# Sometimes I wish the hospital would not sedate my psych patients before



## Hockey (Jan 27, 2009)

my 150 mile transfer


You become bored and have no one to talk to except your partner and yourself


Only 1.5 more hours left before we get there! Woohoo!

I was hoping for a crazy crazy.  Not annoying lets ask the EMT 500000 questions of "why"



That is all


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## Sasha (Jan 27, 2009)

Hockey9019 said:


> my 150 mile transfer
> 
> 
> You become bored and have no one to talk to except your partner and yourself
> ...




Oh yes.. Long distances with a violent psych patient is LOADS of fun. 

I've done the long distance transfer with an unsedated "crazy crazy" person. It's NOT entertaining, it's actually quite scary when they start hitting the seats and talking about hurting people and you're not sure if you and your partner are strong enough to posy this guy down.

It's also quite sad. I feel bad for them.


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## Hockey (Jan 27, 2009)

Sasha said:


> Oh yes.. Long distances with a violent psych patient is LOADS of fun.
> 
> I've done the long distance transfer with an unsedated "crazy crazy" person. It's NOT entertaining, it's actually quite scary when they start hitting the seats and talking about hurting people and you're not sure if you and your partner are strong enough to posy this guy down.
> 
> *It's also quite sad. I feel bad for them.*



One of the lowlife "psychs" , found my Xbox 360 that was under the seat, and decided to steal it last night.  Locked car, they pried the new car door open.

I can't feel bad for anyone today 

But yes. once they start throwing a fit, it makes things "interesting" to say in the least


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## Sasha (Jan 27, 2009)

> But yes. once they start throwing a fit, it makes things "interesting" to say in the least


Interesting? These people are NOT your entertainment, they're your patients!



> lowlife "psychs"





> I can't feel bad for anyone today


Perhaps your lack of empathy is better suited for another career where you're not in charge of taking care of people.


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## triemal04 (Jan 27, 2009)

Sasha...I think the quote marks around interesting are there for a reason.

Anyway, I prefer to talk to myself on trips like that.  Of course, I'm usually the one on the gurney but oh well...


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## downunderwunda (Jan 27, 2009)

One thing I have noticed in my time in EMS is the prevailing attitude to psych patients.

Psychiatric Illness is like an illness to any other part of the body. Never forget that. Statistics prove that 20% of us will suffer from some sort of mental illness at some point in our lives.

Let me ask you to reflect on this, would you speak of patients with Renal Failure, Chronic Heart Disease, Cancer, COPD or multiple fractures in the same way you talk about your mentally ill patients?

People do not choose Heart Disease, in the same way they do not choose Mental Illness.




> One of the lowlife "psychs" , found my Xbox 360 that was under the seat, and decided to steal it last night. Locked car, they pried the new car door open.



Lowlife? or doing what they need to do to survive?



> I can't feel bad for anyone today



If this is because of an Xbox, GET OVER IT. One is a human being, the other is a games console. Please, if your life is so pathetic that you have to prioritise an Xbox over a human life, maybe you need psychiatric help.



> But yes. once they start throwing a fit, it makes things "interesting" to say in the least



Or pattients are not her for our amusement. We are hear to help them. There is not reason for our patients to be treated like a toy. Seizures (the proper name for what you called fits) are dangerous causing Hypoxia to the brain. How is this interesting?

I think you might need to seek help yourself. You sound like you will be in the 20%.


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## JPINFV (Jan 27, 2009)




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## daedalus (Jan 27, 2009)

A non medicated and non restrained pysch patient got out of the back of another crew's unit on the 405 freeway and ended up dodging cars until CHP got their. 

I do not think I am supposed to talk about that...


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## raisingkahne9 (Jan 27, 2009)

There are some cases, when Psych patients need to be sedated. However, there are times when they do not need to be. I guess it all depends on patient history. I've been on transfer's where the patient has been sedated. And I've also been on ones where the patient hasn't been sedated, when they should have been. Clearly a poor judgement.


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## JPINFV (Jan 27, 2009)

daedalus said:


> A non medicated and non restrained pysch patient got out of the back of another crew's unit on the 405 freeway and ended up dodging cars until CHP got their.
> 
> I do not think I am supposed to talk about that...



I would be interested to know what the patient's history is and if there were any indications prior to leaving the facility that the patient might be an elope risk. 

My feeling on the restraint issue is that it seems that most EMTs fall into two polar opposite camps. There's the "restrain everyone on a hold" camp who discount the idea that the vast majority of psych patients are neither violent nor an elope risk. The other side almost never uses restraints, but don't ask the appropriate questions to determine if the need to use restraints.


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## BLSBoy (Jan 27, 2009)

Hockey9019 said:


> One of the lowlife "psychs" , found my Xbox 360 that was under the seat, and decided to steal it last night.  Locked car, they pried the new car door open.



One reason. ONE reason why you had an X-Box in the back. 

*Edited* What makes you think that it was a psych pt?

And go.


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## Meursault (Jan 27, 2009)

I agree with most of the finger-wagging so far, but:



downunderwunda said:


> One is a human being, the other is a games console.


Humans:

Self-reproducing
Prone to doing really stupid things when brought together in large numbers
Spend their lifetimes annoying me
Extremely difficult to improve or correct
Consoles:

Require assembly, therefore making them rarer than humans
Awesome when brought together in large numbers (ignoring the power requirements)
Spend their lifetimes entertaining me
Can be quickly and completely shut off without legal repercussions
New and improved version every few years
The winner is obvious.

To add to BLSBoy's questions, why wasn't the console hidden and, seriously, how do you know it was either a psych or a "psych" (whatever you mean to imply by that) patient? Did they carve a little psi on your upholstery before  running off cackling into the distance?


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## daedalus (Jan 27, 2009)

JPINFV said:


> I would be interested to know what the patient's history is and if there were any indications prior to leaving the facility that the patient might be an elope risk.
> 
> My feeling on the restraint issue is that it seems that most EMTs fall into two polar opposite camps. There's the "restrain everyone on a hold" camp who discount the idea that the vast majority of psych patients are neither violent nor an elope risk. The other side almost never uses restraints, but don't ask the appropriate questions to determine if the need to use restraints.



