Behavioral Behavioral EmergenciesEmergencies

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BehaviorBehaviorBehaviorBehavior

Behavioral emergency:Behavioral emergency:

Abnormal behavior in a Abnormal behavior in a situation that results in situation that results in potential harm to oneself or potential harm to oneself or others.others.

Behavior that is unacceptable or intolerable to self, family members or community.

Behavioral Behavioral ChangesChanges

Behavioral Behavioral ChangesChanges

Conditions that Alter Behavior Conditions that Alter Behavior

Situational stressesSituational stresses

Medical illnessesMedical illnesses

Illegal and legal drugs/alcoholIllegal and legal drugs/alcohol

Diabetics with low blood sugarDiabetics with low blood sugar

Hypoxia and poor cerebral blood flowHypoxia and poor cerebral blood flow

Excessive heat or coldExcessive heat or cold

Head injuryHead injury

Alcohol can produce obvious changes in behavior.

Geriatric patients may be at more risk for behavioral emergencies.

Organic brain syndrome:Organic brain syndrome:

A condition caused by a A condition caused by a disturbance of physiologic disturbance of physiologic functioning of brain tissue.functioning of brain tissue.

More common in elderly patients.

Psychological Psychological CrisesCrises

Psychological Psychological CrisesCrises

Psychotic:Psychotic:

Refers to behavior by a person Refers to behavior by a person who has lost touch with reality.who has lost touch with reality.

Mental illness may produce psychotic thinking.

Types of Psychoses Types of Psychoses ParanoiaParanoia

May be unreasonably afraid of malicious intentions or acts of othersMay be unreasonably afraid of malicious intentions or acts of others

ManiaMania May be very agitated, moving and speaking rapidly without producing clear or complete sentencesMay be very agitated, moving and speaking rapidly without producing clear or complete sentences

DepressionDepression May not want to move or answer questionsMay not want to move or answer questions

Types of Psychoses continued Types of Psychoses continued PhobiaPhobia

Acute anxietyAcute anxiety

DisorientationDisorientation

DisorganizationDisorganization

Suicidal Suicidal GesturesGesturesSuicidal Suicidal GesturesGestures

Risk Factors of Suicide Risk Factors of Suicide

Patient more than 40 years of age, widowed or divorced, alcoholic or depressedPatient more than 40 years of age, widowed or divorced, alcoholic or depressed

Patient who has talked about taking Patient who has talked about taking their own lifetheir own life

Patient with a previous history of Patient with a previous history of self-destructive behaviorself-destructive behavior

Patient with a recently diagnosed Patient with a recently diagnosed serious illnessserious illness

Risk Factors of Suicide continued Risk Factors of Suicide continued

Patient in an environment where there is an unusual gathering of destructive Patient in an environment where there is an unusual gathering of destructive articles articles (e.g., guns or many pills)(e.g., guns or many pills)

Patient who has recently lost a loved onePatient who has recently lost a loved one

Patient who has recently been arrested or imprisonedPatient who has recently been arrested or imprisoned

Patient who has recently lost a jobPatient who has recently lost a job

Suicide can be devastating for the family and friends of the victim.

Assessment and Assessment and Emergency CareEmergency CareAssessment and Assessment and Emergency CareEmergency Care

Scene Size-upScene Size-up

If the scene is unsafe, If the scene is unsafe, stay outstay out and... and...

……contact law enforcement.contact law enforcement.

Signs of Potential Violence Signs of Potential Violence

Sitting on edge of seat, as if ready to moveSitting on edge of seat, as if ready to move

Clenched fistsClenched fists

Yelling and using profanityYelling and using profanity

Standing or moving toward EMTStanding or moving toward EMT

Throwing thingsThrowing things

Holding a potentially dangerous objectHolding a potentially dangerous object

Any behavior that makes the EMT uneasyAny behavior that makes the EMT uneasy

Never allow participants in a Never allow participants in a dispute to get between you and dispute to get between you and the exit route. the exit route.

If you feel the situation If you feel the situation may get out of control, may get out of control, call call for assistance.for assistance.

Obtain information from bystanders Obtain information from bystanders

about the patient’s behavior prior to about the patient’s behavior prior to

EMS arrival.EMS arrival.

Domestic disputesDomestic disputes often often erupt erupt in violence.in violence.

Caution:Caution:Any object Any object

near the near the

patient can patient can

be be

dangerous!dangerous!

Communication and Communication and Emergency Medical Emergency Medical

CareCare

Communication and Communication and Emergency Medical Emergency Medical

CareCare

Assess how the patient

actually feels, and

determine if they are

exhibiting suicidal

tendencies.

Questions to Ask the Patient Questions to Ask the Patient

What is your name, the date, What is your name, the date, your address?your address?

How do you feel?How do you feel?

Would you like some help with your problem?Would you like some help with your problem?

Do you have a history of heart disease, diabetes, etc.?Do you have a history of heart disease, diabetes, etc.?

