The Humanology Project comes together with Stony Brook’s Volunteer Ambulance Corps, better known as SBVAC, on campus. Both teams are striving to bring awareness to mental health emergencies, which have been on the rise since COVID-19 hit the nation. One of our writers, Srishti Chauhan, interviews two very important people involved in SBVAC: Nikhil Bamarajpet, Chairman of the Board of Directors, President of SBVAC and Kevin Quintero, First Assistant Chief of Operations.
Srishti: Hello Nikhil and Kevin! Can you please introduce yourself and explain what your duties are, as well as what you both contribute to Stony Brook’s Volunteer Ambulance Corps (SBVAC) on campus?
Nikhil: Of course we can! My name is Nikhil Bamarajpet, I am the Chairman of the Board of Directors and President of Stony Brook’s Volunteer Ambulance Corps. I am in charge of overseeing university relations, personal budget, administration, outreach events, alumni and community relations. Apart from that, my other roles are crew chief, or cleared EMT-B and field training officer. As the crew chief, I am responsible for crew safety and all of patient care during medical emergencies. As a field training officer, I am responsible for overseeing all of the training that takes place for the EMT-Bs on site and evaluating their performance on medical emergencies.
Kevin: And my name is Kevin Quintero and my title is First Assistant Chief of Operations. I am responsible in the clearing process for anyone in our organization to become a cleared lead technician for emergency calls.
Srishti: Why did you choose to get involved in this type of agency? How long have you been working with SBVAC?
Nikhil: I wanted to get involved with SBVAC because I thought it was amazing as someone as young as me at the time, a freshman starting his undergraduate career, could be held accountable for patient care during a medical emergency. Ultimately, my personal career goal is to become a doctor and being involved in SBVAC seemed like an incredible way to get hands on patient care experience. I have been involved with SBVAC for about four years now, I joined during the first fall semester of my freshman year. I have currently run over 300 medical alarms and spent over 2,000 hours in emergency medical services (EMS).
Kevin: I got involved towards the spring semester of my freshman year. The reason why I wanted to get involved in something like SBVAC was because at the time I wasn’t involved in many extracurriculars on campus. At the time, I was a biology major, on the pre-med track. I wanted to expand my horizons, I was seeking what medicine was like outside of what I thought it was. SBVAC gave me an opportunity to see what that was like.
Srishti: What is a typical day for you on duty? What is a typical type of call that you get on a regular basis?
Nikhil: On a typical day, I arrive for my shift and one of the things we always do at the start of the shift is we do rig check. Essentially, rig check is when we go through an ambulance vehicle and check if all the equipment we need is onboard; if any medication is expired, if the batteries for machines are up and running or if the oxygen tank is filled. After the ambulances have been checked, we go back to our headquarters and wait for a medical alarm to go off. In terms of a typical call that we get, a medical alarm could be anything like a car crash or a patient has fallen down somewhere, or something simple as a stomach ache. Who knows? Could be a respiratory difficulty, or cardiac problems. It really could be anything. Just off the top of my head, a typical call we might get on the grounds of Stony Brook University could be an ankle sprain over at the recreation center. That’s generally a simple call that we may get. We get alerted a traumatic injury has taken place where we are connected through hearing it from our radio and see it on our phones. I see that we have a medical emergency and grab all the bags that we need. We have a blue bag that includes oxygen tanks and non-rebreather masks (NRBs, typically used with low levels of oxygen in the blood). We come prepared to every medical emergency because we don’t know what we’re going to see until we reach the medical emergency. So, we get to the call, treat the patient, and see if it’s necessary for the patient to be taken to the hospital or not.
Kevin: A regular and typical call on campus tends to vary a lot. Sometimes, we don’t get any calls at all. Just like Nikhil said, we tend to get injuries from the recreation center and during the winter season, people tend to get into accidents where they have slipped on ice. The pandemic has also contributed to the types of calls that we get. There are less people living on campus than normal. Therefore, it varies on the kind of calls we get each day. However, a decent amount of mental health emergencies come in.
Srishti: Aside from the physical medical emergencies you may receive, do you often get emergencies that are defined as a mental health emergency?
Nikhil: Absolutely. We definitely get mental health emergencies quite frequently I would say. Typically, I find that mental health emergencies happen more often in the beginning and middle of the semester. That’s when we usually see peaks in mental health emergency cases. I would say that we get mental health emergencies on campus more frequently than off campus which is where I also work as an EMT.
Srishti: So, what are the kinds of mental health emergencies that you get?
Nikhil: This can range from many different things that we regularly see, you know. This could be a Stony Brook student who is extremely anxious for various reasons like school is starting again for them and are having trouble breathing. Or someone who has not been taking their medication. An example I could say is an 18 year old who just started their college career and started drinking. We usually find that young adults who haven’t drank before and are experiencing mental health symptoms are not usually a good mix.
