About
Section 1: General Patient Care
Section 2: Medical Protocols
2.01 - Adrenal Insufficiency / Crisis (Adult & Pediatric)2.02A - Allergic Reaction / Anaphylaxis2.02P - Allergic Reaction / Anaphylaxis2.03A - Altered Mental / Neurological Status / Diabetic Emergencies / Coma - Adult2.03P - Altered Mental / Neurological Status / Diabetic Emergencies / Coma - Pediatric2.04 - Behaviorial Emergencies (Adult & Pediatric)2.05 - Behaviorial Emergencies - Restraints (Adult & Pediatric)2.06A - Bronchospasm / Respiratory Distress (Adult)2.06P - Bronchospasm / Respiratory Distress (Pediatric)2.07 - Hyperthermia (Environmental - Adult & Pediatric)2.08 - Hypothermia (Environmental - Adult & Pediatric)2.09 - Nerve Agent / Organophosphate Poisoning2.10 - Obstetrical Emergencies2.11 - Newly Born Care2.12 - Resuscitation of the Newly born2.13 - Pain and Nausea Management2.14 - Poisoning / Substance Abuse / Overdose2.15A - Seizures2.15P - Seizures2.16A - Shock2.16P - Shock2.17A - Sepsis2.17P - Sepsis2.18 - Stroke2.19 - Hyperkalemia2.20 - Home Hemodialysis Emergency Disconnect
Section 3: Cardiac Emergencies
Section 4: Trauma Protocols
Section 5: Airway Protocols & Procedures
Section 6: Medical Director Options
Section 7: Medical Policies & Procedures
Section 8: Special Operations Principles
Appendices
2.04 - Behaviorial Emergencies (Adult & Pediatric)
EMT-Basic (Standing Orders)
- 1.0 Routine Patient Care, followed by:
- One EMT should manage the patient while the other handles scene control, but no EMT or First Responder should be left alone with the patient.
- Avoid areas/patients with potential weapons (e.g., kitchen, workshop), and avoid areas with only a single exit; do not allow patient to block exit.
- Keep environment calm by reducing stimuli (may need to ask family/friends to leave room, ask patient to turn off music/TV). Transport in a non-emergent mode unless the patient’s condition requires lights and sirens.
- Respect the dignity and privacy of the patient.
- Make eye contact when speaking to the patient.
- Speak calmly and in a non-judgmental manner; do not make sudden movements.
- Maintain non-threatening body language (hands in front of your body, below your chest, palms out and slightly to the sides).
- Establish expectations for acceptable behavior, if necessary.
- Ask permission to touch the patient before taking vital signs, and explain what you are doing.
- Assess the patient to the extent that they allow without increasing agitation, maintain a safe distance from a violent patient.
- Stop talking with patient if they demonstrate increased agitation; allow time for them to calm down before attempting to discuss options again.
- Provide reassurance by acknowledging the crisis and validating the patient’s feelings and concerns; use positive feedback, not minimization.
- Determine risk to self and others (“Are you thinking about hurting/killing yourself or others?”).
- Encourage patient to cooperatively accept transport to the hospital for a psychiatric evaluation and treatment.
- Consider asking friends/relatives on scene to encourage patient to accept transport, if needed; but only if they are not a source of agitation.
- Ask law enforcement or Online Medical Control to complete a MDMH Section 12 application for uncooperative patients who acknowledge intent to self-harm or harm others, but do not delay transport in the absence of this document.
- Use restraints in accordance with 2.5 Behavioral Emergencies: Restraint if de-escalation strategy fails and the patient is a danger to him/herself or others.
- Male gender
- Homicidal or violent intent or plans
- Intoxication or recent substance use
- Actions taken on plans/threats
- Unconcerned with consequences
- No alternatives to violence seen
- Intense fear, anger, or aggressive speech/behavior
- Specified victim (consider proximity, likelihood of provocation)
EMT-Advanced (Standing Orders)
Caution:
Haloperidol should be administered by INTRAMUSCULAR injection ONLY.
EMT-Paramedic (Standing Orders)
- Initiate an IV of Normal Saline at a KVO rate.
- Apply cardiac monitor if clinically feasible, obtain 12 lead ECG-manage dysrhythmias per protocol.
- Position patient to ensure breathing is not impaired.
- If providing medication to patients > 70 years of age, limit dose.
- Haloperidol 5 mg IM; and/or
- Midazolam 2-6 mg IV/IO/IM/IN
- Ketamine 4mg/kg IM only, to a maximum dose of 400mg IM only, as a single dose.
- NOTE: In patients >70 years of age, limit medication to half these doses.
- Midazolam 0.1mg/kg IV/IO/IM/IN, to maximum dose of 6 mg.
Note:
Medical Control may order additional doses of above medication
Caution:
Haloperidol is preferable for psychotic patients; but do not administer to patients with a history of seizures or prolonged QT intervals.