"Is he competent?". Do you have protocols or informal standards?

[mycrofft]

You arrive at a scene downtown. Someone is sitting quietly on a bus bench with a police office standing by them, and informs you the subject is "5150". Let's say the person also looks a little disheveled and maybe has a scrape on their knee.

DO you have a protocol about alleged "5150" cases (threat to self or others/psychiatric)? Do you have somer sort of eval you perform? What about transport of such people against their wishes, chemical or physical restraint?

(I looked for a Walmart fashion fail to include, but they all had people's faces or were just too crude).

 

[JPINFV]

If the officer has signed the form, then the patient goes. I might not agree with the 5150, but pretty much the only person who can break a 5150 is a psychiatrist.

 

[Akulahawk]

If the officer has signed the form, then the patient goes. I might not agree with the 5150, but pretty much the only person who can break a 5150 is a psychiatrist.

Pretty much this...

It's up to the patient to decide if he/she wants to sue the Officer for deprivation of rights under the color of authority, especially if the patient isn't/wasn't truly a danger to self/others.

 

[DrParasite]

DO you have a protocol about alleged "5150" cases (threat to self or others/psychiatric)? Do you have somer sort of eval you perform? What about transport of such people against their wishes, chemical or physical restraint?

for clarrification, who is making the 5150 call? the EMS provider or the LEO?

if EMS isn't making the call, then there is no need for EMS to perform the assessment. LEO made the call, so EMS serves as the taxi service. Not only that, but since the LEO is making the call, the LEO should be accompanying the patient to the ER, and restraining as neccessary.

If there is any issue, it should be falling on the LEO who signed the 5150 form, not the EMS provider who played taxi service.

Let me ask another question: if the officer says the person is 5150, and your eval and protocols say they aren't, then what? the 5150 form was signed by LEO, so now we are at an impass: the person should be committed per the legal expert (the cop who signed the form), but the taxi driver is disagreeing and now is refusing to do their job and transport the 5150 (as per the legal definition) to the proper authority. I'll even take it one step further: when the white shirts get involved (ie, the various supervisors and admin), who do you think will be coming out of this situation still employed? the municipal police officer who has a pension, union and beeon on the job for 5+ years, or the private EMT whose agency wants everyone to be happy, including other public safety agencies and the governming body, and knows that the EMT can be replaced in about 4 weeks with little disruption to the EMS agency's overall operations?

 

[JPINFV]

for clarrification, who is making the 5150 call? the EMS provider or the LEO?

EMS providers can't place patients on holds in California.

if EMS isn't making the call, then there is no need for EMS to perform the assessment. LEO made the call, so EMS serves as the taxi service. Not only that, but since the LEO is making the call, the LEO should be accompanying the patient to the ER, and restraining as neccessary.

Why? Is the officer going to stick around the ED and restrain the patient in the ED as necessary? Does your ambulance not carry restraints? Are EMTs in your state not trained in restraining patients?

 

[Rialaigh]

EMS providers can't place patients on holds in California.


Why? Is the officer going to stick around the ED and restrain the patient in the ED as necessary? Does your ambulance not carry restraints? Are EMTs in your state not trained in restraining patients?

The officer made the call on whether the patient was a harm to themselves or not. The officer will explain that to the nurse. If I assess the patient and don't think they are a harm to themselves they still get transported with the officer, the report however will state that the officer has the patient under his control and is requesting the patient get medically and psychologically cleared. If the officer absolutely refuses to go with the patient I will let him know I am going to put the patient in the ambulance and if the patient wants to get out in a block and not go to the hospital I am going to let him.

 

[exodus]

The officer made the call on whether the patient was a harm to themselves or not. The officer will explain that to the nurse. If I assess the patient and don't think they are a harm to themselves they still get transported with the officer, the report however will state that the officer has the patient under his control and is requesting the patient get medically and psychologically cleared. If the officer absolutely refuses to go with the patient I will let him know I am going to put the patient in the ambulance and if the patient wants to get out in a block and not go to the hospital I am going to let him.

That report is dictated in the narrative portion of the 5150.

 

[Angel]

no forms, if the officer has them on a hold they are transported accordingly, usually the doc will decide if they need a psych consult based on all information provided even the patient.

there is no reason why the officer cant take the pt to the ED his/herself. I don't have the training or qualifications to go against an officer who believes the person is a 5150.

handover reports are important

 

[Akulahawk]

no forms, if the officer has them on a hold they are transported accordingly, usually the doc will decide if they need a psych consult based on all information provided even the patient.

there is no reason why the officer cant take the pt to the ED his/herself. I don't have the training or qualifications to go against an officer who believes the person is a 5150.

handover reports are important

If you transport a patient on a 5150 hold without having the LEO present, you'd better have that form with you. If the LEO doesn't think there's a medical complaint but department policy says the ED has to clear medically, then there's no reason the LEO can't transport to the ED. I would imagine that most LEO would transport directly to an Emergency Psych Facility unless they feel there's a medical need.

In other words, if I'm called to do a 5150 transport by LE, you'd better believe that the LEO is following me, accompanying the patient in the ambulance, or has given me the completed paperwork I need.

 

[mycrofft]

no forms, if the officer has them on a hold they are transported accordingly, usually the doc will decide if they need a psych consult based on all information provided even the patient.

there is no reason why the officer cant take the pt to the ED his/herself. I don't have the training or qualifications to go against an officer who believes the person is a 5150.

handover reports are important

Agreed generally. However, what if there is evident medical need, such as uncontrolled bleeding or a penetrating wound to the torso or neck?:huh:

So what I'm reading is that EMS doesn't make determinations about mental competence/threat to self or others.

