LIGHT Team

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They can be intentional or non-intentional. Intentional overdose may be a manifestation of a suicide attempt. Unintentional overdose can be the result of confusion over taking prescription medications or misuse of recreational or illicit drugs. Overdoses of psychiatric psychoactive medications pose a unique challenge. Often these overdoses involve more than one medication confusing the presentation and management of the patient.\u003cbr\u003e\n\u003cbr\u003e\nGeneral treatment of overdoses\u003cbr\u003e\n\u003cbr\u003e\n1.\tThe patient needs a comprehensive history taken including all medications and a physical examination.\u003cbr\u003e\n2.\tA search for prescription bottles must be undertaken and an estimate made of the types and quantity of medications that may have been taken.\u003cbr\u003e\n3.\tAny history of a recreational drug or illicit drug should be investigated.\u003cbr\u003e\n4.\tThe patient should be evaluated with a monitor that can obtain vital signs, pulse oximetry, end tidal CO2 and the cardiac rhythm.\u003cbr\u003e\n5.\tOxygen should be given if indicated.\u003cbr\u003e\n6.\tIntravenous access should be obtained if indicated.\u003cbr\u003e\n7.\tSuicide interventions should be conducted if needed.\u003cbr\u003e\n8.\tThe New Mexico Poison Control Center offers excellent information if more is needed for the evaluation, treatment, and monitoring of overdose patients. (800) 222-1222.\u003cbr\u003e\n9.\tOverdose patients should be transported to an appropriate medical facility for evaluation and treatment.\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\nMedical Interventions\u003cbr\u003e\n\u003cbr\u003e\n1.\tTRICYCLIC ANTI-DEPRESSANTS\u003cbr\u003e\n\u003cbr\u003e\nA.\tThese highly toxic medications often produce serious and occasionally fatal results when overdosed. Expeditious transport to an appropriate medical facility should be undertaken once the patient is prepared for treatment and transport.\u003cbr\u003e\nB.\tIn addition to monitoring a 12-lead EKG should be obtained.\u003cbr\u003e\nC.\tCommon arrythmias associated with tricyclic overdoses include a variety of AV blocks, sinus and ventricular tachycardias, prolongation of the PR, QRS, and QT intervals and rarely Torsades.\u003cbr\u003e\ni.\tArrythmias that compromise the patient’s hemodynamic stability or are a threat such as Ventricular Tachycardia with a pulse should be treated with intravenous SODIUM BICARBANATE. This may need to be repeated to contain the arrythmia.\u003cbr\u003e\nii.\tCPR and cardiopulmonary resuscitation may be required.\u003cbr\u003e\niii.\tHypotension should be managed with fluid resuscitation. Shock states may require a vasopressor. NOREPINEPHRINE is recommended. See LCFD Treatment Guidelines for dosing.\u003cbr\u003e\nD.\tSome examples of Tricyclic Anti-Depressants in common use include Amitriptyline, Nortriptyline, Imipramine, Desipramine, and Doxepin. There are others less commonly prescribed.\u003cbr\u003e\n\u003cbr\u003e\n2.\tBENZODIAZEPINES\u003cbr\u003e\n\u003cbr\u003e\nA.\tThese medications have a wide safety range but can prove fatal especially when taken with other sedating medications or alcohol. Sedation and compromise of breathing are the most common results of overdose.\u003cbr\u003e\nB.\tThe treatment is primarily supportive. This includes maintaining a patent airway, ensuring adequate ventilation and oxygenation, and supporting blood pressure. \u003cbr\u003e\n\u003cbr\u003e\nSECOND GENERATION ANTI-DEPRESSANTS\u003cbr\u003e\n\u003cbr\u003e\n1.\tSSRI, SNRI\u003cbr\u003e\n\u003cbr\u003e\nA.\tThis is a large class of medications including Fluoxetine, Sertaline, Citalopram, Escitalopram. The SNRI’s include Duloxetine, Venlafaxine, and Desvenlafaxine. There are many others\u003cbr\u003e\nB.\tOverdoses with this class of drugs generally have a favorable outcome with proper monitoring and supportive care.\u003cbr\u003e\nC.\tSigns and symptoms include: Muscle spasms (Clonus), Tremors, Sweating, Dilated pupils, Tachycardia, Tachypnea, Confusion, Agitation, and Delirium.\u003cbr\u003e\nD.\tTreatment is largely supportive. Maintaining a patent airway and ensuring adequate ventilation and oxygenation are important.\u003cbr\u003e\nE.\tKETAMINE is not recommended in treating these patients for undifferentiated severe agitation or delirium.\u003cbr\u003e\n\u003cbr\u003e\n2.\tBUPROPRION\u003cbr\u003e\n\u003cbr\u003e\nA.