It was one of those situations where two EMTs disappeared without explanation (suspension pending investigation) and a new memo was issued the next morning, requiring a blanket policy of restraint of all pysch patients. I ignore this policy because LA county EMS trumps mere company policy and they have a protocol that prohibits blanket use of restraints. 

You are completely correct about the two camps of EMTs when it comes to use of restraints.


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## sir.shocksalot (Jan 27, 2009)

call me crazy but all my psychs get stretcher rides. I am not going to be that guy that had the psych pt run off and murder someone (if that psych pt is so inclined). But on that same note I think we all need to realize that psychs are people too, and you are seeing them only in their worst condition, who knows, they might be great people after appropriate treatment. And never forget that people will always remember an ambulance ride, its up to you to make it a positive experience for the pt.


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## JPINFV (Jan 27, 2009)

sir.shocksalot said:


> call me crazy but all my psychs get stretcher rides.



I'm not saying that it's appropriate to walk psych patients into the ER, just that most psych patients do not need restraints. The little goth girl with skulls on her slippers who got into a fight with her mom and was threatening suicide probably doesn't need the leather bracelets, even if she is on a psych hold.


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## Ridryder911 (Jan 27, 2009)

Well here we go again. It is very obvious that the EMT receives very little or no real training and education in psychiatric care. 

Psychiatric patients are mentally ill and may not be physically ill. Treat appropriately. Requiring or even attempt to slightly force one to be on a stretcher may not be the best modality. 

If a patient is sedated, there is usually a reason. Allow the patient to rest as in some conditions the mind ...never shuts off. 

With all the fun one could describe; lets remember we are there for the patient not the patient is there for us. 

R/r 911


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## silver (Jan 27, 2009)

Hockey9019 said:


> my 150 mile transfer
> 
> 
> You become bored and have no one to talk to except your partner and yourself
> ...



and now you know how they became psych patients...


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## raisingkahne9 (Jan 27, 2009)

My question is, why is there an x-box in an ambulance? I realize that people take game consoles to work, for when its a slow night, but for crying out loud keep them in your personal vehicle. And you have no one but yourself to blame for it being stolen. If it wasn't there in the first place, and to accuse a patient of breaking into the ambulance to steal it is pretty low, in my own opinion.


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## Sapphyre (Jan 27, 2009)

Hey, Kahne, some of us only leave our rig on scene and at the hospital...  We don't post at a station between calls.  And, some of us, are lucky, and have storefronts with couches and TVs, but not actual stations, so, you're still not making it back to where your car is....  But, I'm still with you, why an xbox 360???  If you're gonna bring games, bring the personal ones  (says someone who brings her laptop on the rig)


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## raisingkahne9 (Jan 28, 2009)

Ok but if that is the case then why the xbox? its not like your going to be able to play it on the rig. My second question is when you take your laptop to work, do you make sure its out of sight, when you are not in the ambulance?


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## Hastings (Jan 28, 2009)

raisingkahne9 said:


> Ok but if that is the case then why the xbox? its not like your going to be able to play it on the rig. My second question is when you take your laptop to work, do you make sure its out of sight, when you are not in the ambulance?



Behind the seat, in a bag.


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## raisingkahne9 (Jan 28, 2009)

Then that I can understand, However, would you blame a  psych patient if it went missing?


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## Hastings (Jan 28, 2009)

raisingkahne9 said:


> Then that I can understand, However, would you blame a  psych patient if it went missing?



Me?

I have yet to meet a Psych patient concerned with stealing anything of mine. I'm nice to Psych patients, take them seriously, treat them like I'd treat any other patient, and I get a very fair amount of respect from them as well. The only time I've heard of someone having trouble with a Psych patient is when that person doesn't treat them with respect. We have a few of those in our company. Psych patients aren't loaded guns looking for any excuse to go off. You don't have to treat them like a ticking bomb. Again, give them respect, help them feel at ease, listen to them, and don't laugh. It's the recipe for a great transfer. They're great people, and extremely interesting if you can gain their trust enough to have a conversation with them.


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## daedalus (Jan 28, 2009)

The psych patients in LA are loaded guns...

My last transports regarding psych patients were all pick ups from LAPD stations in the brig. One was arrested for throwing rocks at african americans in downtown, and calling them racial slurs. The cops took him away before he was killed, and punted to us. He was loaded up on some serious drugs and took four police to restrain him to the gurney. I have never been called so may expletives in my life. 

Another was a few months ago. A man from another LAPD substation in West LA who was telling the female officers he was going to rape them and than kill and chop them up and eat them. When he came out of his cell, he told the officers he had left a gift for them inside the cell. Turns out he smeared seamen all over the walls. He fought the whole way to the hospital.

Yet another was a women who set herself on fire in the middle of MLK Blvd.

Genders and locations, etc may have been changed. But as far as everything else, its all true.


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## Hastings (Jan 28, 2009)

Guess we should have established the difference between the average Schizophrenic and the criminally insane / psychopaths.


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## daedalus (Jan 28, 2009)

Hastings said:


> Guess we should have established the difference between the average Schizophrenic and the criminally insane / psychopaths.


No your absolutely correct. The majority of patients are depressed or suicidal and have great stories to tell. Since we (my service) gets the county pysch calls, we have the privilege of taking drunks and pyschos from jail to the serious pysch facilities.


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## downunderwunda (Jan 28, 2009)

I think the overiding thing to remember is that regardles of our personal opinions, mentally disordered patients are still human beings. They deserve the same respect as any other patient with any other illness.

EMS sees these patients at their worst, &, in reality they are a very small proportion of the population.

To label them as criminals is medieval & small mided at the very least.

Yes some are criminals, yes some have issues with living on the wrong side of the law but the majority we never see, live as functioning members of our communities & contribue effectivly to society. We should also consider that those who do live on the wrong side of the law, in many cases, are forced there because of the narrow minded attitudes, as have been displayed in some posts here. This is an illness, an illness of the mind. Yes some are violent, but so are drunks, do we label them in the same way? 

Open your mind, look inside & be 100% certain that you will NEVER have any mental illness issues before you criticize too hard.

Answer this question, i will answer it in a week, lets see who says what.

