First Responder EMS Curriculum for Training Centers in Eurasia

ManagementThe general approach to the patient with a change in behavior begins with trying to calmthe patient. It is important that you do not leave the patient alone once you have madecontact. Always consider the need for additional help from law enforcement. If thepatient has had a suspected overdose, give the medications or drugs found at the sceneto the transporting EMS personnel.Principles for Assessing Behavioral Emergency PatientsWhen approaching a patient with a behavioral emergency, identify yourself and let theperson know you are there to help. Inform the patient of what you are doing and whenyou are going to do it. Always try to ask questions in a calm, reassuring voice. Allowthe patient to tell you what happened. Listen to the patient, and show that you arelistening by rephrasing or repeating part of what the patient tells you. Try toacknowledge the patient’s feelings. The goal is to assess individuals with behavioralemergencies, prevent further harm or escalation of the abnormal behavior, and transportthe patient safely to an emergency care facility.Assessing patients with an abnormal change in behavior begins with an assessment ofthe patient’s mental status. Evaluate the patient’s appearance, activity, speech, andorientation to person, place, and time. Observe the patient’s appearance. Observe thepatient’s clothing, general state of hygiene, and identify any obvious external injuriesthat the patient may have suffered or self-inflicted. Observe the patient’s activity. Notewhether the patient is hyperactive or somnolent, and identify any abnormal activity thatyou see. Listen to the patient’s speech. Is it pressured or relaxed, garbled or clear?Finally, determine if the patient is oriented to person, place, and time. When additionalEMS personnel arrive, inform them of your observations prior to transfer.Assessment of Potential ViolenceViolent, or potentially violent, patients present a difficult problem for the FirstResponder, as well as for other EMS personnel, law enforcement, and innocentbystanders. The first priority when approaching a potentially violent patient is the scenesize-up. Assess the safety of the scene for both the patient and yourself. Try to obtain ahistory from the family or bystanders. Try to determine if there is a known history ofaggressive or combative behavior. Note the patient’s posture. The patient may bestanding or sitting in a position that threatens the patient or others. Look to see if thepatient’s fists are clenched or if lethal objects are in the patient’s hand or nearby. Notethe patient’s vocal activity, whether he/she is yelling or verbally threatening harm tohimself/herself or others. Finally, note the patient’s physical activity. A violent patientmay move toward you, carry heavy or threatening objects, exhibit quick or irregularmovements, or simply exhibit tense muscles. Always be aware of your surroundings andyour relative position to the patient. Never compromise your own safety.Methods to Calm Behavioral Emergency PatientsWhen assessing patients with behavioral changes, several methods may be helpful tocalm the potentially violent or unstable patient. Following these guidelines will improveyour effectiveness as a First Responder and help to protect the patient and yourself frompotential harm or injury.1. Acknowledge that the person seems upset and restate that you are there to help.2. Inform the person of what you are doing.132 First Responder EMS Curriculum/AIHA, July 2002