Editor’s note: Behavioral crisis calls can change quickly. A person who initially appears calm and communicative may become agitated, withdraw from the conversation or begin showing signs of a medical emergency. In this article, Bram Duffee explains how officers can avoid becoming anchored to their first impression and recognize when changing behavior or new information requires a different response.
By Bram Duffee, Ph.D., EMT-P
The read you formed in the first 60 seconds is a hypothesis, not a verdict.
That sounds simple. It is hard to live by when the call is moving and the person in front of you seemed to be settling. The danger is not limited to misreading the situation at the outset. It also arises when an initially sound assessment is not updated as conditions change.
This article is about that second read, and the third. It is about recognizing when the situation you initially assessed is no longer the situation in front of you.
The first 60 seconds are a starting point
When you arrive on scene, you are forming an impression fast. You commit to an approach. That is the right thing to do. But committing to an approach is not the same as closing the file.
Every piece of information that comes after that first impression should be tested against one question: Does this change what I thought I was looking at?
The answer will sometimes be no. Often, though, it will be yes. Officers who recognize that shift are the ones who continue testing their initial assessment as the encounter unfolds.
When the body changes before the words do
Escalation rarely announces itself cleanly. It may show up in the body first.
Watch for rising psychomotor agitation: pacing that picks up speed, fists clenching and unclenching, or sudden destruction of nearby objects. If someone who was seated and talking is now standing and pacing, that change should prompt a reassessment. What shifted? Does your positioning still make sense?
Pay close attention to the eyes and hands. Repeatedly looking toward a potential weapon, an exit, an open window, a stretch of highway or another possible target can be an important pre-assault or pre-flight indicator. The glance may come before the movement.
A bladed stance, tightening shoulders or other preparatory movements should also draw attention. If someone reaches toward a nearby object, officers should immediately reassess the person’s intent, access to a potential weapon and the level of threat.
Each of these changes should trigger the same questions: What does this tell me about where this person may be headed, and what do I need to reconsider about my distance, positioning and available resources?
When the talking stops
Sudden silence can be easy to misread.
A person who has been highly verbal and then goes quiet is not necessarily calming down. The change may signal that the person is withdrawing from the conversation, becoming increasingly focused on an action or losing the ability to remain engaged.
Silence can also accompany cognitive deterioration. When someone can no longer follow simple directions or track questions, their thought process may be fragmenting. The change could also indicate that the encounter involves a medical emergency rather than, or in addition to, a behavioral crisis.
Either way, when the words stop, treat the change as new information rather than evidence that the crisis has passed. Reassess the person’s behavior, your positioning and the need for additional resources.
When behavior shifts, so should your footing
Every meaningful change in presentation is a reason to reconsider where you are standing and whether your current approach remains appropriate.
Maintain a reactionary gap appropriate to the person’s behavior, access to weapons, physical surroundings and your agency’s training. If the person advances, adjust your position when feasible to preserve time and distance. Remain aware of obstacles, potential escape routes and avenues of approach.
In my new book, “Psychological Emergency Communication and Care by First Responders,” I offer a practical framework for exactly these moments. The book introduces 16 new mnemonics designed to help first responders communicate more effectively with people in psychological crisis. The GUARD protocol offers a scene-safety check for moments when the picture begins to shift:
- Gauge the scene: Scan for weapons, hazards and objects within reach.
- Use distance: Maintain space that protects both parties and may reduce pressure on the person.
- Anchor your exits: Identify clear routes of movement and avoid becoming trapped.
- Request backup: Call for additional resources if the situation is deteriorating.
- Decide to engage: Move toward closer contact only after reassessing the risks and available resources.
When the scene changes, GUARD can serve as a reset, helping turn a changed picture into a changed plan.
When the presentation may not be behavioral at all
Some reassessment failures happen when a medical emergency initially presents as a psychiatric or behavioral crisis.
Profuse sweating, rapid breathing, an elevated pulse, unusually hot or flushed skin, confusion and severe agitation may indicate an acute medical emergency. These signs do not allow an officer to determine the cause, but they should prompt consideration of a medical response.
Other observations may also be significant. Changes in pupil size, breathing, awareness or behavior can be associated with drug use, medication effects or medical conditions. Sudden confusion in an older adult with no known psychiatric history may be connected to infection, medication or a metabolic problem. Hypoglycemia, hypoxia and head injuries can also cause confusion, agitation or combativeness.
The officer’s role is not to diagnose. It is to recognize when a person’s presentation may not be purely behavioral, request EMS and adjust the response accordingly. A person experiencing a medical emergency may be unable to understand or follow directions. Treating an inability to comply as a deliberate refusal can cause the encounter to deteriorate.
When new information arrives
The clearest signal that your first read needs updating may come from outside: A family member shares something, dispatch radios a missed detail or EMS provides new information.
“He’s diabetic and hasn’t eaten since yesterday.” “This came on suddenly.” “She took something before we called.” Each of those statements should influence the assessment.
The danger is anchoring bias. The call was coded as a mental health contact, so officers may interpret sweating as anxiety or silence as defiance instead of considering other explanations. The dispatch label was a starting point. It should not override what officers are seeing and learning on scene.
When new information arrives, ask one question: Does this change what I thought I was looking at? If it does, change the plan.
Two scenarios
Scenario one
You respond to a man threatening self-harm on a second-floor balcony. He is crying, talking and engaged. Your initial read: high distress and active risk, but still verbal and connected. You work the conversation.
Then he goes quiet mid-sentence. He starts glancing at the railing and the drop below. His hands grip the rail, and his weight shifts forward.
What changed: Verbal engagement stopped, and repeated glances toward the drop appeared alongside a preparatory weight shift.
What to reconsider: The level and immediacy of risk may have changed. Reassess your position, the availability of additional resources and whether your communication should shift from open-ended dialogue to short, concrete directions consistent with your training. Avoid sudden movements that could accelerate the person’s actions. The first read may have been right for the first five minutes. It is no longer sufficient now.
Scenario two
Dispatch sends you to a man pacing his yard and shouting at no one. The call is coded as a psychiatric crisis. Your initial read: elevated but manageable.
Then you notice that he is drenched in sweat despite moderate weather. He is breathing rapidly, his skin appears flushed and hot, and he cannot track your questions.
What changed: The presentation now includes physical and cognitive signs that may not fit a straightforward psychiatric episode.
What to reconsider: This may involve a medical emergency. Maintain an appropriate reactionary gap, request EMS and coordinate the response before initiating hands-on intervention unless immediate action is necessary to protect life.
The takeaway
The skill that separates a measured crisis response from a reactive one is not limited to what you do in the first 60 seconds. It is whether you continue reading the situation after that.
Watch for changes in the body before the words change. Treat sudden silence as information, not resolution. Recognize when the physical presentation may point away from a purely behavioral explanation and toward a possible medical emergency. Let new facts replace your opening impression when they need to.
The read you formed at the start was a hypothesis. Every moment after that is a chance to test it.
About the author
Bram Duffee, Ph.D., EMT-P, is a critical care paramedic based in Houston and a faculty member at Kennesaw State University, where he teaches communication. He is the host of “EMS Research with Professor Bram,” a vlog and podcast focused on bringing medical research to frontline practitioners. Duffee is the co-author of Psychological Emergency Communication and Care by First Responders and Hypnotic Communication in Emergency Medical Settings. Learn more at ProfessorBram.com/Publications.
