Chapter 23: Behavioral Health Emergencies

Goals of the Chapter

• Recognize behaviors posing risks to EMTs, patients, and others.
• Understand basic principles of the mental health system.
• Gain skills to assess and manage behavioral health emergencies within legal scope of practice.

Behavioral Crisis and Misconceptions

• Behavioral crises can result from acute medical situations, mental illnesses, substances, stress.
• Emotional crises are common; not everyone develops mental illness.
• Misconceptions:
  • Feeling depressed doesn't mean illness.
  • Most people with mental health issues are not violent or unmanageable.

Defining Behavioral Crisis

• Behavior: Response to environment through actions.
• Stress can overwhelm normal coping mechanisms.
• Behavioral crisis: Agitated, violent, or uncooperative behavior dangerous to self or others.
• Abnormal behavior patterns lasting a month are concerning.

Magnitude of Mental Health Disorders

• Mental health disorders affect millions in the US annually.
• Common disorders: Anxiety disorders, PTSD, OCD.
• Levels of mental health assistance vary from counseling to hospitalization.

Pathophysiology in Behavioral Emergencies

• EMTs not responsible for diagnosing underlying causes.
• Two basic diagnoses:
  1. Organic: Physical brain dysfunction (illness, injury, substance abuse).
  2. Functional: Psychological condition (schizophrenia, anxiety, depression).

Patient Assessment in Behavioral Crisis

• Scene Safety: Evaluate scene danger and patient response.
• Primary Assessment:
  • General impression from a safe distance.
  • Rapid physical exam and AVPU scale.
  • Assess ABCs: Airway, Breathing, Circulation, Disability.
• History Taking: Use SAMPLE history, check mental health history.
• Secondary Assessment: Look for reasons of unresponsiveness, signs of self-harm.
• Transport Decision: Law enforcement involvement if needed, ground transport preferred.

Managing Behavioral Health Emergencies

• Reassessment: Constant monitoring, especially if restraints are used.
• Interventions:
  • De-escalate with communication.
  • Avoid physical contact unless necessary.
  • Use verbal de-escalation before restraints.

Specific Conditions

• Acute Psychosis: Delusions, substance-induced psychosis, schizophrenia.
  • Approach: Calm, straightforward, involve trusted individuals.
• Excited Delirium: Agitation, irrational behavior, hallucinations.
  • Approach: Supportive, empathetic, minimize stimuli.

Restraints and Safety

• Restraints used to prevent harm.
• Require law enforcement presence.
• Follow state protocols for restraint methods.
• Document all restraint use thoroughly.

Suicide Risks

• Depression is a significant risk factor.
• Warning signs include sadness, despair, and specific suicidal plans.

PTSD and Combat Veterans

• PTSD results from traumatic events (assault, war, disaster).
• Symptoms: Anxiety, reliving trauma, possibly suicidal.
• Special care needed for veterans: Avoid stimuli, be calm.

Legal Considerations

• Consent: Implied consent for those mentally incompetent.
• Authority: Limited legal authority in non-life-threatening cases.
• Always document patient interactions thoroughly.

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Review Questions Recap

• Behavioral crisis defined by interference with daily activities.
• Depression and schizophrenia are examples of functional disorders.
• Primary concern in assessing behavioral crisis: Potential patient harm to others.
• Avoid rapid transport; focus on thorough care and communication.

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Conclusion: Understanding and managing behavioral health emergencies involve assessing risk, communicating effectively, ensuring safety, and understanding legal boundaries. Restraints and suicide interventions require careful consideration and documentation. Combat veterans and PTSD present unique challenges needing empathy and respect.