# pysch and ems... please help!



## emtgirl_in_training (Jul 9, 2007)

so i'm taking a abnormal pysch class and have been given 2 weeks to write a 12 page term paper on the topic of my choice.  clearly, i'm taking the simplest route and basically writing page upon page of "war stories."  if anyone has an info or a good EDP story and wants to help please let me know.  thanks so much in advance!


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## Ridryder911 (Jul 10, 2007)

Hmm.. I don't quite see "war stories" and psych as the same. As well I am not familiar with the term ..EDP is. I am sure it is similar to protective orders. 

I would suggest many any topics on acute depression, inner actions with patients in crisis, etc. There are many authors and journals in regards to that subject.

R/r 911


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## knxemt1983 (Jul 10, 2007)

emtgirl_in_training said:


> so i'm taking a abnormal pysch class and have been given 2 weeks to write a 12 page term paper on the topic of my choice.  clearly, i'm taking the simplest route and basically writing page upon page of "war stories."  if anyone has an info or a good EDP story and wants to help please let me know.  thanks so much in advance!


so I am sure I can come up with some stories for you, but I am not sure how much detail or exactly what you are looking for... I am with rid, what is EDP? I could think of some EMS terms for it...


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## DT4EMS (Jul 10, 2007)

In EMS we get "Behavioral" as the dispatch where most police receive "EDP" for "Emotionally Disturbed".


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## gradygirl (Jul 10, 2007)

To be honest, and I'm sure most people here will agree with me, if you want to find a good base for a psych paper, just look around you when you go to work. I guarantee you that most of your partners will have as many abnormal psychoses as almost any EDP you pick up. An EDP, as my good buddy Kip said, is an "Emotionally Disturbed Person." In Hartford, we have two "classes" of EDPs, if you will, with the pt. either being a nonviolent or a violent, as I'm sure everyone is probably familiar with. And then you have the "violent psych" who's not really violent but just called and told the dispatcher that she was so that she could have us get there as quickly as we could.

I've gotta run right now, but later tonight I'll get back on and share some of the better 44s I've come across. (44=HPD 10 code for a psych)


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## VentMedic (Jul 10, 2007)

Thread lightly and with respect when talking about EDPs.  I've ran calls involving EMTs, Paramedics, LEOs, Nurses and Physicians as the patient.  Not to be nerd about this but I just saw this story come across the wire.  The events happening all around us today remind us that there is a fragile line of mental health that can be crossed by anyone at anytime.  Healthcare and EMS workers are sometimes the last to seek help before they break because of the stigma and jokes about EDPs in the field.  

http://www.emsresponder.com/article/article.jsp?siteSection=1&id=5701

*Colorado Nurse Jumps to Her Death from Moving Ambulance*

Story by thedenverchannel.com

GREENWOOD VILLAGE, Colo. -- 

Authorities still do not know why a 36-year-old nurse jumped to her death from a moving ambulance on Interstate 25. 

Melissa Lynn Watkins, of Aurora, was being transported as a patient from Parker Adventist Hospital to another hospital when she jumped out of the back of the ambulance, slammed on to the pavement and rolled to the side of the highway. 

Other vehicles behind the ambulance were able to avoid hitting her. She died Sunday afternoon from her injuries. 

*more at *
http://www.emsresponder.com/article/article.jsp?siteSection=1&id=5701


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## VentMedic (Jul 10, 2007)

Was just re-reading the article I posted earlier a little closer.

http://www.emsresponder.com/article/article.jsp?siteSection=1&id=5701



> An emergency medical technician and a paramedic with Action Care were both on board the ambulance when she jumped, authorities said. They were both shaken by what they saw and were given trauma counseling.



I can not imagine what good the trauma counseling will do when these two employees will be questioned many times by many different people. Their actions will be critiqued and they will critique themselves many times. 

Now, back to the original thread question:

Another link about alcohol, pills and right to transport:
http://s125.photobucket.com/albums/p79/cmk1883/?action=view&current=BlameTiVo.flv

I would start with an introductory to EMS role with the EDP. 

