Behavioral Emergencies – Prehospital – Combative Patient

Also See: North Coast EMS Combative Patient policy #6035

Prehospital personnel must consider that aggressive or violent behavior may be a symptom of medical conditions such as: Head trauma, alcohol, drug related problems, metabolic disorders, stress and psychiatric disorders. Ensure the safety of both the patient and the patient attendants when dealing with combative individuals.

The responsibility for patient health care management rests with the highest medical authority on scene.

The following verbal de-escalation guidelines should be employed:

  • Remain calm and friendly. Be aware of your emotions.
  • Position yourself between the individual and your exit.
  • Keep your hands in front of your body (Non-threatening Manner).
  • Only one provider should communicate with the individual.
  • Maintain a soothing tone of voice.
  • Listen to the individual’s concerns.
  • Empathize. Use positive feedback.
  • Be reassuring. Outline the individual’s choices.
  • Be willing to slow down and disengage if appropriate.
  • Calmly set boundaries of acceptable behavior.

If physical restraints are required to ensure patient and/or attendant safety, North Coast EMS Patient Restraint policy #6036 should be followed.

If chemical restraints are required, North Coast EMS Sedation (Chemical Restraint) policy #6552 should be followed. Sedation of a combative patient requires prior base hospital authorization. 

WIC 5008 (m):  “Emergency” means a situation in which action to impose treatment over the person’s objection is immediately necessary for the preservation of life or the prevention of serious bodily harm to the patient or others, and it is impracticable to first gain consent. It is not necessary for harm to take place, or for it to become unavoidable prior to treatment.

Medical intervention and patient destination shall be determined by EMS prehospital personnel in consultation with their assigned base hospital, alternative base hospital, or modified base hospital.