((If trainees do not perform BGL within the first 3 minutes — patient begins to rock back and forth and repeatedly states 'they are coming for me'; facilitator prompts: 'Have you excluded an organic cause for this behaviour?'))

((If trainees do not remove sharp objects and potential ligatures from the immediate environment — patient picks up a nearby pen and begins pressing it against her forearm; facilitator states: 'She is escalating — what environmental controls have you implemented?'))

((If trainees leave patient alone at any point — patient attempts to stand and run from the FAP shouting; facilitator prompts: 'She is attempting to leave — what is your safety plan?'))

((If trainees do not contact SOC/CSP for advice — patient escalates to RASS +4, becoming physically combative; facilitator prompts: 'You are now dealing with a RASS +4 patient. Who should you be contacting right now?'))

((If trainees attempt to administer sedative medications themselves — facilitator intervenes: 'What is your scope of practice for sedation at EHS Primary Care level? Sedation is outside your authority — what are your escalation options?'))

((If medication history is not obtained — facilitator prompts: 'She has a phone in her pocket. Her mother's number is in it. What information might her family be able to give you?'))

This patient is suffering from an acute exacerbation of psychosis, precipitated by non-compliance with antipsychotic medication (olanzapine not taken for 3 days), presenting with auditory hallucinations, disorganised behaviour, agitation (RASS +3), and active self-harm risk.

• Ensure scene safety BEFORE approaching — confirm FAP environment is clear of sharps, ligatures, and other items the patient could use to harm herself or others
• Call for relevant assistance through State Operations Centre early — request Police if scene safety cannot be maintained and consider urgent backup
• Do NOT approach alone — ensure a crewmate or security officer is present at all times
• Perform Primary Survey — airway patent, breathing adequate, circulation intact; note superficial self-inflicted scratch marks to bilateral forearms
• Perform BGL — result 5.4 mmol/L; exclude hypoglycaemia as organic cause
• Perform Vital Sign Survey including SpO2 and temperature — all within normal limits; tachycardia consistent with agitation
• Attempt de-escalation using calm, non-confrontational, non-threatening verbal technique — use patient's name, lower body language, avoid sudden movements
• Do NOT leave patient alone at any point — suicidal/self-harm ideation is present
• Carefully remove or have security remove dangerous objects from the patient's immediate environment (pens, lanyards, sharps, bottles)
• Contact emergency contact (mother, Karen Drummond, 0412 774 381) to confirm medication history — olanzapine 10mg daily, not taken for 3 days
• Contact SOC Clinical Support Paramedic (CSP) to advise of presentation, seek guidance, and arrange Priority 1 ambulance transport
• Apply Richmond Agitation Sedation Scale (RASS) score — document as RASS +3 after meaningful de-escalation effort; agree and document RASS score with crewmate
• Do NOT administer sedative medications — sedation (olanzapine oral dispersible, droperidol, ketamine) is outside EHS Primary Care scope and requires Advanced Care clinician authority
• Dress superficial forearm scratch wounds with non-adherent dressings and crepe bandage as per Minor Wound Management — haemorrhage is controlled
• Monitor patient persistently — repeat vital signs every 10 minutes; monitor for escalation in RASS score, emerging organic causes, or respiratory compromise if restraint becomes necessary
• If physical restraint becomes necessary — use minimum force necessary, DO NOT restrain prone, DO NOT allow patient to be handcuffed to stretcher, monitor airway and breathing continuously during restraint
• Document RASS score, all de-escalation attempts, restraint decisions, and clinical rationale thoroughly on ePCR
• Scenario ends on arrival of ambulance and IMISTAMBO handover
• Attention to hand hygiene will be given throughout the scenario.

Clinical references: Disturbed & Abnormal Behaviour · Minor Wound Management · Blood Glucose Monitor · Primary Survey · Secondary & CNS Survey