Kevin: What I have noticed the most in mental health emergency calls is anxiety. Many people are a bit apprehensive about going to the hospital, especially during the pandemic. I think when people’s mental health is not looked after, it can manifest into physical symptoms.
Srishti: I think for many people who hear the word “emergency,” they often think of something physical, where someone has had an accident resulting in rapid EMS response. Nikhil and Kevin, what’s your take on this?
Nikhil: Yeah, I certainly agree with that. Usually, when you’re thinking about an ambulance, someone might be thinking about a car crash. I think that is a small subset of what we do. When I think about it, there are so many different medical issues that can arise from a medical alarm. In regards to a patient, the issues could be pertaining to cardiac, respiratory issues, or currently in our communities, a common issue with COVID-19. We do tend to treat regular cardiac and respiratory cases, even delivering babies before we get to the hospital because that is what we see. However, it’s so much more than that. I’d like people to know that above all that, we also treat mental health emergencies.
Srishti: That’s a great response. I think there is a stigmatized view on mental health emergencies and a patient’s mental health rights. The center of our topic: Do you think people are unaware of their mental health rights? If yes, how so?
Nikhil: I completely agree with that. I definitely think people are unaware of their mental health rights, and in general the kinds of rights they have when an ambulance shows up. People tend to assume when an ambulance arrives, “I have to go to the hospital immediately.”. However, that is not always the case as we have mental capacity assessments which include four different kinds of questions we ask. If the patient’s mental capacity is cleared, it is up to the patient whether they would like to go to the hospital or not. I don’t think a lot of people really know that or understand that. Some people are unaware of refusal of medical attention, better known as RMA. If a patient does not want to listen to my recommendations during a medical emergency, they are more than welcome to talk to a doctor on what is best fit for the situation. I am not shocked that people are unaware of their mental health rights, I mean I was certainly unaware of these rights before I was an EMT.
Kevin: I think the general views on mental health in our society are quite skewed. People need to be more educated and better informed behind the issues of mental health. However, I have become hopeful because I have noticed that students on campus have more of an open mindset in learning about mental health than before. I think mental health is much more accepted and recognized on campus than most other places. So to answer your question, in my experience, when there has been a mental health emergency, the person who called the ambulance is typically not the patient themselves. It might have been the patient’s roommate in a dorm that they share or a close family member. I think the presence of law enforcement and the entirety of EMS can be a bit jarring for a patient at first. I don’t think people are aware of their mental health rights at the time of the emergency call, I think people assume we will immediately take them away to a hospital. That’s not usually the case.
Srishti: Nikhil, can you please elaborate on the four questions you ask during a mental capacity assessment?
Nikhil: So, the questions we ask when we assess a patient’s mental capacity are “Where are you right now? Who is the president? What time of day is it? What happened?” If the patient clears all of these questions, we call it A&O x 4, which means alert and oriented times four, the patient was able to answer all four of those questions. If they miss one of the questions asked, we consider that to be AMS, meaning altered mental status. Of course, that comes with it’s caveats. If we are comparing a 20 year old patient and an 80 year old patient who was diagnosed with Alzeimer’s, when we ask what time of day it is, we could be concerned if the younger patient was unable to tell the time of day than in regards to the much older patient. The older patient would be considered baseline AMS.
Srishti: How would you define mental health rights? What are the limitations to these rights?
Nikhil: Yeah, you know people with mental health conditions do have the right to make decisions about their lives, which includes their treatment. But, if they present that they are a danger to themselves or to others, and they have an altered mental status, this is where I come in as a medical professional to make that decision for them. That decision will be to take the patient to the hospital. A limitation could be if the patient does not answer those questions, which could be in a case scenario they are inebriated or consumed substances such as illicit drugs that have altered their mental status. Or the patient has suffered a head injury, or related cranial trauma which leads to a situation where the patient is unable to answer those questions. In a situation where the patient is assessed as a danger to themselves, which could be when they have physically intended to harm themselves or others, the patient does not have the right to make a medical decision. A patient like this may not have the mental capacity to make a safe and correct decision upon their medical care. In that case, the decision would be made by me, which would ultimately take the patient to the hospital.
Srishti: What happens when the patient is a harm to themselves or others and refuses to be taken to the hospital?
Nikhil: I think in a situation like this where I have been in many times, it is definitely hard on us EMTs and one of the toughest medical calls we take. This type of medical call could have been sent from a friend or family member of the patient who is really concerned for the patient’s mental status. For me, it is a very difficult situation where the patient does not want to be taken to the hospital. A few things I have learned over the years are to set them aside and ask them genuinely why they do not want to go to the hospital, what do they think is the best option for them right now, and let’s try to talk about this together. I will then try to bring in a new face from my crew and let them talk to the patient. If all else fails, we do involve the police department where we might possibly have to restrain the patient if they become combative and we assess from there.
