1. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter 33 Behavioral Emergencies and Crisis Response

2. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 33.1 Define the following terms: a.behavior b.behavioral emergency 33.2 Compare and contrast neurosis and psychosis. 33.3 List and explain four factors that can cause stress or lead a person to behave strangely. continued

3. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 33.4 List the signs and symptoms of common behavioral emergencies. 33.5 Identify techniques to help maintain rescuer safety when responding to a behavioral emergency. 33.6 Describe and demonstrate how to assess a patient with a behavioral emergency. continued

4. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 33.7 Describe and demonstrate the treatment of a patient with a behavioral emergency. 33.8 List the indications for restraining a patient. 33.9 Describe and demonstrate how to properly restrain a patient. 33.10 List the five phases of the Kübler-Ross grieving process.

5. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Topics Case Presentation Anatomy and Physiology Common Behavioral Emergencies Death and Grief Assessment Management Chapter Summary

6. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Presentation A male in his 20s is having an anxiety attack and yelling at his sister. He is yelling threats as the patroller, appears wild-eyed, angry, and suspicious; he is clenching and unclenching his fists.

7. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Anatomy and Physiology Brain is responsible for homeostasis. Stress is a response to demands/ pressures (fight or flight) ◦ Responses occur throughout the body ◦ Some stress is normal; too much or prolonged can cause imbalance /altered mental processes and abnormal behavior. continued

8. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Anatomy and Physiology Structural abnormalities or chemical imbalances may alter perception of reality.

9. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Common Behavioral Emergencies Medical disorders: ◦ Hypoxia and hypoglycemia Chemical exposures: ◦ Alcohol and drugs Trauma: ◦ Brain injury/hypoxia Behavioral conditions: ◦ Neurosis and psychosis

10. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Behavioral Conditions Neurotic disorders: ◦ Anxiety ◦ Depression ◦ Paranoia ◦ Agitation Psychotic disorders: ◦ Schizophrenia ◦ Bipolar disorder ◦ Suicide

11. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Behavioral Conditions Copyright Craig Brown

12. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Suicide Often occurs as a reaction to severe emotional distress. Some are at greater risk. Risky behaviors may mask suicidal intentions. Patient with suicidal gestures cannot be left alone or refuse medical care.

13. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Violence and Abuse Violence ◦ Violence may be directed inward or outward, intentional or unintentional. ◦ Fight/flight response may be violent. ◦ May result from mental illness. ◦ May be neurotic or psychotic.

14. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Violence and Abuse Abuse ◦ Abuse may be verbal, physical, sexual. ◦ Is a crime – know reporting requirements

15. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Death and Grief Survivors experience varied responses – some abnormal. Rescuers also experience stress. Life saving interventions are initiated in most circumstances. continued

16. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Death and Grief Interventions may be withheld if certain signs of death or a DNR order is on record, coupled with physician input. continued

17. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Death and Grief Grief has predictable phases ◦ No time frame ◦ Some people may become stuck in a certain phase or revert to an earlier phase, especially at key times.

18. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Death and Grief Copyright Mike Halloran

19. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Posttraumatic Stress Disorder Follows exposure to a traumatic incident Can affect patient, family, rescuers May be immediate or delayed Symptoms differ person-to-person Treatment is needed

20. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Update Scene safety is important. You assure the man that you are here to help him. After obtaining his permission, you approach him. His heart rate is 105 bpm, his blood pressure is 126/72, and his respiratory rate is 32. As you begin to build trust, you learn that the patient’s brother died one year ago today. During your assessment, you learn that the patient has not eaten since last night. The physical assessment is unremarkable.

21. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Assessment Scene safety is paramount ◦ Law enforcement presence may be desirable ◦ Have escape routes in mind ◦ Assume patient is dangerous ◦ Do not approach if there is a weapon All verbalizations/actions are calm Be honest, don’t judge or confront Summon help continued

22. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Assessment Observe ABCDs and behavior, determine if patient is in reality ◦ Delay physical contact if necessary ◦ No diagnosis of underlying cause Trauma and medical history are vital ◦ Ask about medications/drugs Review S&S of behavioral emergency If patient is willing to talk, listen to content to assess mental state continued

23. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Assessment It may not be possible to assess psychotic patients – they may refuse or not give coherent answers. ◦ Questions about meds are important Suspected abuse should be reported. Normal physical exam should be made if possible.

24. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management Keep patient and rescuers safe Assume medical condition as cause Use high flow oxygen or glucose based on assessment Continue to calm and reassure Notify management/law enforcement as needed Document thoroughly

25. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Continuum of Responses

26. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Restraints Use when danger is imminent: ◦ Involve area security/law enforcement ◦ Non-law enforcement use is restricted Assess capacity of person to refuse care: ◦ Based on local protocols Methods/procedures must be established by local area

27. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Critical Incident Stress Rescuers can have PTSD: ◦ Know signs and symptoms in self and others Know how to get in touch with CISM help.

28. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Disposition He drinks some bottled drink from his backpack. He thanks you for your kindness. You and another OEC Technician accompany the patient and his sister to the top of the ridge, which is only a quarter mile away. This behavioral emergency was likely brought on by the combination of anxiety, grief, and low blood sugar.

29. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary Personal safety is the top priority when managing a behavioral emergency. A behavioral emergency exists when a person exhibits abnormal thoughts or actions. The cause of a behavioral emergency may be medical, chemical, traumatic, or psychiatric. continued

30. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary Signs and symptoms of a behavioral emergency include panic, agitation, violence, and self-destructive behavior. The five stages of grief are denial, anger, bargaining, depression, and acceptance. Calming patients is one of the most important components of managing a behavioral emergency. continued

31. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary If appropriate, call for help, including area security personal and police authorities. Always keep your cool. continued