the 100% directionless thread

RocketMedic

King of the Improbable
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Kommiefornia never fails to deliver. I mean c’mon, we’re just a means of public transportation for them.
Not at all transit workers get rights lol
 

StCEMT

Forum Deputy Chief
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Got to attend a short ultrasound class taught by my level 1's Residents and Attendings. I have a new toy on my wish list I want my employer to get.
 

Akulahawk

EMT-P/ED RN
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Well, no one I voted for won, though honestly I can't say I'm all that surprised heh.

Though it sounds like CA voters screwed over their EMS workers by passing Prop 11 :/
Yep. That happened. As per usual, the voters were misled about what Prop 11 was about, so they passed it.
 

RocketMedic

King of the Improbable
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Another mass shooting in CA....12 dead plus the shooter in Thousand Oaks. This is terrible.
 

Aprz

Forum Deputy Chief
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Prop 11 passed.

Mass shooting.

California is on fire again.

Nothing new.
 

Akulahawk

EMT-P/ED RN
Community Leader
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Another mass shooting in CA....12 dead plus the shooter in Thousand Oaks. This is terrible.
Yep. The worst part of it is that the shooting was probably preventable. He was looked at for a 5150 hold and was released. Unfortunately I have learned over the past couple years that I've got a pretty good feel for figuring out which of my patients are likely "keepers" for those purposes. Even though I've developed that feel, I do not want to go through the 5150 training to make me a nurse that's authorized to write those holds. IMHO, that's what our social workers are for.
 

Peak

ED/Prehospital Registered Nurse
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Yep. The worst part of it is that the shooting was probably preventable. He was looked at for a 5150 hold and was released. Unfortunately I have learned over the past couple years that I've got a pretty good feel for figuring out which of my patients are likely "keepers" for those purposes. Even though I've developed that feel, I do not want to go through the 5150 training to make me a nurse that's authorized to write those holds. IMHO, that's what our social workers are for.
I'm always shocked at how strict other states are about needing holds in order to transport. When I was in fire our protocols stated that we could take patients in to the hospital for evaluation against their will (including chemical or physical restraints if needed) if they met hold criteria without needed PD or anyone else to write a formal hold; if the doc decided that they didn't need a hold that was fine but we never ran into that issue.

The burden on EMS/PD to take the patient to a facility in order to be evaluated is way too high, why would I expect someone trained in prehospital emergency medicine or law enforcement to be able to make the evaluation that we have a LCSW or LPC at a minimum evaluate to determine the need and level of psychiatric care?
 

Akulahawk

EMT-P/ED RN
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I'm always shocked at how strict other states are about needing holds in order to transport. When I was in fire our protocols stated that we could take patients in to the hospital for evaluation against their will (including chemical or physical restraints if needed) if they met hold criteria without needed PD or anyone else to write a formal hold; if the doc decided that they didn't need a hold that was fine but we never ran into that issue.

The burden on EMS/PD to take the patient to a facility in order to be evaluated is way too high, why would I expect someone trained in prehospital emergency medicine or law enforcement to be able to make the evaluation that we have a LCSW or LPC at a minimum evaluate to determine the need and level of psychiatric care?
If you transport someone that's alert & oriented against their will, that's often considered kidnapping. Without a proper hold, I won't transport. Someone that's suicidal or homicidal, I'm getting LE involved. If I think someone should be on a "Gravely Disabled" hold, then I'm very much going to get LE involved. Those folks don't often think there's anything wrong. You don't need someone with a high level of training to do the screening in the field. You just need someone to do some screening to determine if the person meets criteria. An appropriately trained RN, LCSW, Peace Officer, etc. can do that. Given the right education and training, I wouldn't have an issue with a Paramedic doing the screening either. I do have some issues with the process as it is, and it could be improved, but at least there's a mechanism in place.
 

Peak

ED/Prehospital Registered Nurse
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If you transport someone that's alert & oriented against their will, that's often considered kidnapping. Without a proper hold, I won't transport. Someone that's suicidal or homicidal, I'm getting LE involved. If I think someone should be on a "Gravely Disabled" hold, then I'm very much going to get LE involved. Those folks don't often think there's anything wrong. You don't need someone with a high level of training to do the screening in the field. You just need someone to do some screening to determine if the person meets criteria. An appropriately trained RN, LCSW, Peace Officer, etc. can do that. Given the right education and training, I wouldn't have an issue with a Paramedic doing the screening either. I do have some issues with the process as it is, and it could be improved, but at least there's a mechanism in place.
We didn't transport mentally competent adults against their will, we still documented that the patient was SI/HI/Gravely disabled in their note but we didn't have to place a formal mental health hold. If there was any gray area we could call in to the ED and run the situation with the doc. I had PD/SO/State helping us to restrain patients to the cot so that we could transport to the ED.

We were basically doing what is now the M-0.5 (a full 72 hour hold is a M-1), but before the state formally established it. Since I can legally place M-1s I haven't kept up to date as to who can place the M-0.5 but @Tigger would probably know, I would assume that trained medics can place them but I could be wrong.

