The Dangerously Agitated Patient: Guidance, Best Practice and Application

The management of the agitated patient is fraught with challenge and controversy. This presentation is intended to acquaint the listener with the current state of the problem in the air medical industry and offer practical, evidence based solutions. Driven by multiple incidents in the industry over the last several years, multiple groups have begun work on potential solutions. This lecture will be driven by discussions with those groups and offer analysis of the problem, key elements that might be required in clinical guidance or protocols. It will offer examples of ways to fulfill those elements that are as evidence based as possible. We will discuss risk stratification of the patient as well as a stratified response to various levels of agitation. Further we will delve into issues of consent, monitoring and stabilization of the acutely agitated patient. In addition, we will discuss the necessity of training, both for pharmacologic and physical control of the dangerously agitated patient. Finally, a discussion of refusal to transport, common fallacies and crew safety will be undertaken.