1. First Aid for Colleges and Universities 10th Edition Chapter 28 © 2012 Pearson Education, Inc. Psychological Emergencies and Disasters Slide Presentation prepared by Randall Benner, M.Ed., NREMT-P

2. Learning Objectives Discuss the goals of psychological first aid care. Outline the basic principles of psychological first aid care. List the factors that cause psychological changes. Distinguish between psychological and physical emergencies. Discuss psychological emergencies, including panic, agitation, and bizarre thinking/behavior. © 2012 Pearson Education, Inc.

3. Learning Objectives Discuss the risk factors for suicide. Describe how to manage a suicidal person. Discuss the principles in assessing psychological emergencies. Discuss the legal considerations in managing psychological emergencies. Describe how to manage a violent victim. © 2012 Pearson Education, Inc.

4. Learning Objectives Describe and demonstrate methods of calming a person undergoing a psychological emergency. Describe and demonstrate how to restrain a violent victim. Discuss how to manage mass casualties and disasters. Describe how to perform triage. © 2012 Pearson Education, Inc.

5. Introduction Psychological emergencies are challenging because you cannot “see” what you're treating. The First Aider must be able to distinguish between physical and psychological emergencies. Psychological support is often as critical to saving life as first aid care is for physical trauma. © 2012 Pearson Education, Inc.

6. Basic Goals and Principles A psychological emergency is one in which a person exhibits abnormal behavior. –Abnormal means unacceptable or intolerable to others. Goals of psychological first aid care –Help the person regain normal function. –If normalcy is impossible, then minimize disability. –Decrease intensity of emotional response. –Prevent the person from hurting themself or others. © 2012 Pearson Education, Inc.

7. Signs and Symptoms of Psychological Distress © 2012 Pearson Education, Inc.

8. Principles of Psychological Care Every person has limitations (even you). Each person has a right to his or her feelings. Each person has more ability to cope than they may think. Everyone experiences emotional disturbances when involved with injury or crisis. Emotional injury is real. People in crisis do not “just get better.” Understanding cultural differences is important. © 2012 Pearson Education, Inc.

9. Victims with Special Needs © 2012 Pearson Education, Inc. Elderly/geriatric people Very young children/infants Deaf people Blind people Non-English speakers Confused/developmentally disabled people

10. Basic First Aid for Psychological Emergencies Guidelines for providing psychological care –Assure your own safety. –Identify yourself. –Express your desire to help. –Speak in a way the victim can understand. –Act interested, give reassurance. –Do not invade victim’s personal space. –Do not lie to or mislead the victim. –Do not give false hope. –Do not judge, criticize, argue, or be overly sympathetic. © 2012 Pearson Education, Inc.

11. Physical Causes of Psychological Crises Understand the types of physical problems that may cause psychological emergencies. –Low sugar, lack of oxygen, head trauma, environmental extremes Distinguish between physical and psychological symptoms and effects. © 2012 Pearson Education, Inc.

12. Common Psychological Emergencies Panic –Overwhelming feeling of helplessness in response to fear or stress Agitation –Uneasiness or upset response Bizarre thinking/behavior –Inappropriate thoughts or behavior Danger to self –Stems from depression Danger to others –Violence is used in attempt to gain control or security © 2012 Pearson Education, Inc.

13. Psychological Crises Suicide –Any willful act designed to end one’s own life Risk factors for suicide –Age, gender, mental state, health status First aid care for suicide –First ensure your own safety. –Assess and treat victim for physical injury. –Determine the seriousness of victim's intent. –Calm the victim and don't leave them alone. –Protect the victim from self-harm. © 2012 Pearson Education, Inc.

14. Suicide Defined as any willful act designed to end one's own life Three times more women than men attempt it Three times more men than women complete it Regarded as vastly under-reported Many victims make last-minute attempts to communicate their intentions. Every suicidal act, gesture, or suggestion should be regarded seriously. © 2012 Pearson Education, Inc.

