Integrating crisis intervention training between police and fire

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Integrating crisis intervention training between
police and fire

• A Collaboration of resources

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How did we get started

• You need to think outside the box . You need to
  knock on some doors to get the message across in
  regards to personnel safety, consumer safety, and
  better service to the community.
• Training
• Safety
• Customer service

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How did we get started

• Training (picture)

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How did we get started

• Safety Roles
• Police the operational consideration in regards
  to the safety of the officer and that of the
  consumer is the possible mechanism of injury or
  other underline cause for their behavior
• Trauma
• Disease
• Infection
• Drug use (prescription and illegal drugs)
• Death of a loved one or some other tragic event
  in their lives
• EMS the operational consideration in regards to
  the safety for EMS/Fire personnel is to standby
  until police clear the scene and declare the
  scene is safe.

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How did we get started

• Customer Service
• Judgment Please do not judge our consumers
• Emotions Dont let your emotions come into play,
  this can and has been proven to be a very
  dangerous proposition

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Benefits of collaboration and why

• Emergency Detention
• the significance of generating the ED form is
  that in its absence the consumer may leave the
  hospital before receiving a proper medical
  evaluation by a physician, thus creating a
  vicarious liability on both departments.
• For Example customer is placed in triage waiting
  room, customer leaves the hospital before
  receiving medical treatment . They could go home
  and finish what they were unable to complete
  prior to Police and EMS intervention.

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Benefits of collaboration and why

• Many times the Fire Department is the first
  responder on the scene. For the Fire
• Dept. to be CIT trained helps in the referral
  process for several reasons
• Fire/EMS can
• Be a credible person to facilitate the Emergency
  Detention process
• Request a CIT trained officer to assist
• Assist the Officer with medically compromised
  consumers
• A lot of times when an Officer arrives at the
  scene the presence of a uniform can cause a
  consumer to hold it together. By having the
  Fire/EMS trained in the Crisis Intervention
  allows for a credible person to inform the
  Officer of any statements or actions observed
  prior to the Officers arrival.

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Role playstactics vs. medical concerns

• The importance of this recognition is for your
  safety and that of the consumer which could
  ultimately become a legal concern for you in the
  future
• Fire Department can assist in finding the root
  cause for what is presumably mental illness which
  in fact maybe some underlying medical conditions
• If your not sure if an underlying medical need
  has not been met or needs to be met, this
  information can be easily ascertained by asking
  the customer or their family
• Some clues as to a the possibility of a medical
  condition or past medical history are
• medic-alert tag
• recent trauma or illness
• bottles of prescription medications on counter or
  surrounding area.

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Mental health crisis vs. Medical Emergency

• Medical emergencies that exist may manifest
  themselves in a manner that appears to be
  behavioral in nature.
• Never discount the possibility that the consumer
  may be suffering from a medical emergency, or the
  potential for medical intervention by EMS/Fire

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Mental health crisis vs. Medical Emergency

• Out in the field it may difficult at best to
  differentiate between mental illness or
• medical distress that is organic in nature, there
  are a few signs to help aid you
• Respiratory rate or difficulty breathing
• Heart rate
• Pupil response
• Temperature
• Skin(very hot, very cold, sweaty)
• Chest Pain
• Obtain a medical history

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Mental health crisis vs. Medical Emergency

• Other conditions may show psychiatric symptoms
• Alzheimers disease
• Diabetes
• Head Trauma
• Brain trauma
• Hypoglycemia
• Dehydration

• Hypoxia
• Hypothermia
• Substance intoxication
• Substance withdrawal
• Stroke

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Citizen support in times of crisis

• Consumer feels threatened and has the potential
  to become violent, and/or aggressive
• Could escalate to the point where they cause harm
  to self or others
• Maintain your degree of professionalism and
  continue to remain an advocate for the consumer
  and their family

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Chemical Sedation consideration in lieu of
electricity

• Depending on your system, EMS may administer
  chemical sedation to consumers that meet
• the behavioral emergency criteria
• When would chemical sedation be a good idea ?
• geriatrics
• excited delirium
• drug induced psychosis
• General behavioral disorders
• When you are considering restraining the customer
  for their safety and yours

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Involuntary transport and patient restraint

• Is the customer a threat to themselves or
  others..?
• Physically restrained and extremely agitated
  consumers should be chemically restrained as well
• Calms behavior with altering consciousness
• Valium, Versed (use with caution and EMS must
  monitor constantly)
• Be alert at all times and assure that the
  customer needs are being met
• Airway
• Position of the customer
• Underline medical conditions
• Diabetes
• Asthma
• Heart Condition
• Mental status

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Involuntary transport and patient restraint

• Restraint asphyxia
• Description and definition
• Inability to expand chest cavity, create negative
  lung pressure for inspiration
• Set of Causes
• Positional asphyxia
• Do not hog tie
• Too tight, incorrect application
• May strangle through escape attempt

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Involuntary transport and patient restraint

• Restraints help prevent injury to the police,
  fire, ems and most importantly the customer.
• Our job is to minimize the effects or potential
  dangers to the consumer and others with minimal
  or the least possible intervention.

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What is it..?Medication identification
Fire/EMS is trained in the areas of medication
recognition. This can help the Officer with his
determination of executing an emergency
detention.
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Lines of responsibility

• Who should be responsible for the transportation
  of the consumer and what facility should the
  consumer be transported ?