Scenario — Stimulant overdose at a music festival

intermediate Toxicology · Adult · 35yr · male

Patient Information

Dispatch	You are called to a 35YO male (Dylan Hartley) found agitated and behaving erratically near the main stage. Bystanders report he may have taken something.
Patient	Dylan Hartley — 35yr (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

Scenario Progression and Treatment Objectives

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 SOC.)
! (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 Priority 1 transport.)
! (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.
11. Do NOT induce vomiting.
12. Do NOT attempt to administer any medication beyond EHS scope (no sedation, no antiemetics unless nausea/vomiting present — if vomiting develops, consider Ondansetron 4mg oral wafer).
13. Reassess vital signs every 10 minutes — monitor HR, BP, temperature, GCS, and SpO2.
14. Contact SOC CSP for advice and to arrange Priority 1 ambulance 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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Signs/Symptoms	Agitation, paranoia, palpitations, sweating, feeling hot, rapid heartbeat.
Allergies	NKDA.
Medications	Nil regular medications.
Pertinent History	Nil significant past medical history. Drinks alcohol socially. Friends confirm he 'took a pill' at the festival. Unknown substance — friends suspect MDMA or methamphetamine.
Last Oral Intake	Alcohol — 2 beers approximately 2 hours ago. Water intermittently.
Events Leading	Patient was dancing at the main stage. Approximately 45 minutes ago he took an unknown substance offered by another attendee. Friends noticed he became increasingly agitated and paranoid, reporting his heart was racing.
Treatment Prior	Nil. Friends have been with him and guided him away from the crowd.

Onset	Approximately 45 minutes ago. Symptoms developed quickly after ingestion.
Pain	Chest tightness rated 3/10. No crushing or radiating pain.
Quality	Palpitations described as 'heart pounding out of my chest'. Chest tightness and feeling of anxiety.
Radiates	Nil radiation reported.
Severity	Agitation 7/10. Palpitations 6/10.