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 patients with behavioral health emergencies within legal parameters.

Behavioral Crises

• Result from medical situations, mental illness, substances, stress, etc.
• Emotional crises don't always indicate mental illness.
• Only a small percentage of those with mental health issues are dangerous.
• Communication can de-escalate situations.

Defining Behavioral Crisis

• Behavior: response to environment over time.
• Crisis when coping mechanisms are insufficient.
• Behavioral crisis includes aggression or danger to self/others.
• Concern if abnormal behavior lasts a month or more.

Mental Health Disorders

• Common in the U.S., affecting millions annually.
• Anxiety disorders: panic, phobias, PTSD, OCD.
• Mental health assistance varies from counseling to psychiatric care.
• Causes include stress, disease, substance use, biological issues.
• EMTs should not diagnose but understand organic (physical) and functional (psychological) conditions.

Organic Disorders

• Brain dysfunction due to physical/psychological disturbances.
• Causes: illness, brain injury, overdose, diseases like Alzheimer's.

Functional Disorders

• Physiological disorders with normal body structure.
• Includes schizophrenia, anxiety conditions, depression.

Patient Assessment

• Scene Size-up: Focus on safety, potential danger, need for law enforcement.
• Primary Assessment: Form general impression, rapid exam, AVPU scale.
• ABCs: Assess airway, breathing, circulation, and disability.
• History Taking: Use SAMPLE history, assess CNS function, drug effects, life changes.
• Secondary Exam: Check for trauma, drug abuse, emotional state.

Transport and Reassessment

• Have support from law enforcement or firefighters.
• Transport decisions based on safety and facility capability.
• Regular reassessment of restrained patients' vitals and functions.

Specific Conditions

• Psychosis: State of delusion, often from substances or stress.
• Schizophrenia: Complex, requires calm, direct interaction.
• Excited Delirium: Hyperactive behavior, potential for cardiac issues.
• Suicide: Depression is a significant factor. Assess risk factors.
• PTSD in Veterans: High incidence among those with combat experience. Manage with understanding.

Restraint Protocols

• Only to ensure safety of patient and providers.
• Protocols must comply with legal guidelines.
• Improper use can lead to legal action or patient harm.

Medical Legal Considerations

• Implied consent if patient is not mentally competent.
• EMTs have limited legal authority in non-life-threatening situations.
• Document all actions and observations carefully.

Review

• Behavioral crisis: reaction that interferes with daily activities.
• Depression and schizophrenia: functional disorders.
• Primary concern: patient harm to self/others.
• Reflective listening: repeating patient’s statements to understand.
• High-risk suicide indicator: alcohol use and recent gun purchase.
• Hypoglycemia: rule out in confused and pale patients.