Heat exhaustion in an 8-year-old girl at a school carnival

Patient Information

Dispatch: You are called to the FAP at Leeming Primary School Carnival. A teacher has brought in an 8-year-old girl (Mia Cartwright) who has been sitting in the sun all morning and is now feeling dizzy and unwell.
Patient: Mia Cartwright — 8yr (25kg)
Incident History: Pt has been participating in outdoor carnival activities since 0900 in direct sun. Teacher noticed Mia was pale, sweaty and complaining of a headache and feeling dizzy. Pt has had minimal water to drink since this morning.
Emergency Contact: Karen Cartwright (Mother) — 0412 387 194

Initial Rapid Assessment

Response: Alert
Airway: Patent. Nil airway obstructions. Nil airway swelling or stridor.
Breathing: Slightly increased rate. Nil wheeze or crackles. Speaking in full sentences.
Circulation: Rapid and weak radial pulse. Skin pale, cool and clammy. No visible bleeding.
Disability: GCS 15 (E4V5M6). Oriented to time, place and person. Complaining of headache and dizziness.
Exposure: Skin pale and diaphoretic. No rashes. No visible injuries. Wearing school sports uniform — no hat.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	98% (RA)	Nil	22	118	94/60	2s	15	4 4 ++	38.1	4.8 mmol/L	4
10 mins	99% (RA)	Nil	18	98	100/64	<2s	15	4 4 ++	37.6	5.2 mmol/L	2

History Taking

Treatment Response

Diagnosis

This patient is suffering from heat exhaustion secondary to prolonged sun exposure, physical exertion and inadequate fluid intake at an outdoor school carnival.

Facilitator Triggers — if trainees miss a critical step

! (If the trainee does not move Mia to a cool/shaded environment within the first 2 minutes, the facilitator advises: Mia says she feels more dizzy and her nausea is worsening — prompt the trainee to consider environment and cooling.)
! (If the trainee does not assess BGL, the facilitator advises: Mia's teacher mentions she has not eaten since breakfast — prompt the trainee to perform a BGL measurement.)
! (If the trainee does not offer oral fluids, the facilitator advises: Mia asks 'Can I have some water?' — prompt trainee to consider conscious state and suitability for oral rehydration.)
! (If the trainee does not monitor for altered conscious state or signs of heat stroke, the facilitator advises: At 8 minutes, Mia becomes more confused and does not answer correctly when asked what year it is — prompt reassessment and escalation consideration.)
! (If cooling measures are not applied within 5 minutes, the facilitator advises: Mia's skin remains hot and dry and her temperature rises to 38.5°C — prompt active cooling measures.)

Treatment Objectives

1 Ensure scene safety and don appropriate PPE.
2 Perform Primary Survey — Airway, Breathing, Circulation, Disability, Exposure.
3 Move patient to a cool, shaded environment immediately — inside the FAP or a shaded area away from direct sun.
4 Position patient supine (lying flat) as appropriate for comfort and haemodynamic support.
5 Perform Vital Signs Survey including temperature, BGL, SpO2, HR, RR, BP, GCS.
6 Assess BGL — result 4.8 mmol/L, within normal range, no glucose gel required.
7 Apply cooling measures — STRIP: remove excess clothing (e.g. sports top if appropriate and with consent); SOAK: spray or apply cool/tepid water to skin; FAN: actively fan patient to promote evaporative heat loss; apply cold packs to neck, groin and armpits.
8 Provide oral fluids — Mia is GCS 15 and fully conscious; offer water to drink in small, frequent sips.
9 Consider Oxygen if clinically indicated as per CPG — SpO2 98% on RA, oxygen not required at this time.
10 Reassess vital signs at 10 minutes — expect improvement in HR, BP, temperature and GCS with correct cooling and hydration.
11 Contact patient's emergency contact (Karen Cartwright, 0412 387 194) to advise of presentation.
12 Monitor closely for signs of heat stroke — altered mental state, inability to coordinate, seizures, worsening temperature — escalate if present.
13 Record full observations every 10 minutes.
14 Advise school staff and parent that Mia should rest, continue hydrating and avoid further sun exposure for the remainder of the day.
15 Consider transport to hospital if symptoms do not improve within 15–20 minutes of active cooling and oral rehydration, or if any signs of heat stroke develop.
16 Scenario ends on arrival of ambulance (if escalated) and IMISTAMBO handover.
17 Attention to hand hygiene will be given throughout the scenario.

Clinical references: Heat Stroke

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