\tThis unique antidepressant is potentially more toxic than the SSRI and SNRI anti-depressants. It is in common usage.\u003cbr\u003e\nB.\tSigns and symptoms include Tachycardia, Drowsiness, Agitation, Hallucinations, Vomiting, Tremors, and in severe cases Seizures.\u003cbr\u003e\nC.\tCardiac toxicity is rare but reported. Prolongation of the QRS and QT can be seen along with various arrythmias. Hypotension can occur.\u003cbr\u003e\nD.\tSeizures should be treated as any other seizure. MIDAZOLAM IM is the treatment of choice. See the LCFD SEIZURE Treatment Guideline for dosing.\u003cbr\u003e\nE.\tHypotension should be treated with fluids.\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\n3.\tMAO INHIBITORS\u003cbr\u003e\n\u003cbr\u003e\nThese highly toxic medications are not in common usage.\u003cbr\u003e\n\u003cbr\u003e\nA.\tThe toxidrome is primarily adrenergic over stimulation. Signs and symptoms are many including Altered Mental Status, Coma, Agitation, Sweating, Tachycardia, Vomiting, Seizures, Cardiorespiratory compromise, Muscle rigidity and Myoclonus (Muscle Spasms), and Fever.\u003cbr\u003e\nB.\tCardiac toxicity is reported and includes a variety of arrythmias and hypertension.\u003cbr\u003e\nC.\tTreatment is largely supportive including securing a patent airway and ensuring adequate ventilation and oxygenation.\u003cbr\u003e\nD.\tSeizures should be managed as any other seizure with MIDAZOLAM IM. See the LCFD Treatment Guidelines for dosing.\u003cbr\u003e\nE.\tExpeditious transport should be obtained.\u003cbr\u003e\n\u003cbr\u003e\nSECOND GENERATION (ATYPICAL) ANTI-PSYCHOTICS\u003cbr\u003e\n\u003cbr\u003e\nA.\tMuch more commonly prescribed than the first-generation anti-psychotic agents these include Resperidone, Quetiapine, Olanzapine, Aripiprazole, and Clozipine with other newer agents coming on the market rapidly.\u003cbr\u003e\nB.\tThe signs and symptoms are often complicated by multiple medications being ingested. There are very often multiple medications prescribed. The signs and symptoms include Delirium, Fever, Tachycardia, Blurred vision, Red Dry Skin, Agitation, Hallucinations, Mumbling Speech. The patient rarely recalls the event.\u003cbr\u003e\nC.\tCardiac toxicity has been reported with QT interval prolongation. Torsades is rarely reported, however.\u003cbr\u003e\nD.\tTreatment is largely supportive care ensuring a patent airway and adequate ventilation and oxygenation.\u003cbr\u003e\nE.\tHypotension if it occurs should be managed with fluids.\u003cbr\u003e\n\u003cbr\u003e\nLITHUM\u003cbr\u003e\n\u003cbr\u003e\nA.\tLithium has been used as a mood stabilizer in bipolar disorder for over a century. It has a narrow range of safety and unintentional overdose is common.\u003cbr\u003e\nB.\tSymptoms and signs vary with the serum concentration of Lithium. They range from Tremor, Overactive Reflexes, Nystagmus (eye tremor), and Ataxia (poor muscle control) to more severe symptoms and signs of Confusion, Agitation, Delirium, and Tachycardia leading to Coma, Seizures, Fever, and Hypotension.\u003cbr\u003e\nC.\tCardiac toxicity is usually non-specific and mild.\u003cbr\u003e\nD.\tTreatment is largely supportive. Ensure a patent airway and adequate ventilation and oxygenation.\u003cbr\u003e\nE.\tHypotension should be managed with fluids.\u003cbr\u003e\nF.\tSeizures are rare and can be managed with MIDAZOLAM. See the LCFD Treatment Guidelines for dosing.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":null,"widget_label":"Widget Label","widget_code":null},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2716755/13380453"},{"listId":13380452,"catId":2716755,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"ANXIETY","summary":"","detail":"ANXIETY\u003cbr\u003e\n\u003cbr\u003e\nSevere anxiety, which comes in many forms, can be impairing to a patient and interfere with cognitive function, decision making, focus, and the ability to understand and cooperate with medical and psychological care. Anxiety can be periodic such as in “anxiety attacks” or be in a more chronic form. It is commonly part of a bigger and more complex mental illness state such as major depression, bipolar disorder, or the cognitive disorders (schizophrenia) as well as others. Whatever form it takes if it is of sufficient severity to impair a patient’s function and ability to understand and cooperate with their care it may be in the best interest of the patient to attempt to reduce their anxiety with medication on scene.