1. What state statutes govern transport and incarceration of the EDP?
    ex. Florida has 2 statutes: Baker Act for mental illness and Marchman Act for substance abuse (drugs and alcohol). 

2. Who can legally declare a person incompetent and in need of medical and/or psych care?

3. How much force can be used by a non law enforcement person?

4. How many restraints and what type are EMS personnel allowed to carrry in your area?  Are leathers still acceptable? Many ERs have special regulations governing different types of restraints. 

5. Does an LEO need to be in the back with you?

6. Who searches for weapons? What to do if weapons are found? 

7. Is alcohol and drug abuse considered a "mental illness" by your local protocols definitiions?

8. If the person refuses transport and there is not law enforcement present, who/what determines mental incompetency to transport against one's will? 

8. Does head trauma have to be categorized as mental incompetency to transport under a "mental health" act or is iimplied consent in place? 

9. What are the different types of facilities that EMS transports to for suspected mental illness?  medical clearance?

10. Affects of job stress and EDP calls on the EMS worker?

11. Incidences of depression, acts of violence and suicide amongst EMS workers? 

You have actually picked a good topic with a broad span of subject matter.

War stories might be useful at happy hour with your friends, but they may come across with a different meaning to your class mates and instuctor.

Good luck with your paper. You'll be able to fill 12 pages in no time with this subject. Just using some of the different classifications of patients as mentioned in previous posts will fill at least a couple of pages.


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## gradygirl (Jul 16, 2007)

This is all very true, psych calls must always be treated with caution and respect...unless you run into the following situations.

1. A man uses a homeless shelter's bathroom, going #2. After that, his rear starts to itch. The only logical explanation he has is that someone is trying to poison him by contaminating his TP, so he calls 911.

2. A man, convinced he's in a swimming pool, runs buck naked through a parking lot.

3. A man, high on god knows what, is removed from a Roger Waters after running buck naked through the crowd screaming "I love you, I hate you." Once he is tied to the stretcher, he begins a heart-felt speech on how he is God, and that we are all dead, but that we are all alive, and how the world needs to stop, but that we should all love life, yet we are, once again, all dead. And how his name is Bill. And Bob. And Stewie.


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## medic5740 (Jul 19, 2007)

*Psych runs*

VentMedic has posted some interesting questions.  I'd really like to know some of the answers from across the country.  I am concerned that we provide patient care even to our psych cases.  I'm sure that none of them really and truthfully want to act like they may be acting.  There is obviously something seriously wrong, and a chemical imbalance may be the cause, whether this chemical was taken willingly or the imbalance happened before the pysch emergency began.  

I am proud to say that I have been quite lucky in talking some psych emergency patients back into the real world long enough to get them transported to a facility that could properly take care of them.  When is the decision made to use restraints?  Is there a period of time before that where someone tries to make a connection with the patient or do you just restrain and ask questions later?  I'm all for restraining someone who needs it for his/her own protection or for EMS provider protection, but how and when is that decision made?  Who makes it?

There seems to be very little tolerance for mentally ill patients in our society.  I can't imagine that one clinically depressed person wants to be depressed, and that would include most of the other commonly known mental illnesses as well. 

Here in rural EMS, these people are our friends and neighbors, and, even though they act differently than you and me, they are still people, are still our patients, and still require patient care.  If you don't care about your patients, then you can't provide patient care.

Now that I have seriously made some people mad, I'll sit back and take the brunt of the attacks.


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## BossyCow (Jul 20, 2007)

medic5740 said:


> Here in rural EMS, these people are our friends and neighbors, and, even though they act differently than you and me, they are still people, are still our patients, and still require patient care.




I'm also in an extremely rural area and I agree with your post.  Another factor we have to consider is that these people also know us, and sometimes where we live, work, shop etc.  It's sometimes a challenge to maintain that professional distance required for safety.  

