Prolonged seizure in a child at a school carnival

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

Treatment Response

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/urgent ambulance via CSP 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 urgent ambulance via CSP indication
11 Activate urgent ambulance via CSP response immediately; advise CSP of findings 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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