Transcript File - Huff Hills Ski Patrol

Chapter 33
Behavioral Emergencies
and Crisis Response
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Objectives
33.1 Define the following terms:
a. behavior
b. behavioral emergency
33.2 Compare and contrast neurosis and
psychosis.
33.3 List and explain four factors that can
cause stress or lead a person to behave
strangely.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Objectives
33.4 List the signs and symptoms of common
behavioral emergencies.
33.5 Identify techniques to help maintain
rescuer safety when responding to a
behavioral emergency.
33.6 Describe and demonstrate how to
assess a patient with a behavioral
emergency.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Objectives
33.7 Describe and demonstrate the treatment
of a patient with a behavioral
emergency.
33.8 List the indications for restraining a
patient.
33.9 Describe and demonstrate how to
properly restrain a patient.
33.10 List the five phases of the Kübler-Ross
grieving process.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Topics
 Case
Presentation
 Anatomy and Physiology
 Common Behavioral Emergencies
 Death and Grief
 Assessment
 Management
 Chapter Summary
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Case Presentation
A male in his 20s is having an anxiety attack and
yelling at his sister. He is yelling threats as the
patroller, appears wild-eyed, angry, and suspicious;
he is clenching and unclenching his fists.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Anatomy and Physiology
 Brain
is responsible for homeostasis.
 Stress is a response to demands/
pressures (fight or flight)
◦ Responses occur throughout the body
◦ Some stress is normal; too much or
prolonged can cause imbalance /altered
mental processes and abnormal
behavior.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Anatomy and Physiology
 Structural
abnormalities or chemical
imbalances may alter perception of
reality.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Common Behavioral
Emergencies
 Medical
disorders:
◦ Hypoxia and hypoglycemia
 Chemical
exposures:
◦ Alcohol and drugs
 Trauma:
◦ Brain injury/hypoxia
 Behavioral
conditions:
◦ Neurosis and psychosis
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Behavioral Conditions
 Neurotic
◦
◦
◦
◦
disorders:
Anxiety
Depression
Paranoia
Agitation
 Psychotic
disorders:
◦ Schizophrenia
◦ Bipolar disorder
◦ Suicide
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Behavioral Conditions
Copyright Craig Brown
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Suicide
 Often
occurs as a reaction to severe
emotional distress.
 Some are at greater risk.
 Risky behaviors may mask suicidal
intentions.
 Patient with suicidal gestures cannot
be left alone or refuse medical care.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Violence and Abuse
 Violence
◦ Violence may be directed inward or
outward, intentional or unintentional.
◦ Fight/flight response may be violent.
◦ May result from mental illness.
◦ May be neurotic or psychotic.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Violence and Abuse
 Abuse
◦ Abuse may be verbal, physical, sexual .
◦ Is a crime – know reporting requirements
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Death and Grief
 Survivors
experience varied
responses – some abnormal.
 Rescuers also experience stress.
 Life saving interventions are initiated
in most circumstances.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Death and Grief
 Interventions
may be withheld if
certain signs of death or a DNR order
is on record, coupled with physician
input.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Death and Grief
 Grief
has predictable phases
◦ No time frame
◦ Some people may become stuck in a
certain phase or revert to an earlier
phase, especially at key times.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Death and Grief
Copyright Mike Halloran
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Posttraumatic Stress Disorder
 Follows
exposure to a traumatic
incident
 Can affect patient, family, rescuers
 May be immediate or delayed
 Symptoms differ person-to-person
 Treatment is needed
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Case Update
Scene safety is important. You assure the man that
you are here to help him. After obtaining his
permission, you approach him. His heart rate is 105
bpm, his blood pressure is 126/72, and his
respiratory rate is 32. As you begin to build trust, you
learn that the patient’s brother died one year ago
today. During your assessment, you learn that the
patient has not eaten since last night. The physical
assessment is unremarkable.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Assessment
 Scene
safety is paramount
◦ Law enforcement presence may be
desirable
◦ Have escape routes in mind
◦ Assume patient is dangerous
◦ Do not approach if there is a weapon
 All
verbalizations/actions are calm
 Be honest, don’t judge or confront
 Summon help
BRADY
continued
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Assessment
 Observe
ABCDs and behavior,
determine if patient is in reality
◦ Delay physical contact if necessary
◦ No diagnosis of underlying cause
 Trauma
and medical history are vital
◦ Ask about medications/drugs
 Review
S&S of behavioral emergency
 If patient is willing to talk, listen to continued
content to assess mental state
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Assessment
 It
may not be possible to assess
psychotic patients – they may refuse
or not give coherent answers.
◦ Questions about meds are important
 Suspected
abuse should be reported.
 Normal physical exam should be
made if possible.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
 Keep
patient and rescuers safe
 Assume medical condition as cause
 Use high flow oxygen or glucose
based on assessment
 Continue to calm and reassure
 Notify management/law enforcement
as needed
 Document thoroughly
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Continuum of Responses
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Restraints
 Use
when danger is imminent:
◦ Involve area security/law enforcement
◦ Non-law enforcement use is restricted
 Assess
capacity of person to refuse
care:
◦ Based on local protocols
 Methods/procedures
must be
established by local area
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Critical Incident Stress
 Rescuers
can have PTSD:
◦ Know signs and symptoms in self and
others
 Know
how to get in touch with CISM
help.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Case Disposition
He drinks some bottled drink from his backpack. He
thanks you for your kindness. You and another OEC
Technician accompany the patient and his sister to
the top of the ridge, which is only a quarter mile
away. This behavioral emergency was likely brought
on by the combination of anxiety, grief, and low blood
sugar.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
Personal safety is the top priority when
managing a behavioral emergency.
 A behavioral emergency exists when a
person exhibits abnormal thoughts or
actions.
 The cause of a behavioral emergency may
be medical, chemical, traumatic, or
psychiatric.

continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
Signs and symptoms of a behavioral
emergency include panic, agitation,
violence, and self-destructive behavior.
 The five stages of grief are denial, anger,
bargaining, depression, and acceptance.
 Calming patients is one of the most
important components of managing a
behavioral emergency.

continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
If appropriate, call for help, including area
security personal and police authorities.
 Always keep your cool.

continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