Elective procedures and hospitalization is gutted due to Covid 19 once again....

[MediMike]

3 hours ago, ohiovolffemtp said:

Actually, EMS is not the least qualified to deal with psyche patients.  We often do two things that others didn't do well: verbally de-escalate them, and realize that medical conditions that needed immediate attention were often part of the picture.  That is what both EMS and the ED do.  I don't know if you've done EM, but resolving all of the medical issues, whether substance abuse, infection, trauma, diabetes, etc is a pre-req before you can place a person in any kind of treatment.  In-patient mental health facilities won't take anyone who has even a hint of any unaddressed medical problem (and usually won't take them until those medical problems are resolved, or at least only requiring oral meds) and outpatient treatment programs won't address those problems.  This isn't about restraining and sedating patients unless it's absolutely necessary, it's about not assuming that the patient has only psychiatric issues and not failing to address the total picture.  De-escalation can fail, especially in patients who have significant substance intoxication, serious head trauma, blood glucose levels that are very high or very low, leading to restraint and sedation as a necessary transition step - just as it can in patients who have those same issues without any psychiatric component.  Simply put, there are times when the brain isn't functioning well enough for words to influence it.

And again you're missing the point that there is an entire specialty dedicated to psychiatry. Do you think all that they do is manage acute psychotic breaks? 

 I disagree that the training EMS received in psych makes them qualified to effectively manage psychiatric issues in the field. That is why there has been a continued push in many regions to have caseworkers, counselors and behavioral specialists respond to prehospital psychiatric issues.

[ohiovolffemtp]

21 hours ago, MediMike said:

I think that advice is only partially true and very much depends on your clinical setting.   Psyche in the ED is very different than in any other setting except the field, in particular very different than in-patient, even a lock-down unit.

This is the beginning of my 1st message on this topic.

I believe this is the key to the difference between what you're saying and what I'm saying.  Again, psyche is practiced differently in different settings, whether primary care, in-patient, out-patient,  ED, or field.  I believe that your messages have argued the same point.  Included in that point is the uniqueness of each, including the field and the ED.  Neither the entire psyche field nor the pre-hospital or ED portion of psyche is about managing only acute psychotic breaks.  However, the pre-hospital and ED world is most often the 1st place those patients in crisis are managed.

We do disagree about how  well EMS manages psyche patients in the field.  That may be because of where we have or do run and how we've taught our EMS students.  We do not disagree about the breadth of what the entire psyche field does.  I believe we also disagree about what all is included the the psyche portion of EM, and what tools need to be EMS's and EM's toolbox.  I believe we also disagree about how EM has to manage these patients, to make sure they are medically cleared before being followed by psyche.

Edited November 16, 2020 by ohiovolffemtp

[LT_Oneal_PAC]

I think we are all saying the same thing here. Medimike is right, there is a lot to be gleaned from studying psychiatry. Whether that’s clinical manifestations of certain diseases, typical treatments, their complications, assessing their risk for self harm, follow up time, learning about resources such as rehabilitation or therapists, and probably most importantly just learning to speak with these people and see them as humans. We can get burned out in the ED and see these people as “squatters” in the ED while they wait from hours to days for a psych bed. I may be in the minority of ED providers, but I have no problem assessing the mental health of a patient and beginning, or more rarely adjusting, management of a patient. There’s a lot of qualifications to that statement since I’m not going to step on any of their primary providers toes or get into complicated cases, but I’ll put on my FM hat and help them get the care they need. Part of that is I do have extensive experience in FM and I work in a small town. I don’t expect this of every ED provider.
 

I think Ohio’s point is our job in the ED is to make sure they make a safe transition to the people who can help them best. The ED is never a therapeutic milieu for the depressed, the anxious, the manic, or the acutely agitated. To do that, it’s long been psychiatry’s belief that it is the EDs job to rule out ANY medical condition if the patient needs placement for ANY reason. The ED literature doesn’t support it, but most psych hospitals won’t accept someone until a standard set of psych labs and EKG are done. Further, it’s our job as emergency medical specialist to ensure that a medical, as opposed to psychiatric, diagnosis isn’t being missed. We, as emergency specialists, probably bring up the acutely agitated patient more often in responsibilities because that’s where we shine. We are managers of chaos. It’s not all we do and we take pride in our work of less extreme patients, but it’s the reason we exist instead of still having EDs  run by FM clinic providers, surgeons, IM, or other generalists.

