1. Drill of the Month Drill of the Month Developed by Gloria Bizjak Behavioral Emergencies

2. 2 Drill of the Month Behavioral Emergencies Student Performance Objective: Student Performance Objective: Given information, resources, and opportunity for discussion, EMTs will be able to: Given information, resources, and opportunity for discussion, EMTs will be able to: Define behavioral emergencies Define behavioral emergencies List causes of behavioral emergencies List causes of behavioral emergencies List signs and symptoms List signs and symptoms State actions and precautions for safety State actions and precautions for safety Describe assessment and care steps Describe assessment and care steps EMTs will follow acceptable Maryland medical practice and Maryland Medical Protocols for Emergency Medical Providers. EMTs will follow acceptable Maryland medical practice and Maryland Medical Protocols for Emergency Medical Providers.

3. 3 Drill of the Month Altered Mental Status: Assessing and Managing Seizure Patients Overview Overview Behavioral Emergencies: Definition Behavioral Emergencies: Definition Causes of Behavioral Emergencies Causes of Behavioral Emergencies Signs and Symptoms Signs and Symptoms Actions and Precautions Actions and Precautions Assessment and Care Steps Assessment and Care Steps

4. 4 Drill of the Month Behavioral Emergencies: Definition Abnormal or atypical behavior that is unacceptable in a given situation with the potential that serious harm is imminent Abnormal or atypical behavior that is unacceptable in a given situation with the potential that serious harm is imminent Unusual and seriously alarming behavior Unusual and seriously alarming behavior –Threats to harm self, particularly suicide –Threats to harm others –Threats to cause serious property damage

5. 5 Drill of the Month Behavioral Emergencies: Definition Any medical/trauma situation that alters normal behavior and physical functioning Any medical/trauma situation that alters normal behavior and physical functioning NOTE: NOTE: Consider all behavioral emergencies as incidents of altered mental status Consider all behavioral emergencies as incidents of altered mental status Do not overlook medical conditions Do not overlook medical conditions –abnormal blood sugar level, hypoxia, stroke, tumor, drug or alcohol intoxication, pain, medications, severe infections

6. 6 Drill of the Month Causes of Behavioral Emergencies Trauma Trauma –Head injury—recent or past  Periodic irritability  Irrational behavior  Confusion and frustration  Amnesia  Delusions

7. 7 Drill of the Month Causes of Behavioral Emergencies Amputation Amputation –Medical—losing a body part can be –mentally traumatic –Traumatic—losing a body part in a crash or other trauma incident can be –mentally traumatic

8. 8 Drill of the Month Causes of Behavioral Emergencies Medical Medical –Metabolic disorders  Hypoglycemia  Hyperglycemia  Endocrine, or hormonal disorders –Stroke –Epilepsy –History of or admission of depression

9. 9 Drill of the Month Causes of Behavioral Emergencies Medical Medical –Hypoxia –Mind-altering substance use –Alcohol or drug abuse –Poison exposure or ingestion –Environmental  Hypothermia  Hyperthermia

10. 10 Drill of the Month Causes of Behavioral Emergencies Neurological Neurological –Organic brain disorder –Other medical conditions with organic causes  Lesions  Tumors  Degenerative diseases  (Alzheimer’s, Parkinson’s, dementia)  Infections  Toxins

11. 11 Drill of the Month Causes of Behavioral Emergencies Stress response or any situation that causes prolonged, extreme stress or sever anger, fear, or grief Stress response or any situation that causes prolonged, extreme stress or sever anger, fear, or grief –Loss of a loved one –Work/job problems or loss –Home/family problems –Money problems –Health problems

12. 12 Drill of the Month Causes of Behavioral Emergencies Psychiatric disorders Psychiatric disorders –History of mental illness, behavioral problems –Overdose of/forgetting to take psychiatric meds –Thought processes not logical to, or consistent with, situation –Unaware of surroundings or situation –Delusions or hallucinations

13. 13 Drill of the Month Signs and Symptoms Observable signs Observable signs –Body language: Expressions or actions  Agitation—anxious, restless, panicky, nervous, rapid speech and movement  Anger, aggressively hostile  Defiance  Violence: Threatening self, others  Suicidal gestures or talk  Shouting, crying out, crying  Isolates self, refuses to talk  Obsessive-compulsive actions

14. 14 Drill of the Month Signs and Symptoms Observable signs Observable signs –Personal appearance: Poor hygiene, grooming, dress –History of alcohol or drug abuse –Delusions or visions: Hears voices, may want to follow “orders” of voices; talks to unseen persons –Persecution: Believes others are plotting against him, no one understands him, blames others for problems

15. 15 Drill of the Month Signs and Symptoms Observable signs Observable signs –Speech or language  Cannot talk or does not appear to understand what you are saying (aphasia)  Result of brain injury (head trauma, stroke, brain tumor, neurological disease, epilepsy, migraine) to specific brain areas—NOT a cognitive disorder –Broca’s area—controls language/speech –Wernicke’s area—control language interpretation  Talks, but word choice is unusual –Quality, pace, articulation

