Human Behaviour and crisis

All Human Behavior Slides

• The slides cover human behavior, with a focus on mental health, crisis intervention and different types of disorders.
• The information presented is about understanding human behaviors and reactions, and how medical professionals (like paramedics) can identify them, the different types of emotional reactions, and various coping mechanisms, and ultimately, how to handle crises and manage/assist individuals dealing with mental health issues (including violence & aggression).
• The presentation provides various clinical terms (and definitions) like, sympathy, empathy, compassion, diplomacy, tact and discretion which provide a framework for paramedics/healthcare professionals to operate in situations involving people with mental health issues.
• The presentations discusses several mental health related concepts (including mental health, mental health continuum, social determinants of health, crisis management, etc) and how they might manifest in particular populations.

Mental Health

• Mental health is defined as a state of psychological, emotional, and social wellbeing.
• Key indicators of mental health include the ability to think logically and rationally, choose among thoughts and emotions, match moods to situations, cope with change, stress, and trauma, accept limitations, be productive and achieve potential, and contribute meaningfully to society.
• The mental health continuum model shows a spectrum ranging from healthy to ill, highlighting the different emotional reactions a person undergoing a crisis may experience (and the various behaviours a paramedic might observe during an emergency). Several examples for each phase and potential behaviours are included in the slide.

Causes of Mental Illness

• Mental illnesses have complex causes involving biological, developmental (childhood experiences), and/or environmental factors.
• Biological aspects include genes, brain structure, and brain chemistry and are often linked to illness/injury.
• Developmental factors, childhood experiences (particularly adverse childhood experiences), and neurodevelopmental differences play a significant role.
• Environmental factors include social issues, poverty, violence, and/or food insecurity.

Maslow's Hierarchy of Needs

• Maslow's Hierarchy of Needs illustrates the different levels of human needs, ranging from basic physiological needs (e.g., food, water, warmth, rest) to self-actualization needs (e.g., achieving one's full potential).
• People with unmet needs might be at greater risk of mental illness, as their access to higher levels of the hierarchy may be affected.

Social Determinants of Health

• Social determinants of health involve factors contributing to health, like income, social status, employment/working conditions, education, childhood experiences, physical environments, social supports, coping skills, access to health services, gender, culture, and race.
• These elements can significantly affect both physical and mental health, with specific implications for certain social groups. These groups will likely experience increased risk of mental illness based on factors and experiences presented in societal factors.

Crisis Management

• A developmental crisis arises from normal life changes such as puberty, leaving home, marriage, childbirth, or retirement.
• A situational crisis results from unexpected trauma, loss, or change like death, divorce, critical illness/injury, violence, or property destruction.
• A paramedic/healthcare professional needs to understand these types of crises when dealing with a patient so they are prepared to make a correct diagnosis.

Key Terminology

• Sympathy involves understanding the feelings of another person without necessarily sharing them.
• Empathy means experiencing the same feelings as another person and understanding their situation.
• Compassion is feeling concern for another person's suffering and misfortune.
• Diplomacy is the art of dealing with people sensitively and effectively.
• Tact is using skill and sensitivity in difficult situations.
• Discretion is responsible behaviour and speech, avoiding upset/offense, or revealing private information.

Emotions and Emotional Reactions

• Slides present a wide range of typical and atypical emotions and reactions, essential for paramedics to recognise and observe for proper management.

Coping Mechanisms

• Healthy coping mechanisms include religion, seeking social/professional support, and exercise/meditation.
• Unhealthy coping mechanisms include substance abuse, risky behaviours, isolation, overworking, and avoidance/denial. Some possible emotional reactions are described and examples are provided for the slide.

Providing Emotional Support

• Providing emotional support through the use of appropriate language, presence, proximity, touch, and sufficient time is vital when dealing with a person in a crisis.

Words Matter

• Avoiding stigmatizing language is crucial - using respectful and accurate terms for mental health conditions is critical. There are some examples of better language choices mentioned.

Mood, Personality, and Psychotic Disorders

• Slides cover the definitions, manifestations (like daily routines, coping mechanisms, relationships, and perceived realities), and causes of various psychological conditions including neurosis, psychosis, mania, delusions, illusions, hallucination, paranoia, and phobias.

