Psychiatric patients – Paramedics can safely evaluate medical condition in the field

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St. Joseph Hospital of Orange clinical nurse Inez White talks with a patient in the Emergency Clinical Decision Unit, a twelve-bed holding area for psychiatric patients before determination of where they will be placed. Some 5250, or involuntary hold patients, leave after the mandatory 72 hours of care. ///ADDITIONAL INFORMATION: Ð MINDY SCHAUER, ORANGE COUNTY REGISTER Ð shot 102314 mentalhealth.st.joseph The St. Joseph Hospital of Orange Emergency Clinical Decision Unit has 12 beds and serves as a holding area before placing psychiatric patients who are brought in to the emergency room.

Emergency medical personnel in Alameda County, California, use a screening process for determining whether to “medically clear” patients experiencing psychiatric emergencies before transporting them.

They identify patients who are at low risk for medical emergencies and take them directly to a special Psychiatric Emergency Service facility specifically designed for people experiencing psychiatric crises.

The protocol used by Alameda County emergency medical staff is an alternative to standard protocols, in which all patients are transported to the nearest emergency department.

During a five-year period ended Nov. 1, 2016, Emergency Medical Services staff used the protocol to transport 41 percent of 53,000 psychiatric emergency cases to the stand-alone psychiatric emergency service facility.

As a result, 22,000 psychiatric patients were treated at a specialized facility without first undergoing the standard trip to the emergency department.

Patients with psychiatric emergencies on involuntary holds are often taken to traditional hospital emergency departments.

However, patients sometimes spend hours to days in an emergency department bed waiting for treatment and access to specialized psychiatric personnel to conduct mental health evaluations.

Psychiatric Emergency Services were established to address this gap.

Patients still are evaluated to determine that they are not suffering from a life-threatening illness before they are transported to a psychiatric emergency services facility.

The researchers examined data for 542,000 Emergency Medical Service encounters in Alameda County over five years.

They noted that because the data are from just one county, the results may not be applicable to counties that have a fundamentally different strategy for managing psychiatric crises before transportation.

Paramedics have the ability to distinguish acute psychiatric crises, which can mimic symptoms of a physical ailment, from life-threatening medical illnesses.

As a result, they can safely divert psychiatric cases from frequently overextended emergency departments in hospitals to specialized psychiatric facilities.

These findings demonstrate the effectiveness of using protocols to assist paramedics in evaluating patients’ medical conditions in the field in order to help direct them to an appropriate facility.

More information: Tarak K. Trivedi et al. Emergency Medical Services Use Among Patients Receiving Involuntary Psychiatric Holds and the Safety of an Out-of-Hospital Screening Protocol to “Medically Clear” Psychiatric Emergencies in the Field, 2011 to 2016, Annals of Emergency Medicine (2018). DOI: 10.1016/j.annemergmed.2018.08.422 

Journal reference: Annals of Emergency Medicine search and more info website

Provided by: University of California, Los Angeles

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