BEHAVORIAL EMERGENCIES REQUIRING RESTRAINT OR TRANSPORT TO ALTERNATIVE DESTINATION
ALL LEVELS
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, delirium, or any action that could cause harm to the patient or others. If the EMS provider makes a good faith judgment that the patient is incapable of making an informed decision about his/her own safety or the need for medical attention and is reasonably likely to suffer disability or death without medical intervention the patient should be transported to a medical facility
EMPHASIS ON PATIENT CARE
Provider safety, transport decisions
1. Primary Management - Assess airway, breathing and circulation and manage as indicated.
a. If evidence of immediate danger/severe agitation/delirium exists:
i. Protect yourself and others (leave the scene, if necessary).
ii. Request law enforcement.
iii. Show of force utilizing law enforcement should be considered if indicated by patient behavior and if necessary to render care.
iv. When considering medication see SEDATION OF THE AGITATED PATEINT WITH MEDICATION guideline in this section.
b. If no evidence of immediate danger/severe agitation/delirium exists:
i. ONE EMT should be responsible for assessing, treating, and communicating with patient.
ii. The SAME EMT should remain with patient during transport.
2. Secondary Management - History, physical exam, vital signs
a. Pertinent medical history, if possible including:
i. Prescription and non-prescription drugs.
ii. Underlying organic cause, i.e. brain tumor, chemotherapy, closed head injury, hypoglycemia, hypoxia, shock, toxin consumption.
iii. Previous psychiatric problems
3. Transport
a. Transport the patient in position of comfort, if not contraindicated by injuries.
b. Keep environment as quiet as possible.
c. If Paramedic administers Ketamine he/she must accompany patient in ambulance unless a Ketamine Special Skills approved Paramedic available in the ambulance.
Notes: Use physical/chemical restraint only if necessary for protection of EMS providers or the patient. 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. A restrained patient will always have an EMT in attendance.
Patients will not be restrained in the prone (face down) position or transported as such. This position, particularly in agitated patients, can lead to “positional asphyxia” and must be avoided.
Special notes on restraint with medications. This is one of those unusual situations where the patient is incapable of giving adequate informed consent. You must be acting in the patient’s best interests (in “good faith”) when making the decision to use medication for restraint and document carefully your justifications. This is a medical decision for the patient’s safety and well-being and should be based on those needs. See SEDATION OF THE AGITATED PATIENT WITH MEDICATION in this section.
SPECIAL CONSIDERATIONS FOR TRANSPORT TO THE CRISIS TRIAGE CENTER
The Crisis Triage Center is intended to meet the needs of the majority of behavioral and psychiatric patients. They are located next to the Detention Center on Copper Loop. The decision to transport a patient to the CTC will require triage in the field. The CTC has limited medical capabilities but has a staff of an RN and a licensed therapist on duty 24 hours a day. They intend to keep patients who are voluntary admissions up to 24 hours. They do not accept involuntary admissions. A psychiatrist is available remotely. There will be a pharmacy and the ability to administer psychotropic medications. They represent a potentially valuable alternative to emergency departments for select patients. The dedicated phone number to contact the Crisis Triage Center is (505) 420-8204.
Acceptable patients:
Medically stable patients not requiring emergency department medical interventions.
Must have the capacity for informed consent and be willing to go to the Crisis Triage Center.
Drug and alcohol impaired patients are acceptable if they choose the Crisis Triage Center. Again, the patient must retain the capacity for informed consent to a reasonable degree.
No sedating medications have been administered.
Must be 18 years old or older. If they have a legal guardian, the guardian is welcome.
COVID positive or suspected are not acceptable.
Needs to be ambulatory.
ALL LEVELS
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, delirium, or any action that could cause harm to the patient or others. If the EMS provider makes a good faith judgment that the patient is incapable of making an informed decision about his/her own safety or the need for medical attention and is reasonably likely to suffer disability or death without medical intervention the patient should be transported to a medical facility
EMPHASIS ON PATIENT CARE
Provider safety, transport decisions
1. Primary Management - Assess airway, breathing and circulation and manage as indicated.
a. If evidence of immediate danger/severe agitation/delirium exists:
i. Protect yourself and others (leave the scene, if necessary).
ii. Request law enforcement.
iii. Show of force utilizing law enforcement should be considered if indicated by patient behavior and if necessary to render care.
iv. When considering medication see SEDATION OF THE AGITATED PATEINT WITH MEDICATION guideline in this section.
b. If no evidence of immediate danger/severe agitation/delirium exists:
i. ONE EMT should be responsible for assessing, treating, and communicating with patient.
ii. The SAME EMT should remain with patient during transport.
2. Secondary Management - History, physical exam, vital signs
a. Pertinent medical history, if possible including:
i. Prescription and non-prescription drugs.
ii. Underlying organic cause, i.e. brain tumor, chemotherapy, closed head injury, hypoglycemia, hypoxia, shock, toxin consumption.
iii. Previous psychiatric problems
3. Transport
a. Transport the patient in position of comfort, if not contraindicated by injuries.
b. Keep environment as quiet as possible.
c. If Paramedic administers Ketamine he/she must accompany patient in ambulance unless a Ketamine Special Skills approved Paramedic available in the ambulance.
Notes: Use physical/chemical restraint only if necessary for protection of EMS providers or the patient. 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. A restrained patient will always have an EMT in attendance.
Patients will not be restrained in the prone (face down) position or transported as such. This position, particularly in agitated patients, can lead to “positional asphyxia” and must be avoided.
Special notes on restraint with medications. This is one of those unusual situations where the patient is incapable of giving adequate informed consent. You must be acting in the patient’s best interests (in “good faith”) when making the decision to use medication for restraint and document carefully your justifications. This is a medical decision for the patient’s safety and well-being and should be based on those needs. See SEDATION OF THE AGITATED PATIENT WITH MEDICATION in this section.
SPECIAL CONSIDERATIONS FOR TRANSPORT TO THE CRISIS TRIAGE CENTER
The Crisis Triage Center is intended to meet the needs of the majority of behavioral and psychiatric patients. They are located next to the Detention Center on Copper Loop. The decision to transport a patient to the CTC will require triage in the field. The CTC has limited medical capabilities but has a staff of an RN and a licensed therapist on duty 24 hours a day. They intend to keep patients who are voluntary admissions up to 24 hours. They do not accept involuntary admissions. A psychiatrist is available remotely. There will be a pharmacy and the ability to administer psychotropic medications. They represent a potentially valuable alternative to emergency departments for select patients. The dedicated phone number to contact the Crisis Triage Center is (505) 420-8204.
Acceptable patients:
Medically stable patients not requiring emergency department medical interventions.
Must have the capacity for informed consent and be willing to go to the Crisis Triage Center.
Drug and alcohol impaired patients are acceptable if they choose the Crisis Triage Center. Again, the patient must retain the capacity for informed consent to a reasonable degree.
No sedating medications have been administered.
Must be 18 years old or older. If they have a legal guardian, the guardian is welcome.
COVID positive or suspected are not acceptable.
Needs to be ambulatory.