Leading with Dignity and Respect- Prehospital Management of Agitation and Behavioral Health Emergencies

Episode: Pediatric Agitation & Behavioral Emergencies

Brought to you by the National Association of EMS Physicians and Missouri Emergency Medical Services for Children (MO-EMSC)

Hosts:

Dr. Joelle Donofrio-Odmann

Dr. Joseph Finney

Website: https://sites.libsyn.com/414020

Guest Experts:

Elizabeth Gallagher, MA, BCBA
Elizabeth is a Board Certified Behavior Analyst. She now works as a Behavior Specialist at the Autism Discovery Institute and for the Autism Friendly Health System Initiative. She is passionate about training parents and hospital staff on how to better support autistic children.

Abbey Hye, M.A., BCBA
Abbey is a board-certified behavior analyst. She has broad training in the implementation of behavioral and developmental interventions for children with autism and other developmental delays. She has a passion for parent coaching and is committed to supporting patients and medical staff to adapt care for neurodivergent youth in the context of hospitalization

Adam Hagar, NRP

Adam is a paramedic at Mehlville Fire Protection District in Saint Louis, Missouri. Adam has over 20 years experience as a prehospital Clinician. Beyond this, he is the father of a 10 year old with autism. Adam combines experience caring for patients with behavioral health emergencies and his lived experience with his son. This unique perspective provides insights and advice that are critical before your next prehospital encounter. 

Episode Summary:

Welcome back to the Pediatric EMS Podcast. In this episode, we tackle one of the most challenging and often uncomfortable calls in prehospital care, pediatric agitation and behavioral health emergencies. Joined by paramedic Adam Hagar who brings lived experience as a parent of a child with autism as well as behavioral health specialists Elizabeth Gallagher and
Abbey Hye, we explore how EMS clinicians can lead with dignity, slow down, and use patient-centered strategies to safely care for children in crisis.

Guided by the Pediatric Agitation PEAK resource from the Emergency Medical Services for Children Innovation and Improvement Center, we discuss how agitation in children is often multifactorial, with contributors including medical illness, pain, psychiatric conditions, developmental differences, and environmental triggers. We emphasize early recognition and rapid assessment to identify underlying causes such as delirium, hypoxia, intoxication, and communication barriers.

The conversation focuses on first-line, non-pharmacologic strategies, including verbal de-escalation, environmental modification, and caregiver engagement. Special attention is given to neurodivergent children, including those with autism, who may require adapted communication and reduced sensory stimulation.

We also review when pharmacologic interventions may be necessary, reinforcing that medications and restraints should be used only when required for safety and with appropriate monitoring.

This episode highlights a central message: pediatric agitation is best managed through calm, structured, and least-restrictive care, partnering with families to improve safety and outcomes.

Key Takeaways:

• Recognize pediatric agitation as a symptom with diverse underlying causes, including medical, psychiatric, and developmental factors.
• Prioritize non-pharmacologic de-escalation strategies, including calm communication and environmental control.
• Engage caregivers early to identify triggers, communication preferences, and effective calming strategies.
• Adapt care for neurodivergent children, including those with autism, by minimizing sensory stimuli and modifying communication approaches.
• Use medications and restraints only when necessary for safety, following local protocols and with appropriate monitoring.
• Leverage community tools and training programs to improve EMS response to pediatric behavioral health emergencies.

References:

Pediatric Agitation PEAK Toolkit – Emergency Medical Services for Children Innovation and Improvement Center
https://emscimprovement.center/education-and-resources/peak/pediatric-agitation/

Improving Emergency Medical Services (EMS) Care for People With Autism in the Prehospital Setting Through Sensory and Communication Aids. PubMed Central

San Diego County Sheriff's Department
https://sandiegoca.gov/content/sdc/sheriff/programs/take-me-home.html

San Diego County Sheriff's Department
https://www.sdsheriff.gov/community/blue-envelope

Autism-Friendly Health System Initiative | Rady Children's Health

Crisis Prevention Program | Marcus Autism Center