Psych Transports.

[Reddfrogg]

I'm a medic working for a non-profit company, in a small town( about 50,000 people in our response area) In PA psych transports are a required BLS transport. They cannot go wheelchair, or litter. Our local hospital has a psych ward, but many patients get transferred to a psychiatric hospital. Most the Psych hospitals in the area, are more than an hour and a half trip one way. Therefore a psych transport requires at least 3 or more hours from start to finish. Most of these transport come in, for some reason, after midnight.

The service I work for runs both 911 emergency calls, and interfacility transports. When the local ER needs a transport, they call our dispatch center, and the on duty crew gets sent on the transport, as long as we aren't already going somewhere else. We are staffed with one EMT, and one Paramedic on the overnight ( post 2300) shift to cover both emergency and transports. When an ALS, or a BLS transport comes in, we must transfer the paramedic from our outlying station, to cover our station for 911 calls.

What this boils down to, is when a Psych transport comes in after midnight, (like it usually does) we must take a paramedic out of service from our primary response area, more three or more hours. These patients require observation, but obviously don't require ALS.

My question is, in your area, do Psych transports require BLS transport? (ie at least two EMTs). Who transports psych patients in your area? Do the police transport psych patients? How far is an average transport?

thanks

Reddfrogg

[Ridryder 911]

In my area all Psych patients are cuffed and transported by Police. Unless they require continuous ALS monitoring, EMS is never involved in hospital to hospital transports.

I wish you luck, shame abuse of EMS is occurring.

R/r 911

[Sassafras]

EMS transports 9 out of 10 psychiatric pts. to area hospitals (EDs) where I work, mainly for "medical clearance" before being transferred to the actual psychiatric hospital. If the pt. has any medical/physical complaint whatsoever (even a hangnail) the psych hospital ED will refuse to see them until they've been cleared medically, and will call 911 for us to come and pick them up. This also includes ETOH. On the rare occasions that we arrive and the pt. is not under the influence of drugs or alcohol, is denying physical complaint and states that they just want to be transported to the psych ED, then the police transport them for us (we are not allowed to transport pts. to the mental facility). For the most part it works out well.

[JPINFV]

As far as I can tell, most psych transports in my area is done BLS (be it IFT or to be cleared medically). Grant it, we aren't hurting for ambulances (7 private companies, most with mix 911/IFT services. ALS provided only by the hose draggers) where I live, so we don't run into the undercoverage problem. Me thinks that you need another BLS unit on at nights to cover the transports then.

Average transports run anywhere from 5-30 minutes depending on where to where. We have 3 dedicated psych hospitals, a dedicated evaluation and treatment center (ETS), and most of the hospitals have a psych unit.

In my area all Psych patients are cuffed and transported by Police. Unless they require continuous ALS monitoring, EMS is never involved in hospital to hospital transports.

I wish you luck, shame abuse of EMS is occurring.

R/r 911

Really? Not all psych patients really need handcuffs. I would expect the restraints to do more harm then anything for most people. An involuntary admit due to grave disability isn't really a danger to anyone. If I ever have a family member transported to a hospital in restrains only because it was "standard procedure," then people would be fired. While JCAHO might not be responsible for the prehospital enviroment, they do highly advocate for consideration and implementation of non-restrictive measures first and restraints as an option of last resort. I'm sure that JCAHO isn't the only group saying this, either.

Grant it (not directed at anyone in particular), EMT-B education in psych disorders and dealing with psych patients is just as sad as the rest of the basic "education." The public preception of psych patients doesn't help very much, either.

[Eric]

psych transports runs around 25mins but i have done a long run before none psych transports CHF PT we left town around 2300 monday and got back around 0500 weday

[strippel]

I'm not that far away from you.

We do psych runs frequently, and many of them are out of town, Philly, State College, etc. We could be gone up to 3-4 hours as well.

The difference is we (usually) have adequate resources. We put 9 trucks out daytime, and 5 overnight, and depending on staffing, a combination of ALS and BLS units. Although our medics do more than their share of transports, a BLS truck will do BLS transports before an ALS truck.

Sounds like you need either a additional BLS truck, or an on call crew.

And yes, in PA, psych IFT runs are BLS, and insurance pays.

[MikeJ]

In my district, psych transports are BLS, even if there are no other medical issues involved. I never understood this.

We almost always insist on bring the police along (either with us in the rig, or following behind), so it's not like we are freeing up law enforcement resources here. The police, not us, are the experts at transporting potentially unruly people, and they, not us, are the ones best equipped to handle an outburst of violence. Maybe they figure that BLS crews are better at calming people down... maybe they will start dispatching us to defuse bar fights and domestics, too.

[hammerpcp]

psych transports runs around 25mins but i have done a long run before none psych transports CHF PT we left town around 2300 monday and got back around 0500 weday

Remind me never to get sick in Kentucky. :shock:

[1aCe3]

Psych transports are a common occurence here in nyc and is usually dealth with by the private transfer companies that are contracted with hospitals. These interfacility transports are either accompanied by the NYPD or Hospital Security staff. However, a large percentage of these transfers do not need either because of the reasons stated above. These transfers can be anywhere from 10 min-2 hours. The hospital usually assesses the situation and determines whether an escort is required, however at times I've argued.. and for good reason. When you're on a long distance psych transfer in the middle of no where.. with help so far away... well, it's your ass on the line. So the crew better do their own assesment and observing before getting on the way. And yes, these are usually BLS crews, unless the pt has some other health issues that requires ALS monitoring.

[cosgrojo]

My question is... Is there a law in place that makes non-emergent, stable, medically clear, voluntary psych patients have to go into the back of an ambulance? Or is it just the way that it gets done? I'm curious what each state or hospital uses for criteria... anyone know?