New policy regarding 201/302 patients.

[JPINFV]

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

...and your GSW is going to have to wait for police to secure the scene because they're transporting your patient for you?

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

Unit hour utilization. Basically how often you're running calls. A UHU of 0.9 would mean that 90% of a shift, you're running calls.

 

[HotelCo]

...and your GSW is going to have to wait for police to secure the scene because they're transporting your patient for you?

Along the line, the GSW part gets lost, and it comes across as just a trauma. No PD.

Unit hour utilization. Basically how often you're running calls. A UHU of 0.9 would mean that 90% of a shift, you're running calls.

Ahh, gotcha. I don't equate making a traffic stop for speeding to a 911 call. What's the UHU for responding to calls?

 

[JPINFV]

Along the line, the GSW part gets lost, and it comes across as just a trauma. No PD.

Again, you're time is more valuable than the police officer's job? Again, why are you pushing off your job on the police? If your system is inundated with psychiatric calls, then shouldn't the solution be for the health care community to find a solution, and not the law enforcement community?

Heck, if we're going to just play the "I don't have time for that" card, why not have fire engines or trucks transport the patient? After all, how much use does the air and light truck actually get?

Ahh, gotcha. I don't equate making a traffic stop for speeding to a 911 call. What's the UHU for responding to calls?

So if a call comes in that isn't something along the lines of an active shooter or officer down, do you think that the police officer is just going to stop the traffic stop? Would you agree that monitoring traffic speeds isn't the same as sitting in a parking lot or station watching a DVD?

 

[HotelCo]

Heck, if we're going to just play the "I don't have time for that" card, why not have fire engines or trucks transport the patient?

Sounds good to me.

So if a call comes in that isn't something along the lines of an active shooter or officer down, do you think that the police officer is just going to stop the traffic stop? Would you agree that monitoring traffic speeds isn't the same as sitting in a parking lot or station watching a DVD?

Give me a ticketbook. I'd love to ticket people who litter.

 

[marineman]

All I see is a bunch of arguing over trivial information here while a bulk of pertinent information has been left out. Nobody will ever win the battle of who's time is more valuable, EMS, PD and Fire could all potentially get called to that next major cluster at any point in time which effectively means there is no correct answer.

Who called the ambulance in the first place? Is the patient agreeable to using other means of transport to the hospital? There are other factors in play as well but those are the big two that jump out at me immediately. You are walking a real fine line of patient abandonment there that I won't walk when my license is at stake.

Next lets take a look at the psychology behind the entire situation, I mean after all we can at least all agree that appropriate use of psychology and psychiatry is the appropriate treatment of these patients. A patient has expressed their depressed mood however has failed to mention those "magic words" of suicidal idealization, we should all recognize that this is a ticking time bomb. With your personal thoughts set aside nobody can deny that depression is a disease. Like any other disease without appropriate treatment it will not improve and will in fact continue to deteriorate. Are you willing to bet your license on the fact that it will not deteriorate to suicidal idealization before your taxi gets there and gets them to the hospital? None of the officers I know are willing to take that chance, thus any mentally unstable patient rides in the back of the squad as a safety barrier. Now is when the big word psychology comes into play, that patient is already depressed with various levels of loss of self worth. In America what is the preconceived notion of anyone riding in the back of a squad car? They have clearly done something wrong. So you take a depressed person who could potentially become volatile at any moment and impose the feeling that they have done something wrong, not only that, it's simply the fact that they have these feelings that is wrong; these feelings are the reason they're in the back of the squad car right?

Oh you want to call them a taxi, ok I can leave the squad car out of the scenario. The pt called the ambulance as an outreach after acknowledging that they need help for their condition. The ambulance got there and determined that their condition simply was not worth the time of the ambulance so they will call a taxi instead. At this point they have reached out to the medical community once and have been shunned for it, will they still be willing to open up if they ever do get to the hospital or will they feel that we are all judging them like the ambulance did? What if that patient since being shunned by the ambulance feels that they don't have a medical condition necessitating treatment thus they never do go to the hospital and again the disease continues to deteriorate while they feel there is no help out there for them. How would you feel working them as a PNB a day, a week or a month later because they committed suicide?

