((If the non-blanching rash is not identified or the glass test is not performed within the first 3 minutes of assessment, mum points to the rash and asks 'Is this serious? It wasn't there this morning.' — cue trainees to inspect and perform glass test))

((If oxygen is not applied within 3 minutes of initial assessment, GCS drops to 11 and RR increases to 32 — facilitator announces 'Mia is becoming more drowsy and her breathing is getting faster'))

((If BGL is not checked, facilitator prompts: 'You notice Mia looks pale and is not responding normally — is there anything else you want to check?'))

((If the parent refusing transfer is not addressed with de-escalation, mum states loudly 'I am taking her home, she just needs rest, you can't make me do anything' — trainees must use calm, non-confrontational communication and explain the life-threatening nature of the rash clearly and compassionately without threatening language))

((If mum continues to refuse after explanation, trainees must escalate to CSPSOC and request ambulance dispatch Priority 1 — facilitator can prompt: 'You have explained the situation. What do you do if she still refuses?'))

((If the 10-minute vitals show deteriorating GCS and trainees have not yet requested ambulance, facilitator announces 'Mia's eyes are harder to open and she is not responding to your voice as well as before'))

((If the BGL of 3.5–3.8 mmol/L is noted but glucose gel is not considered, facilitator prompts: 'Mia's BGL is borderline — what is your threshold for treatment and is this patient able to safely swallow?' — note: at GCS 11–13 oral glucose gel safety must be assessed; if GCS drops to ≤12 it should not be administered orally))

This patient is suffering from suspected meningococcal septicaemia presenting with a non-blanching petechial rash, fever, altered conscious state, photophobia, neck stiffness, and haemodynamic compromise consistent with Red Flag sepsis in a paediatric patient.

• Ensure scene and FAP safety — don appropriate PPE including gloves and mask given potential infectious aetiology
• Perform Primary Survey — airway patent, breathing tachypnoeic, circulation compromised with mottling and weak rapid pulse
• Apply high-flow oxygen via non-rebreather mask at 10–15 L/min — titrate to SpO2 94–98%
• Perform glass test on petechial rash — confirm non-blanching; identify this as a Red Flag sign for meningococcal septicaemia
• Perform full Vital Signs Survey including GCS, RR, HR, BP, SpO2, temperature, BGL, CRT, and pain score
• Assess BGL — result 3.8 mmol/L; patient currently GCS 13 and oriented to person; do NOT administer oral glucose gel at this time as conscious state is insufficient (GCS <15) and is deteriorating — monitor BGL closely and reassess
• Identify Red Flag sepsis criteria: altered mental state (GCS 13), tachycardia (HR 138), tachypnoea (RR 28), hypotension (BP 88/60), reduced SpO2 (95% RA), non-blanching rash — document Red Flag sepsis on ePCR
• Activate Priority 1 ambulance via CSPSOC immediately — do not delay for any treatment steps; meningococcal septicaemia is a time-critical emergency
• Pre-notify receiving facility (Perth Children's Hospital preferred for paediatric patient) — advise suspected meningococcal septicaemia, Red Flag sepsis, non-blanching petechial rash, GCS 13, haemodynamic compromise
• De-escalate parent (Linh Tran) using calm, empathetic, non-confrontational language — acknowledge her concerns, explain clearly that the non-blanching rash is a sign of a life-threatening condition that requires immediate hospital care, and that time is critical for Mia's survival and outcome
• If parent continues to refuse, escalate to CSPSOC for guidance — document refusal attempts and escalation clearly; do not use threatening or coercive language; involve event management if available for additional support
• Position Mia semi-recumbent or in a position of comfort — do not lay flat given altered conscious state and risk of vomiting/aspiration
• Monitor GCS, RR, HR, BP, SpO2, CRT, and BGL every 5 minutes given time-critical status — document all observations
• Prepare suction and BVM at bedside — anticipate potential deterioration in conscious state and airway compromise
• Do NOT administer paracetamol — this is outside EHS scope as an IV medication and the oral route is not appropriate given the patient's deteriorating conscious state and risk of vomiting
• Maintain continuous reassurance to both Mia and her mother throughout — keep environment calm, dim lighting where possible given photophobia
• Await ambulance; prepare IMISTAMBO handover including: name/age/weight, suspected meningococcal septicaemia, non-blanching rash location and distribution, time of rash onset, current GCS, vital signs trend, Red Flag sepsis documented, parent initially refused transfer, oxygen applied, ambulance pre-notification made
• Scenario ends on arrival of ambulance and IMISTAMBO handover
• Attention to hand hygiene will be given throughout the scenario.

Clinical references: Sepsis · Disturbed & Abnormal Behaviour · Unconsciousness · Seizures · Primary Survey · Blood Glucose Monitor · Oxygen Delivery · Glucose Oral Gel · Glasgow Coma Scale (GCS) · Secondary & CNS Survey · Tympanic Thermometer · Pulse Oximetry