Are we really appropriately trained to deal with EDPs?

[WAS967 97]

This one I expect to garner some interesting comments. I'll hold mine for the moment and see what everyone else has to say first.

http://www.wstm.com/Global/story.asp?S=2924026

Woman who attempted suicide dies after jumping out of vehicle

LAKE PLACID, N.Y. A woman who attempted to jump off an Adirondack bridge

later succeeded in killing herself -- by jumping out of the moving ambulance

that was taking her to a mental health facility.

Patrons at a bar in Lake Placid last weekend say 28-year-old Kirsten Dumas

of Gansevoort in Saratoga County told them she had overwhelming legal and

family problems. She later left the bar, walked to a nearby bridge and

attempted to jump off, but the bartender and some customers ran out and

pulled her to safety.

Police were called, and they had Dumas transported to a local hospital.

Laster, as she was being taken by ambulance to a mental health facility in

Glens Falls, she jumped out of the moving vehicle as it was passing through

Ray Brook.

Authorities say she died as a result of her injuries after intentionally

jumping out the back of the ambulance.

[mikeinet 37]

It's hard to be "properly trained" for ANYTHING in the EMS industry... especially for things like this - - I feel like the only way you'd know how to deal with these type of things is if you spend say 10 years+ getting PHD's in multiple areas.

That's why we get paid to do certain things, and doctors get paid a lot more to diagnosis other things

It sucks, but what can be done.

[jps385 0]

Stamford Ct. just had a similar incident with a male EDP. Unfortunately short of using restraints (I mean poseys, four points ect. not seat belts) on every patient there not much we can do. If a patient takes off their seat belts or stretcher straps and heads for the door theres a good chance their going to make it. With only one person in the back wrestling the patient gives you a good chance of following them out the door.

Obviously on known EDPs we'll be a little more careful but at the end of the day anything can happen on this job. Just remember to be safe.

[STAT213 332]

I haven't had someone jump out of my rig yet. Now, I have had someone be thrown out of my truck...

[COMMANDCHIEF 4]

No, no one in my opinion is trained enough for dealing with EDP's. The problem is, EDP's are as unpredictable as earthquakes. One of the top killers of Police Officers are EDP's that is probably second to domestic disputes.

We as emergency service providers have to remember that this person can become unglued at any minute. Our safety is paramount here. If it takes 4 point restraints to get you home at night. Then so be it. Safety first, worry about hurting feelings second.

[DOC22 1]

No, no one in my opinion is trained enough for dealing with EDP's. The problem is, EDP's are as unpredictable as earthquakes. One of the top killers of Police Officers are EDP's that is probably second to domestic disputes.

    We as emergency service providers have to remember that this person can become unglued at any minute. Our safety is paramount here. If it takes 4 point restraints to get you home at night. Then so be it. Safety first, worry about hurting feelings second.

=D> =D> =D> =D> =D> =D> =D> =D> =D> =D> =D>

[calhobs 110]

Police were called, and they had Dumas transported to a local hospital.

Laster, as she was being taken by ambulance to a mental health facility in

Glens Falls, she jumped out of the moving vehicle as it was passing through

Ray Brook.

I am sure there was a struggle in the back of the rig. So why didnt the EMT tell his driver to pull over and help? You also have an option of having police ride with you, at least we do here for EDP's. What i do fine interesting is though are police quilfied to determine someone as a EDP. I have seen many cases in the city where you pull up to the police station and the police are just tired of the way the person is acting so they declare him EDP, and off he goes to the hosptial. I am pretty confident in my ability to treat EDP's.(Maybe i just been lucky with my EDP's) There is always someting else to learn about it though. I guess the best thing to do and remember Your saftey first then Your partners.

[EJS1810 7]

EDP is not a medical condition. they should not be transported in an ambulance. Most EDP's are arrested under the Mental health Law. That is a Police matter. They have the training and equipment to properly deal with them. The Police should be the ones transporting EDP's not Ambulances, expecially Volunteer Ambulances.

[x635 4,066]

EDP is not a medical condition.  they should not be transported in an ambulance.  Most EDP's are arrested under the Mental health Law.  That is a Police matter.  They have the training and equipment to properly deal with them. The Police should be the ones transporting EDP's not Ambulances, expecially Volunteer Ambulances.

Actually, "EDP" can be a medical condition. Schitzophrenia and Bipolar disorder, just to name a couple are disorders in the brain which cause behavioral disorders. Also, the symptoms of an "EDP" can also be caused by a diabetic emergency, drug overdose, stroke, hypoxia, or other life-threatening medical condition.

Although some psych patients can be transported by PD to the hospital for evaluation, and in some cases, should be (Depression/Suicidal Idealogy), most of the times an ambulance is warranted and the safe thing to do. There have been several cases where the patient had been handled as an "EDP" by PD, and later died due to the undetected medical condition.

