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Every clinic that practices integrated care needs to have a specific protocol in place in terms of what to do in a true emergency. Because resources vary tremendously from clinic to clinic, the AIMS Center can only give very general suggestions (have someone watch the patient, call 911, take the patient to the emergency department) and provide some examples. One adult medicine clinic we work with  walks the patient downstairs to the psych ED (PES) for evaluation. A primary care clinic we work with calls 911 and has the patient taken for evaluation at the nearest emergency department. A protocol should also be in place in case the patient doesn't want to cooperate. These situations are rare, but they can happen. If a patient shows up in clinic with thoughts of suicide at 4:30 on a Friday afternoon, you want to be prepared.