Skip to main content
. Author manuscript; available in PMC: 2008 Apr 30.
Published in final edited form as: Gen Hosp Psychiatry. 2007;29(3):199–206. doi: 10.1016/j.genhosppsych.2007.01.013

Table 2.

Sample Emergency Protocols

Sample of emergency protocol for ongoing rural telepsychiatry clinic (specific names in bold have been changed to preserve clinic, community and provider anonymity)
Note: This clinic involves a model of ongoing telepsychiatric treatment. Agreements have been made with a hospital system near the patient site to provide emergency treatment and after-hours emergency coverage. Other areas of the protocol (not shown) cover use of local services (labs, etc) with this hospital system and sharing of patient information between the telepsychiatry clinic and the hospital system.
EMERGENCIES
For routine issues between scheduled appointments, patients will be informed through the clinic (see patient form) that they need to contact the local telepsychiatry clinic staff (patient site) to schedule a walk-in visit or speak directly with the telepsychiatry provider. 30–45 minutes will be reserved each week for walk-in visits to deal with patient issues that they feel cannot wait until their next appointment, such as questions about medications, requests for refills, or other non-emergent matters.
Definition of a Psychiatric Emergency
For the purposes of this service, a psychiatric emergency will be defined as patient reports of;

  1. New suicidal thoughts or homicidal thoughts that are causing distress to the patient, or an impulse or plan to act upon any such thoughts.

  2. Grossly impaired behavior due to symptoms of mental illness. (Such as being unable to eat, take care of one’s basic needs e.g., shelter).

  3. A severe reaction to a medication prescribed through the clinic. (such as severe, intractable vomiting). It will be the telepsychiatry providers’s responsibility to describe severe medication reactions to each patient for each medication prescribe and to educate the patient as to when to seek medical attention for such a reaction.


Emergency coverage will be provided by Local (patient site) Mental Health Crisis Services.
Emergency Procedure Outside of Clinic Time
Patients will be instructed that anytime they feel they are in psychiatric crisis outside of telehealth clinic hours to contact the local Emergency Room and ask for Mental Health Services. They will also be instructed to notify the telepsychiatry provider through a message left at their voicemail that they have contacted the ER. To the extent that the telepsychiatry provider is available, they will attempt to provide information and coordinate care with local ER. If the patient contacts the telepsychiatry clinic staff during a psychiatric emergency, the clinic staff will direct the patient to follow the same emergency procedure, which is to contact the local ER and inform the telepsychiatry provider.
Emergency Procedure During Clinic
If a psychiatric emergency situation is identified during a telehealth clinic then the telepsychiatric provider will work to arrange an emergency evaluation for the patient by the local ER. The telepsychiatric provider will contact the ER and arrange for an emergency evaluation. The telepsychiatric provider will also work with the telepsychiatry staff to arrange patient transportation as necessary. The patient depending on the circumstances may 1) arrange own transportation 2) utilize ambulance services 3) utilize local van services if appropriate and available. Local telepsychiatry clinic staff will not be involved at anytime in transporting patients.
Local staff may help the telepsychiatric provider to coordinate transportation but will not be directly involved in emergency assessment.
If a patient from this service is deemed in need of an inpatient admission by the local ER then the Regional MH inpatient hospital will be contacted and the local ER will work with the Regional MH inpatient hospital to coordinate inpatient care at that facility, or another facility if no bed is available. The telepsychiatric clinician and telepsychiatry clinic staff may also work to help facilitate inpatient admission.
Sample of emergency protocol taken from larger information sheet given to patients enrolled in the local telepsychiatry clinic (specific names in bold have been changed to preserve clinic, community and provider anonymity)
WHAT IS A MENTAL HEALTH EMERGENCY?
There are several things that may be considered a mental health emergency.

  1. Having thoughts of wanting to harm your self or harm others, especially when:

    • These are new thoughts.

    • You feel you may act on these thoughts.

    • You begin to make plans to carry out these thoughts.

  2. Being unable to take care of your basic needs (such as food, shelter, clothing) because of the state of your mental health. For example feeling so sad that you are unable to eat.

  3. Having a severe reaction to a medicine that Dr. Telepsychiatrist has prescribed for you. For each medication that Dr. Telepsychiatrist recommends you take, he will inform you of the signs of a serious reaction, and what you should do about it.

  4. ther thoughts or behaviors not described above where you feel that yourself or others maybe in danger or be harmed because of a mental or medical condition. Remember it is always better to be safe, and seek help and advice when you are unsure if you are having an emergent mental health or medical condition than to try and handle a situation by yourself.

WHAT SHOULD I DO IN THE CASE OF AN EMERGENCY?
This clinic is taking place by telehealth (live interactive video conferencing). The clinic staff and Dr. telepsychiatrist will not be available for emergency care except during scheduled clinic hours. The Local Hospital will provide emergency services and care for patients involved in this clinic. If at anytime you feel you are having an emergency due to a mental health condition you need to contact the Local Hospital at xxx-xxx-xxxx and ask for the Emergency Room. When connected with the ER, explain your situation and ask for Mental Health Emergency Services. You may also go directly to the Emergency Room. Please remember to tell the Emergency staff that you are receiving treatment through this clinic, and inform them of any medications you are taking. If you have any contact with emergency services, at your earliest opportunity please call Dr. Telepsychiatrist so they are aware of what is occurring.