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Scenario — Febrile seizure in a child at a school carnival
Patient Information
Dispatch
You are called to the first aid tent at Riverside Primary School Autumn Carnival. A parent has brought in an 8-year-old boy (Lachlan Dempsey) who had a brief shaking episode near the jumping castle and is now drowsy and confused.
Incident History
Mum says Lachlan was running around at the carnival when he suddenly went stiff then started shaking for approximately 2 minutes. He has stopped shaking and is now drowsy. Mum states he has been unwell since this morning with a fever and runny nose.
Emergency Contact
Sarah Dempsey (Mother) 0412 447 893
Initial Rapid Assessment
Response
Voice
Airway
Patent. Nil airway obstruction. Nil secretions visible. Nil stridor.
Breathing
Breathing spontaneously. Slightly increased rate. Nil audible wheeze or stridor.
Circulation
Radial pulse present, regular, slightly elevated. Skin warm and flushed. CRT 2s. Nil active bleeding.
Disability
GCS 12 (E3V4M5). Disoriented to time and place. Drowsy but rousable to voice. Post-ictal state.
Exposure
Nil rashes. Nil visible injuries. Skin warm and dry. No incontinence noted.
Vitals
Time SpO2 Resp Dist RR Pulse BP CRT GCS PERL Temp BGL Pain
Initial 96% (RA) Nil 22 118 96/60 2s 12 4 4 ++ 38.9 5.4 mmol/L 2
10 mins 98% (O2 simple face mask 6L) Nil 18 108 100/64 2s 14 4 4 ++ 38.9 5.4 mmol/L 1
History Taking
Signs/Symptoms
Drowsy and confused post-seizure. Warm and flushed. Mum reports shaking of all four limbs lasting approximately 2 minutes followed by unresponsiveness then gradual improvement.
Onset
Seizure occurred approximately 10 minutes ago. Has been unwell since this morning.
Pain
Nil pain reported. Rates discomfort 2/10 on prompting — generalised headache.
Quality
Generalised tonic-clonic movements observed by bystanders. No focal features reported.
Radiates
Nil
Severity
2/10
Allergies
NKDA
Medications
Nil regular medications
Pertinent History
No known seizure disorder. No prior febrile seizures reported by mum. Was seen by GP 2 days ago for upper respiratory tract infection. No meningism symptoms reported.
Last Oral Intake
Ate a sausage sizzle approximately 1 hour ago. Drinking water throughout the morning.
Treatment
Mum placed Lachlan in the recovery position after the shaking stopped. No medications given.
Events Leading
Was running and playing at the carnival jumping castle area when he suddenly stopped, went rigid then began shaking. Mum was present throughout.
Scenario Progression and Treatment Objectives

((If airway is not assessed and patient is not placed in the lateral position within 2 minutes, Lachlan begins to snore and oxygen saturation drops to 92% on room air — prompt trainees to reposition and reassess airway.))

((If BGL is not checked within the first assessment cycle, facilitator advises trainee that Lachlan's mum is asking 'is his blood sugar okay?' — prompt BGL assessment.))

((If temperature is not taken and documented, mum asks 'does he have a fever?' — prompt tympanic temperature assessment.))

((If seizure recurs during scenario — lasting >5 minutes — trainee must manage as per Seizures CPG: protect from injury, maintain airway, apply oxygen, note start time, and prepare for Priority 1 transport with pre-notification.))

This patient is suffering from a febrile seizure (post-ictal phase) in the context of an underlying febrile illness (URTI), now in a post-ictal drowsy state with no ongoing seizure activity.

  • Ensure scene safety and don appropriate PPE.
  • Perform Primary Survey: confirm airway patent, assess breathing and circulation.
  • Position Lachlan in the lateral position — post-ictal patient with GCS 12, airway protection required.
  • Apply oxygen via simple face mask at 6 L/min — titrate SpO2 to target ≥95% for paediatrics.
  • Perform full Vital Signs Survey: GCS, BGL, SpO2, RR, HR, BP, temperature.
  • Obtain BGL — result 5.4 mmol/L, no treatment required for hypoglycaemia.
  • Obtain tympanic temperature — result 38.9°C, confirms febrile illness.
  • Assess pupils — PERL 4mm bilaterally.
  • Take IMISTAMBO history from mum: confirm seizure duration (~2 minutes), no prior seizure history, current febrile illness, nil medications, NKDA.
  • Monitor patient persistently — repeat vital signs every 10 minutes.
  • Do NOT actively cool Lachlan by sponging — this may cause shivering and increase temperature.
  • Reassess GCS at 10 minutes — improving to GCS 14 expected as post-ictal phase resolves.
  • Reassess for seizure recurrence throughout scenario — if seizure recurs and lasts >5 minutes, treat as time critical and arrange Priority 1 transport with pre-notification of receiving facility.
  • Complete Secondary and CNS Survey once seizure has terminated and patient is stable.
  • Arrange transport to hospital for medical review — all paediatric febrile seizures require ED assessment.
  • Scenario ends on arrival of ambulance and IMISTAMBO handover.
  • Attention to hand hygiene will be given throughout the scenario.

Clinical references: Seizures · Hypoglycaemia · Primary Survey · Oxygen Delivery · Tympanic Thermometer · Blood Glucose Monitor · Lateral Position · Glasgow Coma Scale (GCS)