Are EMS Providers Adequately Trained to Deal with Psychiatric Emergencies?

[Tigger]

Though a recent thread devolved into several rules violations, I thought a good point came up from it.

The EMT curriculum devotes one chapter (in the Brady book at least) to dealing with psych emergencies. A good portion of it is centered around protecting yourself from danger and how to take down dangerous patients. Some lip service is paid towards the concept of verbal deescalation and that these patients are experiencing "real" health crises. But that's really it, and many of us do end up having a significant volume of psych calls, either transfers or otherwise.

As a disclaimer, I do not know what a typical medic class curriculum regarding this subject looks like, someone enlightenment me please?

So I ask this, do you feel that you are adequately trained to deal with patients experiencing significant psychiatric classes?

Do you have any insight on what might be lacking and what you would like to know more about?

Does your service offer additional training regarding psychiatric emergencies?



There's a poll for kicks as well.

 

[NYMedic828]

Are we adequately trained, period?


Honestly I find psychology to be a bit of a joke. Prescribing meds for various conditions is one thing but it shouldn't take training to talk to someone and calm them down if it is possible.

 

[bigbaldguy]

You get nothing on how to appropriately interact andnmanage a psych patient. I would like some intensiven trainingnin this subjects.

 

[Tigger]

Honestly I find psychology to be a bit of a joke. Prescribing meds for various conditions is one thing but it shouldn't take training to talk to someone and calm them down if it is possible.

I didn't think it took any specific training until a partner walked into an ED psych room and proceeded to drop the "we can do this the easy way or the hard way" cliche. He then marched the patient to the stretcher cop style and attempted to tie down the patient's arms with the seat-belts.

Obviously this reaction is absurd, but if you're taught that every psych patient is a threat to your life, then it is slightly more understandable.

 

[Veneficus]

I think the answer to this is "yes and no"

in the acute emergent setting, the person who is a threat to themself or others needs to be handled by law enforcement. Not because they are any better trained, but because they are charged with insuring public safety.

They have the training in arresting/subduing techniques along with the legal authority to do so.

The psych experts, both psychology and psychiatry, have advanced degrees and specialized training that takes years to reach the minimum level in order to handle these types of patients. It is not something that should be left to somebody who read a chapter or two in a book.

A law enforcement officer specifically trained as a negotiator with an additional background in psych is probably the best solution in my opinion.

It is all about recognizing your limits.

Risking the life of yourself or the mentally disturbed person with an amateur, better than nothing attempt is just not a good idea.

You can be injured or killed and if the person ends up injuring or killing themselves the finger of blame is certainly going to fall on the EMS provider.

I have heard the phrase uttered "anyone who is suicidal is homicidal" by LE officers. I think that is an inaccurate oversimplification of a very complex topic and as such is only true in some cases. Not enough to make it anywhere near a significant amount.

Bottom line: Let the cops deal with it.

 

[Medic Tim]

My program required intro to psych and developmental psychology ( 3 and 4 college credits) on top of lifespan which was peds, geri, and psych (3 credits and a major requirement)

We used the aaos text behavioral emergencies ( I think that was the name) for the psych component. We had mental health nurses and counselors guest lecture as well as had required psych clinicals. We also had some certification class as well... I can't remember the name of it but it was about talking to suicidal pts.

I think this was a good foundation to build from.

 

[Shishkabob]

I voted no, but I have a caveat.


Adequate is subjective. But taking in to account that nearly 25% of our calls have a psych component, no, we don't spend enough time on it. Not that studying more would change what we do in the field, but it never hurts to have a more down to earth grasp on it.

 

[JPINFV]

Honestly I find psychology to be a bit of a joke. Prescribing meds for various conditions is one thing but it shouldn't take training to talk to someone and calm them down if it is possible.

Depends... are we talking about the "Don't be an a-hole to the patient that we're transporting" type of training, or actual therapy style training?

 

[NYMedic828]

Depends... are we talking about the "Don't be an a-hole to the patient that we're transporting" type of training, or actual therapy style training?

The don't be an a-hole type training. If a psych patient gets mad at you, in my experience, its because you've chosen very poor wording. Otherwise they are just dangerous in general and need law enforcement to be handled.


I think a major issue is that many EMS providers for whatever reason like to act like they are an authority figure such as a police officer and as stated above drop the "we can do this the easy or hard way" line.

