Behavioral Violent/Combative Administrative Guideline

Question 1

History

Answer 1

• Past medical history
• Pertinent medication history
• Compliance with medications
• Recent exacerbating factors
• Petitioned or court ordered
• Collateral information
• Substance abuse history

Question 2

Sings and symptoms

Answer 2

- Statements of suicidal/homicidal
thoughts/ actions
- Agitated/violent behavior
- Exhibiting behaviors that can be
deemed dangerous to self or others
- Acute psychological complaint

Question 3

Differential

Answer 3

- Altered mental status related to drug
usage
- Trauma
- Hypoglycemia/Hyperglycemia
- Infection/Fever

Question 4

Patient violent or exhibiting behavior that is dangerous to self or others during transport

Answer 4

Attempt verbal reassurance and calm patient
Engage friends or family if they are able to help calm patient
Follow SOP for restraints.

Question 5

CAN safely apply restraints without meds?

Answer 5

O2 to maintain sat > 94%
IV/IO access
Apply cardiac monitor and EtCO2 as soon as possible.
Consider 12-lead ECG

Question 6

CANNOT safely apply restraints without meds?

Answer 6

Consider midazloam 0.1 mg/kg IM/IN/IV/IO
- 8 - 13 yrs or > 65 years (max 2.5 mg), May repeat
every 5-10 minutes as indicated (max total 5 mg)
- 14-65 yrs: (max 5 mg), May repeat q 5-10 minutes as
indicated (max total 10 mg)
- ? 8 yrs: Contact Medical Direction for orders
Use caution when patient at risk for hypotension,
as midazolam administration will lower blood
pressure.

Then go to “CAN apply” step.

Question 7

Once restraints are on:

Answer 7

Reassess and document mental status and vital signs every 5 minutes and neurovascular status of all extremities every 15 minutes

Question 8

What about combative TBI patients

Answer 8

Combative patients with traumatic injury/TBI present a uniquely challenging scenario. The provider
must consider the risks of causing hypotension by providing chemical sedation only when absolutely
necessary