Overview
This lecture covers behavioral health emergencies for EMTs, focusing on recognizing risky behaviors, assessing and managing patients in crisis, and understanding legal considerations.
Introduction to Behavioral Health Emergencies
- Behavioral crises can be caused by medical conditions, mental illness, substance use, stress, or life changes.
- Not all emotional crises indicate mental illness; normal responses include grief or depression after loss.
- Only a small percentage of individuals with mental health disorders are violent.
- EMTs often encounter behavioral crises due to the emergency nature of their role.
Defining Behavioral Crisis & Mental Health Disorders
- Behavioral crisis: behavior that is agitated, violent, uncooperative, or dangerous to self/others.
- Concern arises when abnormal behavior persists for a month or more.
- Psychiatric disorders: illnesses with psychological/behavioral symptoms causing impaired functioning.
- Common disorders include anxiety, depression, schizophrenia, and bipolar disorder.
Causes & Classification of Disorders
- Causes: social/situational stress, disease, physical illness, chemical/bio disturbances, and non-compliance with medication.
- Organic disorders: brain dysfunction from illness, injury, or substances (e.g., Alzheimer's, TBI).
- Functional disorders: impaired function with no physical abnormality (e.g., schizophrenia, depression).
Assessment & Management of Behavioral Patients
- Scene safety and patient assessment are top priorities; request law enforcement if unsafe.
- Use the AVPU scale for alertness; perform rapid exams while maintaining a safe distance.
- Evaluate ABCDs (Airway, Breathing, Circulation, Disability), obtain sample history, and identify baseline mental status.
- Use reflective listening and observe for signs like abnormal speech, appearance, or behavior.
Handling Specific Behavioral Emergencies
- Psychosis: disconnection from reality, may involve hallucinations or delusions.
- Schizophrenia: complex, chronic disorder with delusions, hallucinations, and erratic behavior.
- Excited delirium: severe agitation, hallucinations, and physical symptoms; can be fatal without rapid intervention.
- Suicide: risk factors include depression, alcohol abuse, access to weapons, and previous attempts.
- PTSD: common in trauma survivors and veterans, characterized by flashbacks, anxiety, and hyperarousal.
Interventions & Restraints
- Diffuse situations with verbal de-escalation before considering physical or chemical restraints.
- Only use approved, minimum necessary force; involve law enforcement as needed.
- Continuously reassess restrained patients (respiration, pulse, motor/sensory function).
Medical-Legal Considerations
- Mentally impaired patients require implied consent; when in doubt, consult law enforcement or medical control.
- EMTs have limited authority to force treatment unless the patient poses immediate risk.
- Document patient statements, behaviors, interventions, and use of restraints thoroughly.
Key Terms & Definitions
- Behavioral Crisis — Behavioral response interfering with daily life or safety.
- Organic Disorder — Brain dysfunction from physical/biological causes.
- Functional Disorder — Psychological disorder with no physical abnormalities.
- Psychosis — Loss of connection with reality.
- PTSD — Stress disorder following trauma.
- AVPU Scale — Alert, Verbal, Painful, Unresponsive assessment tool.
Action Items / Next Steps
- Review key assessment techniques and restraint protocols.
- Study the difference between organic and functional disorders.
- Complete assigned reading for Chapter 23.