The Psych Call We Can All Learn From

The call began the same way as all EMS calls in my small, volunteer fire department do—with a radio dispatch over our personal radios.

“KCE 357 BF1 to the Bethany Fire Department, ambulance needed, priority 2, for a psychiatric emergency at ABC Kennels, 123 Anywhere Road.”

I headed to the firehouse, grabbed my partner and we drove the ambulance to the location. My partner and I wondered what kind of a psych emergency could occur at a kennel and pet grooming establishment. We couldn’t come up with any good answers.

The location had a number of outdoor runs for the dogs and a converted ranch house in the back that served as the grooming and office area. There was a big deck in front of the house. We pulled into the dirt driveway and noticed a state police cruiser in one driveway, and another cruiser in the other driveway, blocking access. A man stood on the deck. One trooper was just getting out of his car when we pulled up.

I asked the trooper, “What do you know?”

He said, “the 9-1-1 call said that he was inside dropping off his dog to be groomed and started ranting and raving and getting really upset. When the staff tried to calm him down, it wasn't working, and then he walked out to the porch still yelling about something to do with his dog. They called 9-1-1 and so here we are.”

I wondered what was going to happen next when he came down the stairs and hopped into his car. Both state troopers were holding up their hands and asking him to wait a minute so they could talk to him. He backed up fairly rapidly, and since there was no unblocked way to leave the kennel, he headed toward our ambulance and revved the engine. I wondered, “Is he just going to smash into the front end of our rig?”

Fortunately both my partner and I were out of the vehicle.

He stopped about three feet from the front of our ambulance. He got out of his car, put both his hands on the roof, and proceeded to repeat “Oh my god, what’s going on? I don't know what's happening.”

I approached him calmly and he said, “I'm really upset and I think I'm having a mental breakdown. I think I need to go to the hospital. I'm a psychiatric patient.”

I agreed. We were going to need to bring him to the hospital to be evaluated.

Before we could depart I had to confirm that no crime had been committed. The troopers told me no staff member had said anything about an offense that would require an arrest.

Our paramedic support arrived. An experienced medic got out of the fly car and asked the patient how he was doing. “I think I'm having a nervous breakdown,” he said. “I don't know what's going on. Maybe I forgot to take my meds today. I just don't know what's happening. I need to go to the hospital.”

We asked him what hospital he prefers and he told us. It was close and we were happy to take him there.

One of our younger members came to me and said “Pete, I think we should put him in handcuffs. He could become violent at any time. We should ask the state police to cuff him to the stretcher and follow us to the hospital. We need to make sure that no one's at risk.”

In the meantime the senior paramedic had led our patient into the back of the ambulance, placed him on the stretcher while calmly and quietly explaining what was going on, and secured him in the five-point restraint we use for every patient.

“I think we can talk this guy to the hospital,” the older medic told me. “Just stay close with the fly car in case I’m wrong.”

The ride to the hospital was uneventful. While en route the paramedic got our patient’s spouse's phone number. She said this wasn’t the first time this happened, and she’d be there soon. We arrived at the hospital and brought him to a psych observation room. Before long we were headed back to the firehouse.

This happens fairly often in EMS. People with mental illness need help and it often manifests itself as some wildly unacceptable behavior in public. We transport them to a hospital with psychiatric staff to be evaluated. Sometimes they are admitted but often they’re sent home with family to see their personal therapist as soon as possible.

In my experience, most psych calls can be managed with a calm demeanor and a supportive affect. Not all—I have certainly transported psychiatric patients in full restraints. But most times, as long as we remain calm and explain that they need to be evaluated by professionals at the hospital because they are having a really bad day, they agree.

Peter Stebinger served as a firefighter-EMT for a volunteer fire department for 35 years and currently serves as chaplain for the Connecticut Disaster Medical Assistance Team (CT1 DMAT) of the National Disaster Medical System.