Behavioral Violent/Threatening

Question 1

Situations Encontered

Answer 1

Either:

• Patient is violent or exhibiting behavior that is dangerous to self or others during transport (Not Trauma Pts)
• Agitation that interferes with
  ability to provide necessary patient care

Question 2

What Ages Impact Pt Care

Answer 2

<14 or > 65 years max initial and total doses are half

<8 yrs: Contact Medical Direction for orders

Question 3

If the Patient is violent or exhibiting behavior that is dangerous to self or others during transport (Not Trauma Pts)

Answer 3

1st:
- Attempt verbal reassurance and calm patient
- Engage friends or family if they are able to help calm patient

If unsuccessful:

• Soft Restraints
• Midazolam 0.1 mg/kg IM
  (10mg MAX initial dose)
  *May repeat 1x at half initial dose (5mg) after 10 min to a max total dose of 15mg

OR

0.05 mg/kg IV/IO
(5mg MAX initial dose)
*May repeat 1x at half initial dose (2.5mg) after 10 min to a max total dose of 7.5mg

• Consider PD if warranted

Question 4

Once Physically & Chemically Restrained..

Answer 4

• Obtain full set of VS
• O2 to maintain sat >94%
• IV/IO Access
• Apply cardiac monitor & EtCO2 ASAP (Consider 12-lead ECG)
• Reassess & Document mental status & VS q 5 min & neurovascular status of all extremities q 15 min (if physically restrained)

Question 5

If Handcuffed used..

Answer 5

• Handcuffs are to be placed by law enforcement only
• If in law enforcement handcuffs, key must be within proximity of patient care at all times (but not within patient’s reach)
• Place stretcher in sitting position
• Do not apply restraints that restrict the patient’s chest wall movement

Question 6

If Soft Restraints used..

Answer 6

• Do not apply restraints that restrict the patient’s chest wall movement
• Restrain all four extremities to stationary frame of stretcher
• All restraints must allow quick release
• Reassess and document neurovascular status of all extremities every 15 minutes

Question 7

For patients with agitation that interferes with necessary patient care..

Answer 7

1st:
- Attempt verbal reassurance and calm patient
- Engage friends or family if they are able to help calm patient

If unsuccessful:

• Midazolam 0.05 mg/kg IM/IV/IO (2.5mg MAX initial dose)
  *May repeat 1x after 10 min for a Total MAX dose of 5mg

Question 8

What Needs to be Reassessed & How often

Answer 8

Neurovascular status of all extremities q 15 minutes

Mental Status & VS q 5 min