drill of the month developed by gloria bizjak

Drill of the Month Drill of the Month

Drill of the MonthDrill of the MonthDeveloped by Gloria BizjakDeveloped by Gloria Bizjak

Behavioral EmergenciesBehavioral Emergencies

22Drill of the MonthDrill of the Month


Student Performance Objective:Student Performance Objective:Given information, resources, and opportunity Given information, resources, and opportunity for discussion, EMTs will be able to:for discussion, EMTs will be able to:

• Define behavioral emergenciesDefine behavioral emergencies• List causes of behavioral emergenciesList causes of behavioral emergencies• List signs and symptomsList signs and symptoms• State actions and precautions for safetyState actions and precautions for safety• Describe assessment and care stepsDescribe assessment and care steps

EMTs will follow acceptable Maryland medical EMTs will follow acceptable Maryland medical practice and Maryland Medical Protocols for practice and Maryland Medical Protocols for Emergency Medical Providers.Emergency Medical Providers.


Altered Mental Status: Altered Mental Status: Assessing and Managing Assessing and Managing

Seizure PatientsSeizure PatientsOverviewOverview Behavioral Emergencies: DefinitionBehavioral Emergencies: Definition Causes of Behavioral EmergenciesCauses of Behavioral Emergencies Signs and SymptomsSigns and Symptoms Actions and PrecautionsActions and Precautions Assessment and Care StepsAssessment and Care Steps


Behavioral Emergencies: Behavioral Emergencies: DefinitionDefinition

Abnormal or atypical behavior that Abnormal or atypical behavior that is unacceptable in a given situation is unacceptable in a given situation with the potential that serious harm with the potential that serious harm is imminentis imminent

Unusual and seriously alarming Unusual and seriously alarming behavior behavior

– Threats to harm self, particularly Threats to harm self, particularly suicidesuicide

– Threats to harm othersThreats to harm others– Threats to cause serious property Threats to cause serious property

damagedamage


Behavioral Emergencies: Behavioral Emergencies: DefinitionDefinition

Any medical/trauma situation that Any medical/trauma situation that alters normal behavior and physical alters normal behavior and physical functioningfunctioning

NOTE: NOTE: Consider all behavioral emergencies Consider all behavioral emergencies

as incidents of altered mental status as incidents of altered mental status Do not overlook medical conditionsDo not overlook medical conditions

– abnormal blood sugar level, hypoxia, abnormal blood sugar level, hypoxia, stroke, tumor, drug or alcohol stroke, tumor, drug or alcohol intoxication, pain, medications, severe intoxication, pain, medications, severe infectionsinfections


Causes of Behavioral Causes of Behavioral EmergenciesEmergencies

TraumaTrauma– Head injury—recent or pastHead injury—recent or past

Periodic irritabilityPeriodic irritability Irrational behaviorIrrational behavior Confusion and frustrationConfusion and frustration AmnesiaAmnesia DelusionsDelusions



AmputationAmputation– Medical—losing a body part can be Medical—losing a body part can be

mentally traumaticmentally traumatic– Traumatic—losing a body part in a crash Traumatic—losing a body part in a crash

or other trauma incident can be or other trauma incident can be mentally traumaticmentally traumatic



MedicalMedical– Metabolic disordersMetabolic disorders

HypoglycemiaHypoglycemia HyperglycemiaHyperglycemia Endocrine, or hormonal disordersEndocrine, or hormonal disorders

– StrokeStroke– EpilepsyEpilepsy– History of or admission of depressionHistory of or admission of depression



MedicalMedical– HypoxiaHypoxia– Mind-altering substance useMind-altering substance use– Alcohol or drug abuseAlcohol or drug abuse– Poison exposure or ingestionPoison exposure or ingestion– EnvironmentalEnvironmental

HypothermiaHypothermia HyperthermiaHyperthermia

1100

Drill of the MonthDrill of the Month


NeurologicalNeurological– Organic brain disorderOrganic brain disorder– Other medical conditions with organic Other medical conditions with organic

causescauses LesionsLesions TumorsTumors Degenerative diseases (Alzheimer’s, Degenerative diseases (Alzheimer’s,

Parkinson’s, dementia)Parkinson’s, dementia) InfectionsInfections ToxinsToxins

1111



Stress response or any situation that Stress response or any situation that causes prolonged, extreme stress or causes prolonged, extreme stress or sever anger, fear, or griefsever anger, fear, or grief– Loss of a loved oneLoss of a loved one– Work/job problems or lossWork/job problems or loss– Home/family problemsHome/family problems– Money problemsMoney problems– Health problemsHealth problems

