Scenario — Prolonged seizure in a child at a school carnival

foundation Neurological · Pediatric · 8yr · female

Patient Information

Dispatch	You are called to a patient (Mia Thornton, 8-year-old female) who has collapsed near the face-painting stall at Riverside Primary School Spring Carnival. Bystanders report she is shaking and unresponsive.
Patient	Mia Thornton — 8yr (25kg)
Incident History	Pt was standing in line at the face-painting stall when she suddenly collapsed to the ground and began convulsing. Witnesses estimate the shaking has been going on for approximately 4 minutes. No reported head strike on the way down. Mia's mum is on scene and states Mia has a known diagnosis of epilepsy.
Emergency Contact	Sandra Thornton (Mother) — 0412 883 047

Initial Rapid Assessment

Response	Unresponsive
Airway	Airway at risk — generalised tonic-clonic activity ongoing. Jaw clenched (trismus present). Secretions visible at corner of mouth. Nil foreign body. Nil stridor.
Breathing	Laboured and irregular. Shallow chest rise with accessory muscle use noted. RR approximately 8 in 30 seconds. Audible gurgling from secretions. SpO2 86% on room air.
Circulation	Radial pulse rapid and weak. Skin flushed and warm. Nil external bleeding. CRT 2 seconds centrally.
Disability	GCS 6 (E1V1M4) — no eye opening, no verbal response, withdraws to pain. Not orientated. Active tonic-clonic convulsive movements of all four limbs.
Exposure	Nil visible rashes or injuries. No medical alert bracelet noted. Clothing intact. Environment is warm, outdoors, no hazards remaining after bystanders cleared area.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	86% (RA)	Severe	8	136	100/65	2s	6	4 4 SL	37.2	4.8 mmol/L	–
10 mins	97% (O2 NRB 15L)	Mild	16	112	102/68	2s	10	4 4 ++	37.2	4.8 mmol/L	–

History Taking

Scenario Progression and Treatment Objectives

Diagnosis

This patient is suffering from a prolonged generalised tonic-clonic seizure (greater than 5 minutes) in a known paediatric epilepsy patient, with associated hypoxia and airway compromise requiring urgent airway management and oxygen therapy.

Facilitator Triggers — if trainees miss a critical step

! (If the EHS officer attempts to force an oropharyngeal airway into the clenched jaw — facilitator advises jaw is firmly clenched and trismus is present; redirect officer to select NPA instead.)
! (If oxygen is not applied within 2–3 minutes, SpO2 drops to 82% on room air and facilitator notes the patient's lips are becoming cyanosed — prompt officer to reassess breathing and apply high-flow oxygen immediately.)
! (If the EHS officer does not perform a BGL, facilitator prompts: 'Mum asks — could it be her blood sugar? She sometimes goes low.' Officer should then obtain BGL.)
! (If the EHS officer does not call for ambulance backup by 5 minutes — facilitator states the seizure has now been ongoing for over 5 minutes and is therefore prolonged; officer should escalate to Priority 1 transport and call SOC.)
! (If the EHS officer attempts to restrain the patient forcefully — facilitator states that restraining the limbs increases injury risk; redirect officer to clear the environment and pad beneath the head only.)

Treatment Objectives

1. Ensure scene safety — clear bystanders from immediate area, remove hazardous objects from around the patient.
2. Don appropriate PPE including gloves.
3. Perform Primary Survey — establish patient is unresponsive and actively seizing.
4. Protect patient from injury during seizure — pad beneath head, do not restrain limbs.
5. Manage airway — jaw is clenched (trismus present), do NOT attempt to force an OPA into the fitting patient's mouth.
6. Insert Nasopharyngeal Airway (NPA) to assist airway patency — select appropriate size (measure from corner of nostril to earlobe), lubricate and insert with gentle twisting action.
7. Suction visible secretions from oral cavity using Yankauer catheter — maximum 5 seconds per attempt.
8. Apply oxygen via non-rebreather mask at 10–15 litres per minute targeting SpO2 ≥95% for paediatric patients.
9. If BVM ventilation required due to inadequate spontaneous effort — ventilate gently with minimal chest rise, do not hyperventilate.
10. Obtain full Vital Signs Survey — GCS, SpO2, RR, HR, BP, BGL (mandatory for any patient with altered GCS), Temperature.
11. Identify and address cause where possible — obtain SAMPLE history from parent on scene.
12. Note time of seizure onset and duration — seizure >5 minutes is an indication for Priority 1 transport.
13. Contact SOC for ambulance backup — seizure is prolonged (>5 minutes), patient is paediatric, Advanced Care required for Midazolam administration.
14. Once seizure terminates — place patient in left lateral position to maintain airway, monitor for airway compromise, aspiration, and secretions.
15. Complete Secondary/CNS Survey once seizure has terminated — assess for injuries, GCS trend, pupil reactions.
16. Repeat vital signs every 10 minutes (or 5 minutes if time critical).
17. Do NOT actively cool the patient with wet sponging — if fever is present, sponging may cause shivering which increases core temperature.
18. Continuous reassurance to parent/guardian throughout.
19. Scenario ends on arrival of ambulance and IMISTAMBO handover.
20. Attention to hand hygiene will be given throughout the scenario.

Clinical references: Seizures · Nasopharyngeal Airway · Oropharyngeal Airway · Suction · Oxygen Delivery · Bag Valve Mask Ventilation · Lateral Position · Blood Glucose Monitor · Glasgow Coma Scale (GCS) · Primary Survey · Secondary & CNS Survey

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Signs/Symptoms	Active generalised tonic-clonic seizure on arrival. Post-ictally: eyes flickering open, moaning, not following commands. Mum reports Mia was 'totally fine' before collapse — no aura reported.
Allergies	Nil known drug allergies — confirmed by mum.
Medications	Sodium valproate daily — mum confirms Mia took her morning dose today.
Pertinent History	Known epilepsy since age 5. Last seizure was approximately 8 weeks ago. Mum states seizures are usually brief (under 2 minutes) and self-limiting. No recent illness or fever reported. No head injury.
Last Oral Intake	Ate lunch approximately 1 hour ago — sandwich and juice.
Events Leading	Mia had been at the carnival for approximately 2 hours, playing games and queuing for face-painting. Mum reports it was a warm day and Mia had been running around. No obvious trigger identified.
Treatment Prior	Mum placed Mia in a recovery position before EHS arrival and cleared objects from around her. No medications administered by bystanders.

Onset	Sudden. Witnessed collapse approximately 4–5 minutes prior to EHS arrival. Seizure was still active on arrival.
Pain	Unable to assess during seizure. Post-ictally: Nil reported pain.
Quality	Generalised tonic-clonic movements of all four limbs. Jaw clenched throughout.
Radiates	Nil
Severity	Unable to assess during seizure.