Micheal Rivers: Altered Mental Status

I’m pleased to host guest blogger Michael Rivers today as he discusses the EMS perspective on altered mental status.

Welcome, Micheal!

EMS handles thousands of calls every year especially in the larger cities like Chicago. There is one kind of emergency call that can take the life of a Paramedic or EMT very quickly, or leave him or her with serious injuries. These calls are either for domestic or institutionalized people with altered mental status.

These calls are handled differently from other calls even involving shooting because the medical personnel have no idea what they can be walking into. Although he is there to help, the sight of the uniform alone can cause a very violent reaction from the patient. The ambulance personnel must not only be wary and insure the safety of the scene, but he has to be inventive when handling his patient.
Depending on the scene you never want the patient to hear your siren or see the flashing lights of the ambulance. It frightens them and they automatically become defensive. If you are running code 3(emergency) stop the siren and the lights a block or more before you arrive on the scene. If at all possible gather all the information on your patient and turn this to your advantage. These are some very good examples that work. This knowledge was gained through experience.
The patient was a 320 pound female confined to a psych facility for homicide. She was known to go through fits of rage even when under the influence of her medication. Arriving on the scene she was found in the nurse’s station sitting in a chair brooding. An armed security guard from the Sheriff’s department stood close by her. Due to the experience of the EMT’s, one stayed at the entrance while the attending EMT walked by the patient basically ignoring her while visually accessing her as he passed by. This assessment tells a great deal about who he is dealing with.
With a better knowledge of the problem and a few personal facts you begin to communicate with your patient. They want to be heard. Listen to them and find a way to get them on the stretcher without a fight. You may have to become an accomplished actor, but you have to convince them you are genuinely concerned and you are their friend, their guardian. In this case the attending EMT was able to get the vitals and convince her to get on the stretcher on her own when in the beginning she refused to be touched. If they had tried to force her, there would have been someone taking a lot of body damage. She was strapped x4 thinking it was for her safety.
Knowing the patient was not diabetic and was allowed sweets was a plus. With a simple cookie and the promise she would not be harmed, (history of physical abuse) she co-operated fully. She was even able to display sympathy for the EMT when he said he would get in trouble if she did not let him take her to the hospital. The call went smoothly and the patient was able to receive treatment without causing further harm to her.
These EMTs were very experienced. Experience cannot always let you see the unexpected coming. They specialized in the Altered Mental Status calls and knew exactly what to look for. Yet, Ambulance 04 was retired one year later after nearly being destroyed as the driver was attacked by a street person from inside the ambulance with altered mental status. This was an incident where the driver’s window was down to answer a man’s question. The street person dove through the window attempting to kill the EMT. At the time they had another patient inside the ambulance also with altered mental status.
This is a perfect example of the symptoms of altered mental status not being displayed by a person you are speaking with. If you are an EMT or Paramedic you already know the question; “Is the scene safe?”

Micheal, born in 1953, is an American author. He served his country as a United States Marine during Vietnam. Born in North Carolina, he lived in the Chicago area in the past and furthered his education there and served the community as an Emergency Medical Technician. Micheal returned to the mountains of North Carolina where he resides with his wife and his Boxer he fondly calls Dee Dee. You can learn more about Micheal at http://michealrivers.com/.

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