Stimulant overdose at a music festival

Patient Information

Dispatch: You are called to a 21YO male (Dylan Hartley) found agitated and behaving erratically near the main stage. Bystanders report he may have taken something.
Patient: Dylan Hartley — 21yr (80kg)
Incident History: Pt found by friends acting paranoid and increasingly aggressive. Friends state he took 'something at the festival' approximately 45 minutes ago. Pt is sweating heavily and has been saying his heart is 'racing out of his chest'.
Emergency Contact: Brooke Hartley (Partner) — 0412 558 204

Initial Rapid Assessment

Response: Alert
Airway: Patent. No obstructions. No stridor. Patient talking loudly and rapidly.
Breathing: Rapid and shallow. No audible wheeze. Accessory muscle use not observed.
Circulation: Pulse rapid and strong. Skin flushed and diaphoretic. No external bleeding.
Disability: GCS 14 (E4V4M6). Agitated and paranoid. Not fully oriented to time — believes the event is still in the early afternoon (it is evening). Oriented to place and person.
Exposure: Dilated pupils bilaterally. Diaphoretic. No rashes or visible injuries. Pt is hot to touch.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	97% (RA)	Mild	22	130	158/102	<2s	14	6 6 SL	38.6	5.8 mmol/L	3
10 mins	96% (RA)	Moderate	26	142	164/108	<2s	13	6 6 SL	39.1	5.8 mmol/L	4

History Taking

Treatment Response

Diagnosis

This patient is suffering from sympathomimetic toxicity consistent with stimulant overdose (suspected MDMA or methamphetamine ingestion).

Facilitator Triggers — if trainees miss a critical step

! (If temperature is not assessed within 5 minutes, advise the facilitator to inform trainees that the patient begins complaining of feeling 'really hot' and starts to remove clothing — prompt temperature reassessment.)
! (If trainees attempt to administer any medication other than those within EHS scope — e.g. attempt to give patient their own medication, benzodiazepines, or other agents — remind trainees that EHS scope is Primary Care only and no specific antidote or sedative is authorised for EHS.)
! (If de-escalation and positioning are not addressed and the patient's agitation is not managed, the patient becomes more aggressive — RASS escalates to +3 — and trainees must consider calling for police/security via CSP.)
! (If trainees do not reassess vitals at 10 minutes, advise that the patient's HR has increased to 142 and temperature has risen to 39.1°C — prompt trainees to consider active cooling and urgent ambulance via CSP.)
! (If cooling measures are not initiated — i.e. trainees do not remove excess clothing and attempt to cool the patient — temperature rises to 39.4°C at 15 minutes and patient develops a brief generalised tremor, prompting discussion of seizure risk.)

Treatment Objectives

1 Ensure scene safety — assess for risks from the agitated patient and the festival environment before approaching.
2 Don appropriate PPE.
3 Perform Primary Survey — assess DRSABCD, establish GCS.
4 Apply pulse oximetry and obtain initial vital signs including temperature and BGL.
5 Attempt de-escalation — approach calmly, use non-confrontational tone, reduce external stimuli where possible (move away from loud music/crowd).
6 Position patient in a cool, shaded area. Have patient sit or lie down to reduce exertion.
7 Assess toxidrome — recognise sympathomimetic features: dilated pupils, tachycardia, hypertension, diaphoresis, agitation, elevated temperature.
8 Collect all available information — ask friends about substance taken, time of ingestion, amount, and any other substances including alcohol.
9 Active cooling: remove excess clothing, apply cool packs to neck, axillae and groin, fan patient, provide water to drink if GCS 15 and able to tolerate safely.
10 Administer Oxygen via nasal cannula at 1–4 L/min to maintain SpO2 94–98% — titrate to clinical response. Confirm 6 medication rights: right patient, right drug, right dose, right route, right time, right documentation.
11 Do NOT induce vomiting.
12 If vomiting develops, consider Ondansetron 4mg sublingual tablet.
13 Reassess vital signs every 10 minutes — monitor HR, BP, temperature, GCS, and SpO2.
14 Contact CSP for advice and to arrange urgent ambulance via CSP response given tachycardia, hypertension, elevated temperature and deteriorating GCS.
15 Monitor for seizure activity — if seizure occurs, manage airway, protect from injury, and manage as per Seizures CPG.
16 Maintain calm, reassuring communication with patient throughout.
17 Scenario ends on arrival of ambulance and IMISTAMBO handover.
18 Attention to hand hygiene will be given throughout the scenario.

Clinical references: Poisons & Overdoses · Heat Stroke · Seizures · Disturbed & Abnormal Behaviour · Oxygen · Ondansetron

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