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Behavioral emergencies are some of the most highly charged problems any person can deal with. They are usually hidden and not blatantly obvious. The symptom for one problem can also be the symptom for several others, each having their own treatments. Because of this, I will be dealing with generalities and not specific treatments. A warning before we continue, if you dive in and try to “treat” your friends, you can cause them to get mad and sometimes even hate you. You can lose friendships in some cases. Others that I have seen in the scene, not only let you know everything about their mental issues, whether you want to know or not, but seem to espouse some pride in them like badges of honor. One person I met told me her mental problems and self-diagnosed issues before I even heard what her name was.

A behavioral emergency is defined as a behavior that is not typical for the situation; when the person’s behavior is unacceptable or intolerable to the person, his family, or the community, or when the person may harm himself or others. A key part of that definition is “within a given situation.” You may have observed, in your own life or in that of friends or family, that behavior varies depending on the situation at hand. For example, if a person is notified unexpectedly of the death of a loved one, a common reaction is screaming, crying, throwing things, or other emotional outbursts. In the context of the situation, this behavior would not be unusual. If the same behaviors were exhibited for no apparent reason in the middle of a shopping center, they might indicate a behavioral emergency.

There are three major groupings of behavioral emergencies, Internally Caused, Externally Caused and Externally Influenced. Each of these may be treated in different ways. Externally caused problems are some of the most easily corrected and can sometimes even be “treated” by friends. “Influenced”, means that there is an internal issue that is aggravated by some external factor. Strictly internal issues are some of the hardest to diagnose and treat because there is no outside sources that you can see and recognize.

External caused problems are caused strictly by external issues. Usually the problem will correct itself fully once the cause is removed. Some of the external causes of altered behavior are:

Low Blood Sugar
This may cause the rapid onset of erratic or hostile behavior similar to intoxication (alcohol), dizziness, headache, fainting, seizures and sometimes coma, severe sweating, hunger, drooling and a rapid pulse with a normal blood pressure (if you are able to take a blood pressure).

If the person is conscious and able to swallow without choking, you can give them something sweet (not sugar free or fake sugar) to drink or candy to suck on. This can perk a person right up and almost immediately correct the problems. If they are unable to swallow or won’t wake up, first of course, check for breathing and circulation, and if there are no other causes such as getting hit and knocked unconscious, you can get some corn syrup, sugar water or even wet your finger and dip it in some sugar. Lightly rub this under the tongue. Do not use enough to cause the person to choke or enough that will cause it to flow down the back of the throat. Rubbing this between the cheeks and teeth works well also. These areas are highly vascular and will allow the sugar to get into the blood stream. Because this is a life threatening problem, 9-1-1 should be called unless it can be corrected in a minute or so. Even if it is corrected, the person should be evaluated by medical professionals.

This is a common problem in diabetics and if there are any diabetics in your group or nearby, they can a lot of times help correct this problem. DO NOT GIVE a person INSULIN. Insulin will usually complicate the problem, depending on the medication. (Tech notes: normal blood sugar is 80-100, some people can operate as low as 40 while other will have problems at 30, below 30 usually causes unconsciousness.)

High Blood Sugar
This may cause a slower, more long term onset of a more lethargic behavior, usually inattentiveness, sleepiness, an unwillingness for usual levels of physical activities. The higher the blood sugar the more “zombie like” a person can act. A real fruity smell from the persons breath may be present as the body tries to “blow off” sugar as ketones. As mentioned previously 80-100 for a blood sugar is good. High blood sugar effects can usually start being seen at 150-200 or higher. I have seen people with blood sugar over 1600. This will not only cause mental changes, but can cause kidney, liver damage and damage to the blood vessels. The higher the level, the more damage that can occur. Mildly high blood sugar may not be noticed because the changes in behavior can take months. Some children can find their blood sugar at 400 or so before a parent may notice a change “out of the norm for a growing maturing child” that may cause a doctors visit.

The treatment for this is insulin or a pill to help the body process the sugar. Again, insulin must be given under a doctor’s care after the person has been medically evaluated. Giving a person insulin that either, has never had it, or is being given someone else’s, can drop their blood sugar to a dangerous level. You can also see that by the numbers, high blood sugar is a lot more “forgiving” in the short term than low blood sugar. So, if the person is a diabetic and is having a behavioral change for some reason, giving them sugar is not a problem (as long as they can swallow or have it rubbed on the gums). A small change in low sugar can really help; a small change in high blood sugar won’t make a very big difference.

Lack of Oxygen
This can be seen as restlessness, confusion, headaches, nausea and cyanosis (blue or blue-grey skin), leading to cellular death and neurological damage, coma and death. In a BDSM realm this is not usually a problem for mental status. Actions such as breath play and choking can cause rapid panic and unconsciousness.

