Seizure at AFL match — ScenarioLab

Patient Information

Dispatch: You are called to a patient (Marcus Doyle, 31YO male) who has been found on the ground shaking near the southern grandstand. Bystanders report he has been seizing for approximately 2 minutes.
Patient: Marcus Doyle — 31yr (80kg)
Incident History: Bystanders state pt was watching the game when he suddenly fell from his seat, became rigid, then began shaking all four limbs. No known history of epilepsy reported by bystanders. Seizure activity still ongoing on EHS arrival.
Emergency Contact: Brooke Doyle (Wife) — 0412 774 309

Initial Rapid Assessment

Response: Unresponsive
Airway: Airway at risk — jaw clenched (trismus). Secretions pooling in oropharynx. No stridor audible.
Breathing: Irregular, shallow. Accessory muscle use visible. RR approximately 10. SpO2 86% on room air.
Circulation: Radial pulse rapid and weak. Skin flushed and diaphoretic. No external bleeding.
Disability: GCS 6 (E1V1M4) — no eye opening, no verbal response, withdraws to pain. Not orientated. Actively seizing on arrival.
Exposure: No rashes or visible injuries. No medic alert bracelet noted. Urinary incontinence present.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	86% (RA)	Moderate	10	118	140/90	2s	6	5 5 SL	37.8	5.4 mmol/L	–
10 mins	97% (O2 NRB 15L/min)	Mild	14	98	128/82	<2s	11	4 4 ++	37.8	5.4 mmol/L	–

History Taking

Treatment Response

Diagnosis

This patient is suffering from a generalised tonic-clonic seizure (now post-ictal) of unknown aetiology, with hypoxia secondary to impaired ventilation during seizure activity.

Facilitator Triggers — if trainees miss a critical step

! (If airway is not managed within 60 seconds — secretions increase, SpO2 drops to 80%, patient begins to cyanose around lips. Prompt trainees: 'What does his airway look like right now?')
! (If oxygen is not applied within 2 minutes of seizure cessation — SpO2 remains at 86% and respiratory rate drops to 8. Prompt trainees: 'His sats haven't improved — what can you do?')
! (If BGL is not checked — patient remains post-ictally confused and the facilitator states: 'The patient's wife calls out — he's a diabetic, I forgot to mention that!' Prompt trainees to recheck BGL and reconsider hypoglycaemia as a cause.)
! (If patient is not placed in lateral position following seizure cessation — patient begins to retch. Prompt trainees: 'He's starting to gag — what's your concern and what do you do?')
! (If temperature is not measured — facilitator prompts: 'Is there anything else you want to assess given his vital signs?')

Treatment Objectives

1 Ensure scene safety — confirm pt cannot injure himself on seating or structural hazards. Move hazardous objects away.
2 Protect patient from injury whilst actively seizing — pad beneath head, do not restrain limbs forcefully.
3 Complete Primary Survey — identify airway at risk due to trismus and secretions.
4 Attempt to insert Nasopharyngeal Airway (NPA) — indicated due to trismus preventing OPA insertion. Select appropriate size (measure corner of nose to earlobe). Lubricate and insert via right nostril with gentle twisting action.
5 Position patient in lateral position immediately following seizure cessation to allow drainage of secretions and protect airway.
6 Apply suction using Yankauer catheter to clear oropharyngeal secretions — maximum 5 seconds per pass.
7 Administer Oxygen via Non-Rebreather Mask at 10–15 L/min — target SpO2 94–98%. Confirm 6 medication rights: right patient, right drug, right dose, right route, right time, right documentation.
8 Perform full Vital Signs Survey — GCS, BGL, SpO2, RR, BP, HR, temperature.
9 Check Blood Glucose Level — BGL 5.4 mmol/L, no hypoglycaemia treatment required. Document result.
10 Reassess GCS post-ictally — note improvement as patient enters post-ictal phase.
11 Repeat vital signs every 10 minutes.
12 Assess for secondary injuries — inspect head, tongue, limbs for trauma sustained during seizure.
13 Complete Secondary/CNS Survey once seizure has terminated — assess pupil response, limb strength, sensation.
14 Gather SAMPLE history from bystanders and via phone to wife — no known seizure history, no regular medications, NKDA.
15 Monitor persistently for recurrent seizure activity — this would indicate urgent ambulance via CSP and IMISTAMBO handover to CSP.
16 Arrange transport to hospital for first-seizure workup — all first-seizure presentations require medical review.
17 Scenario ends on arrival of ambulance and IMISTAMBO handover.
18 Attention to hand hygiene will be given throughout the scenario.

Clinical references: Seizures · Nasopharyngeal Airway · Oropharyngeal Airway · Suction · Lateral Position · Oxygen Delivery · Blood Glucose Monitor · Glasgow Coma Scale (GCS) · Primary Survey · Secondary & CNS Survey

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