Psychiatric emergencies in preclinical emergency medical service: frequency, treatment, and assessment by emergency physicians and paramedics

Preclinical psychiatric emergency situations (PES) rank third in frequency of calls in the German emergency medical system (EMS). However, few data ex ist concerning relevance and treatment of PES. The aim of this study was to investigate this relevance in preclinical EMS and its appraisal by emergen cy physicians and paramedics. The protocols filled in by EMS physicians on emergency duty in a German district were evaluated concerning PES. In addit ion, the emergency physicians and paramedics of the district were asked to complete a validated questionnaire concerning the importance, their own und erstanding of PES, and interest in training programs. With 9.2%, preclinica l PES ranked third in frequency of all EMS calls. The most frequent case wa s substance abuse disorder (70%), followed by suicide attempts or ideation (33%). Specific therapy for psychiatric disorders is hardly ever performed. Emergency physicians and paramedics estimated the importance of knowledge about PES as high but rated their own knowledge as poor, Assessing five typ ical PES, emergency physicians gave the correct diagnoses in 71% of cases ( paramedics 39%) and the correct therapy in 32% (paramedics 14%). The intere st in training programs was significantly higher in experienced EMS physici ans. Preclinical PES is a relevant diagnosis within EMS and correct treatme nt is hampered by limited knowledge. Sufficient training is not yet availab le, although programs are necessary and the willingness to participate in t hem is high.