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Cheung EH, Whitfield DA, Kipust A, Tadeo R, Gausche-Hill M. Advancing Emergency Medical Services' (EMS) Response Capability for Behavioral Health Emergencies: Los Angeles County's Performance Improvement Initiative. PREHOSP EMERG CARE 2024:1-11. [PMID: 38526711 DOI: 10.1080/10903127.2024.2333494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/05/2024] [Indexed: 03/27/2024]
Abstract
INTRODUCTION Behavioral health emergencies (BHEs) are a common patient encounter for emergency medical services (EMS) clinicians and other first responders, in particular law enforcement (LE) officers. It is critical for EMS clinicians to have management strategies for BHEs, yet relatively little information exists on best practices. In 2016, the Los Angeles County EMS Agency's Commission initiated a comprehensive evaluation of the 9-1-1 response for BHEs and developed a plan for improving the quality of care and safety for patients and first responders. METHODS A Behavioral Health Initiative Committee was assembled with broad representation from EMS, LE, health agencies, and the public. Committee objectives included: 1) produce a process map of the BHE response from the time of a 9-1-1 call to patient arrival at transport destination, 2) identify and describe the different agencies that respond, 3) describe the critical decision points in the EMS and LE field responses, 4) acquire data that quantitatively and/or qualitatively describe the services available, and 5) recommend interventions for system performance improvement. RESULTS The committee generated comprehensive process maps for the prehospital response to BHEs, articulated principles for evaluation, and described key observations of the current system including: 9-1-1 dispatch criteria are variable and often defaults to a LE response, the LE response inadvertently criminalizes BHEs, EMS field treatment protocols for BHEs (and especially agitated patients) are limited, substance use disorder treatment lacks integration, destination options differ by transporting agency, and receiving facilities' capabilities to address BHEs are variable. Recommendations for performance improvement interventions and initial implementation steps included: standardize dispatch protocols, shift away from a LE primary response, augment EMS treatment protocols for BHEs and the management of agitation, develop alternate destination for EMS transport. CONCLUSION This paper describes a comprehensive performance improvement initiative in LAC-EMSA's 9-1-1 response to BHEs. The initiative included a thorough current state analysis, followed by future state mapping and the implementation of interventions to reduce LE as the primary responder when an EMS response is often warranted, and to improve EMS protocols and access to resources for BHEs.
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Affiliation(s)
- Erick H Cheung
- David Geffen School of Medicine, Department of Psychiatry, University of California Los Angeles (UCLA), Los Angeles, California
- UCLA Resnick Neuropsychiatric Hospital, Los Angeles, California
| | - Denise A Whitfield
- Los Angeles County Emergency Medical Services Agency, Los Angeles, California
- Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Los Angeles, California
- The Lundquist Institute, Los Angeles, California
| | | | - Richard Tadeo
- Los Angeles County Emergency Medical Services Agency, Los Angeles, California
| | - Marianne Gausche-Hill
- Los Angeles County Emergency Medical Services Agency, Los Angeles, California
- Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Los Angeles, California
- The Lundquist Institute, Los Angeles, California
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Meijer P, Ford-Jones P, Carter D, Duhaney P, Adam S, Pomeroy D, Thompson S. Examining an Alternate Care Pathway for Mental Health and Addiction Prehospital Emergencies in Ontario, Canada: A Critical Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:146. [PMID: 38397637 PMCID: PMC10888317 DOI: 10.3390/ijerph21020146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 02/25/2024]
Abstract
Paramedics in Ontario have largely been limited to transporting those with mental health or addiction (MHA)-related emergencies to the emergency department (ED). The ED has repeatedly been identified as a problematic and challenging setting for people with MHA needs. This article examines an innovative patient care model (PCM) established by the Middlesex-London Paramedic Service and its partners for specific MHA emergencies where patients were given options for care that included transportation to a Canadian Mental Health Association (CMHA) Crisis Centre or information for support. Qualitative and quantitative data that were utilized for regular reporting to the Ministry were included in the analysis. The findings indicated that the goals of reducing pressures on EDs and paramedic services, enhancing paramedics' ability to address MHA calls, and improving patient care experiences were met. This model improves patient autonomy and options for care, improves the means for addressing patients' social determinants of health, and offers transportation to a non-medicalized facility.
