{
  "scenario": {
    "id": "hypothermia-elderly-01",
    "name": "Elderly Hypothermia — Subtle Deterioration",
    "description": "85-year-old woman brought from nursing home with low-grade hypothermia and confusion. Vitals look deceptively near-normal except low temperature and altered mentation. Tests whether the system catches the NEWS2 escalation from temperature and AVPU contributions that are easy to miss clinically.",
    "durationMinutes": 180,
    "tags": ["elderly", "hypothermia", "subtle", "avpu", "nursing-home"]
  },
  "patient": {
    "firstName": "Mei-Ling",
    "lastName": "Wu",
    "dateOfBirth": "1941-04-12",
    "gender": "Female",
    "mrn": "SIM-006"
  },
  "encounter": {
    "department": "Emergency",
    "room": "ED-5",
    "bed": "B",
    "encounterType": "Emergency",
    "chiefComplaint": "Found confused and cold at nursing home, not eating for 2 days"
  },
  "events": [
    { "offsetMinutes": 0, "type": "observation", "data": { "code": "HEART_RATE", "value": 68, "unit": "bpm", "source": "monitor" } },
    { "offsetMinutes": 0, "type": "observation", "data": { "code": "RESP_RATE", "value": 14, "unit": "/min", "source": "manual" } },
    { "offsetMinutes": 0, "type": "observation", "data": { "code": "SYSTOLIC_BP", "value": 118, "unit": "mmHg", "source": "manual" } },
    { "offsetMinutes": 0, "type": "observation", "data": { "code": "DIASTOLIC_BP", "value": 72, "unit": "mmHg", "source": "manual" } },
    { "offsetMinutes": 0, "type": "observation", "data": { "code": "TEMP_C", "value": 35.8, "unit": "°C", "source": "manual" }, "note": "Low-normal temperature" },
    { "offsetMinutes": 0, "type": "observation", "data": { "code": "SPO2", "value": 96, "unit": "%", "source": "monitor" } },
    { "offsetMinutes": 0, "type": "observation", "data": { "code": "AVPU", "value": 1, "unit": "score", "source": "manual" }, "note": "Responds to voice — confused" },
    { "offsetMinutes": 0, "type": "observation", "data": { "code": "GLUCOSE_MG_DL", "value": 62, "unit": "mg/dL", "source": "lab" }, "note": "Borderline hypoglycemia" },

    { "offsetMinutes": 45, "type": "observation", "data": { "code": "HEART_RATE", "value": 64, "unit": "bpm", "source": "monitor" } },
    { "offsetMinutes": 45, "type": "observation", "data": { "code": "RESP_RATE", "value": 13, "unit": "/min", "source": "manual" } },
    { "offsetMinutes": 45, "type": "observation", "data": { "code": "SYSTOLIC_BP", "value": 114, "unit": "mmHg", "source": "manual" } },
    { "offsetMinutes": 45, "type": "observation", "data": { "code": "DIASTOLIC_BP", "value": 70, "unit": "mmHg", "source": "manual" } },
    { "offsetMinutes": 45, "type": "observation", "data": { "code": "TEMP_C", "value": 35.4, "unit": "°C", "source": "manual" }, "note": "Temperature dropping further" },
    { "offsetMinutes": 45, "type": "observation", "data": { "code": "SPO2", "value": 96, "unit": "%", "source": "monitor" } },
    { "offsetMinutes": 45, "type": "observation", "data": { "code": "AVPU", "value": 1, "unit": "score", "source": "manual" } },

    { "offsetMinutes": 90, "type": "observation", "data": { "code": "HEART_RATE", "value": 58, "unit": "bpm", "source": "monitor" }, "note": "Bradycardic — hypothermia effect" },
    { "offsetMinutes": 90, "type": "observation", "data": { "code": "RESP_RATE", "value": 11, "unit": "/min", "source": "manual" }, "note": "RR dropping — warning range" },
    { "offsetMinutes": 90, "type": "observation", "data": { "code": "SYSTOLIC_BP", "value": 108, "unit": "mmHg", "source": "manual" } },
    { "offsetMinutes": 90, "type": "observation", "data": { "code": "DIASTOLIC_BP", "value": 66, "unit": "mmHg", "source": "manual" } },
    { "offsetMinutes": 90, "type": "observation", "data": { "code": "TEMP_C", "value": 35.0, "unit": "°C", "source": "manual" }, "note": "Hypothermic — critical range" },
    { "offsetMinutes": 90, "type": "observation", "data": { "code": "SPO2", "value": 95, "unit": "%", "source": "monitor" } },
    { "offsetMinutes": 90, "type": "observation", "data": { "code": "AVPU", "value": 2, "unit": "score", "source": "manual" }, "note": "Now responds to pain only" },
    { "offsetMinutes": 90, "type": "observation", "data": { "code": "GLUCOSE_MG_DL", "value": 54, "unit": "mg/dL", "source": "lab" } },
    { "offsetMinutes": 90, "type": "observation", "data": { "code": "WBC_K_UL", "value": 3.8, "unit": "×10³/µL", "source": "lab" }, "note": "Low WBC — possible immunosuppression" },

