Monday, July 11, 2011

EMS's Own Silent Epidemic

A simple question from the "Why Do We Do This?" File:
Why do 911 ambulances transport stable, uninjured psych patients who have no medical or toxicological complaints?
It's never made any sense, and recent injuries to good friends of mine in the field have only highlighted my disdain for the practice.
A friend of mine just learned today that he's out of work for another week, making four total, due to a back injury incurred lifting a stretcher on which was loaded an angry psych patient -- who had no medical complaint, other than being angry. This patient decided to lunge, without warning and at the exact perfect moment during my friend's lift, and now he's been off the job for a month. He has a mortgage and several small children to feed on a Paramedic's salary, so you can imagine what this is doing to his financial security.
And for what?
There was no compelling reason for this patient to go anywhere in an ambulance. Indeed, given the patient's state of mind, she would have been far safer in the back of a police cruiser, in handcuffs if need be, applied by a law enforcement officer with the authority and training to restrain this person.
For EMS personnel, psychs represent nothing but risk.
We aren't allowed by law to restrain them, but they turn violent so often that we are often left with no alternative.
There is no medical problem for us to attend to, and the minimal training we get in EMS for responding to psychiatric emergencies is laughably inadequate.
In my opinion, the number of EMS providers significantly injured on the job by psych patients is a silent epidemic that for some reason is talked about only on ambulance docks, or in crew quarters, or on the bus.
I have yet to work for an EMS agency that really addressed the issue, or even mentioned it in passing.
In the 17 years I've been in EMS, I've been injured exactly once -- by a psych patient who, for no reason and completely out of the blue, scissor kicked me in the chest as I was getting her settled on our ambulance stretcher.
I suffered an agonizing month with costochondritis, a painful injury that made attempts at sleep excrutiating and deep breaths impossible.
And because I couldn't afford to take the time off from work (due to my own mortgage and legion of mouths to feed), I kept the pain to myself and suffered in silence until the injury healed itself.
How many millions of dollars a year are wasted in EMS on time lost to injury due to violent psychiatric patients?
These patients rightly belong to the police.
They have the authority and the means to safely restrain these patients, and the backseat of a police cruiser is a far more secure environment -- with its cages, Lexan glass and doors without handles -- than the patient care compartment of an ambulance, with its myriad of options for escape and self-injury.
I understand completely that most police officers are going to be resistant to the idea.
And while I respect those folks and have many friends in law enforcement, I say it's time for that particular branch of public safety to step up and assume this role that so clearly belongs to them.


Michael Morse said...

Well stated, Ted, this has been going on far too long, I've written about it numerous times, nobody seems to care but us. Try refusing to transport a psych patient who hasn't attacked anybody yet and the law laughs at you. The buck stops with us, and that is just sad.

Rod Witkos said...

Shit and liability flows downhill and I'm there with my hands out. 

A hypovolemic bleeding heart clinician once told me she didn't want the patient to be stigmatized riding in a patrol wagon. 

So I have to be the recipient of their disrespect and abuse. I'm not allowed to defend myself from their violent outbursts or I'll lose my job. I have been investigated for false child abuse allegations filed by clinicians at my own hospital. I am just waiting for the civil rights lawsuit. Sadly, only the choir can hear us.