Cooling the Flames: De-escalation of Mentally Ill & Aggressive Patients

Cooling the Flames coverIndividuals suffering from psychiatric or substance abuse disorders sometimes display any one of a number of frightening behaviors: verbal outbursts, physical threats and even violence. First responders must deal with such individuals on a frequent basis. In this comprehensive guidebook, 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.
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The first section of this book is tactical: everything from field safety and strategic planning on one side, to honing your intuition to pick up early signs of danger on the other. In the second section of the book, the authors focus on us: what we can do to achieve a state of integrity and powerful calm. Rather than abstract pronouncements, they offer specific strategies, including a method of breathing for the purpose of maintaining one’s own center in crisis situations. They then move on to the heart of the book, discussing specific behaviors ranging from confusion and obsessive concerns to psychosis, mania and acute disorganization. In one very important section, they discuss interactions with opportunistic and manipulative individuals (at worst, those referred to as sociopaths), people who present a danger to the psychological and physical well-being of anyone with whom they come in contact.

Amdur and Murphy do not merely confine themselves to the important subject of despondent suicidal individuals who attempt to kill themselves. They also offer strategic interventions for ‘para- suicidal’ individuals, those who either threaten to harm themselves, or repetitively do so, requiring almost constant involvement of EMS, police, hospitals and the mental health system.They then move on to a discussion of anger and potentially violent behavior, whether directed at fire- fighters and EMTs or others. The authors give succinct information on how to immediately recognize different modes of aggression, whether displayed by adults, youth, or children, 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. Finally, 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 Lieutenant Michael Paulus, ret.) Rather than abstract information, more useful in a consulting room than in the field, Cooling the Flames is tactically based, from start to finish.

This book provides a comprehensive course of study of ‘boots-on-the-ground’ encounters with emotionally disturbed individuals.

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