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Understanding Behavioral Health Emergencies

Apr 23, 2025

Chapter 23: Behavioral Health Emergencies

Learning Objectives

  • Recognize behaviors that pose risks to EMTs, patients, and others.
  • Understand basic principles of the mental health system.
  • Assess and manage patients with behavioral health emergencies within legal scope.

Key Concepts

  • Behavioral Crisis: Resulting from acute medical issues, mental illness, substances, stress.
  • Not all emotional crises equate to mental illness.
  • Only a small percentage with mental health disorders are dangerous.

Defining Behavioral Crisis

  • A response to the environment, actions over time.
  • Crisis arises when normal coping mechanisms fail.
  • EMS is called when behavior is unacceptable to the patient, family, or community.

Mental Health Disorders Magnitude

  • Common in the US, affecting millions.
  • Includes anxiety disorders, PTSD, OCD.
  • Handled by various levels of mental health professionals.

Causes of Behavioral Health Disorders

  • Social stress, disease (schizophrenia), physical illness, chemical imbalance.
  • Non-compliance with medications complicates conditions.

Pathophysiology

  • EMTs don't diagnose but recognize organic (physical) vs. functional (psychological) disorders.
  • Organic Disorders: Dysfunction from illness, injury, substances.
  • Functional Disorders: Psychological with no physical explanation (e.g., schizophrenia).

Safe Approach to Behavioral Crisis

  • Approach, assess, communicate, obtain history, provide care.
  • Scene Safety: Check for danger, legal issues, need for law enforcement.

Assessment

  • Scene Size-Up: Safety, legal issues.
  • Primary Assessment: General impression, ABCs, AVPU scale, rapport.
  • History Taking: Sample history, CNS functions, substance effect, life changes.
  • Secondary Assessment: Physical exam, look for trauma, emotional indicators.
  • Transport Decision: Law enforcement, comfort, ground transport preferred.
  • Reassessment: Safety, monitor restraints.

Communication & Documentation

  • Warn hospitals of behavioral emergencies and restraints.
  • Document type and reason for restraints.

Specific Conditions

  • Psychosis: Affects reality perception. Causes include substances, stress, schizophrenia.
  • Schizophrenia: Onset often in early adulthood, symptoms include delusions, hallucinations.
  • Excited Delirium: Symptoms include hyperactivity, hallucinations. Approach calmly.

Restraints

  • Follow protocols, use minimum force, involve law enforcement.
  • Risks include positional asphyxia, legal actions.
  • Never leave restrained patients unattended.

Potentially Violent Patients

  • History, posture, scene, vocal activity, physical activity as danger indicators.
  • Determine danger based on behavior, history of violence.

Suicide Risk

  • Depression major factor, requires immediate intervention.
  • Warning signs include sadness, specific plans, detachment.

PTSD and Combat Veterans

  • PTSD from trauma, affects many veterans, increased suicide risk.
  • Signs include hyperactivity, reliving events, anxiety.

Medical Legal Considerations

  • EMTs have limited authority for non-life-threatening cases.
  • Consent is complex; involve law enforcement when unsure.

Review Questions

  • Definitions and examples provided for behavioral crisis, disorders, and response strategies.

For a complete understanding of behavioral health emergencies, engage in continuous learning and refer to your textbook for detailed protocols and procedures.

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