Mood Disorders

• Defining (and describing) mood disorders, like major depressive disorder, generalized anxiety disorder and bipolar disorder.

Depression

• Symptoms (low mood, lack of pleasure in activities, weight changes, sleep problems, difficulty concentrating) for depression and how to identify in patients (some examples are provided for this slide).

Anxiety

• Symptoms (excessive worry and anxiety, restlessness, difficulty sleeping, impaired concentration, irritability, and hypervigilance) for anxiety, and how to appropriately assess in patients. Some examples are included in this slide to help the medical professional to understand the different presentations and reactions in patients.

Bipolar Disorder

• Defining bipolar disorder (extreme mood swings and intense emotional states often at the extremes of the emotional spectrum, including ‘highs’/‘lows’) and the possible challenges when dealing with this condition in a medical setting.

Personality Disorders

• Slides give descriptions of three clusters of personality disorders (odd and eccentric, dramatic and erratic, fearful and anxious). This section provides types of possible personality and behavioral differences in a patient.

Psychotic Disorders

• Defining and describing psychotic disorders (featuring delusions, hallucinations, and other experiences involving a loss of touch with reality). Examples are provided alongside these definitions.

Conversion Disorders

• Psychological disorders manifesting as physical symptoms (e.g., paralysis, weakness, loss of sensation, or other physical issues).

Substance Abuse, Violence, & Aggression

• Recognizing substance use, violence, and aggression. A discussion on risk factors and possible symptoms amongst different populations exposed to certain risk factors.

Addiction & Substance Misuse

• Slides include facts (like young people having a high risk of substance use) about rates of substance abuse, including substance related deaths in Canada. This slide provided facts and statistics.

Addiction

• Common elements of addiction like harmful consequences, loss of control, craving, compulsion are discussed here alongside the commonly used four-C’s related to addiction. Also covered are common triggers for addiction, and potential issues involving the brain and different environments.

Clinical Opioid Withdrawal Scale (COWS)

• The slide introduces the COWS scale and various medical conditions which this scale/tool is meant to help diagnose and manage. This scale is used to asses, monitor, diagnose, and classify a patient’s condition and management.

Opioid Management

• This section provides an overview of treatments for opioid dependence, including medications like Naloxone, Methadone, and Suboxone.

Stimulants

• Covered are common stimulants (amphetamine, methyphenidate, cocaine, etc.), uses, common presentations, and methods of use including, injection, snorting, smoking etc.

Sedatives, Hypnotics & Anxiolytics

• Identifying common drugs (such as Benzodiazepines, Ketamine, GHB, PCP, Nitrous Oxide). Their methods of usage, and symptoms when used. This includes, signs, symptoms, and potential danger to patients when exposed to these substances.

Hallucinogens

• Information on hallucinogens, including common drugs like LSD, Psilocybin, and Ketamine, their methods of use, and potential signs and symptoms when a person might be experiencing use.

Violence & Aggression

• Concepts like conflict, assertiveness, aggressiveness, violence, assault, and battery, contrasted with assertive behaviours, and how to manage these conditions. This section includes discussion on the stages of aggression (e.g., triggering event, escalation, plateau, recovery, post-crisis depression) in patients.

Treating/Transporting Without Consent

• Paramedics' role in intervening and giving emergency help without consent, guidelines, and legal considerations when treating incapacitated patients. Legal guidelines and considerations when dealing with unconscious patients.

Physical Restraint

• Guidelines on restraining procedures (physical restraints in specific situations), equipment, and roles of different personnel (like police) involved when responding in violent or resisting patient situations.

Chemical Restraint

• Medical professionals and their involvement in chemical restraint and administration to address the safety of both the patient and the medical professional.

Electrical Restraint

• Procedures and guidelines for employing electrical restraint tools. Specific areas to avoid when applying this type of restraint.

Victims of Abuse

• Categories of abuse (child, elder, intimate partner). Different types of abuse (physical, sexual, emotional, neglect, financial), definitions and examples describing the different types. There are a few images, describing the different types.

Physical Abuse (Children)

• Descriptions and examples of physical abuse in children, differentiating between accidental and non-accidental injuries and the importance of recognizing risk factors/patterns in children.

