5150 transport

JPINFV said:
...but what sort of non-locking restraint are you equipped with that allows both a full range of movement, yet can't be reached to be unlocked?
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seatbelt around the chest that locks behind the gurney... Think the way the pedi-mate attaches to the back of the gurney.
 
exodus said:
seatbelt around the chest that locks behind the gurney... Think the way the pedi-mate attaches to the back of the gurney.
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I personally could careless is they are able to move their chest. I would be more worried about their arms and legs.
 
If you feel that the pt's a threat to self and crew, call Chuck Norris. Problem solved. B)
 
firefite said:
I personally could careless is they are able to move their chest. I would be more worried about their arms and legs.
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That's why you out their arms under the belt! :p
 
exodus said:
That's why you out their arms under the belt! :p
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And there is no way at all to get your arms free from the seatbelt at all...... Oh wait that's really easy to do.... :lol:
 
if the patient presents a threat to the crew and / or themselves (is exhibiting violent behavior), then absolutely restrain them. A lot of IFT companies in my area just use the "policy" of restraining all patients on psychiatric holds, which may be illegal (the jury is still out on this one...meaning that we have approached the county and found contradictions in the state and county laws, namely that EMT's and Paramedics have no authority under state law to hold a person against their will even if they are on a psychiatric hold, whereas the county admits that they have no clear guidelines on the matter). When in doubt, the best way to approach the matter is from a CYA perspective. As long as you can say that you did what you did in the best interest of your patient, then you should be okay. That being said, if you are indeed in California, you may want to research out the laws in your area, namely those regarding the 5150, 5585, 5250 holds etc and "officer of the state" policies and definitions.
 
Handsome Rob said:
if the patient presents a threat to the crew and / or themselves (is exhibiting violent behavior), then absolutely restrain them. A lot of IFT companies in my area just use the "policy" of restraining all patients on psychiatric holds, which may be illegal (the jury is still out on this one...meaning that we have approached the county and found contradictions in the state and county laws, namely that EMT's and Paramedics have no authority under state law to hold a person against their will even if they are on a psychiatric hold, whereas the county admits that they have no clear guidelines on the matter). When in doubt, the best way to approach the matter is from a CYA perspective. As long as you can say that you did what you did in the best interest of your patient, then you should be okay. That being said, if you are indeed in California, you may want to research out the laws in your area, namely those regarding the 5150, 5585, 5250 holds etc and "officer of the state" policies and definitions.
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For us once someone is considered on a 5150 hold they pretty much lose all their own opinions. If they don't want to be transported well too bad they are going. They aren't even allowed to sign any paperwork once on a 5150 hold at least for my area.
 
From what I got, is that we don't have the authority to restrain 5150 patients then if they say no....?
 
exodus said:
seatbelt around the chest that locks behind the gurney... Think the way the pedi-mate attaches to the back of the gurney.
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This is what we do for psych patients that aren't violent. Just tie the female end of the buckle around the piston that moves the head up and down before you go into the facility. It looks like just another seatbelt.
 
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JPINFV said:
Interesting article in the California Ambulance Association newsletter Siren regarding 5150 transports and the authority to detain. It's on page 6.

http://www.the-caa.org/pdf%20docs/Winter%20Siren%202010%20web.pdf
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I'm trying to figure out what this all means to me.

"If an ambulance is utilized for transporting the detainee, the person writing the 72-hour hold should accompany the patient"

Many of the 5150s I transport have been on a hold for hours and the person writing the hold is often completely unavailable.

"...There is no proper delegation of authority to the EMT transporter under the law as it is written"

5150. When any person, as a result of mental disorder, is a danger
to others, or to himself or herself, or gravely disabled, a peace
officer, member of the attending staff, as defined by regulation, of
an evaluation facility designated by the county, designated members
of a mobile crisis team provided by Section 5651.7, or other
professional person designated by the county may, upon probable
cause, take, or cause to be taken, the person into custody and place
him or her in a facility designated by the county and approved by the
State Department of Mental Health as a facility for 72-hour
treatment and evaluation.
Such facility shall require an application in writing stating the
circumstances under which the person's condition was called to the
attention of the officer, member of the attending staff, or
professional person, and stating that the officer, member of the
attending staff, or professional person has probable cause to believe
that the person is, as a result of mental disorder, a danger to
others, or to himself or herself, or gravely disabled. If the
probable cause is based on the statement of a person other than the
officer, member of the attending staff, or professional person, such
person shall be liable in a civil action for intentionally giving a
statement which he or she knows to be false.



