Would you have transported this patient?

[Shishkabob]

Meh, I prefer treating them like an immature kid, and when that fails, snowing them with Benzos. But that's just me ^_^

 

[FDNYRescueMedic]

Stand behind you partner while he darts him with 10 of versed. Just kidding! You and your partners safety always comes first. If you can restrain him with the staff provided great, otherwise get PD involved. EDP's are very unpredictable regardless of how calm they may seem at the moment.

 

[Dominion]

You're on a BLS rig, you're an EMT-B, no sedatives available.

Dispatched to an assisted care facility for a 22 Y/o M, C/C disturbance in behavior.

Upon arrival and speaking to facility staff you find out pt. was discharged from a hospital earlier that day to the care facility. Within 20 min. of arrival at the facility, pt became hostile and assaulted two staff members, one with his fists, the other using a chair as a weapon.

At this time, the patient is confined to his room and has made no attempt to leave, has been courteous to the staff watching his room. Patient is 6'3" 220lbs, is not on a 5150 (psychiatric evaluation) hold, and is in the facility on a conservatorship.

Pt is Dx with Schizophrenia with a Hx of paranoid delusions.

The hospital you are supposed to take him to is, at best speed in ideal conditions, 30 minutes away, but it's raining, and we all know how California freeways are when it rains.

With this knowledge, would you transport this patient or defer to PD/SO involvement?

Without reading replies:

I would transport this patient as I don't have sedatives anyways. However only if requested. If facility wants him taken to another psych location or he is suicidal. If he is neither of these it's a PD matter. However lets assume for now he is suicidal. I would attempt to get him to come with me calmly, without using any posturing, force, etc. We'd go nice and easy, try to hold a conversation with him etc. Also I would have given my partner strict instructions to watch the back through the rear view occasionally and be ready to call for PD. I would ask PD if they can spare a unit for an escort to our destination, where I"m from PD would go anyways due to the attack but they would defer to me if they need to ride with or just follow.

 

[Aidey]

I would look at his med orders and call the patient's doctor and find out what he thinks will be serve the pt, and what best fits the pts care plan.

 

[Bosco578]

Stand behind you partner while he darts him with 10 of versed. Just kidding! You and your partners safety always comes first. If you can restrain him with the staff provided great, otherwise get PD involved. EDP's are very unpredictable regardless of how calm they may seem at the moment.

LOL, we had a similar call, PD called to facility,lady restrained, darted with versed as per our protocol.

 

[Veneficus]

a chemical restraint is both more humane and less stressful to the patient than a physical restraint.

If the psych facility would rather tie somebody up than chemically restrain them, they will be their own worst enemy.

There is a reason why in many western countries physical restraint is the last resort or not permitted at all.

From my experience doing both, verbal reduction of escalation is the first choice. But the drugs early in any event helps a lot.

 

[firecoins]

Except it's not -just- you. It's you, your partner, and facility staff. You aren't going to get a swat team of officers to put the patient on the gurney.

Good with luck with that theory. The facility is calling us because the patient is out of control beyond their capability. If the patient is legitimately out of control, we will call in the necessary help. If my partner and I deem we are capable of doing it, we will. If not, we will call for the cops if need be. I have done this on several occassions.

However if the patient is regularly using ambulance transport, it's a little hard to accept the assumption that the patient will jump directly to, "dark uniform, must be police."

You mean the psych patients who tell me I am cop don't really think I am cop? Sure.

 

[JPINFV]

Good with luck with that theory. The facility is calling us because the patient is out of control beyond their capability. If the patient is legitimately out of control, we will call in the necessary help. If my partner and I deem we are capable of doing it, we will. If not, we will call for the cops if need be. I have done this on several occassions.

How can you deem that if you don't go on scene and make patient contact?

You mean the psych patients who tell me I am cop don't really think I am cop? Sure.

So every single patient thinks you're the police?

