DB 20-18 - Management of Patients In Custody or with Combative Behavior

Question 1

Patients In-Custody (PIC) have a significantly higher risk for _______ and _______.

Patients In-Custody SHALL BE transported by LAFD ambulance to an emergency department.

Answer 1

Adverse medical outcomes and Litigation

Question 2

The relationship between law enforcement personnel and the LAFD members on scene of a patient in-custody (PIC) is defined within the California ________ Code.

Answer 2

California Health and Safety Code (Division 2.5, Section 1798)

Question 3

In relation to patient care and transport, what can patients in custody (PIC) refuse?

Answer 3

They MAY NOT refuse transport, however they MAY refuse prehospital treatment.

Question 4

What medical treatment/transport rights do patients “detained” by LAPD have?

Answer 4

Patients who are “detained” by law enforcement but ARE NOT under arrest ARE NOT in custody so they retain the right to refuse treatment and transport.

Question 5

Where there is a disagreement on scene between law enforcement and LAFD members on scene regarding patient TRANSPORT/DISPOSITION, a _______ shall be requested to be dispatched to the incident.

Answer 5

EMS Battalion Captain

Question 6

Can LAPD request LAFD to transport a patient in custody to a police station, police infirmary, police medical dispensary or jail?

Answer 6

Negative.

SHALL go to an Emergency Department

Question 7

A suspect in custody shall be considered a patient and transported accordingly whenever any of the following apply:

Answer 7

1. The person in custody verbalizes or appears to have a medical complaint or apparent injury.
2. Law enforcement summons us to perform a medical evaluation.
3. A mechanism of injury is sufficient to suspect an injury may have occurred.
4. Any evidence, signs or suspicion that the suspect may be under the influence of illicit drugs or may have overdosed on or missed taking their prescribed medication.
5. Any display of abnormal, irrational or aggressive behavior.
6. Anytime the suspect’s reliability appears questionable or there is uncertainty between members, the suspect shall be perceived as a patient and transported.

Question 8

If requested by LAPD, our policy may permit the conditional bypassing of the most accessible hospital but only for a destination that is a DHS-approved 9-1-1 receiving facility such as the jail ward at LAC+USC Hospital. This requires _____ approval.

Answer 8

base station

Question 9

Verbal de-escalation shall always be attempted prior to the application of physical restraints unless?

Answer 9

members perceive an immediate danger to their safety or the safety of others on scene.

Question 10

Members should request additional LAFD resources PRIOR to attempting to subdue a patient who has lost their mental capacity to cooperate.

At no time should members attempt to engage with a patient who is dangerously violent or who MAY possess a weapon unless?

Answer 10

there is an immediate life threat to themselves or bystanders and waiting for the arrival of law enforcement is not an option.

Question 11

Who should be requested to respond anytime there is a disagreement between LAFD and LAPD of a patient REQUIRING RESTRAINT?

Answer 11

-EMS Battalion Captain or Battalion Chief
-LAPD Supervisor

Question 12

DHS Prehospital Care Policy, Reference ______, establishes principles and policies for emergency procedures and use of restraints during transport of patients who are violent or may harm themselves or others.

Answer 12

Reference 838 (Got-to-Restraint)

Question 13

Restraint methods must allow the patient to straighten the ______ and _____ in order to take full breaths.

Answer 13

Abdomen and chest

Question 14

DHS Reference 838:

The type of restraint devices applied by EMS personnel must be either ______ or ________.

Answer 14

padded hard restraints or soft restraints

** Both methods must be keyless and allow for quick release. Restraints shall be applied as a two point padded wrist and belt restraint or four point padded wrist and ankle restraints.**

Question 15

The following methods of restraint shall NOT be utilized by EMS personnel:

Answer 15

-Hard plastic ties or any restraint device requiring a key to remove.

-Restraining a patient’s hands and feet behind their back.

-“Sandwich” method (e.g., backboard, scoop stretcher or flats).

-Materials applied in a manner that could cause vascular, neurological or respiratory compromise (e.g., gauze bandage or tape).

Question 16

Restrained extremities should be evaluated IMMEDIATELY following application and every 15 minutes thereafter for:

Answer 16

-pulse quality
-capillary refill
-color
-temperature
-nerve and motor function

Question 17

Under no circumstances are patients to be transported in the _____ position regardless of who applies the restraint.

Answer 17

prone

Question 18

EMS personnel must ensure that the patient’s position allows for:

Answer 18

-adequate monitoring of vital signs

-does not compromise respiratory, circulatory, or neurological status

-does not preclude any necessary medical intervention to protect or manage the airway should vomiting occur.

Question 19

Restraint devices applied by law enforcement require the Officer’s continued presence to ensure patient and scene management safety.

The LAPD Officer SHALL accompany the patient in the ambulance. In the unusual event that this is not possible, the Officer should?

Answer 19

-Follow by driving in tandem with the ambulance on a pre-determined route.

(A method to alert the officer of any problems that may develop during transport should be discussed PRIOR to leaving the scene.)

Question 20

DHS Reference 838 Required Documentation:

Answer 20

1. Reason restraints were applied.
2. Type of restraints applied.
3. Identity of agency/medical facility applying restraints.
4. Assessment of the overall cardiac and respiratory status of the patient; and the circulatory, motor and neurological status of the restrained extremities every 15 minutes.
5. Reason for removing or reapplying the restraints or any abnormal findings.

Question 21

The TranZport Spit Hood is the only acceptable device to control the exposure of prehospital care providers to a patient’s bodily fluids and when the patient is combative, belligerent, or otherwise uncontrollable and when a ______ or ______ cannot be safely applied.

Answer 21

N95 mask or oxygen mask

Question 22

If a TranZport Spit Hood is not immediately available at a time of need, what else can be temporarily applied in a loosely fitting manner?

Answer 22

-towel
-sheet
-other shielding device

Question 23

The TranZport Spit Hood shall not be used on anyone who is:

Answer 23

-Vomiting
-dyspneic
-hemorrhaging profusely from mouth or nose
-presents signs of a compromised airway (Continuous use of pulse oximetry shall be performed and documented whenever possible.)

Question 24

A _______ shall be requested to respond to the scene (or meet the ambulance at the hospital if their estimated time of arrival (ETA) is extended) to assist with medical oversight whenever a spit hood is applied.

Answer 24

EMS Battalion Captain