History:

 

• Traumatic Injury

• Drug Abuse
• Cardiac History
• History of Asthma
• Psychiatric History

 

Signs and Symptoms:

 

• External signs or trauma
• Palpitations
• Shortness of breath
• Wheezing
• Altered Mental Status
• Intoxication/Substance Abuse

 

Differential:

 

• Agitated Delirium Secondary to Psychiatric Illness
• Agitated Delirium Secondary to Substance Abuse
• Traumatic Injury
• Closed Head Injury
• Asthma Exacerbation
• Cardiac Dysrhythmia

 

Treatment:

 

• Universal Patient Care Protocol

 

Evidence of Traumatic Injury or Medical Illness ?

 

• Yes

 

• • Appropriate Protocol and Transport

 

• No

 

Use of Pepper Spray ?

 

• Yes

 

• • Irrigate face/eyes
  • Remove contaminated clothing

 

Wheezing ?

 

• Yes

 

• • Respiratory Distress Protocol and Transport

 

• No

 

History of Asthma ?

 

• Yes

 

• • Observe 20 min

 

Wheezing ?

 

• Yes

 

• • Respiratory Distress Protocol and Transport

 

History of Asthma ?

 

• No

 

Agitated Delirium ?

 

• Yes

 

• • Consider Restraint Procedure and/or Behavioral Protocol

 

• No

 

• • Coordinate disposition with patient, law enforcement personnel, and if necessary Medical Control

 

Use of Taser ?

 

• Yes

 

Significant Injury from Entry Point of Taser or from Fall after Taser Use ?

 

• Yes

 

• • Appropriate Protocol and Transport

 

• No

 

• • Wound Care Taser-Probe Removal Procedure

 

Cardiac History with Pacemaker, Chest Pain, or Palpitations ?

 

• Yes

 

• • Appropriate Protocol and Transport

 

• No

 

Agitated Delirium ?

 

• Yes

 

• • Consider Restraint Procedure and/or Behavioral Protocol

 

• No

 

• • Coordinate disposition with patient, law enforcement personnel, and if necessary Medical Control.

 

Pearls:

 

• For this protocol to be used, the patient does not have to be under police custody.
• Agitated delirium is characterized by marked restlessness, irritability, and/or high fever. Patients exhibiting these signs are at high risk for sudden death and should be transported to hospital by ALS personnel.
• Patients restrained by law enforcement devices cannot be transported in the ambulance without a law enforcement officer in the patient compartment who is capable of removing the devices.
• If there is any doubt about the cause of a patient’s alteration in mental status, transport the patient to the hospital for evaluation.
• If an asthmatic patient is exposed to pepper spray and released to law enforcement, all parties should be advised to immediately recontact EMS if wheezing/difficulty breathing occurs.
• All patients in police custody retain the right to request transport. This should be coordinated with law enforcement.
• If extremity/chemical/law enforcement restraints are applied, complete Restraint procedure in call reporting system.