Sudden onset neurological symptoms — suspected stroke

Patient Information

Dispatch: A 52YO female (Mia Carrington) has been brought to the FAP by a friend at the Perth Royal Show. The friend says she suddenly started talking strangely and her face looks 'droopy' on one side.
Patient: Mia Carrington — 52yr (65kg)
Incident History: Pt was watching a show display with her friend when she suddenly complained of a headache, then her speech became slurred and her friend noticed her left arm 'went weak'. Onset approximately 20 minutes ago.
Emergency Contact: Daniel Carrington (Husband) — 0412 883 047

Initial Rapid Assessment

Response: Alert
Airway: Patent. Nil airway obstruction. Nil stridor. Mild pooling of saliva at left corner of mouth due to facial droop.
Breathing: Self-ventilating. Respiratory effort adequate. No accessory muscle use. No abnormal sounds.
Circulation: Radial pulse present — regular, moderate strength. Skin warm and dry. Nil external bleeding.
Disability: GCS 13 (E4V3M6). Confused — oriented to person only. Left facial droop noted. Left arm weakness on assessment. Slurred speech.
Exposure: Nil rashes, nil injuries, nil incontinence. Wearing casual clothing. Nil medic alert visible.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	97% (RA)	Nil	16	88	158/94	<2s	13	4 4 ++	36.8	6.2 mmol/L	6
10 mins	96% (RA)	Nil	17	92	162/96	<2s	12	4 4 ++	36.8	6.2 mmol/L	6

History Taking

Treatment Response

Diagnosis

This patient is suffering from a suspected acute cerebrovascular accident (stroke) with left-sided facial droop, left arm weakness, and dysphasia — onset within the last 20–30 minutes, placing her well within the 9-hour FAST+ window.

Facilitator Triggers — if trainees miss a critical step

! (If BGL is not checked within the first 5 minutes, the patient becomes more confused — GCS drops to 11 — and the facilitator states: 'Your partner asks whether you have ruled out hypoglycaemia.')
! (If the trainee does not note the time of symptom onset and document it, the facilitator prompts: 'The receiving hospital calls back and asks you — what time did symptoms start? You are unsure.')
! (If oxygen is applied unnecessarily to a patient with SpO2 97% on room air without clinical indication, prompt the trainee: 'What is your SpO2 target for this patient and is supplemental oxygen indicated?')
! (If the trainee attempts to administer any medication other than oxygen if indicated, prompt: 'What medications are you authorised to administer for this presentation?')
! (If urgent ambulance is not requested within 5 minutes of assessment, GCS drops to 11 and left arm becomes flaccid — facilitator states: 'The patient's condition is deteriorating. What is your transport priority?')

Treatment Objectives

1 Ensure scene safety and don appropriate PPE.
2 Perform Primary Survey — open, clear and maintain airway; note pooling of saliva and position patient appropriately (lateral position if airway at risk); assess breathing and circulation.
3 Establish and document exact time of symptom onset — approximately 20 minutes ago (well within 9-hour window).
4 Perform Vital Sign Survey including GCS, BGL, SpO2, BP, RR, HR, temperature, and pupils.
5 Check BGL — result 6.2 mmol/L, ruling out hypoglycaemia as cause of altered conscious state.
6 Administer Oxygen only if clinically indicated — SpO2 97% on room air does not meet threshold; do NOT apply oxygen if SpO2 maintained ≥94%. Confirm 6 medication rights: right patient, right drug, right dose, right route, right time, right documentation.
7 Recognise FAST+ criteria: Left facial droop (Face), Left arm weakness (Arms), Slurred speech (Speech), Onset <9 hours (Time) — patient is FAST+.
8 Recognise this is a time-critical presentation — minimise on-scene time.
9 Call CSP immediately for urgent ambulance support — communicate FAST+ findings, time of onset, and patient GCS to CSP.
10 Place patient in position of comfort — seated or semi-recumbent with head support; use lateral position if airway becomes compromised.
11 Provide continuous reassurance to patient and companion; keep patient calm and limit exertion.
12 Do NOT administer aspirin — haemorrhagic stroke cannot be excluded in the field.
13 Record full observations every 5 minutes given time-critical status and document all findings for IMISTAMBO handover.
14 Prepare IMISTAMBO handover: Identity — Mia Carrington, 35F; Mechanism — sudden onset neurological symptoms at public event; Injuries/Illness — suspected acute CVA with FAST+ findings, left facial droop, left arm weakness, dysphasia, GCS 13; Signs — BP 158/94, HR 88, SpO2 97% RA, BGL 6.2, GCS 13; Treatment — oxygen if indicated, monitoring; Allergies — Nil known; Medications — OCP; Background — Nil prior stroke/TIA, on OCP; Other — symptom onset approximately 20 minutes ago, within 9-hour window.
15 Scenario ends on arrival of ambulance and IMISTAMBO handover.
16 Attention to hand hygiene will be given throughout the scenario.

Clinical references: Stroke (Cerebrovascular Accident) · Primary Survey · Oxygen · Blood Glucose Monitor · Glasgow Coma Scale (GCS)

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