Suicidal ideation at outdoor music festival

Patient Information

Dispatch: You are called to a distressed female (Megan Hartley, 22YO) near the main stage at Sunset Grove Music Festival. A bystander reports she is sitting alone, crying, and has told a friend she 'doesn't want to be here anymore.'
Patient: Megan Hartley — 22yr (65kg)
Incident History: Pt was found sitting alone behind the merchandise tent by a friend who became concerned when Megan made a comment about not wanting to be alive. Friend has stayed with her. Pt is alert but tearful and not engaging well with bystanders.
Emergency Contact: Daniel Hartley (Husband) — 0412 774 093

Initial Rapid Assessment

Response: Alert
Airway: Patent. Nil airway obstructions. Nil stridor or swelling.
Breathing: Self-ventilating. Rate slightly elevated secondary to distress. Nil audible abnormal breath sounds.
Circulation: Radial pulse present, regular, normal rate. Skin warm and dry. Nil external bleeding identified.
Disability: GCS 15 (E4V5M6). Orientated to time, place and person. Tearful and withdrawn. Minimally engaging with EHS.
Exposure: No visible injuries. No rashes. No signs of trauma. Pt is fully dressed. No medications or substances visible in immediate area.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	98% (RA)	Nil	20	98	118/76	<2s	15	4 4 ++	36.8	5.4 mmol/L	0
10 mins	98% (RA)	Nil	18	88	116/74	<2s	15	4 4 ++	36.8	5.4 mmol/L	0

History Taking

Treatment Response

Diagnosis

This patient is suffering from an acute mental health crisis with passive suicidal ideation in the context of a known depressive illness.

Facilitator Triggers — if trainees miss a critical step

! (If trainee does not ask directly about suicidal thoughts or a plan — Megan becomes more withdrawn and states 'I just want everyone to leave me alone.' Prompt the trainee: how do you sensitively explore whether Megan has a plan or intent?)
! (If trainee leaves Megan unattended at any point — Megan attempts to stand and walk away toward the festival perimeter. Facilitator prompts: 'What is your priority right now regarding patient safety?')
! (If trainee does not check for medications or substances in the area — a friend mentions she 'had a bag with her earlier' that is now missing. Trainee must locate and secure the bag; it contains Megan's personal supply of sertraline tablets.)
! (If trainee attempts to call Megan's husband without first gaining her consent — Megan becomes visibly distressed and her RASS score escalates to +1. Facilitator prompts trainee to consider patient privacy and consent in mental health presentations.)
! (If trainee does not request Police or additional EHS support and Megan's distress escalates to RASS +2 — Megan begins shouting and attempts to push the officer away. Facilitator prompts: 'At what point do you consider requesting Police assistance?')

Treatment Objectives

1 Ensure personal safety and scene safety before approaching — assess for immediate threats to self, crewmate, bystanders and patient.
2 Approach calmly using a non-confrontational technique. Be mindful of personal space and body language.
3 Do NOT leave patient alone at any time following disclosure of suicidal ideation.
4 Attempt to establish rapport through de-escalation. Use open, empathetic, non-judgemental questioning.
5 Sensitively and directly enquire about suicidal thoughts, helpless or hopeless feelings, and whether the patient has a plan or intent.
6 Carefully and discreetly remove or secure any dangerous objects from the immediate area (medications, sharp items) — have bystander assist if appropriate without alarming patient.
7 Complete Vital Sign Survey including BGL and SpO2 where safe to do so — repeat every 10 minutes.
8 Assess and address any organic causes for behavioural change (BSL, SpO2, GCS, temperature).
9 Contact CSP for Clinical Support Paramedic (CSP) advice and to arrange Police attendance if required for patient safety.
10 Request Police support via 000 if patient poses an immediate risk to herself or others, or if safe transport cannot be achieved without legislative authority.
11 Do NOT attempt to physically restrain unless essential to prevent immediate harm, and only using minimum force necessary.
12 Call CSP for urgent ambulance support transport to the nearest Emergency Department — document suicidal ideation clearly for handover.
13 Transport in a calm, quiet manner — monitor vital signs throughout transport.
14 Do NOT allow patient to be handcuffed to stretcher. Document clearly if this cannot be achieved.
15 Scenario ends on arrival of ambulance and IMISTAMBO handover.
16 Attention to hand hygiene will be given throughout the scenario.

Clinical references: Disturbed & Abnormal Behaviour

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