Vision Care Knowledge & ExpertiseVol. 5
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Q&A
Healthcare professionals encounter unexpected patient situations daily, requiring quick thinking and established protocols to ensure positive outcomes. This article presents 16 practical approaches to handling patient crises, featuring real-world advice gathered from experienced healthcare experts. These tried-and-tested strategies offer valuable guidance for maintaining patient safety while delivering compassionate care during challenging clinical moments.
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Audrey SchoenLicensed Marriage and Family TherapistAudrey Schoen, LMFTI had a couples session where one partner suddenly disclosed they'd been having an affair--completely blindsiding both their spouse and me. The betrayed partner immediately stood up to leave, saying "we're done," while the other broke down sobbing.
I quickly shifted into what I call "crisis containment mode." Instead of letting them storm out separately, I asked the leaving partner to stay for just 10 more minutes to ensure they both had safety plans before driving home emotionally dysregulated. I used breathing exercises with both of them right there in the room--the same measurement techniques I use in my intensive therapy work.
The key was separating immediate crisis management from actual therapy work. I didn't try to process the affair or save their marriage in that moment. I focused purely on: can they both get home safely, do they each have one person to call tonight, and when would they each like to schedule individual sessions.
My advice: have your "emotional first aid" toolkit ready before crisis hits. Know your grounding techniques cold, always prioritize immediate safety over therapeutic progress, and remember that sometimes the best intervention is simply slowing everything down rather than trying to fix it all in the moment.
I've been treating trauma for over a decade using EMDR and somatic approaches, so I've learned to read when someone's nervous system is hitting a wall before they even realize it.
During one EMDR intensive session, my client suddenly went completely silent mid-processing and started staring at the ceiling with a blank expression--classic dissociative response that can derail hours of work. Instead of pushing forward or stopping entirely, I immediately shifted to grounding techniques from my Sensorimotor training, had them feel their feet on the floor and describe three things they could see in the room.
Within two minutes they were back present, and we were able to continue processing that same memory more safely. The key was recognizing that their nervous system needed regulation before we could access the trauma material again.
My recommendation: always have your "circuit breakers" ready before diving into intense emotional work. Whether it's therapy, coaching, or any high-stakes conversation, know how to bring someone back to safety first--the content can wait, but losing someone to overwhelm kills all progress.
Dr. Rosanna GilderthorpClinical Psychologist & DirectorKnow Your Mind ConsultingDuring my time in NHS services, I had a pregnant client who arrived for what should have been a routine therapy session but was clearly in severe distress from hyperemesis gravidarum (severe pregnancy sickness). She was visibly dehydrated and hadn't been able to keep fluids down for days, but was terrified that seeking medical help would somehow harm her baby.
I immediately shifted from our planned session to crisis support mode. Rather than dive into therapy work, I spent time validating her very real medical emergency while gently challenging the catastrophic thinking that was keeping her from getting help. I used the "name the issue" approach I teach managers - directly addressing that untreated dehydration was actually the bigger risk to both her and baby.
Within 20 minutes, I had contacted her GP practice, arranged same-day emergency care, and crucially, helped her call her partner to drive her there immediately. She was admitted that afternoon for IV fluids and anti-nausea medication.
My advice for any healthcare provider: always have your emergency protocols memorized and trust your clinical instincts over your session agenda. Keep key medical contacts readily available, and remember that sometimes the most therapeutic thing you can do is pause therapy entirely to address immediate physical safety. That client later told me that validation of her medical crisis was more helpful than months of traditional counseling would have been.
Maya WeirFounderThrivingCaliforniaThree months into my practice at Thriving California, I had a new mom client experiencing severe postpartum anxiety during our telehealth session when her baby started screaming uncontrollably in the background. She became completely dysregulated, started hyperventilating, and said she felt like a "terrible mother" who couldn't even handle a therapy session.
I immediately shifted from our planned session structure to crisis intervention mode. Instead of asking her to step away from the baby, I guided her through the exact 6-question framework I use with triggered parents while she was holding her crying infant. We worked through "What does my child need right now?" and "How can I comfort myself in this moment?" in real-time.
