23)Behavioral Emergencies

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23)Behavioral Emergencies

  1. 1. Behavioral Emergencies
  2. 2. Behavioral Emergencies <ul><li>Behavior </li></ul><ul><ul><li>Manner in which a person acts </li></ul></ul><ul><ul><li>Physical and mental actions </li></ul></ul><ul><li>Behavioral emergency </li></ul><ul><ul><li>Situation in which the pt exhibits abnormal behavior that is unacceptable to pt, family, community. </li></ul></ul><ul><ul><li>Extremes of emotion leading to violence </li></ul></ul><ul><ul><li>Psychological or physical conditions that lead to violence </li></ul></ul>
  3. 3. Common Causes <ul><li>AEIOU-TIPS </li></ul><ul><li>Situational Stress </li></ul><ul><li>Psychiatric problems </li></ul><ul><li>Alcohol/drugs </li></ul><ul><li>Medical illness </li></ul><ul><ul><li>Low blood sugar </li></ul></ul><ul><ul><li>Lack of O2 </li></ul></ul><ul><ul><li>Inadequate blood flow to brain </li></ul></ul><ul><ul><li>Head trauma </li></ul></ul><ul><ul><li>Excessive cold </li></ul></ul><ul><ul><li>Excessive heat </li></ul></ul>
  4. 4. Characteristics <ul><li>Panic </li></ul><ul><li>Agitation </li></ul><ul><li>Bizarre thinking/behavior </li></ul><ul><li>Danger to self </li></ul><ul><ul><li>Self destructive behavior </li></ul></ul><ul><ul><li>Suicide </li></ul></ul><ul><li>Danger to others </li></ul><ul><ul><li>Threatening behavior </li></ul></ul><ul><ul><li>Violence </li></ul></ul>
  5. 5. Assessment for suicide risk <ul><li>Depression </li></ul><ul><ul><li>Sad, tearful </li></ul></ul><ul><ul><li>Thoughts of death, taking ones life </li></ul></ul><ul><li>Suicidal gestures </li></ul><ul><ul><li>Individuals over 40, single, widowed, divorced, alcoholic, depressed </li></ul></ul><ul><ul><li>Defined lethal plan of action that is verbalized </li></ul></ul><ul><ul><li>Unusual gathering of articles that can cause death </li></ul></ul><ul><ul><li>Previous Hx of self destructive behavior </li></ul></ul><ul><ul><li>Recent diagnosis of serious illness </li></ul></ul><ul><ul><li>Recent loss of loved one </li></ul></ul><ul><ul><li>Arrest, imprisonment, loss of job </li></ul></ul>
  6. 6. Assessment Findings <ul><li>Pt in unsafe environment </li></ul><ul><li>Pt has unsafe objects in possession </li></ul><ul><li>Display of self destructive behavior </li></ul><ul><li>Questions to think about… </li></ul><ul><ul><li>How does the pt feel. </li></ul></ul><ul><ul><li>Determine suicidal tendencies </li></ul></ul><ul><ul><li>Is pt a threat to self or others </li></ul></ul><ul><ul><li>Is there a medical problem </li></ul></ul><ul><ul><li>Interventions </li></ul></ul>
  7. 7. Medical Legal Considerations <ul><li>Consent to treatment GREATLY reduces legal problems </li></ul><ul><li>If pt refuses: </li></ul><ul><li>To provide care against pt will you MUST show there is a reasonable belief the pt will harm himself or others </li></ul><ul><li>Pt may be transported after contacting med control </li></ul><ul><li>Usually law enforcement is needed. </li></ul><ul><li>Avoid unreasonable force </li></ul>
  8. 8. Reasonable Force <ul><li>Reasonable force </li></ul><ul><ul><li>Force necessary to prevent pt from injuring self/others </li></ul></ul><ul><li>Depends on </li></ul><ul><ul><li>Pt size and strength </li></ul></ul><ul><ul><li>Type of abnormal behavior </li></ul></ul><ul><ul><li>Sex of pt </li></ul></ul><ul><ul><li>Mental status </li></ul></ul><ul><ul><li>Method of restraint </li></ul></ul><ul><li>Some pt may cause unexpected injury to self/other after periods of aggression </li></ul><ul><li>Avoid physical acts that will injure the pt </li></ul><ul><li>EMS personnel may use reasonable force to defend against attack by an emotionally disturbed pt. </li></ul>
