Contra Costa Training Consortium
Quarter III 2010
Head Trauma? Seizure Disorder?
Hypoglycemia? Drug Abuse?
Hypoxia? Severe Hypertension?
Post Traumatic Stress Disorder (PTSD)
Transient Personality Disorders
A discrete period of intense fear or discomfort
in which symptoms develop abruptly and
reach a peak within 10 minutes
These patients commonly contact Emergency
Medical Services (especially first time attacks)
Palpitations Chest Pain
Develops after exposure to any event that
results in psychological trauma
Re-experiencing traumatic event is common
Common treatment includes therapy and a
wide range of medications that are prescribed
based on the patients specific symptoms.
A condition in which you show psychological
stress in physical ways.
These patients will often exhibit some of the
Paralysis of limb or body Impaired Vision
Psychogenic Seizures Gait Problems
Characterized by abnormalities in the
perception or expression of reality
Symptoms typically begin to manifest in early
AKA: Major Depressive Disorder
Characterized by all-encompassing low mood,
low self-esteem, and aversion to activities
Treatment typically involves therapy and anti-
Major cause of morbidity and typically occurs
with other psychiatric problems
Defined by the presence of one or more
episodes of manic episodes and one or more
Elevated risk of suicide during depressive
Typically treated with Mood Stabilizers such as
An enduring pattern of inner experience and
behavior that deviates markedly from the
expectations of the culture of the individual
10+ different types of personality disorders
ranging from paranoid to dependent
Each type of personality disorder presents with a
unique set of symptoms and treatment for those
Section 5150 is a section of the California Welfare and
Institutions Code which allows a qualified officer or
clinician to involuntarily confine a person deemed to
have a mental disorder that makes them a danger to
him or her self, and/or others and/or gravely disabled.
A qualified officer, which includes any California
peace officer, as well as any specifically designated
county clinician, can request the confinement after
signing a written declaration. When used as a term,
5150 can informally refer to the person being confined
or to the declaration itself.
The 5150 hold may be written out on Form MH 302, Application for
72 Hour Detention for Evaluation and Treatment
Section 5150 is not intended to be used to hold a person reported
to the police by a non-professional. It is intended for a police
officer to use to submit a subject for a hold when the officer has
observed the qualifying symptoms in the routine process of a
response. This is commonly used to allow the officer to process a
subject into the psych facility without requiring criminal
It can be used to hold an inebriated person in the drunk tank to be
released upon sobriety with a citation issued
During the period of confinement, a confined
individual is evaluated by a mental health professional
to determine if a psychiatric admission is warranted.
Confinement and evaluation usually occurs in a county
mental health hospital or in a designated ED. If the
individual is then admitted to a psychiatric unit, only a
psychiatrist may rescind the 5150 and allow the person
to either remain voluntarily or be discharged.
The person under a 5150 hold has a limited ability to
contest the legality of the hold.
On or previous to the expiration of the 72 hours, the
psychiatrist must assess the person to see if they still
meet criteria for hospitalization. If so, the person may
be offered a voluntary admission. If it is refused, then
another hold for up to 14 days, the 5250 (WIC-5250),
must be written to continue the involuntary
confinement of the person. A Certification Review
Hearing (W&I 5256) must occur within four days
before a judge or hearing officer to determine whether
probable cause exists to support the 5250.
The criteria for writing requires probable cause.
This includes danger to self, danger to others
together with some indication, prior to the
administering of the hold, of symptoms of a
mental disorder, and/or grave disability. The
conditions must exist under the context of a
Assure that all fields are completed prior to
transporting the patient.
Ensure that the Patients Name and Date of Birth
match the form
Ensure that officer signs and dates the form and
includes a brief description for the reason the
application for a hold is being placed.
The original 5150 Application should
accompany the patient to the hospital.
Under California law, the following rights may never be denied (Cal.