1122



Psychiatric disordersPsychiatric disorders– History of mental illness, behavioral History of mental illness, behavioral

problemsproblems– Overdose of/forgetting to take psychiatric Overdose of/forgetting to take psychiatric

medsmeds– Thought processes not logical to, or Thought processes not logical to, or

consistent with, situationconsistent with, situation– Unaware of surroundings or situationUnaware of surroundings or situation– Delusions or hallucinationsDelusions or hallucinations

1133


Signs and SymptomsSigns and Symptoms Observable signsObservable signs

– Body language: Expressions or actionsBody language: Expressions or actions Agitation—anxious, restless, panicky, Agitation—anxious, restless, panicky,

nervous, rapid speech and movementnervous, rapid speech and movement Anger, aggressively hostileAnger, aggressively hostile DefianceDefiance Violence: Threatening self, othersViolence: Threatening self, others Suicidal gestures or talkSuicidal gestures or talk Shouting, crying out, cryingShouting, crying out, crying Isolates self, refuses to talkIsolates self, refuses to talk Obsessive-compulsive actionsObsessive-compulsive actions

1144



– Personal appearance: Poor hygiene, Personal appearance: Poor hygiene, grooming, dressgrooming, dress

– History of alcohol or drug abuseHistory of alcohol or drug abuse– Delusions or visions: Hears voices, Delusions or visions: Hears voices,

may want to follow “orders” of voices; may want to follow “orders” of voices; talks to unseen personstalks to unseen persons

– Persecution: Believes others are Persecution: Believes others are plotting against him, no one plotting against him, no one understands him, blames others for understands him, blames others for problemsproblems

1155



– Speech or languageSpeech or language Cannot talk or does not appear to Cannot talk or does not appear to

understand what you are saying (aphasia)understand what you are saying (aphasia) Result of brain injury (head trauma, stroke, Result of brain injury (head trauma, stroke,

brain tumor, neurological disease, brain tumor, neurological disease, epilepsy, migraine) to specific brain areasepilepsy, migraine) to specific brain areas—NOT a cognitive disorder—NOT a cognitive disorder– Broca’s area—controls language/speechBroca’s area—controls language/speech– Wernicke’s area—control language Wernicke’s area—control language

interpretationinterpretation

Talks, but word choice is unusualTalks, but word choice is unusual– Quality, pace, articulationQuality, pace, articulation

1166



– Age (with any of the above signs)Age (with any of the above signs) 15-25 years of age15-25 years of age Over 40 years of ageOver 40 years of age The elderlyThe elderly

1177


Signs and SymptomsSigns and Symptoms SymptomsSymptoms

– Possible rapid pulse ratePossible rapid pulse rate– Possible rapid breathing ratePossible rapid breathing rate– Trouble breathingTrouble breathing– Complains of headache or other painsComplains of headache or other pains– Depression or suddenly coming out of Depression or suddenly coming out of

a depression and feeling bettera depression and feeling better

1188


Actions and PrecautionsActions and Precautions GeneralGeneral

– Assess the scene for dangers or safety problemsAssess the scene for dangers or safety problems– Protect yourself and othersProtect yourself and others– Watch for changes in behavior from calm to violentWatch for changes in behavior from calm to violent– Be alert for weapons or items that can be used as Be alert for weapons or items that can be used as

weaponsweapons– Have family members, friends, others leave room or Have family members, friends, others leave room or

area if patient is agitated by their presence area if patient is agitated by their presence Alternately, have someone stay if that person helps calm Alternately, have someone stay if that person helps calm

patient or patient responds positively to that personpatient or patient responds positively to that person

– Take safety actions with threat of dangerTake safety actions with threat of danger Retreat, call law enforcementRetreat, call law enforcement

1199


Actions and PrecautionsActions and Precautions SpecificSpecific

– The suicidal patientThe suicidal patient Take suicidal threats seriouslyTake suicidal threats seriously Get eye-level with patient; sit next to Get eye-level with patient; sit next to

patient; maintain eye contactpatient; maintain eye contact Talk to patient about thoughts and feelings; Talk to patient about thoughts and feelings;

listenlisten Talk to patient about previous attempts or Talk to patient about previous attempts or

plansplans

2200



– The aggressive or hostile patientThe aggressive or hostile patient Ensure safety: Watch for sudden changes in Ensure safety: Watch for sudden changes in

behavior, movements, actionsbehavior, movements, actions Be alert for weaponsBe alert for weapons Call for assistance from law enforcementCall for assistance from law enforcement Call for medical direction if necessaryCall for medical direction if necessary

