((If cooling is not commenced within the first 2 minutes of assessment: patient reports pain escalating to 9/10 and begins to show signs of increased distress — prompt trainee to apply cooling.))

((If the trainee attempts to remove clothing or jewellery from the burned area without first assessing for adherence: facilitator reminds trainee to check whether clothing or jewellery is adhered to the wound before removal.))

((If the trainee does not ask about inhalation injury risk — soot, hoarseness, singed hair — facilitator prompts: 'Is there anything about the mechanism of injury that concerns you regarding the airway?'))

((If the trainee fails to perform a pain assessment: patient asks 'Can you do anything for the pain?' — prompt analgesic consideration.))

((If the trainee does not check for circumferential burns: facilitator prompts 'Have you fully assessed the extent and distribution of the burn?'))

This patient is suffering from a superficial (partial thickness) burn injury to the right forearm and dorsum of the right hand, estimated at approximately 9% TBSA, caused by a thermal flash from a BBQ grill. There is no evidence of inhalation injury, circumferential burn, or systemic compromise. The burn does not meet the threshold for direct Burns Centre transfer or IV fluid replacement at this care level.

• Ensure scene safety and don appropriate PPE including gloves.
• Perform Primary Survey — confirm patent airway, adequate self-ventilating breathing, intact circulation, GCS 15.
• Assess for inhalation injury — inspect nasal and oral cavity for soot, assess for hoarseness, cough, singed nasal hair, stridor. None present in this patient.
• Document time of burn injury.
• Perform burn injury assessment using Rule of Nines — right forearm and dorsum of hand approximately 9% TBSA. Reddened, blistered skin consistent with superficial partial thickness burn.
• Assess burn depth and site — confirm no involvement of face, airway, perineum, genitalia, or joints. Confirm no circumferential burns.
• Cool the burn area with tepid water (optimal 15°C) for a minimum of 20 minutes continuously — do not use ice or ice water.
• While cooling: carefully remove right-hand jewellery (rings, watch) before oedema develops — check that items are not adhered to burned skin before removal.
• Remove clothing from burned area only if not adhered to the wound — do not force removal of adhered clothing.
• Perform Vital Sign Survey — HR, BP, RR, SpO2, temperature, GCS, pain score.
• Perform Secondary Survey — assess for any other injuries or burns not identified on primary assessment.
• Perform pain assessment — document pain score (7/10 initial).
• Administer Methoxyflurane (Penthrox) 3 mL inhaled via Penthrox inhaler — for moderate-to-severe pain (7/10). Instruct patient to self-administer, attach charcoal filter, attach wrist strap. Monitor for dizziness and over-sedation.
• After minimum 20 minutes of cooling: apply damp sterile dressings to burned area.
• Do NOT apply hydrogel dressing as a replacement for water cooling — water cooling is the preferred first-line method.
• Monitor patient persistently — record full observations every 10 minutes.
• Reassess pain score post analgesia (target improvement documented).
• Determine transport decision — 9% TBSA superficial burn in an adult does not meet the threshold for direct Tertiary Burns Centre transfer (threshold ≥10% TBSA). Arrange transport to nearest Emergency Department.
• Transport Priority 1 is NOT indicated for this patient — no airway involvement, no circumferential burns, no haemodynamic compromise. Arrange standard transport with pre-notification.
• Document time of burn injury, cooling duration, wound assessment findings, and all interventions on patient care record.
• Scenario ends on arrival of ambulance and IMISTAMBO handover.
• Attention to hand hygiene will be given throughout the scenario.

Clinical references: Burn Trauma · Methoxyflurane (Penthrox) · Oxygen Delivery · Primary Survey · Secondary & CNS Survey · Pain Assessment · Penthrox Inhaler Administration · Minor Wound Management