Post on 20-May-2015
description
Affordable Realistic Tactical Training
Presented by:Presented by: Jerry StatonJerry Staton
Affordable Realistic Tactical TrainingAffordable Realistic Tactical TrainingSenior Master TASER InstructorSenior Master TASER Instructor
In-custody Death SpecialistIn-custody Death Specialist
What first responders need to knowWhat first responders need to know
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Distinguish between Excited Delirium & mental illness
Provide best care for the patient
Minimize risk and liability to all firstresponders (police, fire, EMS)
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ED is a Medical Emergency
Police – Contain, Capture, Control, & Restrain
Medics - Sedate, Treat, & Transport
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A label for any person displaying a specific set of behaviors or traits
which puts them at an increased risk for dying while in your care.
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MetabolicInfectious
PharmacologicalPsychological
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Phase I: Hyperthermia (not always)
Phase II: Delirium (incoherent)
Phase III: Respiratory ArrestPhase IV: Cardiac Arrest
Who Needs Training
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All first responders need to know the capabilities of the other players.
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Plaintiff’s attorneys argue Excited Delirium is not a medically recognized disease.
They are right The American College of Emergency Physicians and the AMA have recently
recognized Excited Delirium as a Condition.
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Manic Excitement
Abnormal Excitement
Psychomotor Excitement
Psychomotor Agitation
Agitation
Delirium
Delirium, Mixed Origin
Delirium, Drug-Induced
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Bell’s maniaDelirium graveAcute delirium
Excited catatoniaLethal catatonia
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SuddenSudden
UnintendedUnintended
UnexplainableUnexplainable
Negative autopsyNegative autopsy
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Sudden Deaths in the U.S.
1849 Dr. Bell, 40 patients / 30 deaths 1881 Term ED in medical literature1849-1947 Similar reports of SD1948-1960 No SD reports (sedation)1960-1980 SD reports reappear 1980s Drastic increase in SD (cocaine)
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Indicators for ED are similar to ones exhibited by a mentally ill person or an overdose
Medical Emergency
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91 to 99% maleBetween the ages of 35-44 Usually involved in a struggleOften follows bizarre behavior The long-term use of illegal drugsMental issues (bipolar & schizophrenia)
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NakedRunning wildly
Running in trafficOften demonstrate:
Violent behaviorBizarre behavior
Aggression toward glass
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Unlimited enduranceSuperhuman strengthReduced sense of pain
Muscle rigidityViolently resist:
capture / control / restraintbefore / during / after arrest
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HallucinationsIntense paranoiaExtreme agitationEmotional changesDisoriented about:
Time/Place/Purpose
DelusionalScattered ideas Easily distractedPsychotic appearanceDescribed as:
Just snappedFlipped out
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Pressured, loud, incoherent speechScreaming for no apparent reason
Talking to imaginary peopleGrunting, guttural sounds
Irrational speech
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Pepper Spray Death
TASER Death
Hogtie Death
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Agitation & Exertion
HyperthermiaAcidosis &
Rhabdomyolysis
“TREAT THE TRIAD”
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Access
Capture
Control Restrain Sedate
Transport
Chart
Plan
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No medical research to verify sedation and/or chemical restraint is the best answerAvailable options currently in use
Valium (Diazepam)Haldol (Haloperidol)Versed (Midazolam) In use in two healthcare systemsKetamine (Ketalar) In use in two healthcare systems
Key – Administer enough to achieve sedation
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At the 2007 IPICD Conference the Miami-Dade program administratorannounced 37 incidents involving patients displaying ED symptoms
Deputy Chief J. Gardner
Zero Deaths
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Urgent and ImmediateExtra manpower needed
Crew safetyMultiple treatments (CPR)Police if transported with handcuffs
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Monitor patient (Pulse, Rate, Respirations)IV fluid administration (Normal Saline 0.09%)
ED patients typically need 20 L in first 24 hrsConsider using cooled fluids (60 degrees)
Counter Acidosis – Raise ph levelControlling ventilationAdministering Bicarb
IV Drip 50 Meq Bicarb/1000 ml NS rapid infusionMay repeat once
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Miami-Dade Fire/EMS Versed Sedation, Cooling and Bicarb
Nashville Fire/EMS Versed Sedation only
Champaign, Illinois Ketamine Sedation
Appleton, Wisconsin Haloperidol Sedation
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Patients behavior prior to and after arrival of responders (police)Capture, Control and Restraint techniques
TASER deployment and probe removalHandcuff vs Soft Restraints
Treatments and ResponseDetails, Details, Details
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Carefully review policies & proceduresLiability is important but should not be your number one priorityExcited Delirium is a MEDICAL EMERGENCYPolice and EMS need to train and work together in the management of Excited Delirium patients
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Presented by:Presented by: Jerry StatonJerry Staton
Affordable Realistic Tactical TrainingAffordable Realistic Tactical TrainingSenior Master TASER InstructorSenior Master TASER Instructor
In-custody Death SpecialistIn-custody Death Specialist