1. INTEGRATING CRISIS INTERVENTION TRAINING BETWEEN POLICE AND FIRE A COLLABORATION OF RESOURCES

2. HOW DID WE GET STARTED You need to think outside the box. You need to knock on some doors to get the message across in regards to personnel safety, consumer safety, and better service to the community. Training Safety Customer service

3. HOW DID WE GET STARTED Training (picture)

4. HOW DID WE GET STARTED Safety Roles Police: the operational consideration in regards to the safety of the officer and that of the consumer is the possible mechanism of injury or other underline cause for their behavior:  Trauma  Disease  Infection  Drug use (prescription and illegal drugs)  Death of a loved one or some other tragic event in their lives EMS: the operational consideration in regards to the safety for EMS/Fire personnel is to standby until police clear the scene and declare the scene is safe.

5. HOW DID WE GET STARTED Customer Service Judgment : Please do not judge our consumers Emotions: Don’t let your emotions come into play, this can and has been proven to be a very dangerous proposition

6. BENEFITS OF COLLABORATION AND WHY Emergency Detention the significance of generating the ED form is that in its absence the consumer may leave the hospital before receiving a proper medical evaluation by a physician, thus creating a vicarious liability on both departments.  For Example: customer is placed in triage waiting room, customer leaves the hospital before receiving medical treatment. They could go home and finish what they were unable to complete prior to Police and EMS intervention.

7. BENEFITS OF COLLABORATION AND WHY Many times the Fire Department is the first responder on the scene. For the Fire Dept. to be CIT trained helps in the referral process for several reasons:  Fire/EMS can: Be a credible person to facilitate the Emergency Detention process Request a CIT trained officer to assist Assist the Officer with medically compromised consumers A lot of times when an Officer arrives at the scene the presence of a uniform can cause a consumer to “hold it together”. By having the Fire/EMS trained in the Crisis Intervention allows for a credible person to inform the Officer of any statements or actions observed prior to the Officers arrival.

8. ROLE PLAYS: TACTICS VS. MEDICAL CONCERNS The importance of this recognition is for your safety and that of the consumer which could ultimately become a legal concern for you in the future Fire Department can assist in finding the root cause for what is presumably mental illness which in fact maybe some underlying medical conditions If your not sure if an underlying medical need has not been met or needs to be met, this information can be easily ascertained by asking the customer or their family Some clues as to a the possibility of a medical condition or past medical history are:  medic-alert tag  recent trauma or illness  bottles of prescription medications on counter or surrounding area.

9. MENTAL HEALTH CRISIS VS. MEDICAL EMERGENCY Medical emergencies that exist may manifest themselves in a manner that appears to be behavioral in nature. Never discount the possibility that the consumer may be suffering from a medical emergency, or the potential for medical intervention by EMS/Fire

10. MENTAL HEALTH CRISIS VS. MEDICAL EMERGENCY Out in the field it may difficult at best to differentiate between mental illness or medical distress that is organic in nature, there are a few signs to help aid you:  Respiratory rate or difficulty breathing  Heart rate  Pupil response  Temperature  Skin(very hot, very cold, sweaty)  Chest Pain  Obtain a medical history

11. MENTAL HEALTH CRISIS VS. MEDICAL EMERGENCY Other conditions may show psychiatric symptoms  Alzheimer’s disease  Diabetes  Head Trauma  Brain trauma  Hypoglycemia  Dehydration  Hypoxia  Hypothermia  Substance intoxication  Substance withdrawal  Stroke

12.  Consumer feels threatened and has the potential to become violent, and/or aggressive  Could escalate to the point where they cause harm to self or others  Maintain your degree of professionalism and continue to remain an advocate for the consumer and their family CITIZEN SUPPORT IN TIMES OF CRISIS

13. CHEMICAL SEDATION CONSIDERATION IN LIEU OF ELECTRICITY Depending on your system, EMS may administer chemical sedation to consumers that meet the behavioral emergency criteria When would chemical sedation be a good idea …?  geriatrics  excited delirium  drug induced psychosis  General behavioral disorders  When you are considering restraining the customer for their safety and yours

14. INVOLUNTARY TRANSPORT AND PATIENT RESTRAINT Is the customer a threat to themselves or others..? Physically restrained and extremely agitated consumers should be chemically restrained as well  Calms behavior with altering consciousness  Valium, Versed (use with caution and EMS must monitor constantly)  Be alert at all times and assure that the customer needs are being met: Airway Position of the customer Underline medical conditions  Diabetes  Asthma  Heart Condition  Mental status

15. INVOLUNTARY TRANSPORT AND PATIENT RESTRAINT Restraint asphyxia  Description and definition Inability to expand chest cavity, create negative lung pressure for inspiration  Set of Causes Positional asphyxia Do not hog tie Too tight, incorrect application May strangle through escape attempt

16. INVOLUNTARY TRANSPORT AND PATIENT RESTRAINT Restraints help prevent injury to the police, fire, ems and most importantly the customer. Our job is to minimize the effects or potential dangers to the consumer and others with minimal or the least possible intervention.

17. WHAT IS IT..? MEDICATION IDENTIFICATION Fire/EMS is trained in the areas of medication recognition. This can help the Officer with his determination of executing an emergency detention.

18. LINES OF RESPONSIBILITY Who should be responsible for the transportation of the consumer and what facility should the consumer be transported …?