Depending on the the comments, someone could have reason to make an example of what is said. The reality is that people do come by and read posts here and some folks use this site as a source of information about EMS. This is evidenced by folks that sign up and ask questions because they're interested in the profession for work, or because they're looking for understand when writing fiction, and so-on. Forums have become a source for news reporting. In Philly, it was domelights.com (a police and fire forum) - site was shutdown and lawsuits were filed. Fortunately, I haven't seen any thing posted here (on any topic) that is anywhere near as vile as what was posted there. But, my point is that forums like this can suddenly become "interesting" to someone else. The moderators are pretty good here, but nonetheless, we should tread carefully with especially sensitive topics such as mental illness.
Best Psych Calls
- Thread starter dalmain
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Depending on the the comments, someone could have reason to make an example of what is said. The reality is that people do come by and read posts here and some folks use this site as a source of information about EMS. This is evidenced by folks that sign up and ask questions because they're interested in the profession for work, or because they're looking for understand when writing fiction, and so-on. Forums have become a source for news reporting. In Philly, it was domelights.com (a police and fire forum) - site was shutdown and lawsuits were filed. Fortunately, I haven't seen any thing posted here (on any topic) that is anywhere near as vile as what was posted there. But, my point is that forums like this can suddenly become "interesting" to someone else. The moderators are pretty good here, but nonetheless, we should tread carefully with especially sensitive topics such as mental illness.
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Had a patient the other day who had been smoking meth for at least three days consecutively and appeared to have suffered from some sort of schizophrenic break. Swastika on neck, 1%er and outlaws gang tattoos on face, and pretty jacked. Oh yea and he was growling at me.
So when he lit a cigarette in the back in the midst of a 45 minute transport, it was a fairly awkward interaction. "Sir you're going to have to put that out." Growl. "Sir please, you can't smoke in an ambulance, there's oxygen and stuff and please just put it out." Growl. "Sir do it now." To which he replied, "there ain't no way that is happening so just deal with it."
Miraculously his buddy riding up front was able to talk him down, otherwise I suspect things would have gone rather poorly. For me.
So when he lit a cigarette in the back in the midst of a 45 minute transport, it was a fairly awkward interaction. "Sir you're going to have to put that out." Growl. "Sir please, you can't smoke in an ambulance, there's oxygen and stuff and please just put it out." Growl. "Sir do it now." To which he replied, "there ain't no way that is happening so just deal with it."
Miraculously his buddy riding up front was able to talk him down, otherwise I suspect things would have gone rather poorly. For me.
I disagree, we can provide just as much care to psych pts as we can trauma pts, which is to say, we take care of life threats and lay the ground work for definitive care. It's just less dramatic with psychs than it is traumas.
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That's so far from the truth. Your ignorance is showing might want to work on that.
Psychiatric illness is involved in the majority of the calls we run, it's within our ranks more than most realize and it's a nasty, ugly problem that kills. Since we come in contact with it so much why not further our education when it comes to psychiatric illness and medicine? Why do police departments have these mobile mental health eval teams and crisis teams but we don't? Seems to me that it'd be more appropriate to have the EMS system provide these patients with appropriate medical care rather than depending on PD or taking them to the hospital.
Do you guys have an alternate destination alternative? I do. I can transport psych patients that want help to the state or private psych facility if the receiving has space and he patient wants to go there. Why aren't more services doing this? Why're EMS providers so negative towards psych patients? Why are they any different from any other patient? Did you know 1 in 4 adults in the U.S. has a diagnosable mental illness? Seems like maybe we need to stop trying to pawn off the responsibility and step up to the plate.
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We are about to start doing this. Many of the facilities were not on board originally as they wanted the patient medically cleared by an MD prior to admitting them and they wanted lab work done often times.
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They usually won't run labs here beyond a UA unless there's a reason for them to do it. We have really, really strict criteria for who we can use our ATA (Ambulance Transport Alternatives) protocol for. It extends beyond psychiatric facilities too. We can triage to the two psych hospitals, the alcohol/drug detox facility, the free/low income clinic and like 12 urgent cares around the area. It's actually a pretty sweet setup. The only complaint I and other medics have is that except for transports to the detox facility the Paramedic has to attend the call and write the chart because of the liability rather than having these low acuity calls attended by our ILS partners. That's supposedly changing eventually to the ILS provider attending the call and documenting it then having the Paramedic review the chart and sign off on it but we'll see if that actually happens.
