Behavioral Emergencies

1. Behavioral Emergencies A lecture about the medically and mentally ill Nikhil Natarajan REMT-P

2. Definitions Behavior - manner in which a person acts or performs; any or all activities of a person, including physical and mental activity.

3. Behavioral Emergency - a situation where the patient exhibits abnormal behavior within a given situation that is unacceptable or intolerable to the patient, family or community. This behavior can be due to extremes of emotion leading to violence or other inappropriate behavior or due to a psychological or physical condition such as lack of oxygen or low blood sugar in diabetes.

4. Crazy people may not be as crazy as you think There are many medical conditions that result in altered mental status such as: Hypoglycemia Hypoxia Head trauma Recreational pharmaceuticals Psychogenic shock resulting in deranged thinking Hypothermia or hyperthermia

5. Psychological Crisis's Behavioral emergencies usually consist of one of the following: Panic Agitation Bizarre thinking and behavior Danger to self - self destructive behavior, suicide Danger to others - threatening behavior, violence

6. Suicidal Patients Most suicidal patients exhibit some signs of depression as well as thoughts of death or taking one’s life. Risk factors: Individuals over 40, single, widowed or divorced, alcoholic, depressed. A defined lethal plan of action which has been verbalized. Unusual gathering of articles which can cause death such as purchase of a gun, large volumes of pills, etc. Previous history of self-destructive behavior. Recent diagnosis of serious illness. Recent loss of significant loved one. Arrest, imprisonment, loss of job

7. Assessment of the Suicidal Patient Some things to consider: How does the patient feel (before and after you arrive) Determine suicidal tendencies Is patient a threat to self or others (I.e. YOU!) Is there a medical problem Interventions Is the patient in an unsafe environment or with unsafe objects in his/her hands

8. What can you do for the suicidal patient Scene size-up, personal safety Patient assessment Calm the patient - do not leave patient alone Restrain if necessary. Consider need for law enforcement. Transport If overdose, bring medications or drugs found to medical facility.

9. There are two types of emotionally disturbed people – The ones that consent to care that are not usually a problem and the others. What do you do for the others? Emotionally disturbed patient will often resist treatment. May threaten EMT-Basics and others To provide care against patient's will, you must show a reasonable belief the patient would harm himself or others. If a threat to self or others, patient may be transported without consent after contacting medical direction. Usually law enforcement is required.

10. What can you do so you don’t get thrown in jail for doing your job? There are two basics types of force that are used in taking control of a violent patient? Reasonable force Unreasonable force

11. Force Reasonable force depends on what force was necessary to keep patient from injuring himself or others. Reasonableness is determined by looking at all circumstances involved. Patients size and strength Type of abnormal behavior Sex of patient Mental state of patient Method of restraint

12. What can you do? Call for police back up as soon as possible You CAN use reasonable force to protect yourself against an emotionally disturbed person, but the best thing to do is to remove yourself from the scene. The best type of dangerous situation is the one that is avoided

13. What do you say to an EDP? Talk calmly Reassure them that you are there to help Never play along with visual or auditory hallucinations

14. Bondage How to do it the right way! First – due no harm! No handcuffs! Soft Restraints only and the patient must meet state and local criteria

15. The End Any questions???