emt-basic curriculum module 4

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State of WisconsinEMT-Basic: A Practice BasedApproach to EMS EducationVI.A. Emotionally disturbed patient who consents to care - legal problemsgreatly reducedB. How to handle the patient who resists treatment1. Emotionally disturbed patient will often resist treatment2. May threaten EMT-Basics and others3. To provide care against patient's will, you must show areasonable belief the patient would harm himself or others4. If a threat to self or others, patient may be transported withoutconsent after contacting medical direction5. Usually law enforcement is requiredC. Avoiding unreasonable force1. Reasonable force depends on what force was necessary tokeep patient from injuring himself or others2. Reasonableness is determined by looking at all circumstancesinvolveda) Patients size and strengthb) Type of abnormal behaviorc) Sex of patientd) Mental state of patiente) Method of restraint3. Be aware after a period of combativeness and aggression somecalm patients may cause unexpected and sudden injury to selfand others4. Avoid acts or physical force that may cause injury to the patient5. EMS personnel may use reasonable force to defend against anattack by emotionally disturbed patientsD. Police and medical direction involvement1. Seek medical direction when considering restraining a patient2. Ask for police assistance if during scene size-up the patientappears or acts aggressive or combativeE. Protection against false accusations1. Documentation of abnormal behavior exhibited by the patient isvery important2. Have witnesses in attendance especially during transport, ifpossible3. Accusing EMT-Basics of sexual misconduct is common byemotionally disturbed patients - have help, same sexattendants, and third party witnessesPrinciples for Assessing Behavioral Emergency PatientsA. Identify yourself and let the person know you are there to helpB. Inform him of what you are doingC. Ask questions in a calm, reassuring voiceD. Allow the patient to tell what happened without being judgmentalE. Show you are listening by rephrasing or repeating part of what is saidF. Acknowledge the patient's feelingsG. Assess the patient's mental statusModule 4-86
State of WisconsinEMT-Basic: A Practice BasedApproach to EMS EducationVII.VIII.IX.1. Appearance2. Activity3. Speech4. Orientation for time, person, and placeAssessment of Potential ViolenceA. Scene size-upB. History - the EMT-Basic should check with family and bystanders todetermine if the patient has a known history of aggression orcombativenessC. Posture - stands or sits in a position which threatens self or others.May have fists clinched or lethal objects in hands.D. Vocal activity - is yelling or verbally threatens harm to self or othersE. Physical activity - moves toward caregiver, carries heavy orthreatening objects, has quick irregular movements, muscles tense.Methods to Calm Behavioral Emergency PatientsA. Acknowledge that the person seems upset and restate that you arethere to helpB. Inform him of what you are doingC. Ask questions in a calm, reassuring voiceD. Maintain a comfortable distanceE. Encourage the patient to state what is troubling himF. Do not make quick movesG. Respond honestly to patient's questionsH. Do not threaten, challenge or argue with disturbed patientsI. Tell the truth, do not lie to the patientJ. Do not "play along" with visual or auditory disturbances of the patientK. Involve trusted family members or friendsL. Be prepared to stay at scene for a long time. Always remain with thepatient.M. Avoid unnecessary physical contact. Call additional help if needed.N. Use good eye contactRestraining Patients - restraint should be avoided unless patient is a dangerto self and others. When using restraints have police present, if possible, andget approval from medical direction. If restraints must be used, do thefollowing:A. Be sure to have adequate helpB. Plan your activitiesC. Use only the force necessary for restraintD. Estimate range of motion of patient’s arms and legs and stay beyondrange until readyE. Once decision has been made - act quicklyF. Have one EMT-Basic talk to patient throughout restrainingG. Approach with four persons, one assigned to each limb all at the sametimeH. Secure limbs with equipment approved by medical direction1. Soft restraints are preferredModule 4-87
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emt-basic curriculum module 4

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