Psych Patients, Take by Amb. or Police?

[Para-Medic]

Hello,

Well, around here we have a pretty substantial amount of psych calls. Some are suicidal, homicidal and others are just odd. So i had this one run where guy was suicidal. The story was he was in a confrontation with his cousin and family stated he grabbed a knife to try and end his life, but the patient stated he grabbed a knife to protect himself. So this is the second time we go out there and our MD states that we should take him. So, OK we take him against his will whatever. We get there and the hospital (which is not a psych facility BTW) basically ask him a couple of questions and get him to sign a release. Our paramedic hears the story and states how dumb it is that they ask him a couple of questions (like do you want to kill yourself/others) and all he has to do is say no to leave. Then again I think to myself, but don't we always take psych patients to this hospital just because it's the closest facility? If he really did try to harm himself shouldn't the police officers of escorted him instead? Not long ago we had the same thing happen and police officers heard the guy say he wanted to kill himself and took the patient himself. Our closest psych facility is about 45 minutes away and they feel it's inconvenient to put a ambulance out of service for so long. Still, sometimes our captain states when to take someone to a psych facility or just a normal hospital. I just don't understand why we would take someone who would require a psychiatric evaluation to a normal hospital when the hospital really can't do anything. Our closest hospital is sometimes constantly on diversion for no rooms and they put a suicidal/homicidal patient out in the waiting room. Does it really make sense for the department to do this though? I would like to hear some inputs and procedures you all take for these type of calls. Please if you have any thoughts, opinions or advice please post. THANKS

[limbstruck]

The Sheriff's department here used to transport the psych patients in their cars, however, things have changed and now we transfer with an officer in the truck with us. When they reach the ER they are screened (psych evaluation) and then transfered to a pychiatric facility. The kicker is that the sheriff's department does that transfer, don't ask me why, I just do what I am told.

[Ridryder 911]

All of our "pysch" patients are routinely transported for evaluation per Sherrif or LEO, unless they require medical intervention enroute to another hospital. Emergency Oder of Detention (EOD) (pysch eval) patients are cuffed (always, no matter how safe they appear), and transported by uniformed officers to a mental health facility.

Be safe,

R/R 911

[Para-Medic]

what I would like to know is whos call is it? who would be able to say this person will go by amb. or SO? I like it when our sheriff take them but they fight to send the patient with us. I don't blame them but I think it should be done because they have more units than us and they can actually get there faster.

[Ace844]

Then again I think to myself, but don't we always take psych patients to this hospital just because it's the closest facility? If he really did try to harm himself shouldn't the police officers of escorted him instead? Not long ago we had the same thing happen and police officers heard the guy say he wanted to kill himself and took the patient himself. Our closest psych facility is about 45 minutes away and they feel it's inconvenient to put a ambulance out of service for so long. Still, sometimes our captain states when to take someone to a psych facility or just a normal hospital. I just don't understand why we would take someone who would require a psychiatric evaluation to a normal hospital when the hospital really can't do anything. Our closest hospital is sometimes constantly on diversion for no rooms and they put a suicidal/homicidal patient out in the waiting room. Does it really make sense for the department to do this though? I would like to hear some inputs and procedures you all take for these type of calls. Please if you have any thoughts, opinions or advice please post. THANKS

"Para,"

There are a few reasons a psych is transported to an ER first.

A.) To rule out primary medical/tox causes which may be causing said psych issue.

B.) To screen the patient to determine whether admission is waranted and to give them access to the opportunity to get EMH help.

C.) To find the most appropriate facility for them and where their insurance (should they have it) pay for them to go.

On your second point, about EMS vs PD, I think it is a mix of:

A.) Law enforcement laziness and unwillingness to "transport" someone, potentially out of town (thus placeing the town down one less available PD unit) to an ER.

B.) The fact that because some psych d/o's are caused by medical issues, if they are missed than the patient may die or suffer permenant damage, placing the PD in a potentially -/teneable litigous position as medicine is not in their "role"

Thus you find yourself with the current state of affairs....In my area we take all of the psychs via EMS means period, first to an ER then potentially later to the psych facility its self. The only notable exception I have seen is when a prisoner is already in the PD system and gets brought directly to an ER by them due to EMH issues. It should be noted that even in this even sometimes we transport the patient with LE. In the end YMMV, and it depends on your area. IMHLO, its a LE function and should eb handled by them in the majority of cases. If they feel uncomfortable, then an EMS unit should meet them at their location, do a full assessment, and if they find no serious medical issues, off they go with the PD!! For those of you who work in systems where the PD does this on any kind of regular basis, consider yourself lucky.

out here,

Ace844

[Guest]

what I would like to know is whos call is it? who would be able to say this person will go by amb. or SO? I like it when our sheriff take them but they fight to send the patient with us. I don't blame them but I think it should be done because they have more units than us and they can actually get there faster.

I'am sure that our PD transports a lot of these pts without us ever being called out. Obviously they find no medical reason for us to be bothered with them. But there are a few that we do get called out on and these are the ones who have downed a few to many pills, or caused themselves to bleed massively or what ever. Most of the PD's do not want to have to ride the Ambulance with us...which I think is bogus. We are not trained to be cops and I am always a little unsettled when transporting one alone. PD will usually say they will follow us in their vehicles....and during transport they are no where in sight..arriving at the ER still they are no where in sight. I do feel a little unprotected when this happens.

[Richard B the EMT]

One of the guys from my "house" (we're an FD-based service) was hurt last night, while transporting an EDP. Apparently, while picking the patient up from the floor, the patient moved, my guy tried to compensate, and threw his back out.

Thank goodness for Worker's Compensation.

Per my lieutenant, who I asked about the incident just before I went off shift, while EDPs are actually a LEO problem, we just supply the vehicle for transport. If he had his "druthers," PD would do the transportation, also. Until the rules get changed, however, he suggests we always have a LEO ride the ambulance with the patient and crew, that way, if the patient has to be restrained, any onus will be on the LEOs, not the EMSers.

[AnthonyM83]

Around here it tends to depend on the situation. If the patient is combative the PD will take them.

If the patient is resistive, but not actively combative, they might just be strapped to the gurney and a police car with follow the ambulance.

If patient is cooperative, they'll go with the ambulance and the officer will meet EMS at the hospital.

I imagine a cop would feel uncomfortable being enclosed with a subject in an ambulance, instead of in their backseat....

[Dustdevil]

If patient is cooperative, they'll go with the ambulance and the officer will meet EMS at the hospital.

All patients are cooperative... right up to the point where they become suddenly and violently uncooperative without warning.

I imagine a cop would feel uncomfortable being enclosed with a subject in an ambulance, instead of in their backseat....

Sorry, doughnut boy. If you are "uncomfortable," I am ten-times that. If it ain't safe for you, then it damn sure ain't safe for me. Your purpose is not to catch the guy after he kills me. Your purpose is to protect me from him in the first place. Either you ride, or you transport in your caged car.

NOTE: "Doughnut boy" and "you" are used in referring to the cop in the scenario. They are not a reference to you personally.

[strippel]

We had a long discussion of this on a local board.

There were two bottom lines.

First, there can very easily be a medical reason for the person being disturbed. This leaves the Po in a severe liability position should something go wrong.

Second, EMS may possibly get paid for doing EDP transports (if the patient has insurance), the police never will.