    { "offsetMinutes": 120, "type": "observation", "data": { "code": "HEART_RATE", "value": 54, "unit": "bpm", "source": "monitor" } },
    { "offsetMinutes": 120, "type": "observation", "data": { "code": "RESP_RATE", "value": 10, "unit": "/min", "source": "manual" } },
    { "offsetMinutes": 120, "type": "observation", "data": { "code": "SYSTOLIC_BP", "value": 104, "unit": "mmHg", "source": "manual" } },
    { "offsetMinutes": 120, "type": "observation", "data": { "code": "DIASTOLIC_BP", "value": 62, "unit": "mmHg", "source": "manual" } },
    { "offsetMinutes": 120, "type": "observation", "data": { "code": "TEMP_C", "value": 34.8, "unit": "°C", "source": "manual" } },
    { "offsetMinutes": 120, "type": "observation", "data": { "code": "SPO2", "value": 94, "unit": "%", "source": "monitor" } },
    { "offsetMinutes": 120, "type": "observation", "data": { "code": "AVPU", "value": 2, "unit": "score", "source": "manual" } },

    { "offsetMinutes": 150, "type": "observation", "data": { "code": "HEART_RATE", "value": 50, "unit": "bpm", "source": "monitor" } },
    { "offsetMinutes": 150, "type": "observation", "data": { "code": "RESP_RATE", "value": 9, "unit": "/min", "source": "manual" } },
    { "offsetMinutes": 150, "type": "observation", "data": { "code": "SYSTOLIC_BP", "value": 100, "unit": "mmHg", "source": "manual" } },
    { "offsetMinutes": 150, "type": "observation", "data": { "code": "DIASTOLIC_BP", "value": 58, "unit": "mmHg", "source": "manual" } },
    { "offsetMinutes": 150, "type": "observation", "data": { "code": "TEMP_C", "value": 34.5, "unit": "°C", "source": "manual" } },
    { "offsetMinutes": 150, "type": "observation", "data": { "code": "SPO2", "value": 93, "unit": "%", "source": "monitor" } },
    { "offsetMinutes": 150, "type": "observation", "data": { "code": "AVPU", "value": 2, "unit": "score", "source": "manual" } },

    { "offsetMinutes": 180, "type": "observation", "data": { "code": "HEART_RATE", "value": 46, "unit": "bpm", "source": "monitor" }, "note": "HR in critical range" },
    { "offsetMinutes": 180, "type": "observation", "data": { "code": "RESP_RATE", "value": 8, "unit": "/min", "source": "manual" }, "note": "RR critical" },
    { "offsetMinutes": 180, "type": "observation", "data": { "code": "SYSTOLIC_BP", "value": 96, "unit": "mmHg", "source": "manual" } },
    { "offsetMinutes": 180, "type": "observation", "data": { "code": "DIASTOLIC_BP", "value": 54, "unit": "mmHg", "source": "manual" } },
    { "offsetMinutes": 180, "type": "observation", "data": { "code": "TEMP_C", "value": 34.2, "unit": "°C", "source": "manual" } },
    { "offsetMinutes": 180, "type": "observation", "data": { "code": "SPO2", "value": 91, "unit": "%", "source": "monitor" } },
    { "offsetMinutes": 180, "type": "observation", "data": { "code": "AVPU", "value": 3, "unit": "score", "source": "manual" }, "note": "Unresponsive — ICU transfer" }
  ],
  "expectedOutcomes": [
    { "afterOffsetMinutes": 45, "type": "alert", "alertType": "WARNING_TEMP_C", "description": "Temp 35.4 enters warning range" },
    { "afterOffsetMinutes": 90, "type": "alert", "alertType": "WARNING_RESP_RATE", "description": "RR 11 enters warning range" },
    { "afterOffsetMinutes": 90, "type": "score", "scoreType": "NEWS2", "expectedMinimum": 7, "description": "NEWS2 HIGH — temp 3pts + AVPU 3pts + RR + low WBC" },
    { "afterOffsetMinutes": 90, "type": "alert", "alertType": "NEWS2_EMERGENCY", "description": "NEWS2 ≥7 with AVPU score 3" },
    { "afterOffsetMinutes": 90, "type": "alert", "alertType": "QSOFA_WARNING", "description": "qSOFA ≥2: AVPU 2 + RR borderline — depends on exact threshold" },
    { "afterOffsetMinutes": 90, "type": "alert", "alertType": "SEPSIS_WARNING", "description": "SIRS: temp <36, WBC <4 — possible sepsis in elderly" },
    { "afterOffsetMinutes": 180, "type": "alert", "alertType": "RAPID_DETERIORATION", "description": "Multi-parameter decline: HR, RR, temp, SpO2 all trending down" }
  ]
}