left the scene (they needed to in order to allow us to get to hospital) so there was no help there. Every so often he would try wrestling with us and he only got stronger. My crewmate called Control for urgent police assistance, normally they would come running to help, but for twenty minutes we were bounced around the inside of the ambulance as he tried to hurt us while we tried to not hurt him.

He also had the strength of an angry man, while we had to remain calm.

Don't get me wrong, if someone tries to assault me because they are drunk, obnoxious or just plain nasty then they will get reasonable force used on them and they'll be throw off my ambulance – but with someone who is apparently not in his right mind I can't exactly knee him in the testicles.

Twenty minutes we wrestled with him while waiting for the police – we didn't want to move because otherwise the police wouldn't be able to find us to help – but after all this time it seemed that we weren't going to get the help that we had urgently called for. By now the sweat was dripping down my body, I was covered in his blood and he'd managed to get a few good scratches and punches in. Thankfully my glasses were intact.

I managed to restrain him enough for my crewmate to drive us to hospital. There was a bit of a stand-off at one point where he kept threatening me, but I managed to keep him controlled.

Unfortunately as my crewmate opened the doors to the ambulance he managed to break past me as by now I was exhausted, sore and feeling sick from the exertion. He burst through the doors and ran down the road after waving goodbye and shouting 'sorry for hurting you'.

I wasn't going to chase him, to be honest I don't think I had the energy in me to chase him even if I'd wanted to.

The police officers at the hospital came over to see what were happening and after telling them they offered to arrest him. I've read enough police blogs to realise that if they did arrest him it'd be a load of paperwork and wasted time for the CPS only to decide no further action because my patient probably wasn't in his right mind.

We spoke to an officer who suggested a ten minute cup of tea, before seeing the expression on my face and realising that sending us home for the last few hours of our shift was for the best. So we returned to the station, filled in the relevant paperwork cleaned up the warzone that was the back of our ambulance, wiping the blood off the walls and cupboards and fixing the chair that had been battered in the struggle.

Then home.

And so I sit here typing this, in pain not because of any great injury – but because my entire body aches from twenty minutes of extreme exercise, I'm walking like a cripple and the grip has gone from my hands. I suppose that I'm just reaping the consequences of not having the chance to do regular exercise. I'm hoping that he didn't have anything nasty in his blood. And I'm off work for a bit due to my inability to walk like a normal person.

£10 per hour after tax doesn't seem enough for this sort of work.

For those concerned about the patient, I believe that another ambulance and police team-up managed to get him to hospital – the further results of which I don't know about.

As for the police not attending our urgent request for help… I spoke to our Control and she told me that she used both the Scotland Yard line and the dedicated line and on both occasions she thinks the phone was picked up by the cleaner rather than someone who actually knew how to answer a phone and dispatch police officers. I believe the phrase she used was 'some civilian numpty' – I think that a complaint from our Control has already gone in to the police.

31 thoughts on “On Being Assaulted”

  1. This is what we all fear the most, I think. You really don't want to have to make a choice between yourself and him, 'cause he's sort of your responsibility. And still if I had to make that choice, it would be easy: me. Seems like you guys did what you could, and who could ask for more? Hope you feel better soon 🙂

  2. Puts my “rough days at the office into context”. That's pretty nasty. Glad you're ok, if a bit bashed though.I assume you are not legally allowed to sedate him, even if it's for his own good?

  3. Yep – no sedation and no restraints on the stretcher.(It's cheaper for one of us to be injured rather than a patient who might sue…)

  4. All the best and get well soon.Two days ago we had a drunk in a busy street with a minor head injury, mid-afternoon. On the floor, kicking off when we tried to help. Policy says call the Police – last time I requested the Police I was told they had no one available to send. Rock and a hard place. Back off and to the general public it looks like “Ambulance Crew abandons man in street”. Got him on the motor and to A&E, where he kicks off again in a busy reception with families too close to him for comfort. No sign of Security, so end up escorting him out of the department. Nursing staff come out for a look, where he gets abusive and leaves – why do we bother??

  5. I should think also that if you were concerned that he may have had a bleed on the brain, the last thing you'd want to be doing from a health point of view would be sedating him.Still, bugger of a situation to find yourself in. :-/

  6. I think the only thing worse than this type of scenario is the person who isnt drunk/drugged and gets agressive while you are already seeing to a patient in the back of your ambulance. but as you have inconvenienced them by doing your job they are going to tell you so. and then get agressive with you too. You cannot restrain them for their own good, as they are not your patient – they cannot be thrown off your ambulance as they don't want to be on it – or have anything to do with it in the first place. they are just being a nasty git – they dont pay enough to put up with that.

