What are your patient management priorities when you first arrive on scene? (tick all that apply)

The patient seems to display an unnatural amount of strength for her size and continues to battle with the 5 Police Officers trying to restrain her. You persist with de-escalating the situation, and your calming methods start to have a positive impact on the patient. Within these scenarios, can you immediately assume that this patient is lacking capacity?

With the information given and seen so far, what would be your first impression and primary diagnosis?

The patient starts to calm further but still seems to be in a ‘hyper’ state, you manage to gain some observations but are having difficulty conducting the rest. 145 HR, 36 RR, SP02 92%, 38.8 Temp, 3.8 BM and she is not diabetic. What treatment are you going to consider when safe to do so? (tick all that apply)

What is the definition of acute behavioural disturbance according to Ambulance service guidelines?

What are the possible signs and symptoms of acute behavioural disturbance? (tick all that apply)

Acute behavioural disturbance can be caused by…? (tick all that apply)

Differential diagnoses of acute behavioural disorders may include? (tick all that apply)

One of the police officers on scene helps you gain IV access by keeping an arm still and you manage to get the patient on to a stretcher as she continues to calm. What is the recommended IV fluid bolus given to ABD patients according to JRCALC guidelines?

You are now on route to the hospital, with a pre-alert gone in for suspected ABD. You try to complete a mental capacity assessment with the patient in a calmed state each patient needs to be assumed capacity unless it is proved otherwise. What are the other four key principles of the Mental Capacity Act 2005? 

You have deemed that this patient does not have capacity and they do not have any other relevant legal paperwork attached to them. Under what act can you, with assistance of police, take the patient to hospital ED for treatment?

If the patient was deemed to have capacity, would this nullify the diagnosis of ABD and stop you from treating them?

In the back of the Ambulance, Police Officers are travelling with you to assist in case of another outburst of violence from the patient. If restraint is required to keep the patient and everyone else safe, what do Police need to aim for to prevent clinical deterioration? (tick all that apply)

Your radio calls and Specialist Response Team clinicians are asking if you need any advanced support on route to hospital. What extra management strategies can a senior clinical team bring to an ABD patient?

The patient has calmed significantly and is now conversing almost normally with you and the Police Officers. You are also very close to the hospital, so you decline further advanced support. With the patient calmed, is it important to restart a primary/secondary survey so a full assessment can be made of the patient in case hidden pathology was missed beforehand, or best to leave be so not to further agitate them?