5150.05. (a) When determining if probable cause exists to take a
person into custody, or cause a person to be taken into custody,
pursuant to Section 5150, any person who is authorized to take that
person, or cause that person to be taken, into custody pursuant to
that section shall consider available relevant information about the
historical course of the person's mental disorder if the authorized
person determines that the information has a reasonable bearing on
the determination as to whether the person is a danger to others, or
to himself or herself, or is gravely disabled as a result of the
mental disorder.
(b) For purposes of this section, "information about the
historical course of the person's mental disorder" includes evidence
presented by the person who has provided or is providing mental
health or related support services to the person subject to a
determination described in subdivision (a), evidence presented by one
or more members of the family of that person, and evidence presented
by the person subject to a determination described in subdivision
(a) or anyone designated by that person.
(c) If the probable cause in subdivision (a) is based on the
statement of a person other than the one authorized to take the
person into custody pursuant to Section 5150, a member of the
attending staff, or a professional person, the person making the
statement shall be liable in a civil action for intentionally giving
any statement that he or she knows to be false.
(d) This section shall not be applied to limit the application of
Section 5328.


5150.1. No peace officer seeking to transport, or having
transported, a person to a designated facility for assessment under
Section 5150, shall be instructed by mental health personnel to take
the person to, or keep the person at, a jail solely because of the
unavailability of an acute bed, nor shall the peace officer be
forbidden to transport the person directly to the designated
facility. No mental health employee from any county, state, city, or
any private agency providing Short-Doyle psychiatric emergency
services shall interfere with a peace officer performing duties under
Section 5150 by preventing the peace officer from entering a
designated facility with the person to be assessed, nor shall any
employee of such an agency require the peace officer to remove the
person without assessment as a condition of allowing the peace
officer to depart.
"Peace officer" for the purposes of this section also means a
jailer seeking to transport or transporting a person in custody to a
designated facility for assessment consistent with Section 4011.6 or
4011.8 of the Penal Code and Section 5150.



5150.2. In each county whenever a peace officer has transported a
person to a designated facility for assessment under Section 5150,
that officer shall be detained no longer than the time necessary to
complete documentation of the factual basis of the detention under
Section 5150 and a safe and orderly transfer of physical custody of
the person. The documentation shall include detailed information
regarding the factual circumstances and observations constituting
probable cause for the peace officer to believe that the individual
required psychiatric evaluation under the standards of Section 5105.
Each county shall establish disposition procedures and guidelines
with local law enforcement agencies as necessary to relate to persons
not admitted for evaluation and treatment and who decline
alternative mental health services and to relate to the safe and
orderly transfer of physical custody of persons under Section 5150,
including those who have a criminal detention pending.



5150.3. Whenever any person presented for evaluation at a facility
designated under Section 5150 is found to be in need of mental health
services, but is not admitted to the facility, all available
alternative services provided for pursuant to Section 5151 shall be
offered as determined by the county mental health director.




5150.4. "Assessment" for the purposes of this article, means the
determination of whether a person shall be evaluated and treated
pursuant to Section 5150.
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From WIC 5150-5157

There is no mention of transport by anyone other than a peace officer or jailer within the code.

Once the patient is turned over to our care, if we can't make a determination that they're "altered" (in which care would fall under implied consent) or otherwise a danger to self or others, or unable to care for themselves they're free to go?
 
This is the gap in the law. In LA County, we bypass this, more or less, by operating under the county policies which are vague at best. Ah, California.

sent from my mobile command center. or phone. whatever.
 
adamjh3 said:
I'm trying to figure out what this all means to me.

"If an ambulance is utilized for transporting the detainee, the person writing the 72-hour hold should accompany the patient"

Many of the 5150s I transport have been on a hold for hours and the person writing the hold is often completely unavailable.

"...There is no proper delegation of authority to the EMT transporter under the law as it is written"



From WIC 5150-5157

There is no mention of transport by anyone other than a peace officer or jailer within the code.

Once the patient is turned over to our care, if we can't make a determination that they're "altered" (in which care would fall under implied consent) or otherwise a danger to self or others, or unable to care for themselves they're free to go?
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Actually... there are more folks other than Peace Officers authorized to do the 5150, take into custody (or cause it) and place the person into the appropriate facility...
a peace
officer, member of the attending staff, as defined by regulation, of
an evaluation facility designated by the county, designated members
of a mobile crisis team provided by Section 5651.7, or other
professional person designated by the county
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The problem is that transport by medical personnel (or for that matter, anyone else) is implied by "take, or cause to be taken" and is not otherwise spelled out in black letter law. Clearly a lot of non-peace officers have the authority to detain people for evaluation under 5150. That person remains detained until released by the psych facility.

