Interfacility psychiatric transfers are far more complex, especially when relegated crews who may lack training and experience. We ask interfacility crews to decide if the patient should go in restraints, consider whether sedation is indicated, if the patient should walk to and from the ambulance, and where the patient should sit.
If someone is going to a treatment facility, an ambulance is indicated. Arguments that the ambulance is somehow “dangerous” are not made with the patients who put EMS providers at the greatest risk: the disinhibited or disoriented. Thousands of times a day, across the U.S., EMTs and paramedics treat potentially combative patients who are intoxicated, post-ictal, brain-injured, hypoglycemic, demented or intellectually disabled.
No one would think to transport a head-injured patient who has been combative, but needs no further intervention, in a police car. Yet, these are one of the most dangerous patient’s EMS providers come into contact with. A 2009 article in JAMA: Psychiatry found that mental illness alone does not make psychiatric patients any more dangerous than those in the general population. Yes, some psych patients are dangerous, but it is inappropriate to automatically equate psychiatric illness with dangerousness.