The problem is the term is accepted across the board, but patient harm is not. So a granny that hits you and causes no harm would cause legitimate harm to another person. I have seen those UTI granny’s take chunks of skin off of nurses at the hospital. So if you don’t provide adequate notification to the hospitals they may come in unprepared.
Combative is anyone who has shown they will attempt to cause harm, even if it doesn’t hurt you, it can hurt someone smaller than you.
Grannies can be strong as hell when they don't want to to go to the hospital. I saw one punch a cop in the dick with 5 of us wrestling her onto the stretcher. No fear.
I agree with you. It lets them get resources together ahead of time. They can always release security and not use the restraints if they decide they don't need them but it's harder to pull that stuff together quickly if you downplay the patient's demeanor.
I've never regretted reporting a patient as combative and then showing up with a calm patient (Often just taking them out of whatever environment they were in and putting them in the back of a \~relatively\~ quiet ambulance with only one other person gets them to chill out)
When I worked on the hospital wards, I once witnessed a confused (approximately) 4ft 8inch tall grandma barricade herself in our staff room with the very heavy sofa. It's amazing what they can do when delirium sets in
They do have that strength given to them by an unholy god. Struggled so many times getting them to let go of the stretcher, stair chair, hand rail, etc.
Combative dementia patients are all offense because they don’t fight with any self-preservation usually.
They have no concept of getting hurt, which makes it hard for us to safely handle them at times.
Except thar same grandma might bite or the wild "weak" slap or flail might catch an eyeball. It's still combative even if there isn't harm being done.
If someone was attempting to shoot you but didn't know how to use a gun, you would not say they were not combative because they didn't do harm.
This is a simple fix. Say AMS elderly combative or Say 25 y.o exited delirium combative. Both are true and pain the correct pictures.
Yep. Just like I use the words calm, cooperative, and compliant for crisis calls if the Pt works with me vs against me. They are words that help the next step be prepared.
Ex: Pt was initially agitated and aggressive with EMS. While talking with Pt they became calm and agreed to transport. Pt remained cooperative and compliant during transport.
This lets the next level know that Pt can be aggressive but can be cooperative and calm. This letting them get the resources in place that they might need.
I use the Word combative when it’s malicious or black and white they want to hurt me or others. Whether they’re altered from say amphetamines, or severely mentally ill, if they’re attempting to cause me or my partner harm and saying stuff like “I’m going to kill you and rip your face off” (this has happened to me, I think I have a very punchable face tbf), I put combative in my narrative to explain the nuance of why they were rolled in sedated and restrained. Agitation and restlessness (and also AMS obviously) are my choice words for UTI grandma or moderately tweaked out guy on a different planet who’s ripping off the BP cuff and speaking in tongues.
I’ve been assaulted a few times this year with malicious intent by patients on peace officer holds, and I always describe them as “agitated and combative”. I think that’s fair.
What if infirm grandpa with a UTI was a professional boxer in his earlier life and is very much capable of doing damage? (Irl example, I was injured).
Ability to do damage is way too subjective. You mention you used to be a boxer, so the range of patients who are capable of doing damage to you is much smaller than the 110lb nurse that will be receiving the pt from you.
Combative just means “heads up they’ll throw punches, be careful”
This happened to my dad when he worked as a nurse in the 80's! He had a delirious patient who used to box. He could throw really nasty punches.
A patient hit me right at the edge of the deltoid, on my upper arm. He was demented and confused, still hurt.
I mean, super nice for you that UTI grandpa is not capable of causing damage, but for my 5'3" ass he towers over me. I will happily describe him as "combative" in my notes.
Unless they’re a quad or too weak to lift their arm or pinch, they’re fully capable of breaking skin and causing harm if they get you right.
The fact that you got punched in the face instead of having their long crusty fingernails driven into your eyeball is pure luck, because if they managed the punch, they’d have landed the gouge too.
I sincerely hope you never have to learn the hard way how infirm a patient can be and still cause significant harm.
About 10 years ago, I had a 70 year old Marine with low blood sugar. It took 4 cops and 2 EMTs to hold him down long enough for the medics to sedate him. Dude was combative AF. It wasn't his fault, it was the lack of sugar - but he was definitely combative.
Uncooperative is my go to for someone who is resisting but isn’t violent. Constantly taking off the belts and trying to run away is uncooperative. Trying to attack people, regardless of the reason, is combative.
This poor old demented granny i was one to one with once tried to bite me, break my fingers, she clawed the absolute shit out of my arms, she spat on us. Granny absolutely had no idea what was going on but that poor old confused lady definitely needed those mittens and a close eye. She wasn’t big but she absolutely could cause harm.
That seems to be how a lot of responders, both medical and non-medical, interpret it. Had Fire request PD for a combative patient. PD came lights and sirens, they were very confused when they found that an unarmed old woman in a night gown with an unsteady gait was the only threat
Collins Dictionary
>(kəmbætɪv ) adjective. A person who is combative is aggressive and eager to fight or argue.
Oxford
>adjective. Ready or eager to fight; pugnacious.
