2019 EMT Refresher Instructor Manual

B.2.A - Behavioral Station: Psych Restraint Instructor Guidance Objectives: 1.

Demonstrate how to use the AVPU scale to test for patient responsiveness. (p 262) 2. Demonstrate how to evaluate a patient’s orientation and document his or her status correctly. (pp 262–264) 3. Demonstrate the techniques for assessing a patient’s airway and correctly obtaining information related to respiratory rate, rhythm, quality/character of breathing, and depth of breathing. (pp 265–269) 4. Demonstrate how to assess a radial pulse in a responsive patient (pp 270–272) 5. Demonstrate history-taking using the SAMPLE mnemonic and the OPQRST mnemonic 6. Demonstrate how to measure blood pressure by auscultation. (pp 296–300, Skill Drill 8-3) 7. Demonstrate how to measure blood pressure by palpation. (p 300) 8. Demonstrate taking a heart rate on a patient 9. Demonstrate taking a breathing rate on a patient 10. Demonstrate how to obtain a pulse rate in a patient. (pp 270–272) 11. Demonstrate how to assess capillary refill in an adult or child older than 6 years. (pp 273–274) 12. Demonstrate how to perform a focused assessment of a patient 13. Demonstrate the use of a pulse oximetry device to evaluate the effectiveness of oxygenation in the patient. (pp 289– 290) 14. Demonstrate the use of electronic devices to assist in determining the patient’s blood pressure in the field. (pp 290– 291) 15. Demonstrate how to measure blood pressure by auscultation. (pp 296–300, Skill Drill 8-3)

16. Demonstrate how to measure blood pressure by palpation. (p 300) 17. Demonstrate how to solicit a medical history from a patient (pp 278) 18. Demonstrate the correct use of medical restraints on a patient. (pp 1321–1322)

Equipment: -

Cohort Bag

Reeves

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Deployment: DO NOT LECTURE – your students should be working hands-on within 5 minutes of arriving

Deploy your students in one team – one student should be patient, the rest rescuers. The patient should sit and pretend to be angry and belligerent. Have them transition through the scenario on the back of this sheet like any other scenario from a scenario lab day. Debriefing: Give students feedback on the case after it is complete. Some points to discuss: - Did they take steps to insure their safety? - When the patient permits it, did they assess the patient’s medical status to rule out medical causes of combativeness such as head injury, etc? - Once the identifies behavioral as the issue, did they try: o Verbal de-escalation o Reorienting the patient to reality o Restraining the patient - Review scenarios when restraint is appropriate: o By medical control order if working for a health system EMS service o As a last resort when the patient is a threat to himself or others – this generally should be done in partnership with the police - Acceptable methods of restraint o Soft restraint system commercially made for restraining patients o Improvised restraint with soft product such as roller gauze o Minimum force necessary involved o Done with lots of staff (4 – one for each extremity) It is not acceptable to play into delusions/hallucinations.

This is a nebulous area for EMTs. Be sure to review this.