A woman attends the funeral of her mother with her sister. At that funeral she meets a man who she believes is her 'Perfect Match'. She has no contact numbers for him. 1 month later she murders her sister. Why did she murder her sister?


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## daedalus (Jan 28, 2009)

She murdered her sister hoping that that perfect man would attend her sister's funeral so she could get his number there?


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## Aidey (Jan 28, 2009)

I have never understood the negative feelings many EMTs/Medics feel towards psych patients. Just because they aren't physically ill doesn't mean they don't need medical care. The vast vast majority of psych patients I've met don't want to be sick, but they are.


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## raisingkahne9 (Jan 28, 2009)

I agree. There are times, when people just need someone to talk to, and if they can't find anyone to talk to, they think that people don't care. So, then they get even more depressed, and they think its the end of the world and they get to become suicidal, in some cases, I'm not saying in all cases. And they are normal people also, however to call them lowlives is completely wrong, and that makes it seem like you think that your better then them all because of a mental illness.


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## Outbac1 (Jan 28, 2009)

It's really simple. They get treated like any other pt. If they have violent tendencies a LEO accompanies. If they get violent they get restrained and/or sedated.  I haven't had to sedate one yet. Usually they want something,(like a smoke), so I make a deal with them. If they behave I let them have their smoke before they go in the destination hosp. I always try to be the good guy. If I have that person again and they remember me I have an easy time, because I kept my word before.


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## downunderwunda (Jan 28, 2009)

daedalus said:


> She murdered her sister hoping that that perfect man would attend her sister's funeral so she could get his number there?




OK, I really hope you have heard this ine before.

This was a psych test to see who was a psychopath, developed by psychiatrists who studied convicted murderers.

You answered the way the majority of psychopaths did.

I hope you have a really nice day, & i will leave very quietly now......


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## Sasha (Jan 28, 2009)

downunderwunda said:


> OK, I really hope you have heard this ine before.
> 
> This was a psych test to see who was a psychopath, developed by psychiatrists who studied convicted murderers.
> 
> ...



Lighten up! That is like the default answer, I'm pretty sure a lot of others would have answered in the same way, including myself.


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## downunderwunda (Jan 28, 2009)

Sasha said:


> Lighten up! That is like the default answer, I'm pretty sure a lot of others would have answered in the same way, including myself.



Actually the vast majority of people answer that it is something to do with the mothers estate.

I was however having a joke when i said



> I hope you have a really nice day, & i will leave very quietly now......



I should have been more precise in my reply & said that the answer given shows the respondant to have psychopathic tendancies. This, if you look into mental illness will show that does not mean you are a psychopath. It also does not mean you will act on your feelings.

The vast majority still have conflict between the Ego & the I, this also helps with the control of good & bad (although not directly related it shows that a person can differentiate between the two, mos psychopaths are ego dominant, like many in 'Uniformed' jobs, most with depression are Id dominant)

Whil that control is still there, we have nothing to worry about. If that is lost, then we may have a problem. Remember also that much of our psyche is learned as children. Having said that, some people are born bad.


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## daedalus (Jan 28, 2009)

I didn't get it right the first time. The answer I gave is consistent with a killer.


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## FF-EMT Diver (Jan 28, 2009)

raisingkahne9 said:


> My question is, why is there an x-box in an ambulance? I realize that people take game consoles to work, for when its a slow night, but for crying out loud keep them in your personal vehicle. And you have no one but yourself to blame for it being stolen. If it wasn't there in the first place, and to accuse a patient of breaking into the ambulance to steal it is pretty low, in my own opinion.



I don't think he meant the ambo, could be wrong though. I think he meant POV.


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## raisingkahne9 (Jan 28, 2009)

Oh, well if that's the case, the fact that he called the psych patient a low life don't change. If it was in his POV how did the patient have access to his vehicle? Especially if they were transporting him in an ambulance to a psych facility? Not all psych patients, are thieves, if i was going to carry and x-box in my vehicle I would put it in a non visble place like the trunk...But under no circumstances would I have accused a patient, psych or not, of stealing it.
But a question of mine is, would he accuse any other patient of breaking in to his vehicle?


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## Hockey (Jan 29, 2009)

Jesus people

I guess I didn't make myself clear 


It was my PERSONAL vehicle.  It was secured behind my seat, under a few coats of mine and other things.  Kills me because I had some of my emt stuff I forgot to get that day.  

I said psych because it seems like the whole neighborhood around our headquarters is filled with them.  I never accused my patient of stealing it.  Was overall a nice guy, just a tad crazy.


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## Hockey (Jan 29, 2009)

Sasha said:


> Interesting? These people are NOT your entertainment, they're your patients!
> 
> 
> 
> Perhaps your lack of empathy is better suited for another career where you're not in charge of taking care of people.



Yes, that must be true since it came from the expert.

Sarcasm?




downunderwunda said:


> One thing I have noticed in my time in EMS is the prevailing attitude to psych patients.
> 
> Psychiatric Illness is like an illness to any other part of the body. Never forget that. Statistics prove that 20% of us will suffer from some sort of mental illness at some point in our lives.
> 
> ...


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## Hockey (Jan 29, 2009)

And about the patient jumping out.  A local private agency had a MVA/PI patient rip off the straps on the backboard, jump out with headblocks taped to him and c-collar on at red light.  I could only immagine what the car behind them thought


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## Sasha (Jan 29, 2009)

> downunderwunder, you must be new in EMS huh? I wasn't saying I wouldn't care about a patient because what happened. I'll say your not too bright on the obvious sarcasm either



I had a post, but on second thought, I'm going to retract it.

Hmph.


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## Flight-LP (Jan 29, 2009)

Hockey9019 said:


> my 150 mile transfer
> 
> 
> You become bored and have no one to talk to except your partner and yourself
> ...



So bored that you stop paying attention to your patient and start playing on the internet?

I see the clarification about the x-box, although it was kind of dumb to bring it work knowing you have local security issues. However, surfing the net while transporting a pt. is completely unexcusable and utterly pathetic. I think your eloquence in describing your patients (i.e. complete lack of tact) is the least of your worries.....................


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## Hastings (Jan 29, 2009)

I hate to say it, but if the patient is completely sedated, is it really so damning to keep one eye on a personal entertainment device and the other on the monitor/IV/patient? I don't believe so. I've never found it necessary to have a staring contest with a stable patient the entire 2 hours during a transport. Glances, sure, but staring, no.