Within 10 minutes, both she and her baby were calm, and she had a breakthrough about how her own childhood experiences of feeling unheard were amplifying her panic. This became one of our most powerful sessions because she experienced the tools working under actual pressure rather than just talking about them theoretically.
My recommendation: when clients are in crisis, meet them exactly where they are instead of sticking to your session plan. The most transformative healing often happens when we can practice coping strategies during real stress, not just discuss them when everything's calm.
I'll never forget treating a young woman with Ehlers-Danlos Syndrome who suddenly dislocated her shoulder during what seemed like a routine gentle mobilization. Her joint literally slipped out mid-treatment, and she went into panic mode because this had triggered a traumatic flashback to a previous injury.
I immediately stabilized her arm in the position of comfort and talked her through controlled breathing techniques I'd learned working with trauma patients in Tel Aviv. Instead of trying to reduce the dislocation myself, I called her orthopedist directly while keeping her calm and supported. The key was recognizing that her psychological state was just as critical as the physical injury.
From my trauma rehabilitation experience, I knew that maintaining patient trust during crisis moments determines whether they'll continue treatment or abandon it entirely. I stayed with her until her doctor arrived and we successfully relocated the joint safely.
My biggest recommendation is to never let your ego override safety protocols--know your scope of practice and have direct lines to specialists. Also, always screen EDS patients for their specific trigger movements and past trauma responses before starting any manual work. These patients taught me that preparation prevents most "unexpected" situations.
As a licensed clinical social worker specializing in maternal mental health, I once had a client call me in complete panic at 2 AM because she was experiencing intrusive thoughts about harming her newborn. She was terrified she might act on them and was considering driving to the hospital to surrender her baby.
I stayed on the phone with her for 45 minutes, walking her through grounding techniques using the 5 senses method I teach--having her describe textures around her, sounds in the house, what she could smell. I helped her understand that intrusive thoughts are actually common in postpartum anxiety and having them doesn't make her dangerous. We created an immediate safety plan where she woke her partner and had them take over baby care for the night.
The key was normalizing her experience while taking her fears seriously. Many new mothers experience these thoughts but are too ashamed to talk about them, which makes the anxiety spiral worse. I connected her with her OB the next morning and we scheduled emergency sessions that week.
My advice: when someone's in crisis, don't minimize their experience but do help them distinguish between thoughts and actions. Have a clear protocol ready--know when to involve partners, medical professionals, or emergency services. Most importantly, normalize their feelings while ensuring immediate safety measures are in place.
My 14 years specializing in trauma and addiction have taught me that crisis moments often reveal the real therapeutic work that needs to happen. I had a client with severe anxiety who suddenly became catatonic mid-session after we touched on childhood trauma - completely unresponsive, rigid posturing, the whole nine yards.
I immediately shifted from talk therapy to somatic grounding techniques from my DBT training. Instead of trying to "talk her through it," I guided her through progressive muscle relaxation and breathing exercises while maintaining a calm, steady presence. Within about 10 minutes, she slowly came back to awareness.
The breakthrough came when I normalized what happened instead of treating it as a setback. I explained how her nervous system was protecting her, and we spent the rest of our sessions building coping strategies for when trauma responses kicked in unexpectedly. That "crisis" became the foundation for her most significant healing work.
My advice is to stay curious instead of panicked when clients present something outside your planned approach. Your therapeutic modalities are tools, not scripts - be ready to pivot based on what the person in front of you actually needs in that moment.
I had a teen client who came in appearing disheveled with dark circles under her eyes, but midway through our session she suddenly went completely pale and started hyperventilating. Her hands were shaking and she kept saying "I can't breathe, something's really wrong with me this time."
I immediately recognized the signs of a panic attack and shifted into grounding mode. Instead of talking through her anxiety, I had her focus on the "5 Senses Grounding Technique" - counting 5 things she could see in my office, 4 sounds she could hear, 3 textures she could touch on the chair. This pulled her out of the spiral within minutes.
