Collapse on the Factory Floor
You are a trained security guard on the factory floor at 11:20 when a 50-year-old maintenance worker collapses beside a conveyor. He is unresponsive, has no obvious injury, and is making occasional gasping sounds. The conveyor has been stopped and the area is safe. About 30 workers are crowding around, some shouting for water; the factory nurse is off-site. The nearest AED is in the security cabin, about 90 seconds away. Your partner is trained in CPR. The ambulance has been called on 108 and is expected in 10–12 minutes. The supervisor wants to sit the man up and give him water. The floor is concrete, a first-aid box is 20 m away, and the worker's wife has been called but is not yet on site. You have a radio and a mobile phone.
1. What do you do in the first 60 seconds, and how do you confirm cardiac arrest?
Read the worked answer
First 60 seconds: make the scene safe-stop the conveyor, check for electrical or machine hazards, and keep the crowd back. Kneel beside him, tap his shoulders, and shout, 'Are you all right?' If there is no response, shout for help, point to a specific person, and say, 'Call 108 and bring the AED from the security cabin-now.' Tilt the head, lift the chin, and look, listen, and feel for normal breathing for no more than 10 seconds. Occasional gasping is agonal breathing, not normal breathing. Check the carotid pulse at the same time if trained, but do not spend more than 10 seconds. If he is unresponsive, not breathing normally, and has no pulse, start CPR. Do not sit him up, give water, or slap him. Record the time of collapse.
2. Describe the CPR and AED sequence, including numbers and roles.
Read the worked answer
Start compressions: heel of the hand on the centre of the chest, 30 compressions at 100–120 per minute, 5–6 cm deep, full recoil, minimal interruptions. Give 2 rescue breaths with a pocket mask or barrier if available; if not, do compression-only CPR. Your partner manages the airway and calls; swap every 2 minutes to avoid fatigue. When the AED arrives: switch it on, dry the chest, apply pads to the bare chest as shown, clear everyone, analyse, shock if advised, then resume CPR immediately for 2 minutes. Do not touch the patient during analysis or shock. Keep the crowd back and the area clear. Continue until the ambulance crew takes over, the patient shows signs of life, or you are physically unable to continue.
3. What if he vomits or starts breathing? How do you hand over?
Read the worked answer
If he vomits: stop compressions briefly, turn him onto his side, clear the mouth with a finger sweep only if visible, wipe, turn him back, and resume CPR. Do not give water. If he starts breathing normally, place him in the recovery position, monitor breathing every minute, keep him warm, and do not let him stand. Hand over to the ambulance: time of collapse, time CPR started, number of shocks, AED prompts, any vomiting, changes in breathing, and the fact that the nurse was off-site. Give the AED download if available. Document names of rescuers and times. Tell the supervisor not to give water and to keep the crowd away.