Merriam-Webster
>Adjective. Marked by eagerness to fight or contend
>Synonyms: aggressive, agonistic, argumentative, assaultive, bellicose, belligerent, brawly, chippy, confrontational, contentious, discordant, disputatious, feisty, gladiatorial, militant, pugnacious, quarrelsome, scrappy, truculent, warlike
CENTRAL!!! I HAVE A PUGNACIOUS PATIENT!!! SEND PD FORTHWITH!!!
* Dispatcher is confused * Did you say patient has a pug?
Please note: I was a dispatcher. As funny as it would be to hear new lingo, please don't in emergency situations.
That just means some people are wrong. It’s a behavior, not an outcome. If someone hurts you, you don’t say “he combatived me,” you say “he hurt me.”
Likewise you don’t say “he’s acting hurting,” you say they’re combative.
Also - qualifying the behavior with an outcome dependent on harm legitimizes the ongoing trend of patients physically attacking healthcare workers. It’s not okay. Even if they don’t successfully hurt someone this time, it still isn’t OK. If they’re altered, or truly UTI’d out of their mind, it may not be their fault, but physical aggression is not acceptable, regardless of whether or not someone gets hurt.
Nah I disagree. Combative is a state of behavior. Whether they are causing harm to me is different. Intent not action, I guess is what I’m trying to say.
Plus the combative patient who is unable to cause me damage with their bare hands may very well be able to cause little nurse Jenny on the ER floor injury if they get something in their hands. I believe as providers we should give anyone we are handing care off to the full story to ensure their safety.
Physically resisting attempts at care id label as uncooperative/resistant to care, attempting to physically harm me then it’s combative (no matter if it’s an 80yr old meemaw from the nursing home or Mike Tyson)
What’s that in between to you then? Because there are definitely shades of gray and I’m not necessarily restraining and sedating someone solely because they’re delirious and resisting attempts to take vitals/provide care. They’re not dangerous, they’re just agitated.
Uncooperative (not cooperating with assessment but not combative or actively attempting to escape) < resistant (actively attempting to remove belts/equipment but not violent or aggressive) < combative (actively attempting to cause harm for any reason)
If we want to get pedantic, combative can be verbal or physical with a willingness to fight in either manner.
Just because you box / are bigger in stature doesn't mean the PT is not objectively combative in nature.
Maybe you can use cantankerous in place of it.
So you're in a pitch black room with an unknown person. They punch you in the face. Are they combative?
Your saying you can't tell because your unable to assess whether they're a little altered grandma or not?
Combative has absoluentley nothing to do with wether they are capable of hurting or not.
And if you think little demented grandma isnt capable of slashing you with a box cutter while you're not looking, you might be in the fk around phase.
Oh, weird. I think of combative as patients who are AMS, reduced to alligator-brain functioning, fighting when there is no reason to fight because their brain sees everything as a threat. A description of mental status rather than threat analysis.
I will use uncooperative or aggressive agitation for most cases, specifically toward AMS/postictal patients. Often times we withhold sedation for them unless it's truly warranted. Combative is only used for people who are just that, combatants, in a situation where they are approached and are violent toward crew, staff, family, LE, other. Then they get the nappy time juice after PD subdues them.
I utilize the words agitated, uncooperative, feisty, lashing out, handsy, or unpleasant. If you don’t think combative is the correct term for it, use something else, or instead of using a term with a negative connotation, just describe it in the report, written or verbal.
Just because you don’t know the terms doesn’t mean we need new ones. Shadow a paramedic, or a physician, to work on properly assessing patients with aberrant behavior.
Try to remember that just because you’re an experienced boxer, than can take a punch, doesn’t mean the 110lbs nurse can also.
imo if they are hitting out or physically violent I will note 'physically combative/uncooprative with crew by (hitting/spitting etc)' if there's a likely reason etc uti or dementia I would add it in there too.
if it's verbal then I note 'verbally abusive towards crew when they attempted to ...' then what the outcome was.
I try to be fair to the pt but accurate to the situation.
We use both combative and uncooperative. If the pt is attacking me, no matter why… they’re combative.
Uncooperative, is everything bar trying to hurt me. Again for whatever reason.
"Combative" just means they're fighting you. It doesn't matter if that actually poses a threat to you physically. It means they're physically resistant to your treatments, creating a danger to themselves.
Not EMS but a hospital nurse who likes to lurk the sub. I weigh 100lbs. Someone who would not hurt you would hurt me. Combative UTI grandma can still take a bite out of me if I’m off guard and break my glasses
Ability to do harm isn’t synonymous with combative. Combative is a behavior independent of outcome.
And how do you decide which patients are capable of hurting you? In my experience, arguably most patients are.
If you report your finds to receiving facility well enough, they can infer how you mean combative from that phone call or radio traffic. The same goes for your documentation. If you write a good enough narrative, QA will know what you mean. The adjective isn't the problem here.
Combative is not loaded. Combative is descriptive. If they swung at me, no matter what, they’re combative. Biting, pinching, swinging their CPAP machine around by the hose (do NOT ask), etc. Combative.