It has already been said in this thread but there are many chief complaints that we can not actively treat with magical miracle drugs and 14 gauge IV's that we transport every day. Why are we picking this one to not transport? What about the other part of psychology where the treatment in and of itself may simply be talking to the patient? Are we completely incapable of that? This thread is completely ridiculous, to the OP, quit your job immediately and offer only to come back when they change their stance on treatment and transport of patients requiring medical care.

 

[marineman]

p.s. if your management has the IQ of a pea they would realize that if PD requests transport of a patient in their custody then the PD can be held responsible for the bill.

 

[Veneficus]

All I see is a bunch of arguing over trivial information here while a bulk of pertinent information has been left out. Nobody will ever win the battle of who's time is more valuable, EMS, PD and Fire could all potentially get called to that next major cluster at any point in time which effectively means there is no correct answer.

Who called the ambulance in the first place? Is the patient agreeable to using other means of transport to the hospital? There are other factors in play as well but those are the big two that jump out at me immediately. You are walking a real fine line of patient abandonment there that I won't walk when my license is at stake.

Next lets take a look at the psychology behind the entire situation, I mean after all we can at least all agree that appropriate use of psychology and psychiatry is the appropriate treatment of these patients. A patient has expressed their depressed mood however has failed to mention those "magic words" of suicidal idealization, we should all recognize that this is a ticking time bomb. With your personal thoughts set aside nobody can deny that depression is a disease. Like any other disease without appropriate treatment it will not improve and will in fact continue to deteriorate. Are you willing to bet your license on the fact that it will not deteriorate to suicidal idealization before your taxi gets there and gets them to the hospital? None of the officers I know are willing to take that chance, thus any mentally unstable patient rides in the back of the squad as a safety barrier. Now is when the big word psychology comes into play, that patient is already depressed with various levels of loss of self worth. In America what is the preconceived notion of anyone riding in the back of a squad car? They have clearly done something wrong. So you take a depressed person who could potentially become volatile at any moment and impose the feeling that they have done something wrong, not only that, it's simply the fact that they have these feelings that is wrong; these feelings are the reason they're in the back of the squad car right?

Oh you want to call them a taxi, ok I can leave the squad car out of the scenario. The pt called the ambulance as an outreach after acknowledging that they need help for their condition. The ambulance got there and determined that their condition simply was not worth the time of the ambulance so they will call a taxi instead. At this point they have reached out to the medical community once and have been shunned for it, will they still be willing to open up if they ever do get to the hospital or will they feel that we are all judging them like the ambulance did? What if that patient since being shunned by the ambulance feels that they don't have a medical condition necessitating treatment thus they never do go to the hospital and again the disease continues to deteriorate while they feel there is no help out there for them. How would you feel working them as a PNB a day, a week or a month later because they committed suicide?

It has already been said in this thread but there are many chief complaints that we can not actively treat with magical miracle drugs and 14 gauge IV's that we transport every day. Why are we picking this one to not transport? What about the other part of psychology where the treatment in and of itself may simply be talking to the patient? Are we completely incapable of that? This thread is completely ridiculous, to the OP, quit your job immediately and offer only to come back when they change their stance on treatment and transport of patients requiring medical care.

A great post.

But I would just like to add one thing.

It is not the patients who are in crisis for the first time that don't use the magic words I worry about.

It is the ones familiar with the system who know what to say and what not to say to get what they want.

 

[DarkStarr]

Our main gripe, apparently, is when PD calls for us to transport, and then follows us to the hospital.

This is an issue with our service and our medical director, and Im not sure whats going to come of it. I don't really forsee any of the crew following policy and calling a taxi for a 201, or refusing to transport a 302 per PD.