16. 16 Drill of the Month Signs and Symptoms Observable signs Observable signs –Age (with any of the above signs)  15-25 years of age  Over 40 years of age  The elderly

17. 17 Drill of the Month Signs and Symptoms Symptoms Symptoms –Possible rapid pulse rate –Possible rapid breathing rate –Trouble breathing –Complains of headache or other pains –Depression or suddenly coming out of a depression and feeling better

18. 18 Drill of the Month Actions and Precautions General General –Assess the scene for dangers or safety problems –Protect yourself and others –Watch for changes in behavior from calm to violent –Be alert for weapons or items that can be used as weapons –Have family members, friends, others leave room or area if patient is agitated by their presence  Alternately, have someone stay if that person helps calm patient or patient responds positively to that person –Take safety actions with threat of danger  Retreat, call law enforcement

19. 19 Drill of the Month Actions and Precautions Specific Specific –The suicidal patient  Take suicidal threats seriously  Get eye-level with patient; sit next to patient; maintain eye contact  Talk to patient about thoughts and feelings; listen  Talk to patient about previous attempts or plans

20. 20 Drill of the Month Actions and Precautions Specific Specific –The aggressive or hostile patient  Ensure safety: Watch for sudden changes in behavior, movements, actions  Be alert for weapons  Call for assistance from law enforcement  Call for medical direction if necessary

21. 21 Drill of the Month Actions and Precautions Specific Specific –The psychiatric patient  Ensure safety: Watch for sudden changes in behavior, movements, actions  Care for medical/trauma problems first, if possible  Talk with the patient in a calm, reassuring voice  Encourage conversation about problems; listen  Use positive body language: Smile, position self at eye level, have hands relaxed at sides or in lap  Do not play along with hallucinations  Do not lie or make promises you cannot fulfill  Involve family members if it is safe or helpful

22. 22 Drill of the Month Actions and Precautions Specific Specific –The patient reacting to stress  Act calmly and take control of the situation  Let the patient know you are there to help  Treat the patient as an individual who has feelings and merit  Do not rush the assessment or interview  Give the patient time to interact with you

23. 23 Drill of the Month Assessment and Care Steps Assessment: Perform General Patient Care (Refer to Maryland Protocols pp 25 pp 31 pp 34 (K) pp 37 – 38 – 38-1 pp 42-43 Assessment: Perform General Patient Care (Refer to Maryland Protocols pp 25 pp 31 pp 34 (K) pp 37 – 38 – 38-1 pp 42-43 –Gather information on approach –Size up the scene  Ensure scene safety  Limit the number of people around the patient  Avoid overwhelming the patient with too many people, too many people talking, too many sounds  Respect the patient’s personal space

24. 24 Drill of the Month Assessment and Care Steps Assessment: Perform General Patient Care (Refer to Maryland Protocols pp 25 pp 31 pp 34 (K) pp 37 – 38 – 38-1 pp 42-43 ) Assessment: Perform General Patient Care (Refer to Maryland Protocols pp 25 pp 31 pp 34 (K) pp 37 – 38 – 38-1 pp 42-43 ) –Perform initial assessment to extent possible  Mental status –Assess memory, concentration, judgment, orientation –Assess mood: facial expressions, body language, response to questions  Airway, breathing, circulation  Provide oxygen if possible  Disability: pulse/motor/sensory  Expose to assess injuries

25. 25 Drill of the Month Assessment and Care Steps Assessment: Perform General Patient Care (Refer to Maryland Protocols pp 25 pp 31 pp 34 (K) pp 37 – 38 – 38-1 pp 42-43 ) Assessment: Perform General Patient Care (Refer to Maryland Protocols pp 25 pp 31 pp 34 (K) pp 37 – 38 – 38-1 pp 42-43 ) –Perform focused history and physical exam— expect distorted information  History to the extent possible: SAMPLE –Patient may be uncooperative –Patient may provide unreliable history –Family or caretakers may be unavailable or not know full history

26. 26 Drill of the Month Assessment and Care Steps Assessment: Perform General Patient Care (Refer to Maryland Protocols pp 25 pp 31 pp 34 (K) pp 37 – 38 – 38-1 pp 42-43 ) Assessment: Perform General Patient Care (Refer to Maryland Protocols pp 25 pp 31 pp 34 (K) pp 37 – 38 – 38-1 pp 42-43 ) –Perform focused history and physical exam— expect distorted information  Physical assessment to the extent possible: –DCAP-BTLS –AEIOU-TIPS Alcohol or acidosis Epilepsy (seizures Infection (sepsis) Overdose Uremia Trauma or tumor Insulin (hyperglycemia or hypoglycemia Poisonings or psychosis Stroke

