Chapter 23 Behavioral Emergencies DOT Directory Limmer et

Chapter 23 Behavioral Emergencies DOT Directory Limmer et al. , Emergency Care, 11 th Edition © 2009 by Pearson Education, Inc. , Upper Saddle River, NJ

U. S. DOT Objectives Directory U. S. DOT Objectives are covered and/or supported by the Power. Point™ Slide Program and Notes for Emergency Care, 11 th Ed. Please see the Chapter 23 correlation below. *KNOWLEDGE AND ATTITUDE • 4 -8. 1 Define behavioral emergencies. Slide 8 • 4 -8. 2 Discuss the general factors that may cause an alteration in a patient’s behavior. Slide 9 • 4 -8. 3 State the various reasons for psychological crises. Slide 9 • 4 -8. 4 Discuss the characteristics of an individual’s behavior which suggest that the patient is at risk for suicide. Slides 16 -17 • 4 -8. 5 Discuss special medical/legal considerations for managing behavioral emergencies. Slides 25, 30 • 4 -8. 6 Discuss the special considerations for assessing a patient with behavioral problems. Slides 13 -14 • 4 -8. 7 Discuss the general principles of an individual’s behavior which suggest that he is at risk for violence. Slide 20 DOT Directory (cont. ) Limmer et al. , Emergency Care, 11 th Edition © 2009 by Pearson Education, Inc. , Upper Saddle River, NJ

U. S. DOT Objectives Directory *KNOWLEDGE AND ATTITUDE • 4 -8. 8 Discuss methods to calm behavioral emergency patients. Slides 10 -11 • 4 -8. 9 Explain the rationale for learning how to modify your behavior toward the patient with a behavioral emergency. Slides 10 -11 DOT Directory (cont. ) Limmer et al. , Emergency Care, 11 th Edition © 2009 by Pearson Education, Inc. , Upper Saddle River, NJ

U. S. DOT Objectives Directory *SKILLS • 4 -8. 10 Demonstrate the assessment and emergency medical care of the patient experiencing a behavioral emergency. • 4 -8. 11 Demonstrate various techniques to safely restrain a patient with a behavioral problem. DOT Directory Limmer et al. , Emergency Care, 11 th Edition © 2009 by Pearson Education, Inc. , Upper Saddle River, NJ

Altered Behavior DOT Directory Limmer et al. , Emergency Care, 11 th Edition © 2009 by Pearson Education, Inc. , Upper Saddle River, NJ

Behavior • The manner in which a person acts or performs DOT Directory © Craig Jackson/In the Dark Photography Limmer et al. , Emergency Care, 11 th Edition © 2009 by Pearson Education, Inc. , Upper Saddle River, NJ

Behavioral Emergency • Abnormal behavior within a given situation that is unacceptable or intolerable to the patient, the family, or the community DOT Directory Limmer et al. , Emergency Care, 11 th Edition © 2009 by Pearson Education, Inc. , Upper Saddle River, NJ

The EMT’s Role • Recognize potentially dangerous patients and act with safety. • Documentation of findings and care • Methods of calming and interacting behavioral emergencies • Restraining a patient • Identify patients experiencing behavior emergencies. DOT Directory Limmer et al. , Emergency Care, 11 th Edition © 2009 by Pearson Education, Inc. , Upper Saddle River, NJ

Causes of Altered Behavior Low blood sugar Excessive heat Excessive cold DOT Directory Lack of oxygen Altered Behavior Mindaltering substances Inadequate blood to the brain or stroke Head trauma Limmer et al. , Emergency Care, 11 th Edition © 2009 by Pearson Education, Inc. , Upper Saddle River, NJ

Situational Stress Reactions Treat patient as individual. Personal interaction inspires confidence in your ability to help. Give the patient time to gain control of his/her emotions. Explain things honestly. Stay alert to sudden changes. DOT Directory Limmer et al. , Emergency Care, 11 th Edition © 2009 by Pearson Education, Inc. , Upper Saddle River, NJ

