Behavioral health calls are on the rise. Recent statistics show that anywhere from 5 percent–15 percent of emergency calls involve either mental health, behavioral concerns or substance abuse. Law enforcement was the first line of defense in mitigating these types of calls, but new response models show the need for an increase in medical and support services.
Educate and train
Within the past few decades, the number of state-operated psychiatric hospital beds in the United States went from 337 per 100,000 people to approximately 11.7 per 100,000 as of 2022. When you add in the fact that, according to the American Psychological Association, approximately 60 percent of psychiatrists today report having no openings for new patients, more people turn to emergency responders in their time of need.
How do we better prepare for the growing number of behavioral health calls? We educate ourselves and we train.
The most important thing to remember when handling these calls is your own safety. One easily can become complacent in how the scene is evaluated. No matter how benign that the call might seem, one must use a high index of suspicion that one’s safety could be at risk.
De-escalate
Once scene safety is established, EMS crews must determine the best method of communicating with the patient. Treating these patients with the utmost respect can help to ensure a positive outcome.
The ultimate goal is to de-escalate the situation. Ways to achieve this include talking in a quiet demeanor, being straightforward and nonjudgmental and practicing active listening. Using the phrase “Let me see if I understand you correctly” followed by calmly restating a patient’s concerns tells the patient that you listened. This also can create a sense of alliance and can disarm anger.
Of course, there are times when a patient is unable or unwilling to cooperate and won’t see the benefit of going to the hospital. For such circumstances, training with your crew and even with law enforcement can be crucial. Further, it’s imperative to thoroughly understand the medications that can be given to chemically restrain a patient—i.e., dosing limits, side effects and how to support ABCs (airway, breathing, circulation). This ensures that the patient is treated appropriately without adverse outcomes. In some instances, patients might need to be physically restrained to protect both themselves and the EMS crew. Continuous monitoring is paramount. Ensure that pulses remain intact in all extremities, that the patient has a patent airway and that vitals remain within normal limits.
Spectrum disorders, panic attacks
Some calls require a different approach because of the nature of the patient’s illness. This is particularly true when dealing with individuals with spectrum disorders, such as autism. They don’t react well to loud noises (see “Five Firefighter Strategies for Safer Encounters for Individuals With ASD,” firehouse.com/55130466). It often is helpful to have one paramedic communicate with the patient or family while others limit anything that might excite the patient, such as lights on the ambulance or excessive noise.
Another call that can require a different approach to treatment: an individual who is suffering from a panic attack. For years, we were taught to coach such an individual to focus on slow breathing. Although this might be effective for some individuals, it can heighten the panic for others. An alternative technique: Using distraction to help to reduce the panic attack. Asking patients to feel the texture of an object or to read something can help to get their mind off of the panic that they are experiencing.
Megan Funk
Megan Funk entered into the fire service in 2013 and has spent the past eight years of her career with the St. Charles, IL, Fire Department as a firefighter/paramedic. She is involved with the department’s hands-on EMS training and health and wellness committee. Previously, Funk served with the Elk Grove Township, IL, Fire Department. She holds a master’s degree of biomedical science from the University of St Joseph.
