Interview Question

[Sdemt_1530]

I recently had an interview in San Diego, CA and was asked this question and wonder how you guys would have answered it. Its been weighing on my mind.

Question: You respond to a call for a man who apparently wants to kill himself. You arrive on scene and FD is already on scene. Upon making PT contact, the PT states "I do not want to kill myself anymore, I just want to be left alone." PD is not on scene yet. What do you do?

My response: I would take the time to reiterate to the patient that we are only there to help and do everything I can in order to get the patient to go get checked out. I would then wait for PD to get on scene to see if they wanted to place them on a 72 hour hold and in case the PT became violent. I definitely not just take the PTs word for it and leave the scene. I would contact my supervisor if I had any concerns or questions

what are your thoughts? I was not sure about restraining the PT at this time in fear of being accused of kidnapping or assult

 

[luke_31]

You had a good answer. Just keep talking with the patient and when PD gets there you or your partner briefs them on the situation and emphasis that you heard the patient state that they had the thought of committing suicide and let PD dictate how it goes from there

 

[COmedic17]

I would call my medical director and put them on a mental health hold.

 

[Aprz]

Good answer.

There are usually protocols and policies written for this already. Follow those.

I imagine the protocols and policies would want you to do something like this... If PD is close by and there is no reason you need to immediately leave the scene then just wait on scene. When in doubt, contact your supervisor or medical direction. If the patient is not placed on a hold still then make every reasonable effort to convince the patient to go. If the patient still doesn't want to go, he is alert and oriented, and he isn't on a hold, then you can't force him to go. Remind him that he is always welcome to call 911 again or go by other means to get help. Document the effort made to have him go and the people involved.

 

[escapedcaliFF]

Good answer but keep in mind he's refusing transport. I would call PD and let them deal with it.

 

[k9Dog]

I hate the phrase "go get checked out".. That phrase has become a joke here in the Bay Area.. Fire uses it constantly and we just look at each other and smile. Anyhow, I think you answered correctly. This person already has expressed their desire to kill themself, too late to change their mind. Just wait on scene and talk to him until PD arrives.

 

[escapedcaliFF]

The issue surrounding this is the person did state they wanted to kill themselves but now expresses the fact they no longer wish to die and want to be left alone. Sounds like a refusal to me. Calls like these tend to be a call for help. They where thinking about it but once they talked to someone they realize life as crappy as it is is worth living. PD can sometimes make these situations worse cause now the PT feels like you are treating them like a criminal. I can think of a couple cases where PD gets called and PD uses it as an excuse to search illegally for firearms. If you honestly think their a threat to themselves go ahead and call PD. There are different avenues such as convincing the PT to call a sibling or parent and waiting till they show up. Leaving the PT with a sibling or parent and getting them to sign the refusal as well will cover you legally. I have employed both tactics of calling both PD or getting the PT to get relatives to come stay with them. In my experience the relatives route has had a way better outcome then calling PD.

 

[DesertMedic66]

The issue surrounding this is the person did state they wanted to kill themselves but now expresses the fact they no longer wish to die and want to be left alone. Sounds like a refusal to me. Calls like these tend to be a call for help. They where thinking about it but once they talked to someone they realize life as crappy as it is is worth living. PD can sometimes make these situations worse cause now the PT feels like you are treating them like a criminal. I can think of a couple cases where PD gets called and PD uses it as an excuse to search illegally for firearms. If you honestly think their a threat to themselves go ahead and call PD. There are different avenues such as convincing the PT to call a sibling or parent and waiting till they show up. Leaving the PT with a sibling or parent and getting them to sign the refusal as well will cover you legally. I have employed both tactics of calling both PD or getting the PT to get relatives to come stay with them. In my experience the relatives route has had a way better outcome then calling PD.

I highly doubt you will be covered legally if you sign this patient AMA and then get a call back in a couple of hours for suicide..

 

[escapedcaliFF]

Doesn't go into affect until 2020. Plenty of time to be repealed.

I highly doubt you will be covered legally if you sign this patient AMA and then get a call back in a couple of hours for suicide..

I always get the relative to sign as well and have yet to have an issue. I just don't think PD is warranted in some cases. Regardless people who are 100 percent set on commiting sucide are gonna do it one way or another.

 

[DesertMedic66]

I always get the relative to sign as well and have yet to have an issue. I just don't think PD is warranted in some cases. Regardless people who are 100 percent set on commiting sucide are gonna do it one way or another.

But a psych evaluation is definitely required for suicidal patients, an assessment that is not done in the field. I don't know about you but I have had patients state "I don't want to kill myself" right aver they attempted suicide. Patients lie. Everyone lies.

 

[Jim37F]

We had a case relatively similar last week...toned out for an overdose with stage for PD (it was funny we were AOR and I saw a cop going Code up ahead of us, I comment to my partner "hey the cops are out playing today" a minute or two later we get the dispatch and I notice that we're both going in the same direction and wouldn't you know it they turn down the same road I'm planning on turning....hmmm I wonder what their call is...)

Anyway we get on scene, cleared to enter, patient od'd by taking rum and a valium, was physically fine, we would've AMA'd her until she said she wanted to hang herself. The firefighters grabbed PD who placed her on a 5150 hold so we didn't have much of a choice ourselves but to transport to our local base hospital that also happens to have a psychiatric wing.

We've had similar calls in the past without PD on scene and our medics have pretty much told them sorry, we cannot leave you now, you're coming with us voluntarily or we will call for police.

 

[RocketMedic]

Refusing to transport expressed-sucidal ideation in anything other than a non-sarcastic context is pretty stupid. If it has the potential to be a legitimate threat, you really ought not to trust your patient.

 

[escapedcaliFF]

I'm just saying that PD involement can actually make the situation worse. There are other options and if your medical director is offering them as an alternative to the police state I think if appropriate per situation should be considered.

 

[phideux]

I think you failed that question. Your answer should have been that you don't go on scene to a possible psych/suicide call until the cops go in first and make the scene safe.

 

[DesertMedic66]

I think you failed that question. Your answer should have been that you don't go on scene to a possible psych/suicide call until the cops go in first and make the scene safe.

Completely depends on the system. We will often have "proceed with caution" to psych calls. It all depends on prior history from the location and how the 911 call went.

 

[medicaltransient]

Good answer. If PD does not emergency detain the pt against their will they are assuming significant liability. If you do not suggest a transport you are assuming significant liability. I PD wont ED I would try to roadhouse the pt into a transport.

 

[phideux]

Completely depends on the system. We will often have "proceed with caution" to psych calls. It all depends on prior history from the location and how the 911 call went.

Around here, all calls like this get a stage and wait for PD to secure the scene type of response.

 

[CaliEmt619]

I recently had an interview in San Diego, CA and was asked this question and wonder how you guys would have answered it. Its been weighing on my mind.

Question: You respond to a call for a man who apparently wants to kill himself. You arrive on scene and FD is already on scene. Upon making PT contact, the PT states "I do not want to kill myself anymore, I just want to be left alone." PD is not on scene yet. What do you do?

My response: I would take the time to reiterate to the patient that we are only there to help and do everything I can in order to get the patient to go get checked out. I would then wait for PD to get on scene to see if they wanted to place them on a 72 hour hold and in case the PT became violent. I definitely not just take the PTs word for it and leave the scene. I would contact my supervisor if I had any concerns or questions

what are your thoughts? I was not sure about restraining the PT at this time in fear of being accused of kidnapping or assult

Im almost positive we both had the same interview with the same company , that being said I was asked the same question and answered it the same exact way you did and I think it was a good answer..My interview was the 28th, still waiting for a call back ! Good luck man