Pediatric emergency medicine trisk 4162 4162
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Pediatric emergency providers are called upon to assess potentially
violent individuals. EDs may also find themselves on the front lines
of violence or possibly active shooter scenarios, and thus need
adequate screening and response policies in place to manage acute
safety.
Remember that agitated or violent behavior may be situation
dependent; once removed from the situation, the patient’s behavior
may significantly improve. In fact, the behavior may appear to be
normal by the time they arrive at the ED. It is potentially a mistake to
equate the lack of significant symptoms in the ED with the absence
of a significant problem. The problematic behavior may easily
reoccur if the patient is returned to the same situation without any
appropriate intervention(s). In assessing the potentially violent
patient obtain thorough collateral information, as patients
themselves may not be fully forthcoming about their thought content
or plans.
There are important medicolegal considerations in caring for these
patients. The ED physician may have Tarasoff obligations to warn
and protect identified targets of violence and must also consider
their obligations to protect society at large. Every state has laws
regarding involuntary admission of patients at imminent risk for harm
to self and/or others. It is incumbent upon ED physicians to
familiarize themselves with their state’s laws and regulations. An
ACEP resource on involuntary psychiatric holds by state can be
accessed at />A significant percentage of patients with psychiatric complaints
have experienced trauma in the past. Treatment in the ED can be
retraumatizing in numerous ways, including having their clothing and
belongings removed, having a security guard present, being
confined to a single room, and receiving chemical and/or physical
restraints. For some patients, these factors may be the underlying or
contributing cause for their agitated or aggressive behavior.
Chronically traumatized children often have an elevated stress
response and live in a state of constant alarm; the ED experience
may be difficult for them to handle. “Trauma-informed care” assumes
that all patients have trauma in their past, the clinician’s approach
