Cooling the Flames: De-escalation of Mentally Ill & Aggressive Patients – A Comprehensive Guidebook for Firefighters and EMS
People suffering from psychiatric or substance abuse disorder can display any one of a number of frightening behaviors. Ellis Amdur and John K. Murphy offer firefighters and EMTs a comprehensive set of strategies to keep themselves and their patients safe, while functioning at the highest level of professionalism. Rather than abstract information, more useful in a consulting room than in the field, Cooling the Flames is tactically based, from start to finish. The first section of this book addresses field safety, including both strategic planning and honing your intuition to pick up early signs of danger. In the second section, the authors offer specific strategies to maintain integrity and calm in crisis situations, including a method of breathing for the purpose of maintaining one’s own center in crisis situations. They then discuss interventions with those displaying confusion and obsessive concerns, psychosis, mania and acute disorganization. In one very important section, they discuss interactions with manipulative people, who present a danger to the psychological and physical well being of anyone with whom they come in contact. The authors discuss suicidal patients, not only from the perspective of despondent individuals who attempt to kill themselves, but also offer strategic interventions for those who either threaten to harm themselves, or repetitively do so, requiring regular involvement of EMS, police, hospitals and the mental health system. The authors explain how to immediately recognize different modes of aggression, and then outline how to quickly and effectively implement de-escalation or control tactics best suited to deal with the type of aggression one is facing. In three essential appendices, they present protocols for physical and chemical restraint, current information on positional and compression asphyxiation (authored by Dr. Gary Vilke), and a protocol, specific to fire and EMS, on excited delirium (authored by Lt. Michael Paulus, ret.)
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