Wonder how that affects things like a pt's ability to grant or deny or withdraw permission for treatment/transport?

 

[vc85]

In that case, our agency would transport to the closest appropriate facility for the treatment of his (potentially life threatening) medical needs. The officer would follow and he or she would hash out the rest of it with the hospital staff once the patient was medically stable.

 

[Bullets]

We dont play that game. If the LEO determines the patient needs a psych hold, then the LEO transports unless there is some actual acute medical issue, such as a result of attempted suicide.

 

[Angel]

If you transport a patient on a 5150 hold without having the LEO present, you'd better have that form with you. If the LEO doesn't think there's a medical complaint but department policy says the ED has to clear medically, then there's no reason the LEO can't transport to the ED. I would imagine that most LEO would transport directly to an Emergency Psych Facility unless they feel there's a medical need.

In other words, if I'm called to do a 5150 transport by LE, you'd better believe that the LEO is following me, accompanying the patient in the ambulance, or has given me the completed paperwork I need.

yea I just meant no forms that we have to determine if they truly are 5150 or to rule it in/out

and I always always take a 5150 with me. I worked for a company that actually I almost got fired for being insistent I get the original copy (nurse told me 'they don't do that') umm, then I cant legally take him!
boss said it was bad customer service and that they would worry about the paperwork (later).

I don't work there anymore.

 

[DrParasite]

EMS providers can't place patients on holds in California.

so it's kind of a moot point as to what the EMS providers think right?

Why? Is the officer going to stick around the ED and restrain the patient in the ED as necessary?

yes!!!! if need be, the officer can. He (or she) wants the person committed, he can explain to the ER why it was done, and it was his call.

Does your ambulance not carry restraints? Are EMTs in your state not trained in restraining patients?

some ambulances do, some done. EMTs do receive SOME training in restraining people... however we can't use handcuffs, and most law enforcement officers recieved MUCH MORE training in restraining people, especially those who don't want to be restrained.

Agreed generally. However, what if there is evident medical need, such as uncontrolled bleeding or a penetrating wound to the torso or neck?:huh:

then its not just a simple 5150, there are other factors at play.

So what I'm reading is that EMS doesn't make determinations about mental competence/threat to self or others.

Wonder how that affects things like a pt's ability to grant or deny or withdraw permission for treatment/transport?

As I said before, that's why LEO goes with you. the person isn't (always) giving consent, so the LEO has made the decision for the person. Once that decision is made, consent isn't needed, and the LEO is making the decision for the person. The LEO is also responsible for enforcing said decision, using the restraining techniques he was trained on (again, with are more than what EMS providers are taught)

 

[mycrofft]

(DrParasite): " As I said before, that's why LEO goes with you. the person isn't (always) giving consent, so the LEO has made the decision for the person. Once that decision is made, consent isn't needed, and the LEO is making the decision for the person. The LEO is also responsible for enforcing said decision, using the restraining techniques he was trained on (again, with are more than what EMS providers are taught)

Yeah, well put. Especially the last nine words (highlighted).
(And handcuffs are not good; they are intended to physically restrain, but it is understood that they also cause discomfort pain and injury if resisted, so their use in a medical sense is not advised; medically designed restraints including leather ones with waist belts are).



The question still stands but amended: CAN you decide if patient is competent to refuse care art ANY scene, without benefit of law enforcement? (And as a sidebar, are they more competent, or do they just have more authority?).

 

[unleashedfury]

We have an outside service issue the psych hold.

Crisis Intervention will visit the home of the potentional psychiatric subject and evaluate for a 302 warrant (psychiatric hold)

If the patient is voluntary, or they have any apparent life threats. Bleeding, overdoses, etc. We take them without intervention.

psychiatric holds often have PD transport them or accompany us in the event of being violent,

 

[berkeman]

At a minimum it would seem that a quick assessment should include checking blood glucose level and doing a stroke test. If they fail the stroke test, that will influence which hospital the Pt gets transported to. If they are hypoglycemic, we can get their blood sugar up some before we get to the hospital, to help speed up their evaluation of the Pt.

 

[mycrofft]

What if they refuse any contact, are not obviously obtunded?

 

[Akulahawk]

What if they refuse any contact, are not obviously obtunded?

It depends upon the state's law regarding psych holds that are "applied" by those authorized to do them. If there's no medical need for monitoring on the way to an Emergency Psych facility, I'm not going to take them. 99% of the psych patients I've ever transported were either NOT alert/oriented enough to be able to refuse or they were able to consent and did consent to transport. The other 1%? Those required LE to restrain and accompany them. Yes, I have had some good luck with Psych patients over the years.

I, somehow, even managed to get a very demented patient to think I was a fantastic guy and got her complete cooperation. I think I was the only person that ever managed that feat. :unsure:

 

[Handsome Robb]

no forms, if the officer has them on a hold they are transported accordingly, usually the doc will decide if they need a psych consult based on all information provided even the patient.



there is no reason why the officer cant take the pt to the ED his/herself. I don't have the training or qualifications to go against an officer who believes the person is a 5150.



handover reports are important

As a paramedic if I don't agree with a hold PD has placed and that patient is refusing transport I will not transport that patient. If there's a medical reason they cannot refuse then it's a no-brainer but if it's a pure psych call with no other underlying issues and the patient doesn't want to be transported by me they're not going to be transported by me.

I have every right to tell that cop no. It happens quite frequently here that they'll try to pull stuff like that. It ain't happening.