Assessing female pt

[JPINFV]

Also, if your area allows 5150's to wear their clothing (and not paper scrubs) during transport, remember to check their pockets and waistbands for weapons or potential weapons. I've found knives on some of our 51's that come from PD before.

If a hospital is routinely denying a psych patient the right to wear their own clothing without good cause then they're at a big risk for a civil rights lawsuit under California Law.

"LPS – Patients Rights Subject to Denial

Psychiatric facilities must also uphold the following specific legal rights of individuals. These rights can only be denied when “good cause” exists

(WIC § 5325: title 9 CCR § 865.2):

1. The right to wear one’s own clothing (per W&I –7232, this right has been removed from persons receiving mental health treatment in a secured perimeter at a State Hospital)."

http://www.camhpra.org/patients-rights-advocacy/chapter-4.html

 

[JPINFV]

County and company protocol. Any patient on a 5150 (psych hold) gets 4 point soft restraints.

I'll try to avoid it with some patients on 911 calls. Had a 14 y/o girl who tied shoe string very gently around her neck because her boyfriend broke up with her. I just had the police officer meet me at the ED to finish the report so legally the patient wasn't on a hold during my care and transport.

I'm, to a point, surprised that there hasn't been a lawsuit over this. It's hard, in my mind, to justify that every patient on a hold necessitates restraints, and this does strike as "unnecessary" and/or "excessive."

 

[Ewok Jerky]

Restraing every psych patient is, for lack of a better term, crazy. Very few of them are a flight risk and even less are dangerous. The majority are either teenage girls who made a comment after fighting with a boyfriend or schizophrenics who got off their meds. I'm not saying be complacent or let your guard down, but restraing everyone is wicked overkill.

 

[RefriedEMT]

Restraing every psych patient is, for lack of a better term, crazy. Very few of them are a flight risk and even less are dangerous. The majority are either teenage girls who made a comment after fighting with a boyfriend or schizophrenics who got off their meds. I'm not saying be complacent or let your guard down, but restraing everyone is wicked overkill.

Yea I have never had to restrain a single psych pt, as long as you can talk to them and keep them calm its all good.

 

[gotbeerz001]

Yea I have never had to restrain a single psych pt, as long as you can talk to them and keep them calm its all good.

I would guess that I restrain 1 in 7 pts.

If I have any doubt about the stability of a pt and/or how successful I would be in a confined-space brawl, I will place (at least) the leather wrist restraints on.

I find that a calm, empathetic approach and using your policy as a scapegoat usually gets people to comply without a fuss.

 

[Jim37F]

I worked for a company that mandated at least 2 point restraints on all 5150 patients. Apparently that policy came about shortly after a psych patient being transported by a different company decided to jump out the back while they were on the freeway...but that was years and years ago...I've personally never felt the need to restrain almost all of my IFT psych patients I've transported before, really only did it in compliance with that companies policy. On those patients I used 2 points and simply explained the policy and why and none of the patients I've had had a problem with it, though I have heard the horror stories. On the 911 side, every time I've had a restrained patient, I've also had PD with us, had more restrained inmates from the city jail than I've had restrained psych 5150's.

But yeah, mandatory head to toe physical assessment policies on anyone short of a major trauma patient, particularly BLS IFT's is, in a word, nuts. Unless there's a company policy dictating hands on, in the OP's case, your eyes are your primary assessment tool. Nothing remarkable noted in their medical history packet? You don't see anything out of the ordinary? No need for hands on.

 

[exodus]

If a hospital is routinely denying a psych patient the right to wear their own clothing without good cause then they're at a big risk for a civil rights lawsuit under California Law.

"LPS – Patients Rights Subject to Denial

Psychiatric facilities must also uphold the following specific legal rights of individuals. These rights can only be denied when “good cause” exists

(WIC § 5325: title 9 CCR § 865.2):

1. The right to wear one’s own clothing (per W&I –7232, this right has been removed from persons receiving mental health treatment in a secured perimeter at a State Hospital)."

http://www.camhpra.org/patients-rights-advocacy/chapter-4.html

I think they are able to do it as they are not a dedicated psychiatric facility, but an emergency room.

 

[BecomingaBetterEMT]

I rarely take vital like blood pressure/ pulse pshyc patient calls. If you do, it can lead to much worse things. Never force a patient into doing anything they're uncomfortable with unless it is absolutely necessary or life-threatening.

 

[gotbeerz001]

I rarely take vital like blood pressure/ pulse pshyc patient calls. If you do, it can lead to much worse things. Never force a patient into doing anything they're uncomfortable with unless it is absolutely necessary or life-threatening.

Um... What?
Vitals are required for even the most basic assessments, which are still required even for psych calls. If you are going to do NO assessment, why not just send them in a cab or call Über?

 

[JPINFV]

I rarely take vital like blood pressure/ pulse pshyc patient calls. If you do, it can lead to much worse things. Never force a patient into doing anything they're uncomfortable with unless it is absolutely necessary or life-threatening.

What sort of "much worse things"?

If they refuse, then they can refuse. A psych hold is not actually carte blanche to do as you please. However, I wouldn't assume that the patient refuses just because they're on a hold, nor will I automatically assume that the patient is a threat because they're on a hold.

