((If trainees do not collect and bag the blister pack for dose/agent identification — patient's friend reports 'she had more tablets in her bag earlier, I don't know if there were any more packs' — prompt trainees to search the immediate area and secure all medication packaging in the green and white patient medications bag))

((If trainees attempt to induce vomiting — the patient begins to gag but no vomit is produced; facilitator states firmly: 'Do not induce vomiting — this is contraindicated in poisoning management'))

((If trainees do not assess BGL in a patient with altered GCS — patient's confusion worsens slightly and she becomes more drowsy, GCS drops to 12 — prompting trainees to complete the full vital signs survey including BGL))

((If trainees do not attempt to clarify the agent, dose, and time of ingestion — the friend volunteers: 'I think she might have taken some other tablets too but I'm not sure' — prompting a thorough SAMPLE history and medication search))

((If oxygen is not applied within 4 minutes — SpO2 drifts to 94% RA and RR increases to 16, prompting trainees to apply supplemental oxygen))

((If trainees do not consider the intentional nature of the overdose and patient safety — facilitator prompts: 'The patient becomes tearful and says she just wanted everything to stop for a while' — trainees must not leave the patient alone and must address the emotional context in their management))

This patient is suffering from a suspected intentional paracetamol overdose (approximately 8g — 16 x 500mg tablets) of unknown exact timing, with an altered conscious state secondary to possible co-ingestion or emotional distress, requiring urgent supportive management, scene safety assessment, agent/dose/time documentation, and Priority 1 transport to ED.

• Ensure scene safety — approach from a safe position, check for additional hazards (other substances, unsafe environment behind stage)
• Don appropriate PPE including gloves prior to patient contact
• Perform Primary Survey — assess DRSABCD systematically
• Open and maintain airway — confirm patent, no suction required at this time
• Apply oxygen via non-rebreather mask at 10–15 litres per minute — titrate to maintain SpO2 94–98%
• Assess and record GCS — document as GCS 13 (E3V4M6)
• Perform full Vital Signs Survey — HR, BP, RR, SpO2, BGL, temperature, pain score, pupils
• Conduct BGL — result 4.8 mmol/L, within normal range, no glucose gel indicated
• Perform Secondary Survey — assess for additional injuries, rashes, or signs of co-ingestion toxidromes
• Obtain IMISTAMBO history — identify Agent (paracetamol 500mg), Dose (estimated 8g — 16 tablets), Route (oral), Time since ingestion (estimated 1–2 hours), and Clinical Features
• Do NOT induce vomiting — contraindicated in poisoning management
• Do NOT attempt to neutralise or dilute the substance at this stage — beyond 10-minute window guidance applies only to corrosives/acids
• Collect all medication packaging — place in green and white patient medications bag for dose/agent calculation at ED
• Remain with patient at all times — do not leave unattended given suspected intentional ingestion and emotional distress
• Remove contaminated clothing if indicated — not required in this scenario (oral ingestion only)
• Position patient in lateral position if conscious state deteriorates further (GCS drops below manageable level) — currently GCS 13, maintain seated or semi-recumbent position with airway monitoring
• Repeat vital signs every 10 minutes — document trends and monitor for deterioration
• Contact State Operations Centre to advise of suspected intentional overdose — consider WAPOL notification for patient welfare if clinically appropriate
• Consider contacting Australian Poisons Information Centre (PIC) on 13 11 26 for specific paracetamol overdose guidance if transport is delayed
• Reassure patient continuously — address distress sensitively, do not leave patient alone
• Prepare for Priority 1 transport — pre-notify receiving ED of: 35YO female, suspected intentional paracetamol overdose approximately 8g (16 x 500mg tablets), timing uncertain 1–2 hours ago, GCS 13, haemodynamically stable, no vomiting, BGL 4.8, oxygen applied
• Scenario ends on arrival of ambulance and IMISTAMBO handover
• Attention to hand hygiene will be given throughout the scenario.

Clinical references: Poisons & Overdoses · Unconsciousness · Oxygen Delivery · Primary Survey · Secondary & CNS Survey · Blood Glucose Monitor · Pulse Oximetry · Lateral Position