Behavioral Emergencies CHAPTER 23 1

Behavior 1

Behavioral emergency: Abnormal behavior in a situation that results in potential harm to oneself or others. Behavior that is unacceptable or intolerable to self, family members or community. 1

Behavioral Changes 1

Conditions that Alter Behavior Situational stresses Medical illnesses Illegal and legal drugs/alcohol Diabetics with low blood sugar Hypoxia and poor cerebral blood flow Excessive heat or cold Head injury 1

Alcohol can produce obvious changes in behavior. 1

Geriatric patients may be at more risk for behavioral emergencies. 1

Organic brain syndrome: A condition caused by a disturbance of physiologic functioning of brain tissue. More common in elderly patients. 1

Psychological Crises 1

Psychotic: Refers to behavior by a person who has lost touch with reality. Mental illness may produce psychotic thinking. 1

Types of Psychoses Paranoia Mania Depression May be unreasonably afraid of malicious intentions or acts of others Mania May be very agitated, moving and speaking rapidly without producing clear or complete sentences Depression May not want to move or answer questions 1

Types of Psychoses continued Phobia Acute anxiety Disorientation Disorganization 1

Suicidal Gestures 1

Risk Factors of Suicide Patient more than 40 years of age, widowed or divorced, alcoholic or depressed Patient who has talked about taking their own life Patient with a previous history of self-destructive behavior Patient with a recently diagnosed serious illness 1

Risk Factors of Suicide continued Patient in an environment where there is an unusual gathering of destructive articles (e.g., guns or many pills) Patient who has recently lost a loved one Patient who has recently been arrested or imprisoned Patient who has recently lost a job 1

Suicide can be devastating for the family and friends of the victim. 1

Assessment and Emergency Care Scene Size-up 1

If the scene is unsafe, stay out and... …contact law enforcement. 10

Signs of Potential Violence Sitting on edge of seat, as if ready to move Clenched fists Yelling and using profanity Standing or moving toward EMT Throwing things Holding a potentially dangerous object Any behavior that makes the EMT uneasy 1

Never allow participants in a dispute to get between you and the exit route. 10

If you feel the situation may get out of control, call for assistance. 10

Obtain information from bystanders about the patient’s behavior prior to EMS arrival. 10

Domestic disputes often erupt in violence. 10

Caution: Any object near the patient can be dangerous! 1

Communication and Emergency Medical Care 1

Assess how the patient actually feels, and determine if they are exhibiting suicidal tendencies. 1

Questions to Ask the Patient What is your name, the date, your address? How do you feel? Would you like some help with your problem? Do you have a history of heart disease, diabetes, etc.? 1

Observe the patient’s: Appearance Activity Speech Orientation to time, person and place 1

Document any abuse observed, or reasons for suspecting abuse. If you suspect spouse or child abuse, contact law enforcement. Document any abuse observed, or reasons for suspecting abuse. 1

Calming the Patient 1

Keeping the Patient Calm Ask questions in a calm and reassuring manner Do not be judgmental Repeat the patient’s answers to show you are listening Remain a comfortable distance away Use good eye contact Don’t make sudden movements 1

Restraints 1

Document patient’s condition before and after applying restraints. Follow local protocols and laws regarding restraints. Document patient’s condition before and after applying restraints. 1

Restraining a Patient Have adequate help, including law enforcement Have a plan of action Use only necessary force Stay beyond patient’s range of motion Act quickly Talk to the patient Work with other EMS personnel, deciding in advance how each will restrain a limb, and approach together 1

Restraining a Patient continued Secure limbs with approved equipment It may be necessary to turn patient face down on stretcher The patient’s face may be covered with a surgical or O2 mask if they are spitting or biting Reassess the situation frequently, including vitals and physical status Document your and the patient’s actions 1

Soft Restraint 1

A patient with leather restraints. 10

Restraining a Patient Approach from behind, pull arms back, and bend at waist. 1

Restraining a Patient continued The patient may be placed prone with restraints. 11

Restraining a Patient continued The patient may be placed supine with restraints. 11

Medical and Legal Considerations Consent 1

If an emotionally disturbed patient consents to treatment and transport, decisions are more easily made, and legal problems possibly avoided. 1

Resistance to Treatment 1

Follow local protocols regarding patients who refuse treatment. You may need to decide if a patient is mentally able to make an informed decision. Follow local protocols regarding patients who refuse treatment. 1

If you are unsure of the mental capabilities of the patient, you should treat and transport. 1

Use of Force 1

Avoid physical force that may cause harm to the patient. Use only enough force to keep patients from injuring themselves or others. Avoid physical force that may cause harm to the patient. 1

Reasonable force depends upon: Patient’s size and strength Type of abnormal behavior exhibited by patient Gender of patient Mental status of patient Method of restraint used 1

Documentation 1

Behavioral Documentation Position in which patient was found Aggressive or abnormal action produced by patient Anything unusual the patient says All aspects of assessment and findings (in detail) Restraining procedures used Names of persons assisting or witnessing treatment and transport 1

SUMMARY Behavior Assessment and Emergency Care Medical and Legal Considerations SUMMARY 1