EMSC Connects
June 2022; Vol.11, Issue 6
Pedi Points
Tia Dickson, RN, BSN
Primary Children's Hospital
I attend many local and national EMS conferences and one of the most well-attended topics is mental health. We all know mental health issues are on the rise especially among our youth, but our training lags behind. As recent mass shootings highlight, it is time to address mental health training, resources, legislation and EMS response. What is your agency doing? If you do not know, find out. It they do not have something in place, start here.
The Doc Spot
Natalie Tedford, MD, Pediatric Emergency Medicine and Global Health Fellow, PGY5
University of Utah and Primary Children's Hospital
Excerpts from May 9th, 2022 PETOS—Pediatric mental health and suicide in prehospital and ED settingsMental health is becoming a crisis in both adults and youth. Across the country, youth are undertreated for depression and the number of youth who experience major depressive episodes is increasing (up by 197,000 cases from last year). Utah ranks in the highest prevalence of these episodes.
Why should we (providers) care?
Definitions
In the prehospital setting, the underlying cause of a behavioral crisis or psychiatric emergency is NOT needed but some understanding of the basics will give you a framework for providing care. Most mental health diagnosis fall into either organic or functional categories.
Safe Approach to a behavioral health crisis
- Be prepared to spend extra time
- Have a definite plan of action
- Identify yourself calmly
- Be direct
- Assess the scene
- Stay with the patient
- Encourage purposeful movement
- Express interest in the patient’s story
- Don’t get too close to the patient
- Avoid fighting with the patient
- Be honest and reassuring
- Do NOT judge
Example of mental health crisis
Prehospital guidelines for dealing with a psychotic patient
- Determine if the situation is dangerous.
- Identify yourself clearly.
- Be calm, direct, and straightforward.
- Maintain an emotional distance.
- Do not argue.
- Explain what you would like to do.
- Involve people the patient trusts, such as family or friends, to gain patient cooperation.
- Involve police support as needed.
Suicide: Depression is the most significant factor that contributes to suicide. It is a common misconception that people who threaten suicide never commit it. Suicide is a cry for help. Someone is in a crisis they cannot handle alone.
There are many myths about suicide but here some facts:
- Asking someone about suicide lowers anxiety, opens communication, and lowers the risk.
- Anyone can stop a suicide: listen, show you care, provide hope.
- Most suicidal people have given some sort of clue or communicated an intent prior to their attempt.
- Those who talk about it may try and even complete a self-destructive act.
- Suicide is a preventable form of death, almost any positive action may save a life.
- If people in crisis get the help they need, they are far less likely to attempt suicide.
Approach to agitated patients
- Be calm, supportive, and empathetic.
- Approach the patient slowly and purposefully and respect the patient’s territory.
- Limit physical contact.
- Do not leave the patient unattended.
- Try to indirectly determine the patient’s state.
- Pay attention to the patient’s ability to communicate, appearance, dress, and personal hygiene.
- If you determine the patient requires restraint, make sure you have adequate personnel available to help you.
- If the patient has overdosed, take all medication bottles or illegal substances to the medical facility.
- Use only as a last resort.
- Use restraints only to protect yourself or others from bodily harm or to prevent the patient from causing injury to himself or herself.
- Use only reasonable force as necessary to control the patient.
- Secure with approved equipment only.
- Treat the patient with dignity and respect.
- Monitor closely (airway and cardiovascular stability).
Crisis Resources
- 1-800-273-TALK (8255)–National Suicide Prevention Hotline
- 1-800-SUICIDE (784-2433)–National Crisis Hotline Network
- 988–National Suicide Prevention Lifeline (new legislation)
Utah
Utah Crisis Line–1-800-273-8255
Utah Warm Line–1-800-587-1055
Blomquist Hale (free and confidential services for DHHS employees)
Training and Learning Resources and Peer Support
Where to start,
EIIC’s Pediatric Advocacy and Education Kit (PEAK): Suicide
Counseling on access to lethal means:
What can YOU do?
- Talk with youth about mental health–kids, nieces/nephews, grandkids, communities, students, patients.
- Prioritize a patient’s dignity in all situations.
- Advocate for mental health resources. Contact your local representative and weigh in on mental health resources and legislation https://nami.quorum.us/action_center.
- Speak up on the current bipartisan mental health legislation for youth.
- reauthorizes the Pediatric Mental Health Care Access (PMHCA) program for 5 years, ensuring the continuation of these telehealth consultation programs while also expanding them to all states and enhancing their capacity to support schools and emergency departments
- provides direct funding to schools by the Substance Abuse and Mental Health Services Administration that can be used for a variety of mental health promotion and suicide prevention purposes, such as educational seminars, awareness campaign materials, peer-to-peer program support, telehealth, and training programs.
Coming soon: EMSC Pediatric Suicide Care Collaborative
National EMSC is working to optimize care for children and adolescents presenting to EDs with acute suicidality through an upcoming collaborative.
https://emscimprovement.center/news/enroll-now-in-the-emsc-pediatric-suicide-care-collaborative/More resources
Grief and support groups
Violence Witness Resources
Bullying prevention in schools
Several non-profit organizations are working to get bullying prevention programs into the elementary schools. One currently working with Davis County is Stand For the Silent https://standforthesilent.org/.
Bullying prevention in schools is a full-time exercise. For true change to take place, the culture of a school must be transformed. But it’s not as difficult as it sounds. With a year-round bullying prevention program, clear expectations of faculty and staff, and established guidelines for how to treat incidents, students and adults can be a part of a culture of caring.Utah Suicide Prevention State Plan 2022–2026
Protocols in Practice
News from Utah EMSC
Name Change for the Bureau of Emergency Medical Services and Preparedness (BEMSP)
The Utah Department of Health has undergone some changes. The bureau now falls under the Utah Department of Health and Human Services (DHHS) and is now called the Office of Emergency Medical Services and Preparedness (EMSP). None of the contact information has changed at this time. EMSC continues as a program within the DHHS Office of Emergency Medical Services.
