General Approach to All Patients

Behavioral Emergencies

Basic Life Support

  • Apply physical restraints if needed to ensure patient/crew safety
  • Restrain patients in supine or lateral recumbent position only, using no excessive force
  • Never allow patients to be restrained in the "hog-tied" position

Advanced Life Support

  • When chemical or physical restraints are used perform Full ALS Assessment and Treatment
  • For patients with severe agitation compromising patient care or patient/crew safety, or for patients who continue to struggle against physical restraints:
    • Ziprasidone (Geodon) 10 mg IM if < 60 kg and 20 mg IM if > 60 kg
      • Avoid if history of long QT-syndrome or dementia-related psychosis
    • Midazolam (Versed) 5 mg IM or intranasal via MAD
  • If cocaine/sympathomimetic toxicity strongly suspected:
    • Midazolam (Versed) 5 mg IM or intranasal via MAD OR 2.5 mg IV
      • Repeat Midazolam (Versed) 5 mg IM or intranasal via MAD OR 2.5 mg IV if adequate sedation not achieved on initial dose

Patients requesting transport directly to a psychiatric facility:

Patients with mild psychiatric decompensation, who are requesting transport to a psychiatric facility, may be released into the custody of Law Enforcement for transport directly to a psychiatric receiving center when the following criteria are met:

  • Preexisting psychiatric history
  • Calm and cooperative, exhibiting no severe psychiatric symptoms (e.g. agitation, violent, uncooperative for exam)
  • Have no other medical complaint or obvious medical necessity noted after a thorough assessment
  • Full set of normal vital signs
  • 1° and 2° survey reveal no acute injuries or abnormalities
  • Denies ingestion or other attempt at self-harm
  • Required no sedation or restraint at any point during the assessment
  • Not requesting transport to a hospital emergency department
  • LEO is willing to transport the patient to the psychiatric facility

If the LEO is unwilling to transport the patient to the psychiatric facility, ambulance transport to the nearest ED shall be offered. If the patient refuses hospital transport, all refusal criteria must be met (see Refusal of Medical Care protocol).