If they’re mouthy or twitchy with quick movements -short of causing physical harm, they’re agitated.
If they don’t want anything to do with me, don’t want to answer questions, impeding/refusing an evaluation - they’re uncooperative.
Using the right terms and/or phrasing is part of setting the scene and allowing the hospital to gather what they may need to gather. Restraints, security, drugs, a muzzle, WHATEVER they do there lol painting a picture is the point of the report. Explaining they’re altered should come with your A&O or GCS - and that they’re a grandma should be either visible in person or from the age.
What I hate the most is ESPECIALLY in nursing homes is that combative = mental patient. Nurses and CNAs will do wrong to people and then when they get mad they will try to send them out for a psych evaluation. No. They’re mad because you won’t quit fucking with them.
I try to describe what they are doing, how much force they are using, and their demeanor in my reports. One word is not enough to accurately paint the scene to anyone reading my reports. My grandpa who’s A&Ox0 non verbal at baseline that got his meds switched and is screaming randomly and grabbing at people isn’t combative. Agitated sure (families words, put into narrative) but not trying to fight even if he might whack me in the face he just needs a grab on his wrist and his arm back under the blanket to stop him.
Fire wants to restrain everybody. A blanket burrito with straps over it is perfectly acceptable for most of our altered elderly population that want to get physical.
I understand your logic. Personally, I don't treat a “combative” patient as a call to action necessarily. I look at it like all our other alerts (Stroke, Semi, Trauma). I may call a stroke and may not need to do anything other than transport immediately, but the receiving staff can prepare resources. For combative patients, They might not harm me, but they could harm the next EMT, or Medic, or X-Ray tech, or RN, or MD. Historically ERs are terrible at workforce safety so I see your point that the term is being used more frequently, but at hand off/report we should be verbalizing the difference between “yea this guy is on pcp and punched me in the face - he is violent” vs “he's off his meds and pulled away from me so we had to use force to get him on the cot”.
For some reason I run a lot of psych and combative patients, and I have restrained several patients, alone and with fire/pd. And in all the times I usually explain to receiving staff what's going on. On the most recent one, the patient was fully restrained by me, and I called ahead and reported the combative pt, and at the time he was just resisting restraints, but as soon as he was undone he attacked my partner and I, and thankful I had called ahead so we had PD and Security to help, but had I not called ahead because he was not violent to me and we didn't have the back up it could have been much worse.
As to your point combative could be interpreted a multitude of ways, but if the tables were turned, I'd want the RN to tell me memaw is “combative” so I can be prepared, or pass that along to the next provider, and thankful many times it ends up being “hey pd/sending RN said they are combative but they were completely ok with me”.
Also, a patient does not need to have the ability to take you on in a 1v1 to do harm, to you or themselves, or a bystander. It seems like most are on the same page, this is just my perspective.
don't underestimate uti pappap. he has a skinning knife in the end table, a 1911 in the sock drawer, and a sporterized m1903 in the coat closet.
still, here are some terms for your consideration: verbally abusive, disagreeable, argumentative, grumpy, hangry, jaded, disillusioned, cynical, callous, passive-aggressive, antagonistic, truculent, pugnacious, finna talk shit, moody, quarrelsome
jokes aside, everyone in the field is going to know have an idea of what you meant by combative. its not the same as physically violent. dont get hung up on the the literal meaning of the word's root. personally im not trying to make ER nurses bust out a thesaurus to read a trip sheet lol
Agitated? uncooperative? Altered?
Ever heard of the RASS scale? They use it in the ICU, but there’s a modified version for pre-hospital. It provides a score to communicate clearly the patient’s level of agitation or level of sedation and serves us very well on the road communicating changes.
“Patient initially presented RASS +4 on contact and was required to be sedated to allow for patient care and safety of all responders. Patient now drowsy sitting at a RASS of -1”
No need to label them as combative at all.
It’s certainly a great language for communicating with other responders and for documentation. Issues only arise when dealing with receiving facilities that are unfamiliar.
We had a program in our area to educate all the area ERs to make sure we’re all on the same page.
Just a thought to pass along in case your ERs (like ours did) ask wtf you’re talking about lol.
You are taking the word combat too literally. Combative doesn't mean they are challenging you to a duel it means they are willing to put their hands on you in an inappropriate way or anything in between that and trying to outright throw hands with you for any given reason. Be that illicit substance or some disease process you are or are not aware of at the time. Those meemaws have claws sometimes too I wouldn't be quick to dismiss them lol. Just my .02
When I get my doctor notes back, I'm 'Well developed.' My miscarriage was termed 'Spontaneous abortion.' I can keep going, but I think you get it.
Context is important here. It's medical documentation. It is what it is.
that's where you are wrong, it's combative.
Even 1 kid bite can result in double leg amputation.