  9. 9. Protection from False Charges <ul><li>Consult medical direction </li></ul><ul><li>Ask for police assistance </li></ul><ul><li>DOCUMENT abnormal pt behavior </li></ul><ul><li>Have witnesses in attendance esp in transport </li></ul><ul><li>Have help </li></ul><ul><li>Same sex EMTs as pt </li></ul><ul><li>Witnesses </li></ul><ul><li>Accusing EMTs of sexual misconduct is common by emotionally disturbed pts </li></ul>
  10. 10. Principles of Assessment <ul><li>Identify yourself </li></ul><ul><li>Let them know youre there to help </li></ul><ul><li>Inform them of what youre doing </li></ul><ul><li>Ask questions in a calm/reassuring voice </li></ul><ul><li>Allow pt to tell what happened </li></ul><ul><li>Don’t be judgmental </li></ul><ul><li>Rephrase or repeat part of what you said to show you are listening </li></ul><ul><li>Acknowledge the pt feelings </li></ul><ul><li>Assess LOC </li></ul><ul><ul><li>Appearance </li></ul></ul><ul><ul><li>Activity </li></ul></ul><ul><ul><li>Speech </li></ul></ul><ul><ul><li>Orientation to time, person, place </li></ul></ul>
  11. 11. Assessment of Potential Violence <ul><li>Scene Size Up </li></ul><ul><li>Hx </li></ul><ul><ul><li>Check with family/bystanders if the pt has a Hx of aggression/violence </li></ul></ul><ul><li>Posture </li></ul><ul><ul><li>Stands/sits in position that threatens self/others </li></ul></ul><ul><ul><li>Clenched fists </li></ul></ul><ul><ul><li>Lethal objects in hands </li></ul></ul><ul><li>Vocal Activity </li></ul><ul><ul><li>Yelling </li></ul></ul><ul><ul><li>Threatens harm to self/others </li></ul></ul><ul><li>Physical Activity </li></ul><ul><ul><li>Moves toward caregiver </li></ul></ul><ul><ul><li>Carries heavy/threatening objects </li></ul></ul><ul><ul><li>Quick irregular movements </li></ul></ul><ul><ul><li>Tense muscles </li></ul></ul>
  12. 12. Methods to Calm Pt <ul><li>Acknowledge they seem upset </li></ul><ul><li>Restate you are there to help </li></ul><ul><li>Inform them of what you are doing </li></ul><ul><li>Ask questions in calm reassuring voice </li></ul><ul><li>Maintain a comfortable distance </li></ul><ul><li>Encourage pt to state what is troubling </li></ul><ul><li>Do not make quick moves </li></ul><ul><li>Respond honestly to questions </li></ul><ul><li>Do not threaten, challenge, argue with pt </li></ul><ul><li>Do not “play along” with visual/auditory disturbances of the pt </li></ul><ul><li>Involve trusted family members or friends </li></ul><ul><li>Be prepared to remain on scene for a long time </li></ul><ul><li>Do not leave pt alone </li></ul><ul><li>Avoid unnecessary contact </li></ul><ul><li>Use good eye contact </li></ul>
  13. 13. Restraining Pt’s <ul><li>Avoid unless pt is threat to self/others </li></ul><ul><li>Get med control approval </li></ul><ul><li>Involve the police </li></ul><ul><li>Be sure you have enough help </li></ul><ul><li>Plan activities </li></ul><ul><li>Use only the force needed for restraint </li></ul><ul><li>Estimate range of motion of pts legs and arms and stay outside it until ready </li></ul><ul><li>Act QUICKLY </li></ul>
  14. 14. Restraining Pt’s: How to… <ul><li>Have one EMT talk to the pt throughout </li></ul><ul><li>Approach with 4 people at the same time </li></ul><ul><ul><li>One for each limb </li></ul></ul><ul><li>Secure limbs together with approved equipment </li></ul><ul><li>Turn pt face down on stretcher </li></ul><ul><li>Secure to stretcher with multiple straps </li></ul><ul><li>If pt spits: Cover mouth with mask </li></ul><ul><li>Reassess circulation often </li></ul><ul><li>DOCUMENT indication for and methods of restraint </li></ul><ul><li>Avoid unnecessary force </li></ul>
  15. 15. And don’t forget….

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