What do you do with psych patients?

[Arctickat]

Then, with all lack of respect, they are crap superiors if they think that is all your job description entails. The long term outcome for your patient is directly determined by the care you provide as the first medical provider in their chain of care. Treatments you provide can reduce or extend hospital stays. Long term care, including psych is most definitely your concern.

You have my sympathy.

[MariB]

I am not sure what your protocols are for when you are out of service, but psych or not, we go.

We have two ambulances, and an order in which to call towns for back up.

We have and will travel as far as 8 hours one way for transport, 17 hours round trip. Luckily, most transfers are less that 5 hours out of service.

A psych patient can be just as a concern as a medical or trauma. Unfortunately, they can become medical or trauma.

[medicgirl05]

I'm not sure what you mean by out of service? And I didn't say we don't go to psych patients

We don't do transfers. We are a rural service with a 30 minute transport time to any of 6 hospitals.

I know the way things currently work are not quite right, but I'm not sure what we can do to change that.

If I have a patient who has already harmed themselves I would not be comfortable bypassing a hospital that could treat the immediate life threat.

I'm thankful for the input!

[Arctickat]

I'm not sure what you mean by out of service? And I didn't say we don't go to psych patients

Out of service means the time the vehicle is occpied during the call. aka Time on Task.

We don't do transfers. We are a rural service with a 30 minute transport time to any of 6 hospitals.

We have similar services here, they only do 911 calls to the nearest hospital, then another ambulance does the transfer.

If I have a patient who has already harmed themselves I would not be comfortable bypassing a hospital that could treat the immediate life threat.

It would really depend on the harm done to the patient. Using my area as an example, any drug overdose gets transported out for treatment because our lab doesn't have the capability of determining tox levels, so, with the exception of charcoal which we can do no treatment is done here. Any substantial physical trauma is no different, they get stabilised here, then sent out. Don't get me wrong, if your local ER can do more than you can in the back of the ambulance to stabilise the patient, then take them in. However, if they've harmed themselves to the extent that they can't make it to a centre capable of treating psych patients, then your medical staff is doing a disservice to your patient by not requiring a psych assessment.

I'm thankful for the input!

You're quite welcome.

Edited December 31, 2012 by Arctickat

[Guest ~~~]

Where I am we have one state psychiatric center. It's around an hour and a half away from where I am, so when we take a psych patient to the hospital they call a specialized team that will go the ED and "comfort" the patient or something like that until the psychiatrist shows up. If the psychiatric decides they need to be admitted they will be sent to a private inpatient care center, I have two centers less than 35-40 minutes away from me that offers it. If the private center decides they need advanced care then they will send the patient to the state hospital. Though as far as the EMS care goes we just pick them up and take them to the hospital then do the paperwork and leave, regardless how many times they have to be taken.. that's sort of the job.

It's a sad situtation you're currently having.

[Bernhard]

We have three psych specialised hospitals here, within 30-45 min away. Plus a tox center including psych ward. That tells a lot about the people here...

We're required to transport there in isolated psychiatric issues, but they can't handle medical/trauma problems, so if there is one, we go to next ER instead. They will take care of interfacility transport afterwards.

"Out of service" isn't an issue, dispatch will call another unit from out of area to cover ours (mutual help between countie EMS is required by law here).

Police is able to force someone into psychiatric care in case of "danger for others or self", a judge has to be informed not longer than 24hrs after that time and has to make a decision not later than 48hrs after the person was forced to (this is state dependent in Germany, I describe the legal situation in Bavaria).

Our paperwork is the same for any transport, police has to do a bit more (so they often refuse to force someone if not really needed - in their view) and judges/psychiatrists are used to it.

So, my suggestion: get a totally clear understanding of your local laws and protocols regarding this issue. Don't let you be fooled by someone who may have read them - or not. If your law and protocols support the way it is now, then you may get further on in improving care. The strategy depends on your standing, the frequency of such issues and the one or other problem that is caused by those situations. Ask colleagues, superiors and ER staff. If noone else sees a need to change things, check your position twice...

[MikeEMT]

8 hospitals in City of Seattle all with inpatient psych facilities. Several dedicated psych facilities as well including Navos which is a secure in patient facility used by the courts.

Psych patient - assuming none of the ER's are on psych divert they go to the closest or most appropriate facility. I usually take the to Harborview though they like to go on psych divert. They have the largest psych unit though and staff MHP's 24/7.

Other hospitals usually get pissed off because I don't automatically use restraints. I only use them if I feel I can't control a patient. Because I used to be a cop, there aren't many patients I can't handle. If my partner is nervous about a patient I will put the patient in restraints.

[Chief1C]

Unless they have attempted suicide, unsuccessfully, and require immediate care that cannot be stabilized in the ambulance, thus requiring the services of the nearest hospital... We take them to a facility that can treat their mental health crisis. Gotta go to an ER before they can go to like a long term place, or a rehab facility.. and we don't do inter-facilities. So, we take them to the nearest hospital, with an attached psych unit. And they are few, and far between. But there are many circumstances that make it kinda vital that they get to where they need to be. If I turfed them off to the nearest ER, they'd get put in a lock down room, they could deny the threats, etc.. get sent home.. hurt us for taking them, hurt loved ones for calling, or be successful. Either way, a system only works if a person WANTS help, if someone is going to harm themselves, after the 72 or 96 hour hold, they can easily lie their way out and start all over again. Now it must be hard to get the folks that are just plain legally fricken insane into a "state hospital" type deal, b/c we continually see them back on the streets. I don't even know where the closest place that handles that type of case would be located, short of a prison with a psych ward.

adding more..

I'm familiar with the system, not on an individual level, but family. Some folks just can't be saved from their own hand. Had a patient a number of years ago, started on a weekend, suicide attempt, three days later, released and a second attempt with in a few hours.. five days later, another attempt.. five days later, a near successful attempt. That one involved severeing the femoral artery, and stating they would kill anyone that came in. So we had to wait for the scene to be cleared, and by then the patient had nearly bled to death. Couple weeks later, released, OD'd, called 9-1-1 probably quite some time afterward, as far as I can figure. Ended up being successful. Why? No idea. Always called for [the persons self], shortly after the attempt. Granted it was summer, so eventually, someone would have noticed.

Edited January 6, 2013 by Chief1C

[Kiwiology]

This is a common problem, many people fall between the unfortunately very wide gaps in the mental health system and suffer because of it.

There are inpatient mental health facilities at the hospitals here so its not so much of a problem getting them there

I have a bunch of mental health problems and gave up on the system a long time ago because its more fucked in the head than I am

[ERDoc]

Here, every psych pt goes to the ER. Every psych facility requires that the pts be "medically cleared" before they can go to a psych facility, even if they have no underlying medical issues. These pts are usually pretty easy to care for, standard set of labs, call social work and wait for them to find a bed.