EMS 23: Behavioral Health Emergencies

Behavior

Observable actions and responses a person displays in response to their environment\

Behavioral crisis

A situation in which a person's behavior is agitated, violent, uncooperative, or dangerous to themselves or others\

Organic disorder

Behavioral or mental disorder caused by a detectable physical change in the brain or body\

Functional disorder

Behavioral or mental disorder caused by abnormal function without an identifiable structural cause\

Scene priorities for behavioral emergencies

Ensure scene safety, request law enforcement if needed, determine whether staging is appropriate, and assess whether the behavior is abnormal\

Assessment of behavioral emergencies

Consider CNS function, drug or alcohol use, significant illness or stress, and history of behavioral illness\

Physical clues in behavioral emergencies

Facial expressions, pulse rate, respiratory rate, and overall appearance\

Behavioral emergency transport

Request law enforcement or firefighters to accompany transport if safety is a concern\

Restraint monitoring

Reassess and document respirations, pulse, motor function, sensation, and restraint status every 5 minutes\

Psychosis

State in which a person loses touch with reality and may experience delusions or hallucinations\

Causes of psychosis

Mind-altering substances, severe stress, schizophrenia, and delusional disorders\

Schizophrenia

Chronic psychiatric disorder characterized by hallucinations, delusions, disorganized speech, and reduced emotional expression or pleasure\

Managing a psychotic patient

Remain calm, identify yourself, speak simply and directly, avoid arguing, explain your actions, maintain emotional distance, and involve trusted individuals when appropriate\

Delirium

Acute disturbance in cognition causing confusion, disorientation, hallucinations, or delusions\

Signs of excited delirium or severe agitation

Hyperactive irrational behavior, vivid hallucinations, hypertension, tachycardia, diaphoresis, and dilated pupils\

Transport considerations for severe agitation

Avoid lights and sirens when possible and request ALS if chemical restraint may be required\

Purpose of patient restraints

Protect the patient, EMS personnel, and others from bodily harm\

When restraints may be used

Only when necessary to prevent harm and when authorized by protocol or law\

First-line management of an agitated patient

Use verbal de-escalation before considering physical restraints\

Personnel required for safe physical restraint

Five people whenever possible—one for each extremity and one controlling the head\

Assessing potential violence

Evaluate history of violence, body position, access to weapons, speech, and physical cues such as clenched fists\

Depression

Mental health disorder that increases the risk of suicide\

Approach to patients with PTSD

Remain calm and firm, respect personal space, and use careful, non-threatening language\

EMT legal authority in behavioral emergencies

EMTs generally have limited authority to force treatment when no life-threatening emergency exists\