PSYCHIATRIC EMERGENCIES

DESIGNATION OF CONDITION

The patient will have an altered mental status with associated inappropriate actions. Signs and symptoms may include: threatened or attempted suicide, aggression, hallucinations, or any action that could cause harm to the patient or others.

EMPHASIS ON PATIENT CARE

Provider safety, transport decisions.

FIRST RESPONDER, BASIC, INTERMEDIATE and PARAMEDIC PRE-HOSPITAL MANAGEMENT

1. Assess airway, breathing and circulation and manage as indicated.

• If evidence of immediate danger exists:
  • Protect yourself and others (leave the scene, if necessary).
  • Summon law enforcement.
  • Show of force utilizing law enforcement should be considered if indicated by patient behavior and if necessary to render care.
• If no evidence of immediate danger exists.
  • ONE EMT should be responsible for assessing, treating, and communicating with patient.
  • The SAME EMT should remain with patient during transport.
• Paramedics may consider administration of benzodiazepine administration with on-line Medical Control orders.

2. Obtain focused H&P - History, physical exam, vital signs.

• Pertinent medical history, if possible including:
  • Prescription and non-prescription drugs.
  • Underlying organic cause, i.e. brain tumor, chemotherapy, and hypoglycemia.
  • Previous psychiatric problems.

3. Transport with patient consent.

• Transport the patient in position of comfort, if not contraindicated by injuries.
• Keep environment as quiet as possible.

4. Transport without consent.

• If medical complications are indicted follow Emergency Transport Protocols.

Note: Use physical restraint only if necessary for protection of EMS providers or the patient. If restraint of the patient is necessary, do not attempt to restrain until you have sufficient resources. A minimum of four people is necessary to assure adequate protection to the rescuers and patient during the restraint process. If restraints have been applied, do not release until transfer at the hospital.
SCENE SAFETY, LEAVE IF NOT SAFE
CONSIDER SHOCK, HEAD INJURY, HYPOGLYCEMIA, TOXICOLOGY AND HYPOXIA