Simulated Patient Scenario

Scenario Details

MDT Information

• Urgent Response - Welfare Check / Suicidal Person
• Caller reports friend is intoxicated and threatening suicide
• Patient is male, mid-40s
• Location is patient's apartment
• Police are en route, not yet on scene

On Arrival

You arrive at an apartment building. The door to the patient's unit is slightly ajar. You announce your presence. The patient, a 45-year-old male, is sitting slumped on a sofa in the living room. He appears tearful and smells strongly of alcohol. Several empty beer bottles and a near-empty bottle of spirits are on the coffee table. The room is dimly lit and somewhat cluttered, but no immediate weapons are visible. Patient acknowledges your presence with a nod.

Initial Impression and Primary Survey

Secondary Survey and Simulation Progression

History (patient may be reluctant or difficult historian)

Vital Signs/Assessment (Initial)

Physical Examination

• Mental State: Appears sad, tearful, withdrawn. Mood congruent with expressed thoughts of hopelessness. Speech slurred but coherent. Thought process slowed. Admits to suicidal ideation with vague plan. Denies auditory/visual hallucinations. Insight appears impaired by alcohol and distress. Mild psychomotor slowing.
• Signs of Intoxication: Strong smell of alcohol on breath, slurred speech, mild ataxia if asked to stand/walk (assess cautiously).
• Neurological: Grossly oriented to person, possibly place/time (assess reliability). No focal neurological deficits apparent.
• General: No obvious signs of trauma or acute injury. Check forearms/wrists for evidence of self-harm (old or recent).
• Abdomen/Chest/Limbs: Unremarkable on visual inspection.

Assessment and Treatment

Appropriate Management Focus

• Prioritize Safety: Ensure safety of patient and crew. Maintain awareness of surroundings. Remove potential means of harm if safe and appropriate (e.g., move alcohol bottles out of immediate reach). Await police arrival if scene feels unsafe or patient escalates.
• Communication & Rapport: Use empathetic, non-judgmental approach. Active listening. Validate feelings ("It sounds like you're going through a really tough time"). Avoid minimizing their distress. Be direct but compassionate when assessing suicide risk.
• Risk Assessment: Assess suicidal intent, plan, access to means, past attempts, protective factors (reasons for living, support systems - may be limited currently). Acknowledge risk is high given ideation, recent stressors, and intoxication.
• De-escalation: Maintain calm demeanor. Avoid arguments. Focus on immediate safety and getting help.
• Assessment: Vital signs, BGL. Consider potential co-ingestions (e.g., overdose on 'sleeping pills'). Assess level of intoxication.
• Supportive Care: Offer reassurance that help is available. Focus on transport to a safe place for assessment.
• Transport Decision: Mandatory transport to Emergency Department for medical clearance and urgent mental health assessment due to active suicidal ideation. Explain the need for transport clearly and calmly.
• Involuntary Treatment Considerations: If patient refuses transport despite expressing clear suicidal intent, involve police for potential transport under mental health legislation (specifics vary by jurisdiction - e.g., Mental Health Act in NSW).
• Sedation: Generally contraindicated unless severe agitation poses immediate risk of harm, and only after verbal de-escalation fails (follow local protocols). Intoxication complicates sedation.
• Teamwork & Communication: Liaise with police on their arrival. Communicate plan with partner. Provide clear handover to ED staff, emphasizing suicide risk and intoxication.

Debrief Focus Points

• Strategies for communicating with distressed/suicidal patients.
• Conducting a suicide risk assessment in the prehospital setting.
• Managing intoxicated patients.
• Scene safety considerations in mental health calls.
• Understanding local mental health legislation regarding involuntary transport.
• Importance of empathy and non-judgmental care.
• Collaboration with police and hospital staff.
• Crew welfare and debriefing after challenging mental health calls.