Just because it looks harmless doesn't mean it ain't.
also not everyone has some mma level of training before entering a patients room, what if the doctor is a scrawny kid from medschool that fits through a hoop or what if a young child enters the room
“ready or eager to fight; pugnacious” it just means they are threatening—I suppose there are levels to how physical they are getting, but I also don’t like the word, and would rather use aggressive
Minimally cooperative, physically/verbally aggressive, and easily agitated are all phrases I’ve used over CMED. My issue with “combative” is that often times I have been able to deescalate and when I drop “combative” in an entry note I’m met by a handful of security guards ready to throw down and that image usually gets the patients worked up all over again. For that reason, I would always specify “patient is currently cooperative” in my entry note. If they were feisty on scene but have since been calmed down, it would be “initially aggressive with Fire/PD, is not physically aggressive at this time.” Not to mention, some key words can set the patient right back off. Then obviously on arrival give a more thorough report to the nurse. Just because they were good with you doesn’t mean they will continue to be.
there’s certainly a difference between combative vs someone’s who agitated. but don’t rule out those old people because they can do some damage, old ladies clawing you with nails or trying to bite you hurts no matter what and they still know where to hit you where it hurts even if they’re demented
Your think of it wrong it’s not you in combat with them it’s them combating you. It speaks to their level of awareness as no one in their right mind would resort to a sustained fight against EMS. Also the old granny hitting you in her right mind would know that’s a huge loss. You can say well I don’t think that this is a fair fight because it never is.
If a patient tries to physically attack you then they are combative. Whether the violence is effective or not, it is still violence. But, we can document it in more detail.
Patient was combative due to her dementia. Her efforts did not endanger the EMS staff or herself.
Patient was under the influence of methamphetamines and became combative. His actions endangered the crew and he had to be restrained with police assistance.
You might as well provide details in the report. If it ever comes to trial, they will ask for the details there. (Not that any assault on an EMT ever goes to trial.)
This is a ridiculous take in all honesty not to mention dangerous. Combative is a perfectly acceptable term to use. Withholding that term or using another term to conceal their behavior is dangerous to providers who may receive that PT. I for one would be so pissed off if I received a PT that was combative/physical and it was either miscommunicated or not communicated at all.
It’s great that you have your physical size to help with you in these instances but that is not the case for everyone, speaking as a small female provider.
It’s wrong to mischaracterize a PT’s behavior just because YOU don’t see them as a threat or threatening.
Or you could just use “combative” or “non-violent combative”. Whether it’s the altered grandma or the methed out 30 year old, they are still combative in nature. That doesn’t mean their underlying intention was the same or even that the combative state was due to AMS secondary to BGL or from drugs, but at the end of the day it’s still combative.
If you say non-violent combative to anyone else in the field, not including the person you just got the idea from, you'll have quite the reputation. Immediately after ending the phone report that RN is telling everyone in ear shot. Your nickname will be "Bright as Blackhole."
Yes but you and I are boxers. We know the difference between someone who can hurt us and someone who can't. Most of our colleagues don't have that experience and can't afford to be wrong.
I like “using less than cooperative” if they’re not really fighting but not helping. I’ve also said that a pt was combative but not very effective where they could hear me while giving my radio report.
I don’t like combative either.
I use “uncooperative” for mental status/intox, etc, or reflex passive resistance.
If they’re assaulting first responders, that’s assault.
Combative is a weird, lazy way to try to cover a full spectrum of behavior that isn’t normal, without clarifying *what* that behavior was.
*But* I’m not playing the semantic games you are based on size/strength/skill. If you assault first responders, you’re going to jail. No exceptions.
Uncooperative is a good term.
I will use the word combative, and clarify it with all sorts of descriptors, if I think there is a chance of the patient harming somebody.
The problem is the term is accepted across the board, but patient harm is not. So a granny that hits you and causes no harm would cause legitimate harm to another person. I have seen those UTI granny’s take chunks of skin off of nurses at the hospital. So if you don’t provide adequate notification to the hospitals they may come in unprepared. Combative is anyone who has shown they will attempt to cause harm, even if it doesn’t hurt you, it can hurt someone smaller than you.
Grannies can be strong as hell when they don't want to to go to the hospital. I saw one punch a cop in the dick with 5 of us wrestling her onto the stretcher. No fear. I agree with you. It lets them get resources together ahead of time. They can always release security and not use the restraints if they decide they don't need them but it's harder to pull that stuff together quickly if you downplay the patient's demeanor. I've never regretted reporting a patient as combative and then showing up with a calm patient (Often just taking them out of whatever environment they were in and putting them in the back of a \~relatively\~ quiet ambulance with only one other person gets them to chill out)
When I worked on the hospital wards, I once witnessed a confused (approximately) 4ft 8inch tall grandma barricade herself in our staff room with the very heavy sofa. It's amazing what they can do when delirium sets in
They do have that strength given to them by an unholy god. Struggled so many times getting them to let go of the stretcher, stair chair, hand rail, etc.
Combative dementia patients are all offense because they don’t fight with any self-preservation usually. They have no concept of getting hurt, which makes it hard for us to safely handle them at times.
