All EMS presentations
Mental HealthClinical presentation

Behavioural crisis / agitation

A streamlined, differential-led presentation for rapid clinical review.

Clinical snapshot

Twenty-second review

  • Agitation may arise from psychiatric illness, intoxication, withdrawal, delirium, hypoxia, head injury, glucose disturbance, or hyperthermic toxic physiology.
  • Immediate violence risk, extreme exertion, hyperthermia, altered LOC, focal deficit, severe intoxication, or respiratory compromise requires urgent coordinated care.
  • Keep hypoglycemia or hypoxia in the differential; overlapping or concurrent illness remains possible.
  • For behavioural crisis / agitation, trends and combinations of findings are more informative than one isolated vital sign.
Differentials

Compare the clinical patterns

The repeated material is grouped inside each possibility. Open only the condition you need.

Serious3 conditions
DeliriumTime-sensitive high-risk possibility

HPI

Clarify immediate safety risks; baseline and precipitating event; medical causes and trauma.

Signs & symptoms

Fluctuation, abnormal vitals, focal signs, trauma, or hyperthermia.

Focused exam

Observe behaviour, speech, thought process, perception, orientation, attention, and signs of intoxication, injury, or medical illness; Assess risk using direct questions and collateral information.

Brief pathophysiology

Delirium may cause behavioural crisis / agitation through a time-sensitive process capable of rapid physiological deterioration.

Vital-sign pattern

What the trend may show

Possible pattern

There is no diagnostic vital-sign pattern for a behavioural, functional, or social presentation. Abnormal physiology should be explained and may indicate delirium, toxicity, infection, trauma, or another medical cause.

Temperature (°C)

Screen for medical cause

Fever or hypothermia suggests infection, exposure, or toxicity.

Blood glucose (mmol/L)

Check when indicated

Glucose disturbance can cause altered behaviour or weakness.

Heart rate (bpm)

Explain abnormalities

Tachycardia may reflect distress but should not be dismissed.

Blood pressure (mmHg)

Compare with baseline

Hypotension or severe hypertension warrants medical evaluation.

Front-load in the triage report

  • Delirium: Fluctuation, abnormal vitals, focal signs, trauma, or hyperthermia.
  • Immediate safety risks?
  • Baseline and precipitating event?
Toxic syndromeTime-sensitive high-risk possibility

HPI

Clarify baseline and precipitating event; medical causes and trauma; substances or medication change.

Signs & symptoms

Fluctuation, abnormal vitals, focal signs, trauma, or hyperthermia.

Focused exam

Assess risk using direct questions and collateral information; Observe from a safe distance; assess attention, speech, thought, pupils, skin, temperature, glucose, trauma, substances, and restraint effects.

Brief pathophysiology

Toxic syndrome may cause behavioural crisis / agitation through a time-sensitive process capable of rapid physiological deterioration.

Vital-sign pattern

What the trend may show

Possible pattern

There is no diagnostic vital-sign pattern for a behavioural, functional, or social presentation. Abnormal physiology should be explained and may indicate delirium, toxicity, infection, trauma, or another medical cause.

Temperature (°C)

Screen for medical cause

Fever or hypothermia suggests infection, exposure, or toxicity.

Blood glucose (mmol/L)

Check when indicated

Glucose disturbance can cause altered behaviour or weakness.

Heart rate (bpm)

Explain abnormalities

Tachycardia may reflect distress but should not be dismissed.

Blood pressure (mmHg)

Compare with baseline

Hypotension or severe hypertension warrants medical evaluation.

Front-load in the triage report

  • Toxic syndrome: Fluctuation, abnormal vitals, focal signs, trauma, or hyperthermia.
  • Baseline and precipitating event?
  • Medical causes and trauma?
Intracranial diseaseTime-sensitive high-risk possibility

HPI

Clarify medical causes and trauma; substances or medication change; suicidal or homicidal thoughts.

Signs & symptoms

Fluctuation, abnormal vitals, focal signs, trauma, or hyperthermia.

Focused exam

Assess risk using direct questions and collateral information; Observe from a safe distance; assess attention, speech, thought, pupils, skin, temperature, glucose, trauma, substances, and restraint effects.

