BEHAVIORAL EMERGENCIES

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BEHAVIORAL EMERGENCIES
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• Defined
• Behavior manner in which a person acts or
  performs any or all activities of a person,
  including physical and mental activity
• Behavioral emergency a situation where the pt.
  exhibits abnormal behavior within a given
  situation that is unacceptable or intolerable to
  patient, family or community

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• Key part of the definition is within a given
  situation
• Cultures with different lifestyles
• Behavioral emergencies
• require patient assessment
• do not judge hastily or solely on the way
  they look or act

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• Physical causes of altered behavior
• Medical and trauma related
• Hypoglycemia
• Lack of oxygen
• Stroke
• Head trauma
• Mind-altering substances
• Excessive cold or heat

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• Situational stress reactions
• Unexpected stress reactions
• fear, grief, anger
• Personal interaction will inspire confidence and
  pt. should begin to calm down and feel able to
  cope
• Let pt. know you are there to help
• Act in a calm manner gives pt. time to get
  control of emotions

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• Keep your own emotions under control
• Let pt. know you are listening and explain things
  honestly
• Stay alert for sudden changes in behavior

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• Care psychiatric
• Identify yourself and your role
• Speak slowly and clearly using calm and
  reassuring tones
• Listen
• Do not be judgmental, show compassion
• do not pry

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• Use positive body language
• avoid crossing arms or looking uninterested
• Acknowledge the pts feelings
• Do not enter the pts personal space
• Be alert for changes in emotional status
• increasingly aggressive behavior

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• Assessment
• Perform a careful scene size-up
• Identify yourself and your role
• Initial assessment
• mental status
• Perform as much as focused or detailed as much as
  possible medical or trauma conditions
• Thorough patient history

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• Common presentations or signs and symptoms
• Panic or anxiety
• Unusual appearance, discolored clothing, poor
  hygiene
• Agitated or unusual activity
• Unusual speech patterns
• Bizarre behavior or thought patterns

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• Violent or aggressive behavior with threats or
  intents to harm others
• Care
• Scene safety
• Treat any life-threats
• Be alert for medical or trauma that could mimic a
  behavioral emergency
• Be prepared to spend time talking to the patient

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• Encourage the pt. to talk to you about what is
  troubling them
• Never play along with any visual or auditory
  hallucinations
• Do not lie to the pt.
• If it appears it will help, involve friends or
  family in the conversation

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• Suicide no one is exempt
• Eight leading cause of death
• Third leading cause of death in 15 24 year olds
• Reached alarming levels among seniors
• Many reasons and many ways

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• Assessment
• Factors associated with a risk for suicide
• Depression
• High current or recent stress levels
• Recent emotional trauma
• Age
• Alcohol and drug abuse

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• Threats of suicide
• Suicide plan
• Previous attempts or threats
• Sudden improvement from depression

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• Care
• Scene size-up
• Treat life-threats to the extent allowed
• Try to establish visual and verbal contact as
  soon as possible
• Avoid arguing, make no threats, show no
  indication of using force
• As soon as possible, perform a focused hx. and PE
  and provide care

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• Detailed PE only if it is safe and you suspect
  pt. may have an injury
• On-going assessment
• Contact E.R. keep them advised and up-to-date
• Throughout interaction speak slowly and patiently
  await response

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Aggressive or hostile patietns

• May be cause by
• Trauma to the brain or nervous system
• Metabolic disorders
• Stress
• Alcohol or other drugs
• Psychological disorders

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• May be alerted to pts condition from
• Dispatch
• Clues
• yelling
• unclean conditions
• Neighbors
• Family
• Bystanders
• Patient stance or position in a room

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• Take the following precautions
• Do not isolate yourself from your partner or
  other source of help
• Make sure you have an escape route
• Do not let the pt. come between you and the door
• Do not take any action that may be interpreted as
  threatening

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• Always be on the watch for weapons
• Stay out of the kitchen
• Stay in safe area until the police can control
  the scene
• Be alert for sudden changes in behavior

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• Assessment
• Responds to people inappropriately
• Tries to hurt self or others
• May have rapid pulse or breathing
• Usually displays rapid speech, movements
• May appear anxious, nervous, panicky

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• Care
• Scene size-up
• Standard precautions
• Medical direction if behavior prevents normal
  assessment and care
• On-going assessment sudden changes in behavior

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• Restraint