Behavioral Emergencies

1

Edgar G. Manood EMT-B,RM,RN,MAN, MA.Ed.,Phd.

You are the providerYou and your EMT-B partner are dispatched to Room 18, 9 waves resort, San Mateo, Rizal for attempted suicide. As you pull up to the room a young and gorgeous hunk comes running out the front door screaming for you to help his rich BFF. He explained that his BFF is in the restroom crying and threatening to kill himself.

1.What is your first step in treatment?2.Should you call for law enforcement support?

2

Learning Objectives After an hour of lecture the participants will effectively:

• Define behavioral emergencies• Discuss the general factors that may cause alteration in a patient’s behavior

• State the various reasons for psychological crises

• Discuss the characteristics of an individual’s behavior which suggest that the patient is at risk for suicide

3

• Discuss special medico legal consideration for managing behavioral emergencies.

• Discuss the special considerations for managing behavioral emergencies

• Discuss the general principles of an individual’s behavior which suggest that the patient is at risk for violence

• Discuss methods to calm behavioral emergency patients.

4

Myth & Reality• Everyone has mental illness problems at some point.•Perfectly healthy people may have symptoms occasionally.• Only a small percentage of

mental health patients are violent

5

6

Behavioral crisis•Any reaction to events that interferes with activities of daily living or that becomes unacceptable to the patient, family, or others.•A pattern, not an isolated incident.

Behavior•What you can see of a person’s response to the environment and his or her actions

Causes of behavioral emergencies

7

•Sudden grief or trauma•Inadequate blood flow to the brain•Drug or alcohol intoxication•Lack of oxygen•Low blood glucose•Other psychological problems•Excessive heat or cold•Organic brain syndrome-caused by

disturbance in brain tissue function•Functional disorder-cannot be traced to change in structure or physiology of the brain

8

Safety guidelines•Be prepared to spend extra time•Have a plan of action•Identify yourself calmly•Be direct•Assess the scene•Stay with patient•Encourage purposeful movement•Express interest.•Do not get too close.•Avoid fighting.•Be honest and reassuring.•Do not judge

9

Assessment of Behavioral emergencies

•Scene size up•Initial assessment

- General impression- Airway- Breathing- Circulation- Transport decision

•Focused history & PE-SAMPLE history- Focused PE

- Baseline vital signs-Intervention

• Detailed PE• Ongoing assessment

- Communication & documentation

10

Suicide• Depression is the single most significant factor that contributes to suicide

• An attempted suicide is a cry for help.

• Immediate intervention in necessary.

• Suicidal patients will usually exhibit warning signs.

11

Risk factors for suicide• Depression• Previous suicide attempt• Current expression of wanting to commit suicide

• Family history of suicide• Older than 40 years• Recent loss of support system• Chronic debilitating illness• Holidays

12

13

•Financial setback•Substance abuse•Children of alcoholic parent•Severe mental illness•Anniversary of death of love one•Unusual gathering or new acquisition of things that cause death

Critical warning signs of suicide

14

•Does the patient have an air of tearfulness, sadness, deep despair, deep despair, or hopelessness?•Does the patient avoid eye contact, speak slowly, or project a sense of vacancy?•Does the patient seem unable to talk about future?•Is there any suggestion of suicide?•Does the patient have any specific plans relating to death.

Additional risk factors for suicide• Are there any unsafe objects in the patient’s hands or nearby.

• Is the environment unsafe?• Is there evidence of self-destructive behavior?

• Keep in mind the suicidal patient may be homicidal as well.

15

Medico legal considerations• Mental incapacity may take many forms.

• Once a patient has been determined to have an impaired mental capacity, you must decide if care is needed.

• Do not leave the patient alone.• Obtain help from law enforcement as necessary.

16

17

Consent•When a patient is not mentally competent, the law assumes that there is implied consent.•The matter is not always clear-cut with psychiatric emergencies.•If you are not sure about the situation, request law

enforcement assistance.

Limited legal authority

18

•As an EMT-B, you have limited legal authority to require or force a patient to undergo care.•Police may put a patient in protective custody to allow you to provide care.•Know your local laws and protocols.

Restraints• You cannot restrain a patient unless it is an emergency.

• Transport a disturbed patient without restrains if possible.

• If you must restrain the patient, use only reasonable force.

• Law enforcement personnel should be involved.

19

20

Potentially violent patientsUse a list of risk factors to assess the level of danger:

-Past history-Posture -Scene-Vocal activity-Physical activity

21

Other factors to consider for potential violence

•Poor impulse control•History of uncontrollable temper•Low socioeconomic status•Substance abuse•Depression•Functional disorders

Buddha’s Advice to Calm a Disturbed

Mind

Emergency Care and Transportation of the Sick

and Injured, 8th Edition AAOS22

Once Buddha was walking from one town to another town with a few of his followers.. This was in the initial days. While they were traveling, they happened to pass a lake. They stopped there and Buddha told one of his disciples, “I am thirsty. Do get me some water from that lake there.”

23

The disciple walked up to the lake. When he reached it, he noticed that right at that moment, a bullock cart started crossing through the lake. As a result, the water became very muddy, very turbid. The disciple thought, “How can I give this muddy water to Buddha to drink!”

24

So he came back and told Buddha, “The water in there is very muddy. I don’t think it is fit to drink.” After about half an hour, again Buddha asked the same disciple to go back to the lake and get him some water to drink. The disciple obediently went back to the lake.

25

This time too he found that the lake was muddy. He returned and informed Buddha about the same. After sometime, again Buddha asked the same disciple to go back. The disciple reached the lake to find the lake absolutely clean and clear with pure water in it. The mud had settled down and the water above it looked fit to be had. So he collected some water in a pot and brought it to Buddha.

26

Buddha looked at the water, and then he looked up at the disciple and said,” See what you did to make the water clean. You let it be…. and the mud settled down on its own - and you got clear water. Your mind is also like that! When it is disturbed, just let it be. Give it a little time. It will settle down on its own. You don’t have to put in any effort to calm it down. It will happen. It is effortless."

27

28

Thank you