Would you have transported this patient?

[adamjh3]

You're on a BLS rig, you're an EMT-B, no sedatives available.

Dispatched to an assisted care facility for a 22 Y/o M, C/C disturbance in behavior.

Upon arrival and speaking to facility staff you find out pt. was discharged from a hospital earlier that day to the care facility. Within 20 min. of arrival at the facility, pt became hostile and assaulted two staff members, one with his fists, the other using a chair as a weapon.

At this time, the patient is confined to his room and has made no attempt to leave, has been courteous to the staff watching his room. Patient is 6'3" 220lbs, is not on a 5150 (psychiatric evaluation) hold, and is in the facility on a conservatorship.

Pt is Dx with Schizophrenia with a Hx of paranoid delusions.

The hospital you are supposed to take him to is, at best speed in ideal conditions, 30 minutes away, but it's raining, and we all know how California freeways are when it rains.

With this knowledge, would you transport this patient or defer to PD/SO involvement?

 

[DrParasite]

he's already used a chair as a weapon? He's a bigger guy than me?

I am not transporting this patient until law enforcement is there to ensure my safety.

 

[CAOX3]

If he is assaulting staff he cant stay. Assault is a crime, get the police involved.

If his violent outbursts are due to med/psych he goes to the hospital, probably restrained if not he goes to jail.

 

[JPINFV]

Patient is 6'3" 220lbs, is not on a 5150 (psychiatric evaluation) hold, and is in the facility on a conservatorship.

Of course he's not on a 5150 (temporary hold for initial assessment and treatment for psychiatric disorder). Think of a conservatorship in California as a year long 5150 with another person appointed as the "conservator" to make estate and treatment decisions for the patient. There is no reason for a patient to be on both a conservatorship and a 5150 as the conservatorship has already accomplished what the 5150 accomplishes, which is the legal ability to mandate pharmacological psychiatric treatment.

With this knowledge, would you transport this patient or defer to PD/SO involvement?

Does the facility have staff (including, but not limited to nursing and security staff) that can help us restrain the patient (acute acts of violence means restraints)?

Have you talked to the patient? How cooperative is he at the current moment? You don't need law enforcement present to talk with him. Is he receptive to transport and restraints? Just because he suffers from psychiatric illness doesn't mean he doesn't know it, doesn't mean to lash out, and is against accepting treatment and help. You won't know if you don't assess your patient.

Is the facility able to and willing to give him a sedative (I know you said "assisted care," but I'm having a hard time seeing a conservatorship patient in most assisted living facilities)?

 

[adamjh3]

Of course he's not on a 5150 (temporary hold for initial assessment and treatment for psychiatric disorder). Think of a conservatorship in California as a year long 5150 with another person appointed as the "conservator" to make estate and treatment decisions for the patient. There is no reason for a patient to be on both a conservatorship and a 5150 as the conservatorship has already accomplished what the 5150 accomplishes, which is the legal ability to mandate pharmacological psychiatric treatment.





Does the facility have staff (including, but not limited to nursing and security staff) that can help us restrain the patient (acute acts of violence means restraints)?

Have you talked to the patient? How cooperative is he at the current moment? You don't need law enforcement present to talk with him. Is he receptive to transport and restraints? Just because he suffers from psychiatric illness doesn't mean he doesn't know it, doesn't mean to lash out, and is against accepting treatment and help. You won't know if you don't assess your patient.

Is the facility able to and willing to give him a sedative (I know you said "assisted care," but I'm having a hard time seeing a conservatorship patient in most assisted living facilities)?

Thank you for the description of a conservatorship, I've always had some confusion over exactly what it was.

Facility has staff to help restrain the patient. Staff is unwilling to chemically restrain.

When you talk to the patient, he's A&Ox3, however, seems confused as to why he's been isolated in his room and is slightly agitated (nervous posture, eyes darting around the room, wiping hands on the top of his knees).

Patient asks why you want to take him to the hospital he just came from you tell him it's so he can talk to his doctor about what has happened since arriving at the facility. Patient seems unwilling to leave his room when asked if he would mind sitting on the gurney for Tx.