2211



– The psychiatric patientThe psychiatric patient Ensure safety: Watch for sudden changes in Ensure safety: Watch for sudden changes in

behavior, movements, actionsbehavior, movements, actions Care for medical/trauma problems first, if possibleCare for medical/trauma problems first, if possible Talk with the patient in a calm, reassuring voiceTalk with the patient in a calm, reassuring voice Encourage conversation about problems; listenEncourage conversation about problems; listen Use positive body language: Smile, position self at Use positive body language: Smile, position self at

eye level, have hands relaxed at sides or in lapeye level, have hands relaxed at sides or in lap Do not play along with hallucinationsDo not play along with hallucinations Do not lie or make promises you cannot fulfillDo not lie or make promises you cannot fulfill Involve family members if it is safe or helpfulInvolve family members if it is safe or helpful

2222



– The patient reacting to stressThe patient reacting to stress Act calmly and take control of the situationAct calmly and take control of the situation Let the patient know you are there to helpLet the patient know you are there to help Treat the patient as an individual who has Treat the patient as an individual who has

feelings and meritfeelings and merit Do not rush the assessment or interviewDo not rush the assessment or interview Give the patient time to interact with youGive the patient time to interact with you

2233


Assessment and Care StepsAssessment and Care Steps Assessment: Perform General Patient Assessment: Perform General Patient

Care Care (Refer to Maryland Protocols pp 25-34, 42)(Refer to Maryland Protocols pp 25-34, 42)

– Gather information on approachGather information on approach– Size up the sceneSize up the scene

Ensure scene safetyEnsure scene safety Limit the number of people around the Limit the number of people around the

patientpatient Avoid overwhelming the patient with too Avoid overwhelming the patient with too

many people, too many people talking, too many people, too many people talking, too many soundsmany sounds

Respect the patient’s personal spaceRespect the patient’s personal space

2244




– Perform initial assessment to extent Perform initial assessment to extent possiblepossible Mental status Mental status

– Assess memory, concentration, judgment, orientationAssess memory, concentration, judgment, orientation– Assess mood: facial expressions, body language, Assess mood: facial expressions, body language,

response to questionsresponse to questions

Airway, breathing, circulationAirway, breathing, circulation Provide oxygen if possibleProvide oxygen if possible Disability: pulse/motor/sensoryDisability: pulse/motor/sensory Expose to assess injuriesExpose to assess injuries

2255




– Perform focused history and physical Perform focused history and physical exam—expect distorted informationexam—expect distorted information History to the extent possible: SAMPLEHistory to the extent possible: SAMPLE

– Patient may be uncooperativePatient may be uncooperative– Patient may provide unreliable historyPatient may provide unreliable history– Family or caretakers may be unavailable Family or caretakers may be unavailable

or not know full historyor not know full history

2266




– Perform focused history and physical Perform focused history and physical exam—expect distorted informationexam—expect distorted information Physical assessment to the extent Physical assessment to the extent

possible: possible: – DCAP-BTLSDCAP-BTLS– AEIOU-TIPSAEIOU-TIPS• Alcohol or acidosis

•Epilepsy (seizures• Infection (sepsis)• Overdose• Uremia

• Uremia• Trauma or tumor• Insulin (hyperglycemia or hypoglycemia• Poisonings or psychosis• Stroke

2277



CareCare (Refer to Maryland Protocols pp 25-34, 42)(Refer to Maryland Protocols pp 25-34, 42)

– Mental assessment: AABCSTMental assessment: AABCST Appearance: patient’s age, sex, hygiene, Appearance: patient’s age, sex, hygiene,

posture, dress (appropriate for season, posture, dress (appropriate for season, situation/event, e.g., dressed for bed at a situation/event, e.g., dressed for bed at a birthday party)birthday party)

Affect: what feelings the patient is Affect: what feelings the patient is demonstratingdemonstrating

Behavior: what patient is doingBehavior: what patient is doing Cognition: patient’s consciousness level, Cognition: patient’s consciousness level,

memory, moodmemory, mood Speech: patient’s word choice, tone, clarity, Speech: patient’s word choice, tone, clarity,

content, pacecontent, pace Thought processes: whether patient shows Thought processes: whether patient shows

reasonable judgment for the situationreasonable judgment for the situation

2288




– Follow treatment protocolsFollow treatment protocols– Communicate with hospital or other Communicate with hospital or other

response personnelresponse personnel– Determine priority and mode of Determine priority and mode of

transport and wheretransport and where

2299


Assessment and Care StepsAssessment and Care Steps Emergency Care Emergency Care (Refer to Maryland Protocols (Refer to Maryland Protocols

p. 42)p. 42)

