((If the trainee attributes altered GCS solely to alcohol and does not initiate active cooling within 2 minutes — patient's GCS drops to 9 (E2V2M5), RR increases to 28, SpO2 falls to 91% on RA. Facilitator states: 'The patient is becoming increasingly unresponsive and her breathing is laboured.'))

((If BGL of 3.6 mmol/L is not identified and acted upon — patient becomes diaphoretic and GCS drops a further point. Facilitator states: 'The patient is now less responsive and sweating profusely.' Trainee should recognise borderline hypoglycaemia and administer Glucose Oral Gel 15g orally if GCS permits safe swallowing.))

((If active cooling is not initiated — temperature remains 40.8°C at 10-minute reassessment. Facilitator states: 'The patient is no longer responding to voice and her skin remains extremely hot and dry.' GCS falls to 9.))

((If patient is not positioned laterally or airway is not monitored given declining GCS — facilitator states: 'The patient vomits.' Trainee must manage airway immediately with lateral position and suction.))

((If alcohol intoxication is used as a reason to withhold oxygen — facilitator prompts: 'Her SpO2 is 95% on room air and she is breathing 24 times per minute — what would you like to do about her oxygen?'))

This patient is suffering from Heat Stroke with significantly elevated core temperature (>40°C), declining GCS secondary to thermoregulatory failure, and concurrent alcohol intoxication which is masking and compounding the presentation.

• Ensure scene safety — confirm patient is in shade or move to cool environment; festival environment, 38°C ambient temperature
• Don appropriate PPE — gloves and eye protection given altered GCS and vomiting risk
• Perform Primary Survey — airway patent, breathing present but increased WOB, circulation intact, GCS 11 (E3V3M5)
• Recognise this is NOT a simple alcohol intoxication — hot dry flushed skin, tachycardia, tympanic temperature 40.8°C, and CNS dysfunction in heat = Heat Stroke until proven otherwise
• Apply oxygen via Non-Rebreather Mask (NRB) at 10–15 L/min — titrate to maintain SpO2 94–98%
• Perform Vital Sign Survey — GCS, temperature (tympanic), BGL, SpO2, RR, BP, HR, CRT
• Identify BGL 3.6 mmol/L — borderline, monitor closely; if GCS permits safe swallowing consider Glucose Oral Gel 15g orally to prevent hypoglycaemia
• Initiate active cooling immediately — STRIP clothing, SOAK with tepid water, FAN patient continuously, apply ice packs to neck, groin and armpits
• Position patient supine if tolerating, ensure airway positioning — given GCS 11 be prepared to place in left lateral position if vomiting risk increases
• Consider delaying transport by approximately 15 minutes to achieve adequate cooling at scene before transport — reassess temperature and GCS at 10 minutes
• Reassess GCS and temperature at 10 minutes — target temperature reduction and GCS improvement confirm cooling is effective
• Consider Ondansetron 4mg oral wafer for nausea/vomiting IF patient is GCS 15 and able to safely swallow — at GCS 11 do NOT administer oral wafer; defer to ambulance crew
• Continue cooling during transport — wet cloths, fan, remove from heat source
• Request ambulance (Priority 1) — time-critical patient with GCS 11, temperature 40.8°C, and declining conscious state
• Reassess every 5 minutes given time-critical status
• Monitor for seizure activity throughout — manage as per Seizures CPG if seizure occurs while continuing active cooling
• Do NOT attribute altered GCS to alcohol alone — heat stroke is the working diagnosis; alcohol is a compounding factor
• Scenario ends on arrival of ambulance and IMISTAMBO handover
• Attention to hand hygiene will be given throughout the scenario.

Clinical references: Heat Stroke · Hypoglycaemia · Glucose Oral Gel · Oxygen · Seizures · Unconsciousness · Ondansetron