Neurological

Suicidal ideation at outdoor music festival

Intermediate

Adult · 35yr · female

Patient Information

Dispatch	You are called to a distressed female (Megan Hartley, 35YO) 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 — 35yr (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 Tearful and withdrawn.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 (If trainee does not ask directly about suicidal thoughts or a plan — Megan becomes more withdrawn and states 'I just want everyone to leave me alone.'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 State Operations Centre (SOC) 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. Arrange Priority 1 ambulance 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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Signs/Symptoms	Tearful, withdrawn, low mood, expressing passive suicidal ideation ('doesn't want to be here anymore'). Denies active plan at this stage.
Allergies	NKDA
Medications	Sertraline 100mg daily (SSRI — prescribed for depression). Reports taking her dose this morning.
Pertinent History	Known history of depression. Under care of a GP and sees a psychologist fortnightly. Denies previous suicide attempts. No current alcohol or drug intake today.
Last Oral Intake	Light meal and water approximately 2 hours ago. Denies alcohol intake.
Events Leading	Pt attended the festival with a group of friends. Felt overwhelmed by the crowd and noise. Separated from the group and found a quiet spot. Began ruminating on recent relationship difficulties and feelings of worthlessness.
Treatment Prior	Nil prehospital treatment. Friend has been sitting with patient since discovering her.

Onset	Pt states her mood has been low for several weeks. Came to the festival with friends hoping it would help. Became overwhelmed and isolated herself approximately 30 minutes ago.
Pain	Nil physical pain reported.
Quality	Emotional distress. Feels hopeless and like a burden to those around her.
Radiates	Nil
Severity	Pt rates emotional distress as 8/10.