I mean, it'd mean paying as much attention to the patient as I do while I write my report during a transport.


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## Sasha (Jan 29, 2009)

Hastings said:


> I hate to say it, but if the patient is completely sedated, is it really so damning to keep one eye on a personal entertainment device and the other on the monitor/IV/patient? I don't believe so. I've never found it necessary to have a staring contest with a stable patient the entire 2 hours during a transport. Glances, sure, but staring, no.
> 
> I mean, it'd mean paying as much attention to the patient as I do while I write my report during a transport.



It doesn't matter if they're sedated or not, you don't have to have a staring contest but surfing the net is really unprofessional. 

The service I used to work for, you can see through the back windows when the light was on, and you KNOW everyone looks! Imagine one of them seeing your patient conked out and you fiddling on your phone or computer. Imagine them making a call to the supers!


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## Hockey (Jan 29, 2009)

Flight-LP said:


> So bored that you stop paying attention to your patient and start playing on the internet?
> 
> I see the clarification about the x-box, although it was kind of dumb to bring it work knowing you have local security issues.* However, surfing the net while transporting a pt. is completely unexcusable and utterly pathetic.* I think your eloquence in describing your patients (i.e. complete lack of tact) is the least of your worries.....................




Yes, because I was watching TV, had a laptop out (was on phone) and not paying any attention to my patient 

He's still a human, its not like I didn't care for him and do my job.  Jeesh, its amazing how people dig way to deep into things.  

So let me ask you, when you are with your patient, and lets say a psych patient, you watch them every second of the ride, not looking out the window, doing your report (which was already done), or looking at your phone, etc etc? You realize some patients just want to be left alone.  Especially psychs?  I guess I could have bothered him and irritated him enough to get his condition going.  But I used common sense

IV, monitor? Sorry, only basics here and we don't get the luxury of having that yet.  

Maybe if I held his hand the whole way down and told him things would be alright you would finally think I would have "tact"


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## Hockey (Jan 29, 2009)

Sasha said:


> It doesn't matter if they're sedated or not, you don't have to have a staring contest but surfing the net is really unprofessional.
> 
> The service I used to work for, you can see through the back windows when the light was on, and you KNOW everyone looks! Imagine one of them seeing your patient conked out and you fiddling on your phone or computer. Imagine them making a call to the supers!



Have you ever been a LONG distance transfer?  What exactly did you do for the full trip?


I think its hilarious some people are making such a mountain out of nothing.  The OP was meant to say how sometimes its fun to just talk to patients on a trip especially after a crapped out day.


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## Sasha (Jan 29, 2009)

Hockey9019 said:


> Have you ever been a LONG distance transfer?  What exactly did you do for the full trip?



I have done LONG distance transports, I used to love them. My longest was about 200 miles. I didn't fiddle with my phone or computer. I monitored my patient, listened to the music playing up front, had a conversation with my partner, or flipped through my Medic field guide and studied drugs and algorithims.  The difference? Anyone rubber necking through your back window wouldn't see a phone or a computer in your hands, but a little spiral flip book.



> The OP was meant to say how sometimes its fun to just talk to patients on a trip especially after a crapped out day.



And no, your OP was saying how you wish your "sedated crazy" patient was "crazy crazy" because you were bored.



> I guess I could have bothered him and *irritated him enough to get his condition going*.



Are you just not reading the things people are saying? Have you not realized how WRONG that is?


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## Hockey (Jan 29, 2009)

I'm seriously not trying to start an argument here over something so small, but your starting to nitpick thinking someone is going to see the difference between a pocketbook, and a cell phone?  You really think someone can see the phone?  MAYBE if at night with the lights on bright.  But sorry, middle of the day, no lights on, and oh, I'm going to make a LOT of you gasp, but our back windows had so much dirt and salt on them, I could barely see out of them.


With all do respect (seriously) you try to pass yourself off as the "perfect" person quite often



> Are you just not reading the things people are saying? Have you not realized how WRONG that is?



I guess not


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## Sasha (Jan 29, 2009)

Hockey9019 said:


> With all do respect (seriously) you try to pass yourself off as the "perfect" person quite often



Far from it. I have many many faults, and a lot come to light on this forum. I just take my patient care seriously.


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## Buzz (Jan 29, 2009)

I once did a transport from a hospital on the north side of Detroit to another hospital on the southern border of Cincinnati. The patient was given quite a few meds prior to us leaving the first hospital to help him tolerate the NG tube and the pain he was having. For close to four hours, this guy slept whilst I suctioned the NG tube every 15 minutes or so, kept an eye on his IV, worked on my report, and did repeat v/s.  I kept the lights off in back most of the time, so that he could sleep a bit easier. His family in the car following us mentioned they were watching me for most of the trip as they were quite bored as well. 

Aside from having something to do every 15 minutes or so, that was the most boring transport I've ever done since I started working. Even looking out the back window was quite boring as it was dark, it was night time (we left around 2300), and Ohio is flat.

Still, I'd much rather do that again than transport someone like my last psych patient... Transport time was 1 hour and fifteen minutes, and the hospital did not sedate this patient prior to sending her out. She was a screamer. Screaming at someone that wasn't there occasionally, but for the most part it was just one really long scream--really only stopping long enough for her to take another deep breath. She was also spitting at us, so I put one of those surgical face masks on her.


But around here, we have two types of psych patients: The psychiatric IFTs, and the psychiatric patients at the state facility having a medical emergency (which will always be more interesting than even the craziest 911 calls I've ever responded to).


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## Sapphyre (Jan 29, 2009)

Hockey9019 said:


> but your starting to nitpick thinking someone is going to see the difference between a pocketbook, and a cell phone?



Hey, just something interesting.....

Before I started EMT school, I was following an ambulance one day, it might have been evening, yes, lights were on, but, I was able to tell the pt's bag of NS was empty, before the medic moved to change it.  It is possible for people to see that clearly into your rig.

