Resistance is Futile!

Let's talk a little about combative patients:

A combative patient is one that fights treatment or control. This can happen for a variety of reasons. When we talk about combative patients in EMS, typically, we're talking about folks who have a brain injury or are hypoxic (brain's starving for oxygen) and they start flailing about. You see, when the brain's in trouble, i.e. starved for oxygen, the body kind of goes into "freak out" mode and starts lashing around in an attempt to somehow correct its oxygen starved state. When you're the paramedic in a small box that's moving down the bumpy road at high speed with said combative patient, this is what is sarcastically referred to as, "fun."

Now, there are patients that are combative because of a physical injury. Then there are patients who are combative due to a chemical insult (too much booze, pills, or whatever they ingested, snorted or shot up) and then there are patients who are combative just because they're ornery! Yep. The injured a**hole. Now, technically, we shouldn't refer to these patients as "combative." That term is usually reserved for folks who do not possess the ability to make an informed mental decision and we've got to fight 'em for their own good. The very reasons they are in such a combative state also usually alters their mental faculties so that they can't give or withhold their permission for treatment. That's when we get "implied consent." and proceed to do the things necessary (we hope) to save their lives, etc..

Now, let's go  back to the ornery ones:

Some folks are just a pain in the butt. They get themselves all banged up, cut up, sick or otherwise in a bad way. Not enough to alter their mental state, mind you, but enough so that someone calls for a paramedic and they actually need some treatment. But they get stubborn and it's a constant argument to get them to let us do the simplest things. For example, I had a patient a while back who had an unfortunate meeting with his lawnmower. This 80-year old gentleman got tired of waiting for, "them darn kids" to show up and cut his grass that he went out, sandals and all, to do it himself. Well, needless to say, the mower somehow rolled back and he's a bit stubbier on his left foot than his right as a result.

We arrive, find him bleeding  a bit, uncomfortable, furious, ornery and in full possession of his mental faculties. No, he doesn't want us to take him to the hospital. No, he won't let us bandage his foot. No, we can't start an IV and hook up the monitor. Who cares how many cardiac medications he takes, "I ain't goin!" All the while he's swatting at my partner and I when we get close, waving his arms around and being a pain.

In the time It took his wife, daughter, my partner and I to convince him to let us treat and transport him, I could have driven him back and forth to the hospital 4 or 5 times. Yes, I could have taken a refusal from him but I would have been back later when he finally gorks out! This happens more often than I'd like in the USA.

Now I'm over here in the Kingdom and there are a lot of differences. I don't see as many drunk, high or chemically altered patients as I did in the USA. I know they exist in the Kingdom but not where I practice, I guess. I also expected a lot more distrust and even open hostility to my white face and lack of Arabic language skill from many of my patients. However, that's just not so.

The men who have fallen under my care seem to be in one of two states: Dramatic flailing, wailing and hollering over the tragedy and pain or completely limp as if they had swooned. Usually, if they're in the first state, they quickly swoon with a melodramatic sigh as soon as a medical person shows up. I'm always so surprised at how uncomplainingly they put up with any of my treatments. A patient may cry out at an IV stick, sure, but he usually doesn't pull back, strike out or otherwise act "ornery." It seems to me that, once medical help is perceived to be on scene, the patient just gives all into Allah's hands and sighs all the way to the hospital. After fighting ornery, bloody lawn-mowing 80-year olds, It's a nice change!


I haven't had any Arabic women patients. Usually, they are brought in by their husbands to the ER directly. I'm sure if I ever do have an encounter with a female patient over here, It'll be seriously blog-worthy!

--maddog