What do you do with psych patients?

[mikeymedic1984]

Sorry, didnt have time to read the whole thread, so much of this may be duplication. 1. Your state laws need to change, a Physician should be able to commit these patients without going through the judge, and I am shocked that your hospitals are discharging them without proper psychiatric consultation, that is a big liability. 2. In most states, law enforcement provides the transport to the psych facility, although ambulances are allowed to do so in many states -- you have to check your state law. 3. Most in-patient psych facilities will not accept a patient from the field, they have to go to an ER first for "medical clearance", then there is the whole insurance issue. So your idea of bypassing the ER is probably not feasible even if the distances have changed. 4. The best solution I can think of for you, which probably requires more work than you are willing to do, is to bring all the players together (Psych facility, ERs, Law Enforcement, EMS) and hold a summit on the entire issue. Possible solutions would include "out-patient crisis clinics" in your area that these patients could be referred to, which could be a profit center for the psychiatric hospitals that they have not thought of. In medicine, we tend to only change things when our payors (insurance) demands a change, otherwise we stay with the status-quo no matter how dumb or painful that is. You might have to involve a congressman to bring this kind of group together.

[Just Plain Ruff]

We are a rural service also. We, however, are lucky that our director and medical director both allow us to travel to the nearest appropriate facility for the pt. If it's the hospital 10 minutes away or 2 hours away. If the pt is unstable, then it's nearest facility and we transfer from there in the appropriate manner (helicopter called in or one of our 3 ambulances in our service). We do have two part time paramedics that can sedate as needed but they can also be treated in the local hospital before transport. We are also allowed to restrain for our protection or that of others if we have the okay by online medical protocol or we can have a police officer ride with us.

Your helicopter service doesn't really transport unstable psych patients do they?

[1EMT-P]

I think the first thing that you need to do is talk to your fellow Paramedics and then to your Medical Director. It sounds like you need to have a protocol for these types of patients. The Medical Director then can talk to your local ED to see what can be done to help with these patients. One possibility would be for the ED to contact local community mental health professionals about being on call to see these patients before discharge.

[musicislife]

Typically with psych patients we have one cop ride in the back and the other ride in the patrol car behind. We usually don't mention we are going to the county psych ward unless they directly ask. The key is to keep these people as calm as possible. Nothing is worse than a crazy guy in the back who gets a little too upset with you. Also, consider restraints if the patient gets too rowdy. Something about EDPs, they seem to like me.

[Just Plain Ruff]

Typically with psych patients we have one cop ride in the back and the other ride in the patrol car behind. We usually don't mention we are going to the county psych ward unless they directly ask. The key is to keep these people as calm as possible. Nothing is worse than a crazy guy in the back who gets a little too upset with you. Also, consider restraints if the patient gets too rowdy. Something about EDPs, they seem to like me.

Seriously, you don't tell them where you are going? So when you get there and they thought they were going to one place and then they get confronted with the committal they don't go nucking futts on you then and there. You don't see that as a safety issue?

Just where do you tell the patient you are taking them? disney land or just to another hospital?

I see that as doing a huge disservice and really lying to the patient and that makes YOU as the bad guy. If the sending facility doesn't have the balls to tell that patient that they are going to the psych facility and they leave it up to you to not tell them either then both of you are LYING to the patient and that's just wrong.

[island emt]

Ruff::: IT'S NJ

what do you expect from them.

[Just Plain Ruff]

^{Oh sorry, should have read where the poster came from. But my original question still stands. Do they routinely lie to psych patients?}

[uglyEMT]

While I can't speak for the other poster from NJ but in my neck of the woods.. NO we do not lie to the patient. If we are transporting to a psych hospital or substance abuse facility we tell them. They might not like it, might get violent over it, or simply shut down but we let them know. As far as communication to the facility we usually let dispatch do that over the telephone (One for patient confidentiality. Two to let us deal with the patient not make radio calls)

Our Medical Director lets us transport to the appropriate facility be it 10 min away or 10hrs away. We have a few options in my area for these kind of patients. The hospital we normally use has a psych ward but not a secure ward. Another hospital farther away has a secure facility we use if LEO requests one.

I will say the hospital we normally use is pretty good when it comes to EDP cases. I have yet to get push back when I request an eval.

As far as the poster that sedates and boards EDPs, please tell me this was a joke?!? Besides the ethical issues what you are doing, at least in NJ, is patient abuse, assault, battery and pushing gross negligence. Do restraints need to be used sometimes? Yes they do. But if soft restraints (ie crevats or specialized cuffs) aren't enough then hard restraints should be applied by law enforcement and said LEO should ride along with said patient.

Here is the NJ EMS Field guide if you need a reference source.

http://www.state.nj.us/health/ems/documents/ems_fieldguide/nj_ems_field_guide.pdf

To the OP. You should try and contact your State's Dept of Health and start a dialog with the psych board to see if you can get the protocols at least looked at. Sometimes it takes a voice for a problem to be known. They may believe everything is working fine because they haven't heard a complaint about it. hearing from one of their front line workers vs a lawyer might be just what the system needs. You're bringing attention to a deficency not a claim sometimes that will help get through the wall of red tape otherwise encountered when money is on the line.

Edited July 10, 2013 by uglyEMT

[scubanurse]

Typically with psych patients we have one cop ride in the back and the other ride in the patrol car behind. We usually don't mention we are going to the county psych ward unless they directly ask. The key is to keep these people as calm as possible. Nothing is worse than a crazy guy in the back who gets a little too upset with you. Also, consider restraints if the patient gets too rowdy. Something about EDPs, they seem to like me.

There is just so much wrong with this I don't even know what to say.

One of the absolute key parts of therapeutic communication is honesty. Regardless if they are EDP or not, you NEVER lie to your patients! Your wording in this also makes me concerned that you really lack the skills to deal with psych patients, the bolded statement in particular. I strongly suggest you do research on therapeutic communication skills as they will help you communicate openly and honestly with the psych patients you encounter, while keeping them as calm as possible. Nothing positive comes from lying to patients.

Unless the patient is super combative, the cop should ride out of view of the patient, this will help keep the situation calm and in control. Restraints should be a last resort and not just because they get "rowdy." There has to be a direct threat to you or the patient to place someone in restraints. They are indicated at times, but should be checked every 15 minutes and on long transports, you should change the position of the restraints at least every hour. Restraints have some very serious consequences if they are used improperly and should not be taken lightly.

[BushyFromOz]

You make the assumption that therapeutic communication skills always work, and that a patient intially responsive and co-operative will remain so

I absolutely agree with the statement that there is nothing worse than a crazy guy in the back who gets a little to upset with you. Even the best communication strategies can fail and calm patient can beceme very agitated and agressive without provocation or warning. Unfortunatley, it part of the parcel for some mentally ill people, but i dont condone lying

I liken it to two wet cats fighting inside a shoebox going down a slippery slide.