Sedation of Mentally Ill Patient for Transportation

[island emt]

From washington state to Utah is going to be a long and dangerous transport for this Patient.

I for one would not want to be on this transport without legally required restraint and a plan along the way for rest stops and feeding him in secure places.

Getting an order for the above will not be easy .

You cannot have someone confined and restrained for that length of time in the back of an ambulance, especially against their will.

Ruff: his honor the grand mayor of Sasquatch land has plenty of time on his hands to deal with blowup dolls :-}

[ERDoc]

This sounds like it might require a higher level of care than a paramedic. There is no way you should be sedating him for the entire trip, especially if he does not need it.

[Just Plain Ruff]

About 15 hours in the ambulance. That's a long trip.

Meal breaks, restroom breaks, rage breaks, no x-box.

This is NOT a trip I would want to take, pt sedated or not.

You need to make sure you have a good updated GPS in the truck with all the local close by hospitals in it. You need your cell phones fully charged and ready to go for when and IF , and it's more likely a when this guy goes off.

This is definately NOT a trip I want to take. This qualifies as Hazard duty to me. I would not volunteer for this trip.

[scubanurse]

Is a medical fixed wing flight an option? Would be much quicker and can just keep him occupied with an ipad, IV access when needed with orders for IV sedation.

[ERDoc]

I don't think I would want to be in a plane, at altitude, if he has an outburst. It's a lot easier to jump out of an ambulance than an airplane.

[scubanurse]

I don't think I would want to be in a plane, at altitude, if he has an outburst. It's a lot easier to jump out of an ambulance than an airplane.

I know :/ I was just thinking it would be a lot quicker and the kid might think it was a cool experience. Overall just sounds like a crappy situation.

[rock_shoes]

Is a medical fixed wing flight an option? Would be much quicker and can just keep him occupied with an ipad, IV access when needed with orders for IV sedation.

This strikes me as a much safer option for all involved. Relatively few aeromedical services have specific procedures for transporting potentially volatile psych patients. Levels of sedation in the aeromedical environment can range anywhere from dimenhydrinate for air sickness/mild sedation to having the patient sedated and intubated for the flight. The level of sedation targeted is varied depending on an individual patient's needs as assessed by the sending physician, air medical transport advisor, and attending flight crew.

The following article gives a brief outline of the psychiatric air medical transport program used in BC as it was first implemented.

http://www.bcmj.org/article/criteria-sedation-psychiatric-patients-air-transport-british-columbia

The initial implementation of these procedures was heavy handed with regard to sedation levels and came under much scrutiny. As procedures have been adapted over time the levels of sedation used have become increasingly adapted to individual patients instead of a more blanket policy. It is worth noting that as of now not a single psych patient transported has been diagnosed with adverse effects attributable to being sedated for transport.

http://www.theglobeandmail.com/news/british-columbia/bc-rules-requiring-sedating-mentally-ill-for-transport-risks-lives-mds-say/article4186567/

[Just Plain Ruff]

Well it has now been a day or two since the supposed meeting with the doctor and no return from the OP.

[lookingforasolution]

Wow - I'm grateful for the responses and information that has come through since I last checked this out. The appointment yesterday went incredibly well. This specific doctor has been working with the kid over the past 5 years and is pretty familiar with the situation; however, previous attempts for specific therapies and programs have never panned out. The mother got a chance to have a one on one conversation with the doctor before the actual appointment. That was crucial because they got to discuss some things that may have made the brother uncomfortable (also, we prepped her to ask some questions based on points made by those who contributed here - THANK YOU!!!). When they all sat down, the doctor explained how incredible this opportunity is for him and his future. They focused on the positives of the program, mainly activities & the chance to farm (which he loves), but also told him that we would all be here for him once he returned - regardless of how his experience went. He trusts this doctor and I do believe he realizes that this his last chance to get real help before turning 18.

The hardest part through this has been getting him on board to go. There was a breakthrough during that appointment in which he admitted that he needed a change. For the first time, he actually embraced this (which led his mom to tears of joy/relief).

As for the actual trip down to Utah, I gotta tip my cap to the kid - he came up with his own plan. He told the doctor and his mother that if he was going to go, he wants his mom, dad, and sister to take him. He said it was important to him that they spend that time together as a family before he leaves and takes this on. The parents have been divorced for a while, and the father been a real pain when it comes to helping with his son.

Although we know there's that constant possibility of him "blowing up" (which now makes me laugh every time I say that because of that hyperlink lol), everyone is taking comfort in his current perspective on the trip. They are all embracing it as an opportunity to catch up on lost time and to stand together as one family to support him - this kind of solidarity has been absent for years.

They are leaving within the next 10 days. If he "blows up", they have his prescribed medication to calm him down. The doctor suggested using what they normally use when he is at home because he is comfortable with it (and it works). But fingers crossed, that won't be necessary.

So, what began as an idea to knock him up on medication and get him down there as fast as possible, regardless of his desire, has turned into a much-needed family vacation and hopefully a new beginning in his life. He is a very smart kid and I think he realizes how important this is to his development for life in the real world. I'm not sure we would be in this place now if it wasn't for some of the feedback I got on this site. Thanks again. I look forward to posting about a successful trip in the next few weeks.

[scubanurse]

Sounds like a great outcome for all involved, good luck.