COPD exacerbation at community festival

Patient Information

Dispatch: You are called to a 61YO female (Karen Elliot) who has presented to the FAP with increasing shortness of breath and wheeze. She states she has been struggling for the last 20 minutes.
Patient: Karen Elliot — 61yr (65kg)
Incident History: Pt was attending the Fremantle Street Festival when she began to feel increasingly short of breath. Pt states she has a history of COPD and ran out of her usual inhalers two days ago.
Emergency Contact: Michael Elliot (Husband) — 0412 774 381

Initial Rapid Assessment

Response: Alert
Airway: Patent. Nil airway obstruction. Nil stridor. Nil audible secretions.
Breathing: Increased work of breathing. Audible wheeze bilaterally. Speaking in short sentences only. RR elevated. Accessory muscle use noted.
Circulation: Radial pulse present, regular, slightly elevated. Skin warm and dry. Nil peripheral cyanosis. Central perfusion intact.
Disability: GCS 15 (E4V5M6). Alert and orientated to time, place and person. Anxious.
Exposure: Nil rashes, wounds or swelling noted. Pt is dressed appropriately for the weather. Nil tripod positioning but sitting forward in chair.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	88% (RA)	Moderate	24	102	138/88	<2s	15	4 4 ++	37.1	–	2
10 mins	91% (O2 NC 2L/min)	Mild	19	94	132/84	<2s	15	4 4 ++	37.1	–	1

History Taking

Treatment Response

Diagnosis

This patient is suffering from an acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD), precipitated by two days without her usual bronchodilator and anticholinergic inhalers, worsened by physical activity and environmental conditions at the festival.

Facilitator Triggers — if trainees miss a critical step

! (If oxygen is applied at high flow via non-rebreather mask without titration — patient's SpO2 climbs to 98% and after 5 minutes she becomes increasingly drowsy, RR drops to 14, GCS drops to 13. Facilitator states: 'Karen seems to be getting sleepier and less responsive.')
! (If the trainee does not position the patient upright or in a position of comfort — patient states 'I really need to sit up, it's much harder to breathe like this.')
! (If vital signs are not repeated at 10 minutes — facilitator prompts: 'Karen asks you if she is getting any better. What are your current observations?')
! (If the trainee does not administer salbutamol via MDI and spacer — facilitator prompts: 'Karen is in bronchospasm and her own inhaler has run out. What bronchodilator can you administer from the EHS kit?')

Treatment Objectives

1 Ensure scene safety and don appropriate PPE.
2 Perform Primary Survey — confirm patent airway, assess work of breathing, assess circulation.
3 Position patient upright or in a position of comfort to optimise respiratory mechanics.
4 Perform Vital Sign Survey — record RR, SpO2 (room air), BP, HR, GCS, and temperature.
5 Identify COPD history and absence of inhalers from history taking.
6 Apply oxygen therapy — commence via nasal cannula at 1–2 litres per minute. Titrate carefully to achieve target SpO2 of 88–92%. Do NOT administer high-flow oxygen via non-rebreather mask without monitoring SpO2 closely — risk of hypercapnic drive suppression.
7 Reassess SpO2 after 2–3 minutes of oxygen therapy and adjust flow rate as needed to maintain SpO2 88–92%.
8 Record full observations every 10 minutes and monitor for deterioration.
9 Administer Salbutamol via MDI and spacer — 4 puffs (400 microg) initially, with one puff per breath via spacer. Reassess response after 20 minutes; repeat up to 12 puffs if required per CPG. Confirm 6 medication rights: right patient, right drug, right dose, right route, right time, right documentation.
10 Reassess SpO2, RR, and work of breathing 5 minutes after salbutamol administration — document response.
11 Request ambulance via CSP if insufficient improvement with initial treatment.
12 Reassure patient continuously throughout the encounter.
13 Perform IMISTAMBO handover to incoming ambulance crew, including COPD diagnosis, current SpO2 on titrated oxygen, oxygen flow rate and mask type, absence of inhalers for 2 days, and clinical observations trend.
14 Scenario ends on arrival of ambulance and IMISTAMBO handover.
15 Attention to hand hygiene will be given throughout the scenario.

Clinical references: Chronic Obstructive Pulmonary Disease (COPD) — Acute Exacerbation · Oxygen · Oxygen Delivery · Pulse Oximetry · Primary Survey · Dyspnoea & Respiratory Distress

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