BEHAVIORAL EMERGENCIES

Defined• Behavior: manner in which a person acts

or performs –any or all activities of a person, including physical and mental activity

• Behavioral emergency: a situation where the pt. exhibits abnormal behavior within a given situation that is unacceptable or intolerable to patient, family or community

• Key part of the definition is “within a given situation”

• Cultures with different lifestyles

• Behavioral emergencies

require patient assessment

do not judge hastily or solely on the way they look or act

Physical causes of altered behaviorMedical and trauma related:• Hypoglycemia• Lack of oxygen• Stroke• Head trauma• Mind-altering substances• Excessive cold or heat

Situational stress reactions• Unexpected stress reactions

fear, grief, anger• Personal interaction will inspire confidence

and pt. should begin to calm down and feel able to cope

• Let pt. know you are there to help• Act in a calm manner; gives pt. time to get

control of emotions

• Keep your own emotions under control

• Let pt. know you are listening and explain things honestly

• Stay alert for sudden changes in behavior

• Care; psychiatric

• Identify yourself and your role

• Speak slowly and clearly using calm and reassuring tones

• Listen

• Do not be judgmental, show compassion

do not pry

• Use positive body language

avoid crossing arms or looking uninterested

• Acknowledge the pt’s feelings

• Do not enter the pt’s personal space

• Be alert for changes in emotional status

increasingly aggressive behavior

Assessment• Perform a careful scene size-up• Identify yourself and your role• Initial assessment

mental status• Perform as much as focused or detailed as

much as possible; medical or trauma conditions• Thorough patient history

Common presentations or signs and symptoms

• Panic or anxiety

• Unusual appearance, discolored clothing, poor hygiene

• Agitated or unusual activity

• Unusual speech patterns

• Bizarre behavior or thought patterns

• Violent or aggressive behavior with threats or intents to harm others

Care• Scene safety• Treat any life-threats• Be alert for medical or trauma that could

mimic a behavioral emergency• Be prepared to spend time talking to the

patient

• Encourage the pt. to talk to you about what is troubling them

• Never play along with any visual or auditory hallucinations

• Do not lie to the pt.

• If it appears it will help, involve friends or family in the conversation

Suicide; no one is exempt

• Eight leading cause of death

• Third leading cause of death in 15 – 24 year olds

• Reached alarming levels among seniors

• Many reasons and many ways

Assessment

Factors associated with a risk for suicide

• Depression

• High current or recent stress levels

• Recent emotional trauma

• Age

• Alcohol and drug abuse

• Threats of suicide

• Suicide plan

• Previous attempts or threats

• Sudden improvement from depression

Care• Scene size-up• Treat life-threats to the extent allowed• Try to establish visual and verbal contact

as soon as possible• Avoid arguing, make no threats, show no

indication of using force• As soon as possible, perform a focused

hx. and PE and provide care

• Detailed PE only if it is safe and you suspect pt. may have an injury

• On-going assessment

• Contact E.R. keep them advised and up-to-date

• Throughout interaction speak slowly and patiently await response

Aggressive or hostile patietns

May be cause by

• Trauma to the brain or nervous system

• Metabolic disorders

• Stress

• Alcohol or other drugs

• Psychological disorders

May be alerted to pt’s condition from• Dispatch• Clues

yellingunclean conditions

• Neighbors• Family• Bystanders• Patient stance or position in a room

Take the following precautions

• Do not isolate yourself from your partner or other source of help

• Make sure you have an escape route

• Do not let the pt. come between you and the door

• Do not take any action that may be interpreted as threatening

• Always be on the watch for weapons

• Stay out of the kitchen

• Stay in safe area until the police can control the scene

• Be alert for sudden changes in behavior

Assessment

• Responds to people inappropriately

• Tries to hurt self or others

• May have rapid pulse or breathing

• Usually displays rapid speech, movements

• May appear anxious, nervous, panicky

Care

• Scene size-up

• Standard precautions

• Medical direction if behavior prevents normal assessment and care

• On-going assessment; sudden changes in behavior

Restraint