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.

EMR - Emergency Medical Responder

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

EMT - Emergency Medical Technician  Perform/Confirm All Above Interventions

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

AEMT – Advanced Emergency Medicine Tech   Perform/Confirm All Above Interventions

Intermediate - Perform/Confirm All Above Interventions

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

Paramedic - Perform/Confirm All Above Interventions

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