15. Suicide Risk Factors Single male over age 40 Alcoholism or drug abuse Suicidal gestures or plans Depression Gathering potential suicide equipment History of self-destructive behavior Recent loss, illness, bad news Arrest, imprisonment, job loss © 2012 Pearson Education, Inc.

16. Psychological Assessment Principles Identify yourself. Be honest with the victim. Ask questions in a calm voice. Allow the victim to answer questions completely. Acknowledge their feelings or limitations. Determine their level of consciousness, orientation, and contact with reality. © 2012 Pearson Education, Inc.

17. Assessing for Potential Violence Locate the victim and look for weapons. Determine whether you can handle the situation alone. Try to get a history from family or bystanders. Look for physical signs of aggression. –Is the victim yelling, cursing, arguing, threatening? © 2012 Pearson Education, Inc.

18. Legal Considerations Guidelines to reduce your legal liability – Whenever possible, get victim consent. – Document what happened if victim refuses care. – Avoid unreasonable force. – Seek police direction or involvement. – Protect yourself from false accusations. – Manage the crime scene, if applicable. Protect items, limit bystanders, document everything. © 2012 Pearson Education, Inc.

19. Managing a Violent Victim Maintain a comfortable distance. Make no quick movements. Respond honestly but don't encourage unrealistic expectations. Don't threaten, challenge, or argue. Involve trusted family or friends, when possible. Don't leave the victim alone. Maintain eye contact. Don't force the victim to make decisions. Disperse onlookers, if any. © 2012 Pearson Education, Inc.

20. Restraining a Violent Patient Gather enough people to overpower the victim. Plan your actions before attempting them. Only use as much force as needed. Act quickly once “take down” is initiated. Assign each First Aider a limb to secure. Place victim supine, do not sit on chest or abdomen. Avoid putting undue pressure on the victim’s head, face, neck, or back. © 2012 Pearson Education, Inc.

21. Mass Casualties and Disasters Defined as a situation involving more than one casualty American Psychiatric Association has identified five types of reactions – Normal Requires little or no emergency care Calm reassurance may suffice – Panic Loss of judgment and reason Be firm, calm, get help – Overreaction Explosion of senseless activity Let victim talk, give them something to do © 2012 Pearson Education, Inc.

22. Mass Casualties and Disasters –Underreaction Unable to recover from shock Establish contact, encourage talk, provide food/drink –Severe physical reaction (conversion hysteria) Victim converts anxiety into actual physical disabilities Express concern, summon medical aid, give a simple assignment © 2012 Pearson Education, Inc.

23. Managing Mass Disasters © 2012 Pearson Education, Inc. Do not become overwhelmed. Assist rescuers on scene (EMS, PD, FD, etc.). Encourage capable victims or bystanders to assist. Assess and care for physical injuries immediately. Keep spectators away. Respect the right of victims to express feelings. Accept your own limitations.

24. Conducting Triage Identify and treat the most severely injured first. Assign victims to one of three categories –Life threatening (highest priority) –Urgent (second priority) –Delayed (lowest priority) Affix tags to victims help identify priority. © 2012 Pearson Education, Inc.

25. Three-Level Triage Highest priority –Critically injured; can recover if treated immediately Second priority –Seriously injured; may die without medical intervention Lowest priority –Either noncritical wounds, or mortal wounds unlikely to respond to treatment © 2012 Pearson Education, Inc.

26. Two-Level Triage First priority –Those with life-threatening injuries that are salvageable –Those requiring immediate care to survive Second priority –Those with serious injuries but whose lives are not threatened –Those with minor injuries –Those whose critical injuries are not treatable or salvageable © 2012 Pearson Education, Inc.

27. Summary The primary goal in a psychological emergency is to help the patient function normally as soon as possible. Physical emergencies can cause psychological emergencies. Take suicide threats seriously at all times. Handle violent victims with multiple rescuers. Always get victim consent and use good documentation skills. © 2012 Pearson Education, Inc.