Collapse on the Gym Treadmill: Agonal Gasps and a Distant AED
You are the only first aider on duty at a gym on a Saturday morning. A 54-year-old man who has been running on a treadmill for about 12 minutes suddenly collapses without making any attempt to break his fall. You reach him within 15 seconds. He is unresponsive, his eyes are closed, and he is making occasional snoring, gasping sounds about every 8 seconds. There is no bleeding and no seizure activity. Two other members are standing nearby watching you; neither has first aid training. The gym's AED is mounted on the wall at reception, roughly 40 metres away and up one flight of stairs. Another member is just walking in through the front door. The floor is hard rubber and there is clear space around the man. The gym has a fixed landline at reception but no mobile coverage on the floor.
1. What are your immediate actions in the first 30 seconds, and how do you decide this is a cardiac arrest rather than a faint or a seizure?
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Check response (shout and shake the shoulders) while at the same time looking at the chest. He is unresponsive and is not breathing normally - the occasional gasps every 8 seconds are agonal breathing, not effective breathing. Unresponsive plus no normal breathing equals cardiac arrest until proven otherwise; do not delay to feel a pulse, because pulse checks by non-clinicians are unreliable and every minute without compressions reduces survival.
Shout for help and give specific instructions to specific people: send the member at the door to reception to call 112 on the landline and to bring the AED back down, and tell the other bystander to stay with you. Vague 'someone call an ambulance' often results in nobody calling.
Start chest compressions immediately: heel of the hand on the centre of the chest, 5–6 cm deep, 100–120 per minute, full recoil between compressions. If you are trained and willing, use 30 compressions to 2 ventilations; otherwise give continuous compressions.
2. The AED arrives and is switched on. Describe how you use it, what you do if a shock is advised, and how you protect compression quality.
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Keep compressions going while the pads are applied. Bare and dry the chest (sweat can prevent the pads sticking), place one pad below the right collarbone and one in the left mid-axillary line as shown on the pad pictures, and avoid any implanted device or medication patch. Plug in the connector if the device requires it.
When the AED says it is analysing, stop compressions, call 'stand clear', and check visually that nobody is touching the man. If a shock is advised, shout 'stand clear' again, confirm nobody is in contact, press the shock button, and resume compressions immediately - do not pause to check a pulse or look for breathing.
If no shock is advised, restart compressions at once. Keep every interruption under 10 seconds: prepare the next step while compressions continue, and swap compressors every 2 minutes because fatigue quietly reduces depth and rate. Leave the pads on; the AED will re-analyse on its own cycle.
3. Twelve minutes later the ambulance has still not arrived but the man starts to move and breathe normally. What do you do now, and what would justify stopping CPR?
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Stop compressions, leave the pads attached and the AED switched on, and place him in the recovery position. Reassess breathing continuously - re-arrest after a brief return of circulation is common, so keep the AED on and be ready to restart CPR immediately if he stops breathing normally. Do not give him anything by mouth: he is post-arrest and at high risk of vomiting and aspiration. Keep him warm and give the crew a clear handover: time of collapse, time CPR started, number of shocks delivered, and any change in his condition.
The justifiable reasons to stop CPR are: return of signs of life (normal breathing, purposeful movement, coughing), a healthcare professional taking over, the scene becoming unsafe, or you becoming physically unable to continue with nobody able to replace you. The ambulance not having arrived yet is never a reason to stop.