Peter Antevy explains how EMS can transport stable psychiatric patients directly to specialized facilities instead of emergency rooms. The approach requires documented psychiatric history, medication verification, and vital sign checks to avoid missing medical emergencies like encephalopathy or overdose.
Chapters
Let's talk about alternative destinations. That's been a common term that you've been hearing in the field of EMS lately. And basically it means taking patients to somewhere other than a hospital emergency department. And you'll see in our protocol, we have now started that process where we can take patients with chronic, chronic mental problems directly to a Baker act receiving facility rather than stopping by an emergency department. And now that's important from the patient and from the healthcare system standpoint, because when you have somebody who's medically stable and just needs psychiatric care, when you bring them to a non Baker act receiving facility in that ER, that patient could be there for 24, 48, even 72 hours awaiting placement in a psychiatric facility. Not good for the er, not good for the hospital, not good for us because it blocks bed for patients that need acute medical care. For patients that appropriately need just psychiatric care and are otherwise medically stable, it is reasonable to actually transport those patients directly to the bakery receiving facility. So how do you determine which patients are useful for that and avoid some of the pitfalls of taking some of these medical conditions that masquerade as psychiatric conditions? Well, step number one is, has the patient had this before? We are only going to take patients who have known diagnosed psychiatric conditions such as depression, prior suicidal ideation, prior schizophrenia, well diagnosed, well worked up conditions. That way we avoid patients that may appear to have those things, but in fact have encephalopathy, meningitis, some sort of toxin that actually can look like psychiatric, but it's actually a medical emergency. So make sure, number one, the patient has a true history of chronic psychiatric condition. Now, sometimes you may not be able to get the full history, but you can look at the medications that the patient's taking. There are some very common psychiatric medications that indicate to you the patient has a chronic psychiatric condition. I'll just list a few of them, such as Clozaril, Geodon, Risperdal, Abilify, Alexapro, Prozac, Alexa, Thorazine, Melaryl, Haldol, these are all common medications and there's certainly many other. But those are some of the most commonly prescribed medications that indicate that you're dealing with a patient that has a chronic psychiatric condition. And then of course, you will see in the protocol we have a number of physiological parameters the patient has to be within. If they're outside of them, then certainly you would go ahead and take them to the emergency department and then do a thorough physical exam. Make sure you see any trauma, you don't suspect any overdose. Anything else that suggests that you actually need an emergency department, but by and large, stable chronic psychiatric cases actually would do better. The patient does better, the healthcare system does better when they're taken appropriately to the, to the correct facility the first time. So take a look at that protocol and you'll see it gives you some extra tools, some extra options to take these patients where they, where they will get the best service for their needs.
