{
  "scenario": {
    "id": "sepsis-ed-01",
    "name": "ED Sepsis Deterioration — UTI Source",
    "description": "72-year-old woman presents to ED with UTI symptoms. Over 4 hours she develops sepsis: rising temperature, tachycardia, hypotension. Antibiotics started at 1 hour. Sepsis bundle completed by hour 2.",
    "durationMinutes": 240,
    "tags": ["sepsis", "ed", "deterioration", "bundle-completion"]
  },
  "patient": {
    "firstName": "Eleanor",
    "lastName": "Chen",
    "dateOfBirth": "1954-03-15",
    "gender": "Female",
    "mrn": "SIM-001"
  },
  "encounter": {
    "department": "Emergency",
    "room": "ED-12",
    "bed": "A",
    "encounterType": "Emergency",
    "chiefComplaint": "Fever, confusion, dysuria for 2 days"
  },
  "events": [
    { "offsetMinutes": 0, "type": "observation", "data": { "code": "HEART_RATE", "value": 88, "unit": "bpm", "source": "monitor" } },
    { "offsetMinutes": 0, "type": "observation", "data": { "code": "RESP_RATE", "value": 18, "unit": "/min", "source": "manual" } },
    { "offsetMinutes": 0, "type": "observation", "data": { "code": "SYSTOLIC_BP", "value": 128, "unit": "mmHg", "source": "manual" } },
    { "offsetMinutes": 0, "type": "observation", "data": { "code": "DIASTOLIC_BP", "value": 78, "unit": "mmHg", "source": "manual" } },
    { "offsetMinutes": 0, "type": "observation", "data": { "code": "TEMP_C", "value": 38.2, "unit": "°C", "source": "manual" } },
    { "offsetMinutes": 0, "type": "observation", "data": { "code": "SPO2", "value": 97, "unit": "%", "source": "monitor" } },
    { "offsetMinutes": 0, "type": "observation", "data": { "code": "AVPU", "value": 0, "unit": "score", "source": "manual" } },

    { "offsetMinutes": 30, "type": "observation", "data": { "code": "HEART_RATE", "value": 94, "unit": "bpm", "source": "monitor" } },
    { "offsetMinutes": 30, "type": "observation", "data": { "code": "RESP_RATE", "value": 20, "unit": "/min", "source": "manual" } },
    { "offsetMinutes": 30, "type": "observation", "data": { "code": "SYSTOLIC_BP", "value": 122, "unit": "mmHg", "source": "manual" } },
    { "offsetMinutes": 30, "type": "observation", "data": { "code": "DIASTOLIC_BP", "value": 74, "unit": "mmHg", "source": "manual" } },
    { "offsetMinutes": 30, "type": "observation", "data": { "code": "TEMP_C", "value": 38.6, "unit": "°C", "source": "manual" } },
    { "offsetMinutes": 30, "type": "observation", "data": { "code": "SPO2", "value": 96, "unit": "%", "source": "monitor" } },
    { "offsetMinutes": 30, "type": "observation", "data": { "code": "AVPU", "value": 0, "unit": "score", "source": "manual" } },
    { "offsetMinutes": 30, "type": "observation", "data": { "code": "WBC_K_UL", "value": 14.2, "unit": "×10³/µL", "source": "lab" }, "note": "Initial labs — elevated WBC" },

    { "offsetMinutes": 60, "type": "observation", "data": { "code": "HEART_RATE", "value": 105, "unit": "bpm", "source": "monitor" } },
    { "offsetMinutes": 60, "type": "observation", "data": { "code": "RESP_RATE", "value": 22, "unit": "/min", "source": "manual" } },
    { "offsetMinutes": 60, "type": "observation", "data": { "code": "SYSTOLIC_BP", "value": 112, "unit": "mmHg", "source": "manual" } },
    { "offsetMinutes": 60, "type": "observation", "data": { "code": "DIASTOLIC_BP", "value": 68, "unit": "mmHg", "source": "manual" } },
    { "offsetMinutes": 60, "type": "observation", "data": { "code": "TEMP_C", "value": 39.1, "unit": "°C", "source": "manual" } },
    { "offsetMinutes": 60, "type": "observation", "data": { "code": "SPO2", "value": 95, "unit": "%", "source": "monitor" } },
    { "offsetMinutes": 60, "type": "observation", "data": { "code": "AVPU", "value": 0, "unit": "score", "source": "manual" } },