(point of clarification, before anyone freaks, I happened to be behind the rig on the freeway, I wasn't literally following them)


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## triemal04 (Jan 29, 2009)

Sasha said:


> I have done LONG distance transports, I used to love them. My longest was about 200 miles. I didn't fiddle with my phone or computer. I monitored my patient, listened to the music playing up front, had a conversation with my partner, or flipped through my Medic field guide and studied drugs and algorithims.  The difference? Anyone rubber necking through your back window wouldn't see a phone or a computer in your hands, but a little spiral flip book.


So you also ignored your pt to read and by holding a conversation with a third party, which could have been considered rude as well.  But for appearances sake you would have looked attentive.  So that makes it ok, right?

For the record, not every pt needs to be constantly monitored.  Keep an eye on them and what's happening, but use your head; if you picked up that pt from a hospital room where they were by themself and had been for hours (or days) there was probably a reason for that.  They'll be fine.


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## Aidey (Jan 29, 2009)

Sasha said:


> Imagine one of them seeing your patient conked out and you fiddling on your phone or computer. Imagine them making a call to the supers!



I know of a couple of services now that use electronic records and tablet laptops to do all of their documentation, so someone could be fiddling on a computer and legitimately doing their job. I still see your point though that the main focus of the transport should be the patient.


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## downunderwunda (Jan 29, 2009)

Hockey9019 said:


> Yes, that must be true since it came from the expert.
> 
> Sarcasm?
> 
> ...




No, I am not new to ems. But i refuse to have an attitude that is as closed minded as yours. I work closley with the mentally ill & see the full range of mental illness & when we in EMS see mentlly ill patients they are not as you so elequantly stated Lowlife?  



> Stealing stuff to sell it for crack? Sure...



That is a pretty big call. 

When we had the big worldwide awakening about 20 years ago, it was considered an invasion of civil liberties to keep a person locked up because of mental illness. This was a worldwide phenominon. Suddenly all the hospitals for the mentally ill were closed, the patients released into the community & left to their own devices. Quite a few went back to family (a lot were not mentally ill to begin with, considering the number of women who were locked up for PMS!!!!!!!) & tried to resume a normal life. Unfortunatley most ended up increasing the number of homless. The prevailing attitude is 'I am not sick, only sick people need meds, i will stop taking them.' Instead they believe they can self medicate with alcohol & tobacco. Many do steal & end up in the psych unit of their jail.

They are not & do not in general terms steal for crack or other drugs, they steal usually because the voices are telling them to, or out of a need for survival.

We have issues with the mentally ill because we, as a society, do not know or understand what the problems are. More to the point we dont want to know. It is easier to close our minds & lable them all & blame the mentally ill because all they do is 



> Stealing stuff to sell it for crack?



Grow up. We have just seen a small narrowminded person show they have no idea about mental illness. God help usa all if they treat all of their patients with as much contempt


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## exodus (Jan 29, 2009)

I know a few of our fire/rescue here use blackberries for reports.


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## triemal04 (Jan 29, 2009)

Sasha said:


> I have done LONG distance transports, I used to love them. My longest was about 200 miles. I didn't fiddle with my phone or computer. I monitored my patient, listened to the music playing up front, had a conversation with my partner, or flipped through my Medic field guide and studied drugs and algorithims.  The difference? Anyone rubber necking through your back window wouldn't see a phone or a computer in your hands, but a little spiral flip book.


Huh.  So you also ignored your pt, focused your attention elsewhere, and, may have been considered rude by having a conversation with a third party around the pt.  But nobody would have known that, so I suppose that makes it ok, right?  After all, appearance is everything isn't it.

For the record, not every pt needs to be constantly monitored and observed 24/7.  Doing something else in that situation is perfectly acceptable as long as you are still checking on the pt and aware of what's going on.  I mean, if you pick someone up from a room where they've been alone for several hours (or days) do you really think that they need you staring at them and constantly asking them questions for the duration of the trip?


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## Flight-LP (Jan 30, 2009)

Hockey9019 said:


> Yes, because I was watching TV, had a laptop out (was on phone) and not paying any attention to my patient
> 
> He's still a human, its not like I didn't care for him and do my job.  Jeesh, its amazing how people dig way to deep into things.
> 
> ...



What is equally amazing is the lack of professional work ethics some bring into EMS. Maintaining situational awareness by looking out the window or completing your required documentation is fine if the pt. does not require your immediate assistance. However, using the phone for personal calls or surfing the internet is not only unprofessional, it is disrespectful to your employer. I seriously doubt that many employers are paying you to engage in your personal wants. I know I wouldn't and I haven't before when I was in management. Drive with your cellphone or screw off while you had a patient, you were gone, plain and simple. You gone today and your replacement starting tomorrow. Perhaps with the decline in the economy, more people will have appreciation and respect for the small things; LIKE A JOB.

I have been on many long distance transfers, some taking an hour, some taking 20 hours. Yes, you do get bored, yes you do get tired, but no you don't slack off. Read your protocols, study some A&P, do something productive that will make you a more proficient EMT. Sorry, EMTlife doesn't count.

Remember, attitude and perception is everything and has a direct correlation to viewed professionalism.

hmmm, that gives me an idea for a new thread................


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## Summit (Jan 30, 2009)

Flight-LP said:


> do something productive that will make you a more proficient EMT. Sorry, EMTlife doesn't count.


Oh, sure it does 

On 24s, 48s, etc we were expected to be productive between 800-1700. Otherwise, if not on a call, you were free.



> hmmm, that gives me an idea for a new thread................



do it!


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## raisingkahne9 (Jan 30, 2009)

After replying to this thread a few times. 

I know that I've touched this on this several times, but it's the thing that bothers me the most about this thread. Calling a psych patient a "low life". 

Psych patients are people too and to call them a low life, makes you look like you are looking down on them, and that your thinking your better than they are, all because they have a mental illness. Who are you to think that you are better than anyone? We all have our faults, and we all have our good points. 

Have you ever stopped to think that the Psych patient you are transporting, has hit rock bottom? Let's say, his wife just left him, he just lost his job, one of his parents passed away, and he's in the middle of a custody dispute. Do you really think that he's going to be in any condition at all to make any type of rational decision? Sure, if he's heartless he will be. However, stealing your "X-box" is probally the last thing on his mind. He's probally more worried about putting his family back together. 

And as for the X-box thing, if your that pissed off about it, turn it in to your insurance company, for theft from a vehicle, and get over it. And if you dont have insurance then sorry about your luck.


