((If trainees do not perform BGL within the first 3 minutes — pt becomes increasingly agitated and attempts to stand up and leave. Facilitator prompts: 'She keeps pulling at her arm and saying she needs to get back to her friends. What organic causes do you need to exclude?'))

((If trainees do not consider organic causes such as head injury, hypoglycaemia, or hypoxia before attributing behaviour to alcohol or drugs — facilitator prompts: 'Her pupils are dilated and her skin is warm and dry. Does this change your thinking about what might be causing this?'))

((If de-escalation is not attempted and restraint is applied immediately — facilitator states: 'She becomes more agitated with physical contact and starts shouting. Security are asking if they should help hold her down. What is your approach?'))

((If trainees attempt to administer any sedative medication — facilitator states: 'That medication is not within EHS scope of practice. What can you do at your level of care to manage this patient?'))

((If trainees do not contact the Clinical Support Paramedic in SOC for guidance within 5 minutes of assessment — facilitator prompts after 10 minutes: 'Her behaviour has not improved and she has attempted to leave twice. Who can you contact for advice on this patient?'))

((If patient is placed supine and left unattended — facilitator states: 'She rolls towards the edge of the stretcher and starts to vomit. What position should she be in?'))

This patient is suffering from Acute Behavioural Disturbance of uncertain aetiology — differential diagnoses include sympathomimetic toxidrome (suspected illicit substance ingestion such as MDMA or amphetamines), alcohol intoxication with agitation, and organic cause such as hypoglycaemia or head injury that must be actively excluded.

• Ensure scene and personal safety before approaching — confirm security presence and position self with clear egress route
• Perform Primary Survey — airway patent, breathing present, radial pulse present, no catastrophic haemorrhage
• Apply non-confrontational approach and de-escalation techniques — calm voice, open body language, maintain personal space, avoid physical contact unless essential
• Perform BGL — result 5.8 mmol/L, hypoglycaemia excluded as primary cause
• Apply pulse oximetry — SpO2 97% on room air
• Obtain tympanic temperature — 37.9°C, does not meet heat stroke threshold but note warm dry skin and tachycardia
• Attempt full Vital Sign Survey including BP, HR, RR, and GCS — document RASS score (RASS +3 initially, reassess following de-escalation)
• Actively exclude organic causes: head injury (no visible trauma, no history of fall reported), hypoglycaemia (BGL 5.8 mmol/L — excluded), hypoxia (SpO2 97% — excluded), stroke (consider but FAST assessment outside EHS scope — maintain high suspicion)
• Note clinical features consistent with sympathomimetic toxidrome: dilated pupils, tachycardia, hypertension, diaphoresis, agitation, hyperthermia — do not diagnose but document and communicate findings
• Do NOT administer any sedative medication — this is outside EHS Primary Care scope
• Do NOT restrain unless essential to prevent immediate harm to patient or crew — if restraint is necessary use minimum force in a safe position (not prone, not supine)
• Do NOT leave patient unattended — if patient expresses suicidal ideation, maintain constant observation
• Position patient in a seated or lateral position — do NOT transport in supine position
• Contact Clinical Support Paramedic (CSP) in State Operations Centre for advice and to request Advanced Care backup given altered conscious state of uncertain aetiology
• Maintain continuous monitoring — repeat vital signs every 10 minutes (or 5 minutes if condition deteriorates)
• Arrange Priority 1 transport to hospital with pre-notification
• Scenario ends on arrival of ambulance and IMISTAMBO handover
• Attention to hand hygiene will be given throughout the scenario.

Clinical references: Disturbed & Abnormal Behaviour · Unconsciousness · Hypoglycaemia · Poisons & Overdoses