FISDAP Behavioral and Psychiatric Emergencies — Questions and Answers
Question 1: When responding to a behavioral emergency, what is the EMT's first priority upon arrival?
- Administer sedation to calm the patient
- Perform a rapid psychiatric assessment
- Ensure scene safety before approaching (Correct answer)
- Restrain the patient to prevent injury
Correct answer: Ensure scene safety before approaching
Scene safety is always the first priority in any EMS call, but it is especially critical in behavioral emergencies where the patient may be unpredictable or violent. EMTs should not approach until law enforcement has secured the scene if there is a threat.
Question 2: Which of the following findings in a patient with altered behavior should prompt the EMT to suspect an ORGANIC (medical) cause rather than a psychiatric cause?
- A history of schizophrenia
- Gradual onset of behavioral changes over years
- A blood glucose of 34 mg/dL (Correct answer)
- Auditory hallucinations reported by the patient's family
Correct answer: A blood glucose of 34 mg/dL
Hypoglycemia (blood glucose of 34 mg/dL) is a classic organic (physical) cause of altered behavior and altered mental status. EMTs should always rule out medical causes — hypoglycemia, hypoxia, trauma, toxins — before assuming a psychiatric origin.
Question 3: A patient is agitated, diaphoretic, hyperthermic, and showing signs of extreme strength. Law enforcement is on scene. The EMT suspects excited delirium. What is the most important consideration during physical restraint?
- Position the patient prone with hands behind the back after restraint
- Use only soft restraints to prevent injury
- Monitor airway and avoid positional asphyxia after restraint (Correct answer)
- Restrain legs only to allow for breathing
Correct answer: Monitor airway and avoid positional asphyxia after restraint
Positional asphyxia is a major risk after physical restraint in excited delirium patients. Once restrained, the patient must be placed in a position that does not compromise the airway or restrict breathing — typically lateral or supine — and monitored continuously. Prone restraint significantly increases mortality risk.
Question 4: Which of the following is the MOST important question to ask when assessing suicide risk in a patient?
- Have you ever been depressed before?
- Do you have a specific plan for how you would harm yourself? (Correct answer)
- Are you taking any psychiatric medications?
- How long have you been feeling this way?
Correct answer: Do you have a specific plan for how you would harm yourself?
Having a specific, detailed plan is one of the strongest predictors of suicide risk and imminent danger. While all factors matter, a specific plan (including means, method, and time) indicates higher immediate risk than ideation alone.
Question 5: A patient in a psychiatric crisis refuses transport and has no injury. Law enforcement states the patient was found wandering in traffic. Under what authority can the patient be transported against their will?
- Implied consent, because the patient is emotionally distressed
- Involuntary commitment laws or a physician's order, when the patient poses a danger to themselves or others (Correct answer)
- The family's verbal consent is sufficient
- EMTs always have the authority to transport any patient who refuses
Correct answer: Involuntary commitment laws or a physician's order, when the patient poses a danger to themselves or others
Involuntary transport requires legal authority — typically state-specific involuntary commitment (psychiatric hold) laws or a physician's order. The basis is that the patient is a danger to themselves or others. EMTs cannot override a competent adult's refusal without this legal backing.
Question 6: Which communication technique is MOST effective when de-escalating an agitated patient experiencing a psychiatric emergency?
- Speak loudly and assertively to establish authority
- Use a calm, low tone, maintain non-threatening body posture, and listen actively (Correct answer)
- Tell the patient their fears are irrational to redirect their thinking
- Avoid eye contact entirely to prevent confrontation
Correct answer: Use a calm, low tone, maintain non-threatening body posture, and listen actively
De-escalation requires reducing perceived threat. A calm, even voice; open, non-threatening body posture; and active listening validate the patient's experience and help lower arousal. Loudness, confrontation, or dismissal of fears escalates agitation.
FISDAP Behavioral and Psychiatric Emergencies
When responding to a behavioral emergency, what is the EMT's first priority upon arrival?