As a First Aid Responded or Family member you may be faced with someone going through a psychological or behavioral crisis. This is a very traumatic event for not only the patient but the rescuer as well. This crisis may be due to a medical condition, mental illness, mind-altering substances, stress, genetic disorders and so many other causes. For this post we will discuss various kinds of behavioral emergencies. “Overdoses, Suicide attempts, violent outbursts, depression, anxiety, inability to cope or understand the actions of others” are all forms of a Behavioral Emergencies. Lets go over what First Aid measures you may be able to implement during this emergency and what care may be required in these situations.
“Never attempt to help a casualty of substance misuse & abuse with your “bare hands“, always ensure your Personal Protection Equipment is on before you help. Avoid secondary exposure as you may suffer adverse effects if you come into contact with the substance”
Everyone experiences an emotional crisis at some point in their life, some more severe than others. Perfectly healthy people may have some of the symptoms and signs of mental illness from time to time. Therefore, “you should not assume that you have a mental illness when you behave in certain ways“, for this reason “Please avoid” assumptions about a patient in any given situation. Emotional crisis’s in healthy individuals is normally short lived and can be coped with by following simple steps to overcome the situation that may seem overwhelming. Its “when an individual has repeated instances of the same pattern that leads to repeated emotional crisis situations, there may be a need to consult a medical professional“.
“The most common misconception about mental illness is that if you are feeling “bad” or “depressed” or “blue” you must be sick!” This is simply untrue, there are many perfectly justifiable reasons for feeling depressed, one part of our “Five Coping Stages” is actually “Depression”, – Denial – Anger – Bargaining – Depression – Acceptance are all natural forms of coping with emotional emergencies, each person is unique and will go through these five stages at their own pace and order.
What is a Behavioral or Mental Crisis?
The definition of a behavioral crisis or mental emergency is “any” prolonged or repeated reactions to events that interfere with “Normal Daily Living” or has behavior that is unacceptable to the patient, family, or community. For example, when someone has an interruption of their daily routine, such as washing, dressing, eating, sleeping. Conversely a “Psychiatric Emergency” includes outbursts of rage, disconnection from feelings or reality, feeling numb or anxiety and panicked over small matters that others would see as a daily chore. Behavioral emergencies that recur on a regular basis may be considered a “Mental Health crisis“, consult a medical professional for more details.
“Having a Mental Disorder does not make you “Broken”, “Defective”, “Unfit”, “Useless”, “Dangerous” or any less of a person than others around you.” Thoughts or feelings that lead you to believe you are, or if you believe that your “Overwhelmed and unable to cope” with the stresses around you “There is no point“, “ I’m all alone“ or that “nobody would care if I just disappeared” consult a professional. They may be able to help in ways that you have not considered before. Not all emotional emergencies require medications. Medications “Assist” the healing process, if you believe that the medication you are using is not working “Consult your Physician” before you stop taking your medication or adjust your dosage. You may feel good right now, but without the continued assistance of certain medical aids you may find your emotional state revert back to its previously undesirable state.
What to watch for:
People going through a “Behavioral Crisis” or even a “Psychiatric Emergency” may present in many different ways, each person is unique and will experience the emergency differently,:
- Some may seem distant “in a different world”
- Numb to the world and those around them
- Depressed with no end in sight
- Have extreme bouts of sadness with the inability to be consoled
- Agitated or violent with or without provocation
- Threaten harm to themselves or others
- Extreme habit changes to their daily routine, eating, sleeping, hygiene, dressing
- Altered level of consciousness
How to help with a Behavioral or Mental Crisis:
- Check the area, once the area is safe, Check the person and ensure the persons ABC’s are present “Airway / Breathing / Circulation“ REMEMBER – Wear gloves if available to avoid bodily fluids or powdered chemical on their clothing / skin.
- Call 911 and get an AED if you are alone, you suspect a Head / Neck or Spine injury, there is a motor vehicle collision, the person is allergic or the injured persons life could be at risk. “911 will also try to help with specific questions and techniques that may help you, help the patient in this difficult situation.“
- Care for the Behavioral or Mental Crisis by:
Always follow recommendations by your Emergency Response professionals and 911 Dispatch personnel. “Never endanger yourself or the victim, you may “not” need to move or roll the injured person“
- If there are other life threatening injuries, treat those first as quickly as possible with as little movement to the injured person.
While you wait for an Ambulance:
a) Be prepared to spend extra time, it may take longer to assess, listen to, and prepare the patient going through the Behavioral or Mental Crisis that they may need further medical help than you can provide.
b) Have a definitive plan of action, “Never” endanger yourself, if the patient looks like they could become agitated or hostile, just stand back, give them space, and have others help you if possible “Never do this alone” if possible. You may find yourself confronted by a hostile individual that may not be able to control their actions, or they may use the time spent alone with you to “alter“ the events that took place when medical professionals arrive. “They may try to blame you, or make you the one experiencing the Behavioral or Mental Crisis” This is a defense mechanism as they do not wish to be judged or harmed.
c) Identify yourself calmly and speak in a low, calm tone. “Avoid shouting, cornering or blame for previous incidence”
d) Be Direct “State your intentions” calmly
e) Stay with them – If you fear that they may hurt themselves, politely stay close to them and let them know that you are going to be there for them should they need you.
f) Encourage purposeful movement, help the patient gather appropriate belongings to take to the hospital.
g) Express interest in their story, If they are comfortable enough to confide in you about the crisis “Just listen” Avoid judgement or offering advice from your own personal opinion “Just listen”.
h) Keep a safe distance “Everyone needs personal space” know the cues, if they pull away, act indifferent, or get agitated with your presence. Keep your distance, you might inadvertently cause more anxiety by being to close.
I) Avoid fighting with them, If you know the patient, respond with understanding to the feelings they are expressing, whether this is anger, fear, or desperation “Just listen”
j) Be honest and reassuring, if they ask whether they should go to the hospital, simply answer “yes”, its better to err on the side of caution and get help rather than let things take a turn for the worse. Your medical professionals will help you with this once they arrive.
k) Do not judge. You may see behavior that you dislike, set those feelings aside, and concentrate on providing emergency care.
Provide continual care and “Never” endanger yourself, some victims of a Behavioral or Mental crisis may also be subjected to a substance misuse & abuse emergency and may become combative and will be unaware of who you are even if they know you well.
While you wait for an Ambulance: “Ask them if they wish to sit or lay in a position of comfort”
- Kneel Beside the victim and place the victims furthest arm from you above their head.
- Place the arm closest to you across the victims chest as a protector arm.
- The Key is in their Knee, bend the nearest leg up at the knee.
- Carefully slip your hand under the hollow of the victims neck to support the Head Neck & Spine, at the same time use your forearm by slipping it carefully under the shoulder for leverage.
- Place your free hand on the Key Knee and gently roll the victim away from you by applying steady pressure against the knee and shoulder at the same time. The victims head should rest on their raised arm.
- To secure the position pull the key knee further up and bring their protector arm out to use the elbow to stabilize the position.
- Check the Airway to make sure their still breathing.
In any emergency just remember to Protect Yourself!!! Call 911!!! Don’t Waste Time!!!
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