2. Sections
Behavioral Emergencies
Pathophysiology of Psychiatric
Disorders
Assessment of Behavioral Emergency
Patients
Specific Psychiatric Disorders
Management of Behavioral
Emergencies
Violent Patients and Restraint
3. Behavioral Emergencies
Behavior
Normal versus Abnormal Behavior
Indications of a Behavioral or Psychiatric
Condition
Behavior that interferes with core life functions
Behavior that poses a threat to the life or well-being of
the patient or others
Behavior that deviates significantly from society’s
expectations or norms
4. Pathophysiology of
Psychiatric Disorders
Mental Health Problems
Role of Medication Noncompliance
Causes of Disorders
Biological (Organic)
Cause related to disease process or structural changes
Psychosocial
Cause related to the patient’s personality style,
unresolved conflicts, or crisis management methods
Sociocultural
Cause related to the patient’s actions and interactions
with society
5. Assessment of Behavioral
Emergency Patients
Scene Size-up
Ensure Personal Safety
Initial Assessment
Suspect Life-Threatening Emergencies
Assess and Manage ABCs
General Impression
Consider posturing, hand gestures, and signs of
aggression.
Observe the patient’s awareness, orientation, cognitive
abilities, and affect.
Consider the patient’s emotional state.
Control the Scene
6. Assessment of Behavioral
Emergency Patients
Focused History and Physical Exam
Obtain the Patient’s History
Listen.
Spend time.
Be assured.
Do not threaten.
Do not fear silence.
Place yourself at the patient’s level.
Keep a safe and proper distance.
Appear comfortable.
Avoid appearing judgmental.
Never lie to the patient.
7. Assessment of Behavioral
Emergency Patients
Mental Status Examination
General Appearance Mood and Affect
Behavioral Intelligence
Observations
Thought Processes
Orientation
Insight
Memory
Judgment
Sensorium
Perceptual
Psychomotor
Processes
8. Assessment of Behavioral
Emergency Patients
Psychiatric Medications
Determine Presence and Type
Compliance
Identify Mental Health Professional
9. Specific Psychiatric
Disorders
Cognitive Disorders
Delirium
Rapid onset of widespread, disorganized thought
Dementia
Gradual development of memory impairment and
cognitive disturbances
• Aphasia, apraxia, agnosia, disturbance in executive
functioning
11. Specific Psychiatric
Disorders
Anxiety and Related Disorders
Panic Attack
Differentiating the panic attack from medical
conditions
Four symptoms peaking within 10 minutes
• Palpitatations, sweating, trembling or shaking, shortness of
breath or smothering, feelings of choking, chest pain or
discomfort, nausea, abdominal distress, paresthesias, chill,
hot flashes, derealization or depersonalization, dizziness,
unsteadiness, or lightheadedness
• Fear of losing control, going crazy, or dying
12. Specific Psychiatric
Disorders
Phobias
Excessive fear that interferes with functioning
Posttraumatic Stress Syndrome
Reaction to an extreme, life-threatening stressor
Characteristics
• Recurrent, intrusive thoughts
• Sleep disorders and nightmares
• Survivor’s guilt
• Often complicated by substance abuse
13. Specific Psychiatric
Disorders
Mood Disorders
Depression
Major Depressive Episodes
• Depressed mood lasting all day, nearly every day
• Diminished interest in pleasure and daily activities
• Significant weight change
• Insomnia or hypersomnia
• Psychomotor agitation or retardation
• Feelings of worthlessness or excessive guilt
• Diminished ability to think; indecisiveness
• Recurrent thoughts of death
14. Specific Psychiatric
Disorders
Major Depressive Disorder
• Requires 5 or more symptoms present during the same 14
day period.
• Depression cannot be accounted for by other problems.
• In Interest
S Sleep
A Appetite
D Depressed Mood
C Concentration
A Activity
G Guilt
E Energy
S Suicide
15. Specific Psychiatric
Disorders
Bipolar Disorder
Manic episodes
• Inflated self-esteem or grandiosity
• Decreased need for sleep
• More talkative than usual or pressure to keep talking
• Flight of ideas or subjective experience that thoughts are racing
• Distractibility
• Increase in goal-directed activity
• Excessive involvement in pleasurable activities
• Delusional thoughts
May alternate with depressed episodes.
Lithium is used.
