I thought this needed added emphasis. I agree completely. However, LE can not do this for you, only the approprite medical provider can, be it at the facility or an ALS unit. If you are truly worried about the possibility of being unable to talk this person down then it is inhumane to simply have them tied down, be it by handcuffs in the back of a squad car or leathers on your cot. Do everyone a favor, be a patient advocate and work on getting the approprite sedation on board however you can.
Would you have transported this patient?
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I thought this needed added emphasis. I agree completely. However, LE can not do this for you, only the approprite medical provider can, be it at the facility or an ALS unit. If you are truly worried about the possibility of being unable to talk this person down then it is inhumane to simply have them tied down, be it by handcuffs in the back of a squad car or leathers on your cot. Do everyone a favor, be a patient advocate and work on getting the approprite sedation on board however you can.
We dont get to have it both ways, from what was provided I'm not even sure this guys a patient, from what I gather this guy has no acute medical emergency going on and maybe he's just pissed off and decided he would beat a few staff members.
Just because he is a resident at a facility doesn't mean he isn't capable of committing a crime, just because he has a past psychiatric history doesn't absolve him from responsibility.
The more I contemplate this scenario the more I think this guys deserves a jail cell not a hospital room. Do the cops normally call you to sedate violent criminals?
I'm a patient advocate when there is a patient, I'm not sure thats the case here.
Just because he is a resident at a facility doesn't mean he isn't capable of committing a crime, just because he has a past psychiatric history doesn't absolve him from responsibility.
The more I contemplate this scenario the more I think this guys deserves a jail cell not a hospital room. Do the cops normally call you to sedate violent criminals?
I'm a patient advocate when there is a patient, I'm not sure thats the case here.
I'm very confused.
There is no medical emergency here, but there appears to be a facility that can't handle its own patients. This is a psych rehab center. They care for individuals with psychotic disorders. Of course there are going to be violent outbursts like this-- that's what chemical restraints and an educated staff are for.
This is akin to a nursing home calling an ambulance because a resident had an involuntary bowel movement. There is nothing EMS can contribute, and leaving an agitated psych patient to languish in the bowels on an emergency department isn't going to do anyone any good.
And calling the PD? Good grief. I wouldn't send my loved ones to that facility.
There is no medical emergency here, but there appears to be a facility that can't handle its own patients. This is a psych rehab center. They care for individuals with psychotic disorders. Of course there are going to be violent outbursts like this-- that's what chemical restraints and an educated staff are for.
This is akin to a nursing home calling an ambulance because a resident had an involuntary bowel movement. There is nothing EMS can contribute, and leaving an agitated psych patient to languish in the bowels on an emergency department isn't going to do anyone any good.
And calling the PD? Good grief. I wouldn't send my loved ones to that facility.
I've been preaching this since post #21 and #31. There is no acute medical condition going on now. The hospital is just going to re-snow this patient and release them, and this should be a condition the facility can manage using their existing policies and procedures. This is not an EMS call or a PD call unless the facility absolutely cannot handle the patient, and that does not appear to be the case here.
I actually agree with this. However, in most areas if you are summoned to the facility via 911 you are now obligated to deal with the issue at hand. Since the patient has been declared incompetent in a court of law and can not refuse treatment or transport, your most likely going to have to transport to the ED. If this is an IFT, I've got a little more leeway, but it's still likely going to require at minimum a phone conversation with med control, and an administrator. Either of those guys balk, we're going to the ED. Not efficent, probably not what's best for the patient, but this is the US EMS system right?
I have been called for a "violent criminal" and sedated them. We can argue over the existince of excited delerium, however there is no question that a percentage of folks who are arrested by police end up being hypermetabolic, a medical condition that calls for sedation. I'm still confused what exactly PD is going to do in this case, if no one wants to press charges. I get the sneaking suspicion that EMT classes have scared the bejebsus out of alot of people, and not fully prepared them to truly evaluate the safety of a situation. Not their fault per say, but something the system should look into.
