A manic patient in the ED is threatening staff; which action is most appropriate?

• A. Ensure de-escalation and request security.
• B. Call crisis intervention team.
• C. Place patient in seclusion.
• D. Proceed with standard admission.

Answer: (B)

When safety is at stake and a manic patient in the ED is threatening staff, the first priority is rapid, skilled management of the crisis. A crisis intervention team brings together clinicians trained in de-escalation, risk assessment, and coordination with security and inpatient services, enabling an immediate, structured response. They can engage the patient to reduce agitation, assess danger level, and decide the appropriate next steps—whether that means continued de-escalation, short-term management, or arranging admission with safeguards. Seclusion or restraint is a last resort, used only if the threat persists after de-escalation and with strict policy safeguards. Proceeding with standard admission would not address the imminent safety risk in the moment.