((If the trainee allows the patient to walk or stand and mobilise at any point — patient immediately complains of worsening headache, nausea, and begins to vomit. Reinforce: DO NOT walk the patient.))

((If the trainee does not apply Pressure Immobilization Technique within 5 minutes — at the 10-minute mark, patient reports the tingling sensation has spread to the groin and he is feeling increasingly drowsy. GCS drops to 13.))

((If the trainee attempts to apply a CAT tourniquet instead of a PIT bandage — facilitator states 'The patient grimaces and says that feels very tight — it's cutting off circulation.' Prompt the trainee to reconsider and use the correct technique.))

((If the trainee attempts to wash, cut, or suck the bite site — facilitator states 'You move toward the wound' and provides a verbal prompt: 'Is that the correct approach for snakebite first aid?'))

((If the trainee does not splint the limb after PIT application — patient shifts position and bends knee, facilitator prompts: 'The patient is moving his leg to get comfortable — what else can you do to minimise movement?'))

((If the trainee removes the PIT bandage before hospital handover — facilitator states 'The patient says the bandage feels tight — do you remove it?' Correct answer: No. DO NOT remove prior to arrival at hospital unless authorised by ASMA.))

This patient is suffering from a suspected snakebite with early signs of envenomation — presenting with bite site pain, developing headache, nausea, and tingling/paraesthesia ascending the bitten limb approximately 20 minutes post-bite.

• Ensure scene safety — confirm snake is no longer present in the immediate area before approaching patient.
• Perform Primary Survey — Airway, Breathing, Circulation, Disability, Exposure.
• Instruct patient to remain STILL — do not allow patient to walk or stand at any point during assessment or treatment.
• Conduct Vital Sign Survey — GCS, SpO2, RR, BP, HR, CRT, pupils, temperature.
• Perform Secondary/CNS Survey — assess bite site on right ankle, note puncture marks, assess for signs of envenomation including nausea, headache, tingling, visual disturbances, weakness, or drooling.
• Apply Pressure Immobilization Technique (PIT) to the right lower limb — commence bandaging from the toes and extend upward as far as possible covering the entire limb, using a snakebite bandage with continuous indicator tensioned to achieve 1.5cm x 1.5cm squares. Firm compression — unable to easily slide a finger beneath bandage.
• Mark the bite site location clearly on the outside of the PIT bandage with a marker.
• Splint the right lower limb to further minimise movement — immobilise in position of comfort.
• Administer oxygen via appropriate mask — titrate to maintain SpO2 94–98%. Apply nasal cannula at 1–4 L/min or simple face mask at 5–8 L/min as clinically indicated.
• Monitor patient persistently — record full observations every 10 minutes, monitoring closely for signs of respiratory depression, increasing weakness, descending eyelids, difficulty speaking or swallowing, altered GCS.
• Do NOT remove PIT bandage or splint prior to arrival at hospital.
• Do NOT attempt to catch, kill, or identify the snake.
• Reassure patient continuously — explain procedures calmly and advise he must remain still.
• Arrange Priority 1 transport with pre-notification of receiving facility — state suspected snakebite with early signs of envenomation, PIT applied, vital signs.
• Scenario ends on arrival of ambulance and IMISTAMBO handover.
• Attention to hand hygiene will be given throughout the scenario.

Clinical references: Snakebite · Pressure Immobilisation Technique (P.I.T) · Primary Survey · Pulse Oximetry · Oxygen Delivery · Secondary & CNS Survey