# Mental patient jumps from moving ambulance on Interstate 65 north of Gardendale



## MMiz (Oct 10, 2009)

*Mental patient jumps from moving ambulance on Interstate 65 north of Gardendale*

A mental patient being taken to Bryce Hospital in Tuscaloosa by the Blount EMS ambulance service this morning jumped out of the ambulance while it was traveling south on Interstate 65 north of Gardendale, an Alabama state trooper said.

The patient had undisclosed injuries and was put in another ambulance and taken to UAB Hospital in Birmingham for treatment, State Trooper Charles Dysart said. The incident happened at 9:37 a.m. at mile marker 275, Dysart said.

*Read more!*


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## redcrossemt (Oct 13, 2009)

Does everyone restrain every psychiatric patient?

What would you do if this patient started unbuckling their belts?

My first action would be to tell the driver to stop. Beyond that, I really think it would depend on the situation. Hopefully you anticipate the patients who will try to elope and have them restrained.


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## Hoofguy (Oct 14, 2009)

Peace out! see ya..   Look until they start giving us the options to protect ourselves(and others) this is going to happen.. Other than telling my partner "Squirrel in the road" and watching him hit the brakes and swerve, I'm too old to be retard wrestling in the back of a rig. After he jumped out I bet he was much easier to deal with..


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## firecoins (Oct 14, 2009)

I has a patient jump out on me.  He started to remove the straps. So I took a step in the driver's direction to tell her to pull over.  She did. And the patient took off. I was behind him so I couldn't do much.  He stopped outside the ambulance and didn't go anywhere.  I talked him back in.


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## DT4EMS (Oct 14, 2009)

This happens quite a bit. Best advice......... Stop and let them out (if possible).

Not only is it nearly physically impossible for one person to "restrain" another person...... according to the NAEMSP you are in another bad position.......

The NAEMSP put out a position paper stating they believe it takes FIVE people to medically restrain a "patient". 

So.....unless you have four people in your pocket...........you put not only your safety at risk, but you and your agencies wallet.


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## redcrossemt (Oct 15, 2009)

Hoofguy said:


> Look until they start giving us the options to protect ourselves(and others) this is going to happen..



What do you mean?

Are you gonna shoot a patient because they want to get out? Or taser them as they start unbuckling? Or better yet, mace them in the ambulance?

The option we have to protect ourselves and patients are called restraints - physical and/or chemical. If you can't do one, the other, or preferably both; you should talk with your medical director about implementing a program/protocol.


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## JPINFV (Oct 15, 2009)

redcrossemt said:


> Does everyone restrain every psychiatric patient?



Are you honestly suggesting that all patients on a psychiatric hold should be restrained without thought to the specifics of that patient encounter?

As far as the article, there is no mention as to whether the patient was on a hold or not nor what the patient was being taken to the hospital for.


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## redcrossemt (Oct 15, 2009)

JPINFV said:


> Are you honestly suggesting that all patients on a psychiatric hold should be restrained without thought to the specifics of that patient encounter?
> 
> As far as the article, there is no mention as to whether the patient was on a hold or not nor what the patient was being taken to the hospital for.



One hospital I used to deal with regularly required that all "committal" patients, or those on a hold as you say, were to be secured/restrained so they could not elope. My comment was actually sarcastic, and meant to challenge this ridiculous approach.

I would restrain any patient that has demonstrated their capability for unsafe behavior that endangers them self or my crew. I would also restrain patients that are at high risk for elopement. Other than those reasons, why else would you restrain someone?


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## JPINFV (Oct 15, 2009)

Sorry, my sarcasm meter doesn't really work with threads about restraints. I've seen too many people who jump at the chance to use the leather bracelets just because their patient happens to be on a hold. "35 y/o soccer mom with suicidal ideations? Oh, is that a hold? Restraint time!" 

I also used the term 'hold' because not all psychiatric patients are on a hold, even ones in locked units. Restraining patients on a psychiatric hold is an acceptable part of the business even if the restraints aren't actually needed. Restraining a patient with psychiatric issues not on a hold is kidnapping provided they don't meet implied consent. Hence the specification. 



redcrossemt said:


> Other than those reasons, why else would you restrain someone?




Training and education for psychiatric emergencies and conditions for EMT-Bs is way too simplistic
Generally the only thing taught it to restrain
People don't think about trying to deescalate patients
Some providers like to screw with patients with psychiatric conditions and without restraints they would get their well deserved beating.
Some people sadly get their rocks off restraining patients.
I might be missing a few.


