Scenario — Syncope at a community fair — elderly female

foundation Neurological · Elderly · 75yr · female

Patient Information

Dispatch	You are called to a patient (Margaret Holt, 75-year-old female) who has fainted near the community stage at the Midland Autumn Fair. Bystanders report she briefly lost consciousness and is now sitting on the ground.
Patient	Margaret Holt — 75yr (60kg)
Incident History	Pt was standing watching a performance in the sun for approximately 40 minutes when she felt dizzy and collapsed to the ground. Bystander reports she was unconscious for approximately 20–30 seconds before coming around. Pt is now conscious and alert but pale and clammy.
Emergency Contact	Diane Holt (Daughter) — 0412 774 391

Initial Rapid Assessment

Response	Alert
Airway	Patent. Nil airway obstruction. Nil stridor or swelling.
Breathing	Adequate. Self-ventilating. No increased work of breathing. No audible abnormal sounds.
Circulation	Radial pulse present — weak and regular. Skin pale, cool and diaphoretic. Nil external bleeding.
Disability	GCS 15 (E4V5M6). Alert and orientated to time, place and person. Nil focal neurological deficit.
Exposure	Nil rashes, nil visible injury. Patient dressed in light clothing. No medic alert jewellery visible.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	97% (RA)	Nil	16	58	88/58	3s	15	3 3 ++	36.6	5.2 mmol/L	0
10 mins	99% (RA)	Nil	14	68	108/70	<2s	15	3 3 ++	36.6	5.2 mmol/L	0

History Taking

Scenario Progression and Treatment Objectives

Diagnosis

This patient is suffering from vasovagal syncope (simple faint), likely precipitated by prolonged standing in warm conditions combined with mild dehydration and the haemodynamic effects of her antihypertensive medication.

Facilitator Triggers — if trainees miss a critical step

! (If the trainee does not lie the patient flat promptly: patient reports increasing dizziness and nausea, BP remains at 88 systolic — prompt trainee: 'The patient says she still feels very dizzy and is going to be sick.')
! (If the trainee fails to obtain a BGL: facilitator prompts — 'What other assessment might be important given her presentation and age?')
! (If the trainee fails to gather medication history: prompt — 'The patient's daughter arrives and asks if her mother's blood pressure tablet could have caused this.')
! (If the trainee attempts to sit the patient upright or mobilise her early: patient becomes pale and diaphoretic again — 'The patient says she feels faint again and grabs your arm.')
! (If the trainee fails to note that this is her FIRST syncopal episode at age 75: prompt facilitator to ask — 'Is there anything about this episode that should concern you regarding transport?' — expected answer: first episode over 40, must be transported.)

Treatment Objectives

1. Ensure scene safety and don appropriate PPE prior to patient contact.
2. Perform Primary Survey — confirm airway patent, breathing adequate, radial pulse present.
3. Position patient supine (lying flat) immediately to restore cerebral perfusion — do NOT allow patient to remain sitting or attempt to stand.
4. Apply pulse oximetry monitoring.
5. Obtain blood glucose level — document 5.2 mmol/L.
6. Perform Vital Sign Survey — note low BP 88/58, bradycardia HR 58, CRT 3s, GCS 15.
7. Obtain full IMISTAMBO history including medication review — identify Perindopril as antihypertensive contributing to postural hypotension.
8. Perform Secondary and CNS Survey — assess for any trauma sustained during fall, check pupils, assess for focal neurological deficit.
9. Monitor patient persistently — repeat vital signs at 10 minutes, confirm BP improvement to 108/70 with supine positioning.
10. Reassure patient continuously throughout assessment and treatment.
11. Advise patient to remain lying flat until vital signs normalise and she feels fully recovered — do not allow early mobilisation.
12. Recognise that this is a first syncopal episode in a patient over 40 years of age — this patient MUST be transported to hospital for further assessment regardless of clinical recovery.
13. Arrange ambulance transfer — Priority 2 unless vital signs deteriorate.
14. Scenario ends on arrival of ambulance and IMISTAMBO handover.
15. Attention to hand hygiene will be given throughout the scenario.

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

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Signs/Symptoms	Dizziness prior to collapse, brief loss of consciousness approximately 20–30 seconds, pallor, diaphoresis, mild nausea on recovery. No chest pain, no palpitations, no dyspnoea, no headache.
Allergies	Penicillin — rash.
Medications	Perindopril 5mg daily (antihypertensive), Atorvastatin 20mg nocte.
Pertinent History	Known hypertension, managed with Perindopril. No prior syncopal episodes. No known cardiac history. No history of diabetes.
Last Oral Intake	Light breakfast approximately 6 hours ago. Minimal fluid intake during the event.
Events Leading	Patient had been standing watching a musical performance in warm sunny conditions for approximately 40 minutes prior to collapse.
Treatment Prior	Nil. Bystanders helped her sit on the ground and called for EHS.

Onset	Sudden onset after standing in the sun for approximately 40 minutes.
Pain	Nil.
Quality	Pt reports feeling 'light-headed and then nothing' before coming around on the ground.
Radiates	Nil.
Severity	Nil pain. Mild nausea 2/10.