((If the trainee does not apply oxygen within 3 minutes of initial assessment, SpO2 drops to 88% and Mia becomes more distressed and stops speaking in phrases — mum becomes increasingly anxious.))

((If the trainee attempts to administer salbutamol MDI via spacer, facilitator reminds them to check their scope of practice — salbutamol for asthma/bronchospasm is Intermediate Care and above per the Asthma CPG. EHS may only assist the patient to use their OWN inhaler if clinically indicated and the patient has a prescribed device.))

((If the trainee does not recognise the moderate severity classification — accessory muscle use, unable to complete sentences, SpO2 90–94% — escalate urgency: Mia says 'I can't breathe properly' and Mum states 'she's getting worse'.))

((If oxygen is not titrated and instead administered at maximum flow without assessment, the facilitator notes SpO2 is 99% on NRB — prompt trainee to titrate to target ≥95% for paediatrics and reduce flow accordingly.))

((If BGL is not considered and primary survey is incomplete, Mia briefly appears slightly drowsy — prompt trainee to complete disability assessment and consider BGL.))

This patient is suffering from an acute viral-induced wheeze / lower respiratory tract illness presenting with moderate respiratory distress. At 8 years of age, this presentation is at the upper boundary of bronchiolitis (typically <2 years); the correct clinical classification is viral-induced wheeze or reactive airways disease in the context of a current URTI. EHS scope does not include salbutamol administration (Intermediate Care and above per Asthma CPG); the key EHS actions are recognition of moderate respiratory distress, appropriate oxygen titration, correct patient positioning, and urgent transport with pre-notification. The trainee must NOT administer salbutamol — this is outside EHS scope for asthma.

• Ensure scene safety and don appropriate PPE.
• Perform Primary Survey — identify patent airway, moderate respiratory distress with expiratory wheeze and subcostal/intercostal recession, SpO2 91% on room air.
• Position Mia upright or in a position of comfort — do NOT force posture change if child has adopted a preferred position.
• Apply oxygen therapy — commence non-rebreather mask at 10–15 L/min; titrate to achieve SpO2 ≥95% for paediatric patient as per Oxygen CPG.
• Conduct Vital Sign Survey — RR, SpO2, HR, BP, temperature, GCS, pain score.
• Assess respiratory distress severity using clinical features — Mia has moderate distress (accessory muscle use, audible wheeze, unable to complete sentences, SpO2 90–94% on RA).
• Recognise that salbutamol administration is OUTSIDE EHS scope for asthma exacerbation (Intermediate Care and above) — do NOT administer salbutamol independently.
• If Mia has her own prescribed salbutamol MDI and spacer with her, EHS may assist her to use her own medication as per the Asthma CPG — confirm she does NOT have a prescribed device with her at this event.
• Reassure Mia and her mother continuously throughout assessment and treatment.
• Monitor full observations every 10 minutes — record RR, SpO2, HR, BP, GCS, pain score, respiratory distress severity.
• Prepare for rapid deterioration — have BVM and suction available at bedside.
• Contact State Operations Centre to request Priority 1 ambulance — Mia is a paediatric patient with moderate respiratory distress and SpO2 91% on RA.
• Pre-notify receiving facility (Perth Children's Hospital) — paediatric patient, 8 years, 25 kg, moderate respiratory distress, expiratory wheeze, SpO2 91% RA improving to 96% on O2.
• Reassess 10-minute vitals — SpO2 96% on O2 10L NRB, RR 24, HR 108, reduced work of breathing. Continue oxygen and monitoring.
• Maintain oxygen therapy during transport — do not cease oxygen.
• Scenario ends on arrival of ambulance and IMISTAMBO handover.
• Attention to hand hygiene will be given throughout the scenario.

Clinical references: Asthma exacerbation · Dyspnoea & Respiratory Distress · Oxygen