Solo Rural GP at 3am

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• Clinical: immediate IM adrenaline (1:1000, 0.01 mg/kg, anterolateral thigh), supine positioning unless airway compromised, high-flow oxygen, IV access for fluids and second-line treatments (antihistamine, hydrocortisone, salbutamol nebs). Be prepared for ongoing adrenaline infusion if poor response. Treat the child according to APLS principles, not as a delay until transfer.
• Coordination: phone RFDS or state retrieval coordinator early — they can support clinical decision-making in real time, advise on bridging treatments, and coordinate transport when weather clears. Mobilise the available local team (nurse, family) to support.
• Reflection: the scenario shows why rural single-doctor coverage is fragile. It is normal in many MM5-MM7 settings. Sustainable rural workforce needs at least 'two deep' coverage, robust telephone consultation backup, and acceptance that even the best system has irreducible risk in remote settings.