General Rules—Psychiatric • • DOT Directory Identify yourself and your role. Speak slowly and clearly. Listen. Don’t be judgmental. Use positive body language. Acknowledge the patient’s feelings. Recognize the patient’s personal space. Limmer et al. , Emergency Care, 11 th Edition © 2009 by Pearson Education, Inc. , Upper Saddle River, NJ

Patient Assessment DOT Directory Limmer et al. , Emergency Care, 11 th Edition © 2009 by Pearson Education, Inc. , Upper Saddle River, NJ

Patient Assessment Scene size-up. Identify yourself and your role. Initial assessment. Perform focused and detailed examination. Obtain history. DOT Directory Limmer et al. , Emergency Care, 11 th Edition © 2009 by Pearson Education, Inc. , Upper Saddle River, NJ

Common Signs and Symptoms • Panic or anxiety • Unusual appearance, disordered clothing, poor hygiene • Agitation or unusual activity • Unusual speech patterns • Bizarre behavior or thought patterns • Suicidal, violent, or aggressive behavior DOT Directory Limmer et al. , Emergency Care, 11 th Edition © 2009 by Pearson Education, Inc. , Upper Saddle River, NJ

Patient Care Involve family members. Encourage patient to talk. Never play along with visual or auditory hallucinations. Be alert for personal or scene safety. Treat life-threatening problems. Be alert for medical and traumatic conditions. DOT Directory Be alert for personal or scene safety. Limmer et al. , Emergency Care, 11 th Edition © 2009 by Pearson Education, Inc. , Upper Saddle River, NJ

Suicide Third leading cause of death in the 15 - to 24 -year age group High levels of depression and suicide in senior citizens Reasons: – Chemical imbalance – Death of a loved one – Financial problems – End of a love affair DOT Directory Limmer et al. , Emergency Care, 11 th Edition © 2009 by Pearson Education, Inc. , Upper Saddle River, NJ

Potential or Attempted Suicide Factors Depression Substance Abuse Recent emotional trauma Age Suicide Factors Suicide Plan Sudden Improvement Stress levels DOT Directory Limmer et al. , Emergency Care, 11 th Edition © 2009 by Pearson Education, Inc. , Upper Saddle River, NJ

Patient Care DOT Directory Limmer et al. , Emergency Care, 11 th Edition © 2009 by Pearson Education, Inc. , Upper Saddle River, NJ

Patient Care Begins with scene size-up. Look for and treat life-threatening problems. Perform a focused history and physical exam. Perform a detailed physical exam. Perform ongoing assessment. DOT Directory Give hospital report. Limmer et al. , Emergency Care, 11 th Edition © 2009 by Pearson Education, Inc. , Upper Saddle River, NJ

Aggressive or Hostile Patients ? DOT Directory Limmer et al. , Emergency Care, 11 th Edition © 2009 by Pearson Education, Inc. , Upper Saddle River, NJ

Precautions • Do not isolate yourself from your partner or other sources of help. • Do not take any action that may be considered threatening by the patient. • Watch for weapons. • Be alert to sudden changes in patient’s behavior. DOT Directory Limmer et al. , Emergency Care, 11 th Edition © 2009 by Pearson Education, Inc. , Upper Saddle River, NJ

Signs and Symptoms— Aggressive Patient • • Responds to people inappropriately Tries to hurt himself or others May have a rapid pulse and breathing Rapid speech and physical movements • Appears anxious, nervous, or panicky DOT Directory Limmer et al. , Emergency Care, 11 th Edition © 2009 by Pearson Education, Inc. , Upper Saddle River, NJ

Patient Care—Aggressive Patient Scene size-up. Consult with medical control. Watch for sudden changes in behavior. Seek assistance from law enforcement. DOT Directory Limmer et al. , Emergency Care, 11 th Edition © 2009 by Pearson Education, Inc. , Upper Saddle River, NJ

