Behavioral Emergencies

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Lewis County On-Going Training and Evaluation
Program 2007-2008
Behavioral Emergencies
MODULE 7
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Lewis County On-Going Training and Evaluation
Program 2007-2008

• Our OTEP modules contain graphic pictures
  depicting injuries that EMS providers may
  encounter while providing care in the field
• Our goal in providing real-life pictures is to
  enhance the learning experience by making the
  OTEP curriculum more interesting and engaging to
  Lewis County EMS providers

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Behavioral Emergencies
Lewis Countys On-Going Training and Evaluation
Program 2007-2008

• A behavioral emergency is created when a
  person is behaving in such a manner as to place
  themselves
• or others in imminent danger.

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Behavioral Emergencies
Lewis County On-Going Training and Evaluation
Program 2007-2008

• Among the most challenging type of calls.
• It is easier to deal with a.
• Trauma patient whose injuries are readily seen.
• Medical patient who can give you a good history.

• Oftentimes, it is difficult to recognize and
  treat the patient who is presenting with
  behavioral problems.

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Behavioral emergencies can result from many
different underlying conditions
Lewis County On-Going Training and Evaluation
Program 2007-2008

• Physical
• Stress or hypoxia
• Heat or cold exposure
• Head injuries or stroke
• Metabolic Disease
• Diabetic emergencies
• Thyroid diseases

• Neurologic Disease
• Dementia
• Alzheimers disease

• Psychogenic
• wide range of..
• behavioral problems or disruptive behavior.

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Treat with Dignity and Respect
Lewis County On-Going Training and Evaluation
Program 2007-2008

• We need to treat patients who are presenting with
  a behavioral emergency.

• With dignity and respect
• Just as we would treat any
• other patient weve been
• called to help.

• Should the patient.
• Give up their ability to act in a dignified
  manner
• We will continue to maintain a professional
  approach to patient care and treatment.

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Scene Safety
Lewis County

• Scene safety is of utmost importance.
• If dispatched to a behavioral emergency.
• Stage a couple of blocks away.
• Wait until law enforcement secures the scene.
• Continue to be cautious and alert to changes.

• If EMS providers are already on the scene and.
• The patient becomes combative or the scene
  becomes unsafe..
• The providers should keep their personal safety a
  priority.
• Tactfully withdraw and contact law enforcement.

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Lewis County

• Warning signs are often seen in the person whose
  behavior is deteriorating

• A person who is alone without support.
• A sad, tearful demeanor or thoughts of death.
• Gathering of destructive articles accompanied by
  a defined plan of action.
• History of destructive behavior.
• Bad news such as.
• The loss of a loved one.
• Diagnosis of a serious illness.
• Being arrested or imprisoned.
• Unexpected loss of income.

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Approach Cautiously
Lewis County On-Going Training and Evaluation
Program 2007-2008

• Move slowly, deliberately and do not place
  yourself in a position of vulnerability.
• Dont play along with delusional
  thinking/behavior.

• Answer questions honestly.
• Listen when the patient responds.
• Do not be argumentative.
• Dont tower over the patient.
• Use your words and body language to calm the
  patient.

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Provide Compassionate Care
Lewis County

• Always provide good patient care

• In a compassionate manner.
• Regardless of the treatment you receive in
  return.
• Always remain professional and competent.
• Consistently maintain a calm and collected
  demeanor.

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Suicide Attempts
Lewis County On-Going Training and Evaluation
Program 2007-2008

• Take all suicide attempts seriously.
• Even if the call for help comes from the patient,
  dont assume the threat has passed.

• Never..
• Turn away from or
• Leave the suicidal patient alone..
• Even for a few seconds.

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Disruptive Behavior
Lewis County On-Going Training and Evaluation
Program 2007-2008

• Sometimes, EMS personnel respond to patients who
  are exhibiting disruptive behavior.

• Take extra time to assess the situation.
• Do not take your eyes off this type of patient.
• Be alert for aggressive behavior.
• Never turn your back or leave the patient alone,
  even for a minute.
• Remember that anything that can be held, thrown,
  swung, jabbed, etc., can be utilized as a weapon.
• It is not your job as an EMS professional to
  disarm anyone.

