Collapse on the Steel Walkway
You are the site security guard at a construction project in the Byrnihat industrial area. It is 11:40, the temperature is 36 °C, and about 20 workers are on site. A 40-year-old worker collapses on a steel walkway about 1.5 m above the ground. He does not respond when you shout. He is breathing only occasionally, with a gasping, snoring sound; his face is flushed and his skin is hot and dry. Workers crowd around. One throws water on his face; another tries to pour water into his mouth; a third wants to carry him 400 m to the site ambulance. Your first-aid box has gloves, gauze and a pocket mask but no oxygen and no AED. The nearest ambulance is 8 km away and the primary health centre 11 km; 108 is on your phone's speed dial. Your first-aid certificate is current.
1. Set out your actions in the first four minutes and explain the order.
Read the worked answer
- Danger. The walkway is steel and may be live; ask a named worker to isolate the supply and keep the crowd back.
- Shout for help and call 108 now. Do not wait to see whether he improves.
- Response and airway. He does not respond. Open the airway, look-listen-feel. Occasional gasping is agonal breathing - it is treated as not breathing, so the working diagnosis is cardiac arrest and CPR starts immediately.
- CPR. Gloves on, pocket mask, compressions 100–120 per minute, 5–6 cm deep, full recoil, 30:2, minimal interruptions.
- Move him only because you must. CPR needs a firm flat surface, and the walkway is a fall hazard. With help, log-roll him to the ground protecting the neck; do not drag him by the arms.
- Cool in parallel. Flushed dry hot skin at 36 °C points to heat stroke: shade, loosen clothing, wet cloths to neck, armpits and groin, fanning. Cooling does not replace compressions.
- Note times: collapse 11:40, CPR started, cycles completed.
2. What do you tell the crowd, and what must you not do?
Read the worked answer
Give each person one clear task and a name attached to it:
- two men to hold the crowd back about 5 m and keep the area clear;
- one to bring the first-aid box and the site attendance register;
- one to stand at the gate to guide the ambulance in;
- one to inform the site engineer and the safety officer.
Must not:
- Pour water into his mouth. An unconscious person cannot swallow; it blocks the airway or reaches the lungs.
- Sit him up or give ORS. Both are for a conscious person.
- Carry him 400 m in a chair hold. A limp body is dropped, and the walkway is a fall hazard. The ambulance comes to him.
- Delay CPR while someone looks for an AED that the site does not have.
- Stop when he jerks or gasps. That is not a return of normal breathing.
- Let anyone photograph the casualty. The register and your report are the record; photographs circulate and humiliate the family.
Splash water on the face does no harm but does nothing either - redirect that person to fanning.
3. How do you hand over to the ambulance crew and the site office?
Read the worked answer
Use a short, structured handover:
- Situation: 40-year-old male, collapsed at 11:40, unresponsive, agonal breathing, CPR started at 11:42.
- Background: working in 36 °C heat, hot dry flushed skin, no known medical history on the site register.
- Assessment: not breathing normally, no AED on site, cooling started.
- Recommendation: continue CPR and transport.
Add the facts only you hold: number of cycles given, whether he vomited, whether there was any return of normal breathing, and the name of the supervisor who took charge. Hand over his ID card and the site medical form.
Then write the daily activity register entry while it is fresh - times, names of witnesses, exactly what you did. Complete the accident report for the site safety officer and the agency the same day. If there is an inquiry or a compensation claim, that contemporaneous record is the only reliable account of what happened in those four minutes.