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G01: Behavioral Emergencies
Christopher Mistiades
Updated:
Reviewed:
Introduction
The prehospital response to a patient presenting with a behavioral emergency focuses on
immediate safety, de-escalation, and e]ective communication to manage the situation and
prevent escalation. The primary goal is to calm the patient and facilitate transport to hospital
for further assessment and care. This involves assessing the situation, maintaining a safe
distance, using calm and clear communication, and understanding potential triggers. If
necessary pharmacological and mechanical restraint should be considered as a last resort,
with a focus on minimizing harm and respecting the individual's dignity.
Essentials
- Consider and treat underlying causes
- Hypoxia
- Hypoglycemia
- Head injury
- Drug actions or withdrawal
- Infection (pneumonia, sepsis)
- Electrolyte imbalances
Interventions
First Responder (FR) Interventions
- Conduct a behavioural risk assessment
- When indicated, await law enforcement arrival
- If law enforcement has applied restraint – ensure patient is ¾-prone if possible:
- Monitor patient for changes in level of responsiveness, pulse and respiration:
- Ensure adequate respirations:
- Ventilation is as important as oxygenation; do not withhold BVM ventilations to a patient
who requires ventilatory support.
Emergency Medical Responder (EMR) & All License Levels Interventions
- Monitor vital signs closely, with attention to temperature
- Consider restraint where patient poses significant harm to self or BCEHS clinician:
- ☎️Clinicall consultation required
- ☎️Post-application consultation required if unable to do so prior.
- Least Restraint Policy
- Correct assessment findings of hypoglycemia
- Transport patient to closest, most appropriate receiving facility – consider intercept with
additional resources and/or higher level of care
Primary Care Paramedic (PCP) Interventions
- Correct hypoglycemia
- Consider vascular access
Advanced Care Paramedic (ACP) Interventions
- Continue further assessment and evaluate interventions,
- Consider restraint if not yet applied,
- Attach cardiac monitor as soon as clinically practical, obtain and interpret 12-lead ECG:
- PR16: 12-Lead ECG Consider exacerbation of underlying medical conditions,
manifestation of secondary cardiac conditions and ECG markers of poisoning
and/or toxic exposure
- Treat manifestations of behavioural emergency as appropriate:
- ☎️CliniCall consultation required if appropriate pharmacological restraint not
achieved with maximum single or maximum cumulative dose of medications AND
for all patients < 12 years of age prior to administration
- If Agitation Assessment = Severe
- If Agitation Assessment = Mild to Moderate
- If salivation exists and is unmanageable with suctioning:
- Ventilation is as important as oxygenation; do not withhold BVM ventilations to a patient
who requires ventilatory support.
Critical Care Paramedic (CCP) Interventions
- Continue further assessment and evaluate interventions,
- Consider restraint if not yet applied,
- Consider antipsychotics:
- Haloperidol *The safety and efficacy of this medication for patients < 12 years of age
has not been established*