Acute Psychiatric Emergencies E-Book
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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Serie: Advanced Life Support Group
- Sprache: Englisch
An essential guide to the emergency treatment of mental health crises
Hospital emergency departments are encountering increasing numbers of patients in mental health crises and the number continues to rise year on year. Despite these challenges, very few practitioners are trained specifically to deal with mental health crises.
Acute Psychiatric Emergencies (APEx) meets this need with a course designed jointly by leading psychiatry and emergency medicine specialists with years of practical experience. It will help in any crisis setting be it in the emergency department, ward, clinic or in the community.
APEx provides a structured approach for the assessment and management of acute mental health emergencies, discusses common presentations, as well as legal frameworks and human factors. Now fully updated to reflect new guidelines and expanded treatment of key subjects, it is an invaluable resource for any practitioner involved in the provision of psychiatric care at any point in the healthcare pathway.
Readers of the second edition of Acute Psychiatric Emergencies will also find:
- Detailed discussion of topics including organic causes for behavioural disturbances, special circumstances and more
- Updated algorithms and figures for improved accessibility
- An emphasis on close cooperation between emergency and mental health teams
APEx is ideal for emergency physicians, psychiatrists, emergency and mental health nurses, paramedics and other crisis care professionals.
Advanced Life Support Group (ALSG) is an organisation dedicated to improving outcomes for people in life-threatening situations, anywhere along the healthcare pathway, anywhere in the world. A leading medical education charity, ALSG has delivered advanced life support training to over 225,000 clinicians in 44 countries.
