Behavioral Emergencies

Behavioral Emergencies

• Behavior• Manner in which a person acts• Physical and mental actions

• Behavioral emergency• Situation in which the pt exhibits abnormal behavior that is

unacceptable to pt, family, community. • Extremes of emotion leading to violence• Psychological or physical conditions that lead to violence

Common Causes

• AEIOU-TIPS• Situational Stress• Psychiatric problems• Alcohol/drugs• Medical illness

• Low blood sugar• Lack of O2• Inadequate blood flow to

brain• Head trauma• Excessive cold• Excessive heat

Characteristics

• Panic• Agitation• Bizarre thinking/behavior • Danger to self

• Self destructive behavior• Suicide

• Danger to others• Threatening behavior• Violence

Assessment for suicide risk

• Depression• Sad, tearful • Thoughts of death, taking ones

life• Suicidal gestures

• Individuals over 40, single, widowed, divorced, alcoholic, depressed

• Defined lethal plan of action that is verbalized

• Unusual gathering of articles that can cause death

• Previous Hx of self destructive behavior

• Recent diagnosis of serious illness

• Recent loss of loved one• Arrest, imprisonment, loss of

job

Assessment Findings

• Pt in unsafe environment• Pt has unsafe objects in

possession• Display of self destructive

behavior• Questions to think about…

• How does the pt feel.• Determine suicidal tendencies• Is pt a threat to self or others• Is there a medical problem• Interventions

Medical Legal Considerations

• Consent to treatment GREATLY reduces legal problems

• If pt refuses:• To provide care against pt

will you MUST show there is a reasonable belief the pt will harm himself or others

• Pt may be transported after contacting med control

• Usually law enforcement is needed.

• Avoid unreasonable force

Reasonable Force

• Reasonable force• Force necessary to prevent pt

from injuring self/others• Depends on

• Pt size and strength• Type of abnormal behavior• Sex of pt• Mental status• Method of restraint

• Some pt may cause unexpected injury to self/other after periods of aggression

• Avoid physical acts that will injure the pt

• EMS personnel may use reasonable force to defend against attack by an emotionally disturbed pt.

Protection from False Charges

• Consult medical direction• Ask for police assistance• DOCUMENT abnormal pt

behavior• Have witnesses in attendance

esp in transport• Have help• Same sex EMTs as pt• Witnesses• Accusing EMTs of sexual

misconduct is common by emotionally disturbed pts

Principles of Assessment

• Identify yourself• Let them know youre there to help• Inform them of what youre doing• Ask questions in a calm/reassuring voice• Allow pt to tell what happened • Don’t be judgmental• Rephrase or repeat part of what you said to show you are listening• Acknowledge the pt feelings• Assess LOC

• Appearance• Activity• Speech• Orientation to time, person, place

Assessment of Potential Violence

• Scene Size Up• Hx

• Check with family/bystanders if the pt has a Hx of aggression/violence

• Posture• Stands/sits in position that

threatens self/others• Clenched fists• Lethal objects in hands

• Vocal Activity• Yelling• Threatens harm to self/others

• Physical Activity• Moves toward caregiver• Carries heavy/threatening objects• Quick irregular movements• Tense muscles

Methods to Calm Pt

• Acknowledge they seem upset• Restate you are there to help• Inform them of what you are doing• Ask questions in calm reassuring

voice• Maintain a comfortable distance• Encourage pt to state what is

troubling• Do not make quick moves• Respond honestly to questions• Do not threaten, challenge, argue with

pt• Do not “play along” with

visual/auditory disturbances of the pt• Involve trusted family members or

friends• Be prepared to remain on scene for a

long time• Do not leave pt alone• Avoid unnecessary contact• Use good eye contact

Restraining Pt’s

• Avoid unless pt is threat to self/others

• Get med control approval• Involve the police• Be sure you have enough help• Plan activities• Use only the force needed for

restraint• Estimate range of motion of pts

legs and arms and stay outside it until ready

• Act QUICKLY

Restraining Pt’s: How to…

• Have one EMT talk to the pt throughout

• Approach with 4 people at the same time

• One for each limb• Secure limbs together with

approved equipment• Turn pt face down on stretcher• Secure to stretcher with multiple

straps• If pt spits: Cover mouth with mask• Reassess circulation often• DOCUMENT indication for and

methods of restraint• Avoid unnecessary force

And don’t forget….