\u003cbr\u003e\n\u003cbr\u003e\nPanic is a unique and usually episodic severe symptom complex. It is often predominated by physical symptoms that often add to the frightening experience. These include such things as chest pain, shortness of breath, dizziness, tingling, and confusion. Interventions that calm the patient and encourage normal breathing may assist. The physical complaints need to be investigated as part of the work up of these patients before medical intervention.\u003cbr\u003e\n\u003cbr\u003e\nProcedure\u003cbr\u003e\n\u003cbr\u003e\n1.\tAn oral benzodiazepine can be an effective, safe, and expeditious intervention.\u003cbr\u003e\n2.\tPrior to any medication administration a medical history and appropriate physical examination will be conducted to the extent the patient will allow.\u003cbr\u003e\n3.\tThe benzodiazepine of choice is MIDAZOLAM. It is safe, short acting, and can be of immediate benefit.\u003cbr\u003e\n4.\tThe recommended dose is 2.5 mg. IN, IM, or IV. IN and IM are recommended.\u003cbr\u003e\n5.\tThe patient should be advised the medication can cause a “buzz” or feelings of unreality or disorientation, sedation, and calming.\u003cbr\u003e\n6.\tThere are few contraindications.\u003cbr\u003e\na.\tAllergy to the medication\u003cbr\u003e\nb.\tSignificant intoxication with alcohol or other sedative drugs\u003cbr\u003e\nc.\tPrior history of a poor reaction to similar medications (Lorazepam, Clonazepam, Diazepam)\u003cbr\u003e\nd.\tEvidence of head trauma or impaired cognition due to an existing medical condition\u003cbr\u003e\n7.\tThe medication can cause impairment itself complicating obtaining informed consent, cooperating with treatment and transport, or completing a refusal of care. This downside must be taken into consideration prior to administering any medication. In most cases the patient is better able to make important decisions and cooperate with care due to the medication’s calming properties. The treating paramedic and team will need to make a determination of the patient’s capacity after the medication has become effective.\u003cbr\u003e\n8.\tAdministration of MIDAZOLAM does not necessitate transport. The overwhelming majority of patients can be left on scene in the company of a responsible adult after use of the medication. Many of these patients, relieved of intense anxiety, will wish to sleep.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":null,"widget_label":"Widget Label","widget_code":null},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2716755/13380452"},{"listId":13380451,"catId":2716755,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"DESTINATION (ALTERNATIVE)","summary":"","detail":"TRANSPORT TO ALTERNATIVE DESTINATIONS OR RESPONSIBLE ADULTS\u003cbr\u003e\n\u003cbr\u003e\nIt is appropriate to consider alternative destinations for some patients encountered by the crisis intervention team rather than an emergency department. See EXLCUSION CRITERIA for additional information. A medically stable patient who has capacity to understand informed consent and shows understanding of their condition and potential outcomes may be a candidate for an alternative transport destination. \u003cbr\u003e\n\u003cbr\u003e\nIn general, it is appropriate to utilize a crisis intervention facility for the destination of the medically stable competent patient experiencing a mental health crisis. These include established mental health care or other appropriate health care facilities.. These facilities have exclusion criteria that is otherwise referenced in these guidelines.\u003cbr\u003e\n\u003cbr\u003e\nThere will be cases where the patient refuses to follow the recommendations of the crisis intervention team and wishes to be left in the care of other responsible adult(s). These adults may be family members or friends. The appropriateness of this decision is left to the discretion of the LIGHT team.\u003cbr\u003e\n\u003cbr\u003e\n1.\tThe patient must be medically stable and have capacity to understand informed consent and their condition as well as possible outcomes including negative outcomes without professional interventions not available on-scene.\u003cbr\u003e\n2.\tIt may be the conclusion of the crisis intervention team that the interventions delivered on-scene are sufficient to allow the patient to remain on-scene or in the care of a responsible adult without transport to a facility.\u003cbr\u003e\n3.