Viva: branching structured oral

Stimulus. A nine-year-old boy with autism spectrum disorder and intellectual disability is brought to the emergency department in acute behavioural disturbance after a long wait in a noisy waiting room. He is throwing chairs.

Stage 1: The first 60 seconds

Examiner. You are the consultant on. The triage nurse calls you to the cubicle. Walk me through your first 60 seconds.

Model answer. I ensure the safety of the staff, the child and others first. I clear the cubicle of other patients and of hazards, I ask for the chairs to be moved out of reach, I confirm the exit is clear, and I call for senior nursing help and a second clinician. I name a team leader (me or a delegate), assign roles, and ask the parents to step back to a safe distance but to stay close because they will be central to the de-escalation. I do not approach the child yet. ^[1]

Examiner probe. Why not approach?

Model answer. Because approaching an autistic child in meltdown head-on, with multiple staff, in a noisy cubicle, reliably worsens the trajectory. The first intervention is environmental: reduce the noise, reduce the light, clear the space, and bring in people the child trusts. I am preparing the conditions for de-escalation, not confronting the behaviour. ^[6]