Physical Abuse

• Physical abuse is defined and described, including various forms of physical injury, and examples are provided. Images are provided to explain different causes of potential injuries.

Physical Abuse: Children

• Differentiating accidental from non-accidental injury in children (by age groups - toddlers, preschoolers, early school-aged children).

Physical Abuse: Adults/Elders

• Recognizing abuse in older adults/elders, considering differences in their physical abilities and susceptibility for various injuries or illnesses

Sexual Abuse: Children

• Identifying different patterns/indications of sexual abuse in children. The different types are mentioned and descriptions alongside examples are illustrated.

Sexual Abuse: Adults

• Descriptions of sexual abuse in adults, including diverse types, and contexts where this type of abuse may occur.

Human Trafficking

• Understanding human trafficking and the different types that may occur. Examples, warning signs, and other relevant/helpful information.

Psychological Abuse

• Identifying and describing various forms of psychological abuse.

Neglect

• Recognizing unmet needs including food/water, care of the environment, and other health needs, and inadequate education, supervision, protection against dangers.

Financial Abuse

• Identifying signs and descriptions of financial exploitation.

Paramedic Roles and Responsibilities

• Defining paramedics roles and responsibilities, including the role of advocacy and the duty to report abuse for both adults and children.

Assessment

• Details on assessment methods (including observation of unusual behavior, family members' comments, or other details). This section also has implications on what to do/say/report as appropriate. Examples are included depending on the situation.

History Taking

• Specific guidelines on eliciting the correct/important information without bias, being polite/professional, managing/allowing proper consent, and handling disagreements. Specific details are related to eliciting accurate patient/caregiver information.

Therapeutic Approach

• Providing a framework for a therapeutic approach. The elements include avoiding assumptions, listening actively, avoiding judgement, respecting privacy, and showing genuine care. Providing a supportive environment/interaction with the patient, rather than trying to fix the patient’s problem/condition immediately.

Escalation

• Describing the range of self-harm behaviors (from low to high risk). A framework for understanding how self-harm behaviors might escalate to suicidal behaviors, and the need for distinguishing between different types of intent.

Suicide Continuum

• A general framework for understanding the progression from passive death wishes to suicide attempts and death by suicide. This section helps medical professionals/paramedics to better understand the complexities of suicide.

Suicide Plans

• Describing different means of suicide, like firearms, knives, hanging, suffocation, poisoning, jumping, vehicular suicide or "suicide by cops". Statistics for both males and females are included

Suicide in Canada: Key Statistics

• Data from Canada (e.g., rates of suicide by age, sex, methods, frequency of thoughts/plans/attempts).

Suicide Warning Signs

• Understanding typical/common warning signs for suicide (talk, behavior, mood).

Eating Disorders

• Different types of eating disorders (including Anorexia nervosa, Bulimia nervosa, Binge Eating Disorder, Avoidant-Restrictive Food Intake Disorder (ARFID), and Pica) and their characteristics, distinguishing symptoms (including physical).

Electrolyte Imbalances

• Recognizing the potential electrolyte imbalances associated with eating disorders (including hypokalaemia, hyponatremia, metabolic acidosis, and alkalosis - what to watch/analyse, and the causes).

Aging, Age-Related & Degenerative Disorders

• Diseases and conditions associated with aging (e.g., osteoporosis, hyperkyphosis, osteoarthritis, rheumatoid arthritis, and other degenerative disorders/conditions - both physical and chronic).

Brain Injuries

• Different types of brain injuries (e.g., traumatic brain injury [TBI] and cerebrovascular accident [CVA]), their causes, and the possible ramifications.

Changes to Body Tissues

• The impacts of aging on different body tissues (skin, brain, bones, joints, and others). Highlighting how aging affects the body, and what issues might arise in the body.

Emergency Treatment & Transport of an Incapable Patient

• Legal aspects to consider when dealing with patients who do not have consent, or may be experiencing extreme reactions. Relevant legal considerations, and specific procedures to follow. There are instances of different patient types in need of proper emergency care, including trauma/violence, mental health, chemical restraint, and substance misuse to name a few.