Drill of the Month Developed by Gloria Bizjak

1. Drill of the MonthDeveloped by Gloria Bizjak • Behavioral Emergencies Drill of the Month

2. Behavioral Emergencies • Student Performance Objective: • Given information, resources, and opportunity for discussion, EMTs will be able to: • Define behavioral emergencies • List causes of behavioral emergencies • List signs and symptoms • State actions and precautions for safety • Describe assessment and care steps • EMTs will follow acceptable Maryland medical practice and Maryland Medical Protocols for Emergency Medical Providers. Drill of the Month

3. Altered Mental Status: Assessing and Managing Seizure Patients • Overview • Behavioral Emergencies: Definition • Causes of Behavioral Emergencies • Signs and Symptoms • Actions and Precautions • Assessment and Care Steps Drill of the Month

4. Behavioral Emergencies: Definition • Abnormal or atypical behavior that is unacceptable in a given situation with the potential that serious harm is imminent • Unusual and seriously alarming behavior • Threats to harm self, particularly suicide • Threats to harm others • Threats to cause serious property damage Drill of the Month

5. Behavioral Emergencies: Definition • Any medical/trauma situation that alters normal behavior and physical functioning • NOTE: • Consider all behavioral emergencies as incidents of altered mental status • Do not overlook medical conditions • abnormal blood sugar level, hypoxia, stroke, tumor, drug or alcohol intoxication, pain, medications, severe infections Drill of the Month

6. Causes of Behavioral Emergencies • Trauma • Head injury—recent or past • Periodic irritability • Irrational behavior • Confusion and frustration • Amnesia • Delusions Drill of the Month

7. Causes of Behavioral Emergencies • Amputation • Medical—losing a body part can be mentally traumatic • Traumatic—losing a body part in a crash or other trauma incident can be mentally traumatic Drill of the Month

8. Causes of Behavioral Emergencies • Medical • Metabolic disorders • Hypoglycemia • Hyperglycemia • Endocrine, or hormonal disorders • Stroke • Epilepsy • History of or admission of depression Drill of the Month

9. Causes of Behavioral Emergencies • Medical • Hypoxia • Mind-altering substance use • Alcohol or drug abuse • Poison exposure or ingestion • Environmental • Hypothermia • Hyperthermia Drill of the Month

10. Causes of Behavioral Emergencies • Neurological • Organic brain disorder • Other medical conditions with organic causes • Lesions • Tumors • Degenerative diseases (Alzheimer’s, Parkinson’s, dementia) • Infections • Toxins Drill of the Month

11. Causes of Behavioral Emergencies • Stress response or any situation that causes prolonged, extreme stress or sever anger, fear, or grief • Loss of a loved one • Work/job problems or loss • Home/family problems • Money problems • Health problems Drill of the Month

12. Causes of Behavioral Emergencies • Psychiatric disorders • History of mental illness, behavioral problems • Overdose of/forgetting to take psychiatric meds • Thought processes not logical to, or consistent with, situation • Unaware of surroundings or situation • Delusions or hallucinations Drill of the Month

13. Signs and Symptoms • Observable signs • Body language: Expressions or actions • Agitation—anxious, restless, panicky, nervous, rapid speech and movement • Anger, aggressively hostile • Defiance • Violence: Threatening self, others • Suicidal gestures or talk • Shouting, crying out, crying • Isolates self, refuses to talk • Obsessive-compulsive actions Drill of the Month

14. Signs and Symptoms • Observable signs • Personal appearance: Poor hygiene, grooming, dress • History of alcohol or drug abuse • Delusions or visions: Hears voices, may want to follow “orders” of voices; talks to unseen persons • Persecution: Believes others are plotting against him, no one understands him, blames others for problems Drill of the Month

15. Signs and Symptoms • Observable signs • Speech or language • Cannot talk or does not appear to understand what you are saying (aphasia) • Result of brain injury (head trauma, stroke, brain tumor, neurological disease, epilepsy, migraine) to specific brain areas—NOT a cognitive disorder • Broca’s area—controls language/speech • Wernicke’s area—control language interpretation • Talks, but word choice is unusual • Quality, pace, articulation Drill of the Month

16. Signs and Symptoms • Observable signs • Age (with any of the above signs) • 15-25 years of age • Over 40 years of age • The elderly Drill of the Month

17. Signs and Symptoms • Symptoms • Possible rapid pulse rate • Possible rapid breathing rate • Trouble breathing • Complains of headache or other pains • Depression or suddenly coming out of a depression and feeling better Drill of the Month

18. Actions and Precautions • General • Assess the scene for dangers or safety problems • Protect yourself and others • Watch for changes in behavior from calm to violent • Be alert for weapons or items that can be used as weapons • Have family members, friends, others leave room or area if patient is agitated by their presence • Alternately, have someone stay if that person helps calm patient or patient responds positively to that person • Take safety actions with threat of danger • Retreat, call law enforcement Drill of the Month

19. Actions and Precautions • Specific • The suicidal patient • Take suicidal threats seriously • Get eye-level with patient; sit next to patient; maintain eye contact • Talk to patient about thoughts and feelings; listen • Talk to patient about previous attempts or plans Drill of the Month

20. Actions and Precautions • Specific • The aggressive or hostile patient • Ensure safety: Watch for sudden changes in behavior, movements, actions • Be alert for weapons • Call for assistance from law enforcement • Call for medical direction if necessary Drill of the Month

