![Page 1: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/1.jpg)
Behavioral Behavioral EmergenciesEmergencies
CH
AP
TER
23
CH
AP
TER
23
![Page 2: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/2.jpg)
BehaviorBehaviorBehaviorBehavior
![Page 3: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/3.jpg)
Behavioral emergency:Behavioral emergency:
Abnormal behavior in a Abnormal behavior in a situation that results in situation that results in potential harm to oneself or potential harm to oneself or others.others.
Behavior that is unacceptable or intolerable to self, family members or community.
![Page 4: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/4.jpg)
Behavioral Behavioral ChangesChanges
Behavioral Behavioral ChangesChanges
![Page 5: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/5.jpg)
Conditions that Alter Behavior Conditions that Alter Behavior
Situational stressesSituational stresses
Medical illnessesMedical illnesses
Illegal and legal drugs/alcoholIllegal and legal drugs/alcohol
Diabetics with low blood sugarDiabetics with low blood sugar
Hypoxia and poor cerebral blood flowHypoxia and poor cerebral blood flow
Excessive heat or coldExcessive heat or cold
Head injuryHead injury
![Page 6: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/6.jpg)
Alcohol can produce obvious changes in behavior.
![Page 7: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/7.jpg)
Geriatric patients may be at more risk for behavioral emergencies.
![Page 8: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/8.jpg)
Organic brain syndrome:Organic brain syndrome:
A condition caused by a A condition caused by a disturbance of physiologic disturbance of physiologic functioning of brain tissue.functioning of brain tissue.
More common in elderly patients.
![Page 9: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/9.jpg)
Psychological Psychological CrisesCrises
Psychological Psychological CrisesCrises
![Page 10: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/10.jpg)
Psychotic:Psychotic:
Refers to behavior by a person Refers to behavior by a person who has lost touch with reality.who has lost touch with reality.
Mental illness may produce psychotic thinking.
![Page 11: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/11.jpg)
Types of Psychoses Types of Psychoses ParanoiaParanoia
May be unreasonably afraid of malicious intentions or acts of othersMay be unreasonably afraid of malicious intentions or acts of others
ManiaMania May be very agitated, moving and speaking rapidly without producing clear or complete sentencesMay be very agitated, moving and speaking rapidly without producing clear or complete sentences
DepressionDepression May not want to move or answer questionsMay not want to move or answer questions
![Page 12: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/12.jpg)
Types of Psychoses continued Types of Psychoses continued PhobiaPhobia
Acute anxietyAcute anxiety
DisorientationDisorientation
DisorganizationDisorganization
![Page 13: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/13.jpg)
Suicidal Suicidal GesturesGesturesSuicidal Suicidal GesturesGestures
![Page 14: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/14.jpg)
Risk Factors of Suicide Risk Factors of Suicide
Patient more than 40 years of age, widowed or divorced, alcoholic or depressedPatient more than 40 years of age, widowed or divorced, alcoholic or depressed
Patient who has talked about taking Patient who has talked about taking their own lifetheir own life
Patient with a previous history of Patient with a previous history of self-destructive behaviorself-destructive behavior
Patient with a recently diagnosed Patient with a recently diagnosed serious illnessserious illness
![Page 15: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/15.jpg)
Risk Factors of Suicide continued Risk Factors of Suicide continued
Patient in an environment where there is an unusual gathering of destructive Patient in an environment where there is an unusual gathering of destructive articles articles (e.g., guns or many pills)(e.g., guns or many pills)
Patient who has recently lost a loved onePatient who has recently lost a loved one
Patient who has recently been arrested or imprisonedPatient who has recently been arrested or imprisoned
Patient who has recently lost a jobPatient who has recently lost a job
![Page 16: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/16.jpg)
Suicide can be devastating for the family and friends of the victim.
![Page 17: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/17.jpg)
Assessment and Assessment and Emergency CareEmergency CareAssessment and Assessment and Emergency CareEmergency Care
Scene Size-upScene Size-up
![Page 18: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/18.jpg)
If the scene is unsafe, If the scene is unsafe, stay outstay out and... and...