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The following slides are a few examples of
Disruptive Behaviors
Lewis County On-Going Training and Evaluation
Program 2007-2008
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Lewis County On-Going Training and Evaluation
Program 2007-2008
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Lewis County On-Going Training and Evaluation
Program 2007-2008
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Lewis County On-Going Training and Evaluation
Program 2007-2008
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Lewis County On-Going Training and Evaluation
Program 2007-2008
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Managing Disruptive Behavior
Lewis County On-Going Training and Evaluation
Program 2007-2008

• Act confidently and decisively.
• Provide care as soon as the risk is minimized.
• Explain what you are doing to the patient.
• Document the patients behavior.
• Do not judge a patients actions or lecture
  him/her about their behavior.
• Be careful about labeling a patient.
• Always assume complaints are genuine.
• Above all, dont get angry with the patient.

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Lewis County On-Going Training and Evaluation
Program 2007-2008
Restraints
If the patient presents a threat to self or
others, providers have the legal right to care
for and even restrain, the patient against his or
her will. Restraints can minimize the risk of
combative/violent patients but must be done in
accordance with Lewis County Protocols.
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Lewis County On-Going Training and Evaluation
Program 2007-2008
Safety Considerations Restraints

• Do not start unless you are confident you can
  accomplish the task.
• Ensure you have enough help to safely restrain
  the patient.

• Call law enforcement for assistance.
• Stay outside of the patient's range of motion.
• Use only the force necessary to restrain the
  patient.

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Lewis County On-Going Training and Evaluation
Program 2007-2008
Restraints
Restraint should be accomplished with soft wide
leather or cloth restraints. If there are none
available with your equipment, then wide tape,
triangular bandages or rolled gauze can be
substituted.
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Positional Asphyxia

• Positional asphyxia is an airway obstruction
  caused by..
• Prone position and/or head being turned or
  tucked down.
• The patient sandwiched between two backboards.
• Hog tied with hands and feet secured behind
  back.
• Risk increases with a decreased mental status
  due to

• Medical illness
• Trauma
• Overdose
• Mental illness
• Substance abuse

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Lewis County EMS Protocols

• BEHAVIORAL
• EMERGENCIES
• FR, EMT-B,
• EMT-I, EMT-P
•  
• Utilize verbal de-escalation techniques
• 1. Begin by asking the patient to follow
  your
• orders.
• 2. Advise him/her of the consequences of
  not
• following your orders.
• 3. Order him/her to do what you want them
  to do.

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Lewis County EMS Protocols

•  
• Requirements for the use of force
• 1. You must have legitimate
• objectives
• a) For your safety.
• b) For the safety of others.
• c) For the patient's safety.
• d) To facilitate treatment in a
  mentally
• incompetent patient.
  

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Lewis County EMS Protocols

•  
• It must be immediately necessary,
• law enforcement must be notified.
• a) Request that law enforcement
  
• place patient in protective custody.
• b) Document officer's name and
• agency if he/she refuses to place
• patient in protective custody
• 3. You must use the minimal amount of effective
  force initially.
• 4. It must immediately cease once objective has
  been met.

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Yakima County EMS Protocols

•  
• EMT-P only Verbal Order - Chemical Restraint -
  Versed 2.0 - 5.0 mg, IM or IV.
• Do not use any of the following restraining
  techniques that could impair breathing.
• 1. Hogtying, where hands feet
• are bound behind the patient.
• 2. Sandwiching the patient
• between two backboards.
• 3. Transporting the patient
• in the prone position.

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Lewis County EMS Protocols

• After a patient is under control,
• use humane techniques to
• restrain the patient.
• Once a patient is restrained,
• do not release him/her.
• If a patient is still in handcuffs, a police
  officer must
• accompany the patient during transport or
  remove the
• handcuffs.
• The patient's condition must be closely and
• continuously monitored.
• Contact the receiving hospital when feasible.
• Document all facts regarding the objectives of
  the
• restraint.

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ANY QUESTIONS?
Lewis County On-Going Training and Evaluation
Program 2007-2008