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Scenario — Sudden onset neurological symptoms — suspected stroke
Patient Information
Dispatch
A 35YO 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.
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
Signs/Symptoms
Sudden onset severe headache, slurred speech, left-sided facial droop, weakness of left arm. Mild confusion.
Onset
Sudden onset approximately 20 minutes ago while stationary at the showgrounds.
Pain
Severe headache — sudden onset, 'worst headache of my life', located across the entire head.
Quality
Headache described as 'like something hit me in the head'. Constant.
Radiates
Nil radiation from headache.
Severity
6/10 pain score for headache.
Allergies
Nil known allergies.
Medications
Oral contraceptive pill (combined). No other regular medications.
Pertinent History
Nil prior episodes. Nil known cardiac conditions. Nil prior stroke or TIA. Non-smoker. Social alcohol only. Nil illicit drug use.
Last Oral Intake
Ate a meat pie and soft drink approximately 1 hour ago.
Treatment
Nil. Friend walked her directly to the FAP.
Events Leading
Patient was standing watching a livestock display at the Perth Royal Show when she developed a sudden severe headache followed rapidly by left-sided weakness and speech difficulty.
Scenario Progression and Treatment Objectives

((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?'))

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.

  • Ensure scene safety and don appropriate PPE.
  • 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.
  • Establish and document exact time of symptom onset — approximately 20 minutes ago (well within 9-hour window).
  • Perform Vital Sign Survey including GCS, BGL, SpO2, BP, RR, HR, temperature, and pupils.
  • Check BGL — result 6.2 mmol/L, ruling out hypoglycaemia as cause of altered conscious state.
  • Administer Oxygen only if clinically indicated — SpO2 97% on room air does not meet threshold; do NOT apply oxygen if SpO2 maintained ≥94%.
  • Recognise FAST+ criteria: Left facial droop (Face), Left arm weakness (Arms), Slurred speech (Speech), Onset <9 hours (Time) — patient is FAST+.
  • Recognise this is a time-critical presentation — minimise on-scene time.
  • Request Priority 1 ambulance immediately with pre-notification to receiving facility — communicate FAST+ findings, time of onset, and patient GCS.
  • Place patient in position of comfort — seated or semi-recumbent with head support; use lateral position if airway becomes compromised.
  • Provide continuous reassurance to patient and companion; keep patient calm and limit exertion.
  • Do NOT administer aspirin — haemorrhagic stroke cannot be excluded in the field.
  • Record full observations every 5 minutes given time-critical status and document all findings for IMISTAMBO handover.
  • 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.
  • Scenario ends on arrival of ambulance and IMISTAMBO handover.
  • 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)