EMS: Combative Suicidal Intent

Learner arrives on-scene to find a 40-year-old female patient with a history of PTSD who is intoxicated and expressing both suicidal and homicidal ideation. The patient refuses to talk to police at the beginning of the case. Police ask the EMS providers to help convince the patient to be transported to the hospital. Patient is unwilling to participate in an interview, but with appropriate verbal de-escalation, they open up to the providers. Learner will ensure scene safety, perform an initial assessment, gather history, and attempt verbal de-escalation techniques to calm the patient. Learner should obtain vitals and perform a general assessment. On inspection of the room, learner finds a gun that they should safely secure with police. Ultimately, these efforts are successful and the patient agrees to be transported to the hospital for definitive care.

Learning Objectives

– Assesses scene, identifying any potential safety concerns, number of patients, presence of bystanders, and additional resources available

– Conducts primary survey and obtains vital signs with attention to the following:
a. Determines level of consciousness and identifies mental status impairment
b. Identifies any signs of airway obstruction, hypoxia, or any observable breathing difficulties
c. Identifies any profuse bleeding, signs of decreased or absent circulation, or any pulse deficits in extremities

– Performs immediate interventions to address concerns identified during the primary survey

– Determines priority of transport

– Conducts a secondary survey to gather additional pertinent HPI and PMH and conduct a focused physical exam

– Performs any necessary medical interventions to ensure patient stability and safety during transport

– Contacts Medical Direction when indicated

– Provides verbal report summarizing patient encounter

– Evaluates a patient in a psychiatric crisis

– Uses verbal de-escalation techniques to convince patient to obtain medical evaluation