ChapterChapter

BehavioralBehavioral

EmergenciesEmergencies

NineteenNineteen

ChapterChapter

Assessment of psychiatric presentation

Differentiation between altered mental status caused by psychiatric condition and altered mental status from medical or traumatic conditions Care for psychiatric patients Safe and effective use of restraints

NineteenNineteenCORE CONCEPTSCORE CONCEPTS

Behavioral EmergencyBehavioral Emergency

A situation in which the patient exhibits A situation in which the patient exhibits behavior that is unacceptable or intolerable behavior that is unacceptable or intolerable to the patient, family, or communityto the patient, family, or community

BehaviorBehavior

The manner in which a person actsThe manner in which a person acts

KKEY TERMSEY TERMS

Low blood sugarLow blood sugar Lack of oxygenLack of oxygen Inadequate blood flow to brainInadequate blood flow to brain Head traumaHead trauma Mind-altering substancesMind-altering substances Excessive coldExcessive cold Excessive heatExcessive heat Psychological crisesPsychological crises

Causes of Behavioral ChangeCauses of Behavioral Change

PanicPanic AgitationAgitation Bizarre thinking and behaviorBizarre thinking and behavior Danger to selfDanger to self Danger to othersDanger to others

Psychological CrisesPsychological Crises

Identify yourself and your role.

Inform patient what you are doing.

Ask questions in a calm, reassuring voice.

ActionsActionsto Taketo Take

(Continued)(Continued)

Behavioral EmergenciesBehavioral Emergencies

Do not be judgmental. Acknowledge patient’s feelings. Show you are listening by rephrasing what is said. Treat patient with respect.

ActionsActions

to Taketo Take

Behavioral EmergenciesBehavioral Emergencies

Patient Patient ASSESSMENTASSESSMENT

Behavioral EmergenciesBehavioral Emergencies

Signs and SymptomsSigns and Symptoms

Assess the patientAssess the patient ’s mental status:’s mental status:• AppearanceAppearance• ActivityActivity• SpeechSpeech• OrientationOrientation

(Continued)(Continued)

Patient Patient ASSESSMENTASSESSMENT

Behavioral EmergenciesBehavioral Emergencies

Signs and SymptomsSigns and Symptoms

Assess for potential violence:Assess for potential violence:• History of violent behaviorHistory of violent behavior• PosturingPosturing• Vocal activityVocal activity• Physical activityPhysical activity

Patient Patient CARECARE

Behavioral EmergenciesBehavioral Emergencies

Emergency Care StepsEmergency Care Steps

Maintain a comfortable distance.Maintain a comfortable distance. Encourage patient to talk.Encourage patient to talk. Do not make quick moves.Do not make quick moves. Respond honestly to questions.Respond honestly to questions.

(Continued)(Continued)

Patient Patient CARECARE

Behavioral EmergenciesBehavioral Emergencies

Emergency Care StepsEmergency Care Steps

Do not threaten, challenge, or argue.Do not threaten, challenge, or argue. Do not play along with visual orDo not play along with visual or auditory disturbances. auditory disturbances. Involve trusted family or friends.Involve trusted family or friends.

(Continued)(Continued)

Patient Patient CARECARE

Behavioral EmergenciesBehavioral Emergencies

Emergency Care StepsEmergency Care Steps

Be prepared to spend time withBe prepared to spend time with patient. patient. Avoid unnecessary physical contact.Avoid unnecessary physical contact. Use positive eye contact.Use positive eye contact. Restrain if necessary.Restrain if necessary.

Use of RestraintsUse of Restraints

Emotionally disturbed patientsEmotionally disturbed patients may refuse care. may refuse care.

For care to be provided against For care to be provided against

patient’s wishes, patient must be patient’s wishes, patient must be

harmful to self/others. harmful to self/others.

Medical-Legal Implications

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If patient is a threat to self or others,If patient is a threat to self or others, you may transport without consent. you may transport without consent.

Medical-Legal Implications

May require medical direction.May require medical direction.

Usually requires law enforcement.Usually requires law enforcement.

(Continued)(Continued)

Use of RestraintsUse of Restraints

Have adequate help.Have adequate help. Plan.Plan. Stay clear of patient until prepared.Stay clear of patient until prepared.