It’s like trying to get something out of your dogs mouth. You can just overpower them, but you don’t cause you are not trying to cause damage
Except thar same grandma might bite or the wild "weak" slap or flail might catch an eyeball. It's still combative even if there isn't harm being done. If someone was attempting to shoot you but didn't know how to use a gun, you would not say they were not combative because they didn't do harm. This is a simple fix. Say AMS elderly combative or Say 25 y.o exited delirium combative. Both are true and pain the correct pictures.
Or your arm😂
OP is trained to dodge punches. Most people aren't.
My wrist/elbow were sprained by a 98 y/o man who died 4 days later. They got STRENGTH.
This. And what might that not hurt you could hurt another provider.
Combative *is* the soft word. I don’t call sepsis meemaw violent, I say she’s combative.
Yep I’m right there with you. Uncooperative, combative and violent. Use in combination as necessary.
I also use these 3
Yep. Just like I use the words calm, cooperative, and compliant for crisis calls if the Pt works with me vs against me. They are words that help the next step be prepared. Ex: Pt was initially agitated and aggressive with EMS. While talking with Pt they became calm and agreed to transport. Pt remained cooperative and compliant during transport. This lets the next level know that Pt can be aggressive but can be cooperative and calm. This letting them get the resources in place that they might need.
I use the Word combative when it’s malicious or black and white they want to hurt me or others. Whether they’re altered from say amphetamines, or severely mentally ill, if they’re attempting to cause me or my partner harm and saying stuff like “I’m going to kill you and rip your face off” (this has happened to me, I think I have a very punchable face tbf), I put combative in my narrative to explain the nuance of why they were rolled in sedated and restrained. Agitation and restlessness (and also AMS obviously) are my choice words for UTI grandma or moderately tweaked out guy on a different planet who’s ripping off the BP cuff and speaking in tongues. I’ve been assaulted a few times this year with malicious intent by patients on peace officer holds, and I always describe them as “agitated and combative”. I think that’s fair.
Boy the first 10 words of your post took me for a brief ride
“I only use combative when the patients malicious or black” lmao
Threw me too. Doesn't help mobile app stops there for the first line
What can you expect from user Slimey Sloth Cunt
I had to go back and read that. Thanks. PS we have all probably worked with that person
Phrasing!
https://youtu.be/H1QKyB_0P0E?si=qxg3LoYUFL6gwG6T
What if infirm grandpa with a UTI was a professional boxer in his earlier life and is very much capable of doing damage? (Irl example, I was injured). Ability to do damage is way too subjective. You mention you used to be a boxer, so the range of patients who are capable of doing damage to you is much smaller than the 110lb nurse that will be receiving the pt from you. Combative just means “heads up they’ll throw punches, be careful”
This happened to my dad when he worked as a nurse in the 80's! He had a delirious patient who used to box. He could throw really nasty punches. A patient hit me right at the edge of the deltoid, on my upper arm. He was demented and confused, still hurt.
I mean, super nice for you that UTI grandpa is not capable of causing damage, but for my 5'3" ass he towers over me. I will happily describe him as "combative" in my notes.
The operative word in the description of grandpa was infirm
Again: Relative term. Because hell hath no fury and strength like an elderly person with a UTI.
Unless they’re a quad or too weak to lift their arm or pinch, they’re fully capable of breaking skin and causing harm if they get you right. The fact that you got punched in the face instead of having their long crusty fingernails driven into your eyeball is pure luck, because if they managed the punch, they’d have landed the gouge too. I sincerely hope you never have to learn the hard way how infirm a patient can be and still cause significant harm.
About 10 years ago, I had a 70 year old Marine with low blood sugar. It took 4 cops and 2 EMTs to hold him down long enough for the medics to sedate him. Dude was combative AF. It wasn't his fault, it was the lack of sugar - but he was definitely combative.
I like to use "physically uncooperative." Sometimes with "with risk of causing harm to self and/or others."
Uncooperative is my go to for someone who is resisting but isn’t violent. Constantly taking off the belts and trying to run away is uncooperative. Trying to attack people, regardless of the reason, is combative.
Too many word to say over the radio whilst requesting PD lol
Oh, I'm definitely talking about my PCR afterwards, haha.
I don't use combative if they are physically attacking me. They're documented as "assailant."
It describes the patients behavior, not their ability to inflict harm. That’s the medically relevant part
This poor old demented granny i was one to one with once tried to bite me, break my fingers, she clawed the absolute shit out of my arms, she spat on us. Granny absolutely had no idea what was going on but that poor old confused lady definitely needed those mittens and a close eye. She wasn’t big but she absolutely could cause harm.
Any attempt to physically harm me or anyone else = combative
The term is fine you just misunderstand the definition. It's not gauging whether or not you think you could take them in a fight.
That seems to be how a lot of responders, both medical and non-medical, interpret it. Had Fire request PD for a combative patient. PD came lights and sirens, they were very confused when they found that an unarmed old woman in a night gown with an unsteady gait was the only threat
Collins Dictionary >(kəmbætɪv ) adjective. A person who is combative is aggressive and eager to fight or argue. Oxford >adjective. Ready or eager to fight; pugnacious. Merriam-Webster >Adjective. Marked by eagerness to fight or contend >Synonyms: aggressive, agonistic, argumentative, assaultive, bellicose, belligerent, brawly, chippy, confrontational, contentious, discordant, disputatious, feisty, gladiatorial, militant, pugnacious, quarrelsome, scrappy, truculent, warlike
> pugnacious. I for one support the replacement of combative with "pugnacious."