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Veröffentlichungsjahr: 2025
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Table of Contents
Cover
Table of Contents
Title Page
Copyright Page
Dedication
Contributors to second edition
Preface to second edition
Preface to first edition
Acknowledgments
Contact details and website information
How to use your textbook
The anytime, anywhere textbook
PART 1
CHAPTER 1: Structured approach to acute psychiatric emergencies
1.1 Introduction
1.2 Preparation
1.3 Close working between emergency and psychiatry staff
1.4 Communication
1.5 Consent
1.6 A structured approach
1.7 Summary
CHAPTER 2: Primary unified assessment and immediate psychiatric management
2.1 Introduction
2.2 Preparation
2.3 Primary assessment: the Unified assessment
2.4 Primary physical risk assessment
2.5 Primary psychiatric risk assessment
2.6 Unified assessment and immediate treatment
2.7 De‐escalation, sedation and rapid tranquillisation
2.8 Staff safety
2.9 Person‐centred care
2.10 Legal framework
2.11 Secondary assessment
2.12 Summary
CHAPTER 3: Secondary physical and psychosocial assessment
3.1 Introduction
3.2 SMART triage
3.3 History: general principles
3.4 Focused physical history and examination
3.5 Focused conversational psychosocial history
3.6 Secondary psychosocial (mental state) examination
3.7 Summary
CHAPTER 4: Mental state examination
4.1 Introduction
4.2 Mental state examination
4.3 Summary
CHAPTER 5: Commonly encountered psychiatric presentations
5.1 Introduction
5.2 Schizophrenia
5.3 Drug‐induced psychosis, psychotic episodes and delusional disorders
5.4 Catatonia
5.5 Bipolar affective disorder
5.6 Depression
5.7 Intoxication and withdrawal
5.8 Delirium and dementia
5.9 Anxiety
5.10 Dissociative disorders, functional neurological disorders and PTSD
5.11 Personality disorder
PART 2
CHAPTER 6: The patient who has harmed themselves
6.1 Introduction
6.2 General principles
6.3 Preparation
6.4 Primary assessment: the Unified assessment
6.5 Secondary assessment
6.6 Emergency management
6.7 Refusal to accept physical treatment following self‐harm
6.8 Case examples
6.9 Summary
CHAPTER 7: Organic causes for behavioural disturbances
7.1 Introduction
7.2 Is there a likely medical issue?
7.3 Secondary assessment
7.4 Management of specific clinical presentations
7.5 Emergency management: principles of shared care
7.6 Determine outcomes and ongoing care plan
7.7 Organic disorders with psychiatric presentations
7.8 Medications and psychiatric side effects
7.9 Handover
7.10 Case examples
7.11 Summary
CHAPTER 8: The apparently intoxicated patient
8.1 Introduction
8.2 Alcohol by numbers: percentages, units and levels
8.3 The apparently intoxicated patient
8.4 Alcohol intoxication
8.5 Diagnoses commonly mistaken for alcohol intoxication (or alcohol withdrawal syndrome)
8.6 Alcohol withdrawal syndrome
8.7 Delirium tremens
8.8 Alcohol‐related brain injury
8.9 Substances with potential for misuse
8.10 Case example
8.11 Summary
CHAPTER 9: The acutely confused patient
9.1 Introduction
9.2 Acute confusional states
9.3 Preparation
9.4 Emergency management: principles of shared care
9.5 Determine outcome
9.6 Ongoing care plan
9.7 Handover
9.8 Case example
9.9 Summary
CHAPTER 10: The aggressive patient
10.1 Introduction
10.2 Principles in assessing aggression and violence
10.3 Risk formulation
10.4 Managing potential aggression and violence
10.5 Assessment, prevention and management of risk
10.6 Case examples
10.7 Rapid tranquillisation
10.8 Summary
CHAPTER 11: Special considerations
11.1 Children and young people
11.2 Long bed waits and the Emergency Department
11.3 Perinatal mental health
11.4 Eating disorders
11.5 Safety Planning
PART 3
CHAPTER 12: Legal aspects of emergency psychiatry
12.1 Introduction
12.2 Determining mental capacity
12.3 Treating a patient who does not have mental capacity
12.4 Treating a patient who has mental capacity
12.5 Consent
12.6 Confidentiality
12.7 Documentation
12.8 Summary
CHAPTER 13: Getting it right: non‐technical skills
13.1 Introduction
13.2 Errors in the healthcare setting
13.3 Situation awareness
13.4 Decision making
13.5 Cognitive bias
13.6 Communication
13.7 Managing critical situations
13.8 Preventing errors
13.9 Summary
CHAPTER 14: The patient experience
14.1 Introduction
14.2 Aspects of a patient’s experience
14.3 Summary
Working group for second edition
Working group for first edition
Contributors to first edition
References and further reading
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Index
End User License Agreement
List of Tables
Chapter 2
Table 2.1 AEIO assessment: minimum number of staff required for safe contai...
Chapter 7
Table 7.1 Psychiatric side effects of common medications
Chapter 9
Table 9.1 Pooled point prevalence of delirium in different patient populati...
Table 9.2 Causes of delirium
Table 9.3 Factors that increase the risk of delirium and hinder recovery
Chapter 13
Table 13.1 Potential causes of our example error
List of Illustrations
Chapter 1
Figure 1.1 The structured approach
Chapter 2
Figure 2.1 Structured approach: primary assessment
Chapter 3
Figure 3.1 Structured approach: secondary assessment
Figure 3.2 SMART clearance tool
Figure 3.3 PHRASED approach
Chapter 4
Figure 4.1 ASEPTIC assessment
Chapter 6
Figure 6.1 ED pathway for patients who have harmed themselves
Figure 6.2 Manchester Triage System: self‐harm chart
Figure 6.3 Building a risk profile in self‐harm
Chapter 7
Figure 7.1 SMART Form
Chapter 8
Figure 8.1 GMAWS
Figure 8.2 Novel psychoactive substances
Chapter 9
Figure 9.1 4AT: assessment test for delirium and cognitive impairment form...
Chapter 10
Figure 10.1 Assessment and prevention
Figure 10.2 An example of a rapid tranquillisation flowchart. Please note th...
Chapter 11
Figure 11.1 HEADSSS
Figure 11.2 Red flags
Figure 11.3 Amber flags
Figure 11.4 A worked example of a Safety Plan
Chapter 13
Figure 13.1 Reason’s taxonomy of errors
Figure 13.2 The Swiss cheese model
Figure 13.3 Situation awareness
Figure 13.4 Similar package design of two different medications
Figure 13.5 Anchoring bias
Figure 13.6 Elements of communication
Figure 13.7 Avoiding preconceptions
Figure 13.8 PACE
Figure 13.9 I’M SAFE
Guide
Cover Page
Table of Contents
Title Page
Copyright Page
Dedication
Contributors to second edition
Preface to second edition
Preface to first edition
Acknowledgments
Contact details and website information
How to use your textbook
Begin Reading
Working group for second edition
Working group for first edition
Contributors to first edition
References and further reading
Index
Wiley End User License Agreement
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Acute Psychiatric Emergencies
A Practical Approach
SECOND EDITION
Advanced Life Support Group
Edited by
Mark Buchanan
Consultant in Adult and Paediatric Emergency Medicine, Arrowe Park Hospital, Wirral University Teaching Hospital NHS Trust;Honorary Clinical Senior Lecturer,University of Liverpool
Damien Longson
Consultant Liaison Psychiatrist,Greater Manchester Mental Health NHS Foundation Trust;Honorary Professor of Psychiatry,University of Manchester
This edition first published 2025© 2025 by John Wiley & Sons Ltd
Edition HistoryJohn Wiley & Sons Ltd (1e, 2020)
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The right of Advanced Life Support Group (ALSG) to be identified as the authors of the editorial material in this work has been asserted in accordance with law.