16. Specific Psychiatric
Disorders
Substance-Related Disorders
Physiological and Psychological Dependence
Somatoform Disorders
Symptoms without Cause
Somatization disorder
Conversion disorder
Hypochondriasis
Body dysmorphic disorder
Pain disorder
17. Specific Psychiatric
Disorders
Factitious Disorders
Characteristics
Intentional production of physical or psychological
signs or symptoms
Motivation for the behavior is to assume the “sick”
role
External incentives for the behavior
• Avoiding police or work
21. Specific Psychiatric
Disorders
Suicide
Assessing Potentially Suicidal Patients
Document observations about the scene that may
be valuable to mental health professionals.
Document any notes, plans, or statements made by
the patient.
Treat traumatic or medical complaints.
22. Suicide Risk Factors
Previous attempts Major separation
Depression trauma
Age Major physical
15–24 or over 40 stresses
Alcohol or drug abuse Loss of independence
Divorced or widowed Lack of goals and
Giving away plan for the future
belongings Suicide of same-
Living alone or in
sexed parent
isolation
Expression of a plan
Presence of psychosis
with depression for suicide
Homosexuality Possession of the
HIV status mechanism for
suicide
23. Specific Psychiatric
Disorders
Crisis in the Geriatric Patient
Assess the patient’s ability to communicate.
Provide continual reassurance.
Compensate for the patient’s loss of sight and hearing
with reassuring physical contact.
Treat the patient with respect.
Avoid administering medication.
Describe what you are going to do before you do it.
Take your time.
Allow family and friends to remain with the patient
whenever possible.
24. Specific Psychiatric
Disorders
Crisis in Pediatric Patients
Avoid separating young children from their parent.
Prevent children from seeing things that will increase
their distress.
Make all explanations brief and simple.
Be calm and speak slowly.
Identify yourself.
Be truthful with children.
Encourage children to help with their care.
25. Specific Psychiatric
Disorders
Reassure children by carrying out all
interventions gently.
Do not discourage children from crying or
showing emotions.
If you will be separated from children,
introduce the next person who will assume
their care.
Allow children to keep a favorite blanket or
toy.
Do not leave children alone.
26. Management of Behavioral
Emergencies
General Management
Ensure scene safety and BSI precautions.
Provide a supportive and calm environment.
Treat any existing medical conditions.
Do not allow the suicidal patient to be alone.
Do not confront or argue with the patient.
Provide realistic reassurance.
Respond to the patient in a simple, direct manner.
Transport to an appropriate receiving facility.
27. Management of Behavioral
Emergencies
Medical
Treat Underlying Problems.
Psychological
Build Trust.
Use interviewing Skills.
“Talk Down” the Patient.
29. Violent Patients
and Restraint
Violent Patients
EMS Safety
Laws of Consent
Authority to determine competence
Determining Threat
Threat to self
Threat to others
30. Violent Patients
and Restraint
Methods of Restraint
Guidelines
Use the minimum force needed.
Use appropriate devices to perform restraint.
Restraint is not punitive.
Patients who have been restrained require careful
monitoring.
Materials for Restraint
31. Restraining the
Unarmed Patient
Ensure you have
adequate
assistance and
prepare the
stretcher and
restraints.
Encircle the patient
and give him or her
one last opportunity
to cooperate.
32. Restraining the
Unarmed Patient
Assign one
person to each
limb and
approach at the
same time.
Keep
communicating
with the patient.
33. Restraining the
Unarmed Patient
Once patient is
restrained, move
patient to a prone or
laterally recumbent
position on the
stretcher and
secure.
Keep the patient
restrained
throughout
transport.
34. Positioning and Restraining
Patients for Transport
Positioning the
patient prone
reduces
resistance and
allows continued
airway
maintenance.
Keep the
stretcher in its
lowest position.
35. Positioning and Restraining
Patients for Transport
Continually
reassess the
patient’s airway,
breathing, and
circulation.
Be alert for signs of
positional asphyxia.
Never hog-tie or use
hobble restraints.
Chemical restraint
36. Psychiatric and
Behavioral Disorders
Behavioral Emergencies
Pathophysiology of Psychiatric
Disorders
Assessment of Behavioral Emergency
Patients
Specific Psychiatric Disorders
Management of Behavioral
Emergencies
Violent Patients and Restraint
Editor's Notes
Cognitive Disorders have organic causes such as injury or disease