 

[Bullets]

Good with luck with that theory. The facility is calling us because the patient is out of control beyond their capability. If the patient is legitimately out of control, we will call in the necessary help. If my partner and I deem we are capable of doing it, we will. If not, we will call for the cops if need be.


You mean the psych patients who tell me I am cop don't really think I am cop? Sure.

I wish i worked in your system. we rarely get cops on call that arent initial PD calls, and if we request them, we would have to wait at least 45 min. EMS assist isnt a priority. and if we have staff willing to help we can boogie

 

[Veneficus]

I think we can rather clearly conclude that this type of incident is purely a judgement call of the indvidual provider.

I agree that once a facility calls, it is your problem if you respond.

I agree that psych doesn't equal dangerous.

I think "scene safety" doesn't require an extremist view of always having PD come out and put somebody down or threaten too.

As food for thought, if you were having a bad day, angry, frustrated, or whatever, and somebody didn't agree with your behavior. (for whatever reason) would you want the first response to be the cops showing up to put you in your place prior to a third party trying to get you to calm down by talking to you?

 

[abckidsmom]

I think we can rather clearly conclude that this type of incident is purely a judgement call of the indvidual provider.

I agree that once a facility calls, it is your problem if you respond.

I agree that psych doesn't equal dangerous.

I think "scene safety" doesn't require an extremist view of always having PD come out and put somebody down or threaten too.

As food for thought, if you were having a bad day, angry, frustrated, or whatever, and somebody didn't agree with your behavior. (for whatever reason) would you want the first response to be the cops showing up to put you in your place prior to a third party trying to get you to calm down by talking to you?

Excellent summary. I completely agree.

Just watch those people with "the look." They may use you to get outside the walls, and then bolt. I've had that happen once, and he attempted suicide by cutting himself when he ran from the unit at a stop sign.

Sometimes, when the people are talked down easier than you think they would be, they have worked out a plan, and are using you.

 

[Sassafras]

Well, psych does not equal dangerous. You are right; however, violent psych does in my book.

 

[CAOX3]

Seems simple to me, you do it your way I'll do it mine.

For those asking if we ever deal with psych or high patients, trying darting or going hands on with a two hundred pounder amped on meth and hope its effects are instantaneous because he's going to use you and your partner as a punching bag until your desired treatment method takes its effect.

You can't use rationalization with a person that isn't rationale.

One more question , if this took place in a residence, would you seek police assistance?

The fact their in a facility doesnt change my outlook on the situation, violence equals police here.

Too many variables especially when the provider isn't looking at the whole picture. Ill say it one last time, nine out of ten times the transport will be unremarkable that one time is when your not going to get a do over.

 

[adamjh3]

I think we can rather clearly conclude that this type of incident is purely a judgement call of the indvidual provider.

I agree that once a facility calls, it is your problem if you respond.

I agree that psych doesn't equal dangerous.

I think "scene safety" doesn't require an extremist view of always having PD come out and put somebody down or threaten too.

As food for thought, if you were having a bad day, angry, frustrated, or whatever, and somebody didn't agree with your behavior. (for whatever reason) would you want the first response to be the cops showing up to put you in your place prior to a third party trying to get you to calm down by talking to you?

Beautiful post as usual, Vene.

Even with a completely mentally sound person, most (all?) of what they do will be in response to their environment.

With a psych patient, threats from their environment may be real or perceived. A mentally ill person reacting to their environment is no different then you or I, just that we sometimes are unable to see or hear what is triggering their response, be it hallucinations or hearing voices.

With the short time that we in EMS spend with these patients, it can sometimes be impossible to learn one's specific triggers or what can calm them down.

This is where being calm, collected, and having the ability to keep yourself and your partner safe come in to play. That involves maintaining situational awareness, knowing what tools and skills you have at your disposal at what time, ALWAYS having an escape route, and keeping yourself in shape for the times when bad turn to worse.