Srishti: From my point of view, I think people are often nervous or scared of judgment to be seen as a mental health emergency. People who are suffering from mental illness may wait until it is too late to ask for help. What can you say to those who feel like this as a first responder?
Nikhil: What bothers me the most in terms of assessing mental health emergencies is the lack of training we get for situations like this. Like I said before, these are typically the hardest medical emergencies we can get. No one trains you on how to handle situations like these or even how to talk to the patient who is suffering from a mental illness. I think it is so important for people to be aware of mental health so they are educated on what to do next if they need to seek out help before an emergency happens where they are unable to help themselves. People should know prevention guidelines in regards to mental health so we could avoid these kinds of scenarios for the well-being of others. I think that is the key. I think there should be a stronger requirement to teach providers on exactly how to aid a patient during mental health emergencies. It is critical that we know how to talk to the patient so we can help them to the best of our ability. It is important that agencies like us actively have training sessions and events to better inform us health care responders about how to handle mental health emergencies. Our agency currently just had a conversational session with the Director of Counseling and Psychological Services, CAPS who had delivered an accompanied training in handling mental health emergencies.
Srisht: Nikhil, I think you really bring up an informative point in terms of health care responders and the missing gaps in mental health training. It is a shame yet common for people working in the healthcare field to lack the proper training and information on handling mental care situations. I think this is a point that needs to be seen more often and not something that should be left out for its poor significance. My question to you and Kevin, what is something you have learned about mental health from taking emergency calls in your experience?
Nikhil: Something I have learned is mental health emergencies do not present themselves as much. It is often hard to detect that a mental health emergency is the primary reason for the medical call. It could be a scenario where someone had been drinking and accidentally fell and their mental health history is overlooked where the patient was experiencing forms of depression and anxiety, which had led them to be inebriated. It is not that easy to be on the site of a medical call and immediately tell that we are dealing with a mental care emergency. Something else I have learned is to never assume anything about a patient and to always get the full story of why the patient is in our care.
Kevin: I think what is so special about mental health is that in order to get medical attention and seek help is that it requires human interaction. I don’t think first responders get a lot of training for mental health emergencies, it’s something you learn on the field. It is not easy to pick up cues from patients who are psychosomatic, individuals experiencing physical symptoms caused by mental health factors or an internal conflict. I think an important part of doing my job is to realize when to be human and get the patient to be comfortable with you so we can get them the proper medical attention that they need. My job is to be the patient’s advocate and I want people to know they shouldn’t be scared or afraid to get help from EMS.
Srishti: Would you agree there are moments of desentization with the responsibilities that you guys hold on a daily basis? Do you think it’s taken a toll on you from all the patient care you have handled so far in your experience?
Nikhil: I don’t think I have experienced feeling desensitized to what my job holds for me, but I think it is very easy for that to happen. I think it is important that if you are feeling desensitized, to talk about it with others in your crew. When I am on duty, I tend to put the patient’s needs before my own because they are what comes first. After we are done for the day, I always try and have an open discussion with my crew, especially our newer members if they’re doing okay with all the emergencies we handled for that day. I always want to talk to them about it and see how they felt about the medical calls we picked up. It actually helps me feel better knowing that I am not alone in how I feel and my crewmates are doing okay!
Kevin: I think there are definitely moments where someone in my shoes can get desensitized from the emergency calls we can get. I’d be lying if I said there hasn’t been a time where I felt like that. I think that every call needs to be taken seriously. If there is a period of time where every call feels mundane, I think it’s important to take a step back and realize there is a patient in front of you who may be having the worst day of their life. Someone calling EMS is not used to what I do everyday. There needs to be moderation in that people who are first responders need to get used to their jobs and take lots of emergency calls in order to assess patients properly, but also be aware to not dehumanize them and treat them accordingly.
Srishti: Any final thoughts you would like to share?
Nikhil: I think I would like to say in the current situation that we are in with regards to surviving the pandemic, people are often at home and maybe glued to their phones and computers. I have noticed that mental health emergencies are on the rise and it is common that people are feeling isolated. I hope people can be aware to seek out help when needed and to not be afraid of receiving help.
Kevin: Mental health emergencies happen more than most people think. Mental health is a side of medicine that we don’t always get to talk about. I would like to say people definitely need to talk about mental health more, just opening up a dialogue about it and seeing what comes from it. I think it will contribute to taking the stigma away from mental health, allowing people to be more comfortable talking about it.