Psych Patients, Take by Amb. or Police?

[*** CDN BACON ***]

From the Mental Health Act of Ontario...Sec 17

Where a police officer has reasonable and probable grounds to believe that a person is acting or has acted in a disorderly manner and has reasonable cause to believe that the person,

(a) has threatened or attempted or is threatening or attempting to cause bodily harm to himself or herself;

( has behaved or is behaving violently towards another person or has caused or is causing another person to fear bodily harm from him or her; or

© has shown or is showing a lack of competence to care for himself or herself,

and in addition the police officer is of the opinion that the person is apparently suffering from mental disorder of a nature or quality that likely will result in,

(d) serious bodily harm to the person;

(e) serious bodily harm to another person; or

(f) serious physical impairment of the person,

and that it would be dangerous to proceed under section 16, the police officer may take the person in custody to an appropriate place for examination by a physician. 2000, c. 9, s. 5.

This came change came as a result of a situation in Hamilton...Ontario Police used to have to find some one actually acting...nuts...the change came when police were repeatedly called to a home in Hamilton for an elderly lady that neighbors claimed was acting irrational...when the Police got on scene she always seemed fine and did not fit the criteria for "apprehension"....... this went on for some time till one day thinking that one of the neighbors children was her long deceased son....she killed him...so I am quite comfortable with erring to the side of safety...if the family is credible and they say they are a danger to themselves or others....that's good enough....I would rather err that way ...let the doctor cut them free on the world....

I have been on both sides of the coin.... if I am policing and the Pt is calm ....they will often go by EMS for voluntary assessment....

If there has violent tendencies in the back of the cruiser they go....on my apprehension powers...cuffs will depend on the situation...a 16 year female Pt. may not seem dangerous however...as a male I can;t search her and cuffing her is a safety issue.... crazy has no age limits...myself and 6 ER staff have wrestled with an eight year old that I swear was minutes from his head spinning and pea soup flying everywhere..his ass was in cuffs....

I know that many officers don't go in the back of the ambulance because it is a pain in the ass to be with out their cruiser.....not really a good reason...but that's the truth...the other reason officers will push for EMS transport is that when the patient is there by voluntary admission the police do not have to remain at the hospital until the patient is formally admitted for a 72 hr EVAL ( i have waited eight hours before....average is four hours)....

[JPINFV]

All I can say is, "wow." I find it somewhat said that supposive medical professionals show such a lack of care for people with medical conditions. All psych patients go restrained? WTF? Sure, my safety and my crew's safety comes paramount, but that does not relieve me of my duty to treat my patients with dignity and use the least amount of restraint needed. Does a psych patient on an involuntary hold for "grave disability" really required physical or chemical restraints? Does every suicide patient really require hand cuffs? Any medical provider (and, regardless of the level of emergent-ness of the condition, we are all, still, prehospital providers) should have a darn good reason for using restraints. "Because I can" does not meet that criteria, in my opinion.

At least locally, transporting patents in restraints is a large pain (as it rightfully should be). V/S q5 minutes. PMS checks q15 minutes.

Please remember this. EMS providers can do nothing for psych patients more than any police officer can do. Err on the side of caution, and DOCUMENT heavily. These calls are a high level of concern by many administrators, due to the level of liability invoked by the service, and most specifically, the provider.

Unless PD can do chemical restraints, this statement is wrong. BLS can't do anything more then PD, though.

[*** CDN BACON ***]

Was the above post meant for this thread ....maybe the "Patient Restraint " Thread....

[JPINFV]

Well, considering the following views expressed in this thread:

Emergency Oder of Detention (EOD) (pysch eval) patients are cuffed (always, no matter how safe they appear), and transported by uniformed officers to a mental health facility.

If some "proper authority" like an EMS crew-person, or a LEO, feels that a suspected or confirmed EDP is a potential threat to either the patient's own self, their family or bystanders at the location, or to the Emergency Responders, have the LEOs restrain (handcuff, at the minimum) the patient. The patient is not under arrest, but placed into "Protective Custody" for everyone's protection.

(Semantics! Use them, learn them, love them!)

as well as the overall feeling it seems that psych patients are a PD problem, not an EMS problem (sure, it might not be emergent, but I see nothing about medicine in the initials PD). My big problem is not with patients who are actively DTO. Slap those restraints right on or (if ALS) drug them up. DTS, though, is a whole 'nother ball game. Just because they were trying to slit their wrists 30 minutes ago (damn Emo music, rotting the brains of America's youth. When your child owns slip ons with a bunch of little skulls on the shoes, don't tell me there aren't any warning signs ), does not constitute them as a current risk to themselves. It definitely does not constitute them as a danger to others. Furthermore, a lot of psych patients are opportunistic, so here's an idea. Take your [your=everyone, not directed at a specific person] chrome plated hemostats out of your pocket and your trauma shears out of your holster and put them some place out of reach (like a cabinet or the front seat). Now there shouldn't be anything sharp in any sort of close proximity to the patient. Another great idea if you are starting to feel uncomfortable, but have not reached that threshold where restraints are needed, seat belt the patient with their arms inside the seat belts. It still ain't restraints, but will buy you time if you need to restrain.

[RescueMe83]

.............

[TechMedic05]

Good thread.

