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Scenario — Acute asthma exacerbation in a child at a school sports carnival
Patient Information
Dispatch
You are called to the FAP at Hale Primary School Sports Carnival. A teacher has brought in an 8-year-old boy (Lachlan Tran) who is wheezing and struggling to breathe after competing in the 100m sprint.
Incident History
Pt was running the 100m sprint when he began coughing and wheezing. Teacher noticed he was struggling to breathe and walked him to the FAP. Pt states his chest feels tight.
Emergency Contact
Mai Tran (Mother) 0412 774 391
Initial Rapid Assessment
Response
Alert
Airway
Patent. Nil obstruction. Nil stridor. Audible wheeze on expiration.
Breathing
Increased work of breathing. Audible expiratory wheeze. Accessory muscle use visible at neck. Unable to speak in full sentences. RR 28/min. SpO2 91% on room air.
Circulation
Radial pulse present, regular, rate elevated. Skin warm and pink. CRT <2s.
Disability
GCS 15 (E4V5M6). Alert and orientated to time, place and person. Anxious.
Exposure
No rashes or visible injuries. Increased subcostal recession visible on chest wall.
Vitals
Time SpO2 Resp Dist RR Pulse BP CRT GCS PERL Temp BGL Pain
Initial 91% (RA) Severe 28 118 102/64 <2s 15 4 4 ++ – – 4
10 mins 96% (O2 simple mask 6L/min) Mild 20 108 104/66 <2s 15 4 4 ++ – – 2
History Taking
Signs/Symptoms
Wheeze, chest tightness, shortness of breath, cough during exertion.
Onset
Acute onset during 100m sprint approximately 10 minutes ago.
Pain
Chest tightness 4/10.
Quality
Tight, squeezing sensation across the chest.
Radiates
Nil.
Severity
4/10 chest tightness. Unable to speak in full sentences.
Allergies
No known drug allergies. Allergic to cats.
Medications
Salbutamol (Ventolin) puffer — prescribed for exercise-induced asthma. Left at home today.
Pertinent History
Known asthmatic diagnosed age 5. Predominantly exercise-induced. Normally well controlled. No prior ICU admissions or intubations. No recent ED visits.
Last Oral Intake
Sandwich and water approximately 1.5 hours ago at lunch.
Treatment
Nil. No puffer available at event.
Events Leading
Competing in the 100m sprint at school sports carnival. Began coughing and wheezing shortly after starting his run.
Scenario Progression and Treatment Objectives

((If oxygen is not applied within 2 minutes of assessment, SpO2 drops to 88% and the patient becomes more distressed, unable to speak more than 2-3 words at a time.))

((If salbutamol is not administered within 5 minutes, the patient's wheeze worsens audibly, RR increases to 32/min, and the patient begins to look exhausted.))

((If the trainee does not sit the patient upright and instead attempts to lay him down, the patient states 'it's harder to breathe like this' and becomes more agitated.))

((If the trainee fails to reassess after salbutamol administration, prompt them: 'It has been 5 minutes since the puffer — how is Lachlan doing now?'))

This patient is suffering from a severe acute asthma exacerbation, triggered by exercise, in a child with known asthma.

  • Ensure scene safety and don PPE.
  • Perform Primary Survey — identify severe asthma exacerbation with SpO2 91% on room air and accessory muscle use.
  • Position patient sitting upright or in a position of comfort — do NOT lay patient flat.
  • Apply oxygen via simple face mask at 5–8 L/min — titrate SpO2 to ≥95% for paediatrics.
  • Perform Vital Sign Survey including SpO2, RR, HR, BP, pain score.
  • Conduct SAMPLE history — confirm known asthma, no puffer available, exercise trigger.
  • Administer Salbutamol (Ventolin) via MDI and spacer: 2–6 inhalations (200–600 microg) for child aged 12 months to 5 years — NOTE: Lachlan is 8 years old (≥6 years), therefore administer 4–12 inhalations (400–1200 microg) via MDI and spacer.
  • Reassess SpO2, RR, work of breathing and wheeze 5 minutes after salbutamol administration.
  • Repeat salbutamol 4–12 inhalations via MDI and spacer every 20 minutes if required, or sooner if clinically indicated.
  • Record full observations every 10 minutes — document pre- and post-salbutamol respiratory status.
  • Contact State Operations Centre (SOC) / CSP for advice if patient does not respond to treatment or deteriorates.
  • Identify risk factors for asthma-related death — reassure if none identified but note no puffer on scene.
  • Call 000 for ambulance — patient has severe exacerbation features (unable to speak in full sentences, SpO2 91%, accessory muscle use).
  • Continue monitoring for deterioration — be alert for silent chest, falling GCS, or exhaustion indicating life-threatening exacerbation.
  • Scenario ends on arrival of ambulance and IMISTAMBO handover.
  • Attention to hand hygiene will be given throughout the scenario.

Clinical references: Asthma exacerbation · Salbutamol Sulphate · Oxygen · MDI & Space Chamber