The Tough-guy

What's the saying?  "The only unfair fight is the one you lose?"  It certainly would explain why a call for a combative drunk elicits a response from four police officers, a security guard, and our three-person crew.  You can fight, but you're just going to go to the hospital or jail tired.  Going up the stairs to the scene, I even feel the rush of adrenaline I used to feel with every sound of the tone, and then only when the call was for chest pain, a cardiac arrest, or a person unresponsive, until I arrived here, where I often dread getting out of bed for a call, and am only fully awake when we're already on the way to the hospital.  

"Rescue 1, officers on scene now have that party restrained," the radio crackles.  

"Received," McWhacker answers, "you can put us on scene."  We walk past a loud party in a dorm room before finding our destination.

Our patient lies face down on a couch in the center of the room, handcuffed, and screaming obscenities.  His face is cut, and the handcuffs bite into his wrists as he strains against them, chewing up skin and issuing a slow trickle of blood.  "Fucking faggots!  I'm going to pound your asses!  Bitches!"  We've heard worse.

His friends tell us he's been like this for the better part of an hour.  His roommate came home to find him ranting in the room; a flat screen TV lies smashed on the bed.  He fled from them, heading for the stairs before they could stop him.  Out of sight, they heard him tumble down the stairs.  When they tried to help him up, he swung at them.  "I hit him back," one of the friends admits, abashed, to a police officer.  They managed to drag him back to his room before calling the police.  When the first police officer arrived, he was met with a fist flying towards his face.  The struggle only lasted a few seconds.  

We listen to the story.

"Yup," McWhacker says, looking at me.

"Yeah," I reply, an unfortunate expression on my face.  We have to backboard him–we know he's combative because he's drunk, but he could have a head injury from the fall.  

"Grab the soft restraints, too," he tells me.  I retrieve the equipment while he and C$ look for other injuries.  

When I come back in, the cops are chatting with the friends, and the patient has temporarily stopped screaming.  "Tell him he can't drink vodka anymore," one of the officers tells them.  "Different things affect people differently–it's like my wife, if she drinks vodka, she turns into an evil bitch."  They laugh.

"Yeah," I add, "I've never seen anyone get belligerent from red wine."

We ready the equipment, and make sure we're all on the same page.  One person to each limb, someone to tie off the restraints to the board.  They'll uncuff him, and we'll roll him back onto the board that sits at an angle on the couch.  We put a collar on him, and take position. We slip the padded cuffs of the restraints around his wrists and ankles.  "BITCHES!" He screams louder.  "Fucking FAGGOTS!  LET ME LOOSE, I'LL KILL YOU."  The cuffs are off.  I take a leg, but he draws his knees towards his stomach, and I lose leverage.  A police officer reacts quickly and sits on his legs.  I grab the leashes from both ankles and snake them through the handholds on the backboard.  The police officer releases the legs as I pull both leads tight, locking his ankles to the board.  I hand off one to the cop while I tie the other.  I fumble with the knots because of my gloves.  Once both ankles and wrists are secured, we rotate the board flat.  C$ quickly produces straps from the collar bag, which we use to flatten his body against the board.  Everybody is sweating.  Apparently, the patient feels exposed on the board: "Just leave me something to cover my dick!" he yells repeatedly.  McWhacker secures his head, but the collar has slipped up over his face in the struggle.  He removes the headblocks to adjust the collar, then replaces them.  We clean up the board job; fix straps that aren't well-placed, then stand back for a minute before moving to the truck.

"Hey bitch," our patient says, making eye contact with McWhacker.

"Hey BITCH!" he says, louder.

"HEY, BITCH!" he screams.

"WHAT?" McWhacker finally acknowledges.  A surprised look on his face, the patient shuts up for a minute.  

Ready to go, McWhacker moves for the feet of the board, leaving the (heavier) head to me.  (Thanks, buddy)

"They're all standing out there waiting for this kid to go by," the security guard comments.  The police officers leave to clear the hall.  

As we move him, the patient flips the bird with not one, but two hands to all who look on.  In case they didn't know, he was not having a good time.

At the end of the hallway, a student gets in the face of one of the cops trying to clear the hall.  In the real world, he would go to jail, and undoubtedly experience some discomfort on the way.  In the cushy bubble of the university, the cops' hands are tied.  Their only recourse is to break up the party and take the names of the problem children.  An unfortunate byproduct of a generous judicial system.

We make it to the truck.  A set of vitals, a blood sugar, and we're off.  A police officer accompanies us.  McWhacker calls triage at Rhode Island, but has trouble hearing over the enraged screams of the patient.  Hey, at least they'll know what to expect.

Sure enough, a fleet of security guards meets us at the curb of the ambulance bay.  One of my favorite triage nurses comes out as we're unloading him.  We give him a quick summary of the story and point out his wounds.  I feel vindicated for having exercised caution by boarding him when we're sent to a critical care room.  It takes four 5 mg doses of haldol to subdue the tough-guy so that they can scan his head.  Before the haldol takes its effect, they put in a foley catheter.  He screams even louder, but I'm sure he won't remember in the morning.  

We disinfect the bloody board and clean the straps.  I clean up the back of the truck.  The adrenaline leaves my system.  I feel calm.  Other places in the country, this might not have gone the same way, I think to myself.  We might not have shown as much restraint.  Nothing he said got to us.  Nobody took anything personally.  The same armor that protects us from the personal tragedies we're exposed to blocks insults, attacks, and physical assaults.  We don't have time to be insulted by someone struggling against us; all we can do is handle it as safely as possible and get back in service for the next call.