"In another community, emergency rescuers find themselves dealing with a woman who entered a stranger's home to use the telephone. She insists she must call the president of the United States, who has been talking to her through her television. She claims that because she didn't follow his instructions, a tsunami and hurricanes occurred, killing hundreds of thousands."

 

You've probably been on a call quite similar to this one. Did you feel prepared? Hopefully, you'd had adequate training beforehand. The National Alliance on Mental Illness has a training program for first responders who will inevitably encounter patients with mental illness. The program focuses on de-escalating a mental health crisis.This training is currently done a on volunteer basis in Maine, as it is not required by their public safety agencies. But providers who have attended find the training very helpful and feel much better prepared for these calls.

 

Read more about the training program, or check out the JEMS article about managing patients with excited delirium—another challenging call.

Tags: crisis, delirium, excited, health, illness, mental

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"Crisis Intervention Paramedic" is the pin that our Advanced Practice Paramedics and District Chiefs receive after completing this course.  An added benefit, they attend this program with the same police officers that they work with on the street.  The staff of our county mental health crisis unit and the volunteers from NAMI do a great job, and the results on the street are outstanding - including one scene where a CIP-trained medic was able to talk out an armed, suicidal person who simply refused to speak with anyone from law enforcement.

 

This is an area where EMS folks are seriously under-trained, one of the many where our curriculum badly needs enhancement.

Spent lots of time w/NAMI folks. Lots of behavior emergencies over lots of years. Priority must be safety, every second. Firearm in play? Job for armed responders. Psychotic uncooperative patient, obvious danger to self/others? Words are not a tool here...no-notice ambush takedown w/overwhelming team, comprehensive restraints is safest for all. And yes, the most humane. If I'm the guy transporting, I do a body search, a good one. The weapons I've found on 'already searched' folks would fill a wheelbarrow. My NAMI contacts are not in lockstep w/me, but my area has a very good safety record for all. I've attended a handful of 'de-escalation trainings'. Only useful for folks who are oriented, rational and fundamentally cooperative. 'Crisis trainers' who are not doing the hands-on work have no credibility.
Guess what - it worked, and safely.  Don't knock it until you've tried it!
Skip, Skip, Skip. Unarmed EMS electively in range of a firearm held by a known unstable person? I am very much of a different opinion. Successful hot zone talk downs w/armed folks is not a reliable certainty. Nobody has that much consistent influence w/conversation. This is unique in my experience. I read that the trainers were armed responders. It's a whole different bag of tricks/mindset when one of your options is to unilaterally terminate the proceedings. Even for them, I have never heard of protracted 'talking down' of gun holding persons by exposed LE's. A quick command to 'drop it', any movement other than dropping it and the police fire. That's what they tell me anyway, I'm staging a block away until LE declares 'scene safe'. I'll wager you a day's pay that unarmed EMS responders in your area will very soon, by policy, cease elective management of armed psych patients. That said, much praise and respect for your investment/concern/training for this patient population. The national standard of care is shameful.

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