    { "offsetMinutes": 65, "type": "medication", "data": { "drugName": "ceftriaxone", "dose": 2, "doseUnit": "g", "route": "IV", "administeredBy": "nurse-rn-1" }, "note": "Broad-spectrum antibiotics started" },

    { "offsetMinutes": 75, "type": "order_result", "data": { "orderDescription": "SEP-1: Blood cultures", "resultValue": "2 sets drawn — pending", "resultedBy": "nurse-rn-1" } },
    { "offsetMinutes": 80, "type": "order_result", "data": { "orderDescription": "SEP-1: Serum lactate", "resultValue": "2.8 mmol/L", "resultedBy": "lab-tech-1" } },

    { "offsetMinutes": 90, "type": "observation", "data": { "code": "HEART_RATE", "value": 112, "unit": "bpm", "source": "monitor" } },
    { "offsetMinutes": 90, "type": "observation", "data": { "code": "RESP_RATE", "value": 24, "unit": "/min", "source": "manual" } },
    { "offsetMinutes": 90, "type": "observation", "data": { "code": "SYSTOLIC_BP", "value": 102, "unit": "mmHg", "source": "manual" } },
    { "offsetMinutes": 90, "type": "observation", "data": { "code": "DIASTOLIC_BP", "value": 62, "unit": "mmHg", "source": "manual" } },
    { "offsetMinutes": 90, "type": "observation", "data": { "code": "TEMP_C", "value": 39.3, "unit": "°C", "source": "manual" } },
    { "offsetMinutes": 90, "type": "observation", "data": { "code": "SPO2", "value": 94, "unit": "%", "source": "monitor" } },
    { "offsetMinutes": 90, "type": "observation", "data": { "code": "AVPU", "value": 1, "unit": "score", "source": "manual" }, "note": "Patient confused — responds to voice" },
    { "offsetMinutes": 90, "type": "observation", "data": { "code": "LACTATE_MMOL_L", "value": 2.8, "unit": "mmol/L", "source": "lab" } },

    { "offsetMinutes": 100, "type": "order_result", "data": { "orderDescription": "SEP-1: Broad-spectrum antibiotics", "resultValue": "Ceftriaxone 2g IV administered", "resultedBy": "nurse-rn-1" } },
    { "offsetMinutes": 105, "type": "order_result", "data": { "orderDescription": "SEP-1: IV fluid bolus", "resultValue": "1L NS bolus started", "resultedBy": "nurse-rn-1" } },

    { "offsetMinutes": 120, "type": "observation", "data": { "code": "HEART_RATE", "value": 118, "unit": "bpm", "source": "monitor" } },
    { "offsetMinutes": 120, "type": "observation", "data": { "code": "RESP_RATE", "value": 26, "unit": "/min", "source": "manual" } },
    { "offsetMinutes": 120, "type": "observation", "data": { "code": "SYSTOLIC_BP", "value": 96, "unit": "mmHg", "source": "manual" } },
    { "offsetMinutes": 120, "type": "observation", "data": { "code": "DIASTOLIC_BP", "value": 58, "unit": "mmHg", "source": "manual" } },
    { "offsetMinutes": 120, "type": "observation", "data": { "code": "TEMP_C", "value": 39.4, "unit": "°C", "source": "manual" } },
    { "offsetMinutes": 120, "type": "observation", "data": { "code": "SPO2", "value": 93, "unit": "%", "source": "monitor" } },
    { "offsetMinutes": 120, "type": "observation", "data": { "code": "AVPU", "value": 1, "unit": "score", "source": "manual" } },

    { "offsetMinutes": 150, "type": "observation", "data": { "code": "HEART_RATE", "value": 115, "unit": "bpm", "source": "monitor" } },
    { "offsetMinutes": 150, "type": "observation", "data": { "code": "RESP_RATE", "value": 24, "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": 60, "unit": "mmHg", "source": "manual" } },
    { "offsetMinutes": 150, "type": "observation", "data": { "code": "TEMP_C", "value": 39.0, "unit": "°C", "source": "manual" } },
    { "offsetMinutes": 150, "type": "observation", "data": { "code": "SPO2", "value": 94, "unit": "%", "source": "monitor" } },
    { "offsetMinutes": 150, "type": "observation", "data": { "code": "AVPU", "value": 1, "unit": "score", "source": "manual" } },
    { "offsetMinutes": 150, "type": "observation", "data": { "code": "LACTATE_MMOL_L", "value": 3.4, "unit": "mmol/L", "source": "lab" }, "note": "Repeat lactate — rising" },

