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

2. Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ DOT Directory U.S. DOT Objectives Directory U.S. DOT Objectives are covered and/or supported by the PowerPoint™ Slide Program and Notes for Emergency Care, 11th Ed. Please see the Chapter 23 correlation below. *KNOWLEDGE AND ATTITUDE 4-8.1 Define behavioral emergencies. Slide 88 4-8.2 Discuss the general factors that may cause an alteration in a patient ’ s behavior. Slide 99 4-8.3 State the various reasons for psychological crises. Slide 99 4-8.4 Discuss the characteristics of an individual ’ s behavior which suggest that the patient is at risk for suicide. Slides 16-1716-17 4-8.5 Discuss special medical/legal considerations for managing behavioral emergencies. Slides 25, 302530 4-8.6 Discuss the special considerations for assessing a patient with behavioral problems. Slides 13-1413-14 4-8.7 Discuss the general principles of an individual ’ s behavior which suggest that he is at risk for violence. Slide 2020 (cont.)

3. Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ DOT Directory U.S. DOT Objectives Directory *KNOWLEDGE AND ATTITUDE 4-8.8 Discuss methods to calm behavioral emergency patients. Slides 10-1110-11 4-8.9 Explain the rationale for learning how to modify your behavior toward the patient with a behavioral emergency. Slides 10-1110-11 (cont.)

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

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

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

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

8. Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ DOT Directory 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. The EMT’s Role

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

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

11. Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ 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. General Rules—Psychiatric

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

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

14. Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ DOT Directory 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 Common Signs and Symptoms

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

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

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

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

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

20. Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ DOT Directory Aggressive or Hostile Patients Aggressive or disruptive behavior may be caused by trauma to the brain and nervous system, metabolic disorders, stress, alcohol, other drugs, or psychological disorders ?

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

22. Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ DOT Directory 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 Signs and Symptoms— Aggressive Patient

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

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

25. Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ DOT Directory 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. Reasonable Force and Restraint

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

27. Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ 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. Guidelines—Restraints (cont.)

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

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

30. Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ DOT Directory 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. Medical-Legal Considerations

31. Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ DOT Directory Review Questions 1. Name several conditions that can 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.)

32. Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ DOT Directory 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 the circumstances that must exist for you to treat and transport a behavioral emergency patient without consent.

33. Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ 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? Street Scenes (cont.)

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

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