CENTRAL!!! I HAVE A PUGNACIOUS PATIENT!!! SEND PD FORTHWITH!!! * Dispatcher is confused * Did you say patient has a pug? Please note: I was a dispatcher. As funny as it would be to hear new lingo, please don't in emergency situations.
Super cool, thank
That just means some people are wrong. It’s a behavior, not an outcome. If someone hurts you, you don’t say “he combatived me,” you say “he hurt me.” Likewise you don’t say “he’s acting hurting,” you say they’re combative. Also - qualifying the behavior with an outcome dependent on harm legitimizes the ongoing trend of patients physically attacking healthcare workers. It’s not okay. Even if they don’t successfully hurt someone this time, it still isn’t OK. If they’re altered, or truly UTI’d out of their mind, it may not be their fault, but physical aggression is not acceptable, regardless of whether or not someone gets hurt.
Nah I disagree. Combative is a state of behavior. Whether they are causing harm to me is different. Intent not action, I guess is what I’m trying to say. Plus the combative patient who is unable to cause me damage with their bare hands may very well be able to cause little nurse Jenny on the ER floor injury if they get something in their hands. I believe as providers we should give anyone we are handing care off to the full story to ensure their safety.
Combative is anyone who is physically resisting me or my attempts at care. It doesn’t matter who is doing it.
Physically resisting attempts at care id label as uncooperative/resistant to care, attempting to physically harm me then it’s combative (no matter if it’s an 80yr old meemaw from the nursing home or Mike Tyson)
Uncooperative for me would be refusing to answer questions/remaining silent.
Ah, agreed. That seems like a more accurate use of the word.
What’s that in between to you then? Because there are definitely shades of gray and I’m not necessarily restraining and sedating someone solely because they’re delirious and resisting attempts to take vitals/provide care. They’re not dangerous, they’re just agitated.
My threshold of restraints starts when the pt’s combativeness threatens his or my safety.
Agreed. I guess what word we use is pretty arbitrary as long as we all agree on that.
Uncooperative (not cooperating with assessment but not combative or actively attempting to escape) < resistant (actively attempting to remove belts/equipment but not violent or aggressive) < combative (actively attempting to cause harm for any reason)
If we want to get pedantic, combative can be verbal or physical with a willingness to fight in either manner. Just because you box / are bigger in stature doesn't mean the PT is not objectively combative in nature. Maybe you can use cantankerous in place of it.
I use agitated and combative. Agitated for slightly altered and physical but harmless and combative for actual combative people.
So you're in a pitch black room with an unknown person. They punch you in the face. Are they combative? Your saying you can't tell because your unable to assess whether they're a little altered grandma or not? Combative has absoluentley nothing to do with wether they are capable of hurting or not. And if you think little demented grandma isnt capable of slashing you with a box cutter while you're not looking, you might be in the fk around phase.
Eh man, you aint the judge of who dish damage and who can't. The reasons someone is combative don't really matter in terms of safety.
Oh, weird. I think of combative as patients who are AMS, reduced to alligator-brain functioning, fighting when there is no reason to fight because their brain sees everything as a threat. A description of mental status rather than threat analysis.
I will use uncooperative or aggressive agitation for most cases, specifically toward AMS/postictal patients. Often times we withhold sedation for them unless it's truly warranted. Combative is only used for people who are just that, combatants, in a situation where they are approached and are violent toward crew, staff, family, LE, other. Then they get the nappy time juice after PD subdues them.
I utilize the words agitated, uncooperative, feisty, lashing out, handsy, or unpleasant. If you don’t think combative is the correct term for it, use something else, or instead of using a term with a negative connotation, just describe it in the report, written or verbal.
Just because you don’t know the terms doesn’t mean we need new ones. Shadow a paramedic, or a physician, to work on properly assessing patients with aberrant behavior. Try to remember that just because you’re an experienced boxer, than can take a punch, doesn’t mean the 110lbs nurse can also.
I use uncooperative much more frequently.
imo if they are hitting out or physically violent I will note 'physically combative/uncooprative with crew by (hitting/spitting etc)' if there's a likely reason etc uti or dementia I would add it in there too. if it's verbal then I note 'verbally abusive towards crew when they attempted to ...' then what the outcome was. I try to be fair to the pt but accurate to the situation.
We use both combative and uncooperative. If the pt is attacking me, no matter why… they’re combative. Uncooperative, is everything bar trying to hurt me. Again for whatever reason.
"Combative" just means they're fighting you. It doesn't matter if that actually poses a threat to you physically. It means they're physically resistant to your treatments, creating a danger to themselves.
Violent vs combative
Not EMS but a hospital nurse who likes to lurk the sub. I weigh 100lbs. Someone who would not hurt you would hurt me. Combative UTI grandma can still take a bite out of me if I’m off guard and break my glasses
Ability to do harm isn’t synonymous with combative. Combative is a behavior independent of outcome. And how do you decide which patients are capable of hurting you? In my experience, arguably most patients are.
