Should we have the authority to ambulance transport a patient to the facility we think is the appropriate destination?
California has presented Assembly Bill 1795 to the state legislature that would allow paramedics to take patients to an alternate facility. Law enforcement currently possesses this ability. Paramedics, however, must provide ambulance transport for the patient to the emergency department when 911 is activated.
Assemblyman Mike Gipson’s bill gives paramedics who receive additional training in crisis intervention the authority to determine the transport destination.
Bill 1795 does not supersede a patient’s choice. The patient still can request transport to the ED. This bill also does not give a paramedic the power to initiate an involuntary psychiatric hold.
The bill’s goal to better use available resources rather than taking up a hospital bed unnecessarily.
Los Angeles County Supervisor Janice Hahn stated the county has five urgent care centers that focus on mental health and one facility that deals with alcohol intoxication, according to an article in the Los Angeles Times. Hahn added these alternate facilities always have beds available.
While this might seem to be a great option for paramedics, the protocols for this type of ambulance transport need to be very specific to ensure dementia and delirium patients are not transported to urgent care when ED care is needed.
Also, alcohol intoxication is a diagnosis of exclusion. It’s important to note that we cannot always rule out some of the causes of altered mental status in pre-hospital settings.
How many of us have heard about misdiagnoses for homeless patients? For example, transport for alcohol intoxication when the real problem was a subdural bleed from falling and hitting their head?
We should watch this bill to see how it pans out.