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Transcript of Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River,...
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Chapter 23Behavioral Emergencies
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
U.S. DOT Objectives Directory
U.S. DOT Objectives are covered and/or supported by the PowerPoint™ Slide Program and Notes for Emergency Care, 11th Ed. Please see the Chapter 23 correlation below.
*KNOWLEDGE AND ATTITUDE• 4-8.1 Define behavioral emergencies. Slide 8• 4-8.2 Discuss the general factors that may cause an alteration in a patient’s
behavior. Slide 9• 4-8.3 State the various reasons for psychological crises. Slide 9• 4-8.4 Discuss the characteristics of an individual’s behavior which suggest that
the patient is at risk for suicide. Slides 16-17• 4-8.5 Discuss special medical/legal considerations for managing behavioral
emergencies. Slides 25, 30• 4-8.6 Discuss the special considerations for assessing a patient with behavioral
problems. Slides 13-14• 4-8.7 Discuss the general principles of an individual’s behavior which suggest
that he is at risk for violence. Slide 20
(cont.)
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
U.S. DOT Objectives Directory
*KNOWLEDGE AND ATTITUDE
• 4-8.8 Discuss methods to calm behavioral emergency patients. Slides 10-11• 4-8.9 Explain the rationale for learning how to modify your behavior toward the
patient with a behavioral emergency. Slides 10-11
(cont.)
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
U.S. DOT Objectives Directory
*SKILLS
• 4-8.10 Demonstrate the assessment and emergency medical care of the patient experiencing a behavioral emergency.
• 4-8.11 Demonstrate various techniques to safely restrain a patient with a behavioral problem.
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Altered Behavior
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Behavior
The manner in which a person acts or performs
© Craig Jackson/In the Dark Photography
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Behavioral Emergency
Abnormal behavior within a given situation that is unacceptable or intolerable to the patient, the family, or the community
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Recognize potentially dangerous patients and act with safety.
Documentation of findings and care
Methods of calming and interacting behavioral emergencies
Restraining a patient
Identify patients experiencing behavior emergencies.
The EMT’s Role
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Causes of Altered Behavior
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Treat patient as individual.
Personal interaction inspires confidence in your ability to help.
Give the patient time to gain control of his/her emotions.
Explain things honestly.
Stay alert to sudden changes.
Situational Stress Reactions
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Identify yourself and your role.
Speak slowly and clearly.
Listen.
Don’t be judgmental.
Use positive body language.
Acknowledge the patient’s feelings.
Recognize the patient’s personal space.
General Rules—Psychiatric
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Patient Assessment
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Patient Assessment
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Panic or anxiety
Unusual appearance, disordered clothing, poor hygiene
Agitation or unusual activity
Unusual speech patterns
Bizarre behavior or thought patterns
Suicidal, violent, or aggressive behavior
Common Signs and Symptoms
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Patient Care
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Suicide
Third leading cause of death in the 15- to 24-year age groupHigh levels of depression and suicide in senior citizensReasons:– Chemical imbalance– Death of a loved one– Financial problems– End of a love affair
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Potential or Attempted Suicide Factors
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Patient Care
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Patient Care
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Aggressive or Hostile Patients
?
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Do not isolate yourself from your partner or other sources of help.
Do not take any action that may be considered threatening by the patient.
Watch for weapons.
Be alert to sudden changes in patient’s behavior.
Precautions
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Responds to people inappropriately
Tries to hurt himself or others
May have a rapid pulse and breathing
Rapid speech and physical movements
Appears anxious, nervous, or panicky
Signs and Symptoms— Aggressive Patient
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Patient Care—Aggressive Patient
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Determined by:– Circumstances involved
– Patient’s strength and size
– Type of abnormal behavior
– Mental status
– Available methods of restraints
Reasonable Force and Restraint
(cont.)
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
EMTs cannot legally restrain a patient.
Restraint is usually within the jurisdiction of law enforcement.
Police and physicians can order you to restrain and transport.
Follow local protocol.
Reasonable Force and Restraint
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Sufficient personnel
Restraints must be humane.
Handcuffs and plastic “throwaway” criminal restraints should not be used.
Use soft restraints, such as leather cuff and belts, if authorized.
Restraint
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Have adequate help.Plan your activities.Estimate range of motion of the patient’s arms and legs.Have one EMT talk to and reassure patient during procedure.Approach with a minimum of four persons.Secure all four limbs with restraints.Position the patient face up.
Guidelines—Restraints
(cont.)
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Use multiple straps or other restraints.
If patient is spitting, use surgical mask and have rescuers wear masks and eye protection.
Reassess circulation.
Avoid unnecessary force.
Document the need for restraint and technique used.
Guidelines—Restraints
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Never “hog tie” the patient or restrain in a manner that will impair breathing.
Improperly restrained patients have died as a result of “positional asphyxia.”
Transport to an appropriate medical facility.
Caution!
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Most states have a provision in the law that allows a patient to be transported against his will if he is a danger to himself or others.
Know your state laws.
Consider contacting medical direction.
Medical-Legal Considerations
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Review Questions
1. Name several conditions that can alter a person’s mental status and behavior.
2. List several methods that can help calm the patient suffering a behavioral or psychiatric emergency.
3. Describe the signs and symptoms of a behavioral or psychiatric emergency.
(cont.)
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Review Questions
4. Describe what you can do when scene size-up reveals that it is too dangerous to approach the patient.
5. List several factors that can help you assess the patient’s risk for suicide.
6. Research your state law. Then describe the circumstances that must exist for you to treat and transport a behavioral emergency patient without consent.
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
What is your first and most important concern?
How should you handle the matter of scene safety?
When should you approach the patient?
Street Scenes
(cont.)
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Street Scenes
How should the patient be approached?
What are the safety concerns when working with an agitated patient?
Does this patient need a medical assessment?
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Sample Documentation