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## Buffalo Dude (Jan 30, 2009)

Had a patient last week tell me that he thought I was a Communist agent sent to kidnap him "James Bond" style.  He also said my English is very good, which I took as a compliment.


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## Emtgirl21 (Jan 30, 2009)

I find it interesting that MOST psych pt really have no need to be in an ambulance being taking to a facility. its usually just a lack of law enforcement for the transport.


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## JPINFV (Jan 30, 2009)

Emtgirl21 said:


> I find it interesting that MOST psych pt really have no need to be in an ambulance being taking to a facility. its usually just a lack of law enforcement for the transport.




Why is a police car more appropriate for psych patients? They didn't break a law after all? Alternatively, when did psychiatry stop being a medical specialty?


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## raisingkahne9 (Jan 30, 2009)

JPINFV said:


> Why is a police car more appropriate for psych patients? They didn't break a law after all? Alternatively, when did psychiatry stop being a medical specialty?




Maybe when Some people failed to realize that its still a medical condition. Correct me if I'm wrong, but some people see psych patients as criminals. For what reason I'm not sure.


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## BossyCow (Jan 30, 2009)

raisingkahne9 said:


> After replying to this thread a few times.
> 
> I know that I've touched this on this several times, but it's the thing that bothers me the most about this thread. Calling a psych patient a "low life".



Some psyche patients are low lifes some are not. Some low lifes are psyche patients some are not. They are not linked traits.


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## downunderwunda (Jan 30, 2009)

Emtgirl21 said:


> I find it interesting that MOST psych pt really have no need to be in an ambulance being taking to a facility. its usually just a lack of law enforcement for the transport.



It is interesting that this narrowminded view has been negated here in parts of aussieland. Police have digressed from all Psych transport because it is a MEDICAL condition, not a legal one. This only reverses IF there is a criminal charge involved also.

With this in mind why are we trying to shove a medical problem onto law enforcment?


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## medic417 (Jan 30, 2009)

BossyCow said:


> Some psyche patients are low lifes some are not. Some low lifes are psyche patients some are not. They are not linked traits.



Some times you feel like a nut.  Sometimes you don't.  Almond joys got nuts, mounds don't.


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## triemal04 (Jan 30, 2009)

downunderwunda said:


> It is interesting that this narrowminded view has been negated here in parts of aussieland. Police have digressed from all Psych transport because it is a MEDICAL condition, not a legal one. This only reverses IF there is a criminal charge involved also.
> 
> With this in mind why are we trying to shove a medical problem onto law enforcment?


The arguement could be made that it's for safety.  The vast majority of paramedics and EMT's recieve little to no training in defensive tactics and threat recognition beyond what they pick up while working in the field.  Take a pt that is being transferred in restraints because they are violent.  At this point they are allready a known threat; wouldn't it make sense to have the people transporting them be the ones who are trained to restrain people, and, if neccasary, fight them?  The same goes for sedation; if they are being sedated because they are potentially a physical danger to themself and others, then the police should be involved; the average EMT is capable of handling someone like that as well as a cop.  (of course in that case they should be going on an ambulance as well; sedation=medical supervision.)

Of course, the above is not neccasary for all psych pt's, just the violent ones.  As well, while a psychiatric problem is a medical issue, that simple fact does not in any way mean that only medical people should, or will be involved in their care.  If it is more appropriate to transport someone in a secure vehicle with cops, then do so.


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## Jon (Jan 30, 2009)

Hockey9019 said:


> _WTF??? Stealing stuff to sell it for crack? Sure..._



#1 - How do you KNOW it was a 'psych' patient that broke into your vehicle?

#2 - How do you KNOW it was stolen to pay for a drug abuser's addiction?




Anyway - I think DownUnder hit the nail on the head. How many EMS workers have battled some form of Mental Illness? I think 20% might be low. We work weird shifts, see humanity at its worst, and many EMS providers I know have other issues, like Alcohol abuse and/or Nicotine Addiction.

As a group, we should be more mentally and physically healthy.


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## Emtgirl21 (Jan 30, 2009)

I am not talking about psych pt that was a 911 calls that could could be actually having a medical problem or altered mental status. I am talking about 96 hr holds and long distance transfers for psych holds. Those pt rarely having a medical problem that requires care en route. Now if they are sedated then their airway needs to be watched bc sometimes they stop breathing and that a bad deal. but a normal hospital to psych facility doesnt true need an ambulance if its a hold. Its not a medical issue its a law enforcement matter. They are at the ER for medical clearnce.

Side note, you fight a couple psych pts that have already been medically cleared going to a psych facility and see if you dont change your mind. I am always polite and professional to all my pt and have found myself a human punching bag more than once


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## downunderwunda (Jan 30, 2009)

Emtgirl21 said:


> I am not talking about psych pt that was a 911 calls that could could be actually having a medical problem or altered mental status. I am talking about 96 hr holds and long distance transfers for psych holds. Those pt rarely having a medical problem that requires care en route. Now if they are sedated then their airway needs to be watched bc sometimes they stop breathing and that a bad deal. but a normal hospital to psych facility doesnt true need an ambulance if its a hold. Its not a medical issue its a law enforcement matter. They are at the ER for medical clearnce.
> 
> Side note, you fight a couple psych pts that have already been medically cleared going to a psych facility and see if you dont change your mind. I am always polite and professional to all my pt and have found myself a human punching bag more than once



Im sorry, I must be an idiot. The definition of a psych is a mental ILLNESS. When did ILLNESS cease to become an ambulatory function?

How many transfers are done for say a wrist fracture in an ambulance, do you consider this a wate of resources also because they could have gone in private transport? How about a minor hand injury, broken toe? All medical, all valid ambulance transfers.

By strict definition, here, we can put someone on a psych hole if 'They are not capable of making a decision that would be made by a "Normal" person. 

Emtgirl21, is the person really having a psych episode, or is it a MEDICAL closed head injury? they can present the same, or are they just drunk or concussed? Is it an altered LOC because of the pharmacology they have self administered, or is it that they have a brain contusion? All of these people can be misdiagnosed with a psych condition, especially if they are combative, because I would suggest you read contraindications to the administration of drugs like diazepam, midazolam & then repost your answer.


