Sometimes I wish the hospital would not sedate my psych patients before

[Emtgirl21]

I find it interesting that MOST psych pt really have no need to be in an ambulance being taking to a facility. its usually just a lack of law enforcement for the transport.

 

[JPINFV]

I find it interesting that MOST psych pt really have no need to be in an ambulance being taking to a facility. its usually just a lack of law enforcement for the transport.

Why is a police car more appropriate for psych patients? They didn't break a law after all? Alternatively, when did psychiatry stop being a medical specialty?

 

[raisingkahne9]

Why is a police car more appropriate for psych patients? They didn't break a law after all? Alternatively, when did psychiatry stop being a medical specialty?

Maybe when Some people failed to realize that its still a medical condition. Correct me if I'm wrong, but some people see psych patients as criminals. For what reason I'm not sure.

 

[BossyCow]

After replying to this thread a few times.

I know that I've touched this on this several times, but it's the thing that bothers me the most about this thread. Calling a psych patient a "low life".

Some psyche patients are low lifes some are not. Some low lifes are psyche patients some are not. They are not linked traits.

 

[downunderwunda]

I find it interesting that MOST psych pt really have no need to be in an ambulance being taking to a facility. its usually just a lack of law enforcement for the transport.

It is interesting that this narrowminded view has been negated here in parts of aussieland. Police have digressed from all Psych transport because it is a MEDICAL condition, not a legal one. This only reverses IF there is a criminal charge involved also.

With this in mind why are we trying to shove a medical problem onto law enforcment?

 

[medic417]

Some psyche patients are low lifes some are not. Some low lifes are psyche patients some are not. They are not linked traits.

Some times you feel like a nut. Sometimes you don't. Almond joys got nuts, mounds don't.

 

[triemal04]

It is interesting that this narrowminded view has been negated here in parts of aussieland. Police have digressed from all Psych transport because it is a MEDICAL condition, not a legal one. This only reverses IF there is a criminal charge involved also.

With this in mind why are we trying to shove a medical problem onto law enforcment?

The arguement could be made that it's for safety. The vast majority of paramedics and EMT's recieve little to no training in defensive tactics and threat recognition beyond what they pick up while working in the field. Take a pt that is being transferred in restraints because they are violent. At this point they are allready a known threat; wouldn't it make sense to have the people transporting them be the ones who are trained to restrain people, and, if neccasary, fight them? The same goes for sedation; if they are being sedated because they are potentially a physical danger to themself and others, then the police should be involved; the average EMT is capable of handling someone like that as well as a cop. (of course in that case they should be going on an ambulance as well; sedation=medical supervision.)

Of course, the above is not neccasary for all psych pt's, just the violent ones. As well, while a psychiatric problem is a medical issue, that simple fact does not in any way mean that only medical people should, or will be involved in their care. If it is more appropriate to transport someone in a secure vehicle with cops, then do so.

 

[Jon]

WTF??? Stealing stuff to sell it for crack? Sure...

#1 - How do you KNOW it was a 'psych' patient that broke into your vehicle?

#2 - How do you KNOW it was stolen to pay for a drug abuser's addiction?




Anyway - I think DownUnder hit the nail on the head. How many EMS workers have battled some form of Mental Illness? I think 20% might be low. We work weird shifts, see humanity at its worst, and many EMS providers I know have other issues, like Alcohol abuse and/or Nicotine Addiction.

As a group, we should be more mentally and physically healthy.

 

[Emtgirl21]

I am not talking about psych pt that was a 911 calls that could could be actually having a medical problem or altered mental status. I am talking about 96 hr holds and long distance transfers for psych holds. Those pt rarely having a medical problem that requires care en route. Now if they are sedated then their airway needs to be watched bc sometimes they stop breathing and that a bad deal. but a normal hospital to psych facility doesnt true need an ambulance if its a hold. Its not a medical issue its a law enforcement matter. They are at the ER for medical clearnce.

Side note, you fight a couple psych pts that have already been medically cleared going to a psych facility and see if you dont change your mind. I am always polite and professional to all my pt and have found myself a human punching bag more than once

 

[downunderwunda]

I am not talking about psych pt that was a 911 calls that could could be actually having a medical problem or altered mental status. I am talking about 96 hr holds and long distance transfers for psych holds. Those pt rarely having a medical problem that requires care en route. Now if they are sedated then their airway needs to be watched bc sometimes they stop breathing and that a bad deal. but a normal hospital to psych facility doesnt true need an ambulance if its a hold. Its not a medical issue its a law enforcement matter. They are at the ER for medical clearnce.

