((If trainees attribute altered GCS solely to alcohol intoxication and do not take temperature — patient's GCS drops to 9 (E2V2M5) at the 5-minute mark, representing ongoing thermoregulatory failure. Facilitator states: 'The patient stops responding to voice and begins to make grunting sounds.'))

((If STRIP and SOAK cooling is not commenced within 3 minutes of scene arrival — temperature rises to 41.2°C at 5-minute mark. Facilitator states: 'The patient begins to have tonic-clonic limb movements consistent with a seizure.' Manage as per Seizures CPG while continuing active cooling.))

((If BGL is not checked and hypoglycaemia is not identified — BGL is 3.6 mmol/L. While not yet below 4 mmol/L, trainees should note the borderline BGL in the context of alcohol consumption and prolonged exertion. If BGL is not monitored and patient deteriorates further, facilitator states: 'BGL now reads 3.2 mmol/L.' Prompt trainees to consider oral glucose gel if GCS allows safe administration.))

((If patient is not placed supine and airway is not monitored — at 7 minutes facilitator states: 'The patient begins to retch. There is a risk of aspiration.' Trainees should be directed to lateral position to protect airway.))

((If oxygen is not applied — SpO2 drops to 91% RA at 5 minutes. Facilitator states: 'The patient's lips appear slightly dusky. SpO2 is now 91%.'))

This patient is suffering from Heat Stroke with a declining GCS secondary to excessive core temperature elevation (40.8°C), complicated by significant alcohol intoxication which masks the clinical picture and increases aspiration risk.

• Scene safety — confirm ambient environment is safe; move patient to shade or cool area immediately
• Don appropriate PPE including gloves
• Perform Primary Survey — establish AVPU/GCS, airway patency, breathing, circulation, exposure
• Position patient supine on a flat surface
• STRIP — remove all clothing to maximise heat loss (preserve dignity where possible)
• SOAK — apply tepid water liberally across entire body surface using available water/spray
• FAN — fan patient continuously to promote evaporative heat loss
• Apply ice packs to neck, axillae and groin if available at FAP
• Administer Oxygen via non-rebreather mask at 10–15 L/min, titrate to SpO2 94–98%
• Obtain tympanic temperature — document 40.8°C; repeat every 5 minutes to monitor cooling effectiveness
• Perform BGL — document 3.6 mmol/L; monitor closely given alcohol intake and borderline BGL
• Perform full Vital Sign Survey including GCS, SpO2, RR, pulse, BP, temp, BGL
• Recognise alcohol intoxication as a complicating factor — do NOT attribute all altered GCS to alcohol; temperature confirms heat stroke diagnosis
• Monitor airway continuously — patient is at high aspiration risk due to reduced GCS and alcohol intoxication; be prepared to place in lateral position if GCS drops further or vomiting occurs
• Consider Ondansetron 4 mg oral wafer if patient has sufficient GCS (15/15) to safely ingest; if GCS does not support safe oral administration, withhold oral medications and monitor
• Do NOT administer oral glucose gel at BGL 3.6 mmol/L as BGL is above 4 mmol/L threshold — continue to monitor BGL closely
• Consider delaying transport by up to 15 minutes to allow active cooling to take effect — reassess GCS and temperature trend before and during transport decision
• Continue active cooling during transport to hospital
• Record full observations every 5 minutes given time-critical presentation
• Request Priority 1 ambulance transport with pre-notification to receiving facility
• Scenario ends on arrival of ambulance and IMISTAMBO handover
• Attention to hand hygiene will be given throughout the scenario.

Clinical references: Heat Stroke · Seizures · Oxygen · Hypoglycaemia · Ondansetron · Glucose Oral Gel · Unconsciousness · Disturbed & Abnormal Behaviour