Will update accordingly.

 

[Aidey]

For the record I want to make it very clear I think psychiatric illnesses are just as legitimate as any other disease/disorder. The research being done on the neurochemical roots of various psychiatric illnesses is fascinating to me. I think eventually we are going to come to a time where there is no differentiating between psychiatry and neurology.

Now that I got that out of the way.

I find the thought that all depressed people need to be transported by ambulance because they might hurt themselves or someone else incredibly insulting and demeaning to anyone with depression.

We do not make that assumption about ANYONE else with a medical condition, but yet we continue to belittle these people by saying "Well, we know you are SAYING you don't want to hurt yourself or anyone else, but we don't believe you". Do we tell poorly controlled diabetics "Well, you say you are going to take your insulin and not eat 6 donuts, but we don't believe you". No. We don't. It is asinine.

I'm not saying that a taxi should replace an ambulance, but the argument being used to justify why a taxi shouldn't be used is crap.

 

[cruiseforever]

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

I would think we can ask the same question for a large chunk of pt.s we transport.

 

[Aerin-Sol]

I find the thought that all depressed people need to be transported by ambulance because they might hurt themselves or someone else incredibly insulting and demeaning to anyone with depression.

I agree. I don't know of any healthcare professions where all depressed patients need constant medical supervision or they'll go suicidal.

 

[Veneficus]

I find the thought that all depressed people need to be transported by ambulance because they might hurt themselves or someone else incredibly insulting and demeaning to anyone with depression.

We do not make that assumption about ANYONE else with a medical condition, but yet we continue to belittle these people by saying "Well, we know you are SAYING you don't want to hurt yourself or anyone else, but we don't believe you". Do we tell poorly controlled diabetics "Well, you say you are going to take your insulin and not eat 6 donuts, but we don't believe you". No. We don't. It is asinine.

I'm not saying that a taxi should replace an ambulance, but the argument being used to justify why a taxi shouldn't be used is crap.

I don't think that the patient population in question is people with depression that they are able to manage themselves.

If somebody engages the health services for a voluntary commitment, or obviously involuntary commitment, then they are seeking healthcare service and have determined it to be in their best interest to let healtcare providers care for them at least temporarily.

Part of that healthcare service is transport to the appropriate facility. There are several ways to achieve this transport, but usually after business hours and certain organizations utilize an ambulance for this for a myriad of reasons, not the least being it is often convenient to outsource transportation.

I don't see it as a reflection of the patient, but as part of the healthcare system operations. Many of which I have strong opinions of its ineffectiveness and lack of compassion. But that is another story.

I do not think that the transport of the sick and injured should be done by the police unless some exceptional circumstance dictates. I do not think they should be left to fend for themselves. If they could fend for themselves, then they wouldn't be seeking the specific level of help they are.

We don't require every person with a heart condition needs an ambulance to see their doctor, but certainly when it crosses over into symptoms which may include a life threatening or altering event we advocate for ambulance transport. (at least I do) Nobody I know suggests these patients find an alternative transport or police transport to be "checked out" when they claim they are ok after somebody engaged 911 or another healthcare provider, why would a psych complaint be any different?

Let's face it, if you call your primary provider and say you have immediate need, the response is always go to the emergency dept or call 911.

In the case of psych it may be "go to the local screening service."

But the message to patients is the same. Take one definitive step, not 3 or 4 steps in order to get help.

With psychiatric illnesses. Once a person decides on their own or it is decided by other criteria that they need inpatient healthcare for their needs, then the benchmark for transport by a healthcare provider is met in my opinion. They should not be left to fend for themselves at such a point.

The fact it is done by an ambulance is just an argument on the vehicle.

 

[Frozennoodle]

New Orleans has an all volunteer response group associated with NOPD made of mostly EMT's called the Crisis Unit and they respond strictly to psychiatric emergencies.