((If trainees do not perform a BGL within the first 3 minutes, Daniel begins to look more confused and asks 'am I dying?' — prompt the trainee to consider and exclude hypoglycaemia as an organic cause for altered behaviour.))

((If trainees do not reassure the patient and attempt de-escalation within 2 minutes of contact, Daniel's breathing rate increases to 34 and he starts to feel numbness in his fingers — prompt: 'the patient is getting more distressed, what are you going to do first?'))

((If trainees immediately reach for oxygen without assessing SpO2, ask them to justify: 'what are Daniel's saturations on room air and what is your target range?' — SpO2 97% RA does not meet the threshold for supplemental oxygen administration.))

((If trainees fail to consider and exclude anaphylaxis given rash/hives are absent and there is no known allergen exposure, facilitator should prompt: 'what two body systems would you need to see involved to consider anaphylaxis?'))

((If trainees do not take a full SAMPLE history including pertinent cardiac history and medications, facilitate patient to mention 'my dad had a heart attack at 50' to prompt the trainee to consider and document this but continue to assess clinically.))

This patient is suffering from a panic attack, presenting with acute onset hyperventilation, palpitations, chest tightness, perioral and bilateral hand tingling (consistent with hypocapnia from hyperventilation), diaphoresis, and a sense of impending doom in the context of a crowded, high-stimulation environment. Organic causes including hypoglycaemia and anaphylaxis have been excluded by assessment.

• Ensure scene safety and don appropriate PPE including gloves.
• Perform Primary Survey — confirm patent airway, assess breathing rate and quality, assess circulation, assess GCS and neurological status.
• Perform Vital Sign Survey — obtain SpO2, RR, HR, BP, BGL, temperature, PERL.
• Perform BGL — result 5.4 mmol/L, within normal range. Document and exclude hypoglycaemia as organic cause.
• Assess SpO2 — 97% on room air. Oxygen is NOT indicated as SpO2 meets target range of 94–98%. Do not administer supplemental oxygen.
• Conduct thorough history taking using SAMPLE/IMISTAMBO framework — signs and symptoms, allergies, medications, pertinent history, last oral intake, events leading.
• Apply RASS score following initial de-escalation attempt — expected RASS +1 to +2 (restless to agitated but not violent).
• Perform de-escalation as primary intervention — calm, quiet reassurance in a low-stimulation area of the FAP. Use a non-confrontational, measured tone. Maintain appropriate personal space.
• Coach patient through slow, controlled breathing — instruct patient to breathe in slowly through the nose for 4 counts, and out through the mouth for 4 counts. Remain with patient throughout.
• Perform Secondary Survey and CNS Survey to exclude organic and trauma-related causes for presentation.
• Reassess vital signs at 10 minutes — expect improvement: RR 16, HR 88, SpO2 98% RA, BP 124/80, GCS 15.
• Reassure patient that symptoms are consistent with a panic attack and are not life threatening. Explain what a panic attack is in simple terms.
• Document all findings, observations, and interventions on ePCR.
• Advise patient to follow up with his GP for review and ongoing management of anxiety.
• Offer patient the option of transport to hospital for further assessment — document informed decision if patient declines.
• 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) · Hypoglycaemia · Anaphylaxis · Primary Survey · Glasgow Coma Scale (GCS) · Blood Glucose Monitor · Pulse Oximetry · Pain Assessment