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## triemal04 (Jan 30, 2009)

downunderwunda said:


> Im sorry, I must be an idiot. The definition of a psych is a mental ILLNESS. When did ILLNESS cease to become an ambulatory function?  When it was determined that an ambulance was not needed for certain medical conditions.  Like it or not, an ambulance isn't always needed for multiple illnesses.
> 
> How many transfers are done for say a wrist fracture in an ambulance, do you consider this a wate of resources also because they could have gone in private transport? How about a minor hand injury, broken toe? All medical, all valid ambulance transfers.  Very very few.  (and to be clear, I mean transfer as in transferred from 1 hospital to another).  And yes, some are a waste of resources; pn management needs being one of the few exceptions.  And no, they are not always valid transfers; just ask your finance dept how often the insurance and/or medicare claims are refused for those types of transfers.  (though that may not be as big an issue in Australia; here there is no obligation for insurance to pay unless it's determined the ambulance was truly NEEDED)
> 
> ...


Not everyone who is sick or injured needs an ambulance.  This includes pt's with psychiatric problems.  It in fact may be innappropriate to transport many people in an ambulance, depending on what is wrong with them.


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## Jon (Jan 30, 2009)

Downunder:

if the patient has been medically "cleared" at a local ED, and is now being transported on a 72 or 96 hour hold... is there perhaps a need for a 3rd variety of transport, that isn't law enforcement, and isn't by private ambulance?

There is a local county that has a quasi-county-run agency that is responsible for some of the treatment and most of the short-term (hours) housing of these patients after the ED clears them and before they are placed in a more appropriate facility. They use specially trained EMT's and their own ambulances and vans to transport the patients. Some of the patients are transported in sedans or vans as passengers... but from what I understand, the vehicles are equipped like prisoner transport vehicles, so that the patient can't escape (as they are legally committed). I think this is a decent model - it provides for medically trained personnel who are FAMILIAR with psychiatric illness to provide the transport.


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## downunderwunda (Jan 30, 2009)

Jon said:


> Downunder:
> 
> if the patient has been medically "cleared" at a local ED, and is now being transported on a 72 or 96 hour hold... is there perhaps a need for a 3rd variety of transport, that isn't law enforcement, and isn't by private ambulance?
> 
> There is a local county that has a quasi-county-run agency that is responsible for some of the treatment and most of the short-term (hours) housing of these patients after the ED clears them and before they are placed in a more appropriate facility. They use specially trained EMT's and their own ambulances and vans to transport the patients. Some of the patients are transported in sedans or vans as passengers... but from what I understand, the vehicles are equipped like prisoner transport vehicles, so that the patient can't escape (as they are legally committed). I think this is a decent model - it provides for medically trained personnel who are FAMILIAR with psychiatric illness to provide the transport.




Does this mean we dont transfer obsterics cases because we are not appropriatley trained & there may be 'more appropriate transport' that should be made available.

We need clarity in definition here, mentally ill people are sick people. While I agree that ambulatory resources are misused with a lot, these people have an illness. Like it or not. Until there is better systems put inplace, it is more appropriate to transport in an ambulance than a police car, unless they are seriously violent.


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## reaper (Jan 31, 2009)

Our hospital handles this on their own. Once the pt is medicaly cleared and ready to be transfered to the psych facility, they have the hospital security transport them in minivans with two security guards. They do not tie up EMS for this. The pt has been cleared by a Dr. and does not need an ambulance to ride in!


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## rhan101277 (Jan 31, 2009)

Outbac1 said:


> It's really simple. They get treated like any other pt. If they have violent tendencies a LEO accompanies. If they get violent they get restrained and/or sedated.  I haven't had to sedate one yet. Usually they want something,(like a smoke), so I make a deal with them. If they behave I let them have their smoke before they go in the destination hosp. I always try to be the good guy. If I have that person again and they remember me I have an easy time, because I kept my word before.



So you roll them out of the ambulance and let the smoke while they are on the stretcher? If they aren't on a stretcher what if they runaway when they get out to smoke?


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## rhan101277 (Jan 31, 2009)

We have to get medical necessity forms for transfers like this.  Wonder why some just can't go in a wheelchair van.  Most of them I see are ambulatory, it would free up an ambulance for something else.

Most of the time they need ambulance transfers for continuous medical supervision.


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## Arkymedic (Jan 31, 2009)

lmao thanks medic B)


medic417 said:


> Some times you feel like a nut. Sometimes you don't. Almond joys got nuts, mounds don't.


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## Sasha (Jan 31, 2009)

rhan101277 said:


> We have to get medical necessity forms for transfers like this.  Wonder why some just can't go in a wheelchair van.  Most of them I see are ambulatory, it would free up an ambulance for something else.
> 
> Most of the time they need ambulance transfers for continuous medical supervision.




I don't think the wheelchair vans can restrain someone, or monitor someone who is sedated. You never know when someone is going to have an adverse reaction to the sedation.


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## Emtgirl21 (Jan 31, 2009)

Downunder do you work for an ambulance service private or other wise. My service does in excess of 20 psych transports a day. We are a 911 service. Not a private transfer service. Medically cleared psych pt going for the er to a holding facility. Ambulatory with no medical problems and on a regular basis EMTs and Paramedics are assualted by these patients. I really dont think you understand what some of us are complaining about or discussing. Or maybe your just trying to start trouble.  Whatever floats your boat....or finds your lost remote.


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## downunderwunda (Jan 31, 2009)

Emtgirl21 said:


> Downunder do you work for an ambulance service private or other wise. My service does in excess of 20 psych transports a day. We are a 911 service. Not a private transfer service. Medically cleared psych pt going for the er to a holding facility. Ambulatory with no medical problems and on a regular basis EMTs and Paramedics are assualted by these patients. I really dont think you understand what some of us are complaining about or discussing. Or maybe your just trying to start trouble.  Whatever floats your boat....or finds your lost remote.



Emtgirl21, 

I work for a fully funded government run service. My qualifications are between your EMT-I & EMT-P. We do not have private transport companies. WE R NOT PART OF A FIRE BRIGADE!!!!!!!

