Paramedics can safely evaluate psychiatric patients' medical condition in the field

Emergency medical personnel in Alameda County, California, use a screening process for determining whether to “medically clear” patients experiencing psychiatric emergencies before transporting them. They identify patients who are at low risk for medical emergencies and take them directly to a special Psychiatric Emergency Service facility specifically designed for people experiencing psychiatric crises. The protocol used by Alameda County emergency medical staff is an alternative to standard protocols, in which all patients are transported to the nearest emergency department. During a five-year period ended Nov. 1, 2016, Emergency Medical Services staff used the protocol to transport 41 percent of 53,000 psychiatric emergency cases to the stand-alone psychiatric emergency service facility. As a result, 22,000 psychiatric patients were treated at a specialized facility without first undergoing the standard trip to the emergency department.

Patients with psychiatric emergencies on involuntary holds are often taken to traditional hospital emergency departments. However, patients sometimes spend hours to days in an emergency department bed waiting for treatment and access to specialized psychiatric personnel to conduct mental health evaluations. Psychiatric Emergency Services were established to address this gap. Patients still are evaluated to determine that they are not suffering from a life-threatening illness before they are transported to a psychiatric emergency services facility.

The researchers examined data for 542,000 Emergency Medical Service encounters in Alameda County over five years. They noted that because the data are from just one county, the results may not be applicable to counties that have a fundamentally different strategy for managing psychiatric crises before transportation.

Paramedics have the ability to distinguish acute psychiatric crises, which can mimic symptoms of a physical ailment, from life-threatening medical illnesses. As a result, they can safely divert psychiatric cases from frequently overextended emergency departments in hospitals to specialized psychiatric facilities. These findings demonstrate the effectiveness of using protocols to assist paramedics in evaluating patients’ medical conditions in the field in order to help direct them to an appropriate facility.

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Dr. Tarak Trivedi, Dr. Melody Glenn, Dr. Gene Hern, Dr. David Schriger and Dr. Karl Sporer. Trivedi led the research at the National Clinician Scholars Program at UCLA.

The study was published in Annals of Emergency Medicine.

Trivedi was supported by the National Clinician Scholars Program at the David Geffen School of Medicine at UCLA; the VA Office of Academic Affiliations through the VA/National Clinician Scholars Program; and the David Geffen School of Medicine at UCLA.