23)Behavioral Emergencies
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23)Behavioral Emergencies






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23)Behavioral Emergencies 23)Behavioral Emergencies Presentation Transcript

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