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Affiliation(s)
- Petra Meijer
- Humber Institute of Technology & Advanced Learning, Toronto, ON M9W 5L7, Canada; (P.F.-J.); (D.P.); (S.T.)
| | - Polly Ford-Jones
- Humber Institute of Technology & Advanced Learning, Toronto, ON M9W 5L7, Canada; (P.F.-J.); (D.P.); (S.T.)
| | - Dustin Carter
- Middlesex–London Paramedic Service, London, ON N6E 1R4, Canada;
| | - Patrina Duhaney
- Faculty of Social Work, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Simon Adam
- School of Nursing, Faculty of Health, York University, Toronto, ON M3J 1P3, Canada;
| | - Danielle Pomeroy
- Humber Institute of Technology & Advanced Learning, Toronto, ON M9W 5L7, Canada; (P.F.-J.); (D.P.); (S.T.)
| | - Sheryl Thompson
- Humber Institute of Technology & Advanced Learning, Toronto, ON M9W 5L7, Canada; (P.F.-J.); (D.P.); (S.T.)
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Van de Glind G, Galenkamp N, Bleijenberg N, Schoonhoven L, Scheepers FE, Crilly J, van Veen M, Ham WHW. Interventions to reduce interpersonal stigma towards patients with a mental dysregulation for ambulance and emergency department healthcare professionals: review protocol for an integrative review. BMJ Open 2023; 13:e072604. [PMID: 37918925 PMCID: PMC10626855 DOI: 10.1136/bmjopen-2023-072604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 10/12/2023] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION Worldwide, there is an increase in the extent and severity of mental illness. Exacerbation of somatic complaints in this group of people can result in recurring ambulance and emergency department care. The care of patients with a mental dysregulation (ie, experiencing a mental health problem and disproportionate feelings like fear, anger, sadness or confusion, possibly with associated behaviours) can be complex and challenging in the emergency care context, possibly evoking a wide variety of feelings, ranging from worry or pity to annoyance and frustration in emergency care staff members. This in return may lead to stigma towards patients with a mental dysregulation seeking emergency care. Interventions have been developed impacting attitude and behaviour and minimising stigma held by healthcare professionals. However, these interventions are not explicitly aimed at the emergency care context nor do these represent perspectives of healthcare professionals working within this context. Therefore, the aim of the proposed review is to gain insight into interventions targeting healthcare professionals, which minimise stigma including beliefs, attitudes and behaviour towards patients with a mental dysregulation within the emergency care context. METHODS AND ANALYSIS The protocol for a systematic integrative review is presented, using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols recommendations. A systematic search was performed on 13 July 2023. Study selection and data extraction will be performed by two independent reviewers. In each step, an expert with lived experience will comment on process and results. Software applications RefWorks-ProQuest, Rayyan and ATLAS.ti will be used to enhance the quality of the review and transparency of process and results. ETHICS AND DISSEMINATION No ethical approval or safety considerations are required for this review. The proposed review will be submitted to a relevant international journal. Results will be presented at relevant medical scientific conferences. PROSPERO REGISTRATION NUMBER CRD42023390664 (https://www.crd.york.ac.uk/prospero/).
