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Permalink Reply by Reg Mathis on September 5, 2008 at 11:33am

Hey Ted,

Thanks for the response! We get a lot of suicides/attempts, but this one was very different. After debriefing, the station responding stated that the mother was instrumental in calming the individual and refused transport because she did not want to upset her son. She also (successfuly) pleaded the IC to not inform the SO as this would also invoke a excited response from her son. Hoping I don't sound callous, but my primary concern is the liability of just leaving the patient in his mothers care. But the options for treatment are excellent guidelines as well!!

Thanks again,

Have a great weekend and stay safe!

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Permalink Reply by Joe Stoltz on September 5, 2008 at 12:27pm

Reg, in our area the county dispatch protocol for "suicidal subjects" is to send law enforcement as well as EMS to the location. We are dispatched to a "law enforcement standby" to a nearby location (street intersection, parking lot, etc.) and once there, we wait until the SO arrives on scene and determines the scene is safe. Meanwhile the dispatcher is looking up call history for the address and relaying any pertinent information to the deputies.

The first-arriving LEO assesses the situation and determines whether or not the threat is legitimate, if weapons are involved, if any drugs have been taken, etc. We will take folks to the hospital for observation, or for treatment of overdose if indicated. The LEO has the authority to make an arrest under the mental hygiene law if the "subject" is uncooperative and/or in need of help.

We have been taught to never go into a situation that seems unsafe; if you get on scene, and things don't appear to be quite right, retreat to a safe distance and call law enforcement. You should also call for LE if the patient seems to be OK but you suspect something is going on. Anyone with a GCS of 13 or less needs to go since this indicates altered mental status, and again LE can be called in to make a mental hygiene arrest.

If your sheriff's deputies are as good as ours, they will be able to cut through the BS fairly quickly with folks that don't quite have it all together.

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Permalink Reply by Moose on September 5, 2008 at 12:35pm

Well, in my experience as an EMT for a paid service, and my volunteer squad, I have always guaranteed a ride to get a psychiatric evaluation to anyone that threatens and or attempts suicide, regardless of what the outcome is or what the family begs of us. To put it simple, we are EMT's, not doctors ( I tell my friends and family this every time they ask me for medical advice!!LOL) and therefore can not guarantee the safety of the patient. Especially in the case you mentioned where his outburst was due to a change in medication...whos to say it would not happen again like you said? Can the mother guarantee that? I would explain it to the mother that its his medication, and it needs to be evaluated, not by me in my ambulance but by the doctor that prescribed the meds to him, and that once she called us we became responsible for both his and your well being. Once we arrive on scene and make pt contact, we should try everything we can to transport, or like Ted mentioned, make sure we explain the circumstances Thouroughly to the patient and the family, and what could happen if they refuse aid or transport to the appropriate facility. Than make sure we have the refusal signature from the Mentally ALERT patient, or the family member/legal guardian of the patient, with the witness signature from the police if at all possible, this way a LE officer was witness to your speech to the family and they agreed.
Otherwise like I said they are getting a ride, that way its out of our hands and in the right hands.

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Permalink Reply by Reg Mathis on September 5, 2008 at 1:31pm

Sounds to me like our FC needs to ammend our SOG!

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Permalink Reply by Jay Nicholson on September 5, 2008 at 3:54pm

Agreed. Any known possibly violent situation NEEDS SO/PD to arrive before you should enter the scene. That attempted suicide could have involved a firearm. Quick way to get a LODD.
Speaking from very old knowledge, you may not have had a choice but to release the patient or face kidnapping charges. A compotent person can refuse medical care/transport. In Calif, only law enforcement, ER docs and physciatrist can 5150 a person for a 72hr hold.

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Permalink Reply by T.J. on September 7, 2008 at 12:48am

For use we call for law on anything that sounds like it could be vilant of a threat of it, and we wont respond into the scene tell law tells use its safe or they cancel use, but we hand it down to law to figure out:)

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