Chapter 23: Behavioral Health Emergencies
Overview
- Focus on recognizing behaviors that pose risks to EMTs, patients, and others.
- Understanding basic principles of the mental health system.
- Skills to assess and manage behavioral health emergencies legally.
Behavioral Crisis Emergencies
- Can result from medical situations, mental illness, substances, stress, etc.
- Emotional crisis doesn't always mean mental illness.
- Communication builds trust and de-escalates situations.
Behavioral Crisis Definition
- Seen in agitated, violent, or uncooperative behavior.
- Considered a crisis when behavior is unacceptable.
- Concern arises if abnormal behavior lasts over a month.
Magnitude of Mental Health Disorders
- Common in the U.S., affecting millions annually.
- Includes anxiety, PTSD, OCD, etc.
- Treated at various levels from counselors to psychiatrists.
Causes of Behavioral Health Disorders
- Social stress, diseases like schizophrenia, physical illness, substance use.
- Non-compliance with medications can worsen conditions.
Pathophysiology
- Organic Disorders: Brain dysfunction from physical/psychological disturbances.
- Functional Disorders: Psychological issues with structurally normal bodies.
Patient Assessment
- Scene Safety: Consider scene safety and need for law enforcement.
- Primary Assessment: Form impression, assess airway/breathing, circulation, prepare for time with patient.
- History Taking: Use SAMPLE history, check CNS function, substance factors, and life changes.
Special Considerations
- Reflective listening for insight.
- Consider prior agitation or drug use in unconscious patients.
Transport Decision
- Involve law enforcement, consider specific facilities, transport by ground.
Reassessment and Interventions
- Document thoroughly, reassess every 5 minutes if restrained.
- Communication with hospital for preparation.
Specific Conditions
Acute Psychosis
- Delusional states with altered reality perception.
- Common causes: substances, stress, schizophrenia.
Schizophrenia
- Complex, with onset in early adulthood.
- Symptoms: delusions, hallucinations, erratic speech.
- Guidelines: Ensure safety, clear communication, involve trusted individuals.
Excited Delirium
- Hyperactive behavior with potential sudden death.
- Approach calmly, avoid physical contact, request ALS for chemical restraints.
Restraints and Safety
- Use only as necessary for safety, with law enforcement if possible.
- Follow protocol for type and method, document thoroughly.
- Avoid positional asphyxia and legal issues.
Suicide Considerations
- High risk with depression, substance use, recent important life changes.
- Warning signs: hopelessness, specific plans, risky behavior.
PTSD and Veterans
- Triggered by traumatic events, common in military personnel.
- Symptoms: anxiety, heightened arousal, flashbacks.
- Care: Respect personal space, limit noise, avoid strong stimuli.
Legal Considerations
- Determine mental capacity for consent, involve law enforcement as needed.
- Implied consent for those not mentally competent.
Conclusion
- Understanding and appropriate response to behavioral health emergencies is crucial.
- Always prioritize safety, clear communication, and thorough documentation.
This concludes Chapter 23: Behavioral Health Emergencies. Remember to subscribe for more lectures on the complete book.