Another Patient Jumps from Ambulance

[FireMedic65]

Those are all very good points/questions. And no, I don't believe I would do much to restrain someone myself. I guess I was more wondering how he was restrained in the first place that allowed him to break free. I definitely think the whole concept of transporting unstable, possibly dangerous psych patients falls (or should fall) outside EMS purvue and is rather obsurd. I understand these people need help and proper care, but not the type of care EMS provides and it placed undue risk on crews.

True. I am unaware of how they were restrained in this situation. And if I am not mistaken, leather restraints are to be removed from ambulances. These people do need care. I am however, not properly trained to deal with them. Usually, they are calm and just lie there. Sometimes make threats and use foul language. If the patient presents violent behavior, I will refuse to transport them on account of my personal safety and my partner.

[Richard B the EMT]

2. Do not the cops have both the authority and the responsibility to take these people?

It becomes somewhat a jurisdictional thing. The Homicidal/Suicidal patient I mentioned was in a Veterans Administration Hospital within the NYPD coverage, to be transported to another VA hospital, in upper Westchester County, where I have no clue if there's a local police force, or is covered by the NY State Police, or both. Also, the company I was then with, was not a 9-1-1 system responder, meaning no matter what call I may have responded to with that employer, unless I personally called 9-1-1, there would not be any PD response. I got grief from the NYPD, when I asked for an NYPD on-board patient escort for going from the Brooklyn VA hospital, to a facility (I think it was also a VA facility) across the Verrazano Bridge in Staten Island, an area covered by different precincts of the NYPD. A mention here that within NYC, at this time, the NY State Police only had an office relating to security for the Governor, and was in the World Trade Center. Apparently, the VA police are only authorized to protect VA facilities, not escort patients between them, or so it seemed back then, from 1975 to 1977. When I was working for the NYC Health and Hospitals Corporation EMS, before the FDNY merger, they had a small branch called PETS, the Psychiatric Emergency Transfer Service. They ran 3 person crews, in basically a minibus, no stretcher, with two EMTs and an HHC Police Officer. At least one of the trio was always a female, for the benefit of patient's security. Budget cutbacks eliminated this service, which was strictly inter-facility, not pickups in the street or from private offices or residences. At least on my 9-1-1 ambulances, EDP calls always have the NYPD on the scene, minimally 4 LEOs in 2 patrol cars. One half of one team will ride, on EMS crew request, in the ambulance, followed by the LEOs partner, to pick up the officer after transfer of care to the Psych ER area. In some cases, the LEOs will insist on the escort, and when they do, I graciously accept. Even with, or despite, that last, I have never had any EDPs attempt to exit the moving ambulance within NYC that I have been made aware of. Edited March 2, 2010 by Richard B the EMT

[spenac]

If I were a betting man I would bet this kid seemed nice and polite. Often emotionally challenged individuals can put on a good front while looking for the opportunity to do what they want which in this case was apparently suicide. As he was acting good the crew probably had no worry about the transport and would have only used normal seat belts allowing for easy escape.

[FireMedic65]

If I were a betting man I would bet this kid seemed nice and polite. Often emotionally challenged individuals can put on a good front while looking for the opportunity to do what they want which in this case was apparently suicide. As he was acting good the crew probably had no worry about the transport and would have only used normal seat belts allowing for easy escape.

As yes, very true. But these people are there for a reason, and being transported to another facility for a reason. Don't let them fool you. They are kind of like stripper. Strippers just want your money. They will pretend to like you and act like you are the sexiest man alive. Once they get your dollar, you are invisible. We know this, we know how they are. Psych patients are no different.. only we don't stuff money in their pants.

[maverick56]

As yes, very true. But these people are there for a reason, and being transported to another facility for a reason. Don't let them fool you. They are kind of like stripper. Strippers just want your money. They will pretend to like you and act like you are the sexiest man alive. Once they get your dollar, you are invisible. We know this, we know how they are. Psych patients are no different.. only we don't stuff money in their pants.

LOL, nice analogy

[crotchitymedic1986]

I honestly don't know the statistics. I just know that we get a story posted about it several times a year. It raises some very serious questions, like:

1. Why the Hell are we being used to transport people who need no medical services that we offer? What's wrong with a police car?

Because most police departments will only do one run per day, and hospitals wont wait and house these patients for that long (regular hospital)

2. Do not the cops have both the authority and the responsibility to take these people?

They have the authority but not the responsibility

3. Do we not have the right to refuse the cops and/or ERs request to transport them?

not if you want to keep your job

4. Why is any medic allowing this to happen without the patient being properly restrained and accompanied?

good question, people who do these transports should use buckle guards so patients can not unbuckle

5. What laws and/or policies are hindering us in dealing with this problem?

none

6. What lack of laws and/or policies is hindering us in dealing with this problem?

none

7. Would you personally physically engage a patient to prevent him from taking a dive out of a fast moving ambulance?

i wouldnt let the patient get unrestrained

[spenac]

So you go the hospital to pick up transfer patient. Patient is unsecured in ER bed. Doctor states patient is going for evaluation and counseling. Are you going to secure this patient to the cot with more than the standard cot seat belts? If you do is it possible you are guilty of illegally restraining the patient as even the hospital did not see a need to secure them? So now you did not use more than the seat belts and patient in 2 seconds or less is out of them are you now going to physically fight this patient?

[FireMedic65]

So you go the hospital to pick up transfer patient. Patient is unsecured in ER bed. Doctor states patient is going for evaluation and counseling. Are you going to secure this patient to the cot with more than the standard cot seat belts? If you do is it possible you are guilty of illegally restraining the patient as even the hospital did not see a need to secure them? So now you did not use more than the seat belts and patient in 2 seconds or less is out of them are you now going to physically fight this patient?

Why is the patient going some where else for evaluation? What brought them to the hospital in the first place? Why do you need me to transfer this patient? All these questions should be asked, instead of blindly agreeing with the doc.

If I feel the need to "retrain" a patient for my own personal safety, my crew, and for the patient themselves, good luck convicting me of anything. Especially if the patient came into the ER showing violent behavior. During transport, I would most definitely secure them with the seat belts. I would watch them and not play on my cell phone texting my friends or whatever. Transferring a patient isn't an "easy" trip. Just because it's not a 911 emergency, that doesn't mean they don't require the same amount of observation.

[Richard B the EMT]

A different angle, folks: Severe depression, and the patient wants to end it all. Will you see signs that the patient wants to hurt themselves? Remember that old dramatic device of literature, TV and movies, that you have to be most cautious of the quiet ones.

[spenac]

Keep in mind the jumper in this sad situation is an autistic boy. Was he violent? Was he panicking because he was being removed from what he was comfortable with as many autistic have difficulty with change?