BEHAVIORAL EMERGENCY

You Will Respond to Many Behavioral Emergencies. Some are Caused by Acute Illness or Injury, Others are Due to Mental Illness, or Mind Altering Substances. Restraints are the Best LAST Option in a Behavioral Emergency.

OVERVIEW

• Identify Patients Who are Experiencing a Behavioral Emergency
• How to Recognize Potentially Dangerous Patients and How to Act Safely
• Methods of Calming & Interacting With Patients Experiencing Behavioral Emergencies
• How to Restrain Patients Safely & Effectively
• How to Document Findings & Care of a Patient With Behavioral Emergencies

BEHAVIORAL EMERGENCY

• Behavior
• Manner in Which a Person Acts or Performs
• Including Physical and Mental Activity

BEHAVIORAL EMERGENCY

• Behavioral Emergency
• Situation Where the Patient Exhibits Abnormal Behavior Within a Given Situation That is Unacceptable or Intolerable to the Patient, Family or Community.

BEHAVIORAL EMERGENCY

• Behavioral Emergencies
• This Behavior Can be Due to Extremes of Emotion Leading to Violence or Other Inappropriate Behavior or Due to a Psychological or Physical Condition.

BEHAVIORAL EMERGENCY

• Situational Stress
• Alcohol
• Drugs
• Psychogenic
• Psychotic Thinking
• Depression
• Panic
• Hypoglycemia
• Hypoxia
• CVA / TIA
• Head Trauma
• Mind Altering Substances
• Excessive Cold / Heat

BEHAVIORAL EMERGENCY

• Psychologic Crises
• Panic
• Agitation
• Bizarre Thinking & Behavior
• Danger to Self – Suicidal
• Danger to Others – Homicidal / Violent

SUICIDE

• Assessment For Suicide Risk
• Depression
• Sad, Tearful, Thoughts of Death
• Suicidal Gestures
• Usually Hints, Provided by Patient, That Require Intervention to Seek Help

SUICIDE

• Risk Factors of Suicide
• 15 to 25 Years Old
• Over 40, Single, Widowed, Divorced
• Alcoholic / Drug Abuse
• Depression
• Verbalized Lethal Plan of Action

SUICIDE

• Risk Factors of Suicide
• Previous History of Suicide Attempt
• Diagnoses of Serious Illness
• Loss of Loved One
• Arrest, Imprisonment, Loss of Job

SUICIDE

• Risk Factors of Suicide
• Unusual Gathering Items That Can Cause Death
• Purchase of Guns
• Large Volume of Pills
• Sudden Fascination of Knives
• Holidays

SAFETY

• Scene Size-Up
• Personal Safety
• Police First
• Police Deal With Violence, Weapons, Secure Scene

SAFETY

• Involuntary Commitment
• 302
• 72 Hour Minimum Mental Health Evaluation
• Court Ordered
• Legal Warrant
• Police Responsibility

SAFETY

• EMS Responsibility
• Medical or Trauma Involved
• Scene Must Be Secured – Police
• If Someone is Willing to Take Their Life They Will be Willing to Take Yours

EMERGENCY CARE

• Patient Assessment
• Remain Calm & Non-Threatening
• Retreat if You Feel Unsafe or Threatened
• Questions to Consider
• How Does the Patient Feel?
• Suicidal Tendencies?
• Is the Patient a Threat to Self or Others?
• Is There a Medical Problem?
• What Interventions Needed?

EMERGENCY CARE

• Patient Assessment
• Calm Patient
• Do Not Leave Patient
• Louder the Patient – Quieter You Need to Be
• Restraints
• Police Present
• Overdose
• Bring Container to Hospital

LEGAL

• Medical / Legal Considerations
• Patient Consents – Legal Problems Reduced
• If Patient Resists
• Call Police
• Call Command
• Reasonable Belief Pt is Threat to Self / Others

LEGAL

• Medical / Legal Considerations
• Force
• Reasonable
• Enough Help?
• Legal Problems Thru the Wazzoo

LEGAL

• Protection From False Accusations
• DOCUMENT
• Especially Unusual Behavior Exhibited
• Witnesses
• At All Times – Even Transport
• Sexual Misconduct – Common Accusation
• Same Sex Attendant
• Third Party Present
• Enough Help?

Assessment of Potential Violence

• Be Observant – No Tunnel Vision
• History of Violence or Aggression
• Ask Family or Bystanders
• Vocal – Yelling That He Will Harm Self/Others

Assessment of Potential Violence

• Be Observant – No Tunnel Vision
• Posture & Physical Activity (Body Language)
• Fists, Tense Muscles, or Quick Irregular Movement
• Prepared to Lunge or Moving Toward EMT
• Carrying Lethal or Heavy Object

Principles of Assessing

• Principles of Assessing Behavioral Patient
• Identify Yourself, There to Help
• Watch Patient & Body Language
• Inform of What You are Doing
• Ask Questions in Calm, Reassuring Voice
• Allow Pt to Talk w/o Being Judgmental
• Show You are Listening – Rephrase/Repeat
• Principles of Assessing Behavioral Patient

• Acknowledge Patient’s Feelings
• Never "I Know How You Feel"
• Its Not About You
• Assess Mental Status

• Appearance
• Activity
• Speech

• Orientation – Person, Place, Time

CALMING

• Methods of Calming a Behavioral Patient
• "I See You’re Upset, I’m Here to Try to Help"
• Tell What You Are Doing
• Calm, Reassuring Voice
• Maintain Comfortable Distance
• Encourage Patient to Talk
• Don’t Make Quick Moves
• Be Honest With Patient – Don’t Lie

CALMING

• Methods of Calming a Behavioral Patient
• Do Not Threaten, Argue, or Challenge
• Don’t "Play Along" with Patient’s Disturbances
• Involve Trusted Family and/or Friends
• Be Prepared to Stay on Scene for Long Period
• Avoid Unnecessary Physical Contact
• Use Good Eye Contact
• Stay Alert

RESTRAINTS

• Last Resort
• Medical Command Order
• Police
• If Done Improperly
• Kidnapping
• Injury

RESTRAINTS

• Use Equipment Approved by Medical Director
• Patient May Have to Be Face Down on Cot
• Watch Where Restraints are Being Secured
• Proper Location for Stretcher Operation
• Make Sure Patient Can’t Disable Restraint

RESTRAINTS

• Reassess Airway / Breathing Constantly
• Reassess Circulation Frequently
• Document Why, How, & Who
• Avoid Unnecessary Force

RESTRAINTS

• Use reasonable force to prevent patient from injuring self and others.
• Avoid force that may injure patient.

Death of a restrained patient — possibly due to respiratory problems caused by restraint

• Do not hog-tie.
• Position patient face-up when possible.
• Monitor patient carefully while restrained.

Use of Restraints

• Reassess patient frequently.
• Document incident thoroughly.
• Indications
• Methods
• Witnesses