There is a pretty big legal burden being put on untrained or under-trained responders to place 72 hour holds which often are unnecessary or the patient in fact has a medical etiology and should be placed on a medical hold rather than a psychiatric hold. There are certain times in which it is very clear that patients are appropriate for direct admission to a CSU or psych unit, but I think saying that EMS/LEO had a genuine concern and just needed legal justification for transport to the ED is okay too. Depending on the evolution of their medical/psych exam we often drop or place M-1s in lieu of medical holds.
 

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Akulahawk

EMT-P/ED RN
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There is a pretty big legal burden being put on untrained or under-trained responders to place 72 hour holds which often are unnecessary or the patient in fact has a medical etiology and should be placed on a medical hold rather than a psychiatric hold. There are certain times in which it is very clear that patients are appropriate for direct admission to a CSU or psych unit, but I think saying that EMS/LEO had a genuine concern and just needed legal justification for transport to the ED is okay too. Depending on the evolution of their medical/psych exam we often drop or place M-1s in lieu of medical holds.
This is why many of our 5150 patients are brought to the ED for medical clearance. Often it's pretty clear the issue is psychiatric but sometimes the issue is some kind of organic disease process. The reason for the formality of a hold is that while we do allow people the right to make stupid decisions, sometimes they're not really able to make that decision because their psychiatric condition doesn't allow it. Once at the hospital, at least in California, we do have the ability to use H&S 1799, which is a 24 hour hold and can be for any medical or psych reason. Mostly it's for allowing the stupid drunk to become sober enough to go home.
 

CALEMT

The Other Guy/ Paramaybe?
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Today and everyday, thank you to those of you that have served.
 

Tigger

Dodges Pucks
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We didn't transport mentally competent adults against their will, we still documented that the patient was SI/HI/Gravely disabled in their note but we didn't have to place a formal mental health hold. If there was any gray area we could call in to the ED and run the situation with the doc. I had PD/SO/State helping us to restrain patients to the cot so that we could transport to the ED.

We were basically doing what is now the M-0.5 (a full 72 hour hold is a M-1), but before the state formally established it. Since I can legally place M-1s I haven't kept up to date as to who can place the M-0.5 but @Tigger would probably know, I would assume that trained medics can place them but I could be wrong.

There is a pretty big legal burden being put on untrained or under-trained responders to place 72 hour holds which often are unnecessary or the patient in fact has a medical etiology and should be placed on a medical hold rather than a psychiatric hold. There are certain times in which it is very clear that patients are appropriate for direct admission to a CSU or psych unit, but I think saying that EMS/LEO had a genuine concern and just needed legal justification for transport to the ED is okay too. Depending on the evolution of their medical/psych exam we often drop or place M-1s in lieu of medical holds.
I suspect that eventually the "M-0.5 hold" will trickle down to paramedics but presently nothing has changed. Realistically I'm not sure it really will affect the day to day much. Suicidal, homicidal, and gravely disabled patients are transported against their will if necessary if they lack the capability to make informed decisions based upon a mental status exam. This happens without call-in. We are one of the few agencies in the state that write Emergency Commitment holds for grossly intoxicated (etoh and drugs). These are up to 72 hour holds that prevent patients from leaving a detox center until they are sober and can be evaluated by a mental health professional.
 

PotatoMedic

Has no idea what I'm doing.
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Well took the AirMethods written test. We shall see what happens. Most of it was pretty straight forward and easy. But I also realized that I needed to review critical care meds more... Oh well.
 

VentMonkey

calpuleque
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Here's to hoping that Creighton puts together their Advanced Critical Care Transport Course. I enjoyed their original course, and would expect much of the same level of education and insight, however, geared towards experienced critical care providers.
 

StCEMT

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Here's to hoping that Creighton puts together their Advanced Critical Care Transport Course. I enjoyed their original course, and would expect much of the same level of education and insight, however, geared towards experienced critical care providers.
Is this one they do regularly? I don't intend to do anything like that for a few years, but down the road I wouldn't mind it.
 

VentMonkey

calpuleque
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Is this one they do regularly? I don't intend to do anything like that for a few years, but down the road I wouldn't mind it.
No, this would be separate from their current critical care course. It sounds more like CE for already certified and experienced providers with topics either in, or above and beyond an experienced providers scope of practice and education.
 

Akulahawk

EMT-P/ED RN
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Not sure if anyone remembers me...I've left full time EMS last year (working 1-2 shifts a month per diem) and I have 1 1/2 year of med school left to go.
And then you have Residency... Yes, some of us do remember you!
 

PotatoMedic

Has no idea what I'm doing.
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Well apparently I passed the written. (Like I said easy besides not knowing my critical care meds like I would like... (But I don't use them and don't interact with them so it is a little tricky for me)). So will soon be contacted by the regional recruiter for a skills assessment and interview.
 
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