Sedation of Mentally Ill Patients for transport

[Happiness]

The reason that I answered the OP is the fact that it was an aircraft of some sort. Normally these pts are transported by ground, but I live on an island and there fore have a bit of knowledege on the transportaion of pt that are flying around. In a heli the pt is next to a door. These doors are designed to be able to open very easily because if they have to have an emergency landing it is easy to get out. Now with this being said it would be very easy for a pt to open that door and boom there is an issue. If the pt is suicidal they can jump ect ect ect. Putting restraints on pts is a last resort because it is one more thing to have to deal with is there is an emergency landing.

People with mental illness should have all the rights as other pts but when your leaving here and you have been violent or suicidal you dont leave unless you are sedated and that is just the way it is.

There isnt even room in a medivac plane for Zap Straps can you imagin having to restrain at pt in there if they freak.

[DartmouthDave]

Hello,

Here is a related story from the NWT in which a psy patient jumped from the medevac plane (fixed wing):

Fatal Jump

Cheers

Edited July 2, 2010 by DartmouthDave

[fakingpatience]

I think that the decision to restrain a pt. either chemically or mechanically should be based off of both the pt's history, and their current presentation. If the pt. is calm now, but staff tell us 1 hour ago, they were calm, then exploded out of no where, and are calm again, I would consider that pt. a threat, even if they are presenting calmly. Now my experience is a little different, as I have never done an IFT of a psych pt., only from the scene to an ER. I have also worked with people with extensive psychiatric histories in my current job. I always find it a little amusing when, after transporting a pt who is high, or drunk and combative to the ER with 4 point restraints, and having them calm down as soon as we enter the ER, the staff will immediately remove all restraints from the pt, even if we tell them the pt has been going through cycles of calm to violent, and back again. At least half the time this has happened, when I am in the ER later that night, I walk past the pt's room and see the pt now in hard restraints... apparently they now became violent with the ER staff. I think that it is important to listen to the staff who are handing the pt off to you, and the pt's history of reactions.

Someone mentioned that people with mental illness have a right to refuse medications. I agree with this to a point. In their own home, they have all the right to refuse to take their medication. However, this right ends when they are at risk of hurting others. To me it all comes down to the "scene safety" we all learned on our first day in EMT school. I would not transport a pt. in a manner that leaves me or my partner unsafe.

[JPINFV]

Someone mentioned that people with mental illness have a right to refuse medications. I agree with this to a point. In their own home, they have all the right to refuse to take their medication. However, this right ends when they are at risk of hurting others. To me it all comes down to the "scene safety" we all learned on our first day in EMT school. I would not transport a pt. in a manner that leaves me or my partner unsafe.

I agree with this as long as the crew isn't making the jump of 'positive psychiatric history means the patient is de facto a danger regardless of what an actual assessment shows.' A patient who is an immediate threat to themselves or others due to disease or disorder, including psychiatric illness lacks capacity, including the capacity to refuse medication needed to stabilize their condition. A patient who is violent while off their medication but is currently is medicated is not a de facto threat who lacks capacity though.

[tniuqs]

She was quite entertaining to listen to, as she spoke about terrorist plots she had information on, the parties she had attended with Yoko Ono, and that she was currently dating Lyndsay Lohan.

According to the documentation we received, she was prone to unprovoked attacks of staff and others, and could be quite dangerous to herself and others.

There were several times on the flight where she was very agitated and fidgety, and we were able to calm her with just talking to her. While we were with this patient, I began to think of our protocols when it comes to transporting patients with a history of violence.

When do we sedate, for our safety rather than theirs? When should we? When do we? Should we ever sedate without the patient's knowledge of what we are giving them?

At what point do we override the patient's rights in order to protect our own safety?

These thoughts were rolling around in my head as I watched her fidget and listened to her talk, so I am now wondering - what do others think? When do we/should we sedate a mentally ill patient during or for transport?

[firemedic37]

I have a lot of experience transfering psych patients due to the fact that I work for a hospital based ambulance. Over the last year or so we have really changed our policy concerning psych patients. We use to transport any and all psych patients if the ER doctor said to do so. Now we have the final say if the pt is stable enough for transport. We have several different medications to use for sedation due to being at a hospital.

Here is the hospitals standard treatments; Ativan 2 - 4 mg IV/IM, Haldol 20 - 40 mg IM or Geodon 10 - 20mg IM. We give them the medication and then let it work before moving the patient to our cot.

Here is our prehospital protocol; Versed 2 - 4 mg IV/IN/IM or Valium 2 - 10 mg IV/IN/IM and in EXTREME conditions we can use Etomidate with Medical Control orders since we are devating from our Protocols. I have never had to sedate a psych patient with Etomidate but it is nice to have just in case. We don't only carry Etomidate for psych patients. We also do feild RSI so we have Versed, Etomidate and Vecuronium.

If you are having problems with psych patients you need to be sure you have a protocol in place to sedate the patient, calling medical control takes too long! It could be a life or death situation. Last year we got our new protocols and they are all Standing Orders besides calling a code in the feild or to devate from our protocols. We no longer have to ask for every little thing. It is nice, I get to help the patient sooner and there is not that delay in patient care.

If you don't have a Standing Order then ask your Medical Director for one and express your concerns for you and your crew. I know many flight programs that sedate with Ativan 2 - 4 mg IVP.

I also like the idea of flying psych patients, we are a ground service and we usually have a 6 - 8 hour turn around time for psych trips due to there being very few psych units in my State.

[Just Plain Ruff]

While reading this was anyone else cringing thinking about having a unsedated violent psych patient in the confines of either a helicopter or airplane?

This just sounds like a disaster waiting to happen.

Why does a psych patient qualify for a helicopter transport. Does it count towards medical necessity? Will the insurance company pay for the flight if the patient has insurance?

[Richard B the EMT]

Why does a psych patient qualify for a helicopter transport?

I thought I saw that at least one patient mentioned in this string was on an island with no psychiatric care facility on said island. Fixed wing or HEMS was the only option to move said patient to the appropriate care facility.

[scratrat]

I'm a firm believer in aerial sprayings of haldol/thorazine as needed. Coming from a women's prison, it drives it home even more! I believe they all need that!(little sprayer for air freshener from the bathroom). I'd even settle for an aerial spraying of Prozac.