IMO, there needs to be more emphasis in the EMT and EMT-P curriculum in how to handle, communicate with, and restrain EDPs. This is a fairly common call, and many people just dont know how to deal with it. However, I do also think that succesfully dealing with EDP's comes with experience and tact. Though sometimes, no matter what you do, chemical restraint is the only way to fly.

[Guest EMSwhitecloud]

I agree a little bit with everyone...When it comes to an EDP, everyone is different....and yes EDP is a medical condition but it only becomes an emergency medical condition when meds are not taken. Most of the time we are called bc that may be the case or they are threatening suicide but then there is the other side of it when there is no emergent problem with them except their exsisting problem, that is when they technically do not need to be taken by ambulance it is then an officers problem to deal with them. Unless you are a "transport agency" ie: Empire, metro care....The EDP does not need to be transported to hospital by an ambulance....we dont do transports. There is emphasis on EDP's maybe not enough....but learning about them and how to deal with them could take months...like previously stated they are all different, they are all going to react different. My suggestion when transporting an EDP ask for a Local PD to follow to the hospital...then take proper restraining measures...if theres a problem..pull over, let the cop deal with it. Bottom line most of dealing with EDPs is common sense and dont play along with the way they are acting and dont treat them different from the way you treat any other patient and dont be afraid to ask for back up if you think its needed....we arent superheros.

[lss207 0]

In cases if EDP's it is important to know your own limitations. As a female FF/EMT, I know that I am not personally able to properly restrain a 200 lb male who is emotionally unstable and combative with the EMS crew. Use your resources. If there is a medical emergency, ask the PD to come in the ambulance with you. If there is no medical emergency, don't risk the protection of yourself and your crew, let the PD handle it.

[WAS967 97]

Alright. I'll take these one at a time.

I am sure there was a struggle in the back of the rig.

How can you be so sure?

I am pretty confident in my ability to treat EDP's.(Maybe i just been lucky with my EDP's)

Maybe so. But be careful how you use that confidence. It's when you let your guard down that you get nailed. EDPs are sneaky. If they don't want something, they will do whatever they can to get out of there. My personal favorite is the "I'm gonna quietly take off my seatbelt and hope the EMT doesn't notice" move. I had that recently. Lady got the top two straps off and was about to bolt. Partner was a newbie and let himself get distracted by someone asking for direction. I told the lost people to ask elsewhere and got his mind back in the game (he was the tech on the call after all). I hope that confidence comes from a LOT of experience, in which case you know better than to be confident when it comes to EDPs. :wink:

[WAS967 97]

No, no one in my opinion is trained enough for dealing with EDP's. The problem is, EDP's are as unpredictable as earthquakes. One of the top killers of Police Officers are EDP's that is probably second to domestic disputes.

We as emergency service providers have to remember that this person can become unglued at any minute. Our safety is paramount here. If it takes 4 point restraints to get you home at night. Then so be it. Safety first, worry about hurting feelings second.

Well said.

[WAS967 97]

EJS1810 wrote:

EDP is not a medical condition. they should not be transported in an ambulance. Most EDP's are arrested under the Mental health Law. That is a Police matter. They have the training and equipment to properly deal with them. The Police should be the ones transporting EDP's not Ambulances, expecially Volunteer Ambulances.

Actually, "EDP" can be a medical condition. Schitzophrenia and Bipolar disorder, just to name a couple are disorders in the brain which cause behavioral disorders. Also, the symptoms of an "EDP" can also be caused by a diabetic emergency, drug overdose, stroke, hypoxia, or other life-threatening medical condition.

Although some psych patients can be transported by PD to the hospital for evaluation, and in some cases, should be (Depression/Suicidal Idealogy), most of the times an ambulance is warranted and the safe thing to do. There have been several cases where the patient had been handled as an "EDP" by PD, and later died due to the undetected medical condition.

IMO, there needs to be more emphasis in the EMT and EMT-P curriculum in how to handle, communicate with, and restrain EDPs. This is a fairly common call, and many people just dont know how to deal with it. However, I do also think that succesfully dealing with EDP's comes with experience and tact. Though sometimes, no matter what you do, chemical restraint is the only way to fly.

What he said. In a distant way you are kind of right. EDP is just a generalization. Anyone can be EDP. I'm an EDP when I get woken up at 3am for a BS call. But as Seth said, you have to consider, is someone is acting inapropriately, you HAVE TO rule out underlying causes.