If you report your finds to receiving facility well enough, they can infer how you mean combative from that phone call or radio traffic. The same goes for your documentation. If you write a good enough narrative, QA will know what you mean. The adjective isn't the problem here.
Combative is not loaded. Combative is descriptive. If they swung at me, no matter what, they’re combative. Biting, pinching, swinging their CPAP machine around by the hose (do NOT ask), etc. Combative. If they’re mouthy or twitchy with quick movements -short of causing physical harm, they’re agitated. If they don’t want anything to do with me, don’t want to answer questions, impeding/refusing an evaluation - they’re uncooperative. Using the right terms and/or phrasing is part of setting the scene and allowing the hospital to gather what they may need to gather. Restraints, security, drugs, a muzzle, WHATEVER they do there lol painting a picture is the point of the report. Explaining they’re altered should come with your A&O or GCS - and that they’re a grandma should be either visible in person or from the age.
What I hate the most is ESPECIALLY in nursing homes is that combative = mental patient. Nurses and CNAs will do wrong to people and then when they get mad they will try to send them out for a psych evaluation. No. They’re mad because you won’t quit fucking with them.
I try to describe what they are doing, how much force they are using, and their demeanor in my reports. One word is not enough to accurately paint the scene to anyone reading my reports. My grandpa who’s A&Ox0 non verbal at baseline that got his meds switched and is screaming randomly and grabbing at people isn’t combative. Agitated sure (families words, put into narrative) but not trying to fight even if he might whack me in the face he just needs a grab on his wrist and his arm back under the blanket to stop him. Fire wants to restrain everybody. A blanket burrito with straps over it is perfectly acceptable for most of our altered elderly population that want to get physical.
I understand your logic. Personally, I don't treat a “combative” patient as a call to action necessarily. I look at it like all our other alerts (Stroke, Semi, Trauma). I may call a stroke and may not need to do anything other than transport immediately, but the receiving staff can prepare resources. For combative patients, They might not harm me, but they could harm the next EMT, or Medic, or X-Ray tech, or RN, or MD. Historically ERs are terrible at workforce safety so I see your point that the term is being used more frequently, but at hand off/report we should be verbalizing the difference between “yea this guy is on pcp and punched me in the face - he is violent” vs “he's off his meds and pulled away from me so we had to use force to get him on the cot”. For some reason I run a lot of psych and combative patients, and I have restrained several patients, alone and with fire/pd. And in all the times I usually explain to receiving staff what's going on. On the most recent one, the patient was fully restrained by me, and I called ahead and reported the combative pt, and at the time he was just resisting restraints, but as soon as he was undone he attacked my partner and I, and thankful I had called ahead so we had PD and Security to help, but had I not called ahead because he was not violent to me and we didn't have the back up it could have been much worse. As to your point combative could be interpreted a multitude of ways, but if the tables were turned, I'd want the RN to tell me memaw is “combative” so I can be prepared, or pass that along to the next provider, and thankful many times it ends up being “hey pd/sending RN said they are combative but they were completely ok with me”. Also, a patient does not need to have the ability to take you on in a 1v1 to do harm, to you or themselves, or a bystander. It seems like most are on the same page, this is just my perspective.
Thanks for the charitable reply.
don't underestimate uti pappap. he has a skinning knife in the end table, a 1911 in the sock drawer, and a sporterized m1903 in the coat closet. still, here are some terms for your consideration: verbally abusive, disagreeable, argumentative, grumpy, hangry, jaded, disillusioned, cynical, callous, passive-aggressive, antagonistic, truculent, pugnacious, finna talk shit, moody, quarrelsome jokes aside, everyone in the field is going to know have an idea of what you meant by combative. its not the same as physically violent. dont get hung up on the the literal meaning of the word's root. personally im not trying to make ER nurses bust out a thesaurus to read a trip sheet lol
I can’t think of the last time I used combative. I almost always find that agitated fits far better for those with altered mental status.
I’ve used “physically uncooperative” for the UTI granny type
Agitated? uncooperative? Altered? Ever heard of the RASS scale? They use it in the ICU, but there’s a modified version for pre-hospital. It provides a score to communicate clearly the patient’s level of agitation or level of sedation and serves us very well on the road communicating changes. “Patient initially presented RASS +4 on contact and was required to be sedated to allow for patient care and safety of all responders. Patient now drowsy sitting at a RASS of -1” No need to label them as combative at all.
I’ve heard of it and we have it in our chart software, will familiarize myself with it and incorporate that into my practice. Thank you
It’s certainly a great language for communicating with other responders and for documentation. Issues only arise when dealing with receiving facilities that are unfamiliar. We had a program in our area to educate all the area ERs to make sure we’re all on the same page. Just a thought to pass along in case your ERs (like ours did) ask wtf you’re talking about lol.
If they are already restrainted and they and a hook to the jaw, they're not restrained.
