Collapse in the staff gym: occasional gasps, an AED 40 metres away
13:20 in an open-plan office. A 58-year-old man has collapsed beside the gym benches in the staff fitness room. You are the only trained first aider on site. A colleague has already shouted for you; a second colleague is on the phone to 999. The man is lying on his back and is unresponsive. You open his airway and for 10 seconds you see and hear an occasional noisy gasp roughly every 8 to 10 seconds, with no regular rise and fall of the chest, and his lips look grey. The AED is mounted in reception, about 40 metres away and down one flight of stairs. The call handler says the ambulance will be with you in about 8 minutes. You have a CPR face shield in your pocket; the first aid kit is in the corridor.
1. Explain why this casualty is not 'breathing normally', and state your immediate actions.
Read the worked answer
Recognition. There is no regular rise and fall of the chest. What I am seeing are agonal gasps - occasional, noisy, ineffective breaths driven by the brainstem in the first minutes of cardiac arrest. They are common, they look and sound alarming, and they are the single most frequent reason a cardiac arrest is mistaken for 'breathing'. Add unresponsiveness and grey lips and the working diagnosis is cardiac arrest.
Actions, in order:
- Confirm unresponsiveness - no response to voice or a shoulder squeeze.
- Airway open and breathing checked for the full 10 seconds (done).
- 999 already running; send the second colleague for the AED in reception now, before I start compressions.
- Start chest compressions immediately: heel of the hand in the centre of the chest, 5–6 cm deep, 100–120 per minute, full recoil between compressions.
- Give 30 compressions to 2 rescue breaths using the face shield, or continuous compressions if breaths are not possible.
The rule is simple: if the casualty is unresponsive and not breathing normally, treat as cardiac arrest. I do not wait to see whether he 'improves', and I do not spend time looking for a pulse.
2. Describe how you and the two colleagues run the AED, including pad placement, safety checks and the move between shocks and compressions.
Read the worked answer
Roles. I keep compressions going; colleague A fetches and then operates the AED; colleague B stays on the phone and meets the ambulance at the door.
Using the AED:
- Turn it on and follow the voice prompts. Bare and dry the chest; remove any medication patch and wipe the skin; shave only if hair stops the pads sticking - quickly.
- One pad below the right collarbone, the other on the left lower chest towards the armpit, following the pictures on the pads. Plug in the connector if required.
- Stop compressions only for the analysis. Say clearly 'stand clear - everyone away from the casualty', check nobody is touching him, then let it analyse.
- If a shock is advised: shout 'stand clear', confirm visually, press the shock button, then resume compressions immediately - no checking for a pulse, no waiting.
- If no shock is advised, continue CPR straight away.
- Keep the cycle: 2 minutes of CPR, then another analysis.
Why it matters. Every second without compressions lowers his chance of survival; the shock only works if oxygenated blood is still circulating. We swap the compressor every 2 minutes at the analysis pause so neither of us tires, and we keep the hands-off time to the absolute minimum.
3. What would you do differently if you were genuinely alone for the first four minutes, and what must you hand to the paramedics?
Read the worked answer
If alone. I would call 999 on speakerphone first, put it down beside him, and start compressions - I cannot do compressions and hold a phone call usefully. I would not abandon him to run downstairs for the AED unless a bystander appears who can go; if an untrained passer-by arrives, I would send them for the AED and keep compressing. Compressions without breaths (compression-only CPR) are far better than no CPR.
Handover to the ambulance crew:
- Time he collapsed and time I started CPR.
- Time the AED was attached, how many shocks were delivered, and what the device advised each time (shock advised / no shock advised); whether there was any sign of recovery - movement, groaning, regular breathing.
- Total time of 'hands-off' pauses, if significant, and who did compressions.
- Any information from colleagues: known heart disease, medication, recent chest pain, and whether he had been exercising.
- What has not been done: no food or drink, no drugs given.
A short, timed, factual handover lets the crew continue without re-questioning everyone, and it must be written in the first aid record afterwards.