Understanding Behavioural Emergencies
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ReeseUnderstanding Behavioural Emergencies
Uploaded by
ReeseModule 18 Behavioural Emergencies
1 Behavioural Emergencies
1.1 Overview on Behavioural Emergencies
May often deal with pts. Undergoing psychological / behavioural crisis
Crisis may be due to emergency situation / mental illness / mind altering substance / stress / many other causes
Behaviour is what you can SEE of a person’s response to the environment
Definition of behavioural crisis / emergency
o Is any reaction to events that interferes with activities of daily living (ADL)
o Or has become unacceptable to pt. / family / community
A person no longer able to respond appropriately to the environment may be having a psychological / psychiatric
emergency
When psychiatric emergency arises, pt. may show agitation / violence / become a threat to themselves / others
This is more serious than typical behavioural emergency that causes an interference with ADL
1.2 Causes of Behavioural Emergencies
Sudden grief / emotional conflict can causes behavioural emergencies
Sudden illness / recent trauma / drug or alcohol intoxication and diseased brain e.g. Alzheimer’s disease
Hypoglycaemia can cause AMS
Two basic categories for behavioural / psychiatric emergencies
o Organic brain syndrome
Is a dysfunction of the brain caused by disturbance in the physical functioning of the brain
E.g. hypoglycaemia
o Functional disorder
Abnormal operation of the an organ cannot be traced to an obvious change to the actual
structure
E.g. schizophrenia
Recognizing the difference may help to save a life
1.3 Assessment of Behavioural Emergencies
Your safety comes FIRST
o Is the situation / scene safe for you and your partner
o If backup is required call for law enforcement
Then assess how the patient is responding to the environment
o Does pts. Behaviour seem normal under the circumstances
o Sometimes pts. May not respond at all to your questions
o In these cases, you can assess much from the pts. emotional state from facial expressions, pulse and
respirations
Tears / sweating / blushing are also indicators of a state of mind
Make sure to assess pt. eyes
o Blank gaze / rapid moving eyes indicate CNS depression / some types extra stress
When trying to determines reason for pt. state / consider three major areas as contributors
o 1 – is pt. CNS functioning properly
Hypoglycaemia / poisoning / physical trauma all play a role
o 2 – are hallucinogens / other drugs / alcohol a factor?
Does pt. see strange things / smell of alcohol on the breath?
o 3 – are psychogenic circumstances involved (mental rather than physical)
Includes death of a loved one / history of mental illness / suicide threats
1.4 Suicide
Single most contributing factor to suicide is depression
Threatening Suicide may be a cry for help
Threatening suicide is indication that someone is in crisis that they cannot handle
o Immediate intervention is necessary
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1.5 Warning Signs
Air of tearfulness / sadness / deep despair / hopelessness that suggest depression
Avoiding eye contact / speaking slowly / projecting sense of vacancy
Unable to talk about future / future is so distant they don’t think about it
Any suggestions / include vague suggestion about suicide (do not take lightly)
1.6 Medico – legal considerations
Mental incapacity can take many forms:
o Hypoxia
o Alcohol
o Drugs
o Stress
o Depression
Once you have determined the pt. has impaired mental capacity, you must decide if the pt. needs emergency
medical care
A pt. that is mentally unstable may resist your attempts to provide care
Do not leave these pts. alone, you may expose yourself to abandonment or negligence
Obtain law enforcement assistance if needed
1.7 Consents
When a pt. is not mentally competent, law assumes there is implied consent
In case of psychiatric emergencies
o The matter is not always clear cut
o Does a life threatening emergency exist or not
o If in doubt call your medical officer / law enforcement assistance
1.8 Limited legal authority
General rule of law:
o A competent adult has the right to refuse treatment/transport, even if lifesaving care is involved
o Provided they can make informed decisions
In psychiatric cases
o A parent / guardian / child or close family would probably consider your actions in providing life-
saving care to be appropriate
o Especially if you believe that the pt. would harm themself
1.9 Restraint
You MAY NOT restraint a pt. WITHOUT authority
o If you do, you may be exposed to a law suit including charges of:
Assault
Battery
False imprisonment and
Violation of civil rights
You may only use reasonable force to control your pt.
o You should consult you ALS before restraining your pt.
You may ONLY use restraints to:
o Protect yourself
o Protect others
o And the pt. from harming themselves
Always try transport a disturbed pt. without restraints if possible
Once decision has been made to restrain pt. must be carried out quickly
Make sure you have adequate help to restrain the pt. safely
o However only 5 people are allowed
Be aware of BSI: If a pt. is spitting, place an oxygen mask over pt. face etc.
Treat pt. with dignity and remember to monitor pt. for vomiting airway obstruction and cardiovascular stability
o Pt. cant fend for himself
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1.10 Violent Patients
The following may be used to assess the level of danger:
o Past history:
Previous violence / aggressive behaviour
o Posture
How are they standing / sitting
Are they tense, rigid, sitting on edge
o The scene
Is the pt. holding / near a potentially lethal weapon
o Vocal activity
Loud / obscene / bizarre speech indicates emotional stress
Pt. using quite / ordered speech is less likely to strike out
o Physical activity
Look for tense muscles / clench fists / glaring eyes / excessive pacing
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