60 y/o Female, that called for nerves are shot.

[Dustdevil]

:shock:

[NREMT-Basic]

"I can make myself aware of possible dangers all I want but awareness isn't going to be able to physically stop a patient that is trying to jump out of the ambulance while were going 100 km/h down the highway, or trying to grab the steering wheel or trying to harm me. If I have any doubt at all that the patient will be cool, calm, and collected the whole ride than they aren't getting in my ambulance."

First off, a properly restrained patient, psych or otherwise, is not all that likely to leap out the back of the rig. That what soft restraints are for. Furthermore, an emotionally or mentally distressed person is not the pervue of the police. If they have are suffering from a biochemical imbalance, this is the realm of EMS just as cardiac arrest or an asthma attack.ie...the person is in medical crisis. If you expect every person you serve to be cool calm and collected, go work at walmart, cause it aint gonna happen. We were taught way back at the beginning of EMT school how to interact with patients etc. And what the hell is the patient doing in a position to grab the stearing wheel anyway...sounds like a refresher course in ambulance ops might be needed. You say if there is any doubt at all about the stability of the patient then they dont get in "your" ambulance. Idiocy. I dont know about where you are, but here once we have made contact with a patient, even down to asking them questions to get a history or introducing yourself (Hi I am an EMT...what caused you to need our help today?) you have initiated care...then pawning them off on someone else without a equal or greater scope than your own, you have just legally abandoned that patient and I would dust of my resume if I were you.

You know what? Pts can be unstable, rude, violent...the can spit and curse and hollar to beat all hell, but you took the job knowing that that was part of the game. Does this mean that a verbally abusive and disoriented diabetic doesnt get your stamp of approval as worthy of care and doesnt get to ride in "your" ambulance? Just food for thought

[MeekoBB]

In my city, when we have behavioral issued pts, 97% of the time PD follows in their unit. If the pt is a known combative or known to give EMS a hard time they ride in the ambulance and depending on the officer, will not hesitate or argue when EMS requests them to ride along.

On private bls transport here, in my experience, if a pt is combative, the hospital usually medicates the pt enough to get to the destination. Few facilities have standing orders for hard leather restraints. I used to do psych transfers from one hospital to a psychiatric hospital they sent many pts to...that particular destination is one that only accepts pts in restraints and its the MD himself that signs the acceptance.

One day I brought a big guy in there and the doc was on lunch taking forever and meds the sending hospital gave the pt was wearing off and he was getting restless shaking the stretcher. We started pressing on security to get the doc there faster because then you'd find us outside and the pt his problem.

[medic_ruth]

I believe you can find that in the same chapter as the one that says you should put your psych patients on the bench seat..

:headbang:

awesome

[Connie31079]

NREMT-Basic wrote: "We were taught way back at the beginning of EMT school how to interact with patients..."

Yes, what I was taught was any potentially violent patients, call the police....they'll transport them.

What were you taught regarding psych patients? Something different? If you guys are being made to transport violent psych patients, remind me to never go to work for your service.

Have you ever been physically attacked by a violent psych patient in the back of your truck? I had my glasses broken and a laceration stitched closed under my left eye a number of years ago by a supposedly "calm" lady that I was transporting. I take no chances anymore with psych patients, if they're gonna freak out with me, they're either going in the back of a police cruiser, or a police officer is coming in the back of the ambulance with me, and they're cuffing the patient to my stretcher.

We don't even have proper restraints in our ambulances here in Nova Scotia. If I want to restrain a patient who becomes violent on me, I have to use triangular bandages and/or duct tape to tie their hands to the stretcher, all while they're fighting me. Think it's easy doing that by yourself? You try it. I'd much rather let the police transport these folks.

I, as an ACP, am also allowed giving 5mg IM versed to violent patients, in an attempt to sedate them enough to calm down. Again, ever try drawing up your med with a syringe/needle while a patient is fighting you? Then you come towards them with the needle and syringe in order to give them the shot, and if they're not ballistic enough, you're gonna make them even worse, because the last thing they want is to be calmed down. Believe me when I say, it's not so easy!!!

I remember an incident a few years back that happened in Halifax, where an ambulance was transporting a psych patient between facilities. The patient had been "sedated", supposedly with enough medication to snow a goat....he was quietly "sleeping" on the stretcher at the hospital when the ambulance arrived. Enroute to the receiving facility, the patient suddenly "woke up" (I really don't think he was properly sedated to begin with, but that's just my opinion), and grabbed the attending medic by the throat, and began choking him. The medic who was driving screamed at the patient, promptly alerted dispatch as to what was going on, and managed to pull the ambulance over to the side of the road in order to try and help his partner. By this time, the medic in the back who was being choked, his lips were cyanotic. Then the police arrived....luckily, no lasting damage to the attending medic.

This could have had a much worse outcome, except for the fact that the police were right around the corner. But such isn't always the case.

I don't advocate EMS never treating psych patients, all I'm saying is, USE COMMON SENSE, for God's sake! Sure, I love my job, but I'm not going to risk my life in order to save somebody else's.....I won't be around too long if I start doing that on a regular basis.

