Psychiatric Patient Assaults

 

 
 
 

Keith Wesley, MD, FACEP | | Friday, August 24, 2007


Review of:

Flannery RB Jr.: Precipitants to psychiatric patient assaults: review of findings, 2004-2006, with implications for EMS and other health care providers. Int J Emerg Ment Health. 9(1):5-11, 2007.

The Science and the Street

This article, which I found in a relatively obscure journal, should be required reading for everyone in EMS. The author, an expert on violence in mental patients reviewed the literature to determine if common factors precipitated the violent behavior. He found that the presence of psychosis, organic impairment, staff interactions and limit setting were cited as frequent precipitants.

Although these precipitants aren t surprising, the paper goes on to describe in detail how these precipitants occur and to provide prevention strategies for EMS workers.

Some of the most striking strategies I found were to frequently re-orient the patient to who you are, what you are doing and that you are there to help them. In our jobs, our patients often become just another transport. But to the mentally ill, we potentially represent their worst nightmare of paranoid delusions. By making direct eye contact, using their formal name and allowing them as much autonomy in deciding how you can best help them you can lower your risk of becoming a victim of violence.

Some of the staff interactions that often precipitated violence included administering routine vaccinations, obtaining vital signs, and even bathing and dressing the patient. Mental-health workers, like any worker, become immune to the daily routine of their tasks. However, for the mentally handicapped patient, each day is viewed as a new and different day filled with many challenges. When dealing with these patients, we must examine everything we take for granted and imagine how it could be misinterpreted as a threat.

The term limit setting is a generic mental-health term that refers to the boundaries imposed on the patient. For example, they may have to stay secluded or be kept away from another patient. They may have to wear certain clothing or sit in a particular place or chair at mealtime. Although these issues don t appear to apply to EMS, the fact of the matter is that we place limits on our patients from the very beginning of our encounter with them. We expect them to sit still, answer our questions and cooperate with our requests. Understanding that these are sensitive issues for the mentally ill should prepare you to approach the patients with greater understanding and provide them more latitude than you otherwise would.

The goal is to return to the station safe and sound. Violence against EMS providers is an ever-present danger. So be prepared, and stay safe.

Feel free to contact me at drwesley@charter.net for a copy of the article.




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