Bernalillo County Fire Mobile Crisis Team Policies & Procedures PDF

**PURPOSE** This policy was created to establish the fire mobile crisis team (FMCT). The FMCT was created to respond to low acuity mental crisis events with a master's level clinician and BCFR Paramedic as requested by on scene law enforcement or fire personnel. It also illustrates the criteria bet...

**PURPOSE** This policy was created to establish the fire mobile crisis team (FMCT). The FMCT was created to respond to low acuity mental crisis events with a master's level clinician and BCFR Paramedic as requested by on scene law enforcement or fire personnel. It also illustrates the criteria between medical vs. behavioral health emergency intervention by the Fire Mobile Crisis Team Paramedic. **POLICY** It is the policy of the Bernalillo County Fire and Rescue (BCFR) to identify scene size up concerns, required information, treatment and dispositions concerns, referral processes, documentation procedures, transportation decision making, precautions and comments relating to the Fire Mobile Crisis Team (FMCT). **PROCEDURE** I. **Request for service** A. Requests for service shall be at the discretion of the on-scene law enforcement officer (LEO) or fire personnel. If the scene is deemed to be low acuity by the LEO or fire personnel then a request for the FMCT can be made. If the Bernalillo County Emergency Communication Center (BCECC) receives a request for service, the on duty FMCT will be dispatched via MDT and radio to the incident. FMCT incident will be coded as appropriate by the dispatcher. II. **Dispatch availability** A. The on duty FMCT paramedic will log into the CAD at the beginning of the shift and verbalize on duty with the BCECC. At the end of shift the FMCT will place the unit out of service and verbalize the unit out of service with BCECC. The FMCT will utilize the MDT for any status changes. III. **Scene Size-Up** A. It is the responsibility of the FMCT Paramedic to: 1. Recognize hazards, scene safety, and if needed, establish a safe area for treatment. 2. Utilize appropriate substance isolation precautions. 3. Recognize hazards to self, client, and others ensuring protection from further injury. 4. Evaluate the surroundings for potential weapons, drug paraphernalia, blood glucose supplies, insulin, etc. 5. Identify number of potential patients and resources needed. 6. Activate EMS, and/or Fire Dept. as needed. 7. Plan strategy to protect evidence at potential crime scene when safe and ensure law enforcement has been notified and enroute. B. It is the responsibility of the Mental Health Clinician to: 1. Mental Health Clinician (MHC) will identify the law enforcement officer in charge of the scene and make contact. 2. 3. Observe position of client. Required Documentation ---------------------- A. Mental Health Clinician (MHC) will complete and document a mental health assessment on the Electronic Health Record (EHR). B. All calls for service will require at a minimum an NFIRS report. C. If the clients crisis is due to a medical condition, then the Paramedic will complete an electronic patient care report (ePCR). D. The MHC and Paramedic will evaluate for changes in mental status: baseline status, onset and progression of altered state, preceding symptoms such as headache, seizures, confusion, trauma, etc. 1. Onset and progression of symptoms is critical in differentiating between dementia and delirium. 2. Environmental surroundings relative to food, clothing, shelter and finances. 3. The MHC will be the first person to contact the client to establish a rapport. They will then obtain permission for the Paramedic to obtain an initial assessment including vital signs. 4. Objective Findings. 5. Complete Vital Signs. 6. Blood Glucose for any client with recent change in mental status and may become a patient. 7. Pain assessment, evaluation, and documented for any complaint of pain or discomfort. V. **Treatment and Disposition** A. 1. If the Paramedic assessment is abnormal, the client will become a patient. If the patient will voluntarily accept transportation to an emergency department, the Paramedic will treat, and request transport by Albuquerque Ambulance (AAS) in accordance with existing patient care protocols. 2. If advanced care is needed request AAS and/or fire department to respond. 3. If the client has the need for medical care and is not willing to be transported voluntarily to an emergency department, disposition will be based on the mental health assessment and current EMS protocol. 4. If the client is determined to be gravely disabled or a danger to themselves or others, disposition will be based on the Bernalillo County/Albuquerque EMS Guidelines and/or Consortium Physician Consultation. Transportation decision/location will be based on patient choice and/or EMS Guidelines. B. 1. If the mental health examdetermines that there is a possible psychiatric emergency, the client will be offered voluntary care and transportation to the closest appropriate psychiatric facility or emergency department. a. Patient will be transported in the FMCT vehicle. 2. If the client needs emergency psychiatric care and is not willing to be transported voluntarily, a Certificate of Evaluation (C of E) will be generated, or transportation will be based on the Bernalillo County/Albuquerque EMS Guidelines and/or Consortium Physician Consultation. b. If a Certificate of Evaluation (C of E) is generated, a Law Enforcement MCT must transport the client. 3. If the client is determined to be gravely disabled or a danger to themselves or others, transportation will be based on the Albuquerque/Bernalillo County EMS Guidelines and/or Consortium Physician Consultation. Transportation decision/location will be based on patient choice or EMS Guidelines. 4. The client will be transported to the closest appropriate psychiatric c. The facility where the client is usually cared for and access to their medical record is readily available. d. The facility of choice is designated by the client, parent, guardian or designated decision maker. 5. The psychiatric emergency facility/department that is closest to the point of contact. VI. **Referral and Priority of Referral** A. 1. If the client needs immediate intervention and does not meet criteria for mental health or medical transportation, the FMCT will attempt to refer the client to Mental Health Services. 2. Adult Protective Services (APS) may be contacted for immediate referral of a dependent or elderly adult or if there is any concern regarding safety, abuse or neglect. B. 3. If the need for referral is urgent or routine, the EHR shall include all necessary documentation to include a direct referral contact and follow- up plan. C. 4. If the client needs a routine referral, based on the FMCT's assessment, and or consultation, referral information will be provided to the client and/or designated decision maker. Documentation ------------- A. An EHR, which includes elements of the psychiatric assessment of the client, will be completed for all clients/patients by the clinician. B. If the patient is turned over to an ambulance for medical transportation, the transporting paramedic will complete an ePCR. The FMCT Paramedic will also complete a separate ePCR with details of assessment/findings up to time of transfer of care, or while enroute to the hospital while in attendance. VIII. **Dispositions** A. Clients assessed by the FMCT may be transported to an Emergency Department designated as a psychiatric emergency service receiving facility, mental health provider office/clinic or shelter, or emergency housing in the FMCT vehicle. B. Transportation to an office or clinic for the provision of psychiatric services, shelter or emergency housing must be pre-arranged by, and in consultation with the FMCT Licensed Clinician. C. If a client is not transported, a FMCT program Non-Transport Form will be signed. IX. **Precautions and Comments** A. If there is a suspicion of abuse or neglect of an elder or dependent adult, the appropriate verbal and written reports will be filed, and appropriate authorities contacted. B. If a senior is identified in need of further care or services, FMCT will refer the client to the Long-Term Care State Ombudsman and if there are concerns about safety, they will ensure this is also reported to APS. (Ombudsman Number is 1-866-451-2901 and APS Number is toll-free at 1-866-654-3219 or 1-505-476-4912.) **REVIEW/REVISION** **[1/2/2023]** - Minor spelling and grammar updates. Fixed capitalization. - Changed reference from EMS protocols to EMS Guidelines. - Added authority for fire personnel to be able to request FMCT.