((If trainees allow the patient to walk or stand to reach the stretcher — patient begins to feel lightheaded and nauseous, HR increases to 110. Remind trainees: do NOT walk the patient.))

((If Pressure Immobilisation Technique is not applied within 5 minutes of assessment — patient begins to develop mild tingling in the right calf and reports feeling slightly weak in the leg. Prompt trainee: 'The patient asks if she should have something wrapped around her leg.'))

((If trainees attempt to cut, suck, or wash the bite site — facilitator stops them and asks: 'Is that recommended for snakebite management?'))

((If trainees attempt to apply a tourniquet — facilitator intervenes: 'What is the difference between a tourniquet and the Pressure Immobilisation Technique for snakebite?'))

((If trainees do not immobilise the limb with a splint after PIT — patient moves her foot to 'get comfortable'. Prompt: 'Can you keep the limb as still as possible?'))

((If trainees do not mark the bite site on the bandage — facilitator prompts: 'Is there anything else you should document on the bandage itself?'))

((If patient is not continuously reassured and kept calm — her RR increases to 22 and she becomes more distressed. Remind trainees that anxiety increases lymphatic flow and venom spread.))

This patient is suffering from a suspected snakebite with potential envenomation to the right lower limb. No overt signs of systemic envenomation are present at this time, however all Australian snakebites must be treated as potentially life-threatening until proven otherwise at a medical facility.

• Ensure scene safety — confirm snake is no longer present and maintain safe perimeter around bushline area.
• Perform Primary Survey — confirm airway patent, breathing adequate, circulation present, GCS 15.
• Keep patient completely at rest — do NOT allow patient to walk or stand. Bring equipment and stretcher to patient.
• Continuously reassure patient to reduce anxiety and minimise lymphatic flow.
• Apply Pressure Immobilisation Technique (PIT) to right lower limb — commence bandaging from toes/foot distally and extend as far up the limb as possible using snakebite bandage with continuous indicator. Bandage should be firm: unable to easily slide finger beneath, similar tension to bandaging a sprained joint.
• Mark the bite site location on the outside of the PIT bandage with a pen/marker.
• Apply splint to right lower limb to further minimise movement.
• Assess distal neurovascular observations to right foot post-PIT application: capillary refill, colour, warmth, movement and sensation to toes.
• Conduct full Vital Signs Survey: GCS, SpO2, RR, BP, HR, CRT — monitor closely for respiratory depression.
• Perform thorough IMISTAMBO history: signs/symptoms, allergies (nil known), medications (OCP), pertinent history (nil), last oral intake, events leading.
• Do NOT remove PIT bandage or splint prior to hospital arrival.
• Do NOT attempt to trap, identify, or kill the snake.
• Do NOT cut, incise, suck, or wash the bite site.
• Do NOT apply an artery tourniquet (CAT) — PIT is the correct technique for snakebite.
• Monitor patient persistently — record full observations every 10 minutes, with close attention to any new neurological symptoms (drooping eyelids, difficulty speaking/swallowing, limb weakness, visual disturbance), worsening respiratory effort, or deteriorating GCS.
• Arrange Priority 1 transport to nearest Emergency Department — pre-notify receiving facility of suspected snakebite with PIT in situ.
• Facilitate gentle transfer to stretcher without patient weight-bearing — use carry device to bring patient to stretcher.
• Scenario ends on arrival of ambulance and IMISTAMBO handover.
• Attention to hand hygiene will be given throughout the scenario.

Clinical references: Snakebite · Pressure Immobilisation Technique (P.I.T) · Primary Survey