View source for 2-15 PSYCHIATRIC & BEHAVIORAL EMERGENCIES

Also consider medical causes of altered mental status, especially hypoglycemia. Enlist Law Enforcement as needed to assist with safe management of the scene and patient.

{| class="wikitable"
|'''EMR - Emergency Medical Responder'''
|}

# '''Scene safety''' is a priority
# Additional resources as needed.  Law Enforcement if patient resistant or violent.
# Initial assessment
# Patient interaction
## Be calm and reassuring
## Verbal de-escalation of agitation
## Enlist Law Enforcement assistance
## Restraint per Law Enforcement
### Maintain airway
### Lateral or supine position.  Never restrain prone 

{| class="wikitable"
|'''EMT - Emergency Medical Technician'''  ''Perform/Confirm All Above Interventions''
|} 

# Perform Glucometry if safe to do so and follow hypoglycemia protocol if indicated.

{| class="wikitable"
|'''AEMT – Advanced Emergency Medicine Tech  ''' ''Perform/Confirm All Above Interventions''
|}
{| class="wikitable"
|'''Intermediate -''' ''Perform/Confirm All Above Interventions''
|} 

# Perform diagnostic telemetry and observe for dysrhythmias if appropriate and patient condition allows. 

{| class="wikitable"
|'''Paramedic -''' ''Perform/Confirm All Above Interventions''
|} 

# If chemical restraint is deemed necessary for protection of the patient from self-harm, or for crew/law enforcement safety, proceed with the following:
## Administer '''KETAMINE''' 1mg/kg IV/IO or 4mg/kg IM.
### Attempt to monitor vital signs if safety permits
### Provider may administer a second dose after 5 minutes if the patient is not adequately sedated, only after consult with '''MEDICAL CONTROL'''
### For any signs of emergence phenomena, such as hallucinations, delirium, or increasing agitation, contact '''MEDICAL CONTROL''' for discussion of supplemental '''Versed'''.
## If post-'''KETAMINE''' sedation is necessary, contact '''MEDICAL CONTROL''' for discussion of supplemental '''Versed'''.