EMT Exam: How to Handle Psychiatric Disorders and Behavioral Emergencies

By Arthur Hsieh

As an EMT, you will need to know how to handle psychiatric and behavioral situations. At some point in their lives, most people experience some type of behavioral event that makes them act out of the ordinary.

In most situations, acute, severe stress is the trigger. Once the trigger is pulled and the stress passes, they return to their normal behavior. Sometimes the stress is so great that it results in a behavior so out of the ordinary that others become frightened or so concerned that the person is out of control that they contact EMS or law enforcement for assistance.

In many of the cases, you can reassure the patient by speaking with her empathetically and professionally. After the crisis passes, the patient can be more cooperative and coherent, which makes things much easier for you to manage.

However, in some situations you’re obligated to take some form of action. A patient may experience acute psychosis — literally being out of touch with reality. Some of your patients may be suicidal, wanting to kill themselves to escape the emotional pain they’re experiencing. Others may become so agitated that they try to hurt others, usually unintentionally.

In this state, patients aren’t able to determine what’s best for them. Law enforcement or authorized social and healthcare providers may need to implement an involuntary hold, which forces the patient to receive acute mental care. As an EMT, you do not have this ability in most states. However, you work alongside others who do, and you help transport the patient to an appropriate care facility.

You may need to physically restrain the potentially violent patient. Doing so is risky and requires training, practice, and a team of people to restrain the patient safely. Don’t try to restrain a patient by yourself or with just your partner.

If your patient’s behavior is out of the ordinary, take a few minutes first to make sure that there isn’t a medical reason. Seizures, low blood sugar, stroke, and brain trauma are just a few reasons why someone may act bizarre or violently. Agitated delirium is an extreme example of irrational behavior with real physical manifestations.

These patients may experience hypertension, tachycardia, diaphoresis, dilated pupils, or hallucinations and are generally very hyperactive. If you have to restrain them for their safety and your own, be sure that they end up supine and not prone for transport.

There are many psychiatric disorders. You should consider them just as you do any medical disorder; they require the same level of assessment and compassion. Diseases range from depression and anxiety disorders to bipolar disorder and schizophrenia. You aren’t expected to be an expert in understanding these diseases; you primarily want to be able to ensure your safety and the safety of the patient.

Police have subdued a 33-year-old male who was “acting suspiciously” at a convenience store. They report that as they approached the suspect, he resisted them and a fight ensued. You find the suspect face down on the floor of the store, with his hands cuffed behind his back. He is breathing rapidly and deeply, and his skin is warm, diaphoretic, and pale.

He is talking rapidly and is not making any sense; he does not answer your questions. His pulse rate is 130, and his blood pressure is 180/110 mm Hg. Which of the following activities is most appropriate for this situation?

  • (A)Remove the handcuffs, sit the patient on the gurney, and administer high-flow oxygen with a nonrebreather mask.

  • (B)Keep him prone on the gurney with the handcuffs, and perform a secondary assessment.

  • (C)Apply soft restraints, remove the handcuffs, and restrain him supine on the gurney.

  • (D)Have police transport the patient to the hospital.

The best answer is Choice (C). Medical personnel use a variety of soft restraints to control the movements of an uncooperative patient. Because it’s unclear what is happening with the patient, you need to maintain physical restraints, eliminating Choice (A).

Keeping the patient prone, Choice (B), may compromise his ability to breathe. This patient has altered mental status and a very high blood pressure; he needs to be medically monitored during transport, making Choice (D) unlikely.