Psych calls

[RngrVnc33]

what are your thoughts? lights&sirens? require ALS? Do you tell the POlice no for routine SCIP runs? thoughts on the mobile "kidnapping" unit from SCIP @ LMC?


-VK-

[tootall]

Westampton runs the most Psych calls hands down in this county and we still deal with issues everyday.

What constitutes a Psych call? Someone "hears" someone else say they wanna kill themselves but than that person denies it. What do you do? Kidnap them?

We have a Psych Hospital that WONT allow our Police to enter the facility with their guns....so we are left alone...or better yet someone goes to that facility for "Help" and they are told them MUST go to LMC first!

Its a fine line we play...get police involved early and try to work out a good game plan.

[cheeseunit31]

Vince you bring up a good point, and to just touch on what craig said, the 27 definatly gets their fair share of Psych calls with Hampton Hospital, Hampton Academy, Family Services, Special Services Schools, and not to mention the welfare offices, but unfortuantly the police will never transport a psych for ya, they are more concerned with getting outta there as fast as they can! As craig can tell ya we rarley get the pd on any squad call. And they usually make it worse with a psych because they get them all fired up. I always go emergency speed to psychs, but 99.9% of the time i go reduced to the hospital unless they are outta control. It just does'nt make sense rushing to the hospital, putting citizens and drivers in danger for what?!? someone that hears voices? we are lucky in Westampton to have 2 hospitals that are in connecting towns, some towns you might be enroute to the hospital for 30-40 minutes with out lights and sirens. but it is the crews calls.

[opsoverkill]

Personally we get abused with regards to this type of call. I believe that the outreach programs but due to staffing cuts or the liability issue just let the squad come out to do the transport.

I have no issue when the pt needs to be restrained because we have the equipment to properly restrain a Pt.

Now for the fella and gals in the 27th. I would mandate that that hospital have a NON-Emergency transport company contracted for these type of calls. And why can't they evaluate the Pt. anyway? But, it really comes down to the almighty dollar is it cost effective to run all those jobs! And are the people calling for Emergency being affected while you are unavailable running all these Transports.

And for the Police not being able to come in. F-them if they are not permitted to provide assistance to you. Tell the hospital meet use at the door. Had that issue with the Prison in Camden. They were making alot of rules and we finally said enough is enough your rules could effect the performance of our jobs and if you do no permit us to come in with what we need Meet us outside. Amazing how long that lasted.

You could alway stay at level one staging and request the police to ensure the scene is safe.

[actanonverba]

Really, what can ALS do on SCIP runs, besides Haldol-ing the shit out of the patient?If the patient is to the point where they need physical or chemical restraint, you may as well just let the police handle it, because you open yourself up to an onslaught of legal and ethical issues.
Lights and sirens, is always a decision that you have to make, with regard to your department policy. I do agree with cheese that a majority of the time, you will be going to the hospital reduced speed. If it's a true "psychiatric emergency" and your patient has "unstable" psychoses or neuroses you should involve or at least notify the PD to cover yourself.
As for restraints, you'd better be able to soundly justify why you're taking it upon yourself to revoke the person's right of movement, and why they are either a real or percieved harm to themselves or you.
Further, Document, document, document. If you're restraining a pt, why, what time were they applied, how were they applied, when were they rechecked, when you assessed PMS, etc.

Like Craig said, it's a very fine line. Use solid clinical judgement, familiarize yourself with current protocols and guidelines for dealing with psychiatric patients,restraint, and know the patient's rights and be an advocate for them.

I know Virtua recently held a class on EMS and restraining patients. Did anybody go? If they did, what's the newest protocol/ what did the class have to say?

[cheeseunit31]

sean great suggestion, if they have a problem with the pd coming in armed, then they should have the pt waiting for us in the lobby, there have been a couple of times(and craig can vouch for this) we have had a scip run at 4 am, theres only 2 nurses in the facility, and the doors are locked behind us, we had a violent pt and the nurse is no where to be found...now what do you do? luckly the police got in, but you have 20-30 patients in one lock down sector, againts what 2 to 5 people at 4 am.

[Kramer]

whats our limitation as EMT's as to what we can do if were attacked? i've prolly been told but cant think of it right now

[mumbles181]

While I would agree tht b/c of the facilities in Westhampton you guys probibly get the most Psych calls, but as far as residents Pemberton is on top.

We have the same problem, PD is no where to be found on most of these calls. When they are there they usually get the patient all fired up and then hand the patient to us saying "enjoy" as they laugh and leave. The other thing they do is when the ptient refuses trnsport they tell the patient that they must go with us or go to jail. I had 1 patient challege that and they just let him go. What a suprise.