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Affiliation(s)
- Geurt Van de Glind
- Institute of Nursing Studies, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Niek Galenkamp
- Institute of Nursing Studies, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Nienke Bleijenberg
- Institute of Nursing Studies, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Lisette Schoonhoven
- University Medical Center Utrecht, Utrecht, The Netherlands
- University of Southampton, Southampton, UK
| | | | - Julia Crilly
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Mark van Veen
- Institute of Nursing Studies, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Wietske H W Ham
- Institute of Nursing Studies, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
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Heffernan J, Pennay A, Hughes E, Gray R. The Association between the Police, Ambulance, Clinician Early Response (PACER) Model and Involuntary Detentions of People Living with Mental Illness: A Protocol for a Retrospective Observational Study. NURSING REPORTS 2023; 13:1452-1467. [PMID: 37873829 PMCID: PMC10594445 DOI: 10.3390/nursrep13040122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/25/2023] Open
Abstract
Emergency services are frequently called to attend mental health incidents and are looking for innovative ways to improve their responses and reduce the burden on services. Involuntary detention of people living with mental illness is considered more frequent than necessary, leading to increased pressure on emergency departments, and is often a traumatic experience for patients. The Police, Ambulance, Clinician Early Response (PACER) model was developed in 2019 in Canberra, Australia, and seeks to reduce involuntary detentions by embedding a mental health clinician into emergency services as a mobile mental health crisis response intervention. This protocol details a retrospective cohort study that will examine the association between PACER and involuntary detentions using medical and police records and compare the results to standard ambulance and police responses. We will use relative risk and odds ratio calculations to determine the probability of being involuntarily detained or diverted from hospital; and we will describe the patient characteristics and outcomes in the PACER cohort. Results will be reported using the STROBE checklist for reporting cohort studies. This study was not registered on a publicly accessible registry.
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Affiliation(s)
- Julia Heffernan
- School of Nursing and Midwifery, La Trobe University, Bundoora, Melbourne, VIC 3086, Australia;
| | - Amy Pennay
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Melbourne, VIC 3068, Australia;
| | - Elizabeth Hughes
- School of Health and Social Care, Edinburgh Napier University, Edinburgh EH11 4BN, UK;
| | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Bundoora, Melbourne, VIC 3086, Australia;
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Heffernan J, McDonald E, Hughes E, Gray R. Tri-Response Police, Ambulance, Mental Health Crisis Models in Reducing Involuntary Detentions of Mentally Ill People: A Systematic Review. NURSING REPORTS 2022; 12:1004-1013. [PMID: 36548169 PMCID: PMC9785608 DOI: 10.3390/nursrep12040096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/29/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022] Open
Abstract
Police, ambulance, and mental health tri-response services are a relatively new model of responding to people experiencing mental health crisis in the community, though limited evidence exists examining their efficacy. Reducing unnecessary involuntary detentions and emergency department presentations is believed to be a benefit of this model. A systematic review was performed to review the evidence base around the relationship between the police, ambulance, mental health tri-response models in reducing involuntary detentions of people experiencing mental health crisis. We searched key health databases for clinical studies and grey literature as per a previously published protocol. Two researchers completed title and abstract screening and full text screening. Our search identified 239 citations. No studies or grey literature met the inclusion criteria. We report an empty review. It is recommended that further investigation of the tri-response mental health crisis model be undertaken to determine its effectiveness and value as a health and emergency service initiative.
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Affiliation(s)
- Julia Heffernan
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC 3086, Australia
- Correspondence:
| | - Ewan McDonald
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC 3086, Australia
| | - Elizabeth Hughes
- School of Health and Social Care, Edinburgh Napier University, Edinburgh EH11 4BN, UK
| | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC 3086, Australia
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Gee B, Nicholls H, Rivett S, Clarke T, Wilson J, Prothero L. 'Very hit and miss': an interpretive phenomenological analysis of ambulance service care for young people experiencing mental health crisis. Br Paramed J 2022; 7:43-50. [PMID: 36452027 PMCID: PMC9662145 DOI: 10.29045/14784726.2022.06.7.1.43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION The ambulance service provides vital front line mental healthcare for young people in crisis, but there is a lack of evidence to guide best practice in this area. The lived experiences of service users can offer important insights to guide service development, therefore we carried out a qualitative evaluation of care provided by the ambulance service to young people experiencing a mental health-related emergency. METHODS Ten participants aged 16-25 years who had used the ambulance service due to a mental health crisis within the past 2 years were interviewed about their experiences and view of the care they received. Interviews were transcribed verbatim and interpretative phenomenological analysis used to explore participants' individual narratives and identify recurrent themes. RESULTS A theme of inconsistent quality of care was evident in all participants' accounts. Contributing to this superordinate theme were six recurrent themes: positive qualities of individual ambulance clinicians, ambivalence about seeking care, the importance of retaining agency, need for mental health training for ambulance clinicians, need for inter-service collaboration and favourable comparison of the ambulance service to other services. CONCLUSIONS We identified some examples of good practice, including person-centred care, respect for patient autonomy and attending to physical health needs. However, our findings suggest the quality of ambulance service mental healthcare is not yet sufficiently consistent. In the absence of mandatory high-quality mental health training and evidence-based protocols, the quality of care appears largely dependent on the qualities and experience of individual ambulance clinicians.