Speaking of underlying causes. FOLKS PLEASE. If you get called for an EDP, DO NOT take them directly to the psych ER at WMC. Any patient who is going to ANY non-medical psych facility (WMC-Psych, Four Winds, Stony Lodge, etc) HAS TO BE medically cleared. IT drives me nuts when I hear ambulances call 10-85 to the psych ER. Don't do it. You're just asking for trouble if you do. Ambulances must go to a MEDICAL ER first. Let them evaluate the patient, then let THEM make the decision to send them to crisis/rehab/psych/etc.

[WAS967 97]

I agree a little bit with everyone...When it comes to an EDP, everyone is different....and yes EDP is a medical condition but it only becomes an emergency medical condition when meds are not taken.

Thats debatable. Medications have theraputic levels that need to be maintained. You can have cases where the patient has something underlying that causes thier levels to be thrown off dropping them into a subtheraputic range, thus making thier normal medication regimen ineffective/inadequate. You also can run into problems with resistance, but I'm not sure how applicable that is to psych meds.

when there is no emergent problem with them except their exsisting problem, that is when they technically do not need to be taken by ambulance it is then an officers problem to deal with them. Unless you are a "transport agency" ie: Empire, metro care....The EDP does not need to be transported to hospital by an ambulance....we dont do transports.

So if you get called to a person with a history of psych problems, they say they don't have any suicidal thoughts, but don't feel right in the head. Do you tell them "sorry, wo don't do transports?" Sure, we all hate BS calls. We've all had em. We've all been woken up for me. Stubbed toe, stuffy nose x5 days, patient fell at NH last week and started vomiting today, etc. But when it comes down to it, no matter how BS we think it is, it's the patient that matters. THEY are the one that feels the need to call for help, THEY are the ones that expect us to respond yesterday, treat them like kings, and give a crap about thier ailments. IT sucks but it's the nature of the beast. Now, if the patient states they "just want to go to the hospital" but don't give specifics, but state thier MD/Shrink is in Tarrytown instead of Peekskill, do you bring em to Peekskill? Well, thats dependant on local protocol and what not. And while I'm sure people will disagree with me, I think the patient should go where they want to go. If that means you call in a transport company because you "don't do transports" then so be it. Of course we take into consideration the stability of the patient.

There is emphasis on EDP's maybe not enough....but learning about them and how to deal with them could take months...like previously stated they are all different, they are all going to react different. My suggestion when transporting an EDP ask for a Local PD to follow to the hospital...then take proper restraining measures...if theres a problem..pull over, let the cop deal with it. Bottom line most of dealing with EDPs is common sense and dont play along with the way they are acting and dont treat them different from the way you treat any other patient and dont be afraid to ask for back up if you think its needed....we arent superheros.

So back to the topic at hand (I'll get off my soap box). What does everyone consider to be "proper restraining measures". Technically, we are supposed to utilize only "humaine restraints". But what is humaine and what is not? (I know I was never taught the difference). How many people/corps utilize special made restrains (like velcro 4 points, etc). How many rely on the cravats and sheets method? Was anyone taught how to properly TIE a restraint? (Again, I know I wasn't...I had to learn it from experience). These are all things that I think need to be addressed in EMT classes, but are not. And lord knows I don't know many companies that have specific procedures on the books for dealing with EDP/Psychs, especially combative ones.

[Guest alsfirefighter]

First as was stated, a person who is classified as an EDP is a medical patient. That can or cannot be ruled out until later with tools we don't have. Often its some sort of chemical imbalance or other induced hysteria or condition from recreational drugs or medications, which makes it an overdose...medical problem. A EDP can be and should be classified as a AMS, Altered Mental Status, regardless of what their history is, if its acute, then its acute AMS, if they have a history for whatever reason they are AMS from theri normal level and they need medical/psychological assistance.

"We don't do transports" "Especially volunteer ambulances." Umm you transport every patient in your ambulance so you do transports, your a transport agency. While I know what you mean, you need to look at them as a patient whom needs care, not a burden. As far as the volunteer comment, you gotta be kidding me right. So because your a volunteer EMS agency you get to pick and choose what you should and shouldn't do? There are a lot of professional, high quality EMS providers in the volunteer EMS field who have been fighting the stereotype you just gave yourself.

As far as the Mental Health Law, yes you are placed into protective custody, but you are not necessarily arrested. There is a difference between the two. They are people, not animals that for whatever reason are not coping with life, or due to numerous other MEDICAL reasons. They do not ask to have the problems that they have, they cannot help it. You could be the one difference in their life that day. What changed my outlook on such cases was a HBO documentary that they did on Bellvue's pysch ward. Most of them were regular people that had some event in their life that pushed them over the limit or some other condition. Yes some return do to not following their medication regimen, yes that does become a pain in the @ss. But they are people, our patients. I can still see this one woman, who looked right at the camera and asked "why does this happen to me, and why does it have to happen to me." Does she deserve to be treated like a common criminal because she has a chemical imbalance?