Observe the patient’s: Observe the patient’s: AppearanceAppearance

ActivityActivity

SpeechSpeech

Orientation to time, person and placeOrientation to time, person and place

If you suspect spouse If you suspect spouse or child abuse, contact or child abuse, contact law enforcement. law enforcement.

Document any abuse observed, Document any abuse observed, or reasons for suspecting or reasons for suspecting

abuse.abuse.

Document any abuse observed, Document any abuse observed, or reasons for suspecting or reasons for suspecting

abuse.abuse.

Calming the PatientCalming the PatientCalming the PatientCalming the Patient

Keeping the Patient Calm Keeping the Patient Calm

Ask questions in a calm and reassuring mannerAsk questions in a calm and reassuring manner

Do not be judgmentalDo not be judgmental

Repeat the patient’s answers to show you are listeningRepeat the patient’s answers to show you are listening

Remain a comfortable distance awayRemain a comfortable distance away

Use good eye contactUse good eye contact

Don’t make sudden movementsDon’t make sudden movements

RestraintsRestraintsRestraintsRestraints

Follow local protocols Follow local protocols and laws regarding and laws regarding restraints. restraints.

Document patient’s condition Document patient’s condition beforebefore and after and after applyingapplying

restraints.restraints.

Document patient’s condition Document patient’s condition beforebefore and after and after applyingapplying

restraints.restraints.

Restraining a Patient Restraining a Patient Have adequate help, including law enforcementHave adequate help, including law enforcement Have a plan of actionHave a plan of action Use only necessary forceUse only necessary force Stay beyond patient’s range of motionStay beyond patient’s range of motion Act quicklyAct quickly Talk to the patientTalk to the patient Work with other EMS personnel, deciding in advance how each will restrain a limb, and approach togetherWork with other EMS personnel, deciding in advance how each will restrain a limb, and approach together

Restraining a Patient continued Restraining a Patient continued

Secure limbs with approved equipmentSecure limbs with approved equipment It may be necessary to turn patient face down on stretcherIt may be necessary to turn patient face down on stretcher

The patient’s face may be covered with a surgical or OThe patient’s face may be covered with a surgical or O22 mask if they are spitting or biting mask if they are spitting or biting

Reassess the situation frequently, including vitals and physical statusReassess the situation frequently, including vitals and physical status Document your and the patient’s actionsDocument your and the patient’s actions

Soft Restraint

A patient A patient

with with leather leather

restraints.restraints.

Restraining a Patient

Approach from behind, Approach from behind, pull arms back, and pull arms back, and bend at waist.bend at waist.

Approach from behind, Approach from behind, pull arms back, and pull arms back, and bend at waist.bend at waist.

Restraining a Patient continued

The patient may be The patient may be placed prone with placed prone with restraints.restraints.

The patient may be The patient may be placed prone with placed prone with restraints.restraints.

Restraining a Patient continued

The patient may be The patient may be placed supine with placed supine with restraints.restraints.

The patient may be The patient may be placed supine with placed supine with restraints.restraints.

Medical and Legal Medical and Legal ConsiderationsConsiderationsMedical and Legal Medical and Legal ConsiderationsConsiderations

ConsentConsent

If an emotionally disturbed

patient consents to

treatment and transport,

decisions are more easily

made, and legal problems

possibly avoided.

Resistance to Resistance to TreatmentTreatment

Resistance to Resistance to TreatmentTreatment

You may need to decide if You may need to decide if a patient is mentally able a patient is mentally able to make an informed to make an informed decision. decision.

Follow local protocols regarding Follow local protocols regarding patients who refuse treatment.patients who refuse treatment.

Follow local protocols regarding Follow local protocols regarding patients who refuse treatment.patients who refuse treatment.

If you are unsure of the

mental capabilities of the

patient, you should treat

and transport.

Use of ForceUse of ForceUse of ForceUse of Force

Use only enough force to Use only enough force to

keep patients from injuring keep patients from injuring

themselves or others. themselves or others.

Avoid physical force that Avoid physical force that may cause harm to the may cause harm to the

patient.patient.

Avoid physical force that Avoid physical force that may cause harm to the may cause harm to the

patient.patient.

Reasonable force depends upon: Reasonable force depends upon:

Patient’s size and strengthPatient’s size and strength

Type of abnormal behavior exhibited by patientType of abnormal behavior exhibited by patient

Gender of patientGender of patient

Mental status of patientMental status of patient

Method of restraint usedMethod of restraint used

DocumentationDocumentationDocumentationDocumentation

Behavioral Documentation Behavioral Documentation

Position in which patient was foundPosition in which patient was found

Aggressive or abnormal action produced by patientAggressive or abnormal action produced by patient

Anything unusual the patient saysAnything unusual the patient says

All aspects of assessment and findings All aspects of assessment and findings (in detail)(in detail)

Restraining procedures usedRestraining procedures used

Names of persons assisting or witnessing treatment and transportNames of persons assisting or witnessing treatment and transport

SU

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Assessment and Emergency CareAssessment and Emergency Care

Medical and Legal ConsiderationsMedical and Legal Considerations