Behavioral Emergencies You are the Provider. Richard W.O. Beebe MS RN NRP MedicThink LLC You and your partner are dispatched to 10213 E Desert Crossings for an attempted suicide. As you pull up to the house, a young woman comes running out the front door screaming for you to help her friend. She explains that her friend is in the house crying and threatening to kill herself. 1) What is your first step? A behavior is: EDP is a BE! Behavioral Emergency - a situation where the patient exhibits abnormal behavior within a given situation that is unacceptable or intolerable to the patient, family or community. This behavior can be due to extremes of emotion leading to violence or other inappropriate. You do NOT have to be crazy to have a Behavioral Emergency!! 1
Crazy people may not be as crazy as you think Myth vs. Reality There are many medical conditions that result in altered mental status such as: n Hypoglycemia n Hypoxia n Hypotension Diff Diagnosis n Alcoholism* n Epilepsy (Complex) n Insulin Overdose n Overdose n Uremia n Trauma - Head n Infection n Psychosis** n Stroke Everyone develops some symptoms of mental illness at some poin in life, but that does not mean everyone develops mental illness. People do not have to be sick if they are feeling bad or depressed. All people with mental disorders are NOT dangerous, violent, or otherwise unmanageable. The Magnitude of Mental Health Problems At one time or another, one in five Americans has some type of mental disorder in their lifetime. Causes may include: n Social, psychological, genetic, physical, chemical, or biologic disturbance. Psychological Crisis's Behavioral emergencies usually consist of one of the following: n Panic n Agitation n Bizarre thinking and behavior n Danger to self - self destructive behavior, suicide n Danger to others - threatening behavior, violence 2
You are the Provider. The woman tells you that her friend does not have any kind of weapon. Once inside, you find a girl in her early teens sitting on the couch sobbing. She is conscious, alert, and oriented. Her RR is labored at 26 bpm. Her parents are not home. She is upset with her boyfriends break-up. 3) Do you have consent to treat the patient? 4) What type of information do you need? Assessment of the Suicidal Patient Some things to consider: n How does the patient feel (before and after you arrive) n Determine suicidal tendencies n Is patient a threat to self or others (i.e. YOU!) n Is there a medical problem? n Interventions n Is the patient in an unsafe environment or with unsafe objects in his/her hands You are the Provider. She states that though she has not done anything today, she wants to kill herself and will do so if she gets the chance. The patient again becomes upset and hysterical; she runs to the bathroom and locks herself in. The police officer breaks down the door and restrains the patient. 7) What are your obligations to the patient? 8) What are your options in patient treatment now that the police have restrained her? Suicidal Patients Most suicidal patients exhibit some signs of depression as well as thoughts of death or taking one s life. Risk Factors n Widowed n Divorced n Alcoholic n Over 40 3
What can you do for the suicidal patient Scene size-up, personal safety Calm the patient - do not leave patient alone Restrain if necessary. Consider need for law enforcement. Patient Assessment It s a must! Transport RMA is not an option! If overdose, bring medications or drugs found to medical facility. EDP There are two types of emotionally disturbed people n The ones that consent to care that are not usually a problem and the others. n What do you do for the others? What can you do so you don t get thrown in jail for doing your job? There are two basics types of force that are used in taking control of a violent patient? n Reasonable force n Unreasonable force Force Reasonable force depends on what force was necessary to keep patient from injuring himself or others. Reasonableness is determined by looking at all circumstances involved. n Patients size and strength n Type of abnormal behavior n Sex of patient n Mental state of patient n Method of restraint 4
What can you do? Call for police back up as soon as possible You CAN use reasonable force to protect yourself against an emotionally disturbed person, but the best thing to do is to remove yourself from the scene. The best type of dangerous situation is the one that is avoided What do you say to an EDP? Talk calmly Reassure them that you are there to help Never play along with visual or auditory hallucinations Medical Restraint How to do it the right way! First do no harm! No handcuffs! Soft Restraints only and the patient must meet state and local criteria You are the Provider. When caring for this form of patient, The safety of yourself and your crew come first! Be honest with the patient. Don t rush the situation. Do no be judgmental. Keep ALL lines of communication open w/ everyone on the scene. 5
The End Any questions??? 6