TheLocalMedic
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California is rolling out Community Care Paramedic pilot programs, and I'm curious to see whether they are given the leeway to transport psych patients to actual psych facilities rather than the ED. I can't stand seeing disruptive psych patient clogging up the ED while they wait for an eval and then taking another ambulance out of service later to go to a psych facility when they could have cut out the middle man in the first place.
My region seems to be getting a little better at dealing with mental health crises though. We now have a county team that is able to come out at the drop of a hat to provide on-site evaluations, write up 5150's and then take the patient to EPS (as long as they are non-violent).
My region seems to be getting a little better at dealing with mental health crises though. We now have a county team that is able to come out at the drop of a hat to provide on-site evaluations, write up 5150's and then take the patient to EPS (as long as they are non-violent).
You really took my few words and ran with them.
I don't think you believe that I, as an EMT, can provide the years of treatment, counseling and careful observation that many of my psych patients require.
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TheLocalMedic
Grumpy Badger
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Sure, EMS can't provide the whole gamut of care that many psych patients require, but think about this:
Who are often the first people to deal with psych crises outside of the hospital? That's right, we are.
Therefore we find ourselves in the unique position where we can either escalate or deescalate a situation, depending on our actions. It behooves us to be knowledgeable and competent in dealing with psychiatric patients because we are very much in a position to do a significant amount of good for them. If we are able to recognize psychiatric emergencies and respond appropriately, we can first defuse the situation and then get them to additional care. Additionally, that first critical contact with a patient often sets the tone for the future interactions that they have with medical personnel. So blindly physically restraining and medicating psych patients with the false belief that your only obligation to them is to force them into compliance so you can ship them off to the ED may be doing more harm than you realize.
While that's true, it's also true that we can't provide bright lights and cold steel, or rehab, or any of the myriad of things that a trauma pt needs.
There's basically nothing we can provide definitive care for...hell, even the things we can, we really don't, we just prop it up (eg hypoglycemia in a known diabetic, definitive care is education to the degree that they stop letting themselves go hypoglycemic).
CentralCalEMT
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I think the "best" calls for are the ones where you are able to easily diffuse the situation that easily could have escalated.
Where I work we have several regulars that have been put on countless 5150/mental health holds over the years. I always treat them like human beings, give them the utmost respect, and never give them a hard time no matter how many times I run on them. They all know me on a first name basis. One time recently, we arrive on scene and the patient has locked themselves in the bathroom and is yelling at the police through the door and the cops are obviously irritated. They state they think they will have to kick the door in and get the patient. I simply call out "John (name changed for HIPPA) its Sean, let's get you checked out at the hospital buddy." Without another word, he came out, sat down on the gurney and we went on an uneventful ride to the hospital.
While it is sometimes necessary to physically restrain a patient, and I will do whatever it takes to get the patient safely to the hospital, I hate it any time the situation escalates itself. I sincerely hate any call where I am unable to simply talk the patient into going and not harming themselves. A little calmness, respect, and empathy goes a long way. Yes I have had intense and unpredictable psych calls where physical altercations happened so I know they happen form time to time and I am not living in the magical world of ponies and unicorns, but those "crazy" calls are not the best.....those are the worst.
Where I work we have several regulars that have been put on countless 5150/mental health holds over the years. I always treat them like human beings, give them the utmost respect, and never give them a hard time no matter how many times I run on them. They all know me on a first name basis. One time recently, we arrive on scene and the patient has locked themselves in the bathroom and is yelling at the police through the door and the cops are obviously irritated. They state they think they will have to kick the door in and get the patient. I simply call out "John (name changed for HIPPA) its Sean, let's get you checked out at the hospital buddy." Without another word, he came out, sat down on the gurney and we went on an uneventful ride to the hospital.
While it is sometimes necessary to physically restrain a patient, and I will do whatever it takes to get the patient safely to the hospital, I hate it any time the situation escalates itself. I sincerely hate any call where I am unable to simply talk the patient into going and not harming themselves. A little calmness, respect, and empathy goes a long way. Yes I have had intense and unpredictable psych calls where physical altercations happened so I know they happen form time to time and I am not living in the magical world of ponies and unicorns, but those "crazy" calls are not the best.....those are the worst.