Jaideux

Thanks so much for your suggestion! I didn't know the bureau existed... I will be contacting them ASAP! I'm really glad your community has the adequate resources to treat your patients. Ours is experiencing (like so many others) the "more people using the ED for bullcrap/ PCP stuff" trend, so even though we just opened up many new beds, and have the nursing/MD staff to staff them, we still have many nights a month where we are overwhelmed with people. Confounding the psych factor is that we have a lot of truly unnecessary MHAs brought here. Less than 1/3 of the people we see get admitted. I'm not being bitter or jaded when I say that I truly think the police would rather drop off the drunks at our doorstep than fill out paperwork to incarcerate them after a barfight. "Oh, he hit someone. I know it's an illegal act, but once upon a time he was in an elevator with a psychiatrist, so he must have a mental illness. It's not right to arrest him." Garbage. And lots of kids who say angry teen things to their parents, who have them MHAd. "Dear Mom and Dad: The fact that Junior trashed your house during a fight with you does not make him bipolar. It makes you ineffective parents somewhere along the line." Not to mention all our "frequent flyers" who use the local EDs like rotating Holiday Inns. They know if they utter the word "chest pain" they are guarenteed at least a few hours in the medical ED while labs are being run, or even sitting in the waiting room. Plus, they know they can get free food, like sandwhiches and ginger ale. And then throwing around the "s" or "v" word (suicide or hearing voices), they know they can buy a few more hours up in psych, watching cable tv and eating MORE free food. And they waste taxpayer money, 9 times out of 10. $500 to take the BLS bus in, and $1500 for the cardiac work up, and another $1500 for the psych evals. And some of them do it at least once a week, if not more! We've known people to call for an ambulance from the waiting room of one ED after discharge to be taken to another! Once, a guy was d/c from one psych hospital, escorted out by the police, and he said "I'm hearing voices" so they MHAd him to us! Even though he was just cleared 10 minutes prior!! /rant that is becoming less about my original post. I'm just frustrated

Hi I do hope I'm in the right spot. I didn't see anything quite about this in my search. If I missed something, I'm happy to check out an old link! In New York, what are the rules about taking a patient to a different hospital than the one requested? When is it okay, if ever? Here is the situation: I'm volunteer EMT, but my real job is working at a regional trauma center, which is also home to the largest psychiatric in-patient care in the area. I work in emergency psych. So, I'm torn between the sides. Here it is: My coworkers really have a problem with all the city medics bringing psych patients to us when we are code red (very acute). Unfortunately, in this city, it seems like most of our hospitals are red most days I frequently try to point out that even though we are operating at max (an above) capacity, the other hospitals which do psych are also probably in a similar boat. When everyone is red, it really means everyone is green, haha. It seems our charge nurses have gotten in the habit of calling the company that has the city contract (and the other commercial company) and telling/asking their dispatchers to direct crews to no longer bring us patients. Here's where I get torn and really would like some education, for my self, and that I can pass on: From the psych side: We are a locked unit. People cannot sign out AMA until cleared by a psychiatrist and when we're busy, it's not uncommon to have 10 hour waits from start to finish. This creates significant tension. Tension can lead to violence, requiring restraints, requiring someone to sit and do a 1-to-1 with the patient, reducing the number of available staff to get people seen and discharged or admitted. To keep it fair, we have a policy to see people in the order they arrive. Even if there were no distractions, no other patients, it would still be at least an hour process. That never happens, and we have to get collateral, wait for labs, wait for them to sober up before we can even interview, so there is usually some sort of backup. There are 3 other hospitals in this city that can accomodate emergency psych issues, and I'm pretty sure all 3 admit. I know 2 do. We may be the only ones with child/adolescent inpatient units. It feels like a disproportionate number come here (but this is an assumption, on my part). It really, really sucks to be overworked. It sucks even more to be in a dangerous setting. Our peds patients are in the same waiting room as the adults, and they are exposed to everything that goes on out there. Granted, they are SUPPOSED to have a parent with them, and there is a sort of wall protrusion separating them, but it's by no means very separate. From the EMS side: They are a hospital. It is their job to treat patients, no matter how many show up or in what condition. We are just the proverbial messenger. If the cops MHA the patient to Hospital X, we have to take them to Hospital X. (Don't we?) If the patient says, "Take me to Hospital X" we have to take them to Hospital X. (Don't we?) So, does anyone have any information on whether or not EMTs actually have to transport a patient to a hospital if there is a concern for patient/staff safety based on a violence potential? As an EMT, I always give my patients the most updated information I have about the hospital codes (Green, Yellow, Red) so they can make an informed choice, but what about the patient that says, "Hospital X" even after I explain it will be a 3+ hour wait to be seen? They all start out thinking they can wait... and after an hour say "I'm leaving", and hospital staff has to say, "no, you're not", and it has been known to get ugly. What if the patient is typically treated at one hospital, but the cops MHA to a different one, or the pt requests to go to a different one? Additionally, if anyone has any good strategies how I can bridge the "us v. them" gap that I'm surrounded by and help each side see the other sides viewpoint/limitations/policies/laws, please let me know!!! I'm so sick of hearing nurses bashing us EMTs because we brought in the 5th patient in the last hour, and I'm also sick of EMTs bitching about sometimes long wait between triaging at the main EMS area and us psych people having time to come downstairs and pick them up to go to the separate psych area, or getting pissy when I ask (nicely!!) to try and go to other hospitals because I fear for my safety. And I'm on pretty good terms/friends with nearly all the EMTs with the city, because my boyfriend works there and I hang out with them quite a lot! Trust me, we aren't sitting up here twiddling our thumbs eating bonbons. And the few times we've called the city law enforcement for patients who were terribly violent (and NOT psychotic!), they were completely unhelpful, so I don't feel like they "have my back". Help? Please? Point me to a policy number, or a lack of policy. Anything.