\tIf it is the opinion of the team that the patient’s best interests lay in going to a facility and the patient is unwilling to follow that recommendation a refusal form should be completed, explained, and signed by the patient if they are willing. \u003cbr\u003e\n4.\tThe team must make a good faith determination that the person or persons the patient wishes to remain with are responsible adults who are not themselves impaired in any way and appear capable and willing to provide for the patient’s needs. This can be a challenging determination. In the end if the patient possesses capacity to make an informed consent, then there may be no alternative but to leave the patient on-scene with the person or persons he/she designates.\u003cbr\u003e\n5.\tIt may at times be necessary to transport the patient to a different location to meet with the chosen responsible adult the patient has designated. It would be preferable to have that individual pick up the patient from the scene but transport by the team is sometimes necessary.\u003cbr\u003e\n6.\tAll determinations need to be in the patient’s best interest and with the agreement of the team when possible. A refusal form should be explained and signed in cases where the recommendations of the team are unacceptable to the patient and the patient does not qualify for involuntary transport.\u003cbr\u003e\n7.\tTransport to the Peak Behavioral Health facility in Santa Teresa, NM, is allowable. The Battalion Chief on duty should be notified that the team will be outside radio range/contact for a period of time.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":null,"widget_label":"Widget Label","widget_code":null},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2716755/13380451"},{"listId":13380450,"catId":2716755,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"SEDATION WITH MEDICATION","summary":"","detail":"SEDATION OF THE AGITATED PATIENT WITH MEDICATION\u003cbr\u003e\n\u003cbr\u003e\nIntroduction\u003cbr\u003e\n\u003cbr\u003e\nThis Guideline brings together the various elements of the sedation of patients from other Guidelines in this document. Medication-assisted sedation of the severely agitated, delirious, combative, drug impaired, and impaired violent patient who poses a risk of harm to themselves and others is safer and more effective than physical restraint. Patients in these hypermetabolic states are at risk for disability or death, and using physical restraints places them at heightened risk for a poor outcome. Sedation is only undertaken under the following conditions. The individual has been turned over to EMS as a patient, a medical indication for sedation is established, and transport to an appropriate medical facility is available within a reasonable amount of time. \u003cbr\u003e\n\u003cbr\u003e\nAs noted, the treating paramedic and team make the decision to sedate a patient with medications. Medication-assisted sedation is not a law enforcement decision. However, officers may be the source of the referral and may be needed to assist in restraining the patient during medication administration. Always act to ensure the patient's safety and well-being.\u003cbr\u003e\n\u003cbr\u003e\nGuideline\u003cbr\u003e\n\u003cbr\u003e\n1.\tThe patient may be the subject of a 911 call, a referral from the MIH/LIGHT team, or law enforcement. In all cases the subject must be turned over to EMS as a patient to determine the needs of the patient and whether sedation is indicated.\u003cbr\u003e\n2.\tAll patients need to be assessed to the extent that the patient’s condition allows including a history and a physical examination.\u003cbr\u003e\n3.\tSedation has significant risks and should only be done for the safety and well-being of the patient and care providers.\u003cbr\u003e\n4.\tOnce it is determined that sedation is indicated it is paramount that all equipment, manpower, and medications are prepared before an attempt to sedate is made. Personnel will be prepared to administer the medication, monitor the patient, and manage any adverse events. Adverse events are rare but need to be anticipated.\u003cbr\u003e\n5.\tThe following medications are approved for medication assisted sedation:\u003cbr\u003e\n\u003cbr\u003e\nA.\tKETAMINE is a NM Special Skill medication. The dose is 2-4 mg./kg. IM. It is generally effective within five minutes. Limited to patients 13 years and older.\u003cbr\u003e\nB.