1. BEHAVIORAL EMERGENCIES

2. Defined Behavior: manner in which a person acts or performs –any or all activities of a person, including physical and mental activity Behavioral emergency: a situation where the pt. exhibits abnormal behavior within a given situation that is unacceptable or intolerable to patient, family or community

3. Key part of the definition is within a given situation Cultures with different lifestyles Behavioral emergencies require patient assessment do not judge hastily or solely on the way they look or act

4. Physical causes of altered behavior Medical and trauma related: Hypoglycemia Lack of oxygen Stroke Head trauma Mind-altering substances Excessive cold or heat

5. Situational stress reactions Unexpected stress reactions fear, grief, anger Personal interaction will inspire confidence and pt. should begin to calm down and feel able to cope Let pt. know you are there to help Act in a calm manner; gives pt. time to get control of emotions

6. Keep your own emotions under control Let pt. know you are listening and explain things honestly Stay alert for sudden changes in behavior

7. Care; psychiatric Identify yourself and your role Speak slowly and clearly using calm and reassuring tones Listen Do not be judgmental, show compassion do not pry

8. Use positive body language avoid crossing arms or looking uninterested Acknowledge the pts feelings Do not enter the pts personal space Be alert for changes in emotional status increasingly aggressive behavior

9. Assessment Perform a careful scene size-up Identify yourself and your role Initial assessment mental status Perform as much as focused or detailed as much as possible; medical or trauma conditions Thorough patient history

10. Common presentations or signs and symptoms Panic or anxiety Unusual appearance, discolored clothing, poor hygiene Agitated or unusual activity Unusual speech patterns Bizarre behavior or thought patterns

11. Violent or aggressive behavior with threats or intents to harm others Care Scene safety Treat any life-threats Be alert for medical or trauma that could mimic a behavioral emergency Be prepared to spend time talking to the patient

12. Encourage the pt. to talk to you about what is troubling them Never play along with any visual or auditory hallucinations Do not lie to the pt. If it appears it will help, involve friends or family in the conversation

13. Suicide; no one is exempt Eight leading cause of death Third leading cause of death in 15 – 24 year olds Reached alarming levels among seniors Many reasons and many ways

14. Assessment Factors associated with a risk for suicide Depression High current or recent stress levels Recent emotional trauma Age Alcohol and drug abuse

15. Threats of suicide Suicide plan Previous attempts or threats Sudden improvement from depression

16. Care Scene size-up Treat life-threats to the extent allowed Try to establish visual and verbal contact as soon as possible Avoid arguing, make no threats, show no indication of using force As soon as possible, perform a focused hx. and PE and provide care

17. Detailed PE only if it is safe and you suspect pt. may have an injury On-going assessment Contact E.R. keep them advised and up- to-date Throughout interaction speak slowly and patiently await response

18. Aggressive or hostile patietns May be cause by Trauma to the brain or nervous system Metabolic disorders Stress Alcohol or other drugs Psychological disorders

19. May be alerted to pts condition from Dispatch Clues yelling unclean conditions Neighbors Family Bystanders Patient stance or position in a room

20. Take the following precautions Do not isolate yourself from your partner or other source of help Make sure you have an escape route Do not let the pt. come between you and the door Do not take any action that may be interpreted as threatening

21. Always be on the watch for weapons Stay out of the kitchen Stay in safe area until the police can control the scene Be alert for sudden changes in behavior

22. Assessment Responds to people inappropriately Tries to hurt self or others May have rapid pulse or breathing Usually displays rapid speech, movements May appear anxious, nervous, panicky

23. Care Scene size-up Standard precautions Medical direction if behavior prevents normal assessment and care On-going assessment; sudden changes in behavior

24. Restraint