On the restraints issue, I try not to use them unless the patient is violent.  There are some patients who need the restraints in order to feel that things are back in control.  Being restrained removes the expectation that they need to be in control of themselves and can be calming in some instances.  Oh.. and on another note.. make sure the restraints are all in place _before_ the medic pushes the Narcan.


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## medic5740 (Jul 20, 2007)

*Rural in Washington State*

Bossy Cow--interesting name.  We seem to have the same kind of philosophy on this one issue, but to me that is pretty important.  I hate to make this post a commercial, but do you know of any rural Washington State agencies that are interested in hiring a rural Michigan paramedic instructor?  If you have any information, please email me at medic5740@yahoo.com.


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## Ridryder911 (Jul 20, 2007)

I believe this is one of the weakest areas we are trained and educated in EMS. Albeit, all of our patients is going through some form of "psychosis" during any emergency event, and yet we only require and have a small chapter on psychiatric emergencies. 

True most do not act upon their feelings and are able to handle and cope appropriately during crisis, most still look upon us to handle the overwhelming situation. True psychiatric patients are difficult to handle and assess even from experts in this field. 

I do believe that we need to address increasing our knowledge and clinical experience in this area. 

I too avoid using restraints until last resort. The possibility of danger to patient, staff is increased as well liability. Understanding on how to properly intervene with these type of patients can be a long and confusing process. Unfortunately, most EMS do not carry psychotropic medications for aggressive patients, instead of utilizing physical restraints. 

r/r 911


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## MMiz (Jul 20, 2007)

I always found it odd that a vast majority of my patients were psych. patients, yet that's the area I had the least training in.  Good 'ole private EMS.


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## RedZone (Jul 20, 2007)

Back during rotations, I had an elderly (80+) female with a history of psychosis who thought someone was chasing her.  She jumped out her window to get away.  Too bad it was on the 14th floor of her building.

We got the call as a jumper down (dual response) and BLS got to her first.

The BLS to ALS report went something like this:

"How high did she jump from?" asked one of my partners

"14th floor"

"START CPR! WHY AREN'T YOU DOING CPR!!!  WHY AREN'T YOU BAGGING HER!"

"She's A&Ox3"   (I still have yet to figure out what everyone here means by A&O4, we only have oriented to person, time, and place here.)

"She's A&O3?"

"A&O times :censored::censored::censored::censored:ing 3, she broke her leg."

She landed, and... broke her leg.  Trauma center confirmed no other injuries.  Neither would they believe us that she jumped 14 stories.

We looked up at the tree, and saw a branch broken near the top.... somehow it broke her fall and saved her life.

Abnormal psych, huh.... good luck!  There's enough diagnoses in the DSM-IV to commit all of us.


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## VentMedic (Dec 16, 2007)

VentMedic said:


> Thread lightly and with respect when talking about EDPs.  I've ran calls involving EMTs, Paramedics, LEOs, Nurses and Physicians as the patient.  Not to be nerd about this but I just saw this story come across the wire.  The events happening all around us today remind us that there is a fragile line of mental health that can be crossed by anyone at anytime.  Healthcare and EMS workers are sometimes the last to seek help before they break because of the stigma and jokes about EDPs in the field.
> 
> http://www.emsresponder.com/article/article.jsp?siteSection=1&id=5701
> 
> ...




*This is a follow up to a news story from a few months ago. Never under estimate the troubled mind of a patient, even those without a history of mental illness. *

*Colo. family sues over woman's fatal jump from ambulance*

http://www.ems1.com/products/vehicles/articles/328101/

Rocky Mountain News
Copyright 2007 Rocky Mountain News

DENVER — The family of a suicidal woman who was killed when she jumped out of an ambulance on Interstate 25 sued the ambulance company Friday in federal court for failing to ensure her safety.

Mellissa Watkins died July 8 after she opened the rear door of an ambulance operated by Action Care Ambulance of Englewood and either jumped or fell to the pavement.

