Neurological

Acute Behavioural Disturbance — agitated male at music festival

Intermediate

Adult · 35yr · male

Patient Information

Dispatch	You are called to the crowd barrier near the main stage at the Perth Soundwave Festival. Security have brought a 35-year-old male to the FAP — he is agitated, shouting, and refusing to cooperate. (Darren Hollis)
Patient	Darren Hollis — 35yr (80kg)
Incident History	Security report Darren was found pushing through the crowd and then sat down on the ground, yelling incoherently. He has been increasingly agitated for the last 20 minutes. Unknown substance use suspected.
Emergency Contact	Karen Hollis (Wife) — 0412 334 876

Initial Rapid Assessment

Response	Alert
Airway	Patent. No visible obstruction. No stridor. Patient shouting full sentences.
Breathing	Rapid and shallow. No wheeze or stridor audible. Accessory muscle use not observed.
Circulation	Radial pulse rapid and strong. Skin flushed, diaphoretic. No visible external bleeding.
Disability	GCS 14 (E4V4M6). Not oriented to time or place. Agitated and combative. Pupils dilated bilaterally.
Exposure	No visible injuries. Clothing intact. No medic alert jewellery observed. Diaphoretic throughout.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	97% (RA)	Mild	22	118	148/94	<2s	14	6 6 +	37.9	5.4 mmol/L	–
10 mins	98% (RA)	Nil	18	104	138/88	<2s	14	6 6 +	37.9	5.4 mmol/L	–

History Taking

Treatment Response

Diagnosis

This patient is suffering from Acute Behavioural Disturbance, likely secondary to sympathomimetic toxicity (suspected illicit stimulant use), presenting with agitation, tachycardia, hypertension, diaphoresis, and dilated pupils.

Facilitator Triggers — if trainees miss a critical step

! (If trainees fail to perform a BGL within the first 5 minutes — Darren's behaviour worsens and he attempts to stand and leave. Prompt: 'Have you considered any organic causes for his behaviour?')
! (If trainees do not attempt de-escalation before any physical intervention — security staff attempt to physically restrain Darren and he becomes more combative. Prompt: 'What is your first-line strategy for managing an agitated patient?')
! (If trainees do not monitor SpO2 and vital signs — Darren's RR increases to 28 and he becomes increasingly diaphoretic. Prompt: 'What monitoring should you have in place for this patient?')
! (If trainees attempt to leave Darren unsupervised at any point — he gets up, knocks over equipment, and shouts about being watched. Prompt: 'Is it safe to leave this patient unattended?')
! (If trainees fail to consider and rule out head injury or hypoglycaemia — facilitator states: 'His wife arrives and tells you he was elbowed in the head earlier in the crowd.' Prompt: 'Does this change your assessment?')

Treatment Objectives

1. Ensure scene safety — assess for immediate threats to self, crewmate, bystanders, and patient before approaching.
2. Don appropriate PPE including gloves.
3. Adopt a non-confrontational approach — position at a safe distance, use calm tone, avoid direct eye contact initially.
4. Apply de-escalation techniques as first-line intervention — introduce yourself, use simple language, acknowledge his distress.
5. Complete Primary Survey — confirm patent airway, assess breathing, circulation, and neurological status.
6. Perform Blood Glucose Level (BGL) testing as soon as safely possible — all patients with altered GCS or abnormal behaviour require BGL testing to exclude hypoglycaemia.
7. Apply pulse oximetry monitoring if tolerated.
8. Obtain vital signs — RR, HR, BP, SpO2, temperature, and BGL. Repeat every 10 minutes.
9. Assess for organic causes of disturbed behaviour: hypoglycaemia (BGL done), hypoxia (SpO2 done), head injury (inspect head if possible), intoxication, CVA signs.
10. Assess and document a Richmond Agitation Sedation Scale (RASS) score — apply only after meaningful de-escalation efforts have been made.
11. Do NOT physically restrain unless essential to prevent injury to patient or others — use minimum force necessary if restraint is required.
12. Do NOT allow patient to be handcuffed to the stretcher at any time.
13. If patient expresses suicidal ideation at any point — do not leave patient alone and remove dangerous objects from the area.
14. Contact State Operations Centre (SOC) Clinical Support Paramedic (CSP) for advice if the patient's condition is not improving or deteriorating.
15. Request Police attendance via SOC if the situation becomes threatening and show of force is required.
16. Transport in a calm, quiet manner in lateral position — do NOT transport supine or prone.
17. Monitor airway and breathing closely, particularly if level of consciousness changes.
18. Scenario ends on arrival of ambulance and IMISTAMBO handover.
19. Attention to hand hygiene will be given throughout the scenario.

Clinical references: Disturbed & Abnormal Behaviour · Hypoglycaemia · Poisons & Overdoses · Primary Survey · Blood Glucose Monitor

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Signs/Symptoms	Agitation, shouting, confusion, diaphoresis, flushed skin, dilated pupils.
Allergies	Unknown — patient not cooperative with history.
Medications	Unknown — patient not cooperative. No medications found on person.
Pertinent History	Unknown. Security observed him arrive alone approximately 1 hour ago. No known medical history available.
Last Oral Intake	Unknown.
Events Leading	Patient was attending the festival alone. Security observed him becoming progressively agitated in the crowd near the main stage before sitting on the ground and shouting.
Treatment Prior	Nil by bystanders or security. No medications administered prior to EHS arrival.

Onset	Approximately 20–30 minutes ago. Abrupt onset noted by security staff.
Pain	Nil reported. Patient not engaging with pain questioning.
Quality	Agitated, pressured speech, paranoid statements about the crowd.
Radiates	Nil
Severity	Nil pain score obtainable.