((If trainees do not palpate along the bony prominences — patient volunteers 'it really hurts right here' pointing to the lateral ankle. Prompt: 'What specific structures would you palpate to help differentiate a sprain from a fracture?'))

((If trainees do not assess neurovascular status of the foot — prompt: 'Before applying any bandage, what else should you check about his foot?'))

((If trainees escalate to calling CSP or ambulance without completing assessment — prompt: 'Before calling for support, what does your assessment tell you? What specific findings suggest fracture?'))

((If trainees do not initiate RICE — ankle swelling visibly worsens over 5 minutes. Prompt: 'Is there anything you can do right now to help limit the swelling?'))

Right ankle lateral ligament sprain (inversion mechanism). No bony tenderness over the malleoli or base of 5th metatarsal on palpation in this scenario. This is a soft tissue injury within EHS scope — no ambulance required unless fracture is suspected on assessment.

• Ensure scene safety and don appropriate PPE.
• Perform Primary Survey — confirm no life-threatening injuries; patient alert with intact airway, breathing, and circulation.
• Obtain brief history — establish mechanism (inversion/roll), time of injury, and whether any other body parts were injured in the fall.
• Inspect the ankle — note swelling, bruising, and intact skin over the lateral ankle.
• Palpate systematically — assess for bony tenderness over the distal fibula (lateral malleolus), distal tibia (medial malleolus), base of 5th metatarsal, and navicular bone; nil bony tenderness at these sites in this scenario.
• Assess neurovascular status — confirm sensation, voluntary movement (wiggle toes, dorsiflex/plantarflex), and CRT of the foot and toes; confirm pedal pulse present.
• Assess weight-bearing ability — patient is currently unable to bear full weight; do not force weight bearing.
• Document pain score — 6/10 at rest.
• Initiate RICE: Rest (no weight bearing), Ice or cold pack (wrapped, 10–15 minutes on, not directly on skin), Compression (crepe or elastic bandage from toes to mid-calf), Elevation (raise foot and ankle above hip level where possible).
• Consider Methoxyflurane (Penthrox) for pain management if pain is significant and patient is cooperative and able to self-administer.
• Advise patient — this presentation is consistent with a lateral ankle ligament sprain; fracture cannot be excluded without X-ray and he should be assessed by a medical practitioner; do not return to walking around the event unassisted.
• Monitor and reassess neurovascular status and pain score periodically while at FAP.
• If bony tenderness is identified on reassessment, neurovascular deficit develops, or pain significantly escalates — contact CSP for further advice.
• Scenario ends when patient is comfortable, RICE has been applied, and advice on further care has been given.
• Attention to hand hygiene will be given throughout the scenario.

Clinical references: Soft Tissue Injuries · Primary Survey · Secondary & CNS Survey · Penthrox Inhaler Administration