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What do you do with psych patients?

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72 replies to this topic

#16 Bernhard

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Posted 01 January 2013 - 03:29 PM

We have three psych specialised hospitals here, within 30-45 min away. Plus a tox center including psych ward. That tells a lot about the people here... :D


We're required to transport there in isolated psychiatric issues, but they can't handle medical/trauma problems, so if there is one, we go to next ER instead. They will take care of interfacility transport afterwards.


"Out of service" isn't an issue, dispatch will call another unit from out of area to cover ours (mutual help between countie EMS is required by law here).


Police is able to force someone into psychiatric care in case of "danger for others or self", a judge has to be informed not longer than 24hrs after that time and has to make a decision not later than 48hrs after the person was forced to (this is state dependent in Germany, I describe the legal situation in Bavaria).


Our paperwork is the same for any transport, police has to do a bit more (so they often refuse to force someone if not really needed - in their view) and judges/psychiatrists are used to it.


So, my suggestion: get a totally clear understanding of your local laws and protocols regarding this issue. Don't let you be fooled by someone who may have read them - or not. If your law and protocols support the way it is now, then you may get further on in improving care. The strategy depends on your standing, the frequency of such issues and the one or other problem that is caused by those situations. Ask colleagues, superiors and ER staff. If noone else sees a need to change things, check your position twice...

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#17 MikeEMT

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Posted 03 January 2013 - 02:20 AM

8 hospitals in City of Seattle all with inpatient psych facilities. Several dedicated psych facilities as well including Navos which is a secure in patient facility used by the courts. 


Psych patient - assuming none of the ER's are on psych divert they go to the closest or most appropriate facility. I usually take the to Harborview though they like to go on psych divert. They have the largest psych unit though and staff MHP's 24/7.


Other hospitals usually get pissed off because I don't automatically use restraints. I only use them if I feel I can't control a patient. Because I used to be a cop, there aren't many patients I can't handle. If my partner is nervous about a patient I will put the patient in restraints. 

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#18 Chief1C


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Posted 06 January 2013 - 03:52 AM

Unless they have attempted suicide, unsuccessfully, and require immediate care that cannot be stabilized in the ambulance, thus requiring the services of the nearest hospital... We take them to a facility that can treat their mental health crisis. Gotta go to an ER before they can go to like a long term place, or a rehab facility.. and we don't do inter-facilities. So, we take them to the nearest hospital, with an attached psych unit. And they are few, and far between. But there are many circumstances that make it kinda vital that they get to where they need to be. If I turfed them off to the nearest ER, they'd get put in a lock down room, they could deny the threats, etc.. get sent home.. hurt us for taking them, hurt loved ones for calling, or be successful. Either way, a system only works if a person WANTS help, if someone is going to harm themselves, after the 72 or 96 hour hold, they can easily lie their way out and start all over again. Now it must be hard to get the folks that are just plain legally fricken insane into a "state hospital" type deal, b/c we continually see them back on the streets. I don't even know where the closest place that handles that type of case would be located, short of a prison with a psych ward.


adding more..


I'm familiar with the system, not on an individual level, but family. Some folks just can't be saved from their own hand. Had a patient a number of years ago, started on a weekend, suicide attempt, three days later, released and a second attempt with in a few hours.. five days later, another attempt.. five days later, a near successful attempt. That one involved severeing the femoral artery, and stating they would kill anyone that came in. So we had to wait for the scene to be cleared, and by then the patient had nearly bled to death. Couple weeks later, released, OD'd, called 9-1-1 probably quite some time afterward, as far as I can figure. Ended up being successful. Why? No idea. Always called for [the persons self], shortly after the attempt. Granted it was summer, so eventually, someone would have noticed.

Edited by Chief1C, 06 January 2013 - 04:01 AM.

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#19 Kiwiology

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Posted 06 January 2013 - 04:58 AM

This is a common problem, many people fall between the unfortunately very wide gaps in the mental health system and suffer because of it.  


There are inpatient mental health facilities at the hospitals here so its not so much of a problem getting them there 


I have a bunch of mental health problems and gave up on the system a long time ago because its more fucked in the head than I am

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#20 ERDoc



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Posted 06 January 2013 - 11:14 AM

Here, every psych pt goes to the ER.  Every psych facility requires that the pts be "medically cleared" before they can go to a psych facility, even if they have no underlying medical issues.  These pts are usually pretty easy to care for, standard set of labs, call social work and wait for them to find a bed.

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