Another Patient Jumps from Ambulance

[treaux]

Unfortunately, dealing with psych patients is an integral part of our job in most places. I don't know about you guys, but we did not cover too much about psych in medic school. I've learned most of what I know from extra reading and experience.

Where I work, the ambulance transports all psych holds. This is due to the fact that our health department doesn't feel that PD can differentiate between an altered patient and a suicidal one (though it still gives them the authority to place them on a hold). If they are larger than me or I feel they can seriously hurt me, I will either have PD follow or ride with me for extra safety.

Since my employer doesn't seem to care what you do unless someone gets hurt or sues, I've made it my personal policy to restrain all 5150s. I explain to them that they have been placed on a hold due to the police feeling they may be a danger to themselves, so while they are in the ambulance they will need to be in restraints. Most are understanding and allow it cooperatively. Some occasionally lose it and become combative, but I'd rather them do that on scene where I have help than in the back of the rig on the road. I don't take risks on this anymore. I've had one patient jump out past me when I was an EMT (thankfully we were parked at the hospital) and after hearing stories like this I just take the safe route.

Secondly, I always have a communication system with my partner so she knows what to do. If I yell "Brakes!" from the back, it mean's I'm holding onto something and to get off the road and stop as fast as possible without accelerating. Usually the force of braking would prevent someone from jumping out the back anyways.

Lastly, I judge every patient I see (not just the holds) on how well I could fend for myself alone with them. I'm a pretty big guy, so putting myself on the bench next to the pt, I can usually hold them down or restrain them myself if they somehow get out of our soft restraints (and I've been there, believe me). That's when I yell brakes and my partner pulls over and comes to help.

Being lazy or inconsistent with your methods is what allows things like this to happen. The one time you think, "ah, it'll be fine. let's just go" is the one time it goes wrong, and that can be a career-ender.

Edited March 3, 2010 by treaux

[CBEMT]

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 somebody decided that a psych problem is a disease, and diseases require medical treatment. People being transferred for medical treatment go in ambulances, not police cars.

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

Not IFT. Occasionally in the field they'll transport to the ER, or in my town PD transports to their station and the patient has a psych eval there from a local agency- but by state law still needs to be medically cleared at a hospital ER prior to psychiatric admission. Thankfully they call a private for the run to the ER instead of tying up the 911 truck.

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

In the case of the ER, they call a private for the transfer to the psych hospital. Sure, the private could refuse, and risk never getting another discharge or transfer from that ER again. If the crew refuses, they're unemployed. In the field the cops can't ORDER me to transport someone, but if it's clear they are having a psychiatric emergency, aren't I obligated to take them?

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

99% of all the ER to psych transfers I ever did (and we did a lot) were alert, oriented, and, if not totally cooperative, than at least resigned to the fact that they were going. What right do I have to walk into a patient that has been prepared for hours or sometimes days by the ER staff that they'll be getting "a nice, easy ride" and say "Sorry, even though I know nothing about you or your situation, I'm scared of you, so you're getting in these restraints or I'm drugging you"? That's messed up. If I was a patient and the doctor told me as long as I went willingly everything would be cool, and then some private ambulance jockey tells me I'm getting restrained anyway, guess where my sense of cooperation just went? And that's me right now, completely rational. Imagine what emotionally fragile people feel like.

The only people I ever had to restrain PRE-hospital were intoxicated and combative, and plus had head injuries. And technically I needed an order for it since we don't have a protocol, but there wasn't exactly time.

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

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

Lack of laws and policies in general. Like I said, there's nothing in my protocol or laws pertaining to EMS that says I'm allowed to restrain anyone for anything. But the fact that a psych transfer will usually get paid, under "services not available at this facility," probably doesn't help.

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

If its between that and explaining on the witness stand why I sat there and watched him go, yeah I probably would. If I felt like I couldn't take him/her at the time of initial contact, I'd ask for more personnel in the back, or other measures as appropriate.

Edited March 3, 2010 by CBEMT

[DwayneEMTP]

*cue dumb face* Do they make those, or did you just invent it in thought?

They do. We have these on all of our cots. It's just a hard plastic case that fits over the buckles and has a narrow slit in it. You can't push the button to release the belt because it's covered by the plastic, and the slit. When you need it off you push a key, or anything thin, through the slit and it pushes the button. Works awesome.

Dwayne

[brentoli]

They do. We have these on all of our cots. It's just a hard plastic case that fits over the buckles and has a narrow slit in it. You can't push the button to release the belt because it's covered by the plastic, and the slit. When you need it off you push a key, or anything thin, through the slit and it pushes the button. Works awesome.

Dwayne

Lil'Wayne....

Can you find out the maker, or distributor of this?