Hypothetical Situation, The Conclusion

Lots of suggestions in the comments to the original post, some good and some not so good. Sedating the guy, wrestling with him for his gun, having the cops wrestle him for his gun, using the Hey, that’s a neat gun, can I see it?” ruse to talk him out of his weapon… all of those disregard the one thing that usually cures the problem with postictal seizure patients: Tincture of Time.

A little more questioning of the employer didn’t yield any answers as to why they see fit to arm a guy with a seizure disorder and then put him to work in a room full of chirping noises and blinking lights, but I did find out what they define as “rowdy.”

Turns out, if you crowd the guy and try to force care on him when he’s postictal, he’ll get a little combative.

Duhr.

Self-preservation is hardwired behavior, folks. The postictal guy doesn’t grasp that six people standing over him and talking at once are there to help. Trying to physically manhandle him only compounds the problem. He’s fuzzy and disoriented, and all of a sudden, there’s a room full of people he doesn’t know violating his personal space. Wouldn’t you be tempted to fight?

Doesn’t really matter in the patient’s addled mind that the physical touch is only to check a blood glucose or to take a blood pressure, it’s still threatening physical contact.

So I’ll tell you what I did and the thought processes behind my actions, not necessarily to suggest that what I did was the right way to handle things, but to demonstrate one way of dealing with the situation that worked.

In this instance.

Heck, the night before this happened, a postictal seizure patient found himself taken down violently with me kneeling ever-so-gently between his shoulder blades until the cops could get him cuffed. I approached that guy the same way I approached big boy with the gun – give ’em some space and some time, but be ready to act.

The difference was, the guy who got taken down posed an overt threat, both by body language and direct actions.When he tried to pick up my oxygen tank and swing it at me, it was time to quit talking and start restraining.

So he got restrained. Decisively.

Big Boy with the gun posed no such threat. He was as docile and cooperative as could be…provided you didn’t try to take his weapon or make him go anywhere against his will. As long as I talked to him, he’d answer all my questions agreeably and do whatever I asked, short of giving up his weapon and getting on my stretcher.

Of course, the first ten minutes of the patient interview went something like this:

AD: “Sir, I’m AD of Borg. I’m a paramedic, and I’m here to help. Can my partner here check your vital signs?”

Armed Big Boy: “Yes.”

AD: “Sir, do you know what happened to you?”

ABB: “Yes.”

AD: “Sir, do you realize you had a seizure? We need to check you out, okay?”

ABB: “Yes.”

AD (sensing a pattern to the guy’s answers): “Sir, if we can find ballerina slippers and a tutu in your size, would you do a few pirouettes for us? Preferably, while playing Feel Like Making Love on the harmonica? It’s a standard part of our assessment.”

ABB: “Yes.”

AD: “I think it’s safe to assume that ABB is not exactly lucid.”

Employer: “He’s got a gun, and he’ll get rowdy with you. That’s not safe.”

AD: “Sez who?”

I noticed that he was armed when I first made contact with him. Didn’t know what it was, because he had it in some cheap Uncle Mike’s (an oxymoron, I know) knockoff with a cover flap and snap closure. You could only see the end of the gun’s butt. No duty belt – he had it threaded on his trouser belt. He had his left hand resting atop the holster. Every time I moved his arm, palpated his pulse, slipped on a pulse oximeter probe, whatever, that hand kept coming back to his holster.

I suppose if you were uncomfortable with guns, that would seem threatening. To me, it meant training. I don’t know how extensive his rent-a-cop weapons training was, and considering that his employer armed him, with a history of seizures, and then assigned him to a casino, I’d suspect that their weapons training was no more stringent than their employment screening.

Be that as it may, it was pretty obvious that, no matter how disoriented he might be, Big Boy was concerned with weapon security. He’d likely practiced it enough that it was an unconscious act – just as it should be when you carry a weapon. Rogue Medic pointed out as much in the comments:

Some people play with their genitals when they are post-ictal. This does not indicate that they like you. The guy is not oriented. You do not know what he will do.

No, what people do is revert to habitual, hardwired behavior when they’re postictal. Like playing with their genitals. Or weapons retention, if they’ve trained with it enough. They’re operating entirely on instinct.

[side note: Please Lord, never let me have a seizure in public. At least not when I’m wearing clothing that allows me easy access to my genitals.]

And I suspected that any attempt to take his weapon from him would have resulted in things going, as LawDog would say, rodeo.

Now, it may well be that the situation would go rodeo anyway, but why hurry things along unnecessarily?

So I had Rookie Partner radio the cops, and our supervisor. And while I was waiting for them to arrive, I kept my hand on Big Boy’s wrist, ostensibly to check a pulse, but mainly to keep my hand between his and the flap on his holster. As long as I didn’t try to touch his holster, he had no problem with it – and I did try, surreptitiously. He noticed, so I let it go. It was pretty obvious to me that I wasn’t going to get that gun out of its holster without a struggle.

On the other hand, it was also obvious that he wasn’t going to get it out of his cheap-assed holster without a struggle either. If he ever needed it in a hurry, some perp would be likely to empty a full mag into him before he ever cleared nylon.

So I had a brief word with RP and The Supervisor Drone, and we had our take-down plan worked out, if it came to that. The cops were on the way, in the hopes that Big Boy would be more likely to give up the weapon to a peer with a badge, not some schmo in a polo shirt.

By the time the cops arrived (remember that when seconds count, the cops are only 23 minutes away!), Big Boy was no longer a threat. He was refusing care, and I didn’t relish fighting him to take him to the ER against his will. His mental status was improving by the minute, so I stayed there with my hand
on his wrist, all while gently trying to convince him to go to the hospital. I wound up questioning him until I was certain that he was lucid enough to make an informed refusal of care, and he signed an AMA form and his employer called his wife to drive him home.

And as it turns out, he wasn’t willing to wear a tutu and play Feel Like Makin’ Love on the harmonica, after all.