Side note, you fight a couple psych pts that have already been medically cleared going to a psych facility and see if you dont change your mind. I am always polite and professional to all my pt and have found myself a human punching bag more than once

Im sorry, I must be an idiot. The definition of a psych is a mental ILLNESS. When did ILLNESS cease to become an ambulatory function?

How many transfers are done for say a wrist fracture in an ambulance, do you consider this a wate of resources also because they could have gone in private transport? How about a minor hand injury, broken toe? All medical, all valid ambulance transfers.

By strict definition, here, we can put someone on a psych hole if 'They are not capable of making a decision that would be made by a "Normal" person.

Emtgirl21, is the person really having a psych episode, or is it a MEDICAL closed head injury? they can present the same, or are they just drunk or concussed? Is it an altered LOC because of the pharmacology they have self administered, or is it that they have a brain contusion? All of these people can be misdiagnosed with a psych condition, especially if they are combative, because I would suggest you read contraindications to the administration of drugs like diazepam, midazolam & then repost your answer.

 

[triemal04]

Im sorry, I must be an idiot. The definition of a psych is a mental ILLNESS. When did ILLNESS cease to become an ambulatory function? When it was determined that an ambulance was not needed for certain medical conditions. Like it or not, an ambulance isn't always needed for multiple illnesses.

How many transfers are done for say a wrist fracture in an ambulance, do you consider this a wate of resources also because they could have gone in private transport? How about a minor hand injury, broken toe? All medical, all valid ambulance transfers. Very very few. (and to be clear, I mean transfer as in transferred from 1 hospital to another). And yes, some are a waste of resources; pn management needs being one of the few exceptions. And no, they are not always valid transfers; just ask your finance dept how often the insurance and/or medicare claims are refused for those types of transfers. (though that may not be as big an issue in Australia; here there is no obligation for insurance to pay unless it's determined the ambulance was truly NEEDED)

By strict definition, here, we can put someone on a psych hole if 'They are not capable of making a decision that would be made by a "Normal" person.

Emtgirl21, is the person really having a psych episode, or is it a MEDICAL closed head injury? they can present the same, or are they just drunk or concussed? Is it an altered LOC because of the pharmacology they have self administered, or is it that they have a brain contusion? All of these people can be misdiagnosed with a psych condition, especially if they are combative, because I would suggest you read contraindications to the administration of drugs like diazepam, midazolam & then repost your answer.
I suppose that when she meant a non-911 call it was to say that it was NOT one of the above situations; for instance someone with a known disorder being moved to another facility. And, again, not all require an ambulance, and, again, in many situations it is appropriate to send them in a secure (which is not an ambulance) vehicle, or at minimum, with a police escort.

Not everyone who is sick or injured needs an ambulance. This includes pt's with psychiatric problems. It in fact may be innappropriate to transport many people in an ambulance, depending on what is wrong with them.

 

[Jon]

Downunder:

if the patient has been medically "cleared" at a local ED, and is now being transported on a 72 or 96 hour hold... is there perhaps a need for a 3rd variety of transport, that isn't law enforcement, and isn't by private ambulance?

There is a local county that has a quasi-county-run agency that is responsible for some of the treatment and most of the short-term (hours) housing of these patients after the ED clears them and before they are placed in a more appropriate facility. They use specially trained EMT's and their own ambulances and vans to transport the patients. Some of the patients are transported in sedans or vans as passengers... but from what I understand, the vehicles are equipped like prisoner transport vehicles, so that the patient can't escape (as they are legally committed). I think this is a decent model - it provides for medically trained personnel who are FAMILIAR with psychiatric illness to provide the transport.

 

[downunderwunda]

Downunder:

if the patient has been medically "cleared" at a local ED, and is now being transported on a 72 or 96 hour hold... is there perhaps a need for a 3rd variety of transport, that isn't law enforcement, and isn't by private ambulance?

There is a local county that has a quasi-county-run agency that is responsible for some of the treatment and most of the short-term (hours) housing of these patients after the ED clears them and before they are placed in a more appropriate facility. They use specially trained EMT's and their own ambulances and vans to transport the patients. Some of the patients are transported in sedans or vans as passengers... but from what I understand, the vehicles are equipped like prisoner transport vehicles, so that the patient can't escape (as they are legally committed). I think this is a decent model - it provides for medically trained personnel who are FAMILIAR with psychiatric illness to provide the transport.

