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.

Natalie Tedford, MD, Pediatric Emergency Medicine and Global Health Fellow, PGY5

University of Utah and Primary Children's Hospital

Mental 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.

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.

• 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

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).

• 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

• DHHS Resource Guide

• Utah Crisis Line–1-800-273-8255

• Utah Warm Line–1-800-587-1055

• Blomquist Hale (free and confidential services for DHHS employees)

• County-specific resources and additional hotlines for Utah

• 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.

National EMSC is working to optimize care for children and adolescents presenting to EDs with acute suicidality through an upcoming collaborative.

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/.

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

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.

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