Behavioral Emergencies

1. Chapter 23
Behavioral Emergencies

2. Behavioral Emergencies (1 of 3)
• Behavior is how a person acts.
• Abnormal behavior may be due to a
psychological or a physical condition.
• Behavior that leads to violence or
other inappropriate activities is known
as a behavioral emergency.

3. Behavioral Emergencies (2 of 3)
• Several factors can change behavior:
• Situational stresses
• Medical illnesses
• Psychiatric problems
• Alcohol
• Drugs

4. Behavioral Emergencies (3 of 3)
• Common reasons for behavioral changes:
• Low blood glucose level
• Lack of oxygen
• Inadequate blood flow to the brain
• Head trauma
• Excessive cold or heat
• Mind-altering substances
• Psychogenic or psychiatric illness

5. Depression
• One of the most common and treatable
mental illnesses
• Types:
• Reactive
• Major or clinical
• Bipolar
• Due to chemical imbalance in the brain

6. Recognizing Depression (1 of 3)
• Persistent sad, anxious, or empty moods
• Feelings of hopelessness, pessimism
• Feelings of guilt, worthlessness,
helplessness
• Loss of interest in hobbies and activities
that were once enjoyed
• Decreased energy, fatigue

7. Recognizing Depression (2 of 3)
• Difficulty concentrating, remembering,
making decisions
• Insomnia, early-morning awakening,
oversleeping
• Appetite and/or weight loss or overeating
and weight gain

8. Recognizing Depression (3 of 3)
• Thoughts of death or suicide; suicide
attempts
• Restlessness, irritability
• Persistent physical symptoms that do not
go away with treatment

9. Care for Depression
• Say, “You look very sad.”
• Do not discourage crying.
• Show concern.
• Interview in private.
• Ask open-ended questions.
• State that many people have periods of
unhappiness, but can be helped
• Mention community resources.

10. Suicide (1 of 6)
• Any willful act that ends one’s life
• Each year, about 30,000 Americans
commit suicide.
• Eleventh reported leading cause of death
in the United States
• More than three times more likely in men

11. Suicide (2 of 6)
• Common methods:
• Firearms
• Hanging
• Poisoning by solids or liquids
• Jumping from high places
• Carbon monoxide poisoning
• Drowning
• Self-inflicted wounds

12. Suicide (3 of 6)
• Peaks during spring months
• Lowest in Northeast; highest in mountain
states
• About 60% of victims have previously
attempted suicide
• Try to keep suicidal person on phone until
EMS reaches scene

13. Suicide (4 of 6)
• If you encounter a suicidal person:
• Remove any dangerous articles.
• Talk quietly with the person.
• Encourage discussion.

14. Suicide (5 of 6)
• If you encounter a suicidal person (cont’d):
• Ask:
• Have you attempted suicide before?
• Have you made concrete plans for a method?
• Has any family member committed suicide?
• Reassure person and take them to medical
help
• Do not leave them alone under any circumstances

15. Suicide (6 of 6)
• When a person attempts suicide:
• First aid care has priority.
• Drug overdoses must be managed.
• Bleeding must be controlled.
• If a drug overdose is involved:
• Collect medication containers, pills, or other
drugs found on the scene.
• Law enforcement should be contacted.

16. Recognizing a Potential
Suicide Victim (1 of 2)
• Gets affairs in order
• Gives away articles of value
• Exhibits signs of planning a suicide
• Obtaining a weapon
• Writing a suicide note

17. Recognizing a Potential Suicide
Victim (2 of 2)
• May say:
• Life isn’t worth
living.
• My family would be
better without me.
• Next time, I’ll take
enough pills.
• Take my valuables.
• I won’t be around to
deal with that.
• You’ll be sorry when
I’m gone.
• I won’t be around
much longer.
• Life’s too hard.
• Nobody
understands me.
• I can’t make it
better.
• I’d be better off
dead.
• I feel like there is no
way out.

18. Care for a Potential Suicide
Victim (1 of 2)
• Be direct.
• Be willing to listen.
• Be nonjudgmental.
• Get involved.
• Do not dare him or her to do it.
• Do not act shocked.

19. Care for a Potential Suicide
Victim (2 of 2)
• Do not be sworn to secrecy.
• Offer hope that alternatives are available.
• Take action.
• Get help from persons or agencies.

20. Emotional Injury
• First aid for an emotional “injury” means
being supportive.
• Although most emotional reactions are
temporary, they are seriously disabling and
may upset others.

21. Typical Reactions
• Common in the face of an emergency:
• Feeling shaky
• Perspiring profusely
• Becoming nauseated
• Determine whether a person needs help.
• Do not be impatient, intolerant, or resentful.
• Do not be overly sympathetic or overly
solicitous.

22. Recognizing Aggressive,
Hostile, and Violent Behavior
(1 of 2)
• Size up the situation before you do
anything.
• Does the person have clenched fists?
• Is he or she holding a weapon?
• Is the person yelling?
• Is the person verbally threatening harm?

