((If haemorrhage control is not initiated within 2 minutes of assessment, the wound begins to bleed more actively — blood visibly pooling beneath the leg.))

((If oxygen is not applied within 3 minutes, SpO2 drifts to 94% on room air and the patient becomes more anxious and pale.))

((If distal neurovascular observations are not checked before and after splinting, prompt the trainee: 'The mother asks if his foot looks the right colour to you — what do you check?'))

((If signs of shock are not recognised and escalation is not considered, patient's pulse increases to 148 and he becomes drowsy — GCS drops to 14.))

((If traction splint is applied without first controlling haemorrhage from the laceration, prompt: 'You notice fresh blood is continuing to soak through — what do you do first?'))

This patient is suffering from a suspected right mid-shaft femur fracture with associated haemorrhage and early compensated hypovolaemic shock secondary to bicycle trauma.

• Ensure scene safety and don appropriate PPE — hand hygiene throughout.
• Perform Primary Survey with c-spine consideration — mechanism is consistent with possible spinal involvement; assess and document clinically.
• Identify catastrophic haemorrhage as the immediate priority — apply firm direct pressure to right mid-thigh laceration using trauma dressing.
• If direct pressure is insufficient to control haemorrhage, apply Combat Application Tourniquet (CAT) to right thigh — position at least 5cm proximal to wound, record time of application.
• Administer Oxygen via non-rebreather mask at 10–15 litres per minute — titrate to SpO2 target ≥95% for paediatrics.
• Assess and document distal neurovascular observations of right lower limb BEFORE splinting — pulse, colour, warmth, movement, sensation, capillary refill time.
• Expose the right leg fully — cut clothing, remove footwear.
• Apply appropriate traction splint to right femur fracture (Kendrick, Fernotrac, Sager, or Slishman) as per clinical skill — immobilise joint above and below injury.
• Reassess distal neurovascular observations AFTER splinting — document any change.
• Perform Vital Sign Survey — HR, BP, RR, SpO2, GCS, CRT. Recognise BP 88 systolic as hypotension in an 8-year-old (threshold: 70 + [2 x 8] = 86 mmHg — patient is at threshold, trending toward haemorrhagic shock).
• Administer Methoxyflurane (Penthrox) 3 mL inhaled — hand to patient to self-administer for pain management (patient 8 years old, 26 kg, able to cooperate — meets criteria for self-administration).
• Perform Secondary/CNS Survey — assess for additional injuries: right forearm abrasion, right shoulder road rash, abdomen, chest, pelvis.
• Dress right forearm abrasion with appropriate wound dressing; apply RICE to forearm.
• Keep patient warm — apply blankets to prevent hypothermia (injured paediatric patient at risk).
• Request ambulance via State Operations Centre — Priority 1 transport for time-critical paediatric trauma with haemorrhage and haemodynamic compromise.
• Record full observations every 5 minutes given time-critical status.
• Pre-notify receiving facility (Perth Children's Hospital for paediatric trauma <14 years) — advise suspected femur fracture, active haemorrhage, early compensated shock.
• Comfort and reassure patient continuously — keep mother involved and informed.
• Scenario ends on arrival of ambulance and IMISTAMBO handover.
• Attention to hand hygiene will be given throughout the scenario.

Clinical references: Haemorrhage · Limb Trauma · Trauma Management Principles · Major Trauma Guidelines · Hypovolemic Shock · Fractures & Dislocations · Combat Application Tourniquet (CAT) · Direct Pressure and Trauma bandages · Kendrick Traction Splint · Pain Assessment · Oxygen Delivery