<SNIP>

All available restraints were not used to keep her on the gurney, and she was able to free herself from the one used around her waist and ankle, while the attendant was looking over paperwork or talking to the ambulance driver, the lawsuit alleges. Watkins got up from the gurney, opened the rear door and either fell or jumped onto the roadway, resulting in her death.
http://www.ems1.com/products/vehicles/articles/328101/


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## firetender (Dec 16, 2007)

*Back In The Day*

Prior to the 1980's there were facilities across the country that housed the bewildered. There were thousands of them (sometimes at one facility, i.e. Pilgrim State Hospital on Long Island) in huge buildings on spreading grounds. These were places where those unable to manage caring for themselves were sent. Even though most were out of touch with themselves and each other, still, their needs were attended to and they DID live in community, in contact with other humans.

Now, they are behind the wheels of ambulances.

(That was a joke, I was sounding too solemn for even myself!)

Anyhow, at about the same time that the Reagan era came in and Government supported facilities started to be bled of funding, the Pharmaceutical companies got going full-steam ahead and packed what was once human-to-human contact and a place to stay and be fed into little pills. An infrastructure was devised to make sure these pills got distributed. 

For sure, a significant proportion of the EDPs you run into (esp. homeless)are also former cannon-fodder from any number of wars.

The pills, basically, were designed to keep the human in check and make sure they weren't a burden. Of course, lots of companies had lots of different pills so the doctors who prescibed them had to do a lot of juggling to find the right chemical combination to keep the individual on a relatively even keel while staying in society.

Most of what you see are ill-advised combinations of drugs that don't quite do what they're supposed to do, or an absence of the drug that keeps the ship steady. As you know, so many of your EDPs are no more than human beings seeking contact and a context to put their lives in -- whether they be "Street People" or YIDs (Yuppies In Distress).

As a Medic, I came to the conclusion that the drugs (or absence thereof)act like a haze that you have to get through to reach the person inside. Once (and if) you are able to do that, more often than not, the person will respond.

The power of keeping aware that these are human beings doing the best they can without the support of their society cannot be emphasized enough. We are becoming less and less a society that takes care of its own. 

It is left to people like us, the professionals, who, overburdened, become one with the dispossessed..


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## Meursault (Dec 16, 2007)

Very interesting thread. Doing transports, I mostly see people who seem to have a very justified reaction to being in a nursing home. I can't say I'd be acting any differently after a couple of months.



RedZone said:


> "She's A&Ox3"   (I still have yet to figure out what everyone here means by A&O4, we only have oriented to person, time, and place here.)



A&Ox4 is oriented to person, place, time, and event. I had it drilled into me in my basic class, and occasionally get a funny look from partners who learned x3. I usually end up writing x3 and documenting alertness to event under CC. 



Firetender: One of my classes got into the dark agendas of Big Pharm. Are you sure that the move towards pharmaceutical treatment for mental illness is a reaction to decreased compensation for other forms of treatment? I was under the impression that the pharmaceutical companies engineered some of the shift, and private and public payers were happy to go along because it appeared cheaper than multiple counseling visits.


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## firetender (Dec 16, 2007)

MrConspiracy said:


> Firetender: One of my classes got into the dark agendas of Big Pharm. Are you sure that the move towards pharmaceutical treatment for mental illness is a reaction to decreased compensation for other forms of treatment? I was under the impression that the pharmaceutical companies engineered some of the shift, and private and public payers were happy to go along because it appeared cheaper than multiple counseling visits.


 
It was a hand-in-hand sort of thing. I'd envision government support moving toward pharm companies (after intense lobbying by them) to facilitate a reduction in services, strengthening the Pharms, thus reducing the need to fund services.

Don't really see it as manufactured, more like call and response in a circular relationship that nudged the people into becoming consumers rather than recipients of service. The Govt. feels it gets off the hook, the pharms rake in the money.


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## certguy (Dec 18, 2007)

VentMedic said:


> Was just re-reading the article I posted earlier a little closer.
> 
> http://www.emsresponder.com/article/article.jsp?siteSection=1&id=5701
> 
> ...



I would suggest adding principles of scene safety and personal protection for EMS personnel , body language interpetation , and interaction guidelines .


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