Scenario — Seizure at AFL match

foundation Neurological · Adult · 35yr · male

Patient Information

Dispatch	You are called to a patient (Marcus Doyle, 35YO 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 — 35yr (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

Scenario Progression and Treatment Objectives

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%.
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 Priority 1 transport and pre-notification of receiving facility.
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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Signs/Symptoms	Witnessed generalised tonic-clonic seizure. Post-ictal — drowsy and confused. No focal neurological deficit identified post-seizure.
Allergies	NKDA — confirmed by wife via phone.
Medications	Nil regular medications reported by wife.
Pertinent History	No known seizure history. No recent head trauma. Wife reports pt has been under significant work stress and had poor sleep over the past week. No alcohol consumed today.
Last Oral Intake	Meat pie and water approximately 1 hour prior.
Events Leading	Pt was seated in the southern grandstand watching the AFL game. He suddenly slumped and fell, with generalised shaking noted immediately after.
Treatment Prior	Bystanders placed pt in recovery position and called for EHS. No medications administered.

Onset	Sudden onset. Bystanders report no warning. Seizure lasted approximately 3 minutes before self-terminating on EHS arrival.
Pain	Unable to assess during seizure. Post-ictally pt states mild headache 3/10.
Quality	Generalised tonic-clonic activity — bilateral limb shaking, jaw clenched, eyes deviated upward during seizure.
Radiates	Nil
Severity	Seizure self-terminated at approximately 3 minutes. Post-ictal confusion present.