At the job I'm trying to leave- we've been having issues with the local police department and us transporting 'psych' patients. Food for thought: This police department has 8 full time members and a small army of part time officers, for 1.1 or so square miles and a population of about 3,000. In Vermont. It's not all that exciting. Somehow, about 3-5 a week, these 'Psychotic' patients end up at the police department. They are not in protective custody, and they are not under arrest. However, they were taken from their home to the police department so our ambulance can pick them up and bring them to the local ER for an evaluation because "That's what you're supposed to do." Is there something not so kosher about this? you betcha. The Police Chief encourages this activity - and refuses to let any officers out of town. One night, dealing with an EtOH patient at the PD [Not under arrest, not PC'ed, in their station against his will] The officer refused to transport because "I'll have to stay with him at the hospital for like, 4 hours! I can't do that!" So he, his Sergeant and another officer sat for 45 minutes trying to convince this slightly inebriated individual that he actually wanted to go to the ER.

Just last week, at town voting, the Chief thought that a woman was acting weird. He sent a minion [part time officer] to the residence - Where he claims she didn't know her own name, was talking about flowers on walls that weren't there, did not know her address, her family, any medical conditions, and any phone numbers of anyone to contact. She was at her own home. After 2 hours - the officer placed the woman in his car and drove her to the police station to call EMS. The crew on found an elderly woman acting appropriately, adamant about not going to the hospital. She knew her name [she went by her middle name - so it didn't match her driver's license]. the flowers on the wall comments were that the school where she voted has the same wallpaper as her old house. She knew her address, her phone number, her daughter's name and home and cell phone number. They signed her off - and the police chief went off the deep end. They had suggested PD just transport the patient to the ER themselves - to which he replied "We don't transport psych's."

He shut up right after they mentioned "then how did she get here?"

And this has nothing to do with the "18 y/o who fell down the stairs at home" with facial fractures - Who was brought to the police department after his "fall" at "home".

When your own police department can not play by the rules of the law, I'm not sure I want them to help me much.

[side note - This very department is the same one who brought a suicidal male who had a knife to his throat downstairs without frisking him, no cuffs - and wanted us to talk to him. HA! He put up a fight - First time I've ever seen anyone tazed while in cuffs while in a police cruiser.]

This police department is a lot like "D'Angelo's"

"Just Plain Great."

[Ace844]

(Acad Emerg Med Volume 13 @ Number 4 435-442,

published online before print March 10, 2006, doi: 10.1197/j.aem.2005.11.072

© 2006 Society for Academic Emergency Medicine CLINICAL PRACTICE

Subsequent Suicide Mortality among Emergency Department Patients Seen for Suicidal Behavior

Cameron Crandall, MD, Lynne Fullerton-Gleason, PhD, Roberto Aguero, MS and Jonathon LaValley, BS

From the University of New Mexico (CC, RA, JL), Albuquerque, NM; and the University of Nevada School of Medicine (LFG), Las Vegas, NV.

Address for correspondence and reprints: Cameron S. Crandall, MD, University of New Mexico, Department of Emergency Medicine, MSC 10 5560, 1 UNM, Albuquerque, NM 87131-0001. E-mail: ccrandall@salud.unm.edu.)

Objectives: To determine whether suicide mortality rates for a cohort of patients seen and subsequently discharged from the ED for a suicide-related complaint were higher than for ED comparison groups.

Methods: This was a nonconcurrent cohort study set at a university-affiliated urban ED and Level 1 trauma center. All ED patients 10 years and older, with at least one ED visit between February 1994 and November 2004, were eligible. ED visit characteristics defined the cohort exposure. Patients with visits for suicide attempt or ideation, self-harm, or overdose (exposed) were compared with patients without these visits (unexposed). Exposure classification was determined from billing diagnoses, E-codes (E950–E959), and free-text searching of the ED tracking system data for suicide, overdose, and spelling variants. Emergency department patient data were probabilistically linked to state mortality records. The principal outcome was suicide death. Suicide mortality rates were calculated by using person-year (py) analyses. Relative rates (RR) and 95% confidence intervals (95% CIs) were calculated from Cox proportional hazards models.

Results: Among the 218,304 patients, the average follow-up was 6.0 years; there were 408 suicide deaths (incidence rate [iR]: 31.2 per 100,000 py). Males (IR: 48.3) had a higher rate than females (IR: 13.5; RR: 3.6; 95% CI = 2.8 to 4.6). A single ED visit for overdose (RR: 5.7; 95% CI = 4.5 to 7.4), suicidal ideation (RR: 6.7; 95% CI = 5.0 to 9.1), or self-harm (RR: 5.8; 95% CI = 5.1 to 10.6) was strongly associated with increased suicide risk, relative to other patients.

Conclusions: The suicide rate among these ED patients is higher than population-based estimates. Rates among patients with suicidal ideation, overdose, or self-harm are especially high, supporting policies that mandate psychiatric interventions in all cases.

[Asysin2leads]

Psychs should go by ambulance, properly restrained with law enforcement accomapanying. We may not always like to think so, but psychs are ill, not (necessarily) criminals, and that's the way we have to go about it.

[JPINFV]

Why restrains and LEO if the patient isn't DTO? Not all psych patients are violent. Not all psych patients need restrains. Just because they might have a pysch (or neuro. Psych disorders and Neuro disorders generally goes hand in hand[sup:567d8d070a]*[/sup:567d8d070a]) problem does not mean that they are not protected from false imprisonment.

[sup:567d8d070a]*[/sup:567d8d070a]Suggested reading: The Man Who Mistook His Wife For A Hat : And Other Clinical Tales by Oliver Sacks

[Rezq304]

All patients are cooperative... right up to the point where they become suddenly and violently uncooperative without warning.

Sorry, doughnut boy. If you are "uncomfortable," I am ten-times that. If it ain't safe for you, then it damn sure ain't safe for me. Your purpose is not to catch the guy after he kills me. Your purpose is to protect me from him in the first place. Either you ride, or you transport in your caged car.

NOTE: "Doughnut boy" and "you" are used in referring to the cop in the scenario. They are not a reference to you personally.

Dust, I couldn't have said it better myself.