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How do you handle a hysterical patient, family member, bystander, etc.? (self.ems)
submitted  by ensign_johnson
I have my EMT-B and plan to start making moves toward working in the field. What are your stories of hysterical family members or patients and what did you do/say for them?
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[–]marmitesandwichUK - Paramedic 8 points  
Give them a job, distracts them and also gets them out of the way.
[–]piggybankcowboy 7 points  
It goes further than this, I think. The hysterics can, and often are, rooted in a feeling of helplessness regarding the situation. By giving them a job, you're not just distracting them, but sort of abating that feeling of helplessness because, for the moment, they've become useful. Or at least it is perceived as being useful. 
Note: this also works if any of you are involved in long-term elderly care. Simple tasks or chores are a wonderful tool in keeping the patient's morale up. 
edit: spelling
[–]maxzlNJ EMT, Emergency Management 3 points  
I once had another EMT tell me that during an 8PT MVA, they had everyone packaged up and were waiting for transport he gave the hysterical PTs (not necessary severely injured) O2 via NC at like 2 lpm or something. He went on to explain that the PT now thinks their job is to "deal with the oxygen and breathe." And it gets the out of the way...
[–]purpd 2 points  
Can you give some examples of "jobs" for someone like that to do?
[–]marmitesandwichUK - Paramedic 3 points  
I went to a 40yo male in cardiac arrest a while ago. Kid asleep in the next room, wife freaking out. It wasn't immediately obvious what had happened but an OD seemed possible so I asked the wife to look through the bins in the kitchen/bathroom/bedroom to look for empty pill packets. It gave her something to do and gave us space to get on with the resus. 
That said, don't rely on hysterical people to actually do your work. She found nothing more than one old packet - we went through the bedroom bin again and founds literally dozens of empty blister packs she hadn't found, fella had taken the biggest OD I've come across. 
[–]Becaus789 2 points  
My standard operating procedure is to get the story from a family member and then before performing my assessment I hand them the clipboard and say "here fill this top box out, their name, address, date of birth, that sort of thing." Like piggybankcowboy said, it gives them something to do. Sometimes you get useless gibberish (which is understandable, it's a traumatic time) in which case I pull out a new sheet and "go over it" with them and hey no time lost. But really 9 times out of 10 you get a well filled out form. I work in a culturally diverse area and it's easier to have them write down an exotic name. And quite often with a caregiver that is a good historian, they will jot down all sorts of useful information (hx rx etc.) This saves me a lot of time. 
[–][deleted] 7 points  
Use someone else to help. PD,fire..... 
[–]mintygood 6 points  
Treat them with respect and hone your diffusing skills. Some people in this industry as so quick to physically restrain, place under PC, sedate, etc when in reality, treating the patient or family like a human being will make them cooperate. Be patient and take your time as long as it isn't a life threatening situation. Build a good rapport and try to gain the patient/family's trust. Of course, that's not to say that this will work with patients that are literally incapable of being reasoned with.
If the shit is quickly hitting the fan, get police involved. I ask for PD whenever I think the scene has the potential to get gnarley.
EDIT: As for a story, I got sent to a suicidal woman a good while back. PD stated that she was a well known meth user and was high. Got on scene, she was irate, cops were yelling at her and threatening to take her to jail if she doesn't shut the fuck up etc. All I did was sit down on the ground in front of her, asked her if she wanted help, and then told her I can take her away from the situation and get her on the path of getting better. She was completely psychotic when I first arrived but after I got on her level (physically placing myself so she couldn't see the cops) and showed her that I was on her side, she was quick to cooperate. Imagine what it felt like to be her... She was high as a kite with 4 cops screaming at her from all angles... OF COURSE she is going to be irate. She needed someone to fight in her corner for her.
I'm totally not trying to justify her drug use but the cops were completely out of line in my opinion... There are many, many more effective social tools than the "my way or the highway" approach. Sure, you need to be firm when it comes to patients BUT there needs to be some level of give-and-take (even if it is only PERCEIVED) or else your patient will not do what you need/want them to do. I hesitate to call it manipulation because of the negative connotation but as long as the patient's best interests are kept in mind then you're doing the right thing. Let's call it social-engineering-for-the-purpose-of-keeping-the-crew-safe-and-the-patient-in-good-health. 
Of course I know that she probably wasn't suicidal and was probably just threatening so she wouldn't have to go to jail but I don't really care. If I gotta run the call, I might as well play along with her stupid shit so we can get to the hospital safely. She probably felt like she was manipulating me the whole time but in the end, I got my way.
[–]Raincoats_GeorgeVA - Advanced Intermediate 2 points  
I had a similar patient. She was a well known in our agency and has a history of psychological problems. I showed up on scene to find police basically screaming at her getting her completely worked up. I did exactly what you did. I put myself between her and the police. I got on her level and I spoke directly to her. She calmed down, she came with us and gave us no problems. 
You cant always get people under control. Drunk people for example can sometimes be completely out of control, but I'd say most patients can be talked down or at least calmed down so they will cooperate with you. 
[–]CejusChristCouldn't afford a taxi medallion 4 points  
Do your best to explain the situation as completely and precisely as possible, in a clear and concise manner. Do not escalate the situation by raising your voice, and answer the questions they're asking in the most correct manner you can. If that doesn't work, have Law step in if need be. You don't need to be getting hurt trying to control someone who is out of control.
It's not easy, but after some practice you will have your own way's of dealing with irate bystanders, but just like everything else in this field, you just need to experience it for yourself firsthand.
[–]1speedbike 3 points  
If it's a parent hysterical about a kid, always ask them to get something of the child's (a stuffed animal, an ipod for an older kid, etc), so they can have it in the ambulance and at the hospital. This will not only let you get the parent off your back for a little while, but you can take the opportunity to ask the kid a few questions without the parent glaring down at them. This is especially useful for kids with possible pregnancy, drug use, doing something they shouldn't be doing, etc, who won't really open up with their parents around.
Other than that, as mentioned, give everyone else a job. Could be meaningful or completely meaningless. If all else fails, just try and ignore them the best you can. Don't try to engage them if they're hysterical, because people who are hysterical usually aren't reasonable. If you haven't been able to calm them down by just talking to them, it's best for everyone to focus on your job and push the distractions to the background. 
[–]Becaus789 5 points  
A momma or pappa bear can be very dangerous. There are more fights at the Chuck E Cheese in my area than all the bars combined. 
[–]GrittySpiceEMT-P DDS ESQUIRE 4 points  
Giant animatronic rodents tend to bring out the worst in human nature.
[–]bubbaderpTaxi-bulance ... eff it 3 points  
Like this calm down
[–]pinkflowersLocation - Designation (student if needed) 2 points  
As far as hysterical pts go, you will encounter a lot of them. I usually just talk to them like a person rather than just a pt. Ask them questions about their life (kids, job, school...etc). That usually distract them from the pain or emotional distress. If that doesn't work, then just lend a listening ear and maybe put your hand on their shoulder as a sort of comfort, so that they feel like you genuinely care. Try and respond appropriately as well. You would be surprised, but I've heard some of my partners say stupid things to a pt while they were bawling their eyes out. As for family and bystanders go, try to get someone else to distract them or get your partner to ask them to get her the pts info (meds, license, SS, med hx, etc), this gives them something to do. If a bystander is in the way or distracting, tell them in a polite way they need to step back so that you can treat your pt. 
[–][deleted] 2 points