Are EMS Providers Adequately Trained to Deal with Psychiatric Emergencies?

[mycrofft]

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.

No, it's pretty right on. Anyone can go in and make things worse by opening their mouth.

Plus, like everyone else, folks with a psych diagnosis are individuals, although their general trend of thought may be divergent. I've had good episodes where, if the person is not floridly delusional, we have talked about what's happening same as we would their having twisted an ankle or accidentally cut themselves in the kitchen. As one patient put it, "There's 'crazy', then there's 'really out there' ". Then, once, without proper prelude, I asked about prior illness with a pt who thought we were trying to find out about him for nefarious purposes...:sad:

I think for this thread we are talking about people with pronounced cognitive or sensory derailments or mood disorders (excitement/rage, fear, etc).

 

[abckidsmom]

No, it's pretty right on. Anyone can go in and make things worse by opening their mouth.

Plus, like everyone else, folks with a psych diagnosis are individuals, although their general trend of thought may be divergent. I've had good episodes where, if the person is not floridly delusional, we have talked about what's happening same as we would their having twisted an ankle or accidentally cut themselves in the kitchen. As one patient put it, "There's 'crazy', then there's 'really out there' ". Then, once, without proper prelude, I asked about prior illness with a pt who thought we were trying to find out about him for nefarious purposes...:sad:

I think for this thread we are talking about people with pronounced cognitive or sensory derailments or mood disorders (excitement/rage, fear, etc).

And in my general practice, I find that those people are few and far between, after the first 5 minutes. Those pivotal minutes establish who's the helper, who's in charge, and what the mood of the interaction will be.

I find that the "really out there" people with "the look" in their eyes are more challenging to control, because in the controlling, you activate the paranoia. I'm more focusing on the 95% of people we see, with some mild level of agitation or anxiety, up to more severe anxiety or severe agitation.

Confronting delusions or challenging false perceptions is not the safest thing to do in EMS. We should just be doing what we can without lying to the patients to keep them safe and get them in the hospital, if that's where they need to be.

 

[Aidey]

No, it's pretty right on. Anyone can go in and make things worse by opening their mouth.

Did you read the posts I had quoted? I was summarizing what the person I quoted had said. They posted two different posts with totally contradictory statements.

 

[NomadicMedic]

Verbal Judo is a good start in learning how to deescalate situations that have the potential to turn into a wrestling match. I'd much rather talk than fight.

 

[NYMedic828]

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.

I'm not contradicting myself in the bolded texts...

I guess it needs to be on an individual basis. Some people are just naturally better at soothing/calming a situation than others who just make things worse.

I just feel in my experience, most of what needs to be sad is common sense. If you go over it in your head and it sounds like it would upset you in their situation, odds are it isn't the right thing to say.

At the same time i have plenty of co-workers who just need to keep their mouth shut indefinitely instead of trying to play police officer. I don't like having to be the tough guy when something goes south and PD is not there with us but plenty of my coworkers have no problem putting me in that unwanted position.

People are just stupid and lack common sense. We aren't diagnosing psychological conditions, we are defusing situations, hopefully before they escalate.

 

[Aidey]

You're still confusing me. You said most of what needs to be said is common sense, and then follow up with people are stupid and lack common sense.

 

[mycrofft]

Did you read the posts I had quoted? I was summarizing what the person I quoted had said. They posted two different posts with totally contradictory statements.

Yep I did. I was referencing the ideas, not your ideas. You just summarized it very well.

ABCKIDSMOM, yes yes yes.

And consider, many people reading this are experiencing some degree of dysphoria or even early stages of mental illness; EMTs etc are not immune, and the holiday season brings it out more than many others (except maybe Spring).

 

[NYMedic828]

You're still confusing me. You said most of what needs to be said is common sense, and then follow up with people are stupid and lack common sense.

Right...

I'm saying it is common sense...

and people lack it...

How doesn't that make sense...

 

[abckidsmom]

Verbal Judo is a good start in learning how to deescalate situations that have the potential to turn into a wrestling match. I'd much rather talk than fight.

In the city I used to work in, some of my friends used to consider it cool to be fighting with patients, and "not take anything off of anybody." It took me a long time to see that I was just deescelating the situations, and letting people say what they wanted and not reacting to their attempts to get a rise out of me.

 

[Aidey]

Right...

I'm saying it is common sense...

and people lack it...

How doesn't that make sense...

It sounds like you are arguing that people should instinctively know what to say and what not to say to a psych patient. And that in addition to that, they should also instinctively know whether or not they know what to say and what not to say, and keep their mouths shut if they lack the ability to be a psych whisperer. All without training.

 

[mycrofft]

I think we can all agree things go better with proper training.

What kinds of protocol must you be seeing about contact with people who seem to have psychiatric/psychological issues?

 

[Veneficus]

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.

Don't be jealous because the voices are talking to me! :unsure:

 

[Aidey]

Don't be jealous because the voices are talking to me! :unsure:

I have my own voices thank you very much. h34r:

 

[mycrofft]

If the pt wasn't wildly hallucinating, we could discuss the voices, how despite knowing intellectually they were from some frayed wiring or such, they were almost irresistible. Like middle ear imbalance: you try to make your brain use your visual input, but the vestibular apparatus oaverrides it.

 

[Bullets]

I one jurisdiction, the cops will just transport in their patrol car unless there is an actual medical emergency or the patient cant get to the car.

The other town has EMS transport "crisis" which has led to some interesting stand-offs with the local cops. The patient states they want to hurt themselves but have not actually done anything yet. The cops deem them to be a hazard to themselves and must be evaluated and held for 72hrs. However they dont want to go, and are completely mentally sound. Do you allow the patient to RMA??

I tend to take the stance of not being confrontational, to the point that i let them believe that they are in charge, we go at their speed, its not me its the cops who are forcing you, ect. Ive rarely had one of these patients go south. One guy was on PCP and fighting prior to our arrival, but that was something LE took care of.