Chapter 17 Psychological Emergencies and Crisis Intervention

Chapter 17 Psychological Emergencies and Crisis Intervention
Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Topics Behavioral Emergencies Drug and Alcohol Emergencies
Rape and Sexual Assault Briefly review the topics with the students Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Behavioral Emergencies

Situation where the patient exhibits abnormal behavior Consider all patients to have an altered mental status Can pose a danger to self and others Can occur with medical, trauma, or psychiatric complaints Briefly review the concept of behavioral emergencies with the students Advise the students that the patient is considered to have an altered mental status, even though they may be alert and oriented to person, place, and time Warn the students that these patients may be a threat to themselves or others Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Identify yourself Keep the patient informed Remain calm Acknowledge the patient’s feelings Advise the students that they must try to calm the situation down, talking quietly with the patient, building a rapport Advise the students that they should never lie to the patient Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Patient assessment Consider law enforcement Complete a thorough scene size-up Ask family/bystanders about recent events Expect violence Advise the students that is a good idea to involve law enforcement, as the patient not willing agree to treatment Remind the students that they must complete a thorough scene size-up to evaluate the scene for potential weapons Advise the students that having law enforcement on scene also provides a witness in case the patient tries to make false claims against the first responder Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

First Responder Care Never leave the patient alone Comfort, calm, and reassure the patient Treat any medical conditions you find Warn the students that they must never allow the patient to be left alone, especially if there is a risk of the patient hurting themselves, as this will give the patient that opportunity Remind the students that, in addition to the behavioral emergency, they must also treat any medical conditions or traumatic injuries they find during their assessment Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Methods to calm patients Maintain a comfortable distance Do not make quick movements Never threaten Never lie Do not play along with hallucinations Review the methods the students may use to try to calm the patients Remind them that they must also keep a safe distance to protect themselves in case the patient becomes violent Warn the students that they should be truthful with the patient, and that they should never lie to the patient Advise the students that they should never play along with a patient’s hallucinations as the patient may feel justified and begin to act out, believing that they are sane Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Restraining patients Should only be done if the patient is a danger to self or others Use reasonable force Size and strength of the patient Type of abnormal behavior the patient is exhibiting Mental state of the patient Method of restraint you are using Advise the students that they must consider all possibilities prior to restraining a patient Advise the students that, if they are going to restrain a patient, they must first ensure that they have adequate resources on scene to handle the patient during the restraint process Advise the students that they must be comfortable with how the restraints work, so that they can be applied quickly Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Restraining patients Positional asphyxia Associated with hog-tie or hobble restraints Anything causing a decreased respiratory effort Never place patient face-down Frequent reassessment, especially with mental status changes Advise the students that a patient should never be restrained in the prone position, or with their hands and legs behind them Describe positional asphyxia to the students as a condition that results when the chest is not able to expand during inspiration Advise the students that they must monitor the patient closely for changes in their respiratory status Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Restraining patients Involve police Protect EMS from injury Protection during a lawsuit Involve third-party, same-gender witnesses Advise the students that it is recommended that the police department be involved whenever the decision is made to restrain a patient Advise the students that it should be recommended to have a person of the same gender present during the restraint process to prevent claims of sexual misconduct Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Legal considerations Patient must consent to care May provide care if the patient is mentally incompetent If patient threatens to hurt self or others May involve law enforcement Advise the students that it is important to obtain the patient’s consent prior to providing treatment Remind the students that, if the patient is a threat to themselves or others, then the patient can be forced to go to the hospital for evaluation Remind the students that they can provide care to the mentally incompetent patient Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Drug and Alcohol Emergencies

Drug abuse Self-administration of a drug not in accord with approved medical practice Overdose Poisoning by drugs or alcohol Withdrawal Effects after a period of abstinence Briefly review the terms and definitions with the students Describe how these terms will affect the first responder Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Occurs due to: Long-term drug use Medication errors Suicide attempts Advise the students that overdoses can occur as patients use a medication for a long time, building up a resistance, forcing them to take higher quantities of the medication for the same effects Advise the students that the patients may also misinterpret the directions on the prescription bottle, resulting in an overdose Warn the students that they must be cautious when they are dealing with the suicidal overdose due to the especially large quantities and varieties of medications they may have ingested Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Patient assessment Signs and symptoms Unresponsiveness Airway problems Irregular pulse Fever Seizures Advise the students that these are only a few of the signs and symptoms that their patients may present with Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Patient assessment If unresponsive Check airway for pills Smell breath for alcohol odors Obtain a detailed history from bystanders Remind the students that it is always important to open and maintain the unresponsive patient’s airway Advise the students that they should open the mouth and look for pills, as the patient may not have swallowed all of them or the patient may have thrown some of them up Advise the students that they must try to obtain a history for the patient from bystanders or family Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Remind the students that it is always important to open and maintain the unresponsive patient’s airway Advise the students that they should open the mouth and look for pills, as the patient may not have swallowed all of them or the patient may have thrown some of them up Advise the students that they must try to obtain a history for the patient from bystanders or family Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

First Responder care Establish and maintain open airway Administer oxygen appropriately Monitor mental status and vital signs Maintain body temperature Stress the importance of maintaining an open airway Warn the students that the overdose patient can progressively deteriorate, requiring additional airway support throughout the treatment Advise the students that the overdose patient will need oxygen and potentially positive pressure ventilation Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

First Responder care Take precautions for shock Support the patient Prepare for vomiting Advise the students that, because of the different effects that the drugs may cause, they should be prepared to treat for shock Remind the students that the patient with an altered mental status needs extra care in case the begin vomiting Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Rape and Sexual Assault

Both emotional and physical trauma Rape Sexual intercourse without consent and by compulsion through force, threat, or fraud Sexual assault Any touch that the victim did not initiate or agree to and that is imposed by coercion, threat, deception, or violence Advise the students that, not only is there emotional and physical trauma, but typically the emotional trauma continues to impact the patient long after the physical trauma has healed Discuss the differences between rape and sexual assault with the students Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Rape trauma syndrome Acute reaction Outward adjustment Depression Acceptance and resolution Advise the student that rape trauma syndrome is the long term psychological side effects of the rape, and that while the patient may appear to have dealt with the rape, this may just be an act for others while they are still suffering from severe depression Review with the students common reactions that the rape patient may have immediately following the trauma Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Managing the rape scene Try to determine the patient’s emotional state Attempt to use a rescuer of the same gender Perform a patient assessment, treating all obvious injuries Do not allow the patient to clean him- or herself or use the bathroom Document thoroughly Review the concerns associated with the rape scene Remind the students that they should only touch what is absolutely necessary to provide patient care Advise the students that they should limit the number of responders that enter the scene so that they limit the destruction or contamination of evidence Warn the students that they may need to have a rescuer of the same gender conduct the assessment as the patient may be too frightened to answer questions and submit to an exam conducted by someone of the same gender as the attacker Remind the students that they must make sure that they do not allow the patient to bathe, use the bathroom, or change prior to examination at the hospital Remind the students that they should only conduct an exam if they suspect life-threatening injuries from the rape Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Summary Consider the need for law enforcement when dealing with the behavioral patient Stay alert for signs of violence Restrain patients when necessary, using reasonable force Rely on a thorough scene size-up Stress the importance of evaluation at the emergency department for rape victims Remind the students of the need to have law enforcement present when dealing with the behavioral emergency, overdose, or rape patient Stress the importance of a thorough scene size-up, especially when the patient has an altered mental status Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Chapter 17 Psychological Emergencies and Crisis Intervention

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