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Guidance For Behavioral Health Calls


We know that some of you are experiencing increasing numbers of behavioral health calls where law enforcement personnel are reluctant to assist with forcible entry, hearsay petitions, searching the individuals for weapons, or assisting EMS in restraining those who are violent or agitated.  

Our current policies give you guidance on this while we are working through appropriate channels to see if any remedy is available.

  1. IT IS IMPERATIVE that EMS personnel carefully assess these patients for their decisional status and suicide risk per the SOPs and fully document their assessment on the PCR.
  2. It is clear that law enforcement is becoming less and less likely to help in some cases  based on internal concerns.  Please work with them on a case by case basis.
  3. Let Dr. Jordan know if you are being placed in a situation in which you believe you are UNSAFE.
  4. PHYSICIAN’S ORDERS: A physician can believe that any patient should receive any medically indicated care - and they may be absolutely correct in their diagnosis and intended care.  It does not mean that we can force that care on a decisional patient.  Behavioral health patients that are deemed decisional and not an immediate risk under the Illinois Mental Health Code fall into that category.  A physician cannot FORCE paramedics to bring such a patient to the hospital.  That’s called false imprisonment and is actionable under Federal law.   This is admittedly a fine line and we are walking it cautiously!
  5. Unfortunately, EMS cannot accept hearsay evidence of intended harm without some visible and/or reliable proof. If an allegation is being made of a suicidal statement or gesture, validate the allegation to the best of your ability from a reliable source and compare that to your current patient assessment findings.
  6. RISK PRESENT: If EMS personnel determine that a patient will imminently harm themselves, others, or be incapable of caring for themselves, we can declare that they are non-decisional per our SOPs and take all appropriate medical means to secure them for their safety which includes verbal de-escalation, physical take downs, application of physical restraints, and/or pharmacologic sedation.
  7. RISK NOT PRESENT: IF the patient is NOT an immediate threat to self, others, or incapable of caring for themselves when EMS is present and the patient refuses to come with us after goof faith therapeutic communication and disclosure of risk , they must be left in the condition in which they were found. The refusal of service is called and documented as an AMA refusal

I didn’t say we like this or want it to happen.   However, it is what it is.  We can only use reasonable force, and should use all the options at our disposal within protocol, which are many.  Please let us know if you have specific questions we can answer while working towards a more comprehensive solution.

Connie J. Mattera, MS, RN, Paramedic
EMS Administrative Director and System Coordinator

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