Protocol 2-110 - Behavioral

CMH EMS & MIH Protocols

EMD:

• No specific protocol.

EMR:

• Ensure scene safety and consider law enforcement for Physical Restraint, if necessary.
• Verbal de-escalation. Stay calm and calm the patient.
• Identify possible causes. Obtain history of current event, crisis, Toxic Exposure, Drugs, ETOH, suicidal, or homicidal.
• Provide emotional support:
• Help meet basic needs.
• Provide simple, clear, and accurate information.
• Listen with compassion.
• Be friendly and calm.
• Provide support and "presence."

EMT:

• Ensure completion of applicable items above.
• Consider performing Blood Glucometry Check.
• Patient is in any form of restraints:
• Vitals shall be documented at least every 15 minutes.
• Mandatory ALS patient.

AEMT:

• Ensure completion of applicable items above.

RN:

• Ensure completion of all applicable items above.

---

• Mild behavioral emergency (responds to verbal de-escalation):
• Consider Versed 1 mg IV/IM.
• Transport in position of COMFORT.

---

• Moderate to severe behavioral emergency (requires Restraint for crew and/or patient safety):

• Adult:

  Pediatric:

  Physical Restraint: Restraints include BOTH chemical AND Physical Restraints; not one or the other. Utilize the least restrictive option appropriate for the situation: Manual Restraint or Four-Point Soft Restraint If handcuffed: Law enforcement must be present throughout the entire transport. Consider Versed 5 mg IV/IM/IN. Consider Benadryl 50 mg IV/IM. Consider Ketamine 1-2 mg/kg IV/IO. Click "calculate" to get dose. Greater than 65 years old: Half the dose. Click "calculate" to get dose. Consider Ketamine 4-5 mg/kg IM. Click "calculate" to get dose. Greater than 65 years old: Half the dose. Click "calculate" to get dose.

  Consider Versed 0.05-0.1 mg/kg IV. Click "calculate" to get dose. Consider Versed 0.1-0.15 mg/kg IM. Click "calculate" to get dose. Consider Versed 0.3 mg/kg IN. Click "calculate" to get dose. Consider Benadryl 1 mg/kg IV/IM. Click "calculate" to get dose. Consider Ketamine 1 mg/kg IV. Click "calculate" to get dose. Consider Ketamine 3 mg/kg IM. Click "calculate" to get dose.

• Monitor Waveform Capnography.
• Transport in position of SAFETY.

Medic:

• Ensure completion of all applicable items above.

CP:

• Ensure completion of all applicable items above.
• Refer to MIH Protocol 4-250 - Chronic Mental Health Management.

CMH Pre-Hospital Services Mission: "Provide safe, exceptional, and compassionate care to our communities with an emphasis on highly trained and empowered staff."

CMH Mobile Integrated Healthcare Mission: "Provide exceptional, compassionate, and patient-centered care by a mobile collaborative team to improve patient experience, improve quality outcomes, and reduce healthcare costs."

Polk, Hickory, Cedar, & St Clair County EMS Protocols is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.