BEHAVIORAL EMERGENCIES

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Robyn Muriel Palmer
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1 LESSON 21 BEHAVIORAL EMERGENCIES 21-1

2 Behavioral Emergencies Process of giving first aid may be complicated by victim s behavior Many injuries or illnesses can cause altered mental status or emotional responses Victims may have emotional problems Abuse and rape are behavioral situations 21-2

3 Emotional and Behavioral Responses to Injury and Illness Normal reactions include fear, anxiety and apprehensiveness Normal reactions may cause trembling, shakiness, nausea, fast heartbeat and breathing, perspiration 21-3

4 Emotional and Behavioral Responses to Injury and Illness continued Do not judge victim s behavior too quickly assess the situation If it is unsafe, call and stay at a safe distance until help arrives 21-4

5 Altered Mental Status Results from many different injuries and illnesses - Lowered levels of responsiveness may result from low oxygen levels Victim may feel dizzy, drowsy, disoriented or confused First aid is often treating underlying cause 21-5

6 Causes of Altered Mental Status Respiratory emergencies Cardiac emergencies Poisoning Head injuries Seizures Diabetic emergencies Stroke High fever Substance abuse Drug overdose Heat or cold emergencies 21-6

7 Reassuring and Calming Victims Tell victim who you are Say you are there to help Avoid seeming judgmental Do not assume victim is intoxicated or on drugs Reassure victim that help is on the way 21-7

8 Reassuring and Calming Victims continued Speak in a caring, reassuring voice Do not give false reassurances or lie about victim s condition Do not argue Show you understand by repeating or rephrasing what victim says Do not challenge irrational or delusional statements 21-8

9 Reassuring and Calming Victims continued Stay a safe distance until victim accepts your help - Do not attempt to restrain or force care - Withdraw if scene not safe Tell victim what you plan to do before doing it Move calmly and slowly Touch victim only as necessary 21-9

10 Actions For Victim With Anxiety Remain calm and patient Follow guidelines for calming and reassuring victim - Often panic will subside in few minutes Victim may need more time to calm down and may suddenly experience renewed anxiety Be empathetic and gentle Allow victims to talk about their feelings 21-10

11 Common Signs and Symptoms of Depression Signs and symptoms: Frequent feelings of sadness Loss of energy Feelings of hopelessness or worthlessness Difficulty concentrating Difficulty making decisions Physical symptoms (abdominal pain, insomnia, appetite loss, recurrent headaches) Thoughts of death or suicide 21-11

12 Actions for a Victim With Depression Encourage victim to talk Acknowledge that person seems sad and ask why Show victim you care Help make person comfortable Allow person to cry and work through emotion 21-12

13 Actions for a Victim With Depression continued Listen sympathetically to complaints but do not offer false reassurances Talk about available resources Be alert to possibility of suicide 21-13

14 Suicide Over 33,000 people commit suicide each year Third leading cause of death among those years old 11 th leading cause of death for persons ages 10 and older Drug overdose and firearms most common methods Most victims talk about committing suicide 21-14

15 Talking about suicide Suicide Warning Signs Comments about hopelessness or worthlessness Taking risks that could cause death Loss of interest in past activities Suddenly and unexpectedly seeming calm or happy after being sad 21-15

16 Actions for Person Who May be Suicidal Take person seriously Listen to what he or she is saying Ask what person is planning to do Talk calmly and be supportive Do not argue with person Tell person you understand and care - Do not give false reassurances 21-16

17 Actions for Person Who May be Suicidal continued Call if appropriate Involve friends or family members Do not leave person alone (unless your own safety is threatened) Remove any weapons, drugs or medications Don t let person drive 21-17

18 Actions for Person Who May be Suicidal continued If person has firearm or is threatening violence - Call Do not try to restrain the person - Withdraw if situation becomes violent 21-18

19 Actions For Person Who May Become Violent Do not enter unsafe scene Call Do not attempt to restrain person Monitor situation from safe distance and wait for help to arrive 21-19

20 Abuse Intentional inflicting of injury or pain on someone under abuser s power Victims include children, spouses, elderly parents Be sensitive to victim s emotional status Be aware of special issues to handle situation 21-20

