Scenario — Prolonged seizure in a child at a school carnival

foundation Neurological · Pediatric · 8yr · male

Patient Information

Dispatch	You are called to an 8-year-old male (Liam Hartley) who has collapsed and is shaking near the jumping castle at Riverside Primary School's end-of-year carnival. Bystanders report he has been seizing for approximately 3 minutes.
Patient	Liam Hartley — 8yr (26kg)
Incident History	Liam was running near the jumping castle when he suddenly dropped to the ground and began convulsing. A teacher has been with him since onset. Bystanders state he is known to have epilepsy.
Emergency Contact	Sarah Hartley (Mother) — 0412 583 247

Initial Rapid Assessment

Response	Unresponsive
Airway	Partially obstructed — jaw clenched (trismus present), saliva pooling at corner of mouth. No visible foreign body. No stridor.
Breathing	Irregular, shallow, laboured. Accessory muscle use visible. RR approximately 10 breaths/min during seizure activity.
Circulation	Rapid, weak central pulse palpable. Skin flushed and warm. No visible external bleeding.
Disability	GCS 6 (E1V2M3) — unresponsive to voice, groaning, motor extension to pain. Active tonic-clonic limb movements ongoing. Not orientated.
Exposure	No visible rashes, no head injury noted. Clothing intact. No medic alert jewellery visible on initial inspection.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	88% (RA)	Moderate	10	130	100/65	2s	6	4 4 SL	37.4	4.8 mmol/L	–
10 mins	97% (O2 NRB 10L/min)	Mild	18	112	102/66	<2s	10	4 4 ++	37.4	4.8 mmol/L	–

History Taking

Scenario Progression and Treatment Objectives

Diagnosis

This patient is suffering from a prolonged generalised tonic-clonic seizure (duration 5 minutes) with associated hypoxia, in a child with known epilepsy.

Facilitator Triggers — if trainees miss a critical step

! (If trainees attempt to force an OPA into the fitting patient's mouth — prompt: 'The patient's jaw is clenched. What airway adjunct is appropriate for trismus?')
! (If trainees do not apply oxygen within 2 minutes of arrival — SpO2 drops to 84% on RA and cyanosis becomes visible around the lips)
! (If trainees do not place Liam in the lateral position once the seizure terminates — simulate vomiting at 6 minutes post-arrival)
! (If BGL is not checked post-ictally — facilitator prompts: 'Liam's mum asks if his sugar levels are okay, as he sometimes goes low')
! (If trainees do not call for ambulance/Priority 1 transport by 5 minutes — seizure has met the prolonged criteria of >5 minutes; facilitator reminds: 'How long has this seizure been going now?')

Treatment Objectives

1. Ensure scene safety — move hazardous objects away from Liam, pad beneath his head for protection
2. Restrain only if needed to prevent injury — do NOT forcibly restrain active seizure activity
3. Perform Primary Survey — identify unresponsive, compromised airway, hypoxic, active seizure
4. Manage airway — do NOT force OPA due to trismus; insert NPA (size by measuring corner of nostril to earlobe) with lubricant
5. Apply oxygen via non-rebreather mask at 10–15 L/min — target SpO2 ≥95% for paediatric patient
6. Place Liam in lateral position once seizure terminates to maintain airway and allow drainage of secretions
7. Suction oropharynx if secretions or vomit present using Yankauer/Penguin device
8. Perform full Vital Signs Survey including GCS, BGL, SpO2, temperature, RR, HR, BP
9. Check BGL — result 4.8 mmol/L; no glucose gel indicated at this level
10. Note total seizure duration — seizure met criteria for prolonged (>5 minutes); this is a Priority 1 transport indication
11. Activate Priority 1 ambulance response immediately; pre-notify receiving facility of prolonged paediatric seizure
12. Repeat vital signs at 10 minutes — document improvement in GCS, SpO2, and RR
13. Perform Secondary and CNS Survey once seizure has terminated — assess for injuries (tongue, head), check pupils, assess limb function
14. Reassure Liam post-ictally and maintain calm quiet environment
15. Contact emergency contact (mother Sarah Hartley — 0412 583 247) to advise of situation
16. Continue monitoring every 5 minutes given time-critical status — GCS, SpO2, RR, HR, BP
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 · Lateral Position · Oxygen Delivery · Suction · Blood Glucose Monitor · Glasgow Coma Scale (GCS) · Primary Survey · Secondary & CNS Survey

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Signs/Symptoms	Active tonic-clonic seizure on arrival. Post-ictal confusion and drowsiness once seizure terminates at approximately 5 minutes. Groaning, eyes opening to voice by 10 minutes.
Allergies	NKDA — confirmed by mother via phone.
Medications	Sodium valproate daily for epilepsy — mother states he took his dose this morning.
Pertinent History	Known epilepsy diagnosed age 5. Normally seizure-free for 18 months. No recent illness. No head injury. No fever reported at home today.
Last Oral Intake	Sausage sizzle and water approximately 1 hour prior.
Events Leading	Liam had been running and playing at the carnival for approximately 2 hours. Was observed to suddenly stop, fall, and begin seizing.
Treatment Prior	Teacher placed Liam in recovery position and cleared surrounding area. No medications given.

Onset	Sudden onset approximately 3 minutes prior to EHS arrival. Total seizure duration approximately 5 minutes.
Pain	Unable to assess during seizure. Post-ictally Liam reports mild headache — 3/10.
Quality	Generalised tonic-clonic movements involving all four limbs. Incontinence of urine noted post-seizure.
Radiates	Nil
Severity	Prolonged generalised seizure — duration 5 minutes. Hypoxia present on arrival.