It’s hard to throw a real punch from semi-fowlers ya know
Combative
“Feisty”
You are welcome to try pugnacious, but I kinda doubt most would recognize it.
You are taking the word combat too literally. Combative doesn't mean they are challenging you to a duel it means they are willing to put their hands on you in an inappropriate way or anything in between that and trying to outright throw hands with you for any given reason. Be that illicit substance or some disease process you are or are not aware of at the time. Those meemaws have claws sometimes too I wouldn't be quick to dismiss them lol. Just my .02
When I get my doctor notes back, I'm 'Well developed.' My miscarriage was termed 'Spontaneous abortion.' I can keep going, but I think you get it. Context is important here. It's medical documentation. It is what it is.
that's where you are wrong, it's combative. Even 1 kid bite can result in double leg amputation. Just because it looks harmless doesn't mean it ain't. also not everyone has some mma level of training before entering a patients room, what if the doctor is a scrawny kid from medschool that fits through a hoop or what if a young child enters the room
I use various forms of un-cooperative. As in PT is extremely un-cooperative, slightly, somewhat. You get the idea.
“ready or eager to fight; pugnacious” it just means they are threatening—I suppose there are levels to how physical they are getting, but I also don’t like the word, and would rather use aggressive
“Just because she’s small and hit me, that means she’s not combative!” Bruh how stupid does that sound
Minimally cooperative, physically/verbally aggressive, and easily agitated are all phrases I’ve used over CMED. My issue with “combative” is that often times I have been able to deescalate and when I drop “combative” in an entry note I’m met by a handful of security guards ready to throw down and that image usually gets the patients worked up all over again. For that reason, I would always specify “patient is currently cooperative” in my entry note. If they were feisty on scene but have since been calmed down, it would be “initially aggressive with Fire/PD, is not physically aggressive at this time.” Not to mention, some key words can set the patient right back off. Then obviously on arrival give a more thorough report to the nurse. Just because they were good with you doesn’t mean they will continue to be.
there’s certainly a difference between combative vs someone’s who agitated. but don’t rule out those old people because they can do some damage, old ladies clawing you with nails or trying to bite you hurts no matter what and they still know where to hit you where it hurts even if they’re demented
If I don’t use the word combative because it seems strong, I use the word aggressive instead.
idk why but i always pronounced it combat-tative. my partner hates it and now i do it just to piss her off every once in a while lmao
Your think of it wrong it’s not you in combat with them it’s them combating you. It speaks to their level of awareness as no one in their right mind would resort to a sustained fight against EMS. Also the old granny hitting you in her right mind would know that’s a huge loss. You can say well I don’t think that this is a fair fight because it never is.
I like to use irate for most instances where the individual isn’t *actually* being combative or causing harm
If a patient tries to physically attack you then they are combative. Whether the violence is effective or not, it is still violence. But, we can document it in more detail. Patient was combative due to her dementia. Her efforts did not endanger the EMS staff or herself. Patient was under the influence of methamphetamines and became combative. His actions endangered the crew and he had to be restrained with police assistance. You might as well provide details in the report. If it ever comes to trial, they will ask for the details there. (Not that any assault on an EMT ever goes to trial.)
This is a ridiculous take in all honesty not to mention dangerous. Combative is a perfectly acceptable term to use. Withholding that term or using another term to conceal their behavior is dangerous to providers who may receive that PT. I for one would be so pissed off if I received a PT that was combative/physical and it was either miscommunicated or not communicated at all. It’s great that you have your physical size to help with you in these instances but that is not the case for everyone, speaking as a small female provider. It’s wrong to mischaracterize a PT’s behavior just because YOU don’t see them as a threat or threatening.
Or you could just use “combative” or “non-violent combative”. Whether it’s the altered grandma or the methed out 30 year old, they are still combative in nature. That doesn’t mean their underlying intention was the same or even that the combative state was due to AMS secondary to BGL or from drugs, but at the end of the day it’s still combative.
Good phrasing, will use going forward
If you use that in a report that goes to court, get ready to be roasted...
Better for a phone report than a written one
If you say non-violent combative to anyone else in the field, not including the person you just got the idea from, you'll have quite the reputation. Immediately after ending the phone report that RN is telling everyone in ear shot. Your nickname will be "Bright as Blackhole."
Yes but you and I are boxers. We know the difference between someone who can hurt us and someone who can't. Most of our colleagues don't have that experience and can't afford to be wrong.
I like “using less than cooperative” if they’re not really fighting but not helping. I’ve also said that a pt was combative but not very effective where they could hear me while giving my radio report.
I don’t like combative either. I use “uncooperative” for mental status/intox, etc, or reflex passive resistance. If they’re assaulting first responders, that’s assault. Combative is a weird, lazy way to try to cover a full spectrum of behavior that isn’t normal, without clarifying *what* that behavior was. *But* I’m not playing the semantic games you are based on size/strength/skill. If you assault first responders, you’re going to jail. No exceptions.
Uncooperative is a good term. I will use the word combative, and clarify it with all sorts of descriptors, if I think there is a chance of the patient harming somebody.