((If the EHS officer does not perform a BGL — remind them that any patient presenting with significant pain and altered behaviour/distress should have a full vital sign survey including BGL to exclude other causes.))

((If pain assessment is not performed before and after analgesia — prompt the trainee: 'How do you know if your treatment is working?'))

((If Methoxyflurane is not offered within 5 minutes of assessment and pain score confirmed ≥4 — patient becomes increasingly distressed and begins dry retching, making assessment more difficult.))

((If nausea and vomiting are not addressed with Ondansetron — patient vomits again at the 8-minute mark, increasing her distress and asking 'Is there anything you can give me for the vomiting?'))

((If the EHS officer attempts to administer a medication outside EHS scope such as opioid analgesia or IV fluids — facilitator prompts: 'What medications are you authorised to administer at this event?'))

((If the EHS officer does not arrange ambulance transport — patient asks 'Do I need to go to hospital?' Facilitator expects trainee to recognise this requires hospital assessment and arrange Priority transport.))

This patient is suffering from suspected renal colic (ureteric calculus), presenting with severe right flank pain radiating to the groin, nausea, and vomiting in an otherwise haemodynamically stable adult female.

• Ensure scene and personal safety — don appropriate PPE.
• Perform Primary Survey — confirm patent airway, adequate breathing, circulation intact, GCS 15.
• Position patient in a position of comfort — seated or semi-recumbent as tolerated; do not leave patient standing.
• Perform full Vital Sign Survey — HR, BP, RR, SpO2, BGL, temperature, pain score.
• Record pain score prior to analgesia: 9/10.
• Prepare and administer Methoxyflurane (Penthrox) 3 mL inhaled via Penthrox inhaler device — for moderate to severe pain. Attach charcoal filter. Hand device to patient. Instruct patient to self-administer by inhaling through the mouthpiece. Onset of pain relief expected after 6–10 inhalations.
• Reassess pain score after Methoxyflurane administration — expect improvement to approximately 5/10 at 10 minutes.
• Administer Ondansetron 4 mg oral wafer — for active nausea and vomiting. Allow wafer to dissolve on tongue. Do not exceed 8 mg within 8 hours. Second dose may be given after 15 minutes if patient remains symptomatic.
• Monitor patient persistently — record full observations every 10 minutes.
• Reassess for clinical deterioration: monitor for fever (which may indicate infected stone — sepsis risk), worsening hypotension, altered conscious state, or inability to tolerate oral medications.
• Arrange ambulance transport to hospital for definitive assessment and management — this condition is beyond EHS definitive treatment capability.
• Prepare IMISTAMBO handover including: identity (Sarah Nguyen, 35F), mechanism/complaint (sudden onset right flank pain radiating to groin, nausea, vomiting), injuries/findings (suspected renal colic, haemodynamically stable), signs (HR 94, BP 122/80, SpO2 98% RA, GCS 15, pain 5/10 post analgesia), treatment (Methoxyflurane 3 mL inhaled, Ondansetron 4 mg oral wafer), allergies (NKDA), medications (OCP), other (nil significant past history).
• Scenario ends on arrival of ambulance and IMISTAMBO handover.
• Attention to hand hygiene will be given throughout the scenario.

Clinical references: Methoxyflurane · Ondansetron · Pain Assessment · Primary Survey · Pulse & Respirations · Blood Pressure · Pulse Oximetry · Blood Glucose Monitor · Tympanic Thermometer