Neurological

Panic attack at outdoor music festival

Foundation

Adult · 35yr · female

Patient Information

Dispatch	You are called to a 35YO female (Megan Hartley) near the main stage who is sitting on the ground, breathing fast, and is visibly distressed. A bystander states she 'just freaked out' in the crowd.
Patient	Megan Hartley — 35yr (65kg)
Incident History	Pt was standing in a large crowd near the main stage at the Riverside Summer Music Festival when she suddenly felt her heart racing, became short of breath and felt like she was going to die. Friends helped her to the ground. No loss of consciousness. No known trigger.
Emergency Contact	Rachel Hartley (Sister) — 0412 874 391

Initial Rapid Assessment

Response	Alert
Airway	Patent. Nil airway obstruction. Nil stridor. Nil swelling.
Breathing	Rapid and shallow. RR 28. Nil wheeze. Nil crackles. Nil use of accessory muscles. Patient speaking in fragmented sentences.
Circulation	Radial pulse rapid and regular. Skin pale, diaphoretic. Nil visible bleeding. CRT <2s.
Disability	GCS 15 (E4V5M6). Alert and oriented to time, place and person. Visibly anxious and tearful. Reports tingling in both hands and around mouth.
Exposure	Nil rashes, welts or urticaria. Nil signs of trauma. Nil medical alert jewellery noted.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	98% (RA)	Mild	28	108	132/84	<2s	15	4 4 ++	37.1	5.4 mmol/L	2
10 mins	99% (RA)	Nil	16	84	118/76	<2s	15	4 4 ++	37.1	5.4 mmol/L	1

History Taking

Treatment Response

Diagnosis

This patient is suffering from a panic attack, presenting with hyperventilation, tachycardia, perioral and bilateral hand paraesthesia, chest tightness, and acute anxiety in the context of a crowded environment. Symptoms are consistent with hyperventilation-induced hypocapnia causing peripheral tingling. No evidence of organic cause — BGL normal, SpO2 normal on room air, nil wheeze, nil urticaria, nil hypotension.

Facilitator Triggers — if trainees miss a critical step

! (If the EHS officer does not perform a BGL — inform them the patient mentions she feels 'really strange and lightheaded' and ask if they would like to check her blood sugar.)
! (If the EHS officer does not ask about allergies or assess for urticaria/rash — patient begins to ask 'Is this an allergic reaction? I did eat something new earlier.' Facilitator should prompt officer to reassess skin for urticaria and re-examine allergy history before dismissing anaphylaxis.)
! (If the EHS officer attempts to administer oxygen to a patient with SpO2 98% on room air — remind them of the oxygen CPG: oxygen should be titrated to clinical need and normoxia is a contraindication to supplemental oxygen.)
! (If the EHS officer does not reassess vitals at 10 minutes — patient states 'I feel a bit better but my hands are still tingling.' Prompt officer to repeat observations to confirm improvement and document trend.)
! (If the EHS officer fails to consider organic causes — prompt with 'What else could cause these symptoms? How would you rule out hypoglycaemia or early anaphylaxis?')

Treatment Objectives

1. Ensure scene safety and approach in a calm, non-threatening manner.
2. Perform Primary Survey — confirm patent airway, assess breathing rate and quality, assess circulation, establish GCS 15.
3. Move patient to a quieter area away from the crowd to reduce environmental stimuli.
4. Reassure patient continuously — explain what is happening in plain language, use a calm tone and grounding techniques (e.g. encourage slow, controlled breathing at a normal rate).
5. Perform Vital Sign Survey — measure BP, pulse, RR, SpO2 on room air, BGL, temperature, and pain score.
6. Assess SpO2 — SpO2 98% on room air; oxygen is NOT indicated as patient is normoxic. Do not administer supplemental oxygen.
7. Perform BGL — result 5.4 mmol/L; hypoglycaemia excluded.
8. Conduct thorough skin assessment — inspect for urticaria, rashes, or welts to exclude allergic reaction or anaphylaxis.
9. Take a structured SAMPLE history including allergies, medications, pertinent history, and events leading to presentation.
10. Assess and document RASS score — patient is RASS +1 (restless, mildly anxious, non-aggressive); de-escalation is the primary intervention.
11. Apply Richmond Agitation Sedation Scale (RASS) — de-escalation techniques are first-line; no medications are indicated for panic attack within EHS scope.
12. Record full observations every 10 minutes and document trend.
13. Reassess at 10 minutes — expect improvement in RR, HR, and resolution of tingling as breathing normalises.
14. Advise patient to avoid re-entering large crowds until fully recovered and encourage her to remain at the FAP until symptoms fully resolve.
15. Offer the patient a cool environment, seated rest, and water if fully conscious and tolerating oral intake.
16. Consider transport to hospital if symptoms do not resolve, if organic cause cannot be excluded, or if patient requests further assessment.
17. Scenario ends on arrival of ambulance and IMISTAMBO handover.
18. Attention to hand hygiene will be given throughout the scenario.

Clinical references: Disturbed & Abnormal Behaviour · Transient Loss of Consciousness (Fainting / Syncope) · Dyspnoea & Respiratory Distress · Hypoglycaemia · Anaphylaxis · Oxygen Delivery · Primary Survey · Blood Glucose Monitor · Pain Assessment

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Signs/Symptoms	Racing heart, shortness of breath, tingling in hands and around mouth, chest tightness, dizziness, overwhelming sense of dread and feeling like she was going to die.
Allergies	Nil known drug allergies.
Medications	Oral contraceptive pill. No other regular medications.
Pertinent History	Has had one previous similar episode two years ago at a shopping centre. Was told at the time it was a panic attack. No cardiac history. No respiratory history. No known mental health diagnosis.
Last Oral Intake	Light meal approximately 2 hours ago. One alcoholic drink 3 hours ago.
Events Leading	Attending the Riverside Summer Music Festival with friends. Was in a very large crowd when she suddenly felt hot and overwhelmed. Symptoms came on without warning.
Treatment Prior	Friend told her to breathe into a paper bag — she declined. No medications taken.

Onset	Sudden onset approximately 10 minutes ago while standing in a large crowd near the main stage.
Pain	Chest tightness, non-radiating. Describes it as pressure rather than pain. 2/10.
Quality	Tightness in chest, feels like she cannot get enough air in. Tingling in both hands and lips.
Radiates	Nil radiation.
Severity	2/10 at time of assessment, was 7/10 at onset.