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Affiliation(s)
- Brioney Gee
- Norfolk and Suffolk NHS Foundation Trust; University of East Anglia ORCID iD: https://orcid.org/0000-0003-0781-7753
| | | | - Sam Rivett
- Norfolk and Suffolk NHS Foundation Trust
| | - Tim Clarke
- Norfolk and Suffolk NHS Foundation Trust; University of East Anglia
| | - Jon Wilson
- Norfolk and Suffolk NHS Foundation Trust; University of East Anglia ORCID iD: https://orcid.org/0000-0002-5279-6237
| | - Larissa Prothero
- East of England Ambulance Service NHS Trust ORCID iD: https://orcid.org/0000-0002-5440-8429
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Önnheim S, Johansson A, Ivarsson B, Hagström C. Self-Perceived Competence of Ambulance Nurses in the Care of Patients with Mental Illness: A Questionnaire Survey. NURSING REPORTS 2022; 12:226-234. [PMID: 35324569 PMCID: PMC8954289 DOI: 10.3390/nursrep12010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/16/2022] [Accepted: 03/16/2022] [Indexed: 11/16/2022] Open
Abstract
Ambulance nurses in prehospital emergency care must assess, treat, and triage patients with mental health issues. This study aimed to investigate the self-perceived competence of ambulance nurses in prehospital emergency care of patients with mental illness. A cross-sectional questionnaire survey was done, a question-index value (Q-IV; range: 0–1.0) was defined as a summary of the proportion of positive responses (%). Correlations of self-perceived competence with education and professional experience were also examined. Overall self-perceived competence was good (mean Q-IV, 0.80). For six of the nine questions, women rated their abilities slightly lower than men. Women rated themselves as fairly good in providing “information about types of effective help available” (Q-IV, 0.55) and in “suggesting tactics for helping a person with mental illness feel better” (Q-IV, 0.56). Men rated their competence as fairly good in “directing patients to appropriate sources of help” (Q-IV, 0.58). Self-perceived competence did not correlate with education level or professional experience. In conclusion, these results indicate that in encounters with patients who have mental illness, ambulance nurses perceive their overall competencies as good, with some sex-based differences in self-perception for specific knowledge areas. Education level and professional experience did not correlate with self-perceived competence.
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Affiliation(s)
- Sandra Önnheim
- Office of Medical Services, Region Skane, Kioskgatan 17, 22185 Lund, Sweden; (S.Ö.); (A.J.); (C.H.)
| | - Anders Johansson
- Office of Medical Services, Region Skane, Kioskgatan 17, 22185 Lund, Sweden; (S.Ö.); (A.J.); (C.H.)
- Department of Clinical Sciences, Lund University, P.O. Box 117, 22185 Lund, Sweden
| | - Bodil Ivarsson
- Office of Medical Services, Region Skane, Kioskgatan 17, 22185 Lund, Sweden; (S.Ö.); (A.J.); (C.H.)