  7. Thanks goodness it was but cuts and bruises physically. And, no worries with the blood, i hope. Still makes for some mental shock for a time tho so hope you feel better soon.We have belts inc. a harness on our stretchers tho they're fairly easy to undo by a patient.

    Head injury… Not Head injury- hard to call sometimes innit.

    take care 🙂

  8. It's pretty common for paramedics in my area to conduct an RSI in situations like this (basically chemically paralyzing someone to put a tube in their throats)… and extremely controversial. I've never done it, as I'm still only a basic, and I'm not saying it's right, only that it seems to be a pretty common form of “medical self-defense” in my area.But yeah, sorry to hear that, and hope you feel better soon. Beware the drunk with the head injury =P

  9. As someone who once had a solid whack to the head, I agree that it can render someone totally incapable of knowing what's best – so sorry to hear about this though, it must have been hellish, and I hope you get better soon.And yes, exercise would be helpful, I'm speaking to myself at present too as I've been in pain for five days – from lifting two bags of shopping. The untoned body will readily take the first opportunity to protest!

  10. I right there with you on this one man! I've worked psych for the last 6 years and have ended up in more scuffles and full on knock-down drag-outs than I care to remember. Just last week I was attacked by a patient with a sharpened comb as a weapon and no – my paycheck doesn't seem to add up either. Not to mention that after 7 days, not one member of the hospital administration team has seen fit to come and ask me if I'm okay, or if anything can be done to prevent this in the future.If however, I had reacted the way I wanted to – and took the guy down hard (!) – there would have been a full on investigation. A deliberate attack on staff with a weapon however doesn't warrant diddly.

    Keep up the excellent work and stay safe!

  11. Re-frame the issue: It's not “Patient Restraint”, it's “Passenger Safety”. What good are the gurney locks in an accident if the patient/passenger isn't held by some sort of safety system just like the crew?It's just happy coincidence that the best places to put gurney belts happen to cross over the patient/passenger at points above the elbow and knee which also happen to prevent him injuring himself when having a seizure… or while trying to kill you. This idea brought to you by overly litigious Americans.

  12. I do agree, and having witnessed a few people who were utterly flying on drink & drugs I'm all for restraint so long as it's humane and appropriate, people really just LOSE IT – not just their temper, all ability to think like a reasoning human.I've probably mentioned this before but I've seen it take 5 or 6 BIG male coppers to hold down one smallish woman, who was in a state – and brain injury is no different, anything that makes the person lose their grip means they don't need or actually benefit from the same treatment you'd give someone who was in possession of all their marbles.

    JMO.

  13. I've been lurking on this blog ever since buying your book as yes I did wonder what was happening in the Ambulance flying past me (yes I'm far too nosy for my own good). I was aware that the resources provided by the emergency services were often abused but I never realised how bad it was.Anyhow, after reading this post I just wanted to wish you a speedy recovery from what must have been a scary experience. i have great respect for what you and your colleagues do. When I see any vehicle with flashing blue lights approaching I always swear, but only because I worry that I can't get out of the way quick enough!

    Best wishes

    Sarah

  14. Oh Dear, Oh Dear, Oh Dear….I have been reading your blog for quite some time and the threat and danger of this happening, and now it has.Although not the same scenario, I got belted a few on the tube late last year, awful. I wish you lots of good karma, warm mustard baths and easy healing.Kerryx

  15. If you injure a patient, they sue you. But if a patient injures you, the management shrug it off. Why doesn't anyone represent you? What would happen if you rang one of those dodgy ambulance-chasing lawyers for your injury at work and sued the patient yourself? Do you have to sign away your rights to a safe workplace when you take the job??(I'm sure this is not the first time someone's thought of this, and I know it is an unrealistic suggestion, but all the same…)

  16. I have ben thinking about that too. Wouldn't it be possible to walk into a police station and lay a charge against this man? There where witnesses to the assault.If you could bring charges, you could almost start to set a 'precedent', with others following suite?

    Or would that just cause a whole lot o trouble?