In any event, from a quick review of current protocols/policies of a couple counties, I get the impression that they would rather have LE transport the 5150 that has no medical needs...
 
I ran out of edit time for my post... so here is what I was going to add:

I would also like to see provision for ambulance transport of 5150 detainees specifically inserted into the law with continued detention authority (delegated to the crew by the person who placed the hold) and immunity provisions for the crew/company/agency transporting the 5150 patient.
 
That person remains detained until released by the psych facility.
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That's where my confusion sets in. Almost all of my 5150 (or 5585) transports come out of facilities that are more or less for screening purposes, they generally don't house the detainee for the full 72 hours of the hold and instead release them to a different psychiatric hospital, which is where we come in. During the time in which myself or my partner has possession of the hold, can we legally detain these individuals?

For example, I took a gentleman out of one of these screening facilities once, he had no psych history, hell hardly any medical history at all. He was placed on a hold by a police officer after LE received a call from his girlfriend stating she received a text from him (which he apparently sent out of frustration over an argument they were having) alluding to him wanting to kill himself. He had no plan to kill himself, had no desire to follow through, he was just pissed off and said the wrong thing at the wrong time. I have no reason to believe he's a danger to himself or others nor gravely disabled. Do I have the authority to detain him if he decides he's not going to the psych hospital?

And looking at San Diego's restraint protocol (policy number s-422) it says nothing about when to restrain, only how and what may and may not be used to restrain. But going over to psychiatric and behavioral emergencies (no s-142) it states:

Restrain only if necessary to prevent injury. Document distal neurovascular status q15'. Avoid unnecessary sirens.
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So... I'm basically in violation of county protocol by following my company's policy of mandatory 4 point restraints on all 5150 patients, yes?
 
Akulahawk said:
Clearly a lot of non-peace officers have the authority to detain people for evaluation under 5150. That person remains detained until released by the psych facility.
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A lot of non-LEOs can write holds, but they all basically fall under 2 groups. Physicians and specifically licensed evaluation teams. To throw an additional wrench into the works, my understanding is that 5150 holds written by physicians and psych teams are only valid in the county that they are written in.


In any event, from a quick review of current protocols/policies of a couple counties, I get the impression that they would rather have LE transport the 5150 that has no medical needs...
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Ideally, the psych hospitals should run the teams. Technically psych patients aren't supposed to be transported in marked patrol cars, but how often is that actually possible? Also, if there's a gap in California law where ambulances can't detain 5150 patients, then in your example, what happens if the patient does need medical care and the officer refuses to ride along?



5153. Whenever possible, officers charged with apprehension of persons pursuant to this article shall dress in plain clothes and travel in unmarked vehicles."
 
JPINFV said:
A lot of non-LEOs can write holds, but they all basically fall under 2 groups. Physicians and specifically licensed evaluation teams. To throw an additional wrench into the works, my understanding is that 5150 holds written by physicians and psych teams are only valid in the county that they are written in.


Ideally, the psych hospitals should run the teams. Technically psych patients aren't supposed to be transported in marked patrol cars, but how often is that actually possible? Also, if there's a gap in California law where ambulances can't detain 5150 patients, then in your example, what happens if the patient does need medical care and the officer refuses to ride along?



5153. Whenever possible, officers charged with apprehension of persons pursuant to this article shall dress in plain clothes and travel in unmarked vehicles."
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There's a convenient "out" in the law that provides for uniformed peace officers to "apprehend" and transport in marked vehicles... The law doesn't mandate plainclothes/unmarked... it just "prefers" that transport be that way. IMHO, the person that placed the hold is the one actually detaining the patient. I simply would like to see something more concrete so that ambulance crews are specifically immune to suit and charges for false imprisonment, unlawful detention and so on simply because the person placing the hold is not physically in the ambulance at the time.

Also, whenever possible, Law Enforcement should transport these people... Ambulances should only transport if there's a medical need.
 
Akulahawk said:
Also, whenever possible, Law Enforcement should transport these people... Ambulances should only transport if there's a medical need.
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What law did a patient with a psychatric condition break? Isn't a mental illness a medical disease?
 
JPINFV said:
What law did a patient with a psychatric condition break? Isn't a mental illness a medical disease?
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No law... but psych transports is hard-coded as a LE responsibility. LE also has much immunity...
 
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