– Use restraints as necessaryUse restraints as necessary Transporting from medical facility: Transporting from medical facility:

obtain physician orderobtain physician order Transporting from field/home: call law Transporting from field/home: call law

enforcement to apply and accompany enforcement to apply and accompany patient in unitpatient in unit

3300


Assessment and Care StepsAssessment and Care Steps Emergency Care Emergency Care (Refer to Maryland (Refer to Maryland

Protocols p. 42)Protocols p. 42)

– Use restraints as necessaryUse restraints as necessary Always use soft, humane restraintsAlways use soft, humane restraints Have enough personnel to perform the Have enough personnel to perform the

restraintrestraint– One person for each extremity; one person One person for each extremity; one person

for the head; one person to apply for the head; one person to apply restraintsrestraints

– Coordinate actionsCoordinate actions– Be cautions of kicking, scratching, bitingBe cautions of kicking, scratching, biting

3311


Assessment and Care StepsAssessment and Care Steps Emergency CareEmergency Care (Maryland Protocols p. 42)(Maryland Protocols p. 42)

– Use restraints as necessaryUse restraints as necessary Restrain in a supine position, never proneRestrain in a supine position, never prone Continuously monitor the restrained Continuously monitor the restrained

patientpatient– Check breathing and pulseCheck breathing and pulse– Be alert for the struggling or agitated patient Be alert for the struggling or agitated patient

who suddenly becomes calm and quietwho suddenly becomes calm and quiet Check responsiveness, breathing, pulseCheck responsiveness, breathing, pulse Be aware of faking, attempts to attack or Be aware of faking, attempts to attack or

injure youinjure you

3322


Assessment and Care StepsAssessment and Care Steps

Emergency CareEmergency Care (Maryland Protocols p. 42)(Maryland Protocols p. 42)

– Implement SAFER modelImplement SAFER model SStabilize situation: stop influence of tabilize situation: stop influence of

sensationssensations AAssess and acknowledge crisisssess and acknowledge crisis FFacilitate/help patient understand situation; acilitate/help patient understand situation;

access resourcesaccess resources EEncourage use of resources and copingncourage use of resources and coping RRecovery or ecovery or RReferral: responsible person or eferral: responsible person or

professional or transportprofessional or transport

– Transport/transfer/transition patient and Transport/transfer/transition patient and informationinformation

3333



Student Performance Objective:Student Performance Objective:Given information, resources, and opportunity for Given information, resources, and opportunity for discussion, EMTs will be able to:discussion, EMTs will be able to:

• Define behavioral emergenciesDefine behavioral emergencies• List causes of behavioral emergenciesList causes of behavioral emergencies• List signs and symptomsList signs and symptoms• State actions and precautions for safetyState actions and precautions for safety• Describe assessment and care stepsDescribe assessment and care steps

EMTs will follow acceptable Maryland medical EMTs will follow acceptable Maryland medical practice and Maryland Medical Protocols for practice and Maryland Medical Protocols for Emergency Medical Providers.Emergency Medical Providers.

3344



ReviewReview Behavioral Emergencies: DefinitionBehavioral Emergencies: Definition

– Provide at lease one definition or description of Provide at lease one definition or description of a behavioral emergencya behavioral emergency

Causes: Name at lease one behavioral Causes: Name at lease one behavioral emergency indication for each of the emergency indication for each of the followingfollowing

TraumaTrauma MedicalMedical NeurologicalNeurological StressStress PsychiatricPsychiatric

3355



ReviewReview Signs and symptomsSigns and symptoms

– Name at least 5 observable signs of a Name at least 5 observable signs of a behavioral emergencybehavioral emergency

– What are some general symptoms of a What are some general symptoms of a behavioral emergency?behavioral emergency?

3366



ReviewReview Actions and PrecautionsActions and Precautions

– What are general actions and precautions What are general actions and precautions to take for the behavioral emergency to take for the behavioral emergency patient?patient?

– What are specific actions and precautions What are specific actions and precautions to take for each of the following to take for each of the following situations?situations? Suicidal patientSuicidal patient Aggressive or hostile patientAggressive or hostile patient Psychiatric patientPsychiatric patient Patient reacting to stressPatient reacting to stress

3377



ReviewReview Assessment and Care StepsAssessment and Care Steps

– List assessment steps for the behavioral List assessment steps for the behavioral emergency patientemergency patient

– List the care steps for the behavioral List the care steps for the behavioral emergency patientemergency patient What are the protocols for using restraints?What are the protocols for using restraints? What are the steps of the SAFER model?What are the steps of the SAFER model?

drill of the month developed by gloria bizjak

Documents

monthbehavioral emergencies

harm self

maryland medical protocols

serious harm

given situation

emergency medical providers

harm othersthreats

monthaltered mental