This doesn't usually please the patient. If you intend to drop that line, you best have backup other than your 80lb soaking wet partner.

 

[Tigger]

The don't be an a-hole type training. If a psych patient gets mad at you, in my experience, its because you've chosen very poor wording. Otherwise they are just dangerous in general and need law enforcement to be handled.


I think a major issue is that many EMS providers for whatever reason like to act like they are an authority figure such as a police officer and as stated above drop the "we can do this the easy or hard way" line.

This doesn't usually please the patient. If you intend to drop that line, you best have backup other than your 80lb soaking wet partner.

Hey now I weigh more than that!

 

[ah2388]

A few friends in law enforcement routinely state that "your best weapon is your voice."

This quite obviously applies to EMS. I voted no in this poll, but I'm not entirely certain there is significant value in training providers in therapeutic techniques, whereas there probably is significant value in training providers to safely defend themselves with the respect to the pt's well being (DT4EMS, etc.) and also techniques to promote a calm, safe verbal approach to the acutely agitated psychiatric pt.

The above example where the provider "cowboy'd up" is clearly outrageous and the guy needs to start looking elsewhere for a new job in a new field.

 

[mycrofft]

I vote a simple "NO".

 

[Tigger]

I vote a simple "NO".

What would you like to see then?

 

[frdude1000]

EMS definitely does not get enough training in this matter...in the past I have dealt with some mental health issues and truely realized from it how little most of us know about them. When people think about psych patients, they think of crazy, violent, suicidal people. Actually, many psych patients have conditions such as anxiety disorders that are very different. I have also noted that many ems providers have very little compassion and empathy for psych patients. Hopefully in time, more psychiatric training will be included in EMS courses. I think a continuing education course would be great, too.

 

[Jambi]

Hell no. I've been working my program director to get local mental health professionals come and do guest lectures, but its a non-starter so far. meh

 

[mycrofft]

An annual class, day long, about the legal and professional ramifications of addressing acutely ill psych patients pre-hospital and in-hospital, and PRACTICAL measures to use to try to get their compliance, know when and what to do to prevent being injured (starting with backing away and calling for help).

 

[Aidey]

Honestly I find psychology to be a bit of a joke. Prescribing meds for various conditions is one thing but it shouldn't take training to talk to someone and calm them down if it is possible.

The don't be an a-hole type training. If a psych patient gets mad at you, in my experience, its because you've chosen very poor wording. Otherwise they are just dangerous in general and need law enforcement to be handled.

So it shouldn't take training to talk to someone and calm them down, but when psych patients get mad it is because you said the wrong thing. That seems a little backwards.

 

[Clare]

I don't have much experience with psychotic or psychosis patients or those who are violent but get lots of experience with patients who have some sort of "mental health" problem most commonly depression but also bipolar, anxiety, etc

There has been a lot of emphasis in CCE about mental health, de-escalation and management and it is covered in both the Degree and Diploma.

Unfortunately our mental health system is not really very good (it never has been) and I often see some otherwise seemingly nice and healthy people fall between the cracks or end up getting pushed from one person to another or forgotten in red tape until they do something to somebody else or commit suicide.

 

[AlphaButch]

I've had ample training in it, both on the LEO side and the EMS side. Our service puts folks through an excited delirium course alongside local PD.

 

[abckidsmom]

In nursing school, we spent an entire semster on psych. The therapeutic communication we learned has been pivotal in my career, my life, and my parenting. Not the psycho-babbly type stuff, but the clear communication of choices, goodwill, and instruction in behavior.

THAT's what I'd like to see all EMS providers get. It's a relatively simple concept to learn, if you're willing, but you have to be willing to use a gentle voice, to simplify a situation down to two reasonable choices that you are equally willing to have the patient choose, and get them to want to choose one of your choices.

http://www.snjourney.com/ClinicalInfo/PracticeAreas/Therapeutic_Communication_Techniques.pdf

These are a few of the psychobabblish techniques we learned, and then we very vigorously had to go have a "therapeutic communication session" with a patient and transcribe it, identifying which therapeutic or non-therapeutic techniques we used each time we spoke in the conversation. It was a way to really bring about awareness of our words and the power they carry.

I'd love to see EMS providers have more skills in dealing with people other than just "calming them down." You know that this is a complicated thing, but using those therapeutic techniques sometimes brings the actual issue to the surface more quickly, making the situations sometimes easier to diffuse.