Kramer:
If you feel your life or the life of others is in jeopary, you may "contain" a patient reasonably. You can use Cravates to hold the patient down, but you may NOT use any kind of "Hard" Restraints (Handcuffs, Leather Restrants, ect.). To tell you the truth if I have no LEO with me, I will let them go. They can jump out of my ambulance when I stop and run.

If they are attacking you........ Protect yourself and get out of the situation! Back out.

[Kramer]

well, if we go by size of district, wrightstown has the most psychs...and wht happens if were still evaluating them before were able to restrain them and they snap? how much force, if any, can we use? in my district it takes the cops a while since theyre coming from bordentown(NJSP)

[mumbles181]

Let them go, No need to get yourself hurt trying to restrain an out of control pt. If they want to run let them.

If they re attacking you, then you have a right to defend yourself. Just make sure you can justify what you did and why you did it.

[Kramer]

ok, because this has almost happened to me once, but then the very large state trooper came in and "subdued" him

[1900]

I can definately say d18 has more then their fair share of SCIP Pt.s...but now working in d30/90 we have quite a few as well...truthfully though it doesnt matter how many you have, it only takes one.

Since I have been on both sides of the fence (EMS/POlice) I see both sides...First no EMS responder should go to the scene of a SCIP Pt. without the POlice first securing the scene...if you have to wait so be it, wait...the POlice can be busy too and in d18 with 5 cops working 64 square miles sometimes POlice calls have to be triaged as well. Once you are there a determination should be made whether EMS or POlice will be transporting...and again in Pemb Twp we always would rather the Squad tranport then POlice again we were always short staffed as it was, and if a cop transports to SCIP then normally get stuck waiting alot longer then the Squad...and like everyone else has said, 9 times outta 10 the POlice only make the Pt. more upset...Alot of times the Pt. is more at ease with EMS then with POlice and lets face it, thats what we want...

However anything can set these people off at anytime...I was recently put in a situation where the Pt. asked to be transported to SCIP so we obliged, and about one minute into transport the Pt. became extremely violent, not to mention the size of the Pt., he was a very large man...we pulled over we were in a van so I couldnt get out, and called for the POlice. Ultimately in the end it became physical...

Now, if you know anything about SCIP Pt.s then you know they have super human strength...a normal or average size person will definately kick your ass. Remember we are not cops, if they wanna go LET THEM, if a scene gets bad LEAVE.

I would rather explain that my safety was in jeopardy so I let the Pt. go and called POlice, then getting physical with a Pt. and the Pt. ultimately becoming injured, more injured or worse...EMTs are not trained to fight or subdue Pt.s so dont...I often find myself stepping in when I should not, I have to remember what uniform I am wearing, but trust me after you have been involved in a few lawsuits your thinking will change.

We all have to work together and get the job done, the Sqauds have to see the Cops point of view and the Cops need to see the Squads point of view. EVERYONES SAFETY is what we need to be concerned with...If you as an EMT do not feel safe then refuse to transport, or have an officer ride with you or follow you...

As for certain facilities not allowing fire arms into the facilty, F them, the Cop has a gun for a reason, if a Cops not gonna go in then why should you, you are only asking for trouble. Buttonwood has tried that in the past, a Cop is not going in without his gun, end of story...it is now up to the facility to figure out what they are going to do to get the Pt. to you.

The thing with Hampton first needing Pt.s to go to LMC is ridiculous...but things like this happen all over the County...Everyone has an excuse and it is always left up to the Squad or Fire Co depending on the situation, never the facility, the Cops, the Doctors, the Nurses, etc...it seems the less your paid the more things get dumped on you, then you feel you need to CYA...

In closing YOUR SAFETY is paramont, if you do not feel comfortable then say so and handle it appropriately.

[division2]

I agree with everything said. the bottom line is we (the EMS agency) transport far too many SCIP patients. If there is a medical need then fine we take them to the ER. For most of them we are only a transport. Just because they are behaving when PD is there doesn't mean a thing. Once the PD is gone all bets can be off. Now for the kicker. How many SCIPs have you transported to LMC only to have the ER nurse send them to the waiting room. The whole process needs to be reviewed and retooled. It really bothers me that the ER sends so many calls to the waiting room. We don't get to pick and choose who we transport. When we get there the patient should be turned over to the ER. No way should we be sitting at registration and then to the Triage nurse in the waiting room. I have spoken to the Administrators from LMC and they assure me that this is not the case. Yeah Right.

[RngrVnc33]

ofcourse this is a double edged sword, but I cant see how its justified to take the duty crew out of service to transport a voluntary scip transport.........

