((If distal neurovascular observations — capillary refill, colour, warmth, movement, sensation to toes — are NOT assessed before splinting, the patient reports that the tingling in her foot has become numbness and her toes look pale. Prompt the trainee: 'What do you notice about her foot?'))

((If splinting is applied without padding of hollows and bony prominences, the patient reports increased discomfort at the ankle. Prompt the trainee: 'She says it feels very tight at her ankle — what might you check?'))

((If distal neurovascular observations are NOT repeated after splinting, inform the trainee: 'Your assessor asks — have you reassessed circulation, movement, and sensation distal to the splint?'))

((If the left shoe and sock are not removed or the limb is not exposed prior to assessment, prompt: 'You have not fully exposed the injury — what else might you be missing?'))

((If jewellery — there is an ankle bracelet on the left ankle — is not removed before splinting and oedema increases, the patient winces and points to her ankle. Prompt: 'She is pointing to something on her ankle — what do you notice?'))

This patient is suffering from a suspected mid-shaft left tibial fracture with distal neurovascular compromise (tingling to left foot).

• Don appropriate PPE including gloves.
• Perform Primary Survey — confirm airway patent, breathing adequate, no life-threatening haemorrhage.
• Control any haemorrhage — confirm skin is intact; apply direct pressure if open wound identified.
• Expose the injured limb — carefully remove left running shoe and sock; note and remove ankle bracelet before oedema occurs.
• Assess distal neurovascular observations BEFORE splinting — capillary refill time, skin colour, warmth, movement (ask patient to wiggle toes), and sensation (ask patient to describe feeling in toes) to left foot.
• Document baseline neurovascular findings — CRT <2s, tingling present to left toes, movement intact.
• Perform Secondary/CNS Survey — assess for any other injuries from the fall including wrists and hands.
• Pad natural hollows, deformities, and bony prominences (ankle, knee) with appropriate padding prior to splint application.
• Apply soft splint or rigid splint immobilising the joint above (knee) and below (ankle) the injury site using broad bandages — maintain limb in position of comfort.
• Reassess distal neurovascular observations AFTER splinting — CRT, colour, warmth, movement, and sensation to toes. Loosen bandages if compromise is found.
• Reassess and document pain score post-splinting — target improvement from 8/10.
• Apply cold pack to injury site wrapped in a towel or bluey — do not apply directly to skin.
• Elevate the injured limb where tolerated to reduce swelling.
• Apply pulse oximetry and monitor vital signs including heart rate and respiratory rate.
• Reassure patient continuously throughout — explain each step before performing it.
• Record full observations every 10 minutes.
• Arrange transport to hospital via ambulance — this injury requires imaging and Advanced Care level pain management beyond EHS scope.
• Document all findings including neurovascular assessment before and after splinting 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: Limb Trauma · Haemorrhage · Primary Survey · Secondary & CNS Survey · Pain Assessment · Fractures & Dislocations — Splinting