EMS World

JAN 2019

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EMSWORLD.com | JANUARY 2019 19 men; they also accounted for substantially more EMS usage. Of the involuntary-hold patients, 48% had only one EMS transport during the study period, compared to 74% of "never-held" patients. Moreover, 4% (1,072) of involuntarily held patients had more than 20 encounters during the study period. There were only 0.4% (820) of never-held patients in this category. Besides unique patients, the authors also looked at total EMS calls. During the study period there were 541,731 patient encoun- ters, and 10% of these (53,887) were for patients receiving involuntary holds. Yes, 26,283 patients accounted for 53,887 EMS encounters involving involuntary holds. They also accounted for 74,116 encounters that did not involve involuntary holds. In total, invol- untary-hold patients accounted for almost a quarter of all EMS encounters in this county (128,003; 24%). Of the 53,887 involuntary-hold encoun- ters, 41% (22,074) resulted in direct trans- port to a psychiatric emergency facility. Only 0.3% (60) of these could be classified as failed diversions! What is even more impressive is that the authors conducted a manual chart review and discovered that in 54 of the 60 failed diversions, the patient developed new symp- toms after arrival at the psychiatric emergen- cy facility, and there was nothing in the PCR that supported transporting these patients to the ED. Of the six patients who should have been transported directly to an ED, none died or required CPR or an advanced airway dur- ing their second transport. Three patients required critical interventions; these included one glucagon administration, one naloxone administration, and placement of one naso- pharyngeal airway. Limitations The authors of this study did a nice job out- lining their limitations. They included that this study was performed in one county, which the authors note has a notably higher rate of involuntary holds compared to the rest of California. The protocol studied has been in place for years, and results may be different dur- ing an implementation phase. They also discussed limitations in the data and the matching algorithm they used to identify unique patients. This was a well-done study that sig- nificantly adds to the literature. It strongly suggests that a protocol that allows EMS providers to divert psychiatric patients to dedicated psychiatric facilities appears to be safe and beneficial. ABOUT THE AUTHOR Antonio R. Fernandez, PhD, NRP, FAHA, is research director at the EMS Performance Improvement Center and an assistant professor in the Department of Emergency Medicine at the University of North CarolinaÐChapel Hill. LET CONGRESS KNOW: EMS is on the Frontlines of Patient Care Wednesday, April 10, 2019 (briefing: evening of April 9) Hilton Crystal City, Arlington, Virginia Info: naemt.org/events Join us for EMS On The Hill Day on April 10, 2019! Help our lawmakers understand the emergent, urgent and preventive care EMS provides to patients in need every day. All members of Congress must understand EMS and the issues we face in providing quality patient care. Please join us!

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