Violence

For those in the UK Panorama tonight has a programme on violent patients in the NHS (BBC One 20:30).

Us ambulance crews are verbally and physically abused on an almost daily basis – it has gotten that we tend to ignore the verbal abuse that we get.  It’s only with the increasingly common physical assaults that we fill in the required forms.

Let me give you an example from my last night shift, a not unusual job.

We were called to ‘woman collapsed in the street’ at gone midnight.  We arrived to discover our ‘patient’ lying under a bus stop with what appeared to be her worldly possessions in a plastic bag.  There was no-one else around except for the minicab driver who had called us from hi office that she had ‘collapsed’ in front of.  While my nose can no longer detect alcohol my crewmate for the shift was able to tell me that the patient smelt as if she had been dunked in a brewery sewer.

A quick check in her bag revealed nothing obviously medically wrong with her (medicalert bracelets or ‘I am an epileptic’ cards).  It did however reveal that the woman had been released from custody earlier in the day.

I tried to wake her, but she screwed her eyes tight and refused to talk to us.  The problem is that we can’t leave her on the street; someone else would call us and we would be back and forth all night.  Likewise if she froze to death we would be to blame and, if she were stabbed later in the night we’d also probably be to blame.  The police also wouldn’t be interested, they have stopped taking people who are drunk, one too many deaths in custody is to blame for this.  So, as she refused to go home or to her hostel, the only place that we could take her was to hospital. 

I was in a good mood, so I explained all this to her, that we couldn’t leave her here, and that if she didn’t come with us the police would probably be called and that they might take a dim view of her drunkenness (a bit of a bluff, but it sometimes works).

So she started to swear at us, she threatened to hit me and she was generally rather rude

Again, this is all water off a ducks back to me.  At one point she tried to kick me, but I’m an old hand at drunks in the street and by the cunning tactic of stepping out the way managed to avoid a scuffed shin.

Eventually we managed to hoik her up and into the back of the ambulance where, after a bit more swearing, she settled down.

She did give me a dirty look at the end of the journey though.

I would say that I get a patient who is verbally abusive at least once or twice in a shift.  I don’t mind violence from people who are medically unwell (e.g. diabetics with low blood sugars, post seizure epileptics).  But can I really count ‘drunk’ as a medical problem?

I also count myself lucky that I work where I do – unlike the hospitals where people become frustrated by long waiting times and percieved injustice I’m often seen as a friendly stranger who makes everything better.

For further stories of assaults you can look here, here, here and here. Unfortunately these won’t be the last.

18 thoughts on “Violence”

  1. Report in the news of an ambulance broken into whilst the crew attended an 85yr old woman. They took communication and sat-nav equipment. Just as bad as physical/verbal abuse staff have to withstand.

  2. Under UK law you *do* have a right to defend yourself. You can even kill someone if you have a reasonable suspicion that your, or another's life is in danger (this is despite what the tabloids would have you believe). If someone came at me with a knife and I was unable to run away, I could kill them and the police wouldn't charge you.Similarly you may use 'reasonable' force at any time – stabbing granny might not be reasonable in this case, but punching her might be. You just have to get over the natural revulsion of using violence against someone in your care.

    As I have always believed, “Better to be judged by 12 than carried by 6”.

  3. Yeah planning to watch that tonight.The abuse can start from quite an early age- young children kicking you when you try to give them an injection for example while their parents watch lovingly, sometimes my hand is itching to give them a quick slap! OOOh that's not pc is it?!

    People seem to think they are more likely to get what they want if they are rude or aggressive- doesn't work that way where I work, not prepared to tolerate it.Agree it's different if they are ill as you suggest but downright rude and unpleasant, no excuse. Time we all said NO

  4. I watched the program, and i tend to agree with the most of the conclusions drawn.For us however zero tolerance means very little indeed. The police (whether their hands are tied, or a lack of interest) tend to actually do very little when they are called. I know of staff that have had cases dropped by the CPS. However our trust (or previous trust) seem to want to do very little under the zero tolerance, w fill in the forms and nothing ever gets done. For years a patent with epilepsy assualted staff who would attend afer they had suffered a “seizure”, they would not hit any bystanders, police officers, only ambulance staff. This aggression was blamed on his disorientation after the “seizure”. One day the pt was reviewed by a new dr who refused to accept that the “seizures” were a factor in the assaults on staff. He was told about this, and guess what? Since this time we have been to them a few times but no further assaults have been committed, if i was cynical it might be to say that the knowledge that not being able to use the medical condition to hide the pt from possible prosecution has meant that behaviour has been adapted.

    In addition to the above, I can agree with Tom you can't blame patients whose conditions modify their behaviour. One of the most violent physical assults (and thankfully it hasn't happened much) was from an elderly patient with dementia. What has a greater effect on me is the threats, you never ever know who will or wont follow it through. This is half the problem and what the public just do not seem to realise…I don't and will not put myself in the postion where i stay there long enough to find out.