\tMIDAZOLAM is a benzodiazepine. The dose is 5-10 mg. IM. It may take up to 20 minutes to become effective.\u003cbr\u003e\nC.\tThe choice of medication is up to the treating paramedic. In general, pure cases of psychosis from schizophrenia, manic psychosis, or other isolated psychoses without drug involvement can be managed best with MIDAZOLAM. Ketamine can aggravate psychosis. If psychoactive drugs may be involved KETAMINE may be the preferred agent.\u003cbr\u003e\n\u003cbr\u003e\nD.\tOnce sedation appears effective and the patient is calm and able to cooperate all physical restraint and restraints should be removed including “The WRAP”. The patient must be kept in a comfortable position that facilitates breathing and hemodynamic stability.\u003cbr\u003e\nE.\tThe patient should be closely monitored by a paramedic. Vital signs, pulse oximetry, and end tidal CO2 will be monitored as well as the patient’s airway and ventilation. Transport to a medical facility should be undertaken when it is safe to do so.\u003cbr\u003e\n\u003cbr\u003e\n6.\tIn unusual situations where KETAMINE appears to be ineffective or even aggravates the patient’s agitated state it is safe to administer MIDAZOLAM. Again, it is necessary to monitor the patient for compromised breathing with two sedating medications in their system.\u003cbr\u003e\n7.\tFor the MIH/LIGHT team it is important that a transporting unit be available within a reasonable period of time in order to safely sedate and transport the patient.\u003cbr\u003e\n8.\tFor MINOR patients there is the opportunity to obtain informed consent from parents or guardians. This opportunity may be taken and a good faith effort made to obtain consent before any medication administration. If no opportunity exists to get informed consent on behalf of the minor patient exercise clinical judgement in determining the appropriateness of sedation in an emergency situation.\u003cbr\u003e\n9.\tPEDIATRIC patients represent an unusual and vulnerable population. Nevertheless, the need for sedation in select severely agitated patients does arise. Again, the opportunity for informed consent is present and should be pursued with the patient’s parents or guardians. KETAMINE has not been extensively studied in pediatric patients and is not recommended below the age of 13. MIDAZOLAM is the preferred medication for sedation. The dose is 0.2 mg./kg. given IM. Maximum dose is 10 mg.\u003cbr\u003e\n10.\tPatients being transported from a facility should be sedated by the facility staff at the facility. No one should be placed in an ambulance unit who is not safe and comfortable in a gurney.\u003cbr\u003e\na.\tThorough history and understanding of medication used to sedate a patient by a facility will be obtained. \u003cbr\u003e\nb.\tContact medical control for direction on continuing sedation if necessary, during transport. \u003cbr\u003e\nc.\tCollaboration with the facility is necessary to ensure safety of the patient and responders.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":null,"widget_label":"Widget Label","widget_code":null},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2716755/13380450"},{"listId":13380449,"catId":2716755,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"RESTRAINT","summary":"","detail":"CHEMICAL RESTRAINT OR SEDATION\u003cbr\u003e\n\u003cbr\u003e\nIn cases of excited delirium, extreme agitation, severe combativeness, and risks of self-harm or harm to care givers chemical restraint or sedation may be indicated. This is a huge decision and should be approached carefully and in good faith . The decision to sedate a patient should be based on sound medical grounds and is not a law enforcement decision. The patient needs to be transferred to the care of the paramedic and a full assessment performed to the limits allowed by the patient’s condition. An appropriate transport vehicle should be in route or otherwise available and the full complement of medications and equipment should be available to manage the patient, manage any adverse events, and monitor the patient.\u003cbr\u003e\n\u003cbr\u003e\nMental health crises can pose specific problems for chemical restraint interventions. Acute psychotic manic episodes or gross hallucination can be exacerbated by Ketamine and Midazolam may be the preferred medication. Some medical conditions should be cautiously approached when considering Ketamine including dangerous hypertension, acute cardiac disease, and sedating medications such as gross alcohol intoxication and other sedatives where the patient already has a depressed level of consciousness.