21. Actions and Precautions • Specific • The psychiatric patient • Ensure safety: Watch for sudden changes in behavior, movements, actions • Care for medical/trauma problems first, if possible • Talk with the patient in a calm, reassuring voice • Encourage conversation about problems; listen • Use positive body language: Smile, position self at eye level, have hands relaxed at sides or in lap • Do not play along with hallucinations • Do not lie or make promises you cannot fulfill • Involve family members if it is safe or helpful Drill of the Month

22. Actions and Precautions • Specific • The patient reacting to stress • Act calmly and take control of the situation • Let the patient know you are there to help • Treat the patient as an individual who has feelings and merit • Do not rush the assessment or interview • Give the patient time to interact with you Drill of the Month

23. Assessment and Care Steps • Assessment: Perform General Patient Care (Refer to Maryland Protocols pp 25-34, 42) • Gather information on approach • Size up the scene • Ensure scene safety • Limit the number of people around the patient • Avoid overwhelming the patient with too many people, too many people talking, too many sounds • Respect the patient’s personal space Drill of the Month

24. Assessment and Care Steps • Assessment: Perform General Patient Care (Refer to Maryland Protocols pp 25-34, 42) • Perform initial assessment to extent possible • Mental status • Assess memory, concentration, judgment, orientation • Assess mood: facial expressions, body language, response to questions • Airway, breathing, circulation • Provide oxygen if possible • Disability: pulse/motor/sensory • Expose to assess injuries Drill of the Month

25. Assessment and Care Steps • Assessment: Perform General Patient Care (Refer to Maryland Protocols pp 25-34, 42) • Perform focused history and physical exam—expect distorted information • History to the extent possible: SAMPLE • Patient may be uncooperative • Patient may provide unreliable history • Family or caretakers may be unavailable or not know full history Drill of the Month

26. Assessment and Care Steps • Assessment: Perform General Patient Care (Refer to Maryland Protocols pp 25-34, 42) • Perform focused history and physical exam—expect distorted information • Physical assessment to the extent possible: • DCAP-BTLS • AEIOU-TIPS • Alcohol or acidosis • Epilepsy (seizures • Infection (sepsis) • Overdose • Uremia • Uremia • Trauma or tumor • Insulin (hyperglycemia or hypoglycemia • Poisonings or psychosis • Stroke Drill of the Month

27. Assessment and Care Steps • Assessment: Perform General Patient Care(Refer to Maryland Protocols pp 25-34, 42) • Mental assessment: AABCST • Appearance: patient’s age, sex, hygiene, posture, dress (appropriate for season, situation/event, e.g., dressed for bed at a birthday party) • Affect: what feelings the patient is demonstrating • Behavior: what patient is doing • Cognition: patient’s consciousness level, memory, mood • Speech: patient’s word choice, tone, clarity, content, pace • Thought processes: whether patient shows reasonable judgment for the situation Drill of the Month

28. Assessment and Care Steps • Assessment: Perform General Patient Care (Refer to Maryland Protocols pp 25-34, 42) • Follow treatment protocols • Communicate with hospital or other response personnel • Determine priority and mode of transport and where Drill of the Month

29. Assessment and Care Steps • Emergency Care (Refer to Maryland Protocols p. 42) • Use restraints as necessary • Transporting from medical facility: obtain physician order • Transporting from field/home: call law enforcement to apply and accompany patient in unit Drill of the Month

30. Assessment and Care Steps • Emergency Care (Refer to Maryland Protocols p. 42) • Use restraints as necessary • Always use soft, humane restraints • Have enough personnel to perform the restraint • One person for each extremity; one person for the head; one person to apply restraints • Coordinate actions • Be cautions of kicking, scratching, biting Drill of the Month

31. Assessment and Care Steps • Emergency Care(Maryland Protocols p. 42) • Use restraints as necessary • Restrain in a supine position, never prone • Continuously monitor the restrained patient • Check breathing and pulse • Be alert for the struggling or agitated patient who suddenly becomes calm and quiet • Check responsiveness, breathing, pulse • Be aware of faking, attempts to attack or injure you Drill of the Month

32. Assessment and Care Steps • Emergency Care(Maryland Protocols p. 42) • Implement SAFER model • Stabilize situation: stop influence of sensations • Assess and acknowledge crisis • Facilitate/help patient understand situation; access resources • Encourage use of resources and coping • Recovery or Referral: responsible person or professional or transport • Transport/transfer/transition patient and information Drill of the Month

33. Behavioral Emergencies • Student Performance Objective: • Given information, resources, and opportunity for discussion, EMTs will be able to: • Define behavioral emergencies • List causes of behavioral emergencies • List signs and symptoms • State actions and precautions for safety • Describe assessment and care steps • EMTs will follow acceptable Maryland medical practice and Maryland Medical Protocols for Emergency Medical Providers. Drill of the Month

34. Behavioral Emergencies • Review • Behavioral Emergencies: Definition • Provide at lease one definition or description of a behavioral emergency • Causes: Name at lease one behavioral emergency indication for each of the following • Trauma • Medical • Neurological • Stress • Psychiatric Drill of the Month

35. Behavioral Emergencies • Review • Signs and symptoms • Name at least 5 observable signs of a behavioral emergency • What are some general symptoms of a behavioral emergency? Drill of the Month

36. Behavioral Emergencies • Review • Actions and Precautions • What are general actions and precautions to take for the behavioral emergency patient? • What are specific actions and precautions to take for each of the following situations? • Suicidal patient • Aggressive or hostile patient • Psychiatric patient • Patient reacting to stress Drill of the Month

37. Behavioral Emergencies • Review • Assessment and Care Steps • List assessment steps for the behavioral emergency patient • List the care steps for the behavioral emergency patient • What are the protocols for using restraints? • What are the steps of the SAFER model? Drill of the Month