NJP220 t1_jahxhwd wrote

As far as the music in the ambulance, unfortunately a lot of the trucks don't have great speaker setups. Ambulances have completely custom bodies usually and music isn't a priority in their design. That being said, the service I work for has speakers in the back and we try to provide music to our psychiatric patients whenever we can. We also have provided a laptop with Netflix open before. Anything to make the process easier and less stressful for all involved.


NJP220 t1_jahoclh wrote

That makes sense. Thank you for the info. It sucks that these are the avenues that need to be used to try to change a broken system. I worry this push for change will unfortunately negatively impact patients at least in the short-term though. Like a game of chess that is for a good cause. The ultimate win may be for the best, but pawns are going to be thrown at the enemy.


NJP220 t1_jah72li wrote

Very sorry for your loss and the struggles your mom faced.

That's what is scary about this order for sure. Of course the hospitals WANT to get the patients to the appropriate facility to help them. But if none of them have space and the hospitals have a finite deadline to get the patient into them, then do they just boot the patient out? Send them home without receiving any proper care for their mental health crisis?

This seems like such a half-baked, knee-jerk reaction to a lawsuit, and I agree that people's lives/wellbeing are at risk.


NJP220 t1_jah06xw wrote

This seems to be missing the core issue. Which is a lack of appropriate facilities, funding and staff in the state for mental health. I work for an ambulance service in the Northern part of the state that often transports psychiatric patients from area hospitals to other facilities. There is no room anywhere. Nearly all of the receiving facilities are in the bottom of the state (Concord, Hampstead, Derry, Nashua) and they are all full.

If a person calls 911 for a mental emergency and an ambulance comes, we have to take them to the closest appropriate facility, which would be the nearest hospital. We legally cannot just say "The better hospital/facility is 2-3 hours away. Let's take them there." We HAVE to go to the nearest hospital. So now that the patient is in the emergency room, the doctor will evaluate them. If they need to go to the better facilities, those places will be called. When they are called, they say that they have no available beds and are full. So the next place is called, and the next, and the next, and the next, until all appropriate options are exhausted.

Now with no available beds at the appropriate facilities and a patient who is considered a danger to themselves or others, the hospital has to figure out how to manage this patient with what they have. All of the hospitals in the state are currently frequently at capacity and have no available beds. So the patient has to stay in the emergency room, with 24h surveillance, until a bed at one of the appropriate psychiatric facilities finally opens up. Then you have to hope that you were caller number 1 and reached them first on your 18th call to them in the last 3+ days.

Now you need to call an ambulance service that can do long distance transfers and have them transport this patient to the new facility. The facility may be over 3 hours from the patient's home and family. Causing untold amounts of additional stress. Let's say you live in and have a psychiatric issue in Littleton, NH. You will go to Littleton Hospital initially and go through that whole process. Then after days of being kept in that hospital, an ambulance with 2 strangers comes and picks you up and takes you hours away to an unfamiliar facility in Hampstead NH, Brattleboro VT, outside of Boston MA. Hours away from family, making it difficult for your support network to be see you. Then after this potentially traumatic experience, you get released, and now have to figure out how to get back home.

This article makes it seem so simple. "Just take them to the appropriate facility." But it completely ignores the issue of why that can't happen. There is not enough available beds, staff, facilities, funding, transportation, in the state of New Hampshire for psychiatric/behavioral care. This order acts like the hospitals were keeping people in the emergency department out of their own convenience. It is a huge burden on the emergency room to manage. They would be much happier to send the person to the appropriate facility. There is simply nowhere to send them.


NJP220 t1_ixryhtb wrote

No problem. There are more than that but they are largely recognized at the state level rather than nationally. Most states, though not all, follow the National Registry of EMTs (NREMT), which recognizes EMR, EMT, AEMT, and Paramedic. They create a standard that we have to test to and pass. Then we have to get licensed in our state after learning and testing for any and all state level protocol differences. An AEMT in one state may not be able to do the same things in the field as one in another state, but they generally have the same base level of training. Then some states have what they call EMT-I or Intermediate which is either between EMT and AEMT or between AEMT and Paramedic. There are even more than that out there and it gets pretty convoluted. Lol. But the 4 levels that the NREMT recognizes are basically the standard.


NJP220 t1_ixpd77f wrote

How EMTs are treated largely depends on where you are. If they are treated poorly by hospital staff then that seems like a major issue that the hospital needs to address. Compared to a Paramedic, EMTs are pretty low in training. Which isn't to say they are poorly trained. Simply not as highly trained or legally approved to perform more advanced medical procedures. So they are often relegated to a sort of "assistant" or driver for the paramedics. But in the more rural areas where medics are less available, EMTs are often the main providers you will find. The majority of ambulance calls don't require a Paramedic level of care and an EMT is more than capable of handling them.

As far as the pay, we all wish it paid more. Many of us do the job knowing that we could make more money working in a different field, with a normal schedule and substantially less risk of PTSD. But not many other jobs provide you with a sense of purpose and like you are making a tangible difference in people's lives.


NJP220 t1_ixp4wr0 wrote

Advanced. There are multiple training levels in EMS. You often hear EMT and Paramedic used interchangeably by the media but they are 2 different license levels. Though some states have differing titles or variants, there are primarily 4 core license levels.

EMR = Emergency Medical Responder.

EMT = Emergency Medical Technician.

AEMT = Advanced EMT (also known as EMT-A).

EMT-P = Paramedic (usually just called a Paramedic or medic for short).

Each level has increasing training and abilities in the field. EMR on the low end and Paramedic on the high end.


NJP220 t1_ixo2h0x wrote

As an A-EMT I can confirm that this is a great fear of many in the profession. In the low population area that I am in, it is basically a guarantee that we will respond to acquaintances, friends, family, and loved ones. My uncle responded to do CPR on his own sister. I have performed CPR on long-time school friends and had to inform their family that they are gone. A partner of mine transported and treated a guy that got ejected through a windshield and didn't realize it was their nephew until their wallet was dug out so they could give info to the hospital.

There is some level of comfort in knowing that we may be able to directly help our loved ones as EMS providers. But it certainly adds another layer of mental trauma for us.

I feel such sorrow for this family. I hope she knows that whether she knew it at the time or not, she was there for her daughter when she was needed the most.