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Limit of Liability/Disclaimer of WarrantyWhile the publisher and authors have used their best efforts in preparing this work, they make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives, written sales materials or promotional statements for this work. This work is sold with the understanding that the publisher is not engaged in rendering professional services. The advice and strategies contained herein may not be suitable for your situation. You should consult with a specialist where appropriate. The fact that an organization, website, or product is referred to in this work as a citation and/or potential source of further information does not mean that the publisher and authors endorse the information or services the organization, website, or product may provide or recommendations it may make. Further, readers should be aware that websites listed in this work may have changed or disappeared between when this work was written and when it is read. Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.
Library of Congress Cataloging‐in‐Publication Data Applied for:
Paperback ISBN: 9781394286263
Cover Design: WileyCover Image: Courtesy of Sinead Kay, © fizkes/Getty Images, © Jacob Wackerhausen/Getty Images
Note to text:
Drugs and their doses are mentioned in this text. Although every effort has been made to ensure accuracy, the writers, editors, publishers and printers cannot accept liability for errors or omissions. The final responsibility for delivery of the correct dose remains with the physician prescribing and administering the drug.
Dedication
We would like to acknowledge and dedicate this manual to ALSG’s former Chair of Trustees (1990–2024), Professor Kevin Mackway‐Jones, in bringing the Acute Psychiatric Emergencies (APEx) course to fruition. By bringing together colleagues from across the acute and mental healthcare sectors, his vision, inspiration and beliefs turned the thought‐provoking idea of essential mental health training that covers emergency management, wherever the setting, into reality.
Contributors to second edition
Roger Alcock
MBChB, BSc(Hons), FRCP Edin, DCH, FRCEM, FRGS, Consultant in Emergency Medicine and Paediatric Emergency Medicine, Victoria Hospital, NHS Fife
Sally Arnold
MBChB, MRCPsych, DRCOG, MA. Consultant Perinatal Psychiatrist, Midlands Partnership NHS Foundation Trust
Mark Buchanan
FCEM, Consultant in Adult and Paediatric Emergency Medicine, Arrowe Park Hospital, Wirral University Teaching Hospital NHS Trust; Honorary Clinical Senior Lecturer, University of Liverpool
Rebecca Chubb
MRCPsych, Locum Consultant Psychiatrist, North Staffordshire Combined Healthcare NHS Trust
Alys Cole‐King
MB, BCh, DGM, MSc, FRCPsych, Clinical Director, 4 Mental Health/retired Consultant Liaison Psychiatrist
Sandrine Dénéréaz
Paramedic, Master in Public Administration, Paramedic School Director, Lausanne, Switzerland
James Ferguson
FRCSEd, FRCS(A&E), FRCEM, FRCPE, FRSM, Consultant Surgeon in Emergency Medicine, NHS Grampian
Damien Longson
PhD, FRCPsych, Consultant Liaison Psychiatrist, Greater Manchester Mental Health NHS Foundation Trust; Honorary Professor of Psychiatry, University of Manchester
Aaron McMeekin
MBChB, LLB(Hons), MSc(Oxon), MRCPsych, PGCertMedEd, FHEA, Consultant Perinatal Psychiatrist, Greater Manchester Mental Health NHS Foundation Trust; Honorary Senior Clinical Teacher, Academic Unit of Medical Education, University of Sheffield
Andrew M. Russell
MBChB, MRCS, FRCEM, Consultant in Emergency Medicine, University Hospital Monklands, Lanarkshire
Murray Smith
MRCPsych, Consultant Liaison Psychiatrist, Department of Psychological Medicine, Aberdeen Royal Infirmary, NHS Grampian
Preface to second edition
The prevalence of mental health distress is increasing and is thought to account for up to 5% of presentations to Emergency Departments (EDs) in England. In 2023–24 there were over 200 000 ED attendances in England where the chief complaint could be identified as a definite or possible mental health issues. The two main reasons for presentation were suicidal thoughts or self‐injurious behaviours. Other diagnoses included depression, anxiety, psychotic disorders and, although not necessarily mental health‐related, substance misuse disorders.