23. Recognizing Aggressive,
Hostile, and Violent Behavior
(2 of 2)
• If the scene is unsafe, do not enter.
• Contact law enforcement officers.
• Encourage the person to speak about
cause of anger
• Notify police if you are unable to
communicate with person

24. Care for Aggressive, Hostile,
and Violent Behavior (1 of 2)
• Acknowledge that the person seems upset.
• Maintain a comfortable distance.
• Encourage the person to state what is
troubling him or her.
• Do not make quick moves.
• Respond to the person’s questions.
• Do not threaten, challenge, or argue

25. Care for Aggressive, Hostile,
and Violent Behavior (2 of 2)
• Tell the truth — do not lie.
• Do not “play along” with the person.
• Involve trusted family members or friends.
• Be prepared to stay with the person.
• Never leave the person alone.
• Avoid unnecessary physical contact.
• Maintain eye contact.

26. Sexual Assault and Rape (1 of 2)
• Rape is forcible sexual intercourse
without the consent of one participant.
• Categories include:
• Acquaintance rape
• Date rape
• Marital rape
• Stranger rape

27. Sexual Assault and Rape (2 of 2)
• The victim may hesitate to report a rape.
• Shame
• Guilt
• Fear of retaliation
• Reluctance to deal with law enforcement
• Doubt that a “real” rape occurred

28. Care for a Rape or Sexual
Assault Victim
• Be tactful and sensitive.
• Convince the victim to seek counseling.
• Ask victim not to change clothes or bathe.
• Suggest that the victim not urinate, douche,
defecate, or wash before being examined.
• Care for any injuries.

29. Child Abuse and Neglect (1 of 2)
• More than 2.5 million cases of child abuse
and neglect cases are reported each year.
• 35% involve physical abuse
• 15% involve sexual abuse
• 50% involve neglect

30. Child Abuse and Neglect (2 of 2)
• Physical effects:
• Damage to the brain and vital organs
• Damage to eyes, ears, arms and legs
• Major categories:
• Physical abuse
• Neglect
• Sexual abuse
• Emotional maltreatment

31. Recognizing Child Abuse and
Neglect (1 of 4)
• Be alert to unexplainable
changes in behavior.
• Physical abuse:
• Any injury that cannot be
explained
Courtesy of Ron Dieckmann, M.D.
Courtesy of Ron Dieckmann, M.D.
Courtesy of Ron Dieckmann, M.D.

32. Recognizing Child Abuse and
Neglect (2 of 4)
• Sexual abuse:
• Fearful behavior
• Abdominal pain
• Bedwetting
• Urinary tract infection
• Genital pain or bleeding
• Sexually transmitted disease
• Sexual behavior inappropriate for child’s age

33. Recognizing Child Abuse and
Neglect (3 of 4)
• Emotional abuse:
• Sudden change in self-confidence
• Headaches or stomachaches with no
medical cause
• Abnormal fears
• Increased nightmares
• Attempts to run away

34. Recognizing Child Abuse and
Neglect (4 of 4)
• Emotional neglect:
• Failure to gain weight
• Desperately affectionate behavior
• Large appetite and stealing of food

35. Care for Child Abuse and
Neglect
• Give appropriate first aid for injuries.
• Do not accuse parents or caregivers.
• Report any suspected abuse to the local
welfare and social service agency.

36. Domestic Violence
• Also known as partner abuse, spouse
abuse, or battering
• Occurs when one person inflicts injury,
either emotional or physical, upon another
person with whom they had or have a
relationship

37. Recognizing Domestic
Violence (1 of 3)
• Physical domestic violence:
• Slapping
• Punching
• Kicking
• Choking
• Shooting
• Stabbing
• Bludgeoning

38. • Injuries that should raise suspicion:
• Bruises or injuries on the head, neck, or chest
• Type/extent of injury inconsistent with
explanation
• Substantial delay between injury occurrence
and seeking of help
Recognizing Domestic
Violence (2 of 3)

39. Recognizing Domestic
Violence (3 of 3)
• Injuries that should raise suspicion (cont’d):
• Injuries during pregnancy
• Evidence of alcohol or drug abuse
• Needs medical care as a result of a suicide
attempt or rape

40. Care for Domestic Violence
• If you are not aware of immediate
danger, but suspect abuse, check with
social service agencies.
• Call the police if the person is in
immediate danger.
• First aid includes calling 9-1-1 and
treating any injuries.

41. Elder Abuse
• Ranges from passive neglect to active
assault
• Occurs most often in women older
than 75 years

42. Recognizing Elder Abuse (1 of 3)
• Physical injury:
• Bruises
• Cuts
• Burn or rope marks
• Broken bones that cannot be explained
• Sudden changes in behavior
• Comments about being battered
• Refusal of the caregiver to allow you to
visit the older person alone

43. Recognizing Elder Abuse (2 of 3)
• Lack of physical care:
• Dehydration
• Malnourishment
• Weight loss
• Poor hygiene
• Bed sores
• Soiled bedding
• Unmet medical needs
• Comments about being mistreated

44. Recognizing Elder Abuse (3 of 3)
• Unusual behaviors:
• Agitation
• Withdrawal
• Fear or anxiety
• Apathy
• Reports of being treated improperly

45. Care for Elder Abuse
• If you are not aware of immediate danger,
but you suspect abuse, check with social
service agencies.
• If you suspect abuse in institutional
setting, report to state ombudsman
• Call police if person is in imminent danger
• First aid includes calling 9-1-1 when
needed and treating any injuries.