Happy Pride month
Utah's Governor Cox issued a proclamation marking LGBTQ+ Pride month. EMSC wishes you a happy Pride month and thank all our LGBTQ+ providers. We recognize this population is especially vulnerable to mental health struggles and encourage all to lend support where you can.News from national
On Topic:
Suicide and Self-Harm Prevention
Changes in Suicidal Ingestion Among Preadolescent Children From 2000 to 2020 | JAMA Pediatrics
Suicide Is Rising Among Younger Students. Here’s How Schools Can Prevent Tragedy|Education Week
For further information about National Mental Health and related resources and events, visit:
Youth.gov’s Mental Health Youth Topic
Office of Adolescent Health, Adolescent Mental Health
Substance Abuse and Mental Health Administration, Caring for Every Child’s Mental Health
Substance Abuse and Mental Health Administration Mental Health Services Locator
Seasonal Prevention:
Approximately 600 children and adolescents die from pedestrian injuries each year. The highest rates of death occur in children ages <1-4 and adolescents ages 15–19. In CSN’s new child pedestrian safety infographic, All Children are Pedestrians! Prevention Tips and Recent Stats, learn more about how to prevent these injuries and keep kids walking safely.PECC Planning
Our 2nd annual PECC Conference is planned for September 16, 2022. You should have received an email RSVP. We are trying to determine who would like to attend in person and who prefers virtual. Please respond to that email as soon as possible. If you are PECC and did not receive the email, contact Jared Wright at jaredwright@utah.gov.
The National Association of EMS Physicians (NAEMSP) has launched a podcast
The Pediatric EMS Podcast* <https://sites.libsyn.com/414020#> provides
case-based discussion with evidence-based recommendations by content
experts in prehospital pediatric medicine to advance the care of children
outside the hospital. In their first episode, hosts Dr. Joseph Finney and
Dr. Joelle Donofrio-Odmann talk about safely and effectively managing pain
in our pediatric patients.
Covid and kids
More than 4.8 million children ages 5 to 11 have been diagnosed with COVID-19 since the pandemic began, 15,000 have been hospitalized, and more than 180 have died. Vaccine boosters help the body create longer lasting, more durable protection against infections by stimulating immune memory cells. The CDC recommends parents have their children ages 5 and older receive a booster dose, and those who haven’t completed their primary series should also get up to date on their vaccines.
Attention EMS providers, your feedback is needed!
Have you attended a home birth transfer of an infant or a mother to a hospital and noticed ways the process could be improved? Have you seen midwives who have really great systems and communication and wish they all did? Help us learn how to improve the collaboration and communication about birth transfers by giving feedback to the Utah Women's and Newborns Quality Collaborative!
Find out more about our work and the improvement tools we have created here: https://mihp.utah.gov/uwnqc/out-of-hospital-births
Ask Our Doc
Pediatric Education and Trauma Outreach Series (Petos)
Utah EMS for Children (EMSC), Primary Children's Hospital (PCH) and Utah Telehealth Network (UTN) have partnered to offer the Pediatric Emergency and Trauma Outreach Series (PETOS) to EMS providers.
This course provides one free CME from the Utah Department of Health Bureau of EMS and Preparedness for EMTs and paramedics. The lectures are presented by physicians and pediatric experts from Primary Children’s Hospital. The format is informal, inviting questions and discussion.
Join us on Zoom each 2nd Monday at 02:00 PM Mountain Time (US and Canada) Click the pic below!
Archived presentations can be viewed and also qualify for CME. Access at https://intermountainhealthcare.org/primary-childrens/classes-events/petos
To obtain a completion certificate
- For "live" (virtual) participants: To receive a certificate of completion for attendance be sure to include your email address when the host requests it in the chat during the live presentation. Certificates are e-mailed out after verification of attendance and processing.
- For archived viewing: After viewing archived presentations (link above) e-mail utah.petos@gmail.com with the date and title of presentation viewed. You will receive a three question quiz to verify participation and once the quiz is returned, certificates are e-mailed out.
We try to have certificates out within a week but will occasionally have delays.
Monday, Jun 13, 2022, 02:00 PM
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Looking for a PEPP class?
Pediatric Education for the Prehospital Provider
Register online at www.peppsite.com. Look up classes in Utah and find the one that works for you. Once you find the class, go to jblearning.com, and look up pepp als in the search tool. Purchase the number ($21.95). Return to peppsite.org to register for the class and follow the prompts.
If you have any questions, please email Erik Andersen at erikandersen@utah.gov or text/call 435-597-7098. Continue to watch the website for additional classes.
EMS Focused Education
University of Utah's EMS Grand Rounds (Offered every 2nd Wednesday of even months)
Wednesday, Aug 10, 2022, 02:00 PM
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Emergency Medical Services for Children, Utah Bureau of EMS and Preparedness
The Emergency Medical Services for Children (EMSC) Program aims to ensure that emergency medical care for the ill and injured child or adolescent is well integrated into an emergency medical service system. We work to ensure that the system is backed by optimal resources and that the entire spectrum of emergency services (prevention, acute care, and rehabilitation) is provided to children and adolescents, no matter where they live, attend school, or travel.
Email: tdickson@utah.gov
Website: https://bemsp.utah.gov/
Phone: 801-707-3763
Facebook: facebook.com/Chirp-UtahDepartmentofHealth