There are Intensive Care paramedics, Community Paramedics, Extended Care Practitioners, Rural and Remote Healthcare Paramedics, CBRNE Paramedics, Fire-fighter Paramedics, Tactical and SWAT Medics, there are Flight Medics, and there are even a few paediatric and neonatal intensive care transport Medics .
But there are NO Mental Health care specialists in our EMS community!
where is the Mental Health Paramedic?
You can refer to this earlier post of mine outlining this crazy gap in patient care, but in a nutshell, mental health emergencies are becoming an ever increasing portion of the EMS workload, some services even quote up to 30% or More of their calls are related to Mental Health!! That’s FAR more than cardiac arrests, sepsis and pregnancy put together! And think of how much training goes into these three categories of medical emergency. Mental health is Under-treated!
So why is there such an almost evasion when it comes to education on mental health and providing a scope to deal with and treat these emergencies?
Are societal stigmatisms a contributing factor?
Could it be the intangible nature of the symptoms and pathologies?
Could our own perceptions – or rather misconceptions, of the limitations of our treatment options be hindering the advancement of further scope for interventions?
Not only is it time to Professionalise and Sub-Specialise (see my previous post), but I believe it’s also time to increase our general education and further promote mental health pathologies as an area where we CAN have an impact and are able to begin interventions that will have measurable effects.
The first issue to address is general education. If every paramedic is expected to understand the birthing process inside-out (pardon the pun) then there is no excuse for not having the same, if not a greater working knowledge of the pathophysiology of mental illness and disease.
The future of EMS is currently pointed in the direction of equipping pre-hospital professionals with clinical tools and pathways to appropriately asses, manage and refer patients.
Paramedics are beginning to utilise NEXUS and Canadian C-Spine criteria in the Pre-Hospital arena, not only that, but they have been using state-wide trauma systems for aeons! Any critical trauma patient is immediately transferred to Level 1 trauma centres – that’s a foundational principle, a part of core EMS education.
So why aren’t psychiatric patients or patients experiencing mental health crises being appropriately transferred to a facility with the means of not only adequately managing these patients, but a facility that specialises in their treatment?!
You wouldn’t send a patient with bilateral femoral fractures to a local Emergency Department, they deserve a trauma centre with 24/7 surgical facilities. Similarly, an individual experiencing a psychological crisis deserves a facility that has 24/7 specialists; a psych unit, not a local hospital with outpatient services.
But the buck doesn’t stop there. Why aren’t there paramedics, who are highly skilled, trained and experienced specifically in the field of mental health emergencies? An Extended care practitioner or Community Paramedic is a specialist in low acuity care; they have undergone additional training and education to deliver a set of skills normally outside the boundaries of traditional EMS.
Why can’t a similar principle be applied?
Wouldn’t it be fantastic to see a day where a unit responds to a patient experiencing a psychological crisis, assesses the patient and calls for assistance from a Specialist Crisis Paramedic? (sounds nicer than Mental Health Paramedic?)
A paramedic who not only has training in ALS skills, but has undergone a formal diploma in counselling or psychology/ psychiatry, similar to a psychiatric RN? A Specialist Paramedic who has an extended scope of practice to intervene in psych. emergencies, an expert in sedation and chemical restraint, an experienced wielder of clinical assessment tools like the DASS, the Hamilton Scale,
PHQ-9 .etc just to name a few. A specialist who deals on a daily basis with this spectrum of disease and understands the finer aspects of each illness and symptom?
Imagine that!
Heck, imagine an Interventionalist who can administer low doses of Ketamine in the pre-Hospital environment that will have a significant impact on the patient for more than 2 days?*
Don’t let my poor understanding of the healthcare system and EMS dissuade you, use your imagination!
And lastly, of all the research being conducted in the Emergency medicine and pre-Hospital care arena, how much of it do you think is being devoted to resuscitation?
Now, how much to thrombolysis?
Diabetes?
All of which are exceptionally worthwhile and vital areas to advance in!
But how much is being devoted to mental health care and psychiatric emergencies?
We cannot afford to let Mental Healthcare become the sibling that gets left behind.
*Berman, RM, Capiello, A., Anand, A., Oren, DA, Heninger, GR, Charney, DS, Krystal, JH. (2000). Antidepressant effects of ketamine in depressed patients. Biol Psychiatry, 47, 351–354
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but besides that, improvisations save lives when things don’t work they way they are supposed to… Unfortunately, it just so happens that it is exactly WHEN we need things that they tend NOT to work!