 

[looker]

Have staff assist with patient being loaded on the gurney and set up restrain . If you feel there is still danger request pd unit to respond and follow you just in case you need extra help.

 

[LondonMedic]

Why are staff unwilling to sedate? This chap needs a benzo (which is probably therapeutic as well) and maybe a touch of vitamin H. He might even do this voluntarily if you ask nicely.

 

[JPINFV]

Why are staff unwilling to sedate? This chap needs a benzo (which is probably therapeutic as well) and maybe a touch of vitamin H. He might even do this voluntarily if you ask nicely.

If it's an "assisted living" facility instead of a skilled nursing facility, it might be because the facility doesn't have anyone present who can administer medications.

 

[Fox800]

PD should be involved and on scene before you even interact with the patient.

 

[JPINFV]

Do facilities that regularly deal with patients with psychatric issues normally call PD where you live or something?

"911, what's you're emergency?"

"This is XYZ Psychatric Hospital. One of our patients is acting out, we have him isolated to a room, but the ambulance crew wants PD on scene before they transport our patient."

"Ok, we'll have a squad car out there as soon as possible, most likely in 2 hours."

Edit:

Oh, and considering that the facility has staff willing to help restrain the patient and the patient is already on a long term "hold," what, exactly, is the value added of having a (as in most likely 1) police officer again?

 

[MrBrown]

Ring up for an RSI trained Intensive Care Paramedic or Doctor, duh

Hmm I don't see know about that clearance Oz,
Oh it's OK Brown just keep coming down you are well clear, bring the tail to me if you like ....

 

[CAOX3]

"911, what's you're emergency?"

"This is XYZ Psychatric Hospital. One of our patients is acting out and assaulted two staff members one with a chair and the other with his fist we have him isolated to a room, but the ambulance crew wants PD on scene before they transport our patient."

"Ok, we'll have a squad car out there as soon as possible, most likely in 2 hours." Ok will be awating your arrival.

There I fixed that for you.

I dont take chances with safety. If it takes four hours for them to arrive, then we wait four hours. If I wanted to be a cop I would have taken the test.

 

[JPINFV]

If facilities that routinely take care of psychatric patients are routinely calling for police, then those facilities should absolutely not be taking care of patients with psychatric conditions. What's next, elementry schools calling police because a child threw a temper tantrum?

Oh, as far as the test to be a police officer? If you don't want to work with psychiatric patients, don't take a test to be a medical professional.

You still haven't mentioned the value added of having a police officer on scene.

 

[MrBrown]

You still haven't mentioned the value added of having a police officer on scene.

They are likely to bring dounts? ^_^

 

[akflightmedic]

You still haven't mentioned the value added of having a police officer on scene.

One word...Tazer.

If chemical restraint is not possible and violence has already been demonstrated, then I want some other form of non lethal force in case sh*t hits the fan.

A patient becoming violent on scene outside a facility is one thing...a patient becoming violent inside a controlled scene/facility which routinely deals with it means I am not part of the restraining process. Once they restrain him, then I will assist...or once LEO shows up and restrains them.

At no point short of me being assaulted will I ever take part in the initial physical restraining process inside a facility that is supposed to be equipped/staffed to handle these sort of things.

Scene safety...but before that comes MA-1 (My *** first).

 

[Fox800]

If facilities that routinely take care of psychatric patients are routinely calling for police, then those facilities should absolutely not be taking care of patients with psychatric conditions. What's next, elementry schools calling police because a child threw a temper tantrum?

Oh, as far as the test to be a police officer? If you don't want to work with psychiatric patients, don't take a test to be a medical professional.

You still haven't mentioned the value added of having a police officer on scene.

You've got to be joking.

Lets see. Large patient. Violent patient. Already assaulted two staff members(committed a crime).

This is NOT a psychiatric facility. That implies a mental health hospital. This is an assisted living facility. You make it sound like a quasi-nursing home. Is that correct?

I'm assuming this is a 911 call? If so PD should be sent for scene safety from the get-go. 911 calls in my area that pop up with "violent pt" would get PD ricky-tick, probably before we got there.

