Memo - Clarification of Baker Act patients transported by EMS

Clarification of Baker Act patients transported by EMS

EMS Guideline: Patients who have had a Baker Act completed by law enforcement or a physician for whom Emergency Medical Services has been requested for transportation, will be transported to the nearest emergency department or freestanding emergency department for medical evaluation. If the patient is, in the judgment of the EMS crew, stable to bypass facilities, patient, family, and/or physician preference will be strongly considered especially as it impacts continuity of care. Other deviations from this guideline will occur on a case-by-case basis but should be thoroughly documented as to why the deviation occurs.

Discussion:

1. Not all patients with behavioral issues are psychiatric patients. In fact, many of them or even most of them are not.
2. All emergency departments are capable of providing medical and psychiatric evaluation and treatment (including transport to another facility) for patients with behavioral problems. Every hospital and freestanding emergency department in our area has agreed that they should and will accept Baker Act patients from EMS when they are the nearest facility.
3. If the behavioral patient does not have a known history of behavioral problems, and sometimes even if they do, they require a medical screening. Until such medical screening is accomplished, there is risk for the patient. Because of that risk, we take behavioral patients, just like any other medical patient, to the nearest facility although we will try to honor patient, family, physician requests/preference, after notifying the patient, family, physician of the possible increased risk of bypassing the nearest facility. We cannot and should not be asked to create more risk for the patient or for the EMS agency by transporting to another facility because of nonmedical, law enforcement request, which actually would increase risk for the law enforcement agency, also.
4. Law enforcement is not required to complete a Baker act on patients without known psychiatric problems in fact, that may not be a legally defensible Baker act. Patients that are having behavioral issues that are not requesting treatment are almost always found to have a possible emergency medical condition, are incapacitated, and unreasonable which under Florida statute 401.445, empowers EMS to take the patient to and emergency department without their informed consent for further evaluation and treatment. Florida statute 401.445 also allows for reasonable force which has been upheld for law enforcement with incapacitated medical patients federally in the fourth circuit Court of Appeals. A Baker act is not necessary for EMS transport. If the patient is found to have a psychiatric condition, the emergency department physician can enact it. They actually prefer to make the decision themselves, after polling all of our emergency departments. It is reasonable and efficient for a law enforcement officer to request EMS transport for a possible psychiatric condition and follow the rescue unit to the emergency department and assure transfer of care to the emergency department.

Sincerely,

Todd M Husty, D.O., F.A.C.E.P.