\u003cbr\u003e\n\u003cbr\u003e\n1.\tDetermine that the patient is a danger to themselves or caregivers due to undifferentiated agitated delirium, severe agitation, severe combativeness, or other conditions amenable to chemical restraint for the patient’s well-being.\u003cbr\u003e\n2.\tBe certain that medical indications exist for medication assisted restraint.\u003cbr\u003e\n3.\tThe patient must be transferred to the paramedic for medical care. The restraint of the patient for safety may require the additional help of law enforcement but this is not a law enforcement decision.\u003cbr\u003e\n4.\tThe patient needs a full assessment to the degree that the patient’s condition allows.\u003cbr\u003e\n5.\tThe patient must be transported to an emergency department for further care.\u003cbr\u003e\n6.\tThe use of soft restraints in any sedated patient (or in general in agitated patients) is allowable. The patient must be in a comfortable position where circulation and breathing are not compromised.\u003cbr\u003e\n7.\tThe LCFD Treatment Guidelines applicable to sedation follow:","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":null,"widget_label":"Widget Label","widget_code":null},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2716755/13380449"},{"listId":13380448,"catId":2716755,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"EXCLUSION CRITERIA","summary":"","detail":"EXCLUSION CRITERIA\u003cbr\u003e\n\u003cbr\u003e\nThe decision whether a patient can be safely transported to a non-emergency department facility/clinic/office is going to be difficult in some cases. The range of possible exclusions is vast and not entirely covered here. The paramedic will need to make a careful good faith1 judgement that the patient does not need the medical evaluation and intervention offered by an emergency department. The goal is to provide the patient with the most appropriate solution for their problem. Often this is a treat-in-place modality and not the emergency department. Take great care when evaluating patients who are in police custody and destined for detention and “medical clearance” is requested. The following exclusion criteria apply, and many patients retain their right to treatment and transport to an appropriate facility or refusal of such care.\u003cbr\u003e\n\u003cbr\u003e\n1.\tPerform the fullest patient assessment that can be safely done and allowed by the patient.\u003cbr\u003e\n2.\tObtain as much information as possible as to the patient’s capacity (competence) to understand their problem, informed consent, and decisions for treatment and transport.\u003cbr\u003e\n3.\tDetermine if in the opinion of the paramedic the patient should be first evaluated in an emergency department before other dispositions are considered.\u003cbr\u003e\na.\tHistory of unstable or active disease that is time-sensitive and in need of evaluation and stabilization.\u003cbr\u003e\ni.\tPossible traumatic brain injury (current or recent)\u003cbr\u003e\nii.\tLife or limb threatening trauma\u003cbr\u003e\niii.\tExacerbations of chronic respiratory disease (asthma, COPD)\u003cbr\u003e\niv.\tExacerbations or active cardiac disease (ischemia, failure, marked hypertension, marked hypotension, marked tachycardia, arrhythmias)\u003cbr\u003e\nv.\tUndiagnosed abdominal or pelvic pain\u003cbr\u003e\nvi.\tPossible risks to pregnancy\u003cbr\u003e\nvii.\tPossible life-threatening overdose or intoxication\u003cbr\u003e\nviii.\tGrossly abnormal vital signs including febrile conditions\u003cbr\u003e\nix.\tAny medical or traumatic issues not mentioned that concern the attending paramedic\u003cbr\u003e\n4.\tIn the event a decision is challenging it may be necessary to contact a physician for medical direction concerning transport to an emergency department.\u003cbr\u003e\n5.\tEach potential health care facility, including Acute Behavioral Health Facilities and established mental health providers, will have exclusion criteria that will need to be assessed and determined on a case-by-case basis.