M1 Transports

[GJMEDIC]

I wanted some input on your practices with M1 transports. We have been seeing an increase in M1 transports out of one of our local hospitals to a psych facility across town. We are now seeing roughly 4-5 transports daily. My question is these patients are all ambulatory and their PCS paperwork states their reasoning is for a "secure transport." My understanding is we are unable to enforce M1 holds as EMS providers. What are your practices with these patients? Does your ems agency transfer these patients or does law enforcement in your area? Any input would be appreciated. Thanks

 

[Jim37F]

What is an M1 transport? Never heard that term before.

 

[ERDoc]

What exactly is an M1 transport?

EDIT: Didn't refresh before posting, sorry about the repeat question.

 

[GJMEDIC]

Sorry about the confusion, a mental health hold is called an M1 in my area.

 

[NomadicMedic]

An old service I was at had the contract for psych transports. Lucrative business.

Strictly BLS. Usually in soft 4 point restraints. We had a BLS truck that didn't do much more then these transports.

 

[CALEMT]

We do psych transports all the time. Thats 99% of calls for our BLS units and every now and again a ALS unit will get a psych transfer. 5150's are a BLS call so the EMT's attend most of the time.

The patients are all ambulatory but require ambulance transport because of restraint requirement. The alternative would be for the sheriff's dept to come and take them to the psych facility. That never happens, its typically a BLS ambulance crew that'll transport 5150's.

 

[Tigger]

My service does them with a single paramedic in an SUV with cop car style backseat. We do both scene and interfacility transports with it. If on scene, we'll draw blood, breathalyze, and POC saliva drug test the patient as well. We usually transport directly to the "crisis stabilization unit" (CSU) which is like a freestanding psych ED. They prefer to not have the patient on a hold, though if they are intoxicated our medics can write an "emergency committal" so the patient is transported to detox to sober up and then the CSU comes to get them for a psych eval. We can also transport directly to inpatient facilities if the patient has been seen there before. We occasionally use the ambulance for pysch transports as well, though we have to transport those patients to an ED as we can't bill an ambulance transport if we transport to CSU. Patients being transported to the CSU must be voluntary and must also pay an approximately $100 fee at time of service. There is no additional charge from us.

It's a unique, and awesome program.

My part time AMR op does psych IFT in wheelchair vans, the back has a partition and a seat that the patient rides in. Combative patients go by ambulance.

 

[Jim37F]

Ah, so M1 sounds roughly equivilant to what we call a 5150 here in CA....here in LA there's a large pool of IFT providers (what, something like 80+ ambulance companies that do exclusive IFT work here?) If it's a cooperative in patient IFT there's no reason to pull a cop out of service. The first private company I worked for didn't have any special psych patient restraint policy on top of the normal existing restraints policy, while the other private I worked for mandated minimum two point restraints on all 5150 patients regardless.

For 911 calls, it really all depends. We'll call PD if the patient is violent or combative (though hopefully if dispatch gets information the patient may be that way they'll auto dispatch PD alongside us, and we'll usually stage out until they have control over the scene). From there it really all depends on things like how "sick" the patient is, their vital signs, their history (new onset? or a flare up of a known existing issue?), what exactly the patient did/didn't do or said and whatnot, basically boiling down to what do the cops and medics on scene think? If everyone agrees that the patient doesn't really need an ambulance ride than we're more than happy to let PD handle it, and if the cops or medics feel more comfortable with ambulance transport that's what we'll do, usually with either an officer and/or FF riding in back as well.

There's been a couple calls I've been on where the patient needed chemical restraints, and that's no question an ALS ambulance transport here (PD riding in back as well with additional officers driving right behind the ambulance). One time after staging out for PD we arrived on scene to find the violent, combative psych patient restrained in the back of the police car, still so agitated no one wanted to wrestle him out of the back and onto the gurney. PD still wanted him checked out at the hospital, and after a bit of discussion, we all decided to basically convoy to the hospital, the fire engine, our ambulance, the police car with the patient/suspect still handcuffed in the backseat followed by the other 3 or 4 police units that had responded. Basic idea being if something happened to the patient enroute we'd all stop, do what we needed to do to transfer the patient into the ambulance and go from there, but fortunately the convoy was fairly uneventful and nothing untoward happened and the patient had calmed down enough to be walked into the ER by the police so we were able to clear right away. Definitely one of those one-off, wont see that happen again (at least for a while lol) calls