Episode Observation Form

Category A — Emergency

These 4 triggers require IMMEDIATE ACTION. Only tick what you are directly observing RIGHT NOW or what occurred during this event.

Inga is convulsing/shaking and it has been going for more than 1.5 minutes

CALL THE HUB IMMEDIATELY
Hub: if convulsing continues past 2 minutes, call 000

📞 Hub: 0482 089 189 📞 Hub use: Call 000

Inga is not breathing or breathing has been severely laboured/stopped for more than 30 seconds

START FIRST AID → CALL 000 → THEN CALL THE HUB

📞 Call 000 📞 Hub: 0482 089 189

Inga is not responding to voice or touch AND her breathing does not sound/look normal

CALL 000 IMMEDIATELY → THEN CALL THE HUB

📞 Call 000 📞 Hub: 0482 089 189

Inga has collapsed/fallen, is not getting up, and is not responding

CALL 000 IMMEDIATELY → THEN CALL THE HUB

📞 Call 000 📞 Hub: 0482 089 189

Category B — Elevated Features

If ANY of these are present, call the Hub now. These are serious but not 000-level.

Cyanosis (blue/purple lips or extremities) persisting more than 2 minutes

Brief loss of responsiveness (Inga did not respond but then came back within 10 seconds)

Body rigidity/stiffness lasting more than 1 minute

Observable Features

Tick what you observed during this event. Remember: normal stimming, normal wailing, and expected medication drowsiness do NOT count.

Pallor

Lip Smacking

Unsteadiness (tick all that apply)

Rocking

Arm Waving / Flapping

Unusual Vocalisation

Running / Leaping

Involuntary Leg / Foot Movement

Trembling / Shaking

Breathing Change

Blank Stare

Eyes Rolled Back

Brief Rigidity (resolved within 1 minute)

Brief Cyanosis (resolved within 2 minutes)

Responsiveness

During the event, did Inga respond when you spoke to her?

After the event, how quickly did Inga return to normal?

Duration & Confidence

Estimated duration

Confidence this was different from normal

Auto-Classification

Classification

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Features Observed

Event Details — complete after event

Your name / initials *

Date of event

Time started (auto-filled, adjust if needed)

Time ended (auto-fills on submit)

Location *

What was Inga doing immediately before?

Additional Notes

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