What saved the situation was staying completely calm myself and not feeding into her fear that something was medically wrong. I used the "surfer" visualization I teach - explaining that we weren't going to stop the wave of panic, but we were going to ride it out together until it naturally subsided.
My recommendation is to master your own emotional regulation first, because clients pick up on your energy instantly. Keep simple grounding tools ready and practice them regularly so you can guide someone through them smoothly when their logical brain has gone offline.
Cristina DeneveFounderEmpower UI'm a bilingual EMDR therapist specializing in transgenerational trauma, so crisis moments often involve cultural identity breakdowns rather than scheduling disasters.
Last month, a second-generation client had a panic attack mid-session when we hit a memory about disappointing her immigrant parents. She started hyperventilating and saying "I'm betraying my family" repeatedly in Spanish. Instead of standard grounding techniques, I immediately switched to Spanish and used a parts work approach--acknowledging both her "loyal daughter" part and her "authentic self" part simultaneously.
I had her physically place one hand on her heart for her family loyalty and one on her stomach for her personal truth. Within minutes, she could breathe normally and said "I can hold both at the same time." This became a breakthrough moment where she realized honoring her culture didn't require sacrificing herself.
My recommendation: when working with multicultural clients in crisis, language switching and body-based interventions often work faster than cognitive approaches. The key is validating the cultural conflict rather than trying to resolve it immediately--let them feel the tension between worlds instead of forcing them to choose sides.
Kelsey FyffeOwner & FounderLive Mindfully PsychotherapyLast year during a session with an elite dancer at Houston Ballet, she suddenly began hyperventilating and couldn't stop picking at her cuticles until they bled - classic signs of an OCD spiral mixed with panic. Her performance was that evening and she was convinced she'd "contaminated" herself and couldn't go on stage.
I immediately shifted from our planned session to crisis intervention mode. Instead of trying to calm her down or reassure her the thoughts weren't real, I guided her through a rapid exposure right there - having her touch the "contaminated" area and then touch her face while breathing deeply. Within 10 minutes, her anxiety dropped from a 9/10 to a 6/10.
The key was recognizing that reassurance would have made her OCD worse long-term, even though it felt counterintuitive in a crisis moment. I kept exposure tools in my office toolkit specifically for these situations - things like hand sanitizer, tissues, and various "contaminated" objects that athletes commonly obsess over.
My advice is to always have your crisis interventions align with your long-term treatment goals, not against them. For OCD specifically, keep exposure materials readily available and practice the techniques when clients aren't in crisis so you can implement them quickly when panic hits.
Dr. Cheryl TwuOBGYNWellness OBGYNThree years ago during my time at Kapiolani Women's Center, I had a patient come in for what seemed like routine bleeding at 20 weeks pregnant. Within minutes of starting the exam, I realized she was in active preterm labor with the umbilical cord presenting first--a true obstetric emergency.
I immediately called for the OR team while keeping the patient in a specific position to prevent cord compression. We had less than 10 minutes to get her to surgery before we'd lose the baby. I stayed with my hands supporting the presenting part while we rushed to the operating room, talking the patient through every step to keep her calm.
Both mom and baby survived what could have been catastrophic. That experience taught me that in medicine, your hands and voice are often more important than any equipment. The key was staying physically present with the problem while simultaneously coordinating the team response.
My advice for any high-stakes situation: don't delegate the most critical task. If something requires your direct intervention, do that first while directing others to handle everything else. Your expertise is most valuable when you're directly solving the core problem, not just managing from a distance.
Ishdeep Narang, MDChildAdolescent & Adult Psychiatrist | Founder, ACES Psychiatry, Orlando, FloridaMy recommendation is to immediately address the emotion, not the behavior. When a situation becomes tense, the most important thing to do is to pause the clinical agenda, make a human connection, and find out what the person is feeling.
I once had a new patient who, during a routine intake, suddenly stood up and accused my staff of a clerical error with a loud, trembling voice. The instinct is to correct the facts, but I could see he wasn't angry—he was terrified. I set my papers down, looked at him directly, and said, "It sounds like this has been incredibly stressful for you. Let's forget the forms for a minute. Tell me what's happening."
