Mixed Crisis Scenario Pack
Eight training cases for dispatch, law enforcement, EMS, emergency departments, hospital security, caregivers, navigators, and supervisors. The diagnosis does not answer the safety question, and the scenario should not announce the “right” interpretation. Use local law, policy, protocols, instructor standards, and clinical scope.
Facilitator method
- Read only the opening facts.
- Ask learners to state the immediate threat, required task, and unknowns.
- Do not reveal autism unless the scenario makes it observable or another person provides that information.
- Add the instructor inject only after learners commit to an initial plan.
- Score observable actions, reasoning, communication, handoff, and documentation—not whether learners guessed the diagnosis.
- Debrief system limits separately from individual performance.
Pacing behind a closed business
Opening facts
An adult is pacing rapidly near a closed store at 11:30 p.m. A caller says the person “looks confused.” No weapon, assault, or property damage is reported. The adult looks away and does not answer the first question.
Instructor inject
After 30 seconds, a phone screen becomes visible with typed text: “waiting for ride. too loud.”
Expected learner work
- Maintain ordinary scene safety.
- Do not treat gaze/silence as threat proof.
- Try usable communication and processing time.
- Check medical confusion, victimization, intoxication, transport need, and why the person is there.
Debrief / documentation
What evidence changed the interpretation? What would “refused to cooperate” omit from the report?
Reaching for the phone during contact
Opening facts
During a vehicle-related interaction, the driver repeatedly glances at and reaches toward a phone after being told to keep hands visible.
Instructor inject
The driver says, slowly, “type… talk,” and points at an AAC/text app. A Blue Envelope is also visible in the document holder.
Expected learner work
- Officer-safety instructions still apply.
- When circumstances permit, give a clear safe method for retrieving/using the communication device.
- Use the Blue Envelope as communication support, not proof of innocence, diagnosis severity, or exemption from lawful instructions.
Contraindicated shortcut
“Autistic = harmless” is as unsafe as “reaching = weapon.” The task is evidence-based threat assessment plus accessible communication.
Running toward a roadway
Opening facts
A teenager runs from home after a loud family conflict and is moving toward a four-lane road. A parent reports autism and says, “Do not touch him; he will fight.”
Instructor inject
The teenager does not respond to their name and is 20 yards from traffic. No weapon is reported.
Expected learner work
- Traffic danger is immediate and changes the available time.
- Use the least force/pressure that can reliably prevent the concrete danger under policy/law.
- Once safe from traffic, promptly reassess and reduce pressure.
- Carry the caregiver's baseline information to EMS/receiving team if transport occurs.
Debrief
Accommodation does not mean watching someone enter traffic. It means not allowing emergency physical intervention to become the permanent communication mode after the threat changes.
“He cannot communicate.”
Opening facts
An adult's parent answers every question in the ED and says the adult “cannot understand this.” The adult avoids speech.
Instructor inject
When handed a tablet, the adult types: “Ask me. Mom gets scared and talks for me.”
Expected learner work
- Use caregiver baseline information.
- Communicate directly through the adult's usable method.
- Clarify actual legal authority only if relevant.
- Document disagreement and assess safeguarding only from facts, not stereotypes.
Debrief
Family partnership and patient autonomy are not mutually exclusive.
Sudden self-injury after two quiet days
Opening facts
A non-speaking autistic adult begins striking the side of their head, crying, and pushing caregivers away. The family says this is “a meltdown.”
Instructor inject
Temperature is elevated. The caregiver later mentions the person has been pulling at one ear and sleeping poorly.
Expected learner work
- Protect immediate safety.
- Do not stop at the behavioral label.
- Assess pain/infection and other medical causes as clinically indicated.
- Use communication/sensory support during assessment.
Contraindicated shortcut
Do not make restraint/sedation the diagnostic plan. If required for immediate safety or necessary care, it still needs clinical indication, monitoring, reassessment, and documentation under applicable protocol.
Shutdown becomes “refusal”
Opening facts
After three hours in a bright waiting area, an autistic patient curls into a chair, stops answering, and will not move when called for triage. Security is asked to “make them comply.”
Instructor inject
The patient's support person says the patient can still type short answers and usually needs several minutes after each question when shut down.
Expected learner work
- Clinical team identifies whether urgent medical instability requires immediate action.
- Security stays in its safety role rather than diagnosing intent.
- Use a lower-demand communication channel and reduce avoidable environmental load if feasible.
Debrief
What part of the task was necessary, and what part of the pressure was created by the environment?
Behavioral-health crisis without an obvious crime
Opening facts
An autistic adult is crying, saying life is pointless, and refusing to leave a bedroom. Family reports no weapon and no current assault. They are unsure whether to call police.
Instructor inject
The person says they have thoughts of dying but denies a current plan when asked in writing. Local in-person crisis availability is not yet known.
Expected learner work
- Do not promise that 988 automatically produces mobile response.
- Assess urgency using the applicable crisis/clinical process.
- Use 988/behavioral-health crisis routes when appropriate and escalate to emergency response if danger/medical need requires it.
- Clarify the next owner and fallback if local capacity is unavailable.
Debrief
The educational point is system navigation under uncertainty—not an online tool deciding suicide risk.
“Someone will call you.”
Opening facts
After an ED visit following police transport, the family receives a generic behavioral-health referral and returns home. Two weeks later no appointment exists and another crisis is building.
Instructor inject
The referral office says it never received the records. The family has no named coordinator and has been calling both offices.
Expected learner work
- Confirm destination and receipt.
- Identify owner, missing record/barrier, next action, check-back date, and fallback.
- Ask what interim safety/support plan exists while the referral is unresolved.
- Capture this as a system-quality failure, not only “family noncompliance.”
Debrief
A crisis system that cannot close post-discharge referrals is structurally designed to create repeat emergency use.