Does this mean we dont transfer obsterics cases because we are not appropriatley trained & there may be 'more appropriate transport' that should be made available.

We need clarity in definition here, mentally ill people are sick people. While I agree that ambulatory resources are misused with a lot, these people have an illness. Like it or not. Until there is better systems put inplace, it is more appropriate to transport in an ambulance than a police car, unless they are seriously violent.

 

[reaper]

Our hospital handles this on their own. Once the pt is medicaly cleared and ready to be transfered to the psych facility, they have the hospital security transport them in minivans with two security guards. They do not tie up EMS for this. The pt has been cleared by a Dr. and does not need an ambulance to ride in!

 

[rhan101277]

It's really simple. They get treated like any other pt. If they have violent tendencies a LEO accompanies. If they get violent they get restrained and/or sedated. I haven't had to sedate one yet. Usually they want something,(like a smoke), so I make a deal with them. If they behave I let them have their smoke before they go in the destination hosp. I always try to be the good guy. If I have that person again and they remember me I have an easy time, because I kept my word before.

So you roll them out of the ambulance and let the smoke while they are on the stretcher? If they aren't on a stretcher what if they runaway when they get out to smoke?

 

[rhan101277]

We have to get medical necessity forms for transfers like this. Wonder why some just can't go in a wheelchair van. Most of them I see are ambulatory, it would free up an ambulance for something else.

Most of the time they need ambulance transfers for continuous medical supervision.

 

[Arkymedic]

lmao thanks medic B)

Some times you feel like a nut. Sometimes you don't. Almond joys got nuts, mounds don't.

 

[Sasha]

We have to get medical necessity forms for transfers like this. Wonder why some just can't go in a wheelchair van. Most of them I see are ambulatory, it would free up an ambulance for something else.

Most of the time they need ambulance transfers for continuous medical supervision.

I don't think the wheelchair vans can restrain someone, or monitor someone who is sedated. You never know when someone is going to have an adverse reaction to the sedation.

 

[Emtgirl21]

Downunder do you work for an ambulance service private or other wise. My service does in excess of 20 psych transports a day. We are a 911 service. Not a private transfer service. Medically cleared psych pt going for the er to a holding facility. Ambulatory with no medical problems and on a regular basis EMTs and Paramedics are assualted by these patients. I really dont think you understand what some of us are complaining about or discussing. Or maybe your just trying to start trouble. Whatever floats your boat....or finds your lost remote.

 

[downunderwunda]

Downunder do you work for an ambulance service private or other wise. My service does in excess of 20 psych transports a day. We are a 911 service. Not a private transfer service. Medically cleared psych pt going for the er to a holding facility. Ambulatory with no medical problems and on a regular basis EMTs and Paramedics are assualted by these patients. I really dont think you understand what some of us are complaining about or discussing. Or maybe your just trying to start trouble. Whatever floats your boat....or finds your lost remote.

Emtgirl21,

I work for a fully funded government run service. My qualifications are between your EMT-I & EMT-P. We do not have private transport companies. WE R NOT PART OF A FIRE BRIGADE!!!!!!!

Now that is out of the way. If you have read my posts, i agree that there are many transfers that are done that are not requiring ambulance resources. What I am challenging here is the notion that

1. as was staed earlier, all psych patients are drug addicts,

2. Even though they may have no physical injuries, a psych patient is indeed a medical emergency because they have an illness of the mind, &

3. That the attitudes that we, as so called prfessional are bordering on the ignorant by believing otherwise.

I have been assaulted by a psych pt in the past, so don't preach to me about that crap. EMS covers a vast array of illnesses, I am sick to death of hearing most people brag about the trauma the do, the cardiac, the off beat jobs, well psych is as off beat as they get, but no one wants to brag about them.

The attitude in the broader communities will never change if the attitudes within the medical community doesnt change. Mental Illness, according to the World Health Organisation will be, by 2020, second only to trauma as a killer. Like it or not, we will be dealing with it more & more over the next few years.

The challenge is to treat psych pateints with the dignity & respect they DESERVE. Sedation is an option, but should always be a final option.

Emtgirl21, try reading all of my posts again & this time read them properly, i am challenging everyone who reads this thread to open their minds, not just label all psych patients. Oh, yeah, & when we do a psych transfer it is in excess of 2 hours & the receiving hospital will not accept them sedated.