Cardiac Arrest on the Motorway Hard Shoulder
On a coach travelling on the A2 motorway near Kavala, a 68-year-old passenger tells the driver she feels unwell. She is pale, sweating, and complains of crushing chest pain spreading to her left arm and jaw. The driver pulls onto the hard shoulder, switches on the hazard lights and puts on a high-visibility vest. The passenger becomes unresponsive and stops breathing normally; she has occasional gasps. There is an AED in the coach's first-aid cupboard, and a trainee nurse among the passengers. The outside temperature is 35 °C. The driver's mobile phone has 5% battery. There is a first-aid kit and a fire extinguisher on board. The coach is 2 km from an exit and 9 km from a hospital. The hard shoulder is narrow and traffic is passing at speed.
1. Set out, in order, the driver's immediate actions, including scene safety, calling 112 and starting CPR.
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Stop as far left as possible on the hard shoulder, hazard lights on, parking brake applied, high-vis vest worn. Do not move the casualty unless there is immediate danger. Check response (shout and shake the shoulders) and breathing (look, listen and feel for no more than 10 seconds). The occasional gasps are agonal breathing - treat them as cardiac arrest.
Send a named person to call 112 and another to place a warning triangle only if it is safe and local rules permit; on a motorway the hard shoulder is dangerous, so keep people behind the barrier. Start chest compressions immediately. Keep the airway open and remove only visible obstruction. Get the first-aid kit and the AED. The trainee nurse can help, but the driver remains responsible for the scene. Keep the passengers calm and seated, and appoint someone to meet the ambulance at the exit. Shade the casualty from the heat if possible without delaying CPR.
2. Describe how CPR and the AED should be used, and what the driver should tell the emergency operator.
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CPR: 30 compressions to 2 rescue breaths if trained and willing; otherwise continuous compressions. Compress the centre of the chest, depth 5–6 cm, rate 100–120 per minute, allow full recoil and minimise interruptions. Use the AED as soon as it arrives: switch it on, attach the pads to the bare, dry chest, follow the voice prompts, ensure nobody touches the casualty during analysis and shock, then resume CPR immediately. If the chest is wet with sweat, dry it first.
Tell 112: motorway A2 near Kavala, direction of travel, kilometre marker or nearest exit, 2 km from the exit and 9 km from the hospital; one casualty, a 68-year-old woman, unresponsive and not breathing normally, possible cardiac arrest, CPR in progress, AED available; a coach with about 40 passengers on the hard shoulder. Give the phone to someone else if the battery is low and ask the operator to call back. If the phone dies, flag down a passing vehicle or use the emergency telephone.
3. What should the driver not do, and how should the other passengers be managed?
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Do not give food or drink, do not slap her or splash water, do not leave her alone, do not move her unnecessarily, and do not drive to hospital yourself while she is in cardiac arrest - the ambulance is better equipped and moving her alone in a coach is dangerous. Do not use the AED on a wet chest without drying it, and do not touch the casualty during shock. Do not let passengers crowd around or stand on the motorway side.
Move passengers away from the hard shoulder if it is safe, keep them seated and calm, and ask the nurse to help with the casualty while another adult manages the group. Keep the hazard lights on and the doors closed on the traffic side. If the phone dies, use the emergency telephone or flag down help. Record what happened and who did what for the later report.