Behavioral Emergencies

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Chapter 23. Behavioral Emergencies. Case History. You arrive at the scene of a disturbance. You find a 30-year-old male throwing articles out the window of the house. He is screaming that everyone is out to get him and he tells you that he will not let anyone touch him. - PowerPoint PPT Presentation

Transcript of Behavioral Emergencies

Mosby’s EMT-Basic TextbookSlide *
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Behavioral Emergencies
Chapter 23
Slide *
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Case History
You arrive at the scene of a disturbance. You find a 30-year-old male throwing articles out the window of the house. He is screaming that everyone is out to get him and he tells you that he will not let anyone touch him.
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Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Behavioral Emergency
Definition:
An occurrence in which the patient exhibits abnormal behavior within a given situation that is unacceptable or intolerable to the patient, family, or community
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Scope of the Problem
Depression is often underemphasized in EMS.
Depression is present in at least 11% of population in U.S.
20% of adults experience at least one episode of clinical depression.
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Depression and Suicide
Symptoms of depression
Sad, tearful
Physical symptoms
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Suicide –
Young person attempts suicide every 90 seconds.
Successful suicide every 90 minutes
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Suicide –
Recent loss of significant loved one
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Suicide –
Lethal plan of action that has been verbalized
Gathering of articles that can cause death
Gun
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Suicide –
Displaying self-destructive behavior?
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Suicide – Important Questions
If so, what interventions have occurred?
Is patient a threat to self or others?
Is there a medical problem?
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Emergency Medical Care
Perform scene size-up.
Conduct patient assessment.
Calm the patient.
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Emergency Medical Care
Restrain, if necessary.
Transport.
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Behavioral Change
Situational stresses
Medical illnesses
Psychiatric problems
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Common Factors
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Common Factors
Mind-altering substances
Excessive cold
Excessive heat
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Situational Reactions
Panic
Agitation
Anger
Anxiety
Paranoia
Denial
Withdrawal
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Personality Disorders
Definition: Character traits that interfere with a person’s ability to function successfully in work or personal relationships
Patient can be manipulative and self-focused.
Avoid getting angry with the patient.
Be positive but establish limits.
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Psychosis
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Organic Brain Syndrome
Tumor
Trauma
Infection
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Scene Size-up
Can present a serious threat to EMT safety
Try to identify potential causes of presenting problem.
Aggressive or bizarre behavior
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Scene Safety
Be aware of potential dangers
If notified of a violent patient, wait for police before entering scene.
First priority is prevention of further injuries.
Environmental dangers may exist.
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Violent Behavior
Do not put yourself in jeopardy.
Assess what can be done to avoid outburst.
Leave yourself an escape route.
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Signs of a
Potentially Violent Patient
Drug intoxication
Situational frustration
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Principles for Assessing Behavioral Emergency
Identify yourself.
Inform the patient of what you are doing.
Ask questions in a calm, reassuring voice .
Allow the patient to tell what happened.
Do not be judgmental.
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Principles of Assessing Behavioral Emergency
Rephrase or repeat to confirm communication.
Acknowledge the patient’s feelings.
Assess the patient's mental status.
Appearance
Activity
Speech
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Assessment of
Potential Violence
Scene size-up
Known history of aggression or combativeness?
Posture
Stands or sits in a position which threatens self or others
Fists clinched or lethal objects in hands
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Assessment of
Potential Violence
Vocal activity
Physical activity
Has quick, irregular movements
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Methods to Calm Behavioral Emergency Patients
Acknowledge that the person seems upset.
Restate that you are there to help.
Inform the patient of what you are doing.
Ask questions in a calm, reassuring voice.
Maintain a comfortable distance.
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Methods to Calm Behavioral Emergency Patients
Do not make quick moves.
Respond honestly to patient's questions.
Do not threaten, challenge, or argue.
Tell the truth.
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Methods to Calm Behavioral Emergency Patients
Involve trusted family members or friends.
Be prepared to stay at scene for a long time.
Always remain with the patient.
Avoid unnecessary physical contact.
Maintain good eye contact.
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Medicolegal Considerations
Management of emotionally or mentally disturbed patient presents high legal risk.
When emotionally disturbed patients consent to care, legal problems are greatly reduced.
Patient will often resist treatment.
Patient may threaten EMT-Basics and others.
To provide care against patient's will, you must show a reasonable belief patient would harm self or others.
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If Patient Resists Treatment
If a threat to self or others, may be transported without consent.
Contact medical direction.
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Reasonable Force
Action necessary to keep patient from injuring self or others
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Determining
Type of abnormal behavior
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Using Force
Calm patients may cause unexpected and sudden injury to self and others.
EMS personnel may use reasonable force to defend against an attack.
Avoid acts or physical force that may cause injury to the patient.
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Police and Medical Direction
Seek medical direction when considering restraining a patient.
Ask for police assistance, if during scene size-up the patient appears or acts aggressive or combative.
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Accusations
Witnesses in attendance, especially during transport
Accusations of sexual misconduct are common.
Same-sex attendants and third-party witnesses can prove beneficial.
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Restraining Patients
Avoid restraints, if possible.
Use only when patient is a danger to self or others.
Have police present.
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Restraining Patients
Plan your activities.
Estimate range of motion of patient’s arms and legs.
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Restraint Technique
Act quickly.
Approach with four persons.
One assigned to each limb, all at the same time
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Restraint Technique
Turn patient face up on stretcher.
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Restraint Technique
Cover patient’s face with surgical mask if spitting.
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Restraining Technique
Avoid unnecessary force.
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Other Behavioral Problems –
Do not belittle or threaten patients.
Be calm and tolerant in your attitude.
Do not agree with disturbed thinking.
Be reassuring.
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Other Behavioral Problems –
Lower distressing stimuli.