Lack of oxygen from a longer term source such as a car running in a closed garage, higher carbon monoxide (CO) buildup because of mechanical problems such as a stove or propane heater not working properly can affect several or most people in a group. If this is thought to be a problem, get outside in the fresh air. The major effects should clear up in a few minutes. If this is the case, call the local fire department. They usually have a meter that can check for CO buildup or help you find what the problem is so it can be corrected.

Several types of drugs can also cause a problem with oxygen binding in the blood and the oxygen’s inability to be delivered to the brain. Again, this is a medical emergency so 9-1-1 is a good idea.

Inadaquate Blood Supply to the Brain
A stroke or TIA (Transient Ischemic Attack or temporary stroke), is a true medical emergency and 9-1-1 should be called. The easiest way to check for a stroke is the American Red Cross F-A-S-T stroke check. F – Face, is there drooping of one side of the face, especially when smiling or one eye not moving as well as usual when they look left, right, up or down (with the eyes). A – arms, have the person put their arms out to their sides, can they keep them level or does one drift? Have them then close their eyes and do the same thing for about 5-10 seconds. If there is drooping or drifting, this may indicate a stroke (this might also indicate intoxication or other problems). S – Speech, are they slurring their words or having trouble making their mouth/tongue work properly? Again, this could be stroke or alcohol or drug problems. And T- time relevance, can they remember what happened 5 min ago, how long they have been there, what happened last week, what day is it. If they have to continually ask the same questions over and over, this could also be an indication Of A stroke.

Drugs / Alcohol
A very drunk person or even those that are not so drunk, can want to start fights, or challenge others and can be easily offended. Drugs such as Ecstasy, PCP, or Cocaine can cause a multitude of problems. Morals of drug use aside, heavy drugs can cause damage and should be evaluated by a medical professional. If the person is having problems that are endangering themselves and / or others, call for help.

Head Trauma
This cause everything from irritability to irrational behavior, amnesia, headaches, nausea, vomiting, confusion, and changes in body functions such as pulse, and blood pressure. This is another medical emergency that needs to be evaluated at a hospital if the person is injured enough to have the aforementioned problems and they do not clear up within a few minutes. If the person loses consciousness for more than a few moments, or you have an injury that, by the mechanism, should have caused more damage than what is obvious, seek medical attention. An example could be, if someone is bound, suspended and falls directly on the back of their head, with no way to brace themselves and is complaining about a headache that will not go away or is nauseous or starts to vomit then there might be something more going on.

Excessive Heat or Cold
Cold can cause the body to basically shut down. Heat can cause the body to over-exert itself trying to cool down. If this is causing mental or behavioral problems then an evaluation is, of course, recommended. You would want to reduce the temperature problem, if hot, cool them down, if cold, warm them up. One word of caution, if the body’s cooling mechanism is “disabled” then heat stress emergencies can easily happen, even when others do not feel there is a problem. Some ways to disable this system would be to cover the skin with something that will not allow the evaporation of sweat. Liquid latex painted over the whole body, rubberized body bags, vacuum beds or placing a person in between two mattresses are ways to do this. This can cause the body to stop cooling and just keep on heating up.

Externally Influenced Behavioral Changes
These are internal problems that are aggravated by an external source. Examples could be a person that was traumatized by a rape getting “set off” by a “take down scene”. Someone who lost a child could have problems with adult babies or age play. Not all people that are “set off” have mental problems that need to be treated. Most people that have issues can be content and happy unless a “trigger” is hit. This would be our responsibility to talk with a person before a scene or before playing and find out what might be triggers, if they even know. If a person has never done breath play, they may not realize the problems until mid-scene. If this happens, the first thing to do is assure your safety and your partner’s safety. Talk calmly to the person. Assure them that they will be all right and if they are restrained, release them. If they are reacting to an object, put the object out of sight but take care of bringing it behind them as this may cause a paranoid-like reaction that you are hiding it to use it on them.

Outside the scene, other reactions can be bad news, bad day at work, kids acting up, and then just getting into an emotionally charged position such as a scene. Once the external source is taken care of, this problem will usually correct itself (they may still be frightened or scared of course, but they would be outside of the “emergency” part of this problem). Sometimes though, if the problem is big enough, or serious enough, it may not be corrected as easily. For a person who has mood swings or gets angry, removing the external influence might not correct the anger issues. If removing the influence does not help the problem, follow the advice of the Internally caused behavioral problems.

Internally Caused Behavioral Problems
These are problems that stem from inside the patient. Alzheimer’s diagnosed, bi-polar, schizophrenia, depressive, and histrionic are all psychiatric labels for some of these problems. They may stem from organic problems such as Alzheimer’s or hormonal problems as in post-partum depression. The problem with these is that it is extremely hard to figure out the actual problem and they are not really treatable outside of a medical field safety.

