Trauma

Ankle sprain after stepping off raised platform at outdoor concert

Foundation

Adult · 22yr · male

Patient Information

Dispatch	You are called to a 22-year-old male (Tyler Brooks) who has been helped to the FAP at the outdoor concert grounds after twisting his right ankle stepping off a raised platform edge.
Patient	Tyler Brooks — 22yr (78kg)
Incident History	Patient stepped sideways off the edge of a raised temporary stage platform (approximately 20cm step) while trying to move to a better viewing position. His right ankle rolled inward and he fell to the ground. Bystanders helped him hop to the FAP. No loss of consciousness. No other injuries reported.
Emergency Contact	Mia Brooks (Partner) — 0412 331 874

Initial Rapid Assessment

Response	Alert
Airway	Patent. Speaking in full sentences. No airway concerns.
Breathing	Comfortable. RR 14. No increased work of breathing. SpO2 99% on room air.
Circulation	Radial pulse strong and regular. Skin warm and dry. CRT <2s.
Disability	GCS 15 (E4V5M6). Alert and orientated. Anxious and frustrated. No neurological deficit.
Exposure	Right ankle — visible swelling forming over the lateral malleolus and anterior ankle. Bruising beginning to develop laterally. Skin intact, no open wounds or deformity. Tenderness on palpation of the lateral ligament complex.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	99% (RA)	Nil	14	84	118/72	<2s	15	4 4 ++	36.7	–	6

History Taking

Treatment Response

Diagnosis

Right ankle lateral ligament sprain (inversion mechanism). No bony tenderness over the malleoli or base of 5th metatarsal on palpation in this scenario. This is a soft tissue injury within EHS scope — no ambulance required unless fracture is suspected on assessment.

Facilitator Triggers — if trainees miss a critical step

! (If trainees do not palpate along the bony prominences — patient volunteers 'it really hurts right here' pointing to the lateral ankle. Prompt: 'What specific structures would you palpate to help differentiate a sprain from a fracture?')
! (If trainees do not assess neurovascular status of the foot — prompt: 'Before applying any bandage, what else should you check about his foot?')
! (If trainees escalate to calling CSP or ambulance without completing assessment — prompt: 'Before calling for support, what does your assessment tell you? What specific findings suggest fracture?')
! (If trainees do not initiate RICE — ankle swelling visibly worsens over 5 minutes. Prompt: 'Is there anything you can do right now to help limit the swelling?')

Treatment Objectives

1. Ensure scene safety and don appropriate PPE.
2. Perform Primary Survey — confirm no life-threatening injuries; patient alert with intact airway, breathing, and circulation.
3. Obtain brief history — establish mechanism (inversion/roll), time of injury, and whether any other body parts were injured in the fall.
4. Inspect the ankle — note swelling, bruising, and intact skin over the lateral ankle.
5. Palpate systematically — assess for bony tenderness over the distal fibula (lateral malleolus), distal tibia (medial malleolus), base of 5th metatarsal, and navicular bone; nil bony tenderness at these sites in this scenario.
6. Assess neurovascular status — confirm sensation, voluntary movement (wiggle toes, dorsiflex/plantarflex), and CRT of the foot and toes; confirm pedal pulse present.
7. Assess weight-bearing ability — patient is currently unable to bear full weight; do not force weight bearing.
8. Document pain score — 6/10 at rest.
9. Initiate RICE: Rest (no weight bearing), Ice or cold pack (wrapped, 10–15 minutes on, not directly on skin), Compression (crepe or elastic bandage from toes to mid-calf), Elevation (raise foot and ankle above hip level where possible).
10. Consider Methoxyflurane (Penthrox) for pain management if pain is significant and patient is cooperative and able to self-administer.
11. Advise patient — this presentation is consistent with a lateral ankle ligament sprain; fracture cannot be excluded without X-ray and he should be assessed by a medical practitioner; do not return to walking around the event unassisted.
12. Monitor and reassess neurovascular status and pain score periodically while at FAP.
13. If bony tenderness is identified on reassessment, neurovascular deficit develops, or pain significantly escalates — contact CSP for further advice.
14. Scenario ends when patient is comfortable, RICE has been applied, and advice on further care has been given.
15. Attention to hand hygiene will be given throughout the scenario.

Clinical references: Soft Tissue Injuries · Primary Survey · Secondary & CNS Survey · Penthrox Inhaler Administration

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Signs/Symptoms	Right ankle pain, swelling, and bruising following inversion (rolling inward) injury. Unable to bear full weight at time of injury.
Allergies	NKDA.
Medications	Nil regular medications.
Pertinent History	No prior ankle injuries. No bone conditions. Plays recreational football. Generally fit and well.
Last Oral Intake	Beer and a burger approximately 90 minutes ago.
Events Leading	Patient was moving through a busy outdoor concert crowd and stepped off the edge of a raised temporary platform. Right ankle rolled inward (inversion) and he fell, landing on the ankle.
Treatment Prior	Bystander applied a cold drink can to the lateral ankle immediately after the injury.

Onset	Immediate following stepping off raised platform approximately 20 minutes ago.
Pain	Sharp, localised pain over the right lateral ankle and anterior ankle region.
Quality	Sharp and aching. Constant, worse on attempted movement or weight bearing.
Radiates	Nil radiation.
Severity	6/10 at rest, 8–9/10 on weight bearing.