Chest pain at AFL match — suspected ACS

Patient Information

Dispatch: You are called to Gate 4 of Optus Stadium where a 54YO 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 — 54yr (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 audible wheeze or crackles. 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

Treatment Response

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 — for suspected ACS. Confirm 6 medication rights: right patient, right drug, right dose, right route, right time, right documentation.
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. Confirm 6 medication rights: right patient, right drug, right dose, right route, right time, right documentation.
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). Confirm 6 medication rights: right patient, right drug, right dose, right route, right time, right documentation.
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 urgent ambulance via CSP 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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