((If the trainee does not move the patient to a cool environment or shade within the first 2 minutes, the patient's GCS drops to 12 and he becomes more agitated and difficult to manage.))

((If the trainee does not remove clothing and begin active cooling within 3 minutes, the patient's temperature rises to 40.4°C and he begins to shiver and becomes more confused.))

((If the trainee attempts to walk or stand the patient to assist cooling or transport, the patient's BP drops to 88/54 and he becomes pale and nearly loses consciousness.))

((If the trainee does not check BGL as part of vital sign survey, prompt: 'The patient is confused — is there anything else you would routinely check?'))

((If the trainee asks about seizures: advise that none have occurred yet but to monitor closely as seizures are a known complication of heat stroke.))

This patient is suffering from Heat Stroke — an excessive elevation of core body temperature with CNS dysfunction (confusion, altered GCS) that does not resolve with rest, occurring in the context of significant physical exertion in hot conditions.

• Ensure scene safety and don appropriate PPE.
• Perform Primary Survey — confirm patent airway, breathing adequate, assess circulation and disability.
• Move patient to coolest available environment at the FAP — shade, air-conditioned tent or cool area.
• Position patient supine.
• Perform Vital Sign Survey — GCS, SpO2, RR, BP, HR, temperature, BGL, pain score.
• Perform BGL — document 4.8 mmol/L; no glucose administration required.
• Apply supplemental oxygen if indicated to maintain SpO2 94–98% — nasal cannula 2–4 L/min or simple face mask 5–8 L/min as clinically required.
• STRIP — remove running shirt, shoes and socks to maximise skin surface exposure.
• SOAK — spray or sponge patient with tepid water across head, neck, torso and limbs.
• FAN — use available fan or manual fanning to promote evaporative heat loss.
• IMMERSE — apply ice packs to neck, groin and armpits if ice bath unavailable.
• COVER — cover patient with wet cold cloths and continue fanning.
• Provide small sips of water if patient is fully conscious (GCS 15) and able to safely swallow — do not force fluids given current GCS 13.
• Reassess GCS and temperature after 10 minutes of active cooling — expected improvement to GCS 14 and temperature 38.6°C.
• Consider antiemetic: if patient reports moderate to severe nausea, administer Ondansetron 4mg oral wafer.
• Monitor closely for seizure activity — manage as per Seizures CPG if seizure occurs while continuing active cooling.
• Record full observations every 10 minutes.
• Consider delaying transport by approximately 15 minutes to allow adequate active cooling prior to ambulance arrival.
• Continue active cooling during transport to hospital.
• Activate ambulance if no improvement in GCS or temperature after 15 minutes of active cooling, or if patient deteriorates.
• Scenario ends on arrival of ambulance and IMISTAMBO handover.
• Attention to hand hygiene will be given throughout the scenario.

Clinical references: Heat Stroke · Seizures · Oxygen · Ondansetron · Blood Glucose Monitor · Primary Survey · Tympanic Thermometer