Behavioral & Psychiatric Emergencies / Suicide

Behavioral emergency

Behavior that is unacceptable / intolerable and requires evaluation or care

Stay objective and assess for medical causes

Excited delirium

A state of extreme agitation, confusion, and often bizarre or aggressive behavior, sometimes associated with severe psychiatric illness or drug intoxication

What physical problems can cause abnormal behavior or AMS

Low glucose, low oxygen, stroke / poor brain perfusion, head injury, seizures, drugs, extreme temperatures

Situational stress reaction

A normal emotional reaction to a stressful event, such as fear, grief, or anger

How should you care for a patient having a situational stress reaction

Slow down, stay calm, listten, be honest, say your there to help, watch for behavior changes

Neurotransmitters

Chemical messengers that help nerve cells communicate with each other

How can neurotransmitters relate to psychiatric disorders

Abnormal levels / activity of neurotransmitters can contribute to disorders such as depression; Many psychiatric medications change neurotransmitter activity

Acute psychosis

A severe break from normal thinking and perception, making it difficult to understand reality or interact appropriately with the environment

Psychosis major signs

“See it, believe it, freeze, scramble”

Hallucinations, delusions, catatonia, disorganized thinking

How should you initially communicate with a behavioral patient

Identify yourself, speak slowly and clearly, make eye contact, listen, and dont judge

What body language techniques help with behavioral patients

Positive body language, dont invade their personal space, stay at least about 3 feet away when possible

Behavioral presentations an EMT may encounter

A patient may be withdrawn, silent, extremely talkative, agitated, bizarre, threatening, or suicidal

Ligature mark

Mark around the neck caused by something such as rope, cord, or noose, potentially indicating hanging / strangulation

What factors increase concern for suicide

Depression, high stress, recent emotional trauma, substance abuse, and previous attempts / threats

Major warning signs for suicide

Suicidal threats, having a plan, previous attempts / threats, sudden improvement after depression

Reasonable force

ONLY the force necessary to prevent the patient from hurting themselves or others

Positional asphyxia

When a person’s body position prevents adequate breathing, potentially causing respiratory arrest

Why must restrained patients be closely monitored

Restraints and body position can interfere with breathing and circulation, continuously monitor patient’s airway, breathing, and condition

Ideal number of rescuers to restrain violent patient

Five: One for each limb and one to communicate with the patient

Why is extremely agitated or psychotic patient a medical concern

Severe agitation can cause dangerous cardiovascular and metabolic stress, potentially becoming life threatening

When can a patient potentially be treated or transported against their will

When legally authorized, such as when the patient is considered a danger to themselves or others

Why are refusal and restraints major concerns for EMTs

They carry significant medical and legal risks

Why might a behavioral patient need transport to a specific facility

Not every hospital is equipped to properly manage psychiatric or behavioral emergencies