(Continued)(Continued)

Use of RestraintsUse of Restraints

Once decision is made — act quickly. Once decision is made — act quickly. Have one EMT-B talk patient through process.

Secure patient with approved position/materials.

(Continued)(Continued)

Use of RestraintsUse of Restraints

Use reasonable force to preventUse reasonable force to prevent patient from injuring self, others. patient from injuring self, others.

Avoid force that may injure Avoid force that may injure patient.patient.

(Continued)(Continued)

Use of RestraintsUse of Restraints

Reasonable force determined by: Reasonable force determined by:

Patient’s size and strength Type of abnormal behavior Sex of patient Mental state of patient Method of restraint

Use of RestraintsUse of Restraints

Positional AsphyxiaPositional Asphyxia

Death of a restrained patient — possibly Death of a restrained patient — possibly due to respiratory problems caused due to respiratory problems caused by restraintby restraint

KKEY TERMEY TERM

Preventing Positional Preventing Positional AsphyxiaAsphyxia• Do not use hog-tie as a hobble Do not use hog-tie as a hobble

restraint.restraint.

• Position patient face up when possible.Position patient face up when possible.

• Monitor patient carefully while Monitor patient carefully while restrained.restrained.

Reassess patient frequently.Reassess patient frequently. Document incident thoroughly:Document incident thoroughly:

• IndicationsIndications• MethodsMethods• WitnessesWitnesses

Use of RestraintsUse of Restraints

Over 40 years old; single,Over 40 years old; single, widowed, or divorced; widowed, or divorced; alcoholic; depressed alcoholic; depressed

Lethal plan of actionLethal plan of action

Possession of articles capable ofPossession of articles capable ofcausing death (gun, pills)causing death (gun, pills)

(Continued)(Continued)

Suicide Risk FactorsSuicide Risk Factors

Previous history of self-Previous history of self- destructive behavior destructive behavior

Recent diagnosis of serious illnessRecent diagnosis of serious illness

Recent loss of loved oneRecent loss of loved one

Arrest, imprisonment, loss of jobArrest, imprisonment, loss of job

Suicide Risk FactorsSuicide Risk Factors

Patient Patient ASSESSMENTASSESSMENT

Suicidal BehaviorSuicidal Behavior

Signs and SymptomsSigns and Symptoms

Size-up is important. Beware of dangers:Size-up is important. Beware of dangers:

Display of self-destructive behaviorDisplay of self-destructive behavior or thoughts or thoughts Illness or injury resulting fromIllness or injury resulting from previous attempts previous attempts

Patient Patient ASSESSMENTASSESSMENT

Breathing AdequacyBreathing Adequacy

Signs and SymptomsSigns and Symptoms

How does patient feel?How does patient feel? Suicidal tendencies?Suicidal tendencies? Is patient a threat to self/others?Is patient a threat to self/others? Is there a medical problem?Is there a medical problem?

Patient Patient CARECARE

Suicidal Behavior: Emergency Care StepsSuicidal Behavior: Emergency Care Steps

Size-up, personal safety concerns.Size-up, personal safety concerns. Perform patient assessment.Perform patient assessment. Calm the patient.Calm the patient. Do not leave patient alone.Do not leave patient alone. Restrain, if necessary.Restrain, if necessary. Consider need for law enforcement.Consider need for law enforcement. Transport.Transport.

Assessment and care of the behavioral emergency patient require a high level of caution. Experienced EMT-Bs know that anything can happen at any time. Newly certified EMT-Bs should be reminded to maintain a safe distance when managing all behavioral emergency patients. Tell them that management of the behavioral emergency takes a while, and as an EMT-B, they must be prepared to spend time with the patient. Encourage them to remember that these types of calls require that they become “patient with the patient.”

PPRECEPTOR RECEPTOR PPEARLEARL

1. List several causes for behavioral1. List several causes for behavioral change. change.2. Describe several verbal and physical2. Describe several verbal and physical methods for assessment of a methods for assessment of a behavioral emergency. behavioral emergency.3. Explain how to safely apply a restraint.3. Explain how to safely apply a restraint.

RREVIEW QUESTIONSEVIEW QUESTIONS