  17. You checked him for stab wounds, am presuming the police had checked he wasn't carrying. One of the worst things about these incidents is the knowledge that it could have been even worse.Surely the trolley should have a few seat belts to keep the patient safe, that could also be used as minimum restraint. Positional so as to avoid putting pressure on injuries or restricting access for treatment.

  18. I can't speak for an ambulance clinical incident form, but in my trust when you complete the paperwork there is definitions of assult.I had my wrist fractured by a tiny old lady when I was giving her, her tablets and a cup of tea, so after my visit to A&E I was sent back to my ward to complete my form.

    You have to tick to state if the patient was;

    violent with intent (i.e. stone cold sober and with complete capacity),

    violent under the influence of non-prescribed medications (sky high on drugs off the street),

    violent under the influence of prescribed medications (sky high cuz the Dr's written it up), or

    violent due to injury/disease/illness that renders the patient confused

    Of course mine was the last and therefore it would be the same box for Tom, meaning that we wouldn't have a leg to stand on as they were not of a mental capacity to cause injury with intent to harm us.

    Hope you feel better soon Tom, a few bumps and bruises and muscles ache is far better than any broken bones or skewered eyes in my book!

    Hope HR don't drill you down for sick leave now……

  19. I had this image of the ambulance state of the art control room, all headsets, computer screens and satellite tracking systems working with the police state of the art control room, to bring you urgent police assistance, now all I can see in my minds eye is an old black bakerlite dial phone, ringing out, in an empty office, because it's after 5pm and they've all gone home. I've been reading Gadgets blog too much 😉 Glad you are intact

  20. But surely it can't be long before someone decides to sue because they have been injured while mentally incapacitated and they argue that the NHS should have sedated/restrained them before they hurt themselves further? I'm not suggesting they should sue, just that management maybe should be taking into account the possibility that at some point someone might? Could they argue that while they were temporarily a 'vulnerable adult' appropriate treatment to prevent further harm was witheld? or is there some protection under the law to prevent that?

  21. Glad that you and your partner survived and were able to walk out of there, hope the pain doesn't last to long.l am sure the managers read this blog l would like to tell them that they are a bunch of total tossers that are in need of a dose of the abuse and kicking and lack of back up that the crews risk and get and if l ever get the chance to meet any nhs managers in person l shall happily pass on the message verbally to their face.

  22. Hi Tom, I'm sorry to hear about this mate, the fact that you guys have got to wear armour for precisely this reason makes me sick. Twenty minutes restraining someone is completely knackering having been there on more than a few occasions I know what it feels like! Re the lack of Police response, as you know us guys on the ground treat LAS requests as urgently as coming from our own people, although on nights when we run out of units the requests do go out Met-wide, we've had quite a few blats from central London out to Romford, Morden, bexleyheath etc to try and help you guys out purely because the locals ran out. Not good especially as 30 seconds is a long time in a fight let alone 10-15 minutes with someone getting stronger with every second as the adrenaline kicks in. Hope you're back up and about in one piece soon

  23. Two words Tom

    CHEMICAL RESTRAINT

    I wouldn't have put up with that at all. Come and work in NZ where your allowed to defend yourself. Even though it's only 10 quid an hour here the standard of living is much better. Come and check it out for your holiday. I even think the we have an exchange scheme with LAS. Let me know ….

    From my point of view the chemical restraint is well justified. I don't think any of my peers would argue any differently. The restraint is for their safety and yours. The autonomy we have with the procedures in our service, works really well. Your allowed to make a decision. Yes there are issues with this form of restraint but we do it under the crimes act. If we were stuck with mental health legal rubbish then it would never happen and then people including ambulance staff would get hurt. A bonus, we use Midazolam so the patient usually forgets what happened at the time.

    One wouldn't like to physically restrain a patient for to long (Hopefully you don't lose it at the time) and have a case of restraint aphyxia. A bit hard to explain that you know. It's all how you do it and the decisions you make

    Dont get me wrong I prefer not to use chemical restraint if I can help it, and will always try and talk the patient down first. But the line has to be somewhere, both for us and for the interests of the patient.

    A few months ago a suicidal patient tried to get out of my moving (quickly) ambulance. To do this he aggressively tried to go through my partner to get out the back door. She politely gave him a precordial thump with her boot. It worked really well. Like you never a police officer around when you want one.

    Well take care Tom. Get well soon. And remember there are actually good people out there that need our help.

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