In August 2024 there were 31 328 new referrals to psychiatric liaison teams in ED. Distress associated with the emergency situation is compounded by additional factors. For example, in the same time period more than 80 000 people experiencing a mental health crisis waited in an ED for more than 12 hours with 26 000 spending more than 24 hours in that setting.
Mental health emergencies present in many settings: prehospital in the patient’s home or in the community, out‐patient departments, emergency departments, acute wards and mental health wards; the response to patients in crisis is best seen as being multiagency: including general practitioners, ED staff, psychiatrist trained staff, paramedics, police and social services to name a few.
The new edition of the Acute Psychiatric Emergencies (APEx) course builds on our experience of running the course in several nations for the past 5 years. We wanted to strengthen the collaborative approach, review acronyms, update key principles and include emerging concepts of pivotal importance in supporting a patient in crisis. This book, with its 2‐day hands on experiential course has been designed to bring teams together to work towards providing safe effective care to patients presenting with acute mental health symptoms in any setting. In the spirit of the collaboration taught on the course, the revised course and book has been completely revised by emergency and psychiatric physicians experienced in dealing with mental health emergencies.
The fundamental principles of the course have not changed. APEx is a structured, flexible and systematic approach for staff supporting patients in mental health crisis, whatever the setting. The APEx approach facilitates safe effective management and promotes joint, parallel working between specialities.
As before, APEx considers both mental and non‐mental health‐related behavioural disturbances with topics varying from organic presentations, de‐escalation and mental health assessments. Into this second edition we have added sections on specific circumstances such as eating disorder emergencies and safety plans. We have introduced important new tools such as the SMART screening tool for triage, and refined the mental state acronyms to improve communication between acute and mental health specialities. The section on human factors has been updated and as always the course places the patient experience and patient safety at the heart of the clinical pathway.
Patients in a mental health crisis deserve better care. A caring, systematic and communicating approach is the start to making this happen.
Mark Buchanan and Damien LongsonJanuary 2025
Preface to first edition
Emergency departments offer open access healthcare 24 hours a day, 7 days a week, 365 days a year. The number of patients attending these departments in England increased by 7.4% between 2010–11 and 2016–17 and is currently at an all‐time high. It is unsurprising that a significant proportion of the patients attending emergency departments present with mental health problems, and the number of patients in crisis is increasing at 10% per year and now make up more than 5% (one in 20) of all attenders.
Despite the high numbers of patients attending in mental health crisis (more attend with this presentation than attend with chest pain), the vast majority of emergency department staff are not trained specifically to deal with patients with mental health emergencies or, indeed, to deal with mental illness at all. A value clarification exercise that looked into emergency mental healthcare in one emergency department in London established that the work most valued by the staff was trauma ‘because of the excitement and drama it provided’. The environmental values for good mental healthcare (privacy, quietness, safety, calmness and having time) were noted to be the ‘antithesis’ of the environment found in the emergency department. Experienced emergency department nurses noted a ‘deficit in mental health knowledge’ but were unable to further identify the deficits. A key theme emerged of ‘a perceived conflict between two cultures’ which gives mental health a low status.
The course that this book supports (APEx) is designed to fill some of the gap and more closely align the cultures of care. The content has been designed jointly by psychiatrists and emergency physicians and is presented in a structured manner. Recognisable presentations (such as ‘overdose and poisoning’, ‘aggression’ and ‘behaving strangely’) are dealt with rather than focusing on diagnoses. Primary assessment is achieved with a new bespoke structured approach (ABCD AEIO U) that is similar to the more familiar ABCD emergency care approach to physical emergencies. Secondary assessment consists of parallel physical and psychosocial history and examinations. Throughout the text close co‐operation between emergency and mental health teams is emphasised as is the value of joint working.
Patients in mental health crisis clearly deserve better than they currently get. This book, and the APEx course it supports, is for them.
