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Chapter 23Behavioral Emergencies

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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.)

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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

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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.

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Altered Behavior

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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

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Behavioral Emergency

Abnormal behavior within a given situation that is unacceptable or intolerable to the patient, the family, or the community

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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

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Causes of Altered Behavior

Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ

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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

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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

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Patient Assessment

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Patient Assessment

Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ

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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

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Patient Care

Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ

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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

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Potential or Attempted Suicide Factors

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Patient Care

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Patient Care

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Aggressive or Hostile Patients

?

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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

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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

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Patient Care—Aggressive Patient

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Determined by:– Circumstances involved

– Patient’s strength and size

– Type of abnormal behavior

– Mental status

– Available methods of restraints

Reasonable Force and Restraint

(cont.)

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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

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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

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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.)

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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

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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!

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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

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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

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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

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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.)

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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

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Sample Documentation