Reasonable Force and Restraint • Determined by: – Circumstances involved – Patient’s strength and size – Type of abnormal behavior – Mental status – Available methods of restraints DOT Directory (cont. ) Limmer et al. , Emergency Care, 11 th Edition © 2009 by Pearson Education, Inc. , Upper Saddle River, NJ

Reasonable Force and Restraint • EMTs cannot legally restrain a patient. • Restraint is usually within the jurisdiction of law enforcement. • Police and physicians can order you to restrain and transport. • Follow local protocol. DOT Directory Limmer et al. , Emergency Care, 11 th Edition © 2009 by Pearson Education, Inc. , Upper Saddle River, NJ

Restraint • Sufficient personnel • Restraints must be humane. • Handcuffs and plastic “throwaway” criminal restraints should not be used. • Use soft restraints, such as leather cuff and belts, if authorized. DOT Directory Limmer et al. , Emergency Care, 11 th Edition © 2009 by Pearson Education, Inc. , Upper Saddle River, NJ

Guidelines—Restraints DOT Directory Have adequate help. Plan your activities. Estimate range of motion of the patient’s arms and legs. Have one EMT talk to and reassure patient during procedure. Approach with a minimum of four persons. Secure all four limbs with restraints. Position the patient face up. (cont. ) Limmer et al. , Emergency Care, 11 th Edition © 2009 by Pearson Education, Inc. , Upper Saddle River, NJ

Guidelines—Restraints • Use multiple straps or other restraints. • If patient is spitting, use surgical mask and have rescuers wear masks and eye protection. • Reassess circulation. • Avoid unnecessary force. • Document the need for restraint and technique used. DOT Directory Limmer et al. , Emergency Care, 11 th Edition © 2009 by Pearson Education, Inc. , Upper Saddle River, NJ

Caution! • Never “hog tie” the patient or restrain in a manner that will impair breathing. • Improperly restrained patients have died as a result of “positional asphyxia. ” • Transport to an appropriate medical facility. DOT Directory Limmer et al. , Emergency Care, 11 th Edition © 2009 by Pearson Education, Inc. , Upper Saddle River, NJ

Medical-Legal Considerations • Most states have a provision in the law that allows a patient to be transported against his will if he is a danger to himself or others. • Know your state laws. • Consider contacting medical direction. DOT Directory Limmer et al. , Emergency Care, 11 th Edition © 2009 by Pearson Education, Inc. , Upper Saddle River, NJ

Review Questions 1. Name several conditions that can DOT Directory alter a person’s mental status and behavior. 2. List several methods that can help calm the patient suffering a behavioral or psychiatric emergency. 3. Describe the signs and symptoms of a behavioral or psychiatric emergency. (cont. ) Limmer et al. , Emergency Care, 11 th Edition © 2009 by Pearson Education, Inc. , Upper Saddle River, NJ

Review Questions 4. Describe what you can do when scene size-up reveals that it is too dangerous to approach the patient. 5. List several factors that can help you assess the patient’s risk for suicide. 6. Research your state law. Then describe DOT Directory the circumstances that must exist for you to treat and transport a behavioral emergency patient without consent. Limmer et al. , Emergency Care, 11 th Edition © 2009 by Pearson Education, Inc. , Upper Saddle River, NJ

Street Scenes DOT Directory • What is your first and most important concern? • How should you handle the matter of scene safety? • When should you approach the patient? (cont. ) Limmer et al. , Emergency Care, 11 th Edition © 2009 by Pearson Education, Inc. , Upper Saddle River, NJ

Street Scenes DOT Directory • How should the patient be approached? • What are the safety concerns when working with an agitated patient? • Does this patient need a medical assessment? Limmer et al. , Emergency Care, 11 th Edition © 2009 by Pearson Education, Inc. , Upper Saddle River, NJ

Sample Documentation DOT Directory Limmer et al. , Emergency Care, 11 th Edition © 2009 by Pearson Education, Inc. , Upper Saddle River, NJ