((If trainee does not ask directly about suicidal thoughts or a plan — Megan becomes more withdrawn and states 'I just want everyone to leave me alone.'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?'))

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

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

Clinical references: Disturbed & Abnormal Behaviour