Our Psych patient transport agents:
Use safe and best practices for field to hospital and interfacility transports of psychiatric patients
Psych patient transport information
Recently, there has been concern about ambulance transport of psychiatric patients. Generally, these kinds of transports fall into two types: The patient is contacted in the field and transported or that the patient requires transport from one facility to another.
A psychiatric patient contact in the field is usually straight forward: scene safety, evaluate the patient, transport or refuse. Often there are many EMS providers and police present.
What are alternatives to ambulance transport?
From the outside, it appeared clear that the local 911 service was the only entity that the hospitals could “bully” into performing unnecessary and probably uncompensated service. I wondered, how did these transfers meet “medical necessity” for payment by Medicare, Medicaid, or other payors?
Retrospective review of the transfers to the Mental Health Facility showed that some were paid for, most were not. We had some discussions about the hospital assuming responsibility for payment for these transfers.
This led to a series of discussions about the appropriateness of this practice and it was ultimately agreed by the involved hospitals that this was not the best way to handle “psych transfers.” The practice used in other states – transport by law enforcement – was adapted for the hospitals. A sedan with a security barrier to protect the driver, as well as secure seat belts, was procured, and hospital personnel handled the transfers.
Does a psych patient need an ambulance?
Some patients just need a ride. They do not require oxygen, resuscitation, medications that paramedics carry, bandaging, splinting, or any type of prehospital care. They only need a ride.
Moreover, EMS has no legal authority from the State to detain anyone against their will. Yes, in a few states EMS has that authority, such as under (Florida’s Baker Act.) If the patient changed their mind about going to the Mental Health Facility and wanted to exit the vehicle on the side of the interstate the right of EMS to do anything except let them out was legally unclear. Patients were not restrained (nor was it appropriate to do so), they were not sedated, and if they were medicated it was with oral medications that they had taken for a long period of time. Again, these were medically-stable patients who needed a ride.
Several times there are difficulties on transport service. As you know the back of an ambulance is a dangerous place, filled with sharp corners, cabinets, objects that can be used as weapons, and minimal opportunity for escape. Medics who attempted to restrain patients who decided to leave the ambulance would get into combat, for which they were not trained. The crew size was insufficient to restrain the patient. Most hospital guidelines call for a minimum of five caregivers to restrain a violent patient. Even a radio call for help might not see five or more responders arrive for 30-60 minutes, if ever.