Behavioral Emergencies and crisis intervention

1
Behavioral Emergencies and
crisis intervention

• Dont let it make you crazy

2
What is Crisis

• A state of severe emotional turmoil
• Psychological homeostasis is off
• Crisis is good!!
• Trigger
• Real issue lies underneath
• Crisis requires short term help
• Crisis is a control problem

3
Basic Psych

• Psychotic and Psychosis
• Neurosis
• Organic Vs. Non-organic
• Does the truth matter??
• Splitting and bargaining

4
Some Organic Disorders

• Schizophrenia
• Bipolar (manic-depression)

5
Some Non- Organic Disorders

• PTSD
• Depression ?
• Personality Disorders
• Borderline Personality

6
Scene Assessment

• Is it safe?
• Do I have means of egress?
• Do we have a plan?
• Does everyone know our plan?
• One person is in charge

7
Patient Approach

• Non threatening (safety first)
• Slow, and calm
• Watch his personal space
• Can I make physical contact?
• Intermittent eye contact
• Stand beside the Patient

8
Provider Posture

• SAFETY, SAFETY, SAFETY
• Body language
• Shoulder first
• Us Vs Them
• Eye level

9
Patient Assessment

• What does the environment look like?
• How does the patient present?
• What is their affect?
• What is my affect?
• How do I present?

10
Patient Assessment

• ABCs (sound familiar)
• Consider Medical or Substance Abuse
• Speech
• Affect
• Alertness
• Thought process

11
Verbal interaction

• Talking is good, keep it going!!!
• Forced teaming
• Empathize
• Open questions echoing
• Cadence and tone

12
Verbal attacks

• Never get angry, (it aint personal)
• What are my options?
• Deflect attack
• Accept attack
• Turn the attack (non-threatening)

13
Control the crisis

• Let the patient know his options
• Steer his direction by giving options
• Options start wide, and narrow down
• Through making decisions the pt regains his
  psychological homeostasis (and control)
• Crisis curve

14
Moving the patient

• Never corner patient (Why not?)
• Never turn your back to a patient
• Never let them out of your sight
• Between the two of you

15
Point of No return

• Options of failed
• Patient escalates to violence
• BE READY!
• KNOW THE PLAN
• Let go??? Are you sure?

16
Take Downs

• Only when all options have failed
• Slow and smooth
• If your angryYour in crisis!!
• One man take down
• Two man take down
• Weapon removal

17
Restraints

• Document (why and how)
• Monitor distal function Q15 minutes
• ROM Q1hour
• Biggest liability
• Can you defend it legally later?

18
Suicidal Patient

• Do they have a plan?
• What was the plan?
• How plausible was the plan?
• Can they promise not to hurt themselves?
• Can they promise not to hurt you?

19
Psychotic patient

• Safety, Safety, Safety
• Two realities involved
• Accept his reality, he will accept you
• Avoid an adrenaline release
• You are not a therapist

20
Intoxicated Patients

• Avoid stereotype
• Any behavioral issue will me magnified
• ETOH multiplies chance of violence
• Safety in numbers

21
Questions?