Now that is out of the way. If you have read my posts, i agree that there are many transfers that are done that are not requiring ambulance resources. What I am challenging here is the notion that 

1. as was staed earlier, all psych patients are drug addicts, 

2. Even though they may have no physical injuries, a psych patient is indeed a medical emergency because they have an illness of the mind, &

3. That the attitudes that we, as so called prfessional are bordering on the ignorant by believing otherwise.

I have been assaulted by a psych pt in the past, so don't preach to me about that crap. EMS covers a vast array of illnesses, I am sick to death of hearing most people brag about the trauma the do, the cardiac, the off beat jobs, well psych is as off beat as they get, but no one wants to brag about them.

The attitude in the broader communities will never change if the attitudes within the medical community doesnt change.  Mental Illness, according to the World Health Organisation will be, by 2020, second only to trauma as a killer. Like it or not, we will be dealing with it more & more over the next few years. 

The challenge is to treat psych pateints with the dignity & respect they _*DESERVE*_. Sedation is an option, but should always be a final option. 

Emtgirl21, try reading all of my posts again & this time read them properly, i am challenging everyone who reads this thread to open their minds, not just label all psych patients. Oh, yeah, & when we do a psych transfer it is in excess of 2 hours & the receiving hospital will not accept them sedated.


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## Sasha (Jan 31, 2009)

downunderwunda said:


> Emtgirl21,
> 
> I work for a fully funded government run service. My qualifications are between your EMT-I & EMT-P. We do not have private transport companies. WE R NOT PART OF A FIRE BRIGADE!!!!!!!
> 
> ...



probably the best post on this thread.


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## downunderwunda (Jan 31, 2009)

Sasha said:


> probably the best post on this thread.



Thank you.


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## ffemt8978 (Jan 31, 2009)

downunderwunda said:


> Oh, yeah, & when we do a psych transfer it is in excess of 2 hours & the receiving hospital will not accept them sedated.



Interesting concept there...
Longer transport time, longer time patient confined to ambulance, farther distance you travel, farther from immediate assistance you are, and you can't use sedation?

So if patient becomes violent during transport, and you sedate them for safety reasons, what are you supposed to do once you get to the receiving hospital?  Drive around the block until the sedation wears off?


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## downunderwunda (Jan 31, 2009)

ffemt8978 said:


> Interesting concept there...
> Longer transport time, longer time patient confined to ambulance, farther distance you travel, farther from immediate assistance you are, and you can't use sedation?
> 
> So if patient becomes violent during transport, and you sedate them for safety reasons, what are you supposed to do once you get to the receiving hospital?  Drive around the block until the sedation wears off?



For all of the psych transfers I have done, i have found that by talking to the patient, negotiating with them, showing empaty to them, I have never even seen a need to chemically retrain. I have on occasion used a mechanical restraint, but that is representative of less than 0.5% of all transfers.

EMS is about knowing how to deal with people, how to talk to them & how to show respect. Drugs should alsways be a last resort in these cases, not a front line option.


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## ffemt8978 (Jan 31, 2009)

downunderwunda said:


> For all of the psych transfers I have done, i have found that by talking to the patient, negotiating with them, showing empaty to them, I have never even seen a need to chemically retrain. I have on occasion used a mechanical restraint, but that is representative of less than 0.5% of all transfers.
> 
> EMS is about knowing how to deal with people, how to talk to them & how to show respect. Drugs should alsways be a last resort in these cases, not a front line option.


I agree 100%, but I was wondering what would happen if you had to use that last option, since the hospital won't take them then.


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## downunderwunda (Jan 31, 2009)

The psych hospital is currently seperate from the main hospital, they go to an ED restraine with mechanical restraints until they r lucid enough for further transfer on to the mental institution.


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## Jon (Jan 31, 2009)

downunderwunda said:


> Does this mean we dont transfer obsterics cases because we are not appropriatley trained & there may be 'more appropriate transport' that should be made available.
> 
> We need clarity in definition here, mentally ill people are sick people. While I agree that ambulatory resources are misused with a lot, these people have an illness. Like it or not. Until there is better systems put inplace, it is more appropriate to transport in an ambulance than a police car, unless they are seriously violent.



I understand what you are saying... but they are also legally committed for a short-term (or longer term) hold... kinda like being arrested. They might need to be restrained. A separate system for transporting these patients makes sense.


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## downunderwunda (Jan 31, 2009)

Jon said:


> I understand what you are saying... but they are also legally committed for a short-term (or longer term) hold... kinda like being arrested. They might need to be restrained. A separate system for transporting these patients makes sense.




The simple fact is that this is still a MENTAL ILLNESS. That is, in reality medical. Not legal. They have a legal constraint to protect themselves & others just in case. The simple reality is that the vast majority are not violent, do not have & will never have violent tendencies & police/law enforcment is more inappropriate than an ambulance.

I always thought EMS was a caring profession, but obviously i must be mistaken, we only want to deal with the glory stuff so we can attempt to show how good we are.

Take the good with the bad. Psych patients deserve as good if not better treatment than most because we can make a real difference in their lives. If we treat them right today & look after them, they will remember it & each time you will make it easier for yourself. Too many in EMS are full of their own self importance & want to look down on our Psych patients. 

Remember this though PTSD is a MENTAL ILLNESS. How many in EMS will suffer from this in varying degrees?


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## Lone Star (Feb 4, 2009)

Hockey9019:

I have to agree with the posts I’ve read about your lack of empathy, compassion and professionalism.  First off, not taking the appropriate steps to secure your belongings is your own fault.  I don’t understand why you felt the need to bring an Xbox to work.  

To refer to a psych patient as a “low life” is highly unprofessional!  I’m willing to bet that when you do geriatric transfers, you refer to them as ‘gomer slings’, ‘raisin runs’ or other ‘derogatory terms’.  These PEOPLE are our PATIENTS, and to diminish that shows that maybe you should consider a different line of work!  I’m sure that this mentality wouldn’t even be tolerated at the local McDonalds!

As I stated earlier, these patients are human beings, and they deserve at least that much respect!  



Buzz,

I too have done some really LONG distance transfers, (Detroit VA to Saginaw VA).  

Yes, it was an ‘uneventful’ transfer, but with monitoring vitals, establishing history, meds, etc; it helped pass the time.


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