Minute (state)	Participant action/trigger	Patient status (simulator response) & operator prompts	Monitor display (vital signs)
0:00 (Baseline)	Patient brought from waiting room to room	Participants should perform an ABC assessment, place patient on monitor, and perform a history and physical examination.	T: 98.9°F HR: 95 BP: 138/76 RR: 22 O2: 94%
04:00	IV placed, labs drawn, CXR ordered	Participants should perform a detailed neurological exam. If participants do not perform neuro exam, nursing will prompt with “Why is the patient laying so still?”	T: 98.9°F HR: 95 BP: 138/76 RR: 22 O2: 94%
	Lab results return	Participants should note the labs indicate a mild respiratory acidosis and are otherwise grossly normal.	T: 98.9°F HR: 95 BP: 138/76 RR: 22 O2: 94%
10:00	Participants should recognize respiratory muscle weakness.	If the team intubates the patient, he will stabilize. If the patient is not intubated, he will develop worsening respiratory function. If the patient is not pre-oxygenated prior to intubation, he will have an oxygen desaturation during the procedure. If the team does not intubate the patient, he will require intubation after admission, or suffer a cardiac arrest if not admitted to ICU. This must be clarified during the debrief.	Intubated: T: 99.8°F HR: 94 BP: 131/84 RR: 20 O2sat: 100% Not intubated: T: 98.9°F HR: 95 BP: 138/76 RR: 22O2: 94%
12:00	Participants should recognize the need for antitoxin	If the team contacts a public health agency the patient will receive antitoxin within 8 hours. If the team does not contact a public health agency the patient will not receive antitoxin and will have a prolonged illness. This must be clarified during the debrief.