PSYCHIATRIC/BEHAVIORAL EMERGENCY

Inclusion Criteria: Patients exhibiting psychological disturbances that produce thoughts, feelings, and behaviors destructive to the patient or another person.  Paramedics must report all patients with suspected suicide attempt or ideation to BioTel before leaving the scene.  Treat patients suspected of taking an overdose using the POISONED PATIENT AND OVERDOSE Guidelines.  Treat patients with an altered level of consciousness using the ALTERED LEVEL OF CONSCIOUSNESS Guidelines.

Special Note: For patients with a psychiatric emergency who are in police custody, refer to the CUSTODY policy.

SPECIAL NOTE: NEVER transport a patient in the prone position.
NOTE:  Consider alternative, organic explanations for seemingly psychiatric or behavioral symptoms. (A-E-I-O-U-T-I-P-S; alcohol, epilepsy (or head injury), insulin (hypoglycemia), overdose, underdose, trauma, infection, psychosis, sepsis.)

Basic Level

  1. Assess and support ABCs.
  2. Position of comfort.
  3. Reduce stimuli by isolating the patient from people or events causing his or her agitation.
  4. Administer oxygen, as needed, to maintain a SpO2 of at least 94%.
  5. If the patient requires restraint, follow the RESTRAINT OF PATIENTPolicy.
  6. If the patient exhibits any seizure activity, follow the SEIZURE Guidelines.
  7. Transport the patient to the nearest hospital for medical clearance.

Advanced Level

  1. Consider continuous ECG and ETCO2 monitoring.
  2. Consider establishing IV/IO access at a TKO rate or use a saline lock.
  3. Monitor vital signs during transport. 
  4. Refer to the DESTINATION Policy for all age groups; for pediatric and adolescent patients, contact BioTel for destination advice.
  5. If excited delirium is suspected, refer to the EXCITED DELIRIUM Guidelines.
  6. For additional patient care considerations not covered under standing orders, consult BioTel.