Behavioral Emergencies

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Behavioral Emergencies

• A lecture about the medically and mentally ill
• Nikhil Natarajan
• REMT-P

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Definitions

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

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• 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.

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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

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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

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Suicidal Patients

• Most suicidal patients exhibit some signs of
  depression as well as thoughts of death or taking
  ones 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

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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

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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.

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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.

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What can you do so you dont 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

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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

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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

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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

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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

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The End

• Any questions???