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":null,"widget_label":"Widget Label","widget_code":null},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2716755/13380448"},{"listId":13380447,"catId":2716755,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"PATIENT ASSESSMENT","summary":"","detail":"PATIENT ASSESSMENT\u003cbr\u003e\n\u003cbr\u003e\nAll patients in a mental health or behavioral crisis should undergo an assessment by a paramedic to the extent that it can be safely done or permitted by the patient. In general, a calm approach to an assessment can provide comfort to the patient who is feeling out-of-control. This is especially true of touching and reassuring the patient. The assessment should be made up of a detailed history, vital signs, a head-to-toe examination, and a discussion with the patient of the findings. The goal is two-fold: calm the patient and find any clues to a medical or traumatic origin to the crisis or contributing to the crisis.\u003cbr\u003e\n\u003cbr\u003e\n1.\tApproach the patient calmly and ask permission to ask questions, take their vital signs, and examine them.\u003cbr\u003e\n2.\tThe history is important\u003cbr\u003e\na.\tHistory of the present illness or crisis.\u003cbr\u003e\nb.\tPast medical and psychological history of similar episodes, mental illnesses, medical problems, recent trauma (especially head), medications and therapy, compliance with medications and therapy, allergies or medication intolerance.\u003cbr\u003e\nc.\tAny psycho-social experiences that may be contributing to the present crisis.\u003cbr\u003e\n3.\tThe physical examination can be comforting to the patient and reassuring that something is being done to help them.\u003cbr\u003e\na.\tVital signs\u003cbr\u003e\nb.\tPrimary survey (ABC’s)\u003cbr\u003e\nc.\tSecondary survey (Head-to Toe examination)\u003cbr\u003e\nd.\tMake every effort to assess the patient’s capacity (competence) to understand and consent to treatment and/or transport and insight into their present crisis.\u003cbr\u003e\ne.\tPoint of care testing as available and necessary for evaluation at an Acute Behavioral Health Facility (this will vary with each facility).\u003cbr\u003e\ni.\tBGL\u003cbr\u003e\nii.\tBreathalyzer for estimated blood alcohol level\u003cbr\u003e\n4.\tInform the patient of any significant findings and reassure that they are safe and in competent hands.\u003cbr\u003e\n5.\tDocument the full assessment in a PCR.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":null,"widget_label":"Widget Label","widget_code":null},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2716755/13380447"},{"listId":13380446,"catId":2716755,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"DOCUMENTATION","summary":"","detail":"DOCUMENTATION\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\nThorough documentation of every patient encounter is necessary. The form that documentation takes will vary with the type of encounter. In all situations where a patient is assessed by a paramedic for psychological or medical disorders and undergoes a history and physical examination a PCR should be completed. \u003cbr\u003e\n\u003cbr\u003e\nThe following are a guideline for what should be included in that PCR.\u003cbr\u003e\n\u003cbr\u003e\n1.\tHistory of the present illness and/or origins of the present crisis.\u003cbr\u003e\n2.\tPast psychological and medical history including current medications and therapy.\u003cbr\u003e\n3.\tCompliance with therapy and medications.\u003cbr\u003e\n4.\tAllergies.\u003cbr\u003e\n5.\tVital Signs.\u003cbr\u003e\n6.\tAny Point of Care testing including BGL and Breathalyzer results.\u003cbr\u003e\n7.\tPhysical examination (head-to-toe) if allowed by patient.\u003cbr\u003e\n8.\tField diagnosis or assessment.\u003cbr\u003e\n9.\tTreatment recommendations and disposition decisions.\u003cbr\u003e\n\u003cbr\u003e\nIn cases where the patient will not be transported or taken to an appropriate facility or office a Refusal Form is not always required. A Refusal Form should be completed along with a complete PCR when the patient is not willing to follow through on treatment recommendations.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":null,"widget_label":"Widget Label","widget_code":null},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2716755/13380446"}],"data":false,"categoryData":{"catName":"LIGHT Team","catId":2716755,"catIcon":""},"parentCategoryData":{"catId":2114007,"catName":"GUIDELINES"}},"match":{"hostname":"www.lcfdapp.com","page":"services_1582148118880_5","category":"2716755"}}},"page":"/[...slug]","query":{"slug":["services_1582148118880_5/2716755"]},"buildId":"1234567890","isFallback":false,"dynamicIds":[1204],"customServer":true,"gip":true,"scriptLoader":[]}