((If distal neurovascular observations — CRT, pulse, colour, warmth, movement, sensation — are not assessed before splinting, facilitator advises: Liam says his right foot feels tingly. Prompt trainee: what distal checks should you perform before and after any splinting?))

((If the limb is not splinted, Liam begins to move and cry out more intensely. Pain score increases to 9/10. Prompt trainee: what can you do to reduce movement and pain for this patient?))

((If jewellery is not removed from the affected limb, facilitator prompts: Liam is wearing a sports ankle bracelet on his right ankle — what do you need to consider before oedema develops?))

((If the trainee attempts to straighten the deformity rather than splint in position found, facilitator intervenes: what does the guideline say about managing dislocated joints and obvious deformities pre-hospital?))

This patient is suffering from a suspected mid-shaft femur fracture of the right lower limb following a fall from height at a public event.

• Ensure scene safety — approach cautiously, confirm ride has been stopped and area is secured by event staff.
• Don appropriate PPE (gloves minimum).
• Perform Primary Survey — confirm ABCDE, manage any immediate life threats.
• Position patient supine on the ground — do not allow Liam to attempt to stand or weight-bear.
• Perform SAMPLE history — confirm mechanism, allergies (Nil), medications (Nil), pertinent history.
• Assess and document pain score using age-appropriate pain scale (numeric or Faces Pain Scale-Revised) — initial score 8/10.
• Perform distal neurovascular assessment of right lower limb BEFORE splinting: pulse (dorsalis pedis/posterior tibial), capillary refill time, skin colour and warmth, movement (wiggle toes), sensation (can you feel me touching your toes?).
• Apply soft splinting or formable splint to right thigh in position of comfort — immobilise joint above (hip) and joint below (knee) the injury site.
• Secure splint with broad bandages above and below the injury site.
• Remove or have parent remove jewellery and footwear from the right foot before oedema develops.
• Apply cold pack wrapped in cloth or gauze to right thigh to reduce swelling and pain — do not place ice directly on skin.
• Re-assess distal neurovascular observations AFTER splinting — document any change in pulse, CRT, colour, warmth, movement, sensation.
• Document re-assessed pain score — target reduction following splint and cold application (expect improvement to approximately 5/10).
• Keep Liam calm and reassure both patient and parent continuously throughout care.
• Monitor full observations every 10 minutes — observe for signs of haemodynamic compromise (femur fractures can cause significant internal blood loss even in paediatrics).
• Request ambulance (Priority 1) via State Operations Centre — paediatric long bone fracture requires further imaging and definitive care.
• Advise parent (Sarah Carter) of Liam's condition and plan for transport.
• 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