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## exodus (Oct 15, 2009)

Company policy is to restrain any PT on a hold.  Even if they're against it, they are a danger to themselves or others, so they get held down. (we restrain bi-laterally at radial) 

Off the Record: I do not always restrain holds. If the pt has shown to be violent in the past, or was violent when the pt came in, they just earned them selves restraints. I always ask the nurses in the facility how the pt has been with them, and if they believe restraints are needed. Then I talk to the pt and decide on final for myself. BUT if the nurse says you wanna restrain. i don't care if the pt is drugged to hell and asleep, they're getting the restraints.


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## Aidey (Oct 15, 2009)

exodus said:


> Company policy is to restrain any PT on a hold.  Even if they're against it, they are a danger to themselves or others, so they get held down. (we restrain bi-laterally at radial)




Most pts are put on holds because they are deemed a risk to themselves or others. In fact, where I am that is the legal requirement to get involuntary papers. The only exception is people who are in violation of a court order by not taking their meds, or going to appointments or whatever.

However, that doesn't mean they are all violent, or are an acute threat which is why policies like that are just absurd. The quickest way to upset a calm psych patient is to tell them "Sorry, we know you are behaving, but we have to tie you up anyway". 

It is degrading to the pt, not to mention it just furthers the pts feelings of not being in control, which upsets them even more and escalates the situation. 

When we respond with Mental Health on pts being served involuntary papers they police nearly always come too. Mental Health is required to give pts a 72 hour warning that they are being served, unless it is an acute situation. I say nearly always because sometimes when the pt have acknowledged that they are going to be held they consent to going in before we even get there. 

I always speak with the MH people on scene prior to making pt contact and find out what their history is with the pt, what conditions they have, why they are being put on a hold, if they have been put on a hold before, and how they have behaved previously. 

Several times I have had the MH people flat out state the pt does not need to be restrained. I've definitely transported more hold pts unrestrained than restrained. I am a big fan of talking to pts (safely, usually with MH or PD there) and deesclating the situation if necessary, rather than being a bully. 


Aside from the violent/threatening pts, the only other type of pt I restrain on a semi-regular basis are the elderly dementia pts/ALOC pts who aren't violent, but won't stop pulling at IVs, Oxygen, J-Tubes, Catheters etc.


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## exodus (Oct 15, 2009)

At a particular facility that will remain nameless. If a pt comes into the facility asking for help, they coarse them into saying the magic words and BAM 5150 hold...


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## JPINFV (Oct 15, 2009)

exodus said:


> Company policy is to restrain any PT on a hold.  Even if they're against it, they are a danger to themselves or others, so they get held down. (we restrain bi-laterally at radial)


[Warning: California specific information]
That's patently false. There's a third criteria for 5150s that does not include being a danger to self or someone else.


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## Medic744 (Oct 15, 2009)

redcrossemt said:


> Does everyone restrain every psychiatric patient?
> 
> What would you do if this patient started unbuckling their belts?
> 
> My first action would be to tell the driver to stop. Beyond that, I really think it would depend on the situation. Hopefully you anticipate the patients who will try to elope and have them restrained.



I have had quite a few psych pts and never had to restrain one.  I think I speak crazy pretty well bacause they all seem really willing to go with me, plus I explain that we can chill and take a nice ride without restraints but the minute they start going wonky again that I grew up on a farm and was married to a cop and can hog tie in 60 secs or less. LOL  It works out well.


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## EMSLaw (Oct 15, 2009)

Hrm.  In NJ, I was taught we have no authority to restrain patients in the ambulance (other than strapping them in for safety, of course).  No taking cravats and tying their wrists to the stretcher.   If there is a problem, that's what the police are for.  

Paramedics might have different authority, I'm not clear on that.


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## redcrossemt (Oct 15, 2009)

EMSLaw said:


> Hrm.  In NJ, I was taught we have no authority to restrain patients in the ambulance (other than strapping them in for safety, of course).  No taking cravats and tying their wrists to the stretcher.   If there is a problem, that's what the police are for.
> 
> Paramedics might have different authority, I'm not clear on that.



Here is an excerpt from the BLS scope and practice for NJ from http://www.state.nj.us/health/ems/documents/njac840r.pdf...

8:40-4.10 Physical behavioral restraints 

(a) Patients shall not be placed and/or transported in physical behavioral restraints unless:
1. A physician or court has authorized the placement of the restraints;
2. The patient is in the custody of a law enforcement officer; or
3. The medical condition of the patient mandates transportation to, and treatment at, a health care facility, and the patient manifests such a degree of behavior that he or she:
    i. Poses serious physical danger to himself or herself or to others; or
    ii. Causes serious disruption to ongoing medical treatment that is necessary to sustain his or her life or to prevent disability.


So, as it pertains to NJ, yes EMT-Basics can restrain patients within the policies, procedures, and protocols of your agency. Check with your agency operations staff before you need to restrain someone so you know their policies!


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