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Scenario — Febrile seizure in a child at a school carnival
Patient Information
Dispatch
You are called to the FAP at Riverside Primary School Spring Carnival. A parent has carried in an 8-year-old girl (Mia Cartwright) who had a shaking episode at the jumping castle. She is now drowsy and the parent is very distressed.
Incident History
Mia was at the jumping castle when her mum noticed she suddenly went stiff and started shaking for approximately 2 minutes. Shaking has now stopped. She has been unwell with a cold and runny nose since yesterday.
Emergency Contact
Sarah Cartwright (Mother) 0412 847 391
Initial Rapid Assessment
Response
Voice
Airway
Patent. No airway obstruction. No stridor. Mouth clear — no vomit or secretions noted.
Breathing
Breathing spontaneously. Unlaboured. Mild increase in rate. No accessory muscle use.
Circulation
Radial pulse present, regular, slightly elevated rate. Skin warm and flushed. No active bleeding. CRT 2s.
Disability
GCS 12 (E3V3M6). Drowsy, confused, not orientated to time, place or person. Post-ictal state. Pupils equal and reactive to light.
Exposure
No rash. No visible injuries. Skin warm and dry to touch. No urticaria or wheals.
Vitals
Time SpO2 Resp Dist RR Pulse BP CRT GCS PERL Temp BGL Pain
Initial 97% (RA) Nil 22 118 96/60 2s 12 3 3 ++ 38.9 5.4 mmol/L –
10 mins 99% (O2 simple face mask 6L/min) Nil 18 106 98/62 2s 14 3 3 ++ 38.9 5.4 mmol/L –
History Taking
Signs/Symptoms
Drowsy and confused following a tonic-clonic shaking episode lasting approximately 2 minutes. Now in post-ictal state. Warm and flushed skin.
Onset
Seizure commenced suddenly approximately 5 minutes prior to EHS arrival. Mum reports Mia stiffened then shook for around 2 minutes before going floppy and becoming drowsy.
Pain
Nil reported — patient unable to reliably self-report due to drowsiness.
Quality
Generalised tonic-clonic episode per mum's description — whole body involvement, eyes rolled back.
Radiates
Nil
Severity
Nil pain score obtainable at this time.
Allergies
Nil known allergies.
Medications
Nil regular medications.
Pertinent History
Has been unwell since yesterday with a runny nose, sore throat and low-grade temperature. No prior seizure history. No known epilepsy. No head injury. No recent overseas travel.
Last Oral Intake
Ate a sausage sizzle and had a juice box approximately 1 hour ago.
Treatment
Mother placed Mia on her side after the shaking stopped. No medications given.
Events Leading
Mia was playing on the jumping castle with friends. Mum noticed she suddenly stopped moving, went rigid, then began shaking. Mia fell to the side and mum caught her. Shaking lasted about 2 minutes then stopped and Mia became limp and drowsy.
Scenario Progression and Treatment Objectives

((If trainee does not place Mia in the lateral position immediately on arrival — Mia begins to produce excess secretions and there is a risk of airway compromise. Prompt the trainee: 'Mia is making gurgling sounds.'))

((If trainee does not obtain a BGL — facilitator prompts: 'The mum asks you if low blood sugar could have caused the shaking.'))

((If trainee does not measure temperature — facilitator prompts: 'Mia feels very hot to touch. The mum mentions she had a warm forehead this morning.'))

((If trainee attempts to place an OPA in a patient who is responding to voice and showing signs of gag — facilitator prompts: 'Mia grimaces and gags when you attempt to insert the airway adjunct. What do you do now?'))

((If trainee does not monitor persistently for a second seizure — at 8 minutes, have Mia briefly stiffen and eye-roll for 5 seconds then settle, requiring reassessment and updated documentation.))

This patient is suffering from a febrile seizure, now in a post-ictal state, with an underlying febrile illness (likely viral upper respiratory tract infection).

  • Ensure scene safety and don appropriate PPE.
  • Perform Primary Survey — confirm airway patent, no active seizure, spontaneous breathing.
  • Position Mia in the lateral position to maintain airway and allow drainage of secretions.
  • Prepare suction equipment and have it at bedside — suction only if secretions present and airway at risk.
  • Apply SpO2 monitoring and assess pulse oximetry.
  • Administer Oxygen via simple face mask at 5–8 L/min, titrating to maintain SpO2 ≥95% in paediatrics.
  • Obtain full Vital Signs Survey: GCS, BGL, SpO2, RR, HR, BP, Temperature.
  • Record BGL — result 5.4 mmol/L, within normal range, no glucose gel required.
  • Record tympanic temperature — result 38.9°C, consistent with febrile illness.
  • Perform Secondary and CNS Survey once seizure has terminated and patient is stable.
  • Obtain SAMPLE history from mother: no known epilepsy, no prior seizures, febrile illness since yesterday, no medications, no allergies.
  • Do NOT actively cool Mia by sponging — this will increase temperature via shivering.
  • Do NOT attempt to force an airway adjunct into the patient's mouth if she is responsive and showing a gag reflex.
  • Monitor persistently — repeat full observations every 10 minutes.
  • Assess for recurrence of seizure activity throughout the scenario — if recurrence, protect from injury, maintain lateral position, reassess airway.
  • Reassure and de-escalate the distressed mother — explain what a febrile seizure is in simple terms and that Mia is being monitored.
  • Recognise this seizure was approximately 2 minutes duration (not prolonged >5 minutes) — Priority 1 transport criteria not yet met but ambulance should be requested given paediatric seizure and post-ictal state.
  • Request ambulance and prepare for IMISTAMBO handover.
  • Document time of seizure onset, duration, and post-ictal observations in patient care record.
  • Scenario ends on arrival of ambulance and IMISTAMBO handover.
  • Attention to hand hygiene will be given throughout the scenario.

Clinical references: Seizures · Oxygen Delivery · Blood Glucose Monitor · Tympanic Thermometer · Lateral Position · Suction · Oropharyngeal Airway · Primary Survey · Secondary & CNS Survey · Glasgow Coma Scale (GCS) · Pulse Oximetry