Reference no: EM133370966

Case Study: Phil is a 19-year-old male who has severe Multiple Sclerosis. He uses a wheelchair. He attends a living skills program at a local community centre to maintain his independence. Occasionally Phil engages in behaviour that makes things difficult and awkward for others. He also makes it difficult for people to get to know and get along with him - especially if he does not get his own way or when his routine is suddenly changed. Today Phil arrived at the skills program complaining of not feeling well. He says nothing further even when he is asked if he is okay. Throughout the morning Phil has been irritable towards everyone, yet has remained compliant. Before lunch, Phil goes to the bathroom to empty his catheter bag and Jayne (one of the occupational therapy assistants) notices his urine is very dark and has a pungent aroma. She reports this to the centre manager. Phil comes back from the bathroom looking a little pale. He says that he is nauseous. The centre manager feels his forehead and he is very warm to touch. She phones Phil's doctor to report it. The doctor thinks that Phil might have a urinary tract infection (UTI) and instructs the manager to call Q Paramedical to transport Phil to the hospital.
Phil is not happy about this and is upset that Jayne has reported his condition. He is very upset that he has to leave the centre. He becomes verbally aggressive toward staff and clients at the centre.
You arrive with your partner Emily, who is on her first call out as a new emergency response medic.
On arrival you observe the surroundings. Clients are eating their lunch and Phil is at the table watching others eat. He appears angry and the manager of the centre confirms this saying, "...he has been told he has to go to hospital and he's not at all happy with the decision and has become verbally aggressive." You scan the area identifying exit points and the position of other patients.
You receive some history from the centre manager while Emily approaches Phil. She begins to introduce herself but Phil picks up the plate of food next to him and throws it at Emily. He begins shouting obscenities at her. The clients become upset and frightened by his behaviour. Emily is taken back and begins to shake. She is not injured. She turns to you for direction and support.
You interact with Phil from a safe distance and talk to him to de-escalate the situation and calm him down. After some communication, intervention and positive affirmation, Phil calms down to a level that enables him to follow instructions and show compliance in acceptable behaviour. He gives permission for you assess to his physical status and take some vital observations.

Your assessment identifies the following:
•Pulse = 110, Reg GCS= 15 Nausea

•BP = 115/75 PEARL Temp = 39.6

•Resp Rate = 24 BGL= 4.4 mmol Pain in the hypogastric region

•SaO2= 96% Diaphoretic Urine = dusky yellow, foreign bodies ? blood clots
Phil agrees to be transported to a health facility and Emily and yourself proceed to transfer him from his chair to a stretcher and then in to the emergency vehicle.
You observe Phil throughout the transfer and notice he is becoming anxious again, verbalising he needs his wheelchair. He is worried about his mobility once he gets to the venue. You reassure him you will also load his wheelchair.

Question: Describe and explain what triggers (physical, psychological and environmental) may have contributed to Phil's behaviour.

List and describe at least four (4) legislative and/or procedural requirements that would be relevant to this situation.