Rule out medical causes first. Safety is priority — yours, patient's, and bystanders'.
Steps by Cert Level
ALL: Scene safety FIRST. Do not enter until law enforcement clears scene. Use verbal de-escalation. Calm voice, non-threatening posture, personal space.
EMT: Rule out medical causes: BGL, SpO2, temp. Physical restraint only if imminent danger — use minimum force. Never prone restraint.
AEMT: IV access if possible. Monitor vitals closely during restraint.
PARAMEDIC: Chemical sedation: Droperidol 5mg IM (first-line), Ketamine 4mg/kg IM (excited delirium/ExDS), Midazolam 5mg IM. Monitor airway aggressively after sedation. Excited Delirium: high mortality — cool patient, IV fluids, cardiac monitor.