looking for advise and guidance....

[sassy_emt_angel69]

I am looking for some advise on a response to dealing with suicidal sevant/bipolar patients.......

had a call in wich i dealt with such a patient......what is the best approach to handling such a patient?

is there any set way to be able to read these patients and be able to "talk" them "down"?

My patient was very scattered in any verbal responses to my questions.....he constantly had a facination with color association and the idea that actions where made in 0.14/secon or faster.......i have dealt with many bi-polar sucidial threats befor but the sevant side is what is throwing me for a loop......

[DwayneEMTP]

When you speak of a savant, there are really many things that you could be describing. Most often I think people associate savant, which is actually a description of any very learned person unless qualified, such as an autistic savant, or what in the past was described as an 'idiot savant.'

I think your question is really interesting and I'd love to explore it, but we're going to need to flesh it out a little bit more. If this child was truly a savant, I'm curious how they also arrived at the bipolar diagnosis, as well, how they came to believe that he was suicidal?

I'm not trying to bust your chops, so please don't run away, as I'd really like to learn from this.

How old was the patient?

What type of environment was he in when you ran on him? Family/group home/homeless/etc.

Where did you get the information concerning his previous diagnosis?

What made you believe that he was suicidal? Had he physically taken any steps to harm himself?

What was his physical condition in general?

How many words per sentence would you say he used?

While in your care, how many words total would you guess that he used.

There is no set way in general, but there are clues to what might be best and certainly best ways to handle them when things go south.

Thanks again for bringing this question to the table. There are a ton of smart folks here and I think there is much to be learned from the discussion.

Dwayne

[crotchitymedic1986]

There is no one "generic" answer that will encompass all patients, but I typically tried to find what they cared about, and then turned that into a reason not to committ suicide; ie.... their children ---- "how do you think they will feel when they learn what you have done ?". Whether super intelligent or dumb as a brick, it usually seemed to work.

[sassy_emt_angel69]

The patient was a 34y/o male .......he was returning home with his mom from college.....while at school he was suffering from bouts of depression and severe mood swings his mom told me were rooted in a childhood diagnosis of bipolar.....

I work part time at a local motel at this is where I met him. His mom came to me and said he was stating that he was feeling like" ending it all". As I spoke with her and discussed his back ground she informed me of the bipolar diagnosis but it wasn't until after my back ups arrived that i found out he was a sevant. His word association of color to describe his moods were my first real incicator that maybe it was more ........he would refer to the color red for angry or blue for depressed......if i was quick enough i got hi to use purple for calm......he would begin to ramble and state that his thought were all jumbled and that he wanted to make them stop...he wanted to die.......

He was very intellegent...about 75% of the time he was very coherant speaking in full sentences....the rest of the time he spoke in 3-5 word bursts. His over all apperance was good .....very healthy and active male......no allergies....no physical conditions......he stateed to me several times he wanted to make the voices stop.....he had been sying on the second flooor of the motel and had at one point when the responding medic from the local ambulance company was working with me with him asked him a question he turned to the medic and stated..." I am going to jump and I am taking her with me.' Neither one of us saw that comming because he up to that moment was ready to go to the truck and volantarily go for treatment

sorry about the miss spelling...juat got off a 10-6 shift and tired.....gotta cat nap for my next shift

crotichymedic,

I tried that ......he seemed to have moments where he didn't care or just seemed to mentally shut down. The shut down reminded me of an autistic person with aspberger's syndrome.....when they get over loaded emotionally they react the same way. I have first hand experience with this as I have three sons with aspberger's syndrome.

[Happiness]

It has been my experience the you talk to them in a monatone voice, If you bring emotion into the senerio they pick it up and that can be a big triger. I also never show any sympathy for them, "Im so sorry you feel that way" just makes them think they are dummies. You should try to get to their level. When I do these calls I take as much time as is needed, dealing with mental health in any form is normally my longest calls.

Sassy you say he wanted " to make the voices stop" is that not red flag that this boy may also have a degree of schizophrenia..

For some reason I have the abilty to calm down so there fore i will get the phyc calls. If you ever come across this boy again at least you will have a bit of a heads up

[DwayneEMTP]

He does sound challenged in some way, but doesn't sound like a savant to me.

Did you manage to get him to go with you? In this situation it can be tricky, as, more than likely you're going to discover that mom was the problem.

One thing for sure, he has to come with me, or he's going with the police, and that's just not going to happen. Calmness is certainly good, as you know from you Aspie boys, and I'm guessing more than likely you could have just asked him if he wanted to ride in the ambulance and he would have gone. In this case I would have payed close attention to the behaviors between he and his mom and more than likely, if possible, had her ride in the front.

If he wouldn't go, then things get hinky. I ran through this with a previous medical director once, about just medicating them early, to save them the emotional and physical trauma of the wrestling match that he would never recover from. He said, 'If you touch him and he resists, well, you have a protocol for medicating combative patients, don't you?" And though I've not run into this situation since that conversation, that is certainly my intention in the future. Medicate early.

If you're BLS, at the point that it becomes obvious that he won't come quietly then you need to allow him to retreat to a place where he feels safe and call in ALS. This is not going to go well and the will need to medicate him, if they have the guts to do it. Should you or the cops choose to just tackle him and tie him down you should, from a patient care standpoint, consider this in the same class as violent sexual rape against a child...that is truly the service you are providing at this point...probably worse.

No cure all, fix all here girl...but that's the best that I've got. First...do no harm. And if you physically restrain these folks you can certainly never pretend that they weren't harmed. Most likely your biggest job here, if you have the balls/ovaries to truly advocate for your patients, is going to be protecting them from the police who have other things to do and will want him in your truck and gone so that they can get about them. Just don't let it happen...

Dwayne