- Department of Clinical Sciences, Lund University, P.O. Box 117, 22185 Lund, Sweden
- Correspondence: ; Tel.: +46-768-870-467
| | - Caroline Hagström
- Office of Medical Services, Region Skane, Kioskgatan 17, 22185 Lund, Sweden; (S.Ö.); (A.J.); (C.H.)
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Ivarsson B, Johansson A, Todorova L. Prehospital emergency nurses' competence progress in assessing psychiatric disorders; 1-year follow-up of a psychiatric emergency response unit. Int Emerg Nurs 2022; 62:101149. [PMID: 35276448 DOI: 10.1016/j.ienj.2022.101149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/02/2022] [Accepted: 01/28/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Bodil Ivarsson
- Clinical Sciences, Lund, University of Lund, SE-221 85 Lund, Sweden; Medicine Services University Trust, Region Skåne, SE-221 85 Lund, Sweden.
| | - Anders Johansson
- Clinical Sciences, Lund, University of Lund, SE-221 85 Lund, Sweden; Medicine Services University Trust, Region Skåne, SE-221 85 Lund, Sweden.
| | - Lizbet Todorova
- Medicine Services University Trust, Region Skåne, SE-221 85 Lund, Sweden.
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Ford-Jones PC, Daly T. Filling the gap: Mental health and psychosocial paramedicine programming in Ontario, Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:744-752. [PMID: 33034116 DOI: 10.1111/hsc.13189] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 09/07/2020] [Accepted: 09/16/2020] [Indexed: 06/11/2023]
Abstract
Paramedics respond to acute medical and trauma emergencies in the community and transport patients to emergency departments (ED). In some cases, paramedics are not only attending calls for mental health and psychosocial care but are also connecting individuals with more appropriate services to address their needs. This study qualitatively explores to what extent there are promising practices to be learned from paramedic services that are connecting patients to mental health and psychosocial programming. The study is organised as follows. In terms of the methods, we conducted a critical ethnographic case study of mental health and psychosocial care within paramedic services in Ontario, Canada. Interviews were conducted with frontline paramedics (n = 31), paramedic services management (n = 5), educators at paramedic college programmes (n = 5) and Base Hospital physicians/directors (n = 5). Work observations were also performed in three paramedic services, with multiple crews across different shifts (n ~90 hr). The study findings outline three promising practices: diversion programmes that transfer patients to a destination other than the ED; crisis response teams that attend calls identified as involving mental health and community paramedicine programmes including referral programmes. We outline the social, political and economic conditions in which these programmes were established and are provided. We also describe the conditions required to enable connecting patients to non-ED supports. The benefits of implementing specific programming for mental health-related calls within paramedic services are discussed, as well as the importance of reaching beyond the prehospital and mental healthcare system to comprehensively and preventatively address mental health needs. Tensions are explored related to running programmatic interventions for mental health by paramedic services. We conclude by noting some public policy-level challenges including the need to focus more broadly on prevention and address the social determinants of health to aid the de-escalation of distress.
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Affiliation(s)
- Polly Christine Ford-Jones
- Faculty of Health Science and Wellness, Humber Institute of Technology & Advanced Learning, Toronto, Canada
| | - Tamara Daly
- School of Health Policy and Management, York University Centre for Aging Research and Education, York University, Toronto, ON, Canada
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A Prehospital Emergency Psychiatric Unit in an Ambulance Care Service from the Perspective of Prehospital Emergency Nurses: A Qualitative Study. Healthcare (Basel) 2021; 10:healthcare10010050. [PMID: 35052214 PMCID: PMC8775765 DOI: 10.3390/healthcare10010050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/20/2021] [Accepted: 12/25/2021] [Indexed: 12/03/2022] Open
Abstract
The prevalence of mental illness is steadily increasing, and ambulance teams frequently attend cases with suspected mental illness. A pilot project, Psychiatric Emergency Response Team (PAP), was carried out in which a prehospital emergency nurse (PEN) was accompanied by a psychiatric specialist nurse in the assessment of individuals with mental illness. The aim of the present study was to evaluate a prehospital emergency psychiatric unit from the perspective of PENs. A qualitative method using content analysis was applied. Seven senior PENs who had worked for 1 year in a prehospital psychiatric ambulance unit were interviewed individually. The analysis resulted in one main theme, “Transition from limited care and insufficient competence to improved and adequate care for psychiatric patients in ambulance care”. This emerged from six subcategories: inter-professional development, access to patient records, theambulance vehicle,non-conveyed patients, cooperation with the police and meetings with patients and next of kin. In conclusion, these results suggest that in ambulance care in general, there is a lack of knowledge and skills about mental illnesses and initial care options. The PAP concept opened new avenues for the care of patients with mental illness, which the PENs described very positively as being helpful and valuable.