21 Signs of Physical Abuse: Child Unexplained scalding or burns, rope burns, lacerations, bites, bruises, broken bones Fading bruises or marks after absence from school or childcare Seems frightened of parents and scared to go home 21-21

22 Signs of Physical Abuse: Child continued Shrinks at approach of adult Reports being injured by someone Appears withdrawn, depressed, cries often Aggressive, disruptive Seems tired Complains of frequent nightmares 21-22

23 Sexual Abuse Includes fondling child s genitals, penetration, incest, rape, sodomy, indecent exposure or exploitation through prostitution or pornography 21-23

24 Signs of Sexual Abuse: Child Difficulty walking or sitting Suddenly refuses to change clothes Reports nightmares or bed-wetting Sudden change in appetite Bizarre, sophisticated or unusual sexual knowledge or behavior 21-24

25 Signs of Sexual Abuse: Caregiver Unduly protective of child Severely limits child s contact with other children Secretive and isolated Jealous or controlling with family members 21-25

26 Reporting Child Abuse If you suspect abuse or neglect, report it to authorities - Police - Child protective services Your report will help protect child and get help for family Your report is confidential and may be anonymous You may be legally required to report it 21-26

27 Care For Apparently Abused Child Do not confront parents Do not ask direct questions about abuse Provide first aid as usual Follow guidelines for documentation - If child tells you injury caused by caregiver or other adult, include this in report 21-27

28 Signs of Domestic Violence Victim unusually fearful Victim s account of injury inconsistent or unlikely Victim uneasy in presence of partner 21-28

29 Guidelines for Suspected Domestic Violence Situations Provide first aid as usual Call for significant injuries and report any suspicions Ensure privacy when providing care Do not directly confront victim with suspicions Try to involve friend or family member 21-29

30 Guidelines for Suspected Domestic Violence Situations continued You may be required to report suspected abuse If victim communicates abuse to you, you can tell victim domestic violence is against the law and help is available If you see physical abuse occurring or the threat of violence, call and stay away 21-30

31 Elder Abuse Physical, emotional or financial abuse or neglect inflicted on someone over age 60 - Affects more than 500,000 in United States each year - 90% of cases, abuser is family member - The older the person, the greater the risk - The more person needs help with daily activities, the greater the risk - Abuse more likely to result in injury 21-31

32 Signs and Symptoms of Elder Emotional/Psychological Abuse Emotional upset or agitation Extreme withdrawal, lack of communication and responsiveness Report of verbal or emotional abuse 21-32

33 Signs and Symptoms of Elder Neglect Dehydration, malnutrition, untreated bedsores, poor personal hygiene Untreated health problems Unsafe living conditions Unsanitary living conditions Report of neglect 21-33

34 Care For Victim of Elder Abuse All states have specific elder abuse laws Report suspected abuse to adult protective service agency - Information is confidential - State agency will investigate and provide services 21-34

35 Sexual Assault and Rape Rape = forced sexual intercourse (both psychological coercion and physical force) Sexual assault = completed or attempted attacks of unwanted sexual contact (may or may not involve force) 21-35

36 Sexual Assault and Rape Statistics 1 of every 6 women is victim of attempted or completed rape in her lifetime million American women have been victims of attempted or completed rape million American men have been victims of sexual assault or rape. 9 of every 10 rape victims are female. 15% of sexual assault and rape victims are under age % are under age

37 Care For Victim of Rape or Sexual Assault Be sensitive to psychological trauma Call Ensure privacy for victim Try to involve friend or family member First aider of same sex may be better 21-37

38 Care For Victim of Rape or Sexual Assault continued Provide first aid as needed, stay with victim till help arrives Preserve evidence - Ask victim not to urinate, bathe or wash any area 21-38

39 Follow-Up Care Rape victims usually have full physical examination Possible later testing for STDs and pregnancy Counseling by rape crisis centers or support groups 21-39

Behavioral Emergencies. Lesson Goal. Lesson Objectives 9/10/2012

Behavioral Emergencies. Lesson Goal. Lesson Objectives 9/10/2012 Behavioral Emergencies Lesson Goal Recognize, assess, & treat patients with behavioral emergencies, including patients with psychiatric history & substance abuse Lesson Objectives Define these terms: Suicide