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Behavioral Emergencies

1. Respect the dignity and privacy of the patient, the establishment and all those involved with the scene.

2. Assure physical safety of the EMS personal, the patient and all on scene.

3. Use reasonable physical restraints only if attempts of verbal control are unsuccessful. Police should be on scene for physical restraints when possible.

4. Consider medical complications that cause irrational behavior.

5. See adult medical protocols for possible Excited Agitated Delirium

Initial Approach

1. Communicate in a calm non-derogatory, non-threatening type manner

2. Ask the patient if they would like assistance.

3. Identify yourself as a medical provider and offer assistance.

4. Contact law enforcement if the person is a threat to themselves or others.

Use of Restraints

1. Physical
a. Use standard accepted restraining techniques
b. Use sufficient padding on all restraints as to protect patient.

2. Chemical
a. Use chemical restraints in conjunction with physical restraints.

3. All restraints
a. Constant monitor and observe patient, vital signs and airway to prevent injury or harm.
b. Carefully and thoroughly document the rationale for the use of restraints and all persons involved including PD.

Transportaion

1. All individuals being transported for psychological evaluation under the Baker Act Statute must be accompanied by a police officer. The paramedic in charge shall determine whether the police officer will ride in the back or follow behind the rescue unit.

2. In those situations where a female patient is being transported and a female is not part of the crew, the paramedic should attempt to have a female police officer accompany the patient to the hospital. Document the beginning and ending mileage with dispatch via radio communication.

Baker Act

Florida Statute chapter 394.463 mental health relates to the authorization of law enforcement officers, physicians, mental health professionals and the courts to dictate certain medical care for persons who pose a threat to themselves or to others.

Chapter 394 of the Florida Statutes is known as "The Baker Act" and as "The Florida Mental Health Act". A Baker Act proceeding is a means of providing an individual with emergency services and temporary detention for mental health evaluation and treatment, either on a voluntary or involuntary basis.

A voluntary Baker Act admission occurs when a person 18 years of age or older, or a parent of a minor, applies for admission to a facility for observation, diagnosis, and treatment.

An involuntary Baker Act admission occurs upon a finding by a court that (1) a person is mentally ill and, because of the mental illness, he/she has refused voluntary placement for treatment or is unable to determine whether placement is necessary; (2) he/she is incapable of living alone or with help, and without treatment is likely to suffer from neglect or refuse to care for him/herself, or there is a substantial likelihood in the near future that he/she will inflict serious bodily harm on him/herself/others as evidenced by recent behavior; and (3) all less restrictive treatment alternatives are not appropriate.

INCAPACITATED PERSONS LAW

Allows for examination and treatment of incapacitated persons in emergency situations. (Patients who are not capable of informed consent as provided in FS Chapter 766.103 cannot refuse medical care.) Florida Statutes may be viewed online at http://m.flsenate.gov/statutes/401.445

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