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Characteristics of Confidence and Preparedness in Paramedics in Metropolitan, Regional, and Rural Australia to Manage Mental-Health-Related Presentations: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041882. [PMID: 33672055 PMCID: PMC7919464 DOI: 10.3390/ijerph18041882] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 01/27/2021] [Accepted: 02/02/2021] [Indexed: 11/17/2022]
Abstract
Mental-health-related presentations account for a considerable proportion of the paramedic’s workload in prehospital care. This cross-sectional study aimed to examine the perceived confidence and preparedness of paramedics in Australian metropolitan and rural areas to manage mental-health-related presentations. Overall, 1140 paramedics were surveyed. Pearson chi-square and Fisher exact tests were used to compare categorical variables by sex and location of practice; continuous variables were compared using the non-parametric Mann–Whitney and Kruskal–Wallis tests. Perceived confidence and preparedness were each modelled in multivariable ordinal regressions. Female paramedics were younger with higher qualifications but were less experienced than their male counterparts. Compared to paramedics working in metropolitan regions, those working in rural and regional areas were generally older with fewer qualifications and were significantly less confident and less prepared to manage mental health presentations (p = 0.001). Compared to male paramedics, females were less confident (p = 0.003), although equally prepared (p = 0.1) to manage mental health presentations. These results suggest that higher qualifications from the tertiary sector may not be adequately preparing paramedics to manage mental health presentations, which signifies a disparity between education provided and workforce preparedness. Further work is required to address the education and training requirements of paramedics in regional and rural areas to increase confidence and preparedness in managing mental health presentations.
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Shirzad F, Hadi F, Mortazavi SS, Biglari M, Sari HN, Mohammadi Z, Atoofi MK, Shariat SV. First line in psychiatric emergency: pre-hospital emergency protocol for mental disorders in Iran. BMC Emerg Med 2020; 20:19. [PMID: 32178629 PMCID: PMC7074981 DOI: 10.1186/s12873-020-00313-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 02/26/2020] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION This article is a report of designing a rapid and effective guide for paramedics who take care of patients in a pre-hospital setting to answer developing demands. METHODS The relevant literature was reviewed, and the topics were extracted. Then, the extracted items were discussed in an expert panel. Finally, items were discussed in a meeting including emergency technicians and emergency technical assistants to identify implementation problems. RESULTS Important topics for managing psychiatric patients were categorized at three levels: 1) Patient safety and security issues, 2) Patient status assessment and diagnosis, and 3) Patient management (medical, behavioral management, and referral to a treatment center). DISCUSSION This protocol can be a solution to improve emergency technician training. Such summarized protocols can be used for rapid review immediately before exposing a patient with an acute psychiatric condition. Due to specific cultural and different access to medicines in Iran, some issues are different.
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Affiliation(s)
- Fatemeh Shirzad
- Spiritual Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Hadi
- Mental Health Research Center, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyede Salehe Mortazavi
- Spiritual Health Research Center, Iran University of Medical Sciences, Tehran, Iran
- School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Biglari
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hassan Noori Sari
- Deputy of Technical and Operations of the Emergency Organization, Tehran, Iran
| | | | | | - Seyed Vahid Shariat
- Mental Health Research Center, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Tehran, Iran
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