60 y/o Female, that called for nerves are shot.

[nsmedic393]

Of course things will go wrong. When something that is unpreventable goes wrong we roll with the punches. A psych patiant freaking out in the back of an ambulance can be prevented by simply not putting them in the ambulance in the first place. This does not apply to every person with a psychiatric problem of course but there is the option to have them transported by the police if you think there is a chance they might harm themselves or you.

I can make myself aware of possible dangers all I want but awareness isn't going to be able to physically stop a patient that is trying to jump out of the ambulance while were going 100 km/h down the highway, or trying to grab the steering wheel or trying to harm me. If I have any doubt at all that the patient will be cool, calm, and collected the whole ride than they aren't getting in my ambulance.

[Callthemedic]

............AND meanwhile back at the thread.

Stick with facts and objective data here.

Pt reports "stressed" but that is subjective. We want objective findings.

After all, she may say "stressed" for a cornucopia of symptoms.

She is not the trained professional, you are. I recommend that you collect objective data in the form of a hx to r/o psych consult instead of starting there with nowhere to go.

2nd what Dust said. Every patient needs to be scrutinized with the same objective exam regardless of cc.

I would ask this LOL what she means by "stressed". Pain? sob? Confusion?

S.A.M.P.L.E.

M. P. and E. should be interesting.

[EmergencyMedicalTigger]

There are many BS calls in EMS. Sometimes after seeing so many really serious pts, there is a tendency to write off pts who don't appear to be ill. Here's something to consider, would you rather just transport this pt who has called b/c she said she is too mentally disturbed to drive herself or would you rather respond to a MVA a little later b/c she 'loses it' while driving? She has the potential to cause harm to herself and numerous others around her. If she needs help and calls you, just transport her, write your simple run report, and go on with your day.

[Ridryder 911]

Okay, since approximately >80% of all illnesses are psychosomatic, then we are in trouble in EMS!

First realize, EMS is piss poorly educated in pysch and behavioral medicine illnesses. Second, just making excuses about not knowing what and how to handle medical calls is B.S. ... yet again, the piss poor attitude of ......"if I can't see it, I can't treat it"... attitude.

NO!!.. I would never recommend a mentally unstable to "drive themselves" to ER in a 4 ton weapon, missile.. If there is a reason that they ......."could not handle it "...then we need to assess and treat appropriately. Yes, this might mean a time you don't have to start an IV or place a monitor on them (god forbid !!) ...

Yes, it is a shame that EMS has not recognized a large portion of the medical health problems in the U.S. we still only address this in one chapter.... where other health care professionals adress this in more detail.

R/r 911

[medic_ruth]

First realize, EMS is piss poorly educated in pysch and behavioral medicine illnesses

Amen Brother

Second, just making excuses about not knowing what and how to handle medical calls is B.S. ... yet again, the piss poor attitude of ......"if I can't see it, I can't treat it"... attitude.

Double Amen

Medic53226: Why the suspense, friend? let us know what was up with this patient.

[Dustdevil]

There are many BS calls in EMS. Sometimes after seeing so many really serious pts, there is a tendency to write off pts who don't appear to be ill.

Although this is indeed true, it is really a double edged sword. Most in EMS don't see a lot of "really serious patients." The majority of what most EMS personnel see is not serious at all. And this causes even more complacency than seeing a lot of serious patients. Either way, those who do not bleed profusely or show funky rhythms on the monitor get mistreated. Too many wankers got in this business for the excitement, and when they find out that over ninety-percent of their work is a very boring routine, rather than move on, they just stay in the field with their piss poor attitudes.

As Rid alluded to, this is a problem with the EMS educational system at its very core. If people weren't introduced to EMS with nothing but 120 hours of first aid training on how to deal with the most serious conditions, there wouldn't be this entrenched mindset that sexy, gross, life threatening emergency conditions are all that we are about. If the entry level of education for EMS included the normal lifespan, social and psychological issues of human development, and routine illness that people commonly present with, not only would we be much better prepared to deal with MOST of our patients, but we also might not have this annoying attitude being copped by so many providers that anything that doesn't bleed is not worthy of our attention. And maybe we wouldn't have so many instances every year of EMS providers undertreating, or worse yet, no-riding people who subsequently die because of it.

[raptor]

I think too many prehospital practitioners see 'psych' as an annoyance. Altered mental status can also be from organic causes. How do you know what is going on until you assess every person thoroughly and equally? The ethics of paramedic practice is dear to my heart. What level of care and understanding should our own family members, the people we love dearly, receive? That should be the standard for all. Ambulance should always be the primary transport authority for all mentally ill people. I am confronted with the 'psych' hatred every day in my colleagues. I find it offensive, especially since I've cared for a lot of mental health pts in the nursing setting also. The police culture, philosophy, and praxis does not allow for police to be the most ethical response to mental health. Paramedics should actually be empowered to assess and arrange placement for pure mental health crisis, fast-track mental health clients in ED, arrange community care, or refer. Currently this segment is let down by every sector in health care. Paramedics should take the lead, by lobbying, and in practice. In Australia we have been evolving to allow sedation using either midazolam, haloperidol, or droperidol over the last decade. I think it's time to take it much further.

[Quicksilver]

okay I'll play, since I haven't been doing this for 13 years I don't have an opion to get in the way of pt care...yet

I have the NOI so to speak, what is my general impression of this women, her house, her dogs...

I'd find out the SAMPLE and OPQRST :arrow:

[medic53226]

Sorry for the delay I have been swamped the last few days, But anyway This pt I was passing of to my Intermediate Partener and he was more than happy to take the pt, so he asked if he could put her on the monitor, he was a new intermediate and I said you dont have to ask my permission to put her on the monitor, and he did so as I was leaving the back of the ambulance. Because she was AOX3 no trauma, no problems, just stressed out over he family life. So as I was stepping out of the ambulance my partener said hey Chad take a look at the monitor and by the tone of his voice, I knew that I really didn't want to see what was on the monitor. So I looked anyway and found the pt to have Tombstone or Firehelment T waves with no distress so I checked the leads and they were right, so I went enroute with my partner driving, and did everything enroute, Pt is W/P/D and her only complaint is that her right elbow started hurting 2 days ago, and she had recently taken a nerve pill but that was all, so in this system we can do 12 Leads and when it printed it stated that she was having a Inferior MI, but she had no symptoms, so as I turned to call my report in I stated my findings and the pts condition and the Dr though I was a idoit, I for sure, but when I got done in the 1 min or less, I spent calling in my report she has went from W/P/D to PALE, DIAPHORETIC, PRESSURE ON THE in her right shoulder, N/V now I had already gave the asa, nitro per protocol but had to request MS if needed when I called, and her BP drop to 98/64 for 132/86. The pt was taken cath lab were on unblockage of the artery she went into VF was shocked and went hope 1 week later. To this day all I say is what I thought that day, were in the hell was that in the paramedic book.

[bassnmedic]

I believe you can find that in the same chapter as the one that says you should put your psych patients on the bench seat..

...........

Good catch and sounds like you may have a good partner as well.

Take care,

Todd