Brief pathophysiology

Intracranial disease may cause behavioural crisis / agitation through a time-sensitive process capable of rapid physiological deterioration.

Vital-sign pattern

What the trend may show

Possible pattern

There is no diagnostic vital-sign pattern for a behavioural, functional, or social presentation. Abnormal physiology should be explained and may indicate delirium, toxicity, infection, trauma, or another medical cause.

Temperature (°C)

Screen for medical cause

Fever or hypothermia suggests infection, exposure, or toxicity.

Blood glucose (mmol/L)

Check when indicated

Glucose disturbance can cause altered behaviour or weakness.

Heart rate (bpm)

Explain abnormalities

Tachycardia may reflect distress but should not be dismissed.

Blood pressure (mmHg)

Compare with baseline

Hypotension or severe hypertension warrants medical evaluation.

Front-load in the triage report

  • Intracranial disease: Fluctuation, abnormal vitals, focal signs, trauma, or hyperthermia.
  • Medical causes and trauma?
  • Substances or medication change?
Common2 conditions
PsychiatricCommon presentation pattern

HPI

Clarify immediate safety risks; baseline and precipitating event; medical causes and trauma.

Signs & symptoms

Behaviour may follow psychosis, mania, fear, or conflict.

Focused exam

Observe behaviour, speech, thought process, perception, orientation, attention, and signs of intoxication, injury, or medical illness; Assess risk using direct questions and collateral information.

Brief pathophysiology

Psychiatric may explain the presenting symptoms through a common clinical mechanism, while serial assessment checks for complications or an alternate cause.

Vital-sign pattern

What the trend may show

Possible pattern

There is no diagnostic vital-sign pattern for a behavioural, functional, or social presentation. Abnormal physiology should be explained and may indicate delirium, toxicity, infection, trauma, or another medical cause.

Temperature (°C)

Screen for medical cause

Fever or hypothermia suggests infection, exposure, or toxicity.

Blood glucose (mmol/L)

Check when indicated

Glucose disturbance can cause altered behaviour or weakness.

Heart rate (bpm)

Explain abnormalities

Tachycardia may reflect distress but should not be dismissed.

Blood pressure (mmHg)

Compare with baseline

Hypotension or severe hypertension warrants medical evaluation.

Front-load in the triage report

  • Behaviour may follow psychosis, mania, fear, or conflict.
  • Immediate safety risks?
  • Baseline and precipitating event?
Situational agitationCommon presentation pattern

HPI

Clarify baseline and precipitating event; medical causes and trauma; substances or medication change.

Signs & symptoms

Behaviour may follow psychosis, mania, fear, or conflict.

Focused exam

Assess risk using direct questions and collateral information; Observe from a safe distance; assess attention, speech, thought, pupils, skin, temperature, glucose, trauma, substances, and restraint effects.

Brief pathophysiology

Situational agitation may explain the presenting symptoms through a common clinical mechanism, while serial assessment checks for complications or an alternate cause.

Vital-sign pattern

What the trend may show

Possible pattern

There is no diagnostic vital-sign pattern for a behavioural, functional, or social presentation. Abnormal physiology should be explained and may indicate delirium, toxicity, infection, trauma, or another medical cause.

Temperature (°C)

Screen for medical cause

Fever or hypothermia suggests infection, exposure, or toxicity.

Blood glucose (mmol/L)

Check when indicated

Glucose disturbance can cause altered behaviour or weakness.

Heart rate (bpm)

Explain abnormalities

Tachycardia may reflect distress but should not be dismissed.

Blood pressure (mmHg)

Compare with baseline

Hypotension or severe hypertension warrants medical evaluation.

Front-load in the triage report

  • Behaviour may follow psychosis, mania, fear, or conflict.
  • Baseline and precipitating event?
  • Medical causes and trauma?
Mimics2 conditions
HypoglycemiaImportant alternative presentation

HPI

Clarify immediate safety risks; baseline and precipitating event; medical causes and trauma.

Signs & symptoms

Reversible physiological causes can present primarily as agitation.

