Differentiating the cause of a patient’s erratic behavior—whether it is due to a medical condition, psychiatric condition or criminal conduct—requires assessment by skilled medical professionals. The threat of serious injury or death to first responders or the patient is very real when attempting to evaluate undifferentiated aggressive or violent behavior.
EMS clinicians and law enforcement officers (LEOs) must rely on distinct, yet complementary, skill sets in such critical, rapidly changing situations. LEOs rely on EMS professionals for medical assessment and transport to a hospital when deemed necessary. EMS professionals rely on LEOs to provide scene safety, to mitigate threats to EMS clinicians and to allow a safe medical evaluation in uncertain and often unfamiliar environments.
EMS professionals dedicate their lives to ensure patient safety and possess a unique skill set of prehospital medical knowledge and operational experience in the field (outside of a safe clinic or hospital). These professionals can assist LEOs in recognizing if atypical behavior is indicative of a medical crisis or criminal behavior and provide continuous quality improvement of procedures to safely manage violent or resistant subjects. It is, however, the individual EMS professional who ultimately is charged with the authority and ability to evaluate these patients when requested. EMS professionals should always base medical decisions on the information available to them and never solely on orders from police.
EMS physicians, along with police, EMS and fire, have dedicated our existence to saving lives. We must respect each other’s priorities, with a delicate balance of safety for the patient, responders and the public to eliminate in-custody injury and death.