His entire demeanor changed. He explained the immense anxiety he felt just getting to the appointment, and the paperwork error was the final straw. By centering on his fear instead of the logistical problem, we built a foundation of trust that allowed us to not only complete the appointment but to have a productive clinical conversation.
This works in any medical setting. When faced with the unexpected, take a breath and ask yourself: What is the emotion driving this? Addressing that underlying feeling first almost always de-escalates the situation and reminds the patient that you see them as a person, not just a problem to be solved.
I had a pregnant patient come in at 38 weeks with severe pelvic pain who suddenly started having contractions during our Webster Technique session. Her water hadn't broken, but the contractions were coming every 3-4 minutes and she was panicking about being stuck on the adjustment table.
I immediately helped her into a comfortable seated position and had her practice breathing techniques while I called her OB. Instead of sending her straight to the hospital, I suggested we monitor for 10 minutes since Webster adjustments can sometimes trigger Braxton Hicks contractions that settle down. Sure enough, the contractions spaced out to 8-10 minutes apart, and her pain decreased significantly.
She went home that day and delivered a healthy baby girl two days later with a much shorter labor than her previous pregnancies. The key was staying calm and using my Webster certification knowledge to distinguish between true labor and the body's response to pelvic realignment.
My advice: always have emergency protocols ready and know your scope of practice inside and out. Keep your certifications current because that advanced training becomes crucial when unexpected situations arise. Most importantly, trust your clinical experience but never hesitate to involve other healthcare providers when needed.
Danielle SwimmConsultantEntrepreneurial TherapistAs a therapist who's run my own practice since 2018 and coached hundreds of therapists, crisis moments happen more often than people think.
I once had a client in an eating disorder session who suddenly disclosed active suicidal ideation mid-appointment. While maintaining calm conversation, I was simultaneously pulling up my crisis protocol on my second screen, texting my supervisor, and mentally mapping out the nearest hospital options. I kept her talking about her safety plan while coordinating a same-day psychiatric evaluation through telehealth.
The key was having multiple systems running simultaneously--my crisis contact list memorized, backup therapist on speed dial, and safety protocols practiced until they became automatic. She got immediate care and stayed safe.
My advice: drill your emergency procedures until they're muscle memory, and always have your crisis resources open in a separate browser tab during sessions. When someone's mental health crisis hits, your preparation in the calm moments determines whether you can think clearly under pressure.
Belle FlorendoMarketing coordinatorRGV Direct CareDuring a routine eye exam, a patient suddenly experienced a severe allergic reaction to a topical diagnostic drop. I immediately paused the exam, ensured the patient's airway was clear, administered emergency medication per protocol, and called for additional support while monitoring vital signs. The rapid response stabilized the patient before transferring them for further evaluation. This situation reinforced the importance of preparedness, remaining calm under pressure, and having clear emergency procedures in place. I recommend that others facing similar circumstances familiarize themselves with emergency protocols, keep necessary medications and equipment accessible, and maintain composure. Quick assessment combined with decisive action can prevent complications and ensure patient safety in unexpected medical events.
Seth CappDivision Chief Pediatric ImagingSpecialty Focused RadiologyAs a pediatric radiologist with 15+ years interpreting emergency cases, I've learned that time-sensitive diagnoses can literally mean life or death for children.
One night around 2 AM, I received a STAT pediatric CT scan through our teleradiology platform showing what initially appeared to be appendicitis in a 7-year-old. However, something felt off about the imaging patterns--the inflammation distribution wasn't typical. Within minutes of my initial read, I called the emergency physician directly instead of just sending the written report.
That phone call changed everything. After discussing the case, we realized this child had intussusception (bowel telescoping into itself) rather than appendicitis, which required completely different treatment. The surgical team was able to perform the correct procedure immediately, avoiding what could have been a dangerous misdiagnosis.
My recommendation: always trust your clinical instincts and pick up the phone when something doesn't feel right. Written reports are important, but direct communication saves lives--especially in pediatric emergencies where parents are terrified and time is critical. During my pandemic volume drop, these direct physician relationships actually helped sustain our practice because trust matters more than convenience.
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