Psych meds?

[Seaglass]

In your area, are you allowed to use any medications solely for psych purposes, with or without contacting medical control? How about choosing a drug you wouldn't otherwise pick for the chief complaint that will just so happen to calm your patient down or otherwise help with psych/emotional disturbances?

Just curious.

 

[vquintessence]

Yes, but with limitations. Although unofficial from statewide treatment and private service standpoint: For those few situations where the pt is incredibly irrate/uncontrollable and posing a danger to themself, bystanders and first responders, we're allowed to administer Ativan 2 mg IM if approved by online med control. Typically that route is sought when the pt hasn't committed a crime and would clearly benefit from a medical and psychiatric evaluation as opposed to being held in PC.

 

[carpentw]

We have haldol in the field. No need to call, but its an auto QA/QI if you administer it.

 

[mycrofft]

Don't get tempted...

1. Meds used for other protocols, notably benadryl and valium, are pretty potent psychoactives, along with atropine, Zofran, gabapentin, and epi. Like it or not, you are already giving "psych meds".

2. Using "psych meds" (meds for psychological or, more precisely, behavioral impact) in the field is generally to control hallcinosis, and to act as a chemical restraint. Each has legal moral and pharmacological implications, as well as potential misadventures because someone's label ("Psych") was treated instead of a potential underlying cause.

In fact, many cases of "crazy" people have turned to to revolve around undiagnosed hyperthyroidism, serum glucose swings, overuse or other misuse of meds (including OTC vasoconstrictant nasal sprays like Afrin and others), other metabolic or neoplastic disorders, and hidden drinking or drug abuse. Your eval could be the one that puts the pt on path on recovery. Of course some aren't crazy, just sociopathic, then I get 'em.

Our local EMS Council rules do not slice that thinly, I think the parameds have to call for info or permission. Calling the pt's treating facility could make a huge difference in tx.

 

[redcrossemt]

Have used diazepam for patients who were extremely uncooperative and continuously fighting restraints, with medical control orders.

 

[Seaglass]

Don't get tempted...

No worries--the question's academic, since I'm not a medic (and won't even be a student for at least a few more months). Just was studying some psychopharm and got curious about variance in local EMS protocols.

And yes, I'm aware of the psych effects of drugs used primarily for other purposes. Hence the second question.

 

[redcrossemt]

I said valium before, but forgot to note that it's not specifically in our protocol.

If I had a choice, haldol would be in our box.

 

[Melclin]

Its an interesting time for this question. I'm doing some research in this field at the moment looking at the perceptions of paramedics and why ambulances are not the first port of call for a psych emergency just as a medical one.

Anyhow, we have an agitated pt guideline which is pretty open ended. It involves 0.1mg/kg IM Midazolam (ten minutely, x4). Although we are not allowed to give it to people who have been recommended for transport under the mental health act because of a legal technicality.

 

[mycrofft]

Good on you for doing the homework!

We had a big ETOH detoxer go off while conducting him to a cell where I would give him his Valium injection, then the two officers would show him in and lock him up. The three of us managed to get him down for a second, as he got his feet planted to try to get up I yanked off the needle cover with my teeth and gave it to him backhand in the anterior thigh through his pants. Worked, he survived to later run down and kill a mom and her two kids without a driver's license.

 

[Aidey]

We have a protocol for chemical restraints using Versed. We don't have to call for orders for it if the pt meets the specific criteria.

I have also received orders for Ativan IM for a patient who was so upset/agitated that we couldn't assess her to even figure out what was going on. She was at an adult family home type place, so we had her med list, allergies and history and knew there were no contraindications to the Ativan. She didn't meet the criteria for the chemical restraint protocol, but she was too agitated to assess thoroughly either. We could have restrained her and put her on the cot, but that wouldn't have helped us assess her any better.

 

[Onceamedic]

I had a lady with a fractured hip and a 35 minute transport time. Patient was allergic to morphine and I have NO other pain options. She was frantic, clutching at me, screaming, the works. I gave her Valium.

It helped. She calmed down. When I got to the ER, the resident scoffed at me. He said Valium was not indicated for pain control. :wacko:

 

[thegreypilgrim]

We have a protocol for Agitated Delirium management which calls for IM/IN Midazolam 2.5 mg. It's really only for pts who are so severely agitated that they're either at risk for sudden cardiac arrest or otherwise make it impossible to do a thorough assessment to figure out what's wrong. Can be given without online medical control.

 

[austinmedic2004]

In your area, are you allowed to use any medications solely for psych purposes, with or without contacting medical control? How about choosing a drug you wouldn't otherwise pick for the chief complaint that will just so happen to calm your patient down or otherwise help with psych/emotional disturbances?

Just curious.

We give Versed IV/IM/IN to combative patients without contacting medical control; this is assuming the patient cannot be safely restrained with less invasive means.