This author uses the terms combative patient and/or violent subject in place of any references to Excited Delirium Syndrome (EDS). This is mostly due to the volume of physically violent individuals encountered by First responders that have other etiology besides EDS. Regardless of the cause, violence is something the First Responder must deal with every day. Before evaluation, treatment and transport can begin, the out of control individual must be subdued and restrained. It would be well advised for agencies to define exactly when a suspect becomes a patient and how to transition from Law Enforcement custody to Fire/EMS care. The “patient” must have cuffs removed, soft restraints applied, secured to a backboard and moved to the medic unit for further evaluation, treatment and transport. In the field, Law Enforcement tries to help, but unfamiliarity of equipment and lack of standards to orchestrate such chaos only increases stress to the officers, crew and the patient. It also takes time; extended on-scene time has been a finding in a number of sudden in-custody deaths. The risk of lawsuit is not eliminated if the suspect dies in a medic unit versus a patrol car. The goal is to foster a safe environment for everyone and help remove the risk of liability to the municipality and the employees that must deal with the physically violent individual.
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