Psychological Behavioral Emergencies

Section 5 -MEDICAL

5.11 PSYCHOLOGICAL / BEHAVIORAL EMERGENCIES

CONSIDER MEDICAL ETIOLOGY OF PSYCHOLOGICAL /BEHAVIORAL DISORDER AND REFER TO APPROPRIATE PRACTICE PARAMETER:

• Hypoxia, INITIAL MEDICAL CARE (2.01).
• Substance Abuse, DRUG OVERDOSE / POISONING (5.05).
• Neurologic Disease, STROKE (5.04).
• Metabolic Derangements, HYPO / HYPERGLYCEMIA (5.10).

Establish SCENE AND PERSONAL SAFETY - Call law enforcement personnel to scene if needed. Above all, DO NOTHING TO JEOPARDIZE YOUR OWN SAFETY.

• Determine and document if patient is a threat to self or others or if patient is unable to care or provide for self. Protect patient from harm to self or others.

Verbal Restraint

The EMS crew should attempt to calm, reassure, or reason with the patient. If the patient appears stable then these attempts should be repeated. If the patient appears unstable, agitated, or aggressive, then verbal restraint should be abandoned early.

Chemical Restraint

If verbal restraint is unsuccessful, and you have determined that the patient must be taken to a hospital without their informed consent then chemical restraint should be attempted. Chemical restraint is best used if a patient has already allowed an IV to be inserted. If attempting intranasal, be cautious of a patient biting or in other ways being physically aggressive. If IV or intranasal is not possible, attempt IM Valium or Versed in the anterior thigh, the upper outer quadrant of the buttocks, or the deltoid. **IM or IN injection of MIDAZOLAM (VERSED) requires immediate IV access upon sedation.

Physical Restraint

If you are unable to verbally or chemically restrain the patient then physical restraint must be used. It is important to know that the least restrictive and least amount of time in physical restraints should be utilized.

INITIAL MEDICAL CARE (2.01).

• If applicable, consult law enforcement for assistance with transport of the unwilling patient.
• If patient becomes severely agitated, to the point of interfering with patient care and / or becomes a physical danger to the crew’s well being, administer
  • MIDAZOLAM (VERSED) 2 – 5 mg IVP or IO or .07-.08 mg/kg IM or 5 mg IN, or DIAZEPAM (VALIUM) 5-10 mg IV or IM.
  • If patient is experiencing ACUTE ALCOHOL WITHDRAWAL, DIAZEPAM (VALIUM) 2 - 20 mg Slow IVP for adults, titrated to effect. If no IV access, administer 10 - 20 mg DIAZEPAM (VALIUM) IM up to a total of 2 ml per large muscle injection site or 1 ml per small muscle injection site.