Welf. & Inst. Code § 5325.1):
The right to treatment services which promote the potential of the person
to function independently. Treatment should be provided in ways that
are least restrictive of the personal liberty of the individual.
The right to dignity, privacy, and human care.
The right to be free from harm, including unnecessary or excessive
physical restraint, isolation, medication, abuse, or neglect. Medication
may not be used as punishment, for the convenience of staff, as a
substitute for, or in quantities that interfere with the treatment program.
The right to prompt medical care and treatment.
The right to religious freedom and practice.
The right to participate in appropriate programs of publicly supported
The right to social interaction.
The right to physical exercise and recreational opportunities.
The right to be free from hazardous procedures.
• New implementation 5/17/2010
• Ringdown to the CCRMC Emergency
Department (10-15 minutes out if feasible)
• Conference call with CSU and ED to determine
destination of patient
• Destination of Patient – Either ED or CSU (it is
estimated that 65-75% of all patients will
qualify for direct admit to CSU)
• Turnover of Care
• ED is requesting the following information PTA:
– Patient’s Name
– Patient’s Date of Birth
– Legal Status (5150, voluntary, under arrest)
– Medical History (Dementia, etc.)
– Vital Signs
• Actual Blood Pressure (if obtainable)
• Actual Pulse (if obtainable)
• Actual Respiratory Rate
• If ALS – Glucose check
– Psychiatric History (if patient is willing to give)
– ETOH/Drug – Use or abuse
– Wounds that may need to be treated in ED prior to being
moved to CSU
– Restraint Status
Patients who have medical issues will be
directed to the Emergency Department
Patients who have behavioral/psychiatric
issues will be directed to CSU
Overflow for CSU will be the ED
Questions or concerns about patient’s medical
stability, default to the ED.
All patients must arrive on
a gurney, with full seat
belts for security reasons.
Same turnover of care as
with any other patient.
• Patients who are direct admits to the CSU,
there are 2 parking spots at the entrance next to
the CCRMC ED.
• For security reasons, all patients are to be
brought to the CSU on a gurney.
– If the patient refuses gurney transport, this should
be reported to the ED staff when you call with your
• Buzz into CSU to gain admittance
• Brief history may be requested.
All patients must arrive on a gurney, with full
seat belts for security reasons.
Patient will be evaluated at this time, by the
CSU Welcome Team (RN, Tech and MD)
Please do not remove patient from gurney until
instructed to do so and where to do so.
Please do not remove any restraints from
patient until instructed to do so.
Transport Crew will be instructed to remove
patient from gurney, or to keep on gurney
based on the following criteria:
Cooperative patients will be allowed off the gurney
and CSU staff will direct them where to go.
Restrained/uncooperative patients will need further
Transport restraints will not be removed until CSU
restraints are applied and under control
• All patients on 5150 holds by law enforcement should have been
searched for weapons (person and belongings) prior to
• If patient is a voluntary committal, law enforcement should be
requested to do a search of the patient and their belongings (if
they consent) prior to transport
• If the patient is voluntary and refuses a search by law
enforcement, they should be questioned about the presence of
• EMS personnel are NOT responsible to search patients or
• Patients and belongings will be searched again by CSU staff upon
arrival in CSU
• Any concerns or issues regarding searches or if no search was
completed prior, should be brought to the attention of the CSU
staff as soon as feasible
• Report will be given to the team admitting the
• Do not leave patients unattended on the
gurney to give report
• Please leave all paperwork (5150 sheet, PCR)
• Staff will request the PCR at time of patient
arrival, due to the fact that there may be
important information pertinent to patient
This is a new process in the CSU
There are still bugs to be worked out and
processes to refine
Give feedback to your supervisor so that this
information can be relayed back to the CSU to
improve the system
For safety to all patients and caregivers, work
Behavioral and Psychiatric crisis patients can
be volatile and should not be taken lightly. Use
good common sense and caution with this
group of patients. Safety issues concern all