Challenges EMS Personnel Face:  Transporting Psych Patients

Transporting Psych Patients involves Perceptive Training

Having worked as a National Risk Manager in the EMS world for several years throughout my career, I’ve realized that while the EMS community has countless talented individuals with exceptional lifesaving skills and excellent bedside manners, we often find that many don’t necessarily have vast knowledge about psychiatric illnesses and transporting psych patient training isn’t always clear because the variables have so much to do with the perception. Allow me to explain. In all fairness, most of us (in general terms) don’t really understand the complexities associated with psychiatric disorders.  My experience has led me to believe that in the case of EMS personnel, the challenge of transporting psych patients lies in understanding that the lack of physical manifestations (as we often see with other illnesses or medical conditions) shouldn’t deter safety procedures and legal protocols. Your perception of a patient’s health condition or mental state should never interfere with EMS due diligence- from both a clinical and safety perspective.

I would like to point out that in no means am I implying that EMS personnel aren’t trained to deal with a psych patient. Instead, I am referring more so to those patients with acute behavioral crisis. In fact, in a position paper published by the National Association of EMS Physicians, only 28% Percentage of EMS providers reported having received any formal training on pre-hospital patient restraints.

EMS providers need to make their ambulances as safe as possible – not just for psychiatric patients, but also for themselves.

Transporting Psych Patients

How we approach and interact with these patients can often lead to great success or the complete opposite, a redundant failure. These failures may lead to patient or even employee injuries, business interruption and last (but paramount) a negative perception of your business from the healthcare community and the public in general.  I always try to stress the following tips during my EMS training sessions.

  • Recognize that an acute psychiatric condition may develop at any time and create the necessary conditions to manage the patient.
  • Maintain respect and empathy will help establish the trust required so that the patient remains cooperative and as calm as possible.
  • Always remain vigilant and on looking for any signs of an impending outburst or violent type behavior so that you may your patient and you safe- remember your “scene safety”.
  • Always make sure that your patient is properly buckled and be sure to use the full harness (include shoulder straps).
  • Always lock the doors to your vehicle while transporting the patient.
  • Create a pre-arranged distress signal or code between you and your partner that indicates distress and the ambulance needs to come to a safe stop.
  • Do not take your eyes off the patient until you have surrendered care to the hospital or authorized care giver (so long as the patient remains in your physical custody you may have responsibility).

Consider the use of some form of deterrent device to keep your patient from gaining access to removing the strap or buckle, there are many devices in the market that achieve this objective without braking the bank. I like the buckle guard because it is intended to Slow and Deter a Patient from unbuckling their Stretcher Safety Restraints.

Finally, never take it personally.

Your patients don’t know you, even with your uniform on. What a patient might say or do in the heat of the moment has nothing to do with you as an individual. Keep in mind that while mental illness may not always manifest itself physically– it is still an illness or medical condition nonetheless.

Stay Safe!

The Alpha Risk Management Team

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