((If trainees do not assess distal neurovascular status — colour, warmth, movement, sensation, and CRT to the right foot — before and after splinting, prompt: 'The patient asks if her foot feels normal — what are you checking for?'))

((If trainees do not remove jewellery from the right ankle/foot before oedema develops, prompt: 'You notice a ring and ankle bracelet on her right foot — is there anything you should do with these?'))

((If trainees do not immobilise the joints above and below the injury site, prompt: 'The patient winces each time her leg moves slightly — what can you do to minimise movement?'))

((If trainees attempt to walk the patient or allow weight-bearing, prompt: 'Margaret tries to stand up saying she will be fine — how do you respond?'))

((If pain is not reassessed after splinting, prompt: 'It has been 10 minutes since you applied the splint — what assessments are still required?'))

This patient is suffering from a suspected right mid-shaft femur fracture following a mechanical fall at a community event.

• Ensure scene safety and don appropriate PPE.
• Perform Primary Survey — confirm patent airway, adequate breathing, and circulation. Identify deformity to right mid-thigh as the primary injury.
• Reassure Margaret continuously and instruct her not to bear weight or attempt to stand.
• Perform initial pain assessment — document pain score of 8/10.
• Assess and document distal neurovascular observations to the right foot BEFORE splinting: check CRT, skin colour and warmth, pedal pulse, sensation, and movement (CWMS).
• Remove any jewellery from the right lower limb (ankle bracelet) before swelling develops.
• Apply soft splinting using a pillow or blanket moulded around the right leg, securing with broad bandages above and below the injury site to immobilise the knee and hip — the joints above and below.
• Reassess and document distal neurovascular observations to the right foot AFTER splinting — confirm no new neurovascular compromise.
• Reassess pain score following splinting — document improvement.
• Position Margaret supine on the stretcher and keep her warm with a blanket.
• Perform full Secondary / CNS Survey to identify any other injuries from the fall.
• Record full observations every 10 minutes and monitor for signs of hypovolaemic shock (femur fractures can result in significant internal blood loss — up to 1.5L).
• Monitor for signs of ischaemia: pain, pallor, paresthesia, pulselessness, or cool/cold limb.
• Administer Methoxyflurane (Penthrox) 3mL via inhaler for pain management if pain score remains high and patient is able to self-administer — confirm patient is co-operative and able to understand instructions.
• Arrange Priority 1 transport and pre-notify receiving facility — time critical due to age, mechanism, and suspected femoral fracture.
• Scenario ends on arrival of ambulance and IMISTAMBO handover.
• Attention to hand hygiene will be given throughout the scenario.

Clinical references: Limb Trauma · Haemorrhage · Fractures & Dislocations — Splinting · Pain Assessment · Methoxyflurane (Penthrox) · Primary Survey · Secondary & CNS Survey