This document discusses the assessment and care of patients experiencing behavioral emergencies. It outlines several causes of behavioral changes including medical conditions, substances, and psychological crises. When assessing a patient, EMTs should evaluate their mental status, speech, orientation, and risk of violence. Care involves maintaining distance, encouraging talking, and avoiding threats or arguments. Restraints may be needed if the patient is a danger, and should be done quickly with adequate help while avoiding positional asphyxia. Suicide risk factors and signs are also outlined.

1. Chapter Behavioral Emergencies Nineteen

2. Chapter Assessment of psychiatric presentation Differentiation between altered mental status caused by psychiatric condition and altered mental status from medical or traumatic conditions Care for psychiatric patients Safe and effective use of restraints Nineteen CORE CONCEPTS

3. Behavioral Emergency A situation in which the patient exhibits behavior that is unacceptable or intolerable to the patient, family, or community Behavior The manner in which a person acts K EY TERMS

4. Low blood sugar Lack of oxygen Inadequate blood flow to brain Head trauma Mind-altering substances Excessive cold Excessive heat Psychological crises Causes of Behavioral Change

5. Panic Agitation Bizarre thinking and behavior Danger to self Danger to others Psychological Crises

6. Identify yourself and your role. Inform patient what you are doing. Ask questions in a calm, reassuring voice. Actions to Take (Continued) Behavioral Emergencies

7. Do not be judgmental. Acknowledge patient’s feelings. Show you are listening by rephrasing what is said. Treat patient with respect. Actions to Take Behavioral Emergencies

8. Patient ASSESSMENT Behavioral Emergencies Signs and Symptoms Assess the patient ’s mental status: Appearance Activity Speech Orientation (Continued)

9. Patient ASSESSMENT Behavioral Emergencies Signs and Symptoms Assess for potential violence: History of violent behavior Posturing Vocal activity Physical activity

10. Patient CARE Behavioral Emergencies Emergency Care Steps Maintain a comfortable distance. Encourage patient to talk. Do not make quick moves. Respond honestly to questions. (Continued)

11. Patient CARE Behavioral Emergencies Emergency Care Steps Do not threaten, challenge, or argue. Do not play along with visual or auditory disturbances. Involve trusted family or friends. (Continued)

12. Patient CARE Behavioral Emergencies Emergency Care Steps Be prepared to spend time with patient. Avoid unnecessary physical contact. Use positive eye contact. Restrain if necessary.

13. Use of Restraints Emotionally disturbed patients may refuse care. For care to be provided against patient’s wishes, patient must be harmful to self/others. Medical-Legal Implications (Continued)

14. If patient is a threat to self or others, you may transport without consent. Medical-Legal Implications May require medical direction. Usually requires law enforcement. (Continued) Use of Restraints

15. Have adequate help. Plan. Stay clear of patient until prepared. (Continued) Use of Restraints

16. Once decision is made — act quickly. Have one EMT-B talk patient through process. Secure patient with approved position/materials. (Continued) Use of Restraints

17. Use reasonable force to prevent patient from injuring self, others. Avoid force that may injure patient. (Continued) Use of Restraints

18. Reasonable force determined by: Patient’s size and strength Type of abnormal behavior Sex of patient Mental state of patient Method of restraint Use of Restraints

19. Death of a restrained patient — possibly due to respiratory problems caused by restraint Positional Asphyxia K EY TERM

20. Preventing Positional Asphyxia Do not use hog-tie as a hobble restraint. Position patient face up when possible. Monitor patient carefully while restrained.

21. Reassess patient frequently. Document incident thoroughly: Indications Methods Witnesses Use of Restraints

22. Over 40 years old; single, widowed, or divorced; alcoholic; depressed Lethal plan of action Possession of articles capable of causing death (gun, pills) (Continued) Suicide Risk Factors

23. Previous history of self- destructive behavior Recent diagnosis of serious illness Recent loss of loved one Arrest, imprisonment, loss of job Suicide Risk Factors

24. Patient ASSESSMENT Suicidal Behavior Signs and Symptoms Size-up is important. Beware of dangers: Display of self-destructive behavior or thoughts Illness or injury resulting from previous attempts

25. Patient ASSESSMENT Breathing Adequacy Signs and Symptoms How does patient feel? Suicidal tendencies? Is patient a threat to self/others? Is there a medical problem?

26. Patient CARE Suicidal Behavior: Emergency Care Steps Size-up, personal safety concerns. Perform patient assessment. Calm the patient. Do not leave patient alone. Restrain, if necessary. Consider need for law enforcement. Transport.

27. Assessment and care of the behavioral emergency patient require a high level of caution. Experienced EMT-Bs know that anything can happen at any time. Newly certified EMT-Bs should be reminded to maintain a safe distance when managing all behavioral emergency patients. Tell them that management of the behavioral emergency takes a while, and as an EMT-B, they must be prepared to spend time with the patient. Encourage them to remember that these types of calls require that they become “patient with the patient.” P RECEPTOR P EARL

28. 1. List several causes for behavioral change. 2. Describe several verbal and physical methods for assessment of a behavioral emergency. 3. Explain how to safely apply a restraint. R EVIEW QUESTIONS