EMT-Basic Exam: The Basics of Medical Emergencies - Behavioral Emergencies

Behavioral emergencies are situations in which a patient displays unusual or abnormal behavior. Such events can arise from mental illness, abnormal physical conditions, or the use of mind-altering substances, such as illegal drugs, alcohol, or prescription medication.
These situations can be dangerous for EMS personnel. This is why it is important to assess any potential dangers before attempting to treat the patient. If you suspect that the situation is dangerous, call the police before entering the scene.

1. Behavior
Behavior is the way a person acts. Stress, illness, and drugs can all affect behavior. In some cases, patients experiencing a behavioral emergency may be suffering from a psychological crisis. These patients exhibit behavior that suggests a break with reality. Patients who may be at risk of harming themselves or others may display depression and verbalize thoughts of death or suicide.

2. Assessment and Emergency Care
When arriving on the scene of a behavioral emergency, the first task EMTs should accomplish is the scene size-up. When you enter the scene, carefully examine the environment for possible dangers. Be sure to observe the patient’s demeanor and check to make sure that he or she is not in possession of any dangerous objects. You should also try to ascertain whether the patient is under the influence of drugs or alcohol. If you think the scene may be dangerous, you should refrain from entering and contact police.

Tip: Stay near a door or an exit if you suspect that the patient’s behavior may turn violent. Do not allow the patient to block a potential escape route.

Once you have determined that the scene is safe, you should introduce yourself to the patient and explain why EMS personnel are present. You can then perform a medical assessment. You should ask basic questions to determine the patient’s condition and its cause. If you think the patient’s condition may be related to a drug overdose, take any drugs or medications you find on-scene with you to the receiving medical facility. In cases involving interpersonal violence, signs or suspicions of physical abuse should be reported to the medical facility.
Try to keep the patient calm by asking questions in a respectful, reassuring manner and make the patient feel comfortable. In situations where you are unable to keep the patient calm, you may need to utilize soft restraints. You may need to restrain the patient in order to provide treatment or initiate transport. You should be aware of the local laws regarding restraining patients, as these may vary in certain states or counties. You may need permission from the medical direction physician or assistance from police in order to apply restraints. Do not use handcuffs or other metal restraints, as these may cause soft tissue damage. If a patient is biting or spitting, you may also apply a surgical or oxygen mask.

3. Medical and Legal Considerations
In most cases, it is the patient’s right to refuse treatment and transport to a medical facility. Behavioral emergencies can be particularly difficult because the patient may not be competent enough to make a sound decision regarding treatment. If a patient refuses treatment or transport, you should be careful to follow the local regulations regarding this situation. Beyond that, your decision on whether to treat or transport should be based on the patient’s mental state, physical condition, and age. You must contact your medical supervisors before attempting to treat or transport a patient without his or her consent. Police assistance may also be necessary.
When you are confronted with a behavioral emergency, you should never use more than reasonable force, which is the basic force required to prevent patients from harming themselves or others. Any additional use of force should only be employed by police.
Finally, it is critically important to document all abnormal behavior the patient may be exhibiting. You should note the patient’s position when found, any aggressive or abnormal actions the patient may take, unusual patient statements, detailed assessment findings, any restraining measures you take, and the names of any persons who witness or assist with the patient’s treatment or transport.

Related Topics You Should Review:
- Signs of potential patient violence
- Risk factors for suicide