……contact law enforcement.contact law enforcement.
![Page 19: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/19.jpg)
Signs of Potential Violence Signs of Potential Violence
Sitting on edge of seat, as if ready to moveSitting on edge of seat, as if ready to move
Clenched fistsClenched fists
Yelling and using profanityYelling and using profanity
Standing or moving toward EMTStanding or moving toward EMT
Throwing thingsThrowing things
Holding a potentially dangerous objectHolding a potentially dangerous object
Any behavior that makes the EMT uneasyAny behavior that makes the EMT uneasy
![Page 20: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/20.jpg)
Never allow participants in a Never allow participants in a dispute to get between you and dispute to get between you and the exit route. the exit route.
![Page 21: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/21.jpg)
If you feel the situation If you feel the situation may get out of control, may get out of control, call call for assistance.for assistance.
![Page 22: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/22.jpg)
Obtain information from bystanders Obtain information from bystanders
about the patient’s behavior prior to about the patient’s behavior prior to
EMS arrival.EMS arrival.
![Page 23: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/23.jpg)
Domestic disputesDomestic disputes often often erupt erupt in violence.in violence.
![Page 24: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/24.jpg)
Caution:Caution:Any object Any object
near the near the
patient can patient can
be be
dangerous!dangerous!
![Page 25: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/25.jpg)
Communication and Communication and Emergency Medical Emergency Medical
CareCare
Communication and Communication and Emergency Medical Emergency Medical
CareCare
![Page 26: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/26.jpg)
Assess how the patient
actually feels, and
determine if they are
exhibiting suicidal
tendencies.
![Page 27: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/27.jpg)
Questions to Ask the Patient Questions to Ask the Patient
What is your name, the date, What is your name, the date, your address?your address?
How do you feel?How do you feel?
Would you like some help with your problem?Would you like some help with your problem?
Do you have a history of heart disease, diabetes, etc.?Do you have a history of heart disease, diabetes, etc.?
![Page 28: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/28.jpg)
Observe the patient’s: Observe the patient’s: AppearanceAppearance
ActivityActivity
SpeechSpeech
Orientation to time, person and placeOrientation to time, person and place
![Page 29: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/29.jpg)
If you suspect spouse If you suspect spouse or child abuse, contact or child abuse, contact law enforcement. law enforcement.
Document any abuse observed, Document any abuse observed, or reasons for suspecting or reasons for suspecting
abuse.abuse.
Document any abuse observed, Document any abuse observed, or reasons for suspecting or reasons for suspecting
abuse.abuse.
![Page 30: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/30.jpg)
Calming the PatientCalming the PatientCalming the PatientCalming the Patient
![Page 31: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/31.jpg)
Keeping the Patient Calm Keeping the Patient Calm
Ask questions in a calm and reassuring mannerAsk questions in a calm and reassuring manner
Do not be judgmentalDo not be judgmental
Repeat the patient’s answers to show you are listeningRepeat the patient’s answers to show you are listening
Remain a comfortable distance awayRemain a comfortable distance away
Use good eye contactUse good eye contact
Don’t make sudden movementsDon’t make sudden movements
![Page 32: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/32.jpg)
RestraintsRestraintsRestraintsRestraints
![Page 33: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/33.jpg)
Follow local protocols Follow local protocols and laws regarding and laws regarding restraints. restraints.
Document patient’s condition Document patient’s condition beforebefore and after and after applyingapplying
restraints.restraints.
Document patient’s condition Document patient’s condition beforebefore and after and after applyingapplying
restraints.restraints.