27. 27 Drill of the Month Assessment and Care Steps Assessment: Perform General Patient Care (Refer to Maryland Protocols pp 25 pp 31 pp 34 (K) pp 37 – 38 – 38-1 pp 42-43 ) Assessment: Perform General Patient Care (Refer to Maryland Protocols pp 25 pp 31 pp 34 (K) pp 37 – 38 – 38-1 pp 42-43 ) –Mental assessment: AABCST  Appearance: patient’s age, sex, hygiene, posture, dress (appropriate for season, situation/event, e.g., dressed for bed at a birthday party)  Affect: what feelings the patient is demonstrating  Behavior: what patient is doing  Cognition: patient’s consciousness level, memory, mood  Speech: patient’s word choice, tone, clarity, content, pace  Thought processes: whether patient shows reasonable judgment for the situation

28. 28 Drill of the Month Assessment and Care Steps Assessment: Perform General Patient Care (Refer to Maryland Protocols pp 25 pp 31 pp 34 (K) pp 37 – 38 – 38-1 pp 42-43 ) Assessment: Perform General Patient Care (Refer to Maryland Protocols pp 25 pp 31 pp 34 (K) pp 37 – 38 – 38-1 pp 42-43 ) –Follow treatment protocols –Communicate with hospital or other response personnel –Determine priority and mode of transport and where

29. 29 Drill of the Month Assessment and Care Steps Emergency Care (Refer to Maryland Protocols p. 42) Emergency Care (Refer to Maryland Protocols p. 42) –Use restraints as necessary –Law enforcement Must be considered  Transporting from medical facility: obtain physician order  Transporting from field/home: call law enforcement to apply and accompany patient in unit  SAFER model (Maryland Protocol p. 42)

30. 30 Drill of the Month Assessment and Care Steps Emergency Care Emergency Care (Refer to Maryland Protocols p. 42) (Refer to Maryland Protocols p. 42) –Use restraints as necessary  Always use soft, humane restraints  Have enough personnel to perform the restraint –One person for each extremity; one person for the head; one person to apply restraints –Coordinate actions –Be cautions of kicking, scratching, biting

31. 31 Drill of the Month Assessment and Care Steps Emergency Care (Maryland Protocols p. 42) Emergency Care (Maryland Protocols p. 42) –Use restraints as necessary  Restrain in a supine position, never prone  Continuously monitor the restrained patient –Check breathing and pulse –Be alert for the struggling or agitated patient who suddenly becomes calm and quiet  Check responsiveness, breathing, pulse  Be aware of faking, attempts to attack or injure you

32. 32 Drill of the Month Assessment and Care Steps Emergency Care (Maryland Protocols p. 42) Emergency Care (Maryland Protocols p. 42) –Implement SAFER model  Stabilize situation: stop influence of sensations  Assess and acknowledge crisis  Facilitate/help patient understand situation; access resources  Encourage use of resources and coping  Recovery or Referral: responsible person or professional or transport –Transport/transfer/transition patient and information

33. 33 Drill of the Month Behavioral Emergencies Student Performance Objective: Student Performance Objective: Given information, resources, and opportunity for discussion, EMTs will be able to: Given information, resources, and opportunity for discussion, EMTs will be able to: Define behavioral emergencies Define behavioral emergencies List causes of behavioral emergencies List causes of behavioral emergencies List signs and symptoms List signs and symptoms State actions and precautions for safety State actions and precautions for safety Describe assessment and care steps Describe assessment and care steps EMTs will follow acceptable Maryland medical practice and Maryland Medical Protocols for Emergency Medical Providers. EMTs will follow acceptable Maryland medical practice and Maryland Medical Protocols for Emergency Medical Providers.

34. 34 Drill of the Month Behavioral Emergencies Review Review Behavioral Emergencies: Definition Behavioral Emergencies: Definition –Provide at lease one definition or description of a behavioral emergency Causes: Name at lease one behavioral emergency indication for each of the following Causes: Name at lease one behavioral emergency indication for each of the following  Trauma  Medical  Neurological  Stress  Psychiatric

35. 35 Drill of the Month Behavioral Emergencies Review Review Signs and symptoms Signs and symptoms –Name at least 5 observable signs of a behavioral emergency –What are some general symptoms of a behavioral emergency?

36. 36 Drill of the Month Behavioral Emergencies Review Review Actions and Precautions Actions and Precautions –What are general actions and precautions to take for the behavioral emergency patient? –What are specific actions and precautions to take for each of the following situations?  Suicidal patient  Aggressive or hostile patient  Psychiatric patient  Patient reacting to stress

37. 37 Drill of the Month Behavioral Emergencies Review Review Assessment and Care Steps Assessment and Care Steps –List assessment steps for the behavioral emergency patient –List the care steps for the behavioral emergency patient  What are the protocols for using restraints?  What are the steps of the SAFER model?