    { "offsetMinutes": 180, "type": "observation", "data": { "code": "HEART_RATE", "value": 108, "unit": "bpm", "source": "monitor" } },
    { "offsetMinutes": 180, "type": "observation", "data": { "code": "RESP_RATE", "value": 22, "unit": "/min", "source": "manual" } },
    { "offsetMinutes": 180, "type": "observation", "data": { "code": "SYSTOLIC_BP", "value": 105, "unit": "mmHg", "source": "manual" } },
    { "offsetMinutes": 180, "type": "observation", "data": { "code": "DIASTOLIC_BP", "value": 64, "unit": "mmHg", "source": "manual" } },
    { "offsetMinutes": 180, "type": "observation", "data": { "code": "TEMP_C", "value": 38.7, "unit": "°C", "source": "manual" } },
    { "offsetMinutes": 180, "type": "observation", "data": { "code": "SPO2", "value": 95, "unit": "%", "source": "monitor" } },
    { "offsetMinutes": 180, "type": "observation", "data": { "code": "AVPU", "value": 0, "unit": "score", "source": "manual" }, "note": "Mentation improving — alert again" },

    { "offsetMinutes": 240, "type": "observation", "data": { "code": "HEART_RATE", "value": 98, "unit": "bpm", "source": "monitor" } },
    { "offsetMinutes": 240, "type": "observation", "data": { "code": "RESP_RATE", "value": 20, "unit": "/min", "source": "manual" } },
    { "offsetMinutes": 240, "type": "observation", "data": { "code": "SYSTOLIC_BP", "value": 112, "unit": "mmHg", "source": "manual" } },
    { "offsetMinutes": 240, "type": "observation", "data": { "code": "DIASTOLIC_BP", "value": 68, "unit": "mmHg", "source": "manual" } },
    { "offsetMinutes": 240, "type": "observation", "data": { "code": "TEMP_C", "value": 38.3, "unit": "°C", "source": "manual" } },
    { "offsetMinutes": 240, "type": "observation", "data": { "code": "SPO2", "value": 96, "unit": "%", "source": "monitor" } },
    { "offsetMinutes": 240, "type": "observation", "data": { "code": "AVPU", "value": 0, "unit": "score", "source": "manual" } },
    { "offsetMinutes": 240, "type": "observation", "data": { "code": "LACTATE_MMOL_L", "value": 2.1, "unit": "mmol/L", "source": "lab" }, "note": "Lactate improving after fluids" }
  ],
  "expectedOutcomes": [
    { "afterOffsetMinutes": 30, "type": "alert", "alertType": "WARNING_TEMP_C", "description": "Temperature 38.6 enters warning range" },
    { "afterOffsetMinutes": 60, "type": "alert", "alertType": "WARNING_HEART_RATE", "description": "HR 105 enters warning range" },
    { "afterOffsetMinutes": 60, "type": "alert", "alertType": "SEPSIS_WARNING", "description": "SIRS criteria met: temp >38.3, HR >90, RR >20, WBC >12" },
    { "afterOffsetMinutes": 90, "type": "alert", "alertType": "QSOFA_WARNING", "description": "qSOFA ≥2: RR 24, SBP 102, AVPU 1" },
    { "afterOffsetMinutes": 90, "type": "bundle", "description": "Sepsis bundle auto-created with 4 orders" },
    { "afterOffsetMinutes": 105, "type": "bundle", "description": "All 4 bundle elements completed — COMPLIANT" },
    { "afterOffsetMinutes": 120, "type": "score", "scoreType": "NEWS2", "expectedMinimum": 7, "description": "NEWS2 reaches HIGH risk" },
    { "afterOffsetMinutes": 120, "type": "alert", "alertType": "NEWS2_EMERGENCY", "description": "NEWS2 ≥7 or single parameter 3" },
    { "afterOffsetMinutes": 120, "type": "alert", "alertType": "RAPID_DETERIORATION", "description": "HR climbed 88→118 and SBP dropped 128→96 rapidly" }
  ]
}