I'm a strong believer in mood transferrance, the more calm and confident you appear, the more willing somone will be to listen to you and try to find their own calm.

Will this always work? No. Should you plan on this working? No. Always have a plan B (and C, and D).

To paraphrase an old saying, be polite, be courteous, but have a plan to restrain everyone you meet.

 

[adamjh3]

Seems simple to me, you do it your way I'll do it mine.

For those asking if we ever deal with psych or high patients, trying darting or going hands on with a two hundred pounder amped on meth and hope its effects are instantaneous because he's going to use you and your partner as a punching bag until your desired treatment method takes its effect.

You can't use rationalization with a person that isn't rationale.

One more question , if this took place in a residence, would you seek police assistance?

The fact their in a facility doesnt change my outlook on the situation, violence equals police here.

Too many variables especially when the provider isn't looking at the whole picture. Ill say it one last time, nine out of ten times the transport will be unremarkable that one time is when your not going to get a do over.

You do make some good points. Yes, if this happened in a residence, you can bet I would have staged for PD.

However, these situations are completely different. At a residence, you do not have security guards - who have already contained the patient - available to assist with restraining, chemically or physically, should it come to it.

Someone high on methamphetamine is not the same as a schizophrenic individual. The former is on an uncontrolled high, and cannot be reasoned with, there's very little chance that he's aware of what he is doing. The high doesn't come and go throughout it's duration. With the latter there is a good chance that he may be well aware of his illness and what he has done, and wants help for it.

 

[Sassafras]

The short time we are with these patients? I don't believe our 30-60 minute transfer times equate to a short time with violent patients. I could see if our station was located in the city, but we aren't.

The assumption that we haven't worked with psych patients just because we would prefer PD is not really valid though considering most of us have had psych experience of some sort. Shoot my last job was all psych patients who could fly off the handle at the flip of a switch. Guess what our crisis intervention plans called for? Violence that threatened safety of family or therapists call 911 and request PD. PD sorts if the ambulance comes. And PD goes with them.

Thankfully I've only ever had to use it once, but I stand by my right to protect myself and to go home to my children at night, regardless of how crazy that may seem to you (general vauge "you").

 

[adamjh3]

The short time we are with these patients? I don't believe our 30-60 minute transfer times equate to a short time with violent patients. I could see if our station was located in the city, but we aren't.

The assumption that we haven't worked with psych patients just because we would prefer PD is not really valid though considering most of us have had psych experience of some sort. Shoot my last job was all psych patients who could fly off the handle at the flip of a switch. Guess what our crisis intervention plans called for? Violence that threatened safety of family or therapists call 911 and request PD. PD sorts if the ambulance comes. And PD goes with them.

Thankfully I've only ever had to use it once, but I stand by my right to protect myself and to go home to my children at night, regardless of how crazy that may seem to you (general vauge "you").

Yes, the short time. In the grand scheme 60 minutes isn't a long time. Especially with someone who needs to be under supervision 24/7. In sixty minutes will you learn of every single thing that will set the patient off or calm them down? Will you have an intimate knowledge of the patient after an hour? Nope. Not as much as family or a caregiver or a long-term friend.

Sixty minutes is a long time to play speed bag, yes. That is where your contingency plans come in - read as your right to protect yourself and go home at the end of the day.

 

[Sassafras]

I'm going to have to respectfully disagree with you about 60 minutes not being a long time with these patients. An hour in an unctontrolled environment for an unstable patient such as this is a long time and offers multiple opportunities for harm to me or my partner.

 

[adamjh3]

I think you missed the point of what I was saying.

I agree that it's a long time to be a punching bag for a violent patient. But in the grand scheme in terms of care it's not a long time at all.

 

[Sassafras]

No, I got what you are saying, but knowing people personally with schizophrenia, I know in crisis it seems like a VERY long time for them. In our world it's not a long time in the grand scheme of things, but until they are medicated and the hallucinations contained it seems as though they will be stuck in the fear of the moment forever.