Chapter 23: Behavioral Health Emergencies

Introduction

• Emergency medical technicians (EMTs) often assist patients in behavioral health emergencies.
• Causes include acute medical conditions, mental illness, mind-altering substances, stress, etc.
• Key areas covered:
  • Drug overdoses
  • Violent behavior
  • Mental illness
• Assessment and emergency care guidance for patients showing behavioral health emergency signs.
• Legal concerns, suicide dangers, PTSD, managing violent patients, and patient restraints.

Myth vs Reality

• Emotional crises are common but rarely result in mental illness.
• Not every behavioral sign indicates mental illness; normal reactions to crises exist.
• Misconceptions about mental illness include assumptions of violence and danger.
• EMTs encounter a higher proportion of violent patients due to the nature of calls.
• Communication is crucial in calming patients and avoiding restraints.

Defining a Behavioral Crisis

• Behavioral crisis involves agitated, violent, or dangerous behavior.
• Emergency medical services are called when behavior becomes problematic for the patient, family, or community.
• Chronic depression can signal underlying health disorders.
• Behavioral health emergencies may cause severe impairments and bizarre behaviors.

The Magnitude of Mental Health Disorders

• Mental disorders affect millions annually in the U.S.
• Anxiety disorders are most common.
• Assistance levels vary: counseling, psychologists, psychiatrists.
• Outpatient treatment common, but hospitalization needed for some cases.

Pathophysiology

• EMTs distinguish between organic and functional disorders.
  • Organic: physical dysfunction (e.g., brain injury, dementia).
  • Functional: physiological disorder with no physical cause (e.g., schizophrenia).

Safe Approach to a Behavioral Crisis

• Essential skills: patient approach, assessment, communication, history-taking, care.
• Scene safety and patient response to the environment are initial considerations.

Patient Assessment

• Scene size-up for safety, legal issues, and need for law enforcement.
• Primary assessment includes observing patient's appearance, speech, and orientation.
• History-taking involves assessing CNS functioning, substance influence, life changes, and medication compliance.

Secondary Assessment

• Focus on physical examination for unconscious patients, considering trauma and intoxication.
• Look for track marks and signs of self-mutilation.

Interventions and Documentation

• The goal is to diffuse and control situations, ensuring safe transport to the hospital.
• Document actions and observations thoroughly.

Acute Psychosis

• Psychosis: state of delusion, disconnected from reality.
• Schizophrenia: complex disorder affecting thinking and behavior, symptoms worsen over time.
• Guidelines: identify yourself, stay calm, don't argue, involve trusted individuals.

Delirium

• Impairment in cognitive function with possible disorientation and hallucinations.
• Approach slowly, respect personal space, and use limited physical contact.

Excited Delirium

• Symptoms include hyperactive behavior and vivid hallucinations.
• Chemical restraint may be necessary to prevent violence.

Restraint

• Used to ensure safety; must follow strict protocols to avoid legal issues and health risks.
• Restraints should be least restrictive, and personnel must be trained.
• Risk factors for violence include history, posture, environment, and behavior signs.

Suicide

• Depression is a major risk factor.
• Warning signs: hopelessness, despair, lack of future plans.
• Immediate intervention is necessary for suicide threats.

Post-Traumatic Stress Disorder (PTSD)

• PTSD results from traumatic events, with symptoms like anxiety, anger, fear, and avoidance.
• Veterans may show higher PTSD incidence due to combat experiences.

Medico-Legal Considerations

• Legal aspects become complex in behavioral health emergencies.
• Patient consent and mental capacity must be assessed.
• State laws dictate the handling of mentally ill or impaired patients.

These notes summarize Chapter 23 on Behavioral Health Emergencies, focusing on the roles and responsibilities of EMTs, patient assessment, intervention strategies, and legal considerations.