The brain works in amazing ways. Our understanding of what is happening around us can be completely distorted by chemicals we ingest or otherwise introduce into our bodies for a variety of reasons. Be it medicinal or recreational, habitual or experimental, the brain interprets it’s surroundings as best it can and adapts actions based on those signals it receives. The signals, however, are often changed by the substances we have ingested.
Case in point:
I’ve been special called as the Paramedic Captain to a “Major MVA” involving a cycle.
As I arrive first on scene, since this occurred not far from my favorite coffee shop (MC would be proud), I find a man slumped over the remains of the windshield of the scooter in the middle of traffic on a rather busy 2 lane road. The engine is not far behind and we approach the scooter, which is still running to assess what has happened.
I’ve been to more than my fair share of “man slumped over steering wheel” calls but this is a first. I have to pull my sunglasses down my nose just to be sure what I’m seeing isn’t a reflection or other distortion from my $25 Target glasses.
Sure enough, he’s balancing the scooter and unresponsive over the shattered windscreen, helmet on the ground nearby. The front of the scooter is also smashed and the engine driver has discovered a few nearby cars with damage consistent with a run away scooter.
Our initial interventions were obvious, get him off the scooter, but as we grabbed under his arms he suddenly awoke.
Confused and clearly under the influence of something you would find on a pool table, his 6’2″ 225lb frame is rigid and mimicking trying to start a motorcycle.
Our calm introductions are met with a diaphoretic face, lip licking and a simple phrase repeated over and over again, “Yeah, yeah, ok, ok,” all the while his brain is convinced he is trying to make an escape on a motorcycle.
As the police arrive our friend is convinced he will remain on the cycle and even our basic interventions to lift him away are putting us in danger of not only a physical altercation we would surely lose, but the concern the scooter will drive off or fall over onto us during his extrication.
Seeing no visible trauma I instruct the officers, who are allowed to fight back when needed and have training in forcibly moving people, to move him to the ground.
That’s when his brain suddenly realized he was not on a Harley, but in hand cuffs on the pavement.
It takes 6 of us to restrain him and apply a spit sock since he has taken to trying to show his displeasure with saliva mixed in with creative verbage regarding my mother and a slew of other relations.
As the ambulance arrived my hero leaped out with a dose of IM Versed that brought our new friend back into the realm of the moderately co-operative.
It was an interesting presentation that later allowed us to discover, from witnesses, that he seemed to be confused and riding the scooter in circles in the narrow street, crashing into a number of cars before inexplicably stopping in the middle of the street, looking all around as if he was hidden, then slumped over the handle bars, seemingly asleep.
It was also a reminder to work carefully and clearly with law enforcement since their end game is a person unable to fight back and ours is being able to treat them safely. Talking through your plan ahead of time with the officers to ensure your plan matches their concerns is key to making sure a handcuffed recumbent patient becomes a properly restrained supine patient with no injury to any party.
And although chemical sedation was indicated and used, be sure to follow your local protocols when encountering agitated people who could mop the floor with you on any given day.