((If scene safety and personal safety are not considered first — patient becomes more combative and attempts to leave the FAP. Prompt trainee: 'What is your priority before approaching this patient?'))

((If temperature is not assessed within the first 5 minutes — patient begins to shiver then becomes more confused. Facilitator states: 'The patient's skin now feels extremely hot to touch and she is less responsive.'))

((If BGL is not checked — facilitator prompts: 'What other assessment should you perform given her altered GCS?'))

((If the trainee attempts to administer any oral medication while GCS is 13 and patient is agitated — remind trainee that safe oral ingestion requires GCS 15/15 and patient cooperation.))

((If cooling measures are not initiated within 5 minutes of temperature assessment — GCS drops to 11 and RR increases to 28 at the 10-minute vitals mark.))

((If trainee attempts to administer a medication outside EHS scope such as a sedative or IV fluid — facilitator states: 'That medication/intervention is outside your scope. What can you do within your authorised scope?'))

((If an IMISTAMBO handover is not prepared as ambulance arrives — facilitator prompts: 'The ambulance crew is here. What information do you hand over?'))

This patient is suffering from sympathomimetic toxicity consistent with stimulant (MDMA/methamphetamine-type) overdose, presenting with tachycardia, hypertension, hyperthermia, dilated pupils, agitation, diaphoresis, and deteriorating GCS.

• Ensure personal safety and scene safety — approach only when patient is seated and not posing immediate danger to self or crew. Request Police assistance via State Operations Centre if patient becomes violently combative.
• Perform Primary Survey — airway patent, breathing rapid but adequate, circulation intact with tachycardia, disability GCS 13 with dilated pupils, expose for diaphoresis and temperature assessment.
• Apply pulse oximetry monitoring continuously.
• Administer Oxygen via non-rebreather mask at 10–15 litres per minute — titrate to maintain SpO2 94–98%.
• Perform full Vital Signs Survey including tympanic temperature — document tachycardia HR 132, hypertension BP 158/100, elevated temp 38.8°C, RR 24, GCS 13.
• Perform blood glucose level (BGL) — result 5.4 mmol/L, no treatment required for hypoglycaemia.
• Attempt to identify the agent involved — question friends for description of the pill, time of ingestion, dose, and any other substances taken. Place any packaging in patient medications bag if available.
• Initiate active cooling measures — remove excess clothing, apply cool wet cloths to neck, groin and axilla, fan the patient. Do NOT immerse in ice bath at this temperature (38.8°C), but prepare for escalation if temperature rises.
• Position patient in a position of comfort — seated or semi-recumbent. Do NOT restrain unless essential to prevent injury to patient or crew. Use minimum force necessary if restraint is required.
• Use de-escalation techniques continuously — calm, quiet communication. Reassure patient and reduce stimulation in the environment.
• Perform ongoing monitoring — repeat full observations every 5 minutes given potential for rapid deterioration. Document deteriorating GCS to 11 at 10 minutes.
• Contact State Operations Centre / Clinical Support Paramedic early — advise of suspected stimulant toxicity, deteriorating GCS, hyperthermia, and request Priority 1 ambulance with pre-notification to receiving ED.
• Do NOT administer any oral medication — patient GCS and agitation preclude safe oral administration. Methoxyflurane is contraindicated as patient is unable to cooperate and has altered conscious state.
• Do NOT induce vomiting.
• Collect all medication packaging and personal effects — place in green and white patient medications bag.
• Prepare IMISTAMBO handover for ambulance crew — include: suspected sympathomimetic toxicity, unknown pill ~90 min ago, HR 148, BP 162/104, temp 39.4°C, GCS 11, cooling initiated, no medications administered by EHS.
• Scenario ends on arrival of ambulance and IMISTAMBO handover.
• Attention to hand hygiene will be given throughout the scenario.

Clinical references: Poisons & Overdoses · Disturbed & Abnormal Behaviour · Heat Stroke · Unconsciousness · Primary Survey