((If trainees do not irrigate the wound before dressing — prompt: 'The wound is contaminated with glass particles from the crate — what do you need to do before dressing?' Facilitator note: irrigation with clean water or saline removes debris and significantly reduces infection risk. This is a critical step before closure.))

((If trainees do not assess for a foreign body — prompt: 'You can see the wound base now — is there anything you should be looking for?' Facilitator note: a glass fragment is visible. Visible, accessible foreign bodies should be removed. The patient should be informed that glass can be difficult to detect fully and medical review with possible X-ray is required.))

((If trainees do not assess tendon function — prompt: 'The laceration is at the base of the thumb — what structures are nearby that you should check?' Expected: trainee should ask patient to flex the thumb, flex and extend fingers, and compare grip strength. All are intact in this scenario.))

((If trainees do not assess sensation — prompt: 'The median nerve runs in this area of the palm — is there anything you should check?' Expected: assess sensation on the palmar surface of the thumb and index finger. Sensation is intact in this scenario.))

((If trainees attempt to suture or deeply probe the wound — redirect: 'Apply wound closure strips to approximate the wound edges and arrange appropriate medical follow-up.'))

Laceration to the thenar eminence of the right dominant hand from a glass foreign body. Approximately 3–4cm, gaping wound edges. Wound requires irrigation, foreign body assessment, and closure strips — the wound requires wound closure strips and medical follow-up for formal closure. Tendon and median nerve function are intact in this scenario but must be assessed. A glass shard is visible at the wound base.

• Ensure scene safety — glass shard risk to both patient and EHS officer; move away from crate area.
• Don appropriate PPE — gloves essential for blood exposure.
• Perform Primary Survey — confirm no life-threatening haemorrhage. Bleeding is capillary, not arterial.
• Apply initial direct pressure to control bleeding while preparing for wound assessment.
• Remove and replace the cloth — inspect the wound under clean conditions.
• Irrigate the wound thoroughly with clean running water or saline — remove debris, blood, and glass particles. Irrigation is the single most important infection prevention measure.
• Identify and remove the visible glass shard using forceps if available — do NOT deeply probe the wound. Inform patient that glass foreign bodies can be difficult to fully detect and medical review with possible X-ray is recommended.
• Assess wound depth and structure involvement — estimate depth, look for exposed structures (tendon, bone, or fat).
• Assess tendon function — ask patient to flex and extend all fingers and the thumb independently; compare grip strength bilaterally. Document normal function.
• Assess sensation — light touch to the palmar surface of the thumb and index finger (median nerve territory). Document intact sensation bilaterally.
• Assess radial and ulnar pulses — both intact.
• Apply wound closure strips (steristrips) to approximate gaping wound edges — do not close under tension. This is a temporary measure.
• Apply a non-adherent dressing and a clean dry bandage wrap. The wound will require formal medical closure (sutures or tissue glue) — arrange urgent GP or Emergency Department review.
• Advise patient: seek medical review within 4–6 hours for formal wound closure; watch for signs of infection (increasing redness, warmth, pus, fever); confirm tetanus status with her GP.
• Offer Methoxyflurane if pain is significant and patient is cooperative.
• Document all findings — wound description, foreign body removed, neurovascular assessment results, advice given.
• Scenario ends when wound is dressed and patient is advised on follow-up.
• Attention to hand hygiene will be given throughout the scenario.

Clinical references: Wound Management · Primary Survey · Secondary & CNS Survey · Methoxyflurane · Bleeding Control