[NREMT-Basic]

Yes, as a matter of fact I have been assaulted by a pt on two seperate occasions. And I never said anything about hard leather restraints. I said soft restraints. I truly am sorry that you had a bad experience with a patient attacking a medic. I have also had the job of pulling an unruly psych patient off of the medic. What I was disagreeing with was the idea that unruly psych pts never go in an ambulance. And as for dropping a patient in the ER and going back out to the rig...I dont know about where you live but here in Illinois that constitutes abandonment and will lose you your license. I also cant imagine that versed would not put a patient down far enough that they wouldnt be any trouble. I have been grabbed around the neck, punched and spit on. However, that doesnt mean that I am going to dump the transfer of an emotionally disturbed patient off on the police. And of the patient is put in handcuffs by the police, you better make sure that the police officer does in fact ride IN the ambulance and not behind it. In my region, we cannot have a patient in cuffs unless the person who put them on the patient (ie PO) is right there with us

[MeekoBB]

Psych or medical...a patient is still a patient and to be treated and transported by EMS. You feel you're in danger and want PD to transport? Have PD with you IN the rig DURING transport.

[Classair]

I transport several phych (Baker Acts) PT per night last one was a 6' 2" 250 lbs M that was talking to the third or forth person in the box hummm I just seen him and my self. :? He sat on the bench and I sat on the captain's chair thats were we carry the extra O2 bottles if you catch my drift.... he did keep asking why I killed his grandmother I kept my right hand on the bottle just incase he needed some O2 :wink:

[medic53226]

Thanks to everyone for you time and information, and I hope that this may help you someday, because I know that if you have been in this business for more than one day you have seen stuff that just puzzles the crap out of you. Another pt I had was checked by a EMS Director and passed to me as he is having a stroke he took no V/S, no BGL, just the FD told him the pt had a history of CVA's and that was all he needed. However the pt had a hx of diabetes and multiple other medical conditions, to say the least. By the way the pts BGL was 32 and after reversing the hypoglycemia, he started throwing couplets, and then VT, and he woke was complaing of chest pain. That at that time the wife stated he had been having chest pain all day before what she called his stroke episode. I wanted to drag my EMS Director out of his little office and ask did they teach you pt assement in you medic program, or you just to lazy to do that since you got you promotion. That is why I hope that I never turn into him, or anyone that just goes by what I'm told and not what I find.

Thanks

Chad

[MeekoBB]

NREMT-Basic wrote: "We were taught way back at the beginning of EMT school how to interact with patients..."

Yes, what I was taught was any potentially violent patients, call the police....they'll transport them.

What were you taught regarding psych patients? Something different? If you guys are being made to transport violent psych patients, remind me to never go to work for your service.

Have you ever been physically attacked by a violent psych patient in the back of your truck? I had my glasses broken and a laceration stitched closed under my left eye a number of years ago by a supposedly "calm" lady that I was transporting. I take no chances anymore with psych patients, if they're gonna freak out with me, they're either going in the back of a police cruiser, or a police officer is coming in the back of the ambulance with me, and they're cuffing the patient to my stretcher.

We don't even have proper restraints in our ambulances here in Nova Scotia. If I want to restrain a patient who becomes violent on me, I have to use triangular bandages and/or duct tape to tie their hands to the stretcher, all while they're fighting me. Think it's easy doing that by yourself? You try it. I'd much rather let the police transport these folks.

I, as an ACP, am also allowed giving 5mg IM versed to violent patients, in an attempt to sedate them enough to calm down. Again, ever try drawing up your med with a syringe/needle while a patient is fighting you? Then you come towards them with the needle and syringe in order to give them the shot, and if they're not ballistic enough, you're gonna make them even worse, because the last thing they want is to be calmed down. Believe me when I say, it's not so easy!!!

I remember an incident a few years back that happened in Halifax, where an ambulance was transporting a psych patient between facilities. The patient had been "sedated", supposedly with enough medication to snow a goat....he was quietly "sleeping" on the stretcher at the hospital when the ambulance arrived. Enroute to the receiving facility, the patient suddenly "woke up" (I really don't think he was properly sedated to begin with, but that's just my opinion), and grabbed the attending medic by the throat, and began choking him. The medic who was driving screamed at the patient, promptly alerted dispatch as to what was going on, and managed to pull the ambulance over to the side of the road in order to try and help his partner. By this time, the medic in the back who was being choked, his lips were cyanotic. Then the police arrived....luckily, no lasting damage to the attending medic.

This could have had a much worse outcome, except for the fact that the police were right around the corner. But such isn't always the case.

I don't advocate EMS never treating psych patients, all I'm saying is, USE COMMON SENSE, for God's sake! Sure, I love my job, but I'm not going to risk my life in order to save somebody else's.....I won't be around too long if I start doing that on a regular basis.

Actually Connie, I wouldn't want to be in your area with a policy like that....I do not recall nor have I ever heard if EMS had a problem with a pt that PD transports during my training course. That is just opening a huge can of worms for a lawsuit. There is a reason why there are restraints on the rig...for violant pts!!! And you want to CYA? Have your PD transport WITH YOU. PD can restraint the pt and provide safety while you medically care for your pt...

In which case....a drug/od pt....Are you going to have PD transport because those can get violent as well, however, its also a medical based call....What are your protocols there? I've transported a pt, approx 30yo male, about 270 lbs, solid muscle, who had used, LCD, PCP, & Angeldust. That was an interesting call with 3 ems personnal and 4 cops restraining him to get his limbs tied/cuffed to the stretcher to provide transport. Having a violent pt like that in a single manned PD car would be EXTREMELY unsafe. PD transported in the rig with us... I do not recall if ALS was with them because I only took pt info from PD as the rig had too many people on it.