 

or maybe I’m just way off base and don’t know what either of you are talking about

 

[EMEDPA]

36 minutes ago, LT_Oneal_PAC said:

 We are managers of chaos. It’s not all we do and we take pride in our work of less extreme patients, but it’s the reason we exist

I used to have a license plate frame that said:

Emergency Medicine

Order From Chaos

 

Then my car got stolen(seriously).

[MediMike]

My main point of disagreement in the entirety of this thread was the idea that psych is all about wrestling patients and/or managing violent patients in the ED.

That makes up *random number generator* like 2% of psychiatry.

And with that...let's get this thread back on track or we can start a new one.

My state is starting to shut down again, 80% of my ICU is COVID, quarantine recommended for people coming into the state...it's getting ugly.

[Reality Check 2]

Washington state just rolled back to heavier restrictions because cases are skyrocketing.

One Congresswoman stated her “disappointment” with the governor’s decisions.

Seriously? She can put on a flimsy mask and hang out in the ERs. She will say anything against the governor. She has NO expertise in anything to comment. At least the governor has a state health doctor he listens to. 

We all know this is devastating to the economy but creating long haulers with disabilities and families with dead earners is worse in my opinion. Dead people don’t contribute to the economy if you want to break it down ugly and simple. 

I don’t get it. Just can’t fathom that folks think this is a hoax and “not that bad” and treat it like a political move.

It didn’t go away with the election.....

WHAT does it take to prove to people that big Thanksgivings and vacations are a BAD IDEA? I cannot even grasp kids being in schools. 

I don’t have pandemic fatigue - I have Pandemic Irritation Syndrome.

Science is real. Can we start there?

Deep Ugly Sigh - 2020 sucks.

[Cideous]

11 hours ago, Reality Check 2 said:

Washington state just rolled back to heavier restrictions because cases are skyrocketing.

One Congresswoman stated her “disappointment” with the governor’s decisions.

Seriously? She can put on a flimsy mask and hang out in the ERs. She will say anything against the governor. She has NO expertise in anything to comment. At least the governor has a state health doctor he listens to. 

We all know this is devastating to the economy but creating long haulers with disabilities and families with dead earners is worse in my opinion. Dead people don’t contribute to the economy if you want to break it down ugly and simple. 

I don’t get it. Just can’t fathom that folks think this is a hoax and “not that bad” and treat it like a political move.

It didn’t go away with the election.....

WHAT does it take to prove to people that big Thanksgivings and vacations are a BAD IDEA? I cannot even grasp kids being in schools. 

I don’t have pandemic fatigue - I have Pandemic Irritation Syndrome.

Science is real. Can we start there?

Deep Ugly Sigh - 2020 sucks.

I love this post in every single way.

[surgblumm]

We need to look at the history of the pandemic in the Spring and realize that non-essential surgery was prohibited as were other procedures such as in radiology and cardiology. We are at the highest levels ever and the buzzword is that we are in terrifying times and have not seen this type of disease in America before. It would have been nice for the federal government to have worked on this over the past six months. Nero played the violin while Rome burned and Trump played golf while this disaster took place. Inexcusable.

[thinkertdm]

So... despite my local hospital systems having chiefs of staff, medical directors, CEO’s, board of directors; the state having a board of medicine, numerous local and state wide epidemiological departments, public health departments, nothing could be done until the president,  1/3 of the government (don’t forget the congress also sat on its ass as well), commanded it?  
 

There were multiple systems failures all along the chain, but lots of finger pointing.  No one along the chain stepped up and said “the buck stops with me”; they -every single one of those highly paid “experts” sat  and waited for someone else to do it.

here’s what could have happened.  The town council of my local jurisdiction could have met with the CEO’s of the local hospitals.  They know who lives where, the capacity of each place.  They could have compiled their own plans....but nope, let the big man do all the thinking.