Crisis, Trauma, and Safety Management
Crisis Intervention
- Crisis is a temporary state of disequilibrium when coping fails; intervention is short-term, focused on immediate problem and safety.
- Assessment: identify the precipitant, patient’s perception, available support, coping skills, risk of harm.
- Techniques: active listening, reassurance, problem-solving, referral to resources; follow-up.
Trauma-Informed Care
- Principles: safety, trustworthiness, peer support, collaboration, empowerment, cultural humility.
- Avoid re-traumatization: explain procedures, ask permission, respect boundaries, provide choices.
- PTSD: assess for flashbacks, hyperarousal, avoidance; use grounding techniques; avoid forced discussion of trauma.
Safety Management
- Suicide risk: direct assessment, safety plan, lethal means restriction, close observation, no-harm contract is not sufficient.
- Violence risk: assess history, triggers, substance use; maintain safe environment; use de-escalation.
- Restraint/seclusion: only for imminent danger, least restrictive, time-limited, monitor vitals, document.
- Disaster/community crisis: triage, psychological first aid.
Traps in Questions
- Relying on no-suicide contracts (not evidence-based).
- Failing to remove means (e.g., allowing patient to keep belongings).
- Using confrontation with a traumatized patient.
- Forgetting mandatory reporting for abuse/neglect.
Worked Example
A patient with PTSD becomes agitated during a physical exam. What is the priority? Answer: Stop the exam and use grounding techniques-trauma triggers require safety and reorientation. Rule of thumb: when in doubt, prioritize safety and choice.