 

[BecomingaBetterEMT]

To the two people that posted above me let me explain. I have dealt with a lot of pshyc patients in my lifetime. Most of the calls I get when involving pshyc patients is that there showing aggression towards someone in an extreme manner. When this happens we have a policeman ride with us to the hospital. Sometimes they're handcuffed and sometimes they are not. I know talking in general because no two calls are the same. Simply put, I use my medical background and what I have learned into making the right decision. I'm not going to take vitals for someone who is yelling and trying to hit me when I'm forced to restrain them. I try but it doesnt work . But I'll take vitals for someone who is calm and I'm able to communicate them when they are a pshyc patient.

 

[gotbeerz001]

To the two people that posted above me let me explain. I have dealt with a lot of pshyc patients in my lifetime. Most of the calls I get when involving pshyc patients is that there showing aggression towards someone in an extreme manner. When this happens we have a policeman ride with us to the hospital. Sometimes they're handcuffed and sometimes they are not. I know talking in general because no two calls are the same. Simply put, I use my medical background and what I have learned into making the right decision. I'm not going to take vitals for someone who is yelling and trying to hit me when I'm forced to restrain them. I try but it doesnt work . But I'll take vitals for someone who is calm and I'm able to communicate them when they are a pshyc patient.

Neat.
I guess we just do things differently in my area.

 

[chaz90]

To the two people that posted above me let me explain. I have dealt with a lot of pshyc patients in my lifetime. Most of the calls I get when involving pshyc patients is that there showing aggression towards someone in an extreme manner. When this happens we have a policeman ride with us to the hospital. Sometimes they're handcuffed and sometimes they are not. I know talking in general because no two calls are the same. Simply put, I use my medical background and what I have learned into making the right decision. I'm not going to take vitals for someone who is yelling and trying to hit me when I'm forced to restrain them. I try but it doesnt work . But I'll take vitals for someone who is calm and I'm able to communicate them when they are a pshyc patient.

Quick aside before you continue...Psychiatric=Psych=\=Pshyc.

 

[JPINFV]

To the two people that posted above me let me explain. I have dealt with a lot of pshyc patients in my lifetime. Most of the calls I get when involving pshyc patients is that there showing aggression towards someone in an extreme manner. When this happens we have a policeman ride with us to the hospital. Sometimes they're handcuffed and sometimes they are not. I know talking in general because no two calls are the same. Simply put, I use my medical background and what I have learned into making the right decision. I'm not going to take vitals for someone who is yelling and trying to hit me when I'm forced to restrain them. I try but it doesnt work . But I'll take vitals for someone who is calm and I'm able to communicate them when they are a pshyc patient.

Because the only thing that makes someone aggressive is psych issues?

 

[Carlos Danger]

Because the only thing that makes someone aggressive is psych issues?

No, but the causes you are alluding to probably aren't going to be detected by a cursory assessment and NIBP.

 

[RefriedEMT]

To the two people that posted above me let me explain. I have dealt with a lot of pshyc patients in my lifetime. Most of the calls I get when involving pshyc patients is that there showing aggression towards someone in an extreme manner. When this happens we have a policeman ride with us to the hospital. Sometimes they're handcuffed and sometimes they are not. I know talking in general because no two calls are the same. Simply put, I use my medical background and what I have learned into making the right decision. I'm not going to take vitals for someone who is yelling and trying to hit me when I'm forced to restrain them. I try but it doesnt work . But I'll take vitals for someone who is calm and I'm able to communicate them when they are a pshyc patient.

I have not had a large amount of psych pts but the last one I had was very combative to the point of looking as if they wanted to kill anyone or anything in sight. I was still able to get all vitals on this pt even as they were screaming and trying to get the restraints off, other than BP which I got after I calmed the pt down just long enough to palpate. I am sure it wont work with every psych pt but so far talking to them and reassuring them does help greatly.

 

[Tigger]

I would be in deep crap if I didn't at least document an effort to obtain vital signs on restrained patient. How hard is it to put a pulse ox on someone? Also getting a BP on someone that is restrained should be pretty easy, they should not be moving around all that much or you didn't do it right.

And restraining every patient on a hold? Yea, that's a terrible policy that I hope no one is defending. There is a time and place for restraining patients, always is not it.

 

[Trauma Queen]

Just because a patient is being treated or transported for a psychiatric issue doesn't automatically make them dangerous and combative. They are usually calm and cooperative. You just need to treat them like a human being. Ask them for permission to take vitals, explain to them what you're doing, treat them like every other patient until they give you a reason not to. Restraining every psych patient because "one time this crazy thing happened ten years ago" makes for bad medicine and cook book providers.

Treating every patient with the same chief complaint or primary impression has the potential to be reckless and dangerous. You have to assess and adapt to every patient.

 

[chriscemt]

Restraining every psych patient because "one time this crazy thing happened ten years ago" makes for bad medicine and cook book providers.

Restraining every psych patient because "one time this crazy thing happened last call" makes for bad medicine...

 

[JPINFV]

Restraining every psych patient because "one time this crazy thing happened last call" makes for bad medicine...

To be fair, there's bad medicine, then there's Southern California.