((If the EHS officer does not perform a BGL — inform them the patient mentions she feels 'really strange and lightheaded' and ask if they would like to check her blood sugar.))

((If the EHS officer does not ask about allergies or assess for urticaria/rash — patient begins to ask 'Is this an allergic reaction? I did eat something new earlier.' Facilitator should prompt officer to reassess skin for urticaria and re-examine allergy history before dismissing anaphylaxis.))

((If the EHS officer attempts to administer oxygen to a patient with SpO2 98% on room air — remind them of the oxygen CPG: oxygen should be titrated to clinical need and normoxia is a contraindication to supplemental oxygen.))

((If the EHS officer does not reassess vitals at 10 minutes — patient states 'I feel a bit better but my hands are still tingling.' Prompt officer to repeat observations to confirm improvement and document trend.))

((If the EHS officer fails to consider organic causes — prompt with 'What else could cause these symptoms? How would you rule out hypoglycaemia or early anaphylaxis?'))

This patient is suffering from a panic attack, presenting with hyperventilation, tachycardia, perioral and bilateral hand paraesthesia, chest tightness, and acute anxiety in the context of a crowded environment. Symptoms are consistent with hyperventilation-induced hypocapnia causing peripheral tingling. No evidence of organic cause — BGL normal, SpO2 normal on room air, nil wheeze, nil urticaria, nil hypotension.

• Ensure scene safety and approach in a calm, non-threatening manner.
• Perform Primary Survey — confirm patent airway, assess breathing rate and quality, assess circulation, establish GCS 15.
• Move patient to a quieter area away from the crowd to reduce environmental stimuli.
• Reassure patient continuously — explain what is happening in plain language, use a calm tone and grounding techniques (e.g. encourage slow, controlled breathing at a normal rate).
• Perform Vital Sign Survey — measure BP, pulse, RR, SpO2 on room air, BGL, temperature, and pain score.
• Assess SpO2 — SpO2 98% on room air; oxygen is NOT indicated as patient is normoxic. Do not administer supplemental oxygen.
• Perform BGL — result 5.4 mmol/L; hypoglycaemia excluded.
• Conduct thorough skin assessment — inspect for urticaria, rashes, or welts to exclude allergic reaction or anaphylaxis.
• Take a structured SAMPLE history including allergies, medications, pertinent history, and events leading to presentation.
• Assess and document RASS score — patient is RASS +1 (restless, mildly anxious, non-aggressive); de-escalation is the primary intervention.
• Apply Richmond Agitation Sedation Scale (RASS) — de-escalation techniques are first-line; no medications are indicated for panic attack within EHS scope.
• Record full observations every 10 minutes and document trend.
• Reassess at 10 minutes — expect improvement in RR, HR, and resolution of tingling as breathing normalises.
• Advise patient to avoid re-entering large crowds until fully recovered and encourage her to remain at the FAP until symptoms fully resolve.
• Offer the patient a cool environment, seated rest, and water if fully conscious and tolerating oral intake.
• Consider transport to hospital if symptoms do not resolve, if organic cause cannot be excluded, or if patient requests further assessment.
• Scenario ends on arrival of ambulance and IMISTAMBO handover.
• Attention to hand hygiene will be given throughout the scenario.

Clinical references: Disturbed & Abnormal Behaviour · Transient Loss of Consciousness (Fainting / Syncope) · Dyspnoea & Respiratory Distress · Hypoglycaemia · Anaphylaxis · Oxygen Delivery · Primary Survey · Blood Glucose Monitor · Pain Assessment