Kevin Mackway‐JonesManchester 2019
Acknowledgments
A great many people have put a lot of hard work into the production of this book, and the accompanying Acute Psychiatric Emergencies course. The Editors would like to thank all the contributors for their efforts.
We are greatly indebted to Kirsten Baxter, Kate Denning and Kelly Flaherty for their exceptional hard work and dedication towards this publication; their encouragement and guidance throughout the process has been gratefully received.
We would like to express our special thanks to Dr Alys Cole‐King, Clinical Director at 4 Mental Health, for the Safety Planning section and use of the Safety Plan template.
Thanks to Catherine Giaquinto for designing the new algorithms and artwork for this edition.
Thanks to Chloe Cobb for her work with the SMART tool.
For the shared use of their images, resources and algorithms, we would like to thank:
eMentalHealth.ca ‐ ASEPTIC Mental Status Examination (MSE) resourceHenry Murray, PharmacistManchester Triage GroupSMART Form, Sierra Sacramento Valley Medical Society
We acknowledge the contribution of Satveer Nijjar, Independent Trainer with Lived Experience, ‘Attention Seekers Training’, who provided her personal account to inform Chapter 14 ‘The patient experience’.
Contact details and website information
ALSG: www.alsg.org
For details on ALSG courses visit the website or contact:
Advanced Life Support GroupALSG Centre for Training and Development29–31 Ellesmere StreetSwinton, ManchesterM27 0LATel: +44 (0) 161 794 1999Email: [email protected]
Updates
The material contained within this book is updated on approximately a 4‐yearly cycle. However, practice may change in the interim period. We will post any changes on the ALSG website, so we advise you to visit the website regularly to check for updates (www.alsg.org).
On‐line feedback
It is important to ALSG that the contact with our providers continues after a course is completed. We now contact everyone 6 months after their course has taken place asking for on‐line feedback on the course. This information is then used whenever the course is updated to ensure that the course provides optimum training to its participants.
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PART 1
CHAPTER 1Structured approach to acute psychiatric emergencies
Learning outcomes
After reading this chapter, you will be able to:
Describe the approach to preparing for an assessment of a patient with possible mental health problems
Explain the importance of close working between emergency medicine and psychiatry staff
Outline the importance of good communication
Identify a structured approach to managing psychiatric emergencies
1.1 Introduction
Psychiatric and behavioural presentations to Emergency Departments (EDs) are common. If substance misuse is included in the figures then some 35–40% of presentations (6–8 million each year in England) are defined as such. This means that on each shift staff are highly likely to have to manage patients with acute psychiatric and/or behavioural emergencies, and as will be explored below, they often do so with limited specialist training.
Adults with mental health illness are three times more likely to attend the ED and five times more likely to have a general admission to hospital (NICE and NHS England (2016)).
Systematic assessment and management of a person with acute mental health problems can present major challenges wherever they arise. Key considerations include:
ED and acute hospital staff receive little training in managing psychiatric emergencies
Responses of mental health staff can be delayed, inconsistent and unsystematic
The acute hospital environment is rarely conducive to the provision of good psychiatric care
These considerations make clear the importance of the Acute Psychiatric Emergencies (APEx) course that seeks to provide a safe, practical system for practitioners. The approaches discussed in APEx are as relevant when seeing a patient in the ED as in any acute setting, including prehospital, the patient’s home and prison. As such the APEx course is not just aimed at psychiatric and emergency medicine clinicians and allied professionals, but also at many other staff groups involved in the management of the patient who is presenting with a possible mental health emergency.
1.2 Preparation
Before starting any assessment for a patient with possible mental health problems:
Gather any available information to allow you to make an assessment of the risk (to self and to the patient) and rapidly identify the need for emergency medical or psychiatric management using the Unified approach (ABCD/AEIO), which will be covered later in this chapter
Ensure that appropriate help is available (a person who is showing signs of acute behavioural disturbance requires a team approach)
Ensure there are suitable facilities to assess the patient
There must be a safe area where people who are acutely disturbed can be assessed and managed appropriately.
1.3 Close working between emergency and psychiatry staff
The safe and successful management of people with acute mental health problems requires close working between emergency/acute hospital teams and liaison mental health teams. Each team needs to carry out their own tasks, be aware of each other’s skills and work collaboratively to ensure the best possible outcome.