[1900]

division2 said:

I agree with everything said. the bottom line is we (the EMS agency) transport far too many SCIP patients. If there is a medical need then fine we take them to the ER. For most of them we are only a transport. Just because they are behaving when PD is there doesn't mean a thing. Once the PD is gone all bets can be off. Now for the kicker. How many SCIPs have you transported to LMC only to have the ER nurse send them to the waiting room. The whole process needs to be reviewed and retooled. It really bothers me that the ER sends so many calls to the waiting room. We don't get to pick and choose who we transport. When we get there the patient should be turned over to the ER. No way should we be sitting at registration and then to the Triage nurse in the waiting room. I have spoken to the Administrators from LMC and they assure me that this is not the case. Yeah Right.

Chief,

As for putting SCIP Pt.s in the waiting room yeah that can at times be alittle iffy...as we all know they can turn at anytime, when we bring in SCIP Pt.s we give security and the charge nurse a heads up, we also relay if this Pt. may pose a problem. I have not always been happy with the outcome but its now there Pt. and ass as well.

As for other Pts being put in the waiting room, I have to respectfully disagree. Like you said we dont get to pick and choose who we transport and maybe if we did we wouldnt have so many bs calls. Now I get paid to answer calls and thats fine, answer calls I will, however my problem is when we miss or are delayed getting to a true medical emergency because someone who should be going to their family Doctor felt they would get seen faster in the ER if an ambulance brought them in....So yes a Therapeutic Wait may in fact help get the point across that the ER is for truely sick people...

And on the flip side I cant tell you how many times we have brought in truely sick Pts that needed true immedicate medical attention and had to wait for Pts to be moved around the ER and out of rooms to open a room for the truely sick Pt.

So in closing if I feel a Pt. truely needs to be seen I am persistent that the Pt. needs to come back, if I do not feel the Pt. is in need of immediate medical attention we automatically take them to registration and give our Pt report to the Triage and Charge Nurse and have them sign off.

[division2]

1900, I agree. Security always gets a heads up on SCIPs to the waiting room. I would rather be busy on a shift than sit in station. It is not about my time in the ER. It about the service not being available for a potential real emergency. I generally don't take anyone to chairs without being sent there. Even the ones that deserve it. Telling the patient first that it is going to happen and then having the nurse end them hopefully drives th point home. Ambulances are for emergencies. Therapeutic wait, I like that. I hope you haven't copyrighted it. I'm going to use that one.

[woody401]

1900 said:

division2 said:

I agree with everything said. the bottom line is we (the EMS agency) transport far too many SCIP patients. If there is a medical need then fine we take them to the ER. For most of them we are only a transport. Just because they are behaving when PD is there doesn't mean a thing. Once the PD is gone all bets can be off. Now for the kicker. How many SCIPs have you transported to LMC only to have the ER nurse send them to the waiting room. The whole process needs to be reviewed and retooled. It really bothers me that the ER sends so many calls to the waiting room. We don't get to pick and choose who we transport. When we get there the patient should be turned over to the ER. No way should we be sitting at registration and then to the Triage nurse in the waiting room. I have spoken to the Administrators from LMC and they assure me that this is not the case. Yeah Right.

Chief,

As for putting SCIP Pt.s in the waiting room yeah that can at times be alittle iffy...as we all know they can turn at anytime, when we bring in SCIP Pt.s we give security and the charge nurse a heads up, we also relay if this Pt. may pose a problem. I have not always been happy with the outcome but its now there Pt. and ass as well.

As for other Pts being put in the waiting room, I have to respectfully disagree. Like you said we dont get to pick and choose who we transport and maybe if we did we wouldnt have so many bs calls. Now I get paid to answer calls and thats fine, answer calls I will, however my problem is when we miss or are delayed getting to a true medical emergency because someone who should be going to their family Doctor felt they would get seen faster in the ER if an ambulance brought them in....So yes a Therapeutic Wait may in fact help get the point across that the ER is for truely sick people...

And on the flip side I cant tell you how many times we have brought in truely sick Pts that needed true immedicate medical attention and had to wait for Pts to be moved around the ER and out of rooms to open a room for the truely sick Pt.

So in closing if I feel a Pt. truely needs to be seen I am persistent that the Pt. needs to come back, if I do not feel the Pt. is in need of immediate medical attention we automatically take them to registration and give our Pt report to the Triage and Charge Nurse and have them sign off.

I agree with taking patients to triage in regards to patients that you feel dont need imediate care but i will have to disagree with going to a registration desk then go to a triage nurse to me that alone dampens our turn around times to make yourself available for the next call

[1900]

I agree with taking patients to triage in regards to patients that you feel dont need imediate care but i will have to disagree with going to a registration desk then go to a triage nurse to me that alone dampens our turn around times to make yourself available for the next call

You simply take them to the registration desk, walk to the Charge and/or Triage nurse tell them what you have brought them and leave.