((If trainee does not sit Mia upright within the first 2 minutes, she begins to lean forward onto her hands and reports feeling more breathless — prompt: 'What position would help this patient breathe more comfortably?'))

((If oxygen is not applied within 3 minutes of arrival, SpO2 drops to 89% on room air and Mia becomes more distressed and tearful.))

((If the trainee does not administer salbutamol via MDI and spacer, at 8 minutes Mia reports no improvement, wheeze becomes louder, and RR increases to 32 — facilitator states: 'Mia looks at you and says she is not getting any better.'))

((If trainee attempts to use a nebuliser rather than MDI and spacer, remind them: 'EHS volunteers are authorised to administer salbutamol via MDI and spacer only — nebulised route is outside EHS scope.'))

((If trainee does not contact the patient's emergency contact or request ambulance backup, facilitator prompts: 'The school principal asks if you need additional resources or if her mother should be called.'))

This patient is suffering from a moderate acute asthma exacerbation triggered by physical exertion.

• Ensure scene safety and don appropriate PPE including gloves.
• Perform Primary Survey — confirm patent airway, assess breathing severity, assess circulation.
• Sit Mia upright or in a position of comfort — do not allow her to lie flat.
• Apply pulse oximetry monitoring.
• Apply oxygen via simple face mask at 5–8 L/min — titrate to target SpO2 ≥95% for paediatrics.
• Conduct Vital Signs Survey — RR, SpO2, HR, BP, GCS, pain score.
• Classify asthma severity — moderate exacerbation (unable to complete sentences, accessory muscle use, SpO2 91%, RR 28).
• Perform history taking — SAMPLEA including allergy, medications, pertinent history.
• Administer Salbutamol 4–6 inhalations (400–600 microg) via MDI and spacer — indication: moderate acute asthma exacerbation in a paediatric patient aged 6 years and over.
• Assist Mia with correct technique: seal lips around spacer mouthpiece, press MDI once, take 4 slow deep breaths per puff, one puff at a time.
• Reassess SpO2, RR, work of breathing, and pain score 5 minutes after salbutamol administration.
• If inadequate response at 20 minutes, repeat salbutamol 4–6 inhalations (400–600 microg) via MDI and spacer.
• Contact emergency contact (mother Linh Nguyen — 0412 338 774) to inform of Mia's condition.
• Request ambulance backup (Priority 1 if deterioration; Priority 2 if improving but requires hospital review).
• Monitor persistently — record full observations every 10 minutes.
• Do NOT leave Mia unattended. Provide continuous reassurance to reduce anxiety.
• Prepare for rapid deterioration — have BVM and suction available at bedside.
• If Mia deteriorates to life-threatening features (reduced consciousness, cyanosis, silent chest, SpO2 <90%), escalate to Priority 1 and manage airway with BVM if required.
• Scenario ends on arrival of ambulance and IMISTAMBO handover.
• Attention to hand hygiene will be given throughout the scenario.

Clinical references: Asthma exacerbation · Salbutamol Sulphate · Oxygen · MDI & Space Chamber · Primary Survey · Pulse Oximetry