If you can't see the value of having an LEO on scene with a violent psych patient, then we really can't help you that much. They are trained in take-downs and restraint techniques. If the pt. becomes increasingly violent then the LEO has the tools and training to deal with that, beyond the old EMT-B grab/tackle/restrain technique. Good luck getting the staff at an assisted living facility to help you with that. The nurses and aides will scatter like cockroaches in the light.

 

[akflightmedic]

They are likely to bring dounts? ^_^

And we say donuts or doughnuts here...but not dounts...

Fries are not chips or chups as you Kiwis refer to it...heaps beached bro.

 

[JPINFV]

You've got to be joking.

Lets see. Large patient. Violent patient. Already assaulted two staff members(committed a crime).

No. The patient suffers from a psychiatric condition where the courts have already ruled that the patient is "gravely disabled" and unable to care for himself. I'm having a hard time thinking that every time a patient is a psychiatric facility gets violent that charges are even sought, little less brought against the patient.

This is NOT a psychiatric facility. That implies a mental health hospital. This is an assisted living facility. You make it sound like a quasi-nursing home. Is that correct?

If the OP is using the terms properly ("assisted living"), then it's like a step below a skilled nursing facility. However, that does not mean that the facility does or does not routinely work patients with psychiatric issues. Considering that the patient is on a conservatorship, I'd really like to know more about the facility. I've been in (as an EMT, not a patient ) nursing facilities set up to handle specifically patients with psychiatric disorders. It might not be a hospital, but those are very much mental health facilities.

I'm assuming this is a 911 call? If so PD should be sent for scene safety from the get-go. 911 calls in my area that pop up with "violent pt" would get PD ricky-tick, probably before we got there.

If it's coming from a facility it's most likely an interfacility call made directly to the company, especially given the fact that the patient is on a conservatorship.

If you can't see the value of having an LEO on scene with a violent psych patient, then we really can't help you that much. They are trained in take-downs and restraint techniques. If the pt. becomes increasingly violent then the LEO has the tools and training to deal with that, beyond the old EMT-B grab/tackle/restrain technique. Good luck getting the staff at an assisted living facility to help you with that. The nurses and aides will scatter like cockroaches in the light.

If I'm not in a facility or in a facility not willing to assist restraining the patient, then I would agree that a LEO has value added, however this is not the case. The OP has already stated that the staff is willing to help.

As far as EMT education for dealing with psychiatric issues, yes it's piss poor and needs to be drastically increased. It's also just another sign that for a trade who are supposed to be the experts at out of hospital care and interfacility transport, we often try to push off everything and anything possible.

 

[MrBrown]

And we say donuts or doughnuts here...but not dounts...

Fries are not chips or chups as you Kiwis refer to it...heaps beached bro.

Oh hah hah ow funny as bro you know what I meant

 

[JPINFV]

One word...Tazer.

If chemical restraint is not possible and violence has already been demonstrated, then I want some other form of non lethal force in case sh*t hits the fan.

...however not all officers everyplace carry tazers.

A patient becoming violent on scene outside a facility is one thing...a patient becoming violent inside a controlled scene/facility which routinely deals with it means I am not part of the restraining process. Once they restrain him, then I will assist...or once LEO shows up and restrains them.

At no point short of me being assaulted will I ever take part in the initial physical restraining process inside a facility that is supposed to be equipped/staffed to handle these sort of things.

Scene safety...but before that comes MA-1 (My *** first).

While I agree with initial restraint, however eventually that patient will need to be moved over to the gurney. Similarly, we don't even know what the patient is willing to agree to with a little talking. According to the OP's followup post, the patient isn't currently violent, is a bit agitated, and is confused. After a little talking, for all we know the patient could very easily "voluntarily" (as in freely submit instead of physically forced) submit to restraints and transport. However many here aren't even willing to approach the fact that words might be the solution to getting the patient restrained on the gurney at present time. The patient is isolated in a room, which is by it's very nature a form of restraint, but apparently we can't even consider any route that doesn't involve escalating the situation further.