Summary of "Chp 23 Behavioral Health"
Summary of Key Wellness Strategies, Self-Care Techniques, and Productivity Tips from Chapter 23 Behavioral Health
1. Understanding Behavioral Health Emergencies
- Behavioral health emergencies include acute mental illness, substance abuse, stress-related crises, agitation, violence, suicidal or homicidal tendencies, and delirium.
- Emotional crises do not always indicate mental illness; normal reactions to stress and grief are common.
- Misconceptions to avoid:
- Feeling depressed does not necessarily mean mental illness.
- Most individuals with mental illness are not violent.
2. Stress and Coping
- Stress is widespread (e.g., COVID-19 impacts) and can overwhelm normal coping mechanisms.
- Behavioral crises often stem from overwhelming stress or underlying medical/psychological conditions.
3. Common Mental Health Disorders
- Anxiety disorders (generalized anxiety, panic disorder, phobias, PTSD, OCD) are very common.
- Psychiatric disorders may impair functioning and require various levels of care (counselors, psychologists, psychiatrists).
- Underlying causes may be social, biological, medical (e.g., hypoglycemia, hypoxia, electrolyte imbalances), or substance-related.
4. Scene Safety and Patient Interaction
- Scene safety is paramount and must be maintained throughout patient contact.
- Use law enforcement backup when necessary; stage until the scene is safe.
- Maintain personal safety by positioning yourself off to the side, not directly in front of agitated patients.
- Avoid physical confrontation; prioritize communication and de-escalation.
- Use calm, clear communication; explain procedures before performing them.
- Establish rapport and use reflective listening (repeat patient’s statements in question form).
- Respect patient preferences for who interacts with them (gender, familiarity).
- Avoid arguing or challenging delusions/hallucinations.
5. Assessment and Care
- Perform a rapid physical exam and observe mental status using AVPU (Alert, Verbal, Pain, Unresponsive).
- Check airway, breathing, circulation, and look for signs of shock or medical causes.
- Gather SAMPLE history including medications, substance use, recent life changes, and behavioral health history.
- Consider medical causes of altered behavior (hypoglycemia, stroke, intoxication).
- Spend adequate time with behavioral patients; do not rush transport.
- Make patients comfortable by adjusting lighting, temperature, and noise.
6. Managing Specific Behavioral Conditions
Psychosis
- Identify yourself clearly.
- Maintain emotional distance.
- Avoid arguing.
- Involve trusted family or friends.
Excited Delirium
- Approach calmly.
- Limit physical contact.
- Never leave the patient unattended.
- Avoid lights and sirens.
- Call ALS for chemical restraints.
Suicide Risk
- Recognize risk factors such as recent loss, substance abuse, depression, and access to weapons.
- Ensure no access to harmful objects.
- Involve law enforcement if needed.
PTSD
- Use a calm, firm voice.
- Respect personal space.
- Limit the number of people present.
- Avoid triggers like loud noises.
7. Restraints and Safety
- Use restraints only when necessary, with proper training and legal authority.
- Apply minimum force necessary; have a team with a designated leader.
- Restrain limbs and head properly; never restrain prone.
- Continuously monitor airway and circulation.
- Communicate with the patient throughout the restraint process.
- Treat patients with dignity and respect.
- Document thoroughly all actions, reasons for restraints, and patient behavior.
8. Legal and Ethical Considerations
- Obtain consent when possible; implied consent applies if the patient is incompetent.
- Competent adults have the right to refuse care.
- Know your local protocols and legal limitations.
- Document all care and observations carefully to protect yourself legally.
9. Self-Care for Providers
- Recognize stress and emotional impact on yourself and colleagues.
- Avoid taking emotional baggage home; maintain professional emotional distance.
- Be aware of PTSD and mental health challenges in first responders and veterans.
- Seek support and resources when needed.
Key Tips and Methodologies
- Reflective Listening: Repeat patient’s statements in question form to encourage communication.
- Scene Safety: Continuously assess and reassess safety; use staging and law enforcement.
- Calming Environment: Adjust sensory stimuli (light, sound, temperature) to reduce agitation.
- Communication: Be calm, clear, direct, and non-confrontational.
- Restraint Protocol: Use trained teams, minimum force, continuous monitoring, and thorough documentation.
- Patient Rapport: Let patients choose preferred communicator; respect personal space.
- Assessment: Use AVPU, SAMPLE history, and physical exam to identify medical causes.
- Transport: Take time with patients; do not rush; involve family/friends if possible.
- Suicide Risk Assessment: Look for risk factors and remove access to harmful objects.
- Provider Wellness: Maintain emotional boundaries; recognize and address stress/PTSD.
Presenters / Sources
- Presenter: John (EMT instructor or speaker)
- References to EMS protocols and behavioral health standards
- Anecdotes and insights from EMS and law enforcement experiences
Category
Wellness and Self-Improvement