Focused exam

Observe behaviour, speech, thought process, perception, orientation, attention, and signs of intoxication, injury, or medical illness; Assess risk using direct questions and collateral information.

Brief pathophysiology

Hypoglycemia can resemble behavioural crisis / agitation through overlapping symptoms or referred physiology despite a different primary mechanism.

Vital-sign pattern

What the trend may show

Possible pattern

Confirm low capillary glucose and reassess after treatment. Adrenergic signs may be absent in recurrent hypoglycemia or blunted by medications.

Blood glucose (mmol/L)

< 4.0 mmol/L

BCEHS defines hypoglycemia as blood glucose below 4.0 mmol/L.

Heart rate (bpm)

May rise

Adrenergic activation commonly produces tachycardia, but this is not universal.

Blood pressure (mmHg)

Often preserved

Blood pressure is not a reliable discriminator; hypotension suggests another or additional process.

Temperature (°C)

May fall

Hypothermia can accompany prolonged or severe hypoglycemia.

Front-load in the triage report

  • Reversible physiological causes can present primarily as agitation.
  • Immediate safety risks?
  • Baseline and precipitating event?
HypoxiaImportant alternative presentation

HPI

Clarify baseline and precipitating event; medical causes and trauma; substances or medication change.

Signs & symptoms

Reversible physiological causes can present primarily as agitation.

Focused exam

Assess risk using direct questions and collateral information; Observe from a safe distance; assess attention, speech, thought, pupils, skin, temperature, glucose, trauma, substances, and restraint effects.

Brief pathophysiology

Hypoxia can resemble behavioural crisis / agitation through overlapping symptoms or referred physiology despite a different primary mechanism.

Vital-sign pattern

What the trend may show

Possible pattern

There is no diagnostic vital-sign pattern for a behavioural, functional, or social presentation. Abnormal physiology should be explained and may indicate delirium, toxicity, infection, trauma, or another medical cause.

Temperature (°C)

Screen for medical cause

Fever or hypothermia suggests infection, exposure, or toxicity.

Blood glucose (mmol/L)

Check when indicated

Glucose disturbance can cause altered behaviour or weakness.

Heart rate (bpm)

Explain abnormalities

Tachycardia may reflect distress but should not be dismissed.

Blood pressure (mmHg)

Compare with baseline

Hypotension or severe hypertension warrants medical evaluation.

Front-load in the triage report

  • Reversible physiological causes can present primarily as agitation.
  • Baseline and precipitating event?
  • Medical causes and trauma?
Red flags

Findings that should escalate concern

  • Excited delirium features
  • Hyperthermia
  • Severe exhaustion
  • Threat to self or others
  • Immediate violence risk, extreme exertion, hyperthermia, altered LOC, focal deficit, severe intoxication, or respiratory compromise requires urgent coordinated care.
  • Delirium, toxic syndrome, or intracranial disease: Fluctuation, abnormal vitals, focal signs, trauma, or hyperthermia.
Related medications

Medication recognition

ApixabanRivaroxabanClopidogrelWarfarin
Related EMS presentations

Continue the clinical pathway

ToxicologyOverdose / drug poisoningMental HealthMental health / suicidal ideationTraumaHead injuryNeurologicDelirium / acute behavioural changeToxicologyStimulant toxicity
References

Clinical and academic sources

Curated clinical guidance and peer-reviewed evidence supporting this presentation. Current BCEHS guidance, medical direction, and local policy remain authoritative for practice.

BCEHS Handbook — specific CPGs

  1. G01: Behavioral EmergenciesBC Emergency Health Services Handbook

    Official BCEHS clinical practice guidance for behavioral emergencies.

Supporting clinical and academic evidence

  1. CEDIS Presenting Complaint List updateCanadian Association of Emergency Physicians

    Presenting-complaint terminology and categorization context. It does not establish a prehospital “top 100” ranking.

  2. Self-harm: assessment, management and preventing recurrenceNational Institute for Health and Care Excellence

    Evidence-based psychosocial assessment, safety, communication, and risk-management guidance.

  3. Management of the Agitated PatientEmergency Medicine Clinics of North America · 2024

    Medical causes, verbal de-escalation, safety, monitoring, and proportionate management of acute agitation.