![Page 34: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/34.jpg)
Restraining a Patient Restraining a Patient Have adequate help, including law enforcementHave adequate help, including law enforcement Have a plan of actionHave a plan of action Use only necessary forceUse only necessary force Stay beyond patient’s range of motionStay beyond patient’s range of motion Act quicklyAct quickly Talk to the patientTalk to the patient Work with other EMS personnel, deciding in advance how each will restrain a limb, and approach togetherWork with other EMS personnel, deciding in advance how each will restrain a limb, and approach together
![Page 35: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/35.jpg)
Restraining a Patient continued Restraining a Patient continued
Secure limbs with approved equipmentSecure limbs with approved equipment It may be necessary to turn patient face down on stretcherIt may be necessary to turn patient face down on stretcher
The patient’s face may be covered with a surgical or OThe patient’s face may be covered with a surgical or O22 mask if they are spitting or biting mask if they are spitting or biting
Reassess the situation frequently, including vitals and physical statusReassess the situation frequently, including vitals and physical status Document your and the patient’s actionsDocument your and the patient’s actions
![Page 36: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/36.jpg)
Soft Restraint
![Page 37: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/37.jpg)
A patient A patient
with with leather leather
restraints.restraints.
![Page 38: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/38.jpg)
Restraining a Patient
Approach from behind, Approach from behind, pull arms back, and pull arms back, and bend at waist.bend at waist.
Approach from behind, Approach from behind, pull arms back, and pull arms back, and bend at waist.bend at waist.
![Page 39: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/39.jpg)
Restraining a Patient continued
The patient may be The patient may be placed prone with placed prone with restraints.restraints.
The patient may be The patient may be placed prone with placed prone with restraints.restraints.
![Page 40: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/40.jpg)
Restraining a Patient continued
The patient may be The patient may be placed supine with placed supine with restraints.restraints.
The patient may be The patient may be placed supine with placed supine with restraints.restraints.
![Page 41: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/41.jpg)
Medical and Legal Medical and Legal ConsiderationsConsiderationsMedical and Legal Medical and Legal ConsiderationsConsiderations
ConsentConsent
![Page 42: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/42.jpg)
If an emotionally disturbed
patient consents to
treatment and transport,
decisions are more easily
made, and legal problems
possibly avoided.
![Page 43: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/43.jpg)
Resistance to Resistance to TreatmentTreatment
Resistance to Resistance to TreatmentTreatment
![Page 44: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/44.jpg)
You may need to decide if You may need to decide if a patient is mentally able a patient is mentally able to make an informed to make an informed decision. decision.
Follow local protocols regarding Follow local protocols regarding patients who refuse treatment.patients who refuse treatment.
Follow local protocols regarding Follow local protocols regarding patients who refuse treatment.patients who refuse treatment.
![Page 45: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/45.jpg)
If you are unsure of the
mental capabilities of the
patient, you should treat
and transport.
![Page 46: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/46.jpg)
Use of ForceUse of ForceUse of ForceUse of Force
![Page 47: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/47.jpg)
Use only enough force to Use only enough force to
keep patients from injuring keep patients from injuring
themselves or others. themselves or others.
Avoid physical force that Avoid physical force that may cause harm to the may cause harm to the
patient.patient.
Avoid physical force that Avoid physical force that may cause harm to the may cause harm to the
patient.patient.
![Page 48: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/48.jpg)
Reasonable force depends upon: Reasonable force depends upon:
Patient’s size and strengthPatient’s size and strength
Type of abnormal behavior exhibited by patientType of abnormal behavior exhibited by patient
Gender of patientGender of patient
Mental status of patientMental status of patient
Method of restraint usedMethod of restraint used
![Page 49: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/49.jpg)
DocumentationDocumentationDocumentationDocumentation
![Page 50: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/50.jpg)
Behavioral Documentation Behavioral Documentation
Position in which patient was foundPosition in which patient was found
Aggressive or abnormal action produced by patientAggressive or abnormal action produced by patient
Anything unusual the patient saysAnything unusual the patient says
All aspects of assessment and findings All aspects of assessment and findings (in detail)(in detail)
Restraining procedures usedRestraining procedures used
Names of persons assisting or witnessing treatment and transportNames of persons assisting or witnessing treatment and transport
![Page 51: Behavioral Emergencies CHAPTER 23. BehaviorBehavior](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649d6b5503460f94a4a4a5/html5/thumbnails/51.jpg)
SU
MM
AR
YS
UM
MA
RY BehaviorBehavior
Assessment and Emergency CareAssessment and Emergency Care
Medical and Legal ConsiderationsMedical and Legal Considerations