1.4 Communication
Good communication and basic rapport building with a person with acute mental illness are essential. Communication is no less important with families of patients and with clinical colleagues – especially between those of different disciplines. Detailed records of current clinical findings, the patient’s history, prior mental health records, physical test results and management plans must be completed, and communicated to staff who will be taking over the care of the patient when they leave the ED.
1.5 Consent
In an emergency, if it is deemed in the patient’s best interests, hospital staff have a duty of care to treat the patient, provided treatment is limited to that which is reasonably required in that emergency situation.
As consent legislation is a complex area with different practices in different countries and jurisdictions, we will highlight the medicolegal aspects of patient care in relevant chapters by detailing the principles of what they achieve. Chapter 12 summarises legal aspects in more detail and maps the principles of the relevant laws. The details will differ depending on the jurisdictions where the APEx course is available.
1.6 A structured approach
A structured approach will enable all clinicians (whether mental health trained or not) to manage psychiatric emergencies optimally, so that patients receive high‐quality care. It will also ensure that important steps in the care process are not forgotten. As it is common for mental and physical health problems to occur at the same time, both require consideration.
A structured approach focuses initially on a primary assessment designed to identify and manage any immediate threats to safety, either for the patient or for others. This involves a rapid assessment of physical risk – Airway, Breathing, Circulation, Disability (ABCD) – and a psychiatric risk assessment of Agitation/Arousal, Environment, Intent, Objects (AEIO). These then inform the Unified assessment.
After a primary assessment has been completed and relevant steps have been taken to ensure safety, a secondary assessment needs to be undertaken. This includes establishing the key features of the presentation. In particular, it is important to establish whether the presentation is predominantly a physical health or a mental health problem (or a combination of both). This process involves being able to interact with the patient in a manner that conveys understanding and empathy, builds rapport, reduces anxiety and enables information gathering in an effective and efficient manner. Secondary mental health assessment includes a focused conversational psychosocial history and examination of the mental state, while secondary physical health assessment involves a focused physical history and full top‐to‐toe examination. Following on from this, an appropriate emergency treatment and management plan can be implemented.
The final phase of the structured approach is to stabilise the patient so that transfer to an appropriate care environment can occur.
Throughout this text the same structure will be used so the clinician will become familiar with the approach and be able to apply it to any clinical emergency situation.
Figure 1.1 shows the structured approach in diagrammatic form.
Figure 1.1The structured approach
See Figure 3.2 for more detail on the SMART Form
1.7 Summary
This book will introduce the structured approach in more detail and then explore its use in the common psychosocial presentations to the ED.
CHAPTER 2Primary unified assessment and immediate psychiatric management
Learning outcomes
After reading this chapter, you will be able to:
Explain how to assess someone who is acutely disturbed
Describe how to take structured steps to ensure safety and minimise any potential harm to others
2.1 Introduction
The effective management of an acutely disturbed patient who has a presumed mental health crisis is a key emergency skill. By using the basic techniques and strategies described, a safe framework can be established, from which a more detailed assessment or intervention can then be carried out. It is essential that all staff who work in an acute hospital setting have these basic skills.
In the structured approach, the person who is acutely disturbed should have a primary assessment that includes ABCD and AEIO risk assessments (see Figure 2.1). It may not be possible to carry out a full physical assessment because of the level of disturbance, but consideration should be given to physical status and potential organic causes of the presentation.
In this chapter, we focus on the mental health assessment, but physical factors should always be considered and accompanied by a parallel physical assessment when appropriate.
2.2 Preparation
Never approach a patient who is acutely disturbed by yourself. Wait until a sufficient number of appropriately trained staff, police officers or security guards are present. The number required will depend upon the physical threat from the patient, the nature and degree of their disturbance, and the environment and resources of the facility in which you are working.
In most circumstances, there is time to gather information quickly before seeing the patient (e.g. if the patient is brought to the Emergency Department (ED) by the family, the police or the paramedic emergency service). The aim at this point is to access relevant information that will inform the rapid assessment.
Information may include verbal accounts from the family, paramedics, police, relevant others and the hospital record systems. Ask and obtain answers to the following questions:
Can you tell me about the behaviour of X whilst in your care?
On a 10 point scale (0 being not disturbed at all, to 10 being extremely agitated/violent/aroused) how would you rate this person’s behaviour?
Can you tell me about/give me an example of the most extreme or disturbed level of behaviour you have witnessed?
Do they speak the local language and, if not, what language do they speak?
