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Mental Health Standard

In situations involving a patient with an emotional disturbance (e.g. erratic behaviour), the paramedic shall:

  1. consider underlying organic disorders;
  2. give particular attention to personal safety as per the General Measures Standard;
  3. in cases of patients with known or suspected suicide attempts or self-harm,
    1. assume that all attempts are of serious intent, and
    2. ask the patient directly whether they have ideation or intent of suicide or self-harm;
  4. in cases in which a patient is being transported without consent, not proceed with transport unless in possession of the appropriate documentation and/or escort (see paragraph 5 below);

Guideline

The Mental Health Act (Ontario) has implications in the manner in which a paramedic may deliver care. Recall:

  • A person who is recommended by a physician for admission to a psychiatric facility as an informal or voluntary patient pursuant to the Mental Health Act (Ontario) may not be transported without consent
  • The following persons may be transported without consent, subject to the provisions of the Mental Health Act (Ontario) (Note: this list is not exhaustive, please refer to the Mental Health Act for further details): 
    • The subject of an application for assessment signed by a physician under subsection 15(1) or 15(1.1) of the Mental Health Act (Ontario) (Form 1)
    • The subject of an order for examination signed by a Justice of the Peace under subsection 16(1) of the Mental Health Act (Form 2); and
    • A person taken into custody by a police officer under subsection 17 of the Mental Health Act (Ontario); and
    • A patient detained in a psychiatric facility under a certificate of involuntary admission under subsection 20(4) of the Mental Health Act (Ontario) (Form 3) or a certificate of renewal (Form 4).
  1. recognize the need for an escort as follows:
    1. If a patient is violent or potentially violent, refer to the Violent/Aggressive Patient Standard,
    2. If a patient is in custody under Court or Ontario Review Board Disposition, a Justice of the Peace or hospital’s officer in charge or delegate will designate the escort;
  2. with respect to use of restraints,
    1. only restrain a patient if,
      1. i. directed by a physician or police officer,
      2. ii. an unescorted patient becomes violent en route, or
      3. iii. use of restraints is required to provide emergency treatment as per the Patient Refusal/Emergency Treatment Standard,
    2. only the reasonable and minimum force shall be used to restrain the patient,
    3. where restraints are applied prior to departing a scene under the direction of a physician or police officer, a physician escort (or delegate) or police officer ordering the restraint is required to accompany the patient in the ambulance,
    4. concurrent with paragraph 6(c) above, if a police officer has handcuffed a patient, the paramedic shall not proceed with transport until such a time that the police officer takes the patient into custody and is present in the patient compartment,
    5. for inter-facility transports,
      1. in cases in which the sending facility is requesting restraints, advise that all restraints must be provided and applied by hospital staff or police prior to transport, and
      2. in cases in which the patient is restrained, the paramedic shall not proceed with the inter-facility transport unless,
        1. the sending physician or sending facility has made a decision that the patient can be transferred safely, either with or without a hospital escort,
        2. the patient does not appear to be a safety risk or have the potential to become violent en route, and
        3. the paramedic feels comfortable with the decision that the patient does not appear to be a safety risk or who has the potential to become violent en route, and
    6. if the patient is restrained, document the following on the Ambulance Call Report, in conjunction with the requirements outlined in the Documentation of Patient Care Standard:
      1. that the patient was restrained,
      2. a description of the patient’s behaviour that required that the he/she be restrained or continue to be restrained,
      3. a description of the means of restraint, including the method of restraint,
      4. the person (e.g. physician, police officer or paramedic) ordering restraint,
      5. the position of the patient during restraint, and
      6. the clinical response to restraint; and

Guideline

Restrained patients are more susceptible to rapid deterioration. Maintain a high index of suspicion for all restrained patients.

  1. not transport a patient in the prone position;

Guideline

When initiating full body restraint, or participating in full body restraint, of a patient:

  • Attempt to organize the team before attempting restraint
  • Prepare all equipment in advance.Prepare all equipment in advance.
  • Inform the patient of the need to restrain them and explain the procedure.
  • Immobilize the patient’s limbs and head in one coordinated effort. Grasp each limb at the main joint and between the main joint and the distal joint, e.g. one hand on the elbow, the other on the forearm.
  • Place the patient in a supine “spread eagle” position or in the left lateral position.
  • Restrain extremities as follows:
    • Secure one arm above the head and the other to the stretcher at waist level, or secure both hands to one side of the stretcher.
    • Elevate the head of the stretcher to protect the airway and to allow the paramedic greater visibility.
    • Secure the feet.
    • Ensure that the limbs are secured to the main frame of the stretcher, not to the stretcher side rails.
  • If the patient is spitting, consider use of a surgical mask on the patient. 

Contact

Ministry of Health and Long-Term Care
5700 Yonge Street, 6th Floor
Toronto, ON M2M 4K5

416-327-7900

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