Navigating an Agitated Patient: Essential Steps for EMTs and Paramedics During Transport

When an unconscious patient unexpectedly awakens during transport and experiences panic or becomes physically aggressive, it's essential to have a clear and structured plan in place. Here, we will discuss the essential steps EMTs and paramedics should take to ensure the safety of both the patient and the medical team.

Staying Calm and Assessing the Situation

First and foremost, staying calm is critical during such scenarios. Your composure can help reduce the patient's anxiety and make the situation more manageable. Quickly assess the patient's vital signs and overall condition to determine their immediate needs. Staying focused on this can prevent any unnecessary panic on the part of the patient.

Communicating Clearly

Clear and reassuring communication is key. Speak in a calm, gentle tone, and introduce yourself. Clearly explain where you are and what has happened. Use simple, straightforward language to minimize confusion. Overwhelming the patient with too much information can often lead to further distress. Breaking down the situation into simple, understandable parts can help the patient grasp what is happening.

Ensuring Safety

If the patient is physically aggressive, prioritize the safety of everyone in the vehicle. This may involve securing the patient's limbs gently but firmly to prevent injury to themselves or others. Ensure that any restraints used are appropriate and only for the duration necessary to ensure safety. Gently reassuring the patient that this is necessary for their own safety can help ease their resistance.

Using Restraints if Necessary

Should verbal de-escalation fail and the patient continues to pose a danger to themselves or others, consider the use of soft restraints. Ensure that these restraints are appropriate for the patient's size and condition, and use them only for as long as necessary. Document the use of restraints in detail and continue to monitor the patient's condition and reactions.

Monitoring Vital Signs

Continuously monitor the patient's vital signs and their level of responsiveness. Be alert to any signs of distress or deterioration. This ongoing observation can help identify when the patient is becoming more calm or when further intervention is needed. If the patient's condition worsens, adjust your care plan accordingly.

Administering Oxygen

If the patient is struggling to breathe or showing signs of distress, provide supplemental oxygen. This can help stabilize their breathing and reduce their panic. Keep an eye on the patient's response to the oxygen and adjust your intervention as needed.

Preparing for Possible Interventions

Be prepared to administer medications if authorized and necessary. For instance, if the patient is suspected of experiencing a medical emergency such as a seizure or severe agitation, having the appropriate medications at hand can be crucial. Always follow the chain of command and ensure that all interventions are authorized.

Communicating with Medical Control

Notify the receiving facility and your medical control of the patient's change in status and your interventions. Provide them with detailed information about the patient's condition and behavior. This information is vital for the medical team to prepare for the patient's arrival and provide the best possible care.

Documenting Everything

After the incident, ensure you document the patient's behavior, your interventions, and the patient's response in detail. Proper documentation is crucial for continuity of care and legal reasons.

Debriefing and Support

After the transport, debrief with your team. Discuss any feelings of stress or trauma that you and your team may have experienced. Working with agitated patients can be emotionally taxing, and it's important to address these feelings to prevent burnout and ensure the well-being of the team.

By following these steps, you can handle agitated patients during transport effectively, ensuring the safety and well-being of both the patient and the medical team. Regular training, practice, and adherence to these procedures will enhance your ability to manage such challenging situations.