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QUOTE=usalsfyre;252664] I get the sneaking suspicion that EMT classes have scared the bejebsus out of alot of people, and not fully prepared them to truly evaluate the safety of a situation. Not their fault per say, but something the system should look into.[/QUOTE]
To their credit this is something that the fire service does very well.
EMS education on scene safety is abysmal. Usually there is a discussion and a few workbook pages with some grossly unsafe scenes.
However, it is when you don't know that there is danger because you have not been told what danger looks like where the problems come in.
I have seen very capable and experienced nonfire medics park an ambulance in spills from MVAs. I see them park ambulances in emergency scenes that get them blocked in or take away their means of egress all the time.
Another failure is in EMS education, "scene safety" is assumed constant. It certainly is not. Patients, bystanders, as well as environment can change rapidly.
everyone on this thread seems focused in on how fast a psych can change from safe to unsafe or begin unsafe.
But how about difficulty breathing? "oh look this patient has signs of CO poisoning and has been sitting in this house all day"
To their credit this is something that the fire service does very well.
EMS education on scene safety is abysmal. Usually there is a discussion and a few workbook pages with some grossly unsafe scenes.
However, it is when you don't know that there is danger because you have not been told what danger looks like where the problems come in.
I have seen very capable and experienced nonfire medics park an ambulance in spills from MVAs. I see them park ambulances in emergency scenes that get them blocked in or take away their means of egress all the time.
Another failure is in EMS education, "scene safety" is assumed constant. It certainly is not. Patients, bystanders, as well as environment can change rapidly.
everyone on this thread seems focused in on how fast a psych can change from safe to unsafe or begin unsafe.
But how about difficulty breathing? "oh look this patient has signs of CO poisoning and has been sitting in this house all day"
Aidey
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Med control. End of discussion.
"Hi Doc, I'm on scene at Acme Psych Facility with a patient on a 5-whatever hold. Just released from XYZ hospital, where he was sedated. After the sedation wore off he had a conflict with the staff and they called us. They haven't spoken with his MD, haven't tried any of his PRN meds, and they want him transported. I want permission to leave him here unless his MD wants him transported, how does that sound?"
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It sounds great.
But I don't think you would get permission to leave him.
Nobody agrees more than I that taking this pt to an ED will serve him no purpose, but if the staff already cannot handle it and something happens to them or the pt, then med control is going to get into a serious jam.
I can also almost promise that when/if the pts MD is called, he will say the same thing every other MD called says when they are not looking at the patient and have no intention of going to see them.
"Go to the ED."
Like I said, you should be able to do something else but i don't see it happening.
Aidey
Community Leader Emeritus
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I've had good luck when it is a care facility that hasn't provided the full level of care they are capable of, and the patient does not want to go (key point I forgot to mention). Specifically, the pt has orders for PRN meds that are applicable but have not been given.
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A little late to this thread but:
That patient may be "with it" enough to be talked into going. While going to the ED is likely not in this patient's interests, it's possible that this facility can not handle him either. He may have even been prescribed a med that doesn't work for him. Talk to him, coach him a bit, see if he's willing to be cooperative with YOU. He may not like the staff there and thus the "outburst".
One of my favorite psych patients knew something was not right because the voices in his head started telling him to hurt himself... and he knew that wasn't right. I was able to talk him onto the stretcher and into the restraints to protect himself. He was evaluated in the ED, got himself stabilized, and later went home. I don't think he actually had a 5150 as he was cooperative with LE and us, and wanted to be seen because he knew he was heading down a bad path... It all worked out great!
That patient may be "with it" enough to be talked into going. While going to the ED is likely not in this patient's interests, it's possible that this facility can not handle him either. He may have even been prescribed a med that doesn't work for him. Talk to him, coach him a bit, see if he's willing to be cooperative with YOU. He may not like the staff there and thus the "outburst".
One of my favorite psych patients knew something was not right because the voices in his head started telling him to hurt himself... and he knew that wasn't right. I was able to talk him onto the stretcher and into the restraints to protect himself. He was evaluated in the ED, got himself stabilized, and later went home. I don't think he actually had a 5150 as he was cooperative with LE and us, and wanted to be seen because he knew he was heading down a bad path... It all worked out great!