Scenario — Syncope at community fun run

foundation Neurological · Adult · 35yr · female

Patient Information

Dispatch	You are called to the finish line area of the Perth City Fun Run. A 35-year-old female (Sarah Nguyen) has collapsed after crossing the finish line and is on the ground.
Patient	Sarah Nguyen — 35yr (65kg)
Incident History	Pt completed the 10km fun run, crossed the finish line and felt dizzy before collapsing to the ground. Bystanders report she was unconscious for approximately 30 seconds and is now sitting up but pale and sweaty.
Emergency Contact	Michael Nguyen (Husband) — 0412 384 901

Initial Rapid Assessment

Response	Alert
Airway	Patent. Nil airway obstructions. Nil stridor or swelling.
Breathing	Breathing present and adequate. RR mildly elevated. Nil audible wheeze or crackles.
Circulation	Radial pulse present, weak and slightly rapid. Skin pale, diaphoretic. Nil active bleeding.
Disability	GCS 15 (E4V5M6). Orientated to time, place and person. Mild residual dizziness reported.
Exposure	Nil visible injuries. No rashes or swelling noted. Running attire — fit and healthy appearance.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	97% (RA)	Nil	20	102	96/62	2s	15	4 4 ++	37.2	4.8 mmol/L	1
10 mins	99% (RA)	Nil	16	84	112/74	<2s	15	4 4 ++	37.2	4.8 mmol/L	0

History Taking

Scenario Progression and Treatment Objectives

Diagnosis

This patient is suffering from vasovagal syncope (exertional/post-exertional transient loss of consciousness), likely precipitated by venous pooling following cessation of exertion, compounded by mild dehydration.

Facilitator Triggers — if trainees miss a critical step

! (If the trainee does not lay the patient supine — patient reports worsening dizziness and pallor increases; prompt trainee: 'Sarah says she feels like she's going to faint again.')
! (If BGL is not checked — facilitator prompts: 'Sarah mentions she has felt shaky before in the past after long runs — what else might you want to check?')
! (If the trainee does not gather a full history including prior episodes and cardiac history — facilitator prompts: 'What else would you want to know before deciding whether this patient needs transport?')
! (If the trainee attempts to sit the patient upright too early — patient's BP drops and she becomes pale and diaphoretic again; prompt trainee: 'Sarah says she feels worse sitting up.')

Treatment Objectives

1. Ensure scene safety and don appropriate PPE.
2. Perform Primary Survey — confirm airway patent, breathing adequate, radial pulse present.
3. Position patient supine (lying flat) to restore venous return and cerebral perfusion — do NOT allow patient to remain seated or standing.
4. Perform Vital Sign Survey — HR, BP, RR, SpO2, GCS, BGL, temperature.
5. Check blood glucose level — confirm BGL 4.8 mmol/L (normoglycaemic, no treatment required).
6. Administer oxygen only if SpO2 falls below 94% — currently 97% on room air, oxygen not indicated at this time.
7. Perform Secondary and CNS Survey — assess for trauma from fall, check pupils (PERL), assess limbs for injuries.
8. Take full IMISTAMBO-style history: signs/symptoms, onset, prior episodes, cardiac history, medications, allergies, last oral intake.
9. Reassess vital signs at 10 minutes — confirm improving BP, HR normalising, GCS 15 maintained.
10. Advise patient to remain supine until fully recovered — BP >100 systolic, HR <100, GCS 15, symptoms resolved.
11. Offer oral fluids (water) once fully conscious and oriented with no nausea.
12. Advise patient that any patient over 40 with no history of prior episodes requires transport; at 35 years of age with rapid full recovery and normal vital signs, transport decision should be based on overall clinical picture and patient preference — document clearly.
13. Note: post-exertional syncope is a worrying sign — recommend patient seek GP review and avoid strenuous exertion until medically assessed.
14. Monitor persistently — record full observations every 10 minutes.
15. Scenario ends on arrival of ambulance and IMISTAMBO handover.
16. Attention to hand hygiene will be given throughout the scenario.

Clinical references: Transient Loss of Consciousness (Fainting / Syncope) · Primary Survey · Blood Glucose Monitor · Oxygen Delivery · Secondary & CNS Survey · Pulse & Respirations · Blood Pressure · Pulse Oximetry

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Signs/Symptoms	Dizziness and light-headedness at finish line, brief loss of consciousness lasting approximately 30 seconds, now fully conscious with mild residual dizziness and nausea.
Allergies	Nil known drug or food allergies.
Medications	Oral contraceptive pill. No other regular medications.
Pertinent History	No prior episodes of fainting. No known cardiac history. No diabetes. No recent illness.
Last Oral Intake	Small banana and water approximately 2 hours prior to race. Limited fluid intake during run.
Events Leading	Patient was competing in the Perth City Fun Run 10km event. She pushed hard in the final stretch and collapsed moments after crossing the finish line.
Treatment Prior	Bystander placed her in lateral position on the ground until EHS arrival. Nil medications given.

Onset	Sudden onset immediately after crossing the finish line following 10km run.
Pain	Nil chest pain. Nil abdominal pain. Mild generalised headache rated 1/10.
Quality	Dizziness described as a 'spinning' sensation prior to collapse.
Radiates	Nil
Severity	1/10 headache. Dizziness resolving.