    People who work in industry and private sector areas do not have to put up with the abuse as they are able to say no thanks. To finish this post I have to leave with my pet hate: the people who sit there and abuse/threaten me, then laugh because I “have to treat them” because they pay my wages and i am a public servant grrrr!!

  5. I'm grateful to encounter this less frequently – due to the rural nature of our area. That's not to say we don't get the offensive drunks, manic suidcidals and plain nasty individuals – just less often. God bless you for putting up with it everyday ! Then again, you always seem to get just enough GOOD calls to make you still want to come back and do it again….It's addictive stuff.

  6. Hmm so far Iv been able to avoid getting Physically assualted. But we get lots of verbal all the time. Infact the majority of the abuse doesnt even come from drunks. Because of the annoying resembelence our Uniform bears with the police we are subjected to that extra air of hostility. Ok thats fair enough. But what about if you have a patient whos subject to a Diabetic Emergency as a result of drinking half a bottle of vodka. Can we blame him if hes combatant lol.

  7. Excellent idea! I didn't get a chance to watch it, mainly because I didnt realise it was on until just now.It is sad to see how abused crews get. It's mindless violence at the end of the day, and is just a pointless as vandalising ambulances, etc is.

    I wonder how many people quit the job because of the risk of violence, people who would otherwise have made great Ambulance staf…

    Regards

    Nick

    http://nickhough.blogspot.com

  8. jamie, i take it you are refering to the SJA black and whites. we have two duties that are higher risk and forced the greens in PPE on the risk assessment. not that we are trying to become NHS, but the First look is well they are not coppers. there are times where police arriving have made treating on duty very hard.Im glad that most of our duties are safe, i could not do the job of A&E NHS staff, the way things are.

  9. whilst i have been the victim of violence in other areas of work, in my current job in a cardiac intensive care we usually get violence from the lovely old people that we have performed major heart surgery on, as many succomb to what is known as 'post pump syndrome'.i vividly remember a pt who was very confused one day after open heart surgery, who in the middle of the night (whilst the nursing staff were treating a very poorly man and took their eyes off the pt for one second) climbed out of bed, ripped his central line out of his neck, picked up a drip pole which had infusion pumps attached (so VERY HEAVY) and used it like a viking battle axe. i had to pick up a office chair and fend him like a lion tamer, as he was advancing towards a sedated and intubated patient who could not be got out of the way. it took 6 grown men to take him down. we had to be very careful using force as he had recently had major surgery and we could have killed him. thankfully with some sedation we were able to sort him out and he made a full recovery, i decided that that was the wrong day to give up smoking. i since have. he weighed only 50 kg!!!!!!!!!!

  10. I agree Dave the majority of our duties dont inherit the same amount of risk as our collegues of the County Ambulance's. I personally believe our Black and White No1. dress uniform is out dated and the the reason why alot of people are put of from joining SJA. Although we are trying to improve our image, SJA's got a long way to go. But with uniform such as our Greens being brought into operation this does leave me with some confidence that SJA national do have some idea about what they are doing. The fact is our No1. dress (Black and Whites) is fine for parades and formal gatherings. Saddly in our county the Black and Whites are depended on far to much, I agree we should look smart but at the same the uniform we are wearing and the condition we are faced with should reflect this. Anyway Im getting of the subject hehe. Thankfully over all we are not faced with many of these incidents and it is fair to say on the rare occasions that we are, we are well backed up.

  11. I watched the Panorama programme, and I can't decide which was most shocking -the violence staff were sunjected to or the way the courts dismissed it with pitiful sentences.So much for 'Zero tolerance', but like everything else it's become a virtually meaningless buzzword, no more.

    They should lock these people up, for a minimum of 6 months, and I don't mean suspended. But let's face it, the prisons are so full they aren't even locking up paedophiles sometimes these days, so what's a bit of violence going to get you?.

    People in the NHS all have my utmost sympathy and admiration, and deserve far higher wages.

  12. Our favourite routine with violent and abusive patients in the military – yes we had our fair share of drunks and morons – was as follows:Medic: Doctor, can I put the drip up/give the patient the injection. I've never done it before.

    Doctor: Of course you can. Just try not to rupture the vein/make sure you don't push through to the bone.

    It was amazing how the patient would just behave themselves after that exchange.

  13. I watched the repeat of this at 2am friday morning – following an evening in A&E after a pt on my ward broke my wrist.Thing is the patient has dementia, I had to fill in paperwork (before I was allowed any pain relief to my disguist). The form did have a code for “injury caused by patient with medical condition contributing to the event”. But It officially goes down in the trust that I have been assulted.

    I am angry that I wasn't warned in my handover that she was aggressive, but how can I be angry at her as she doens't know what she's done. When I was at work friday afternoon her relatives asked what i'd done – but I hadn't the heart to tell them that their mother had grabbed and twisted my arm that badly that she'd cracked my arm!

    So I feel that sometimes the figures given aren't quite right, but I wish I had the right to act in self defense against a patient.

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