Agitated Patient Management
Agitated Patient Management currently accounts for 15% of all calls to MEDICO Cork, the HSE’s National 24 hour Emergency Telemedical Support Unit.
Agitated Patients present a significant logistical, emotional and resource challenge for prehospital practitioners. They are a subset of patients with a high, particularly in the case of Traumatic Brain Injury, mortality rate. Timely and appropriate intervention in this subset of patients can make a significant difference to long term functional outcome.
a great deal of time and thought has gone into several iterations of a PHECC CPG aimed at better streamlining the prehospital practitioners’ approach to agitation. It is a challenging CPG to write, particularly as there are multiple aetiologies for agitation.
Incidence
An extensive survey by Dr. Jennifer Bevan in 2016 showed:
- Sustained exponential increase in frequency in practitioners looking for support to manage agitation or aggression
- No "one size fits all" remedy
- Need to inetgrate approach with multiple other CPGs
Approach
Start with the premise that agitation or aggression is secondary to:
- Pain
- Hypoxia
- Circulatory compromise
- Hypoglycaemia
- Head injury
For example, the head injury CPG might offer an agitated pathway that begins at pain management.
Try to clarify if the patient has capacity or not.
- Does mental health act apply (when does it not apply) - patient may be better served under common law
- If the patient is deemed to lack capacity through mental illness, and they are refusing the offer of care, then we are advising Physician intervention, i.e. GP to scene or Garda detention under Section 12 of the Act