•         Alcohol or drug abuse

•         Head injury

•         Metabolic disorders

o       Insulin shock

o       Diabetic coma

o       Endocrine disorders

•         Neurological diseases

o       Organic brain syndrome

•         Psychiatric illness

o       Believe that others are plotting against him

o       Agitation, violence

o       Suicidal gestures or verbalizations

•         Stress response

·          Assess the situations

·          Take charge

·          Call for back up as needed (law enforcement)

·          ALS response if patient is altered, short of breath, chest pain, possible ingestion of poisonous substance, Hazmat exposure, or if you are suspicious of metabolic causes

·          Complete primary and secondary assessment

·          Provide appropriate medical care

·          Protect yourself and the patient

Restraint application in compliance with L.A. County Ref. #838

·          Reduce environmental distractions

·          Communicate with the patient

·          If the patient is relating well to a family member or friend allow them to accompany the patient

·          Describe the patient’s behavior

·          Transport if patient consents (avoid lights/sirens)

·          If patient refuses transport consider a 5150

·          Do NOT:

o       Diagnose/Judge/Label

o       Express accusations or anger

o       Be deceptive or “lie” to the patient

·          Venous access prn

·          Glucometer if altered or suspicious of hypoglycemia

·          Monitor prn

·          ALS medications

·          D50 if hypoglycemic

·          Valium for active seizures

·          Narcan if suspicious of narcotic overdose

·          Question patient regarding suicidal feelings, attempts

·          Ask open-ended questions

·          Sit down next to patient

·          Keep direct eye contact

•     Geriatric

•     Aphasic

•     Pediatric

•     Deaf/mute

•     Blind

•     Non-English speaking

•     Confused or developmentally disabled

•     Geriatric/aphasic

·          Do not assume senility or lack of understanding

·          Use patient's name

·          Check for impaired hearing/vision

·          Allow time for response

·          Attention to spouse

·          Explain procedures

•     Pediatric

·          Be honest

·          Use simple terms

·          Maintain eye contact

·          Move slowly

·          Explain procedures

·          Allow child to retain security crutch

·          Allow parent/sibling to help calm/explain

•     Deaf/mute

·          Determine if lip reader

·          Speak slowly, clearly and distinctly

·          Don't shout

·          Allow patient to see your lips when speaking

·          Use interpreter if necessary

·          Use written messages

•     Blind

·          Determine if patient has impaired hearing

·          don't shout

·          Explain incident in detail

·          Explain procedures before initiating

·          Lead patient if ambulatory, alerting to obstacles

•     Non-English speaking

·          Determine level of understanding

·          Use interpreter if available

·          Use gestures

•     Confused or developmentally disabled

·          Determine level of understanding

·          Speak at appropriate level

·          Wait for response if delayed

·          Evaluate understanding and explain again if necessary

·          Listen carefully       

·          Use only when necessary

·          Patient is a danger to themselves or others

·          Look for all possible causes for the behavior

·          Restraints must allow for adequate monitoring of vital signs

·          Restraints applied by law enforcement must allow sufficient “slack”

·          Patient must be able to straighten the abdomen and chest and take full breaths

·          The officer must accompany the patient in the ambulance

·          Approved equipment for prehospital personnel

·          Padded leather

·          Soft restraints (posey, velcro, seatbelts)

·          Unapproved methods of restraint for prehospital personnel

·          Hard plastic ties or device that requires a key to remove

·          Backboard, scoop, or flat used to sandwich the patient

·          “Hog - tied” (hands and feet behind the patient)

·          Methods or material that could cause neurovascular compromise

·          Evaluate and document the condition of the restrained extremity (neurovascular check) every 15 minutes.

·          Transport to the most accessible basic emergency department facility (Ref. #502)

·          If a 5150 order has been written by a mobile Psychiatric Response Team and admission has been arranged to a psychiatric facility the patient may be transported to that facility

·          If a peace officer requests transport to medical facility other than the closest, the request may be honored with Base Station concurrence.

·          Reason the restraints were needed

·          Which agency applied the restraints

·          Information and data regarding the monitoring of circulation to the restrained extremity

·          Information and data regarding the monitoring of respiratory status while restrained

•     Denial

•     Guilt

•     Obvious grief

•     Hostility

•     Hysteria

•     Crying

•     Abnormal affect

•     Physiological response

·          Nausea

·          Vomiting

·          Syncope

•     Resuscitate patient unless obviously dead

•     Keep family informed

·          Be truthful

·          Avoid trite phrases

·          Do not offer false hope

·          Empathize/sympathize

·          Allow emotional response

•     Maintain professionalism

•           Denial

•           Anger

•           Bargaining

•           Depression

•           Acceptance

•     Do not isolate the family

•     Allow feelings to be expressed

•     Provide for patients physical comfort

•     Allow for patients dignity in dying process

•     Resuscitate according to local protocol regardless of a living will

•     Assess situation

•     Protect self and others

•     Summon law enforcement if necessary

•     If no evidence of immediate danger, then one EMT responsible for assessing, treating and communicating with patient

•     Transport with consent without sirens

•         If patient refuses, consider 5150

·          Valid DNR Orders in a Licensed Health Care Facility

·          Written order in the patient’s chart

·          Verbal order by physician that is physically present

·          Valid DNR Orders for patients NOT in Licensed healthcare facility

·          County of Los Angeles DNR Form (Ref. 815.1)

·          State EMS DNR Form (Ref.  815.2)

·          State EMS Medallion (Ref. 815.3)

·          Helplessness/Guilt

·          Anger/Frustration

·          Avoidance

·          Nightmares

·          Gallows humor

·          Physiological response

·          Nausea

·          Vomiting

·          Syncope

•           Request a break

•           Request reassignment to less stressful area

•           Discuss situation with co-workers and/or supervisor

•           Seek professional assistance

•           Pursue outside interests

•           Critical Incident Debriefing