New policy regarding 201/302 patients.

[DarkStarr]

My employer posted a new policy regarding our never ending battle regarding psych patients:

201 - Call Mental Health Services and request a taxi for the patient.

If the magic words are spoken (homocide/suicide), then we are to 302 them, after the police pat them down. If violent and therefore, restrained, police are to ride in with us (and not follow, but sit in back with us).

I feel like it would be a little awkward with the 201 taxi situation, but, we generally don't end up getting paid for 201 transports.

For the 302 situation, it seems like they are trying to make it inconvenient for everyone in order to play a strong hand against our medical director. In the past, we refused to do pysch's for the reasons above and because sometimes PD would call us for a transport, which was not medically necessary, and they could just as easily take the patient themselves.

Thoughts?

 

[HotelCo]

What's a 201?

 

[JPINFV]

Thoughts?

Besides wondering why the police or a taxi are transporting patients with medical conditions?

 

[DarkStarr]

What's a 201?

Voluntary Commitment

Besides wondering why the police or a taxi are transporting patients with medical conditions?

You consider it okay for a 911 ambulance to go out of service to transport a nonviolent, nonthreatening depressed person to the hospital?

I guess it comes down to whether it can be classified as a medical condition for billing purposes, which, is beyond my control.

I do think it would feel awkward calling for a taxi for this patient. Chances are, they don't have the money to pay for a taxi, let alone us.

 

[Veneficus]

You consider it okay for a 911 ambulance to go out of service to transport a nonviolent, nonthreatening depressed person to the hospital?

Absolutely for certain.

If you leave a voluntary commit and before they make it to the hospital they kill themself, that will be tough to explain on the news.

But not nearly as tough as if they injure or kill somebody else doing it.

The very best way to manage an emergency is to prevent it.

I guess it comes down to whether it can be classified as a medical condition for billing purposes, which, is beyond my control.

I think you mean billed as needing an ambulance

I do think it would feel awkward calling for a taxi for this patient. Chances are, they don't have the money to pay for a taxi, let alone us.

I hope that anyone doesn't expect 911 service to be anything other than an economic loss.

If your agency expects they will not have to eat the cost of things like this, perhaps they should become an IFT only service.

But it does make a fine case for EMS needing the education to damand payment for medical service, not for transport.

 

[JPINFV]

You consider it okay for a 911 ambulance to go out of service to transport a nonviolent, nonthreatening depressed person to the hospital?

I guess it comes down to whether it can be classified as a medical condition for billing purposes, which, is beyond my control.

I do think it would feel awkward calling for a taxi for this patient. Chances are, they don't have the money to pay for a taxi, let alone us.

You think it's ok for someone who's reached the point where either they can't care for themselves (hence seeking inpatient care), or reached the point where they need to be committed on those grounds to wait, alone, for a taxi?

What other types of patients do we refuse to transport on grounds of probably being unable to pay?

How long are you willing to wait on scene for your taxi or alternative service? At what point does it become quicker to just transport instead of waiting on scene?

Edit: I'm all for some sort of alternative medical transport options for patients with psychiatric disorders. A taxi or police cruiser, however, does not meet that bar.

 

[HotelCo]

Edit: I'm all for some sort of alternative medical transport options for patients with psychiatric disorders. A taxi or police cruiser, however, does not meet that bar.

Why don't you want a police officer taking a suicidal person to the ER?

 

[DarkStarr]

The very best way to manage an emergency is to prevent it.

This may be the best response for either of the situations.

 

[DarkStarr]

Why don't you want a police officer taking a suicidal person to the ER?

Additionally, if we are in a situation where the police officer is going to follow us in anyway, and the patient does not need immediate medical attention.. then why can't they sit in the back of a cruiser?

 

[DarkStarr]

You think it's ok for someone who's reached the point where either they can't care for themselves (hence seeking inpatient care), or reached the point where they need to be committed on those grounds to wait, alone, for a taxi?

What immediate medical attention are we going to provide that will benefit this patient?

 

[JPINFV]

What immediate medical attention are we going to provide that will benefit this patient?

How many patients, some with critical illnesses, can you ask that about that are transported every day? What are you going to do for a patient with a respiratory infection? Going to have them call a cab on that one too? What about abdominal pain? Are you prepared to call a taxi for every patient that might not require intervention, or just patients with psychiatric illnesses?

Oh, and chemical restraints would be one.

How about this. Emergency Medical Services. Psychiatry = medicine.
Law Enforcement Agency. What laws has a patient with psychiatric illness broken?

 

[JPINFV]

Why don't you want a police officer taking a suicidal person to the ER?

Why would I want a police officer doing my job? Are all suicidal patients violent? Definitely not in my experience.

 

[JPINFV]

You know, let's be honest here [sets up strawman for the hell of it]. The only reason why EMS doesn't want to treat psychiatric patients is because they aren't bleeding (yet). It doesn't rank high enough on your chart of "real medicine," and therefore should be anyone's problem but yours.

 

[HotelCo]

Why would I want a police officer doing my job? Are all suicidal patients violent? Definitely not in my experience.

Police are more than qualified to do what we do for those patients: Drive them to the hospital.

 

[JPINFV]

Police are more than qualified to do what we do for those patients: Drive them to the hospital.

Still doesn't explain why the medical service isn't transporting the patient instead of the law enforcement branch. We should be qualified to transport that patient too. I'll ask again, what laws has this patient broken?

 

[HotelCo]

Still doesn't explain why the medical service isn't transporting the patient instead of the law enforcement branch. We should be qualified to transport that patient too. I'll ask again, what laws has this patient broken?

We are qualified, but if PD is able to, why not? Especially if you're in a busy system, tying up an ambulance to transport a suicidal patient doesn't make much sense to me.

 

[JPINFV]

...because the police have free time on their hands to transport your patients?

I wonder what the UHU for a police car is compared to the ambulance in your area. I'm thinking that the police car is somewhere around 0.9 when you consider things like traffic enforcement.

 

[HotelCo]

...because the police have free time on their hands to transport your patients?

And my GSW patient should have to wait, because someone was feeling down?

I wonder what the UHU for a police car is compared to the ambulance in your area. I'm thinking that the police car is somewhere around 0.9 when you consider things like traffic enforcement.

I don't know what this means. UHU? 0.9?

 

[HotelCo]

Let me say: I like your idea of a separate service for psychiatric patients.

 

[DarkStarr]

Apparently this is a sore subject