Scenario — Chest pain at AFL match — suspected ACS

intermediate Cardiac · Adult · 35yr · male

Patient Information

Dispatch	You are called to Gate 4 of Optus Stadium where a 35YO male (Marcus Hale) is sitting on a bench complaining of chest pain. He was watching the Dockers game when the pain came on.
Patient	Marcus Hale — 35yr (80kg)
Incident History	Pt was seated in the stands watching the AFL game when he developed a heavy, squeezing sensation in the centre of his chest approximately 20 minutes ago. Pain has not resolved with rest. A bystander walked him down to Gate 4 and called for EHS.
Emergency Contact	Renee Hale (Wife) — 0412 883 247

Initial Rapid Assessment

Response	Alert
Airway	Patent. Nil airway obstruction. Nil stridor.
Breathing	Breathing is present. Slightly increased respiratory rate. Nil wheeze or crackles on auscultation. Able to speak in full sentences though appears uncomfortable.
Circulation	Pulse present — regular, moderate strength. Skin pale and diaphoretic. Nil external haemorrhage.
Disability	GCS 15 (E4V5M6). Orientated to time, place and person. Anxious.
Exposure	No rashes, swelling or visible injuries. Patient clutching centre of chest.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	96% (RA)	Mild	18	98	148/92	<2s	15	4 4 ++	37.1	6.4 mmol/L	7
10 mins	97% (RA)	Nil	16	88	138/86	<2s	15	4 4 ++	37.1	6.4 mmol/L	4

History Taking

Scenario Progression and Treatment Objectives

Diagnosis

This patient is suffering from a suspected Acute Coronary Syndrome (ACS) — chest pain of presumed cardiac origin with ongoing symptoms at rest, diaphoresis, and a positive family history.

Facilitator Triggers — if trainees miss a critical step

! (If aspirin is not offered — ask trainee: 'Is there anything else you want to give this patient?' If not identified within 5 minutes, patient states pain is getting worse and he feels more sweaty.)
! (If GTN is administered without first checking blood pressure — facilitator states: 'What would happen if his BP was low before you gave that?' Prompt trainee to reassess BP before each GTN dose.)
! (If GTN is given and pain remains >3/10 after 5 minutes and Methoxyflurane is not considered — patient reports pain is still 6/10 and asks 'Can you give me something stronger?')
! (If patient is not kept seated or is asked to walk — patient becomes pale and dizzy, BP drops to 110/70, HR rises to 110. Prompt trainee: 'What position should this patient be in and why?')
! (If oxygen is administered without clinical indication — prompt trainee: 'His SpO2 is 96% on room air — what are your oxygen targets for this patient?')

Treatment Objectives

1. Ensure scene safety and don appropriate PPE.
2. Perform Primary Survey — confirm patent airway, adequate breathing, circulation, GCS 15.
3. Position patient seated or semi-recumbent — limit exertion, do not walk the patient.
4. Perform Vital Sign Survey including SpO2, BP, HR, RR, BGL, pain score, and temperature.
5. Reassure patient continuously throughout assessment and treatment.
6. Oxygen is NOT indicated at this stage — SpO2 96% on room air is above threshold; titrate only if SpO2 falls below 94%.
7. Confirm no contraindications to aspirin (no hypersensitivity, patient is 35 years old — over 16, not an active bleed).
8. Administer Aspirin 300mg oral — chewed or dissolved — for suspected ACS.
9. Confirm no contraindications to GTN: BP is 148/92 (systolic >90), HR 98 (within 50–150 range), no PDE5 inhibitor use, no hypersensitivity.
10. Administer GTN 400 microg (1 spray) sublingually — administer in seated or semi-recumbent position. Do not shake bottle.
11. Reassess BP before each subsequent GTN dose.
12. Reassess pain score 5 minutes after GTN — if pain remains >3/10, consider Methoxyflurane (Penthrox) 3mL inhaled via Penthrox inhaler for ongoing analgesia.
13. Administer Methoxyflurane 3mL via Penthrox inhaler (self-administered) if pain >3/10 post GTN and no contraindications (patient is alert, GCS 15, no head injury, no hypersensitivity to fluorinated anaesthetics).
14. Monitor patient continuously — record full observations every 10 minutes. Monitor for deterioration, dysrhythmia signs, or clinical worsening.
15. Request ambulance early — this is a Priority 1 transport given suspected ACS.
16. Perform IMISTAMBO handover on ambulance arrival.
17. Scenario ends on arrival of ambulance and IMISTAMBO handover.
18. Attention to hand hygiene will be given throughout the scenario.

Clinical references: Chest Pain / Acute Coronary Syndrome · Aspirin · Glyceryl Trinitrate (GTN) · Methoxyflurane · Oxygen

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Signs/Symptoms	Heavy, squeezing pressure in the centre of the chest. Associated mild shortness of breath and diaphoresis. Denies nausea or vomiting. Denies arm or jaw pain.
Allergies	Nil known allergies.
Medications	Nil regular medications.
Pertinent History	No prior cardiac history. Non-smoker. Father had a heart attack at age 52. No recent illness.
Last Oral Intake	Ate a meat pie and had a beer approximately 1 hour ago.
Events Leading	Patient was seated watching the AFL match when pain began without warning. He initially ignored it hoping it would pass but it persisted for 20 minutes with no improvement at rest.
Treatment Prior	Nil. Bystander assisted him to Gate 4 and called for EHS. No self-treatment.

Onset	Sudden onset approximately 20 minutes ago while seated watching the football. No exertional trigger — pain came on at rest.
Pain	Central chest — heavy, squeezing pressure.
Quality	Squeezing, pressure-like. Patient describes it as 'like someone sitting on my chest'.
Radiates	Nil radiation reported.
Severity	7/10 at rest.