With regards to calls for psychiatric issues, I've begun wondering if EMS is perhaps not best suited to respond. Some would say "Well, GCP, you just don't like going on psych calls." I won't deny that they aren't my favorite, but that's not the reason.
Last night, my partner and I responded to a psych call. This by itself is not out of the ordinary in Gotham City. However, the circumstances of the call were a bit different. Without going into too much detail, one party requested EMS, stating that the second party (who happened to be an ex) was threatening to hurt himself/herself, as well as the child that the two parties had parented together (are you following me so far?). We responded, along with several representitives of the Gotham City Police Department. On arrival, we found the second party who vehemently denied suicidal and homicidal ideations or plans, stated that the first party was lying and that they had been involved in an extended argument recently, and denied any and all physical complaints. After consultation with the GCPD officers, we all agreed that the second party did not pose a danger to him/herself or others, and we cleared.
As I sat on post in a 7-11 parking lot and wrote the call report a few minutes later, it occurred to me that maybe we're going about this the wrong way. As a paramedic, my speciality is in treating patients with physical issues, be they of medical or traumatic origin. While I understand that many psychological issues stem from biological issues of altered brain chemistry or past trauma, the typical psych patient does not actually need emergent medical care, because they are not experiencing a physical issue. All I do on most psych calls is monitor vitals to insure that the the patient is in no physical danger, and provide an empathetic listening ear on the way to the hospital.
I would also suggest that paramedic school left many of us woefully underprepared for dealing with patients having psychological issues. We spent a lot of time talking about what the different disorders are, and why they occur, but we did not spend much time learning how to actually help the person experiencing them. Mostly, we were just told "be sympathetic, caring, try to listen." However, we were not trained in counseling techniques.
To be fair, there are some patients with psych issues who are also having medical issues. Or, due to suicidal ideations and gestures, have given themselves traumatic injuries or medical injuries. These patients absolutly need paramedics, EMTs, and ambulances. But I'm not really talking about those patients. Right now, I'm talking about the medically stable patient with depression, suicidal or homicidal ideations, or hallucinations.
My patient last night was not having psycological issues. But let's pretend, for a mement, that my call was for real suicidal ideations, rather than simply the product of a nasty custody battle. My call report was full of "medical speak;" I wrote about my physical exam, vitals, past medical history, allergies, and prescribed medications. All were normal. I used the tools and training that I, as a paramedic, have. However, my assessment was not the assessment needed, and did nothing towards diagnosing what the patients problem was. The problem was not "medical."
And that's why I'm starting to think we're doing patients with psycological issues but no medical problems a disservice by sending paramedics, EMTs, and ambulances to them. We are not giving them the care they need, despite doing excellent patient assessment and collecting pristine vital signs. Are we hurting them? Probably not. We are, after all, getting them to definative care. But should we be satisfied with that level of treatment? Would we be satisfied with that level of treatment for STEMI patients? Or diabetics? Or trauma? I say no.
So what's the answer? I'm not really sure. I don't really have an alternative. My partner and I bounced some ideas around, and I think the best one we came up with consisted of a two-person team in a mini-van; a psychological ambulance, if you will. Make one of them an EMT so you have some basic medical training on board. If something requiring a medical response happens on the mini-van, Gotham City EMS is just around the corner (probably literally; we at Gotham City EMS are known for haunting every 7-11 parking lot in the city). The other crew member on the van should be a counselor. Someone who can do psych assesments in the field, and maybe start untangling the true issue the patient is dealing with.
I think you could send an ambulance on these calls as well, just as some extra insurence to assess the patient and make sure that this isn't actually a medical problem in disguise. But I think having a resource which responds with psychological care in the field, as well as the capability for transport to definitive care would be far more effective than sending an ambulance staffed with two medical techniticians who have been given a minimum of training in psycological emergencies. Let's face it; that's kind of like sending a carpenter with some basic knowlege of pipes to an overflowing bathtub, rather than a fully trained and equipped plumber.
My whole goal in this is the same as for every other patient I treat; to provide them with the best, most effective, and most appropriate care. Again, this is a proto-thought, and isn't fully thought out yet. If you have uestions or comments, or would just like to help me refine my thinking, feel free to comment or email me.
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