Our concern as friends and partners is to assure safety of everyone. Because psychiatric emergencies affect the brain and judgment, care has to be taken. The person might be in such a state that they might not recognize you, remember you are a friend, or understand you are trying to help them. If there is any danger to yourself or bystanders, back off. Allow them to rant and rave, or yell and scream. Sometimes doing nothing can help. If the person is actively being a danger, threatening to kill themselves, pulls a knife out to “defend” themselves, your best bet is to call 9-1-1 and back off.

Nothing is actually tried and true, 100% effective on all situations. Some people might respond to a more submissive posturing; others will need a firm voice guiding their actions. This is the problem; you can’t just read a gauge or look at a monitor and say this is the problem now we can fix it. Some suggestions that can be used in many circumstances would be:

• Be calm yourself and state that you are concerned that they are having a problem.
• Speak slowly, firmly and clearly.
• Try to use a calm, reassuring tone.
• Actually listen to the person, occasionally giving them feedback by restating some of the conversation so you can show you really are paying attention to them.
• Don’t be judgmental, and don’t be silly, sarcastic or condescending. This can anger many people.
• Use positive body language such as hands to your sides, or down on a knee if they are on the ground.
• Don’t cross arms or appear disinterested.
• Ask them questions, see if you can find out what the problem is.
• If they are talking, they are not doing something worse, and a lot of times, just talking can calm down the situation.
• Acknowledge their problem when they talk about it, let them know you will help them if they will let you.
• Do not enter their personal space (approx 3 feet) unless you are invited to and feel safe. Three feet will keep you out of an immediate grab range so they have to lunge, plus it will help keep them from feeling blocked in.
• Do not have many people standing around, one maybe two near the person, and others can be in sight but a farther distance away.
  Do not stare at the person as this can be viewed as a challenge.
  Be watchful for changes in their mental status. If they start acting more aggressively, back off some.

Try changing tactics as you talk to them. It is possible you may need to leave the area and call for help. If the person is near their toy bag or near weapons such as knives, sticks, or whips, offer to listen to them; maybe suggest they go sit down and get a drink of water (try to avoid sugar and caffeine if you can) and just sit and talk (of course the chairs that look the most comfortable would be away from dangerous objects.) Also, if they are sitting in a chair or on the ground on a blanket, it is harder for them to rush at someone. Do not lie to the person. Do not play along with audio/visual hallucinations as this can be seen as condescending if they figure you are lying. If they have a weapon (even if they are not threatening) suggest that they go ahead and place the “item” down and come over and talk. Be honest if they question you. Tell them that they are acting a bit different, and you would feel better if they put the item down.

Suicide
If the person is talking suicide, or says they are going to attempt it, call 9-1-1. Don’t try the stereotypical television counter-ploy of suggesting or challenging them to do it, or offering advice how to do it properly. If the person is bluffing or making a half-hearted attempt just for attention, then let them get the attention, ambulance, fire trucks, police, a hospital visit can go along way to dissuade them from doing it. Some tactics that MIGHT work could be to let them know that talk like that is not appreciated. Or that you will not stand by and be a party to them attempting to kill themselves, and if they continue, they would be losing a good friendship and that you will not deal with them at all. (That is about as far as a challenge as I would suggest, and it should only be done if you feel it would work with that person)

Hostile Acting or Aggressive Persons
Some of the people you might deal with might be hiding their aggression, or luring you “in”. Take care with people that are responding to you inappropriately, tries or threatens to hurt themselves or others, exhibits rapid breathing, rapid movements, jerky movements or explosive movements or speech. People that are acting extremely anxious, nervous or panicky (if it does not fit the situation) should be watched. Do not allow them to get between you and your escape route, they should not be near weapons and if the person is a lot bigger than you are, have someone nearby, maybe even two people, talking with him. If your group has a leadership, a person in a position of authority, or someone that is usually respected by the person they might be your best and safest bet.

Thank you for following thru with this extra long three-part series on BDSM First Aid. This did of course go beyond what most people would see, but almost everyone knows how to put a band-aid on. It is the life threatening and complicated issues that people fail to deal with properly. A little knowledge can go a long way in dealing with crisis but practical experience and education is your best ally. Try to take a CPR or First Aid class, and during the class, have them talk about behavioral problems, a lot of times they will not talk about it, so suggest it.

The information, in this article and in the local classes you take can be used in the dungeon, at parties and elsewhere in life. As I am sure there are many medical professionals that are out there reading this, (and cringing) please understand that I have tried to simplify the information for this article. The 10th edition of the Brady – Emergency Care book was referenced often during the writing of this series.

If you have any questions or feel that this information was helpful please contact me thru my editor point of contact at Switchy @ thedomsview.com.