Collapsed man in a rural sub-centre waiting area
At 11:40 a.m. in the waiting area of a rural sub-centre in Haryana, a 58-year-old man who had come for a blood pressure check suddenly slumps sideways on a low wooden bench and becomes unresponsive. You are the only trained healthcare worker present; a helper and two villagers are nearby. You confirm he does not respond to shouting or a shoulder shake. He is not breathing normally, but makes an occasional noisy gasp. There is no AED at the sub-centre and no oxygen cylinder in the waiting area. The floor is bare concrete, and the bench is about 45 cm high. The 108 ambulance has been called and is expected in 14 minutes. The nearest CHC is 9 km away. The man's wife is crying and asking you to 'give him some water and make him sit up'. Another villager starts shaking the man's shoulders and asking everyone to pour water on his face. You have a mobile phone with intermittent signal and a first-aid kit containing gloves, gauze and a pocket mask.
1. List, in order, what you will do in the first 60 seconds, and justify why each step comes at that point rather than later.
Read the worked answer
The priority is to prevent delay in chest compressions.
- Make the scene safe and put on gloves; ask the villagers to stop shaking the patient and to move back.
- Check response by shouting and shaking the shoulders - already done.
- Shout for help and confirm that 108 has been called; ask the helper to bring the pocket mask.
- Open the airway with head-tilt/chin-lift and look, listen and feel for no more than 10 seconds. Occasional gasps are agonal breathing, not normal breathing, so this is a cardiac arrest.
- Ask two villagers to move him from the 45 cm bench to the concrete floor; effective compressions need a hard, flat surface.
- Start chest compressions immediately.
Do not sit him up, give water or splash water on his face: he cannot swallow, these actions waste the 4–6 minutes before brain injury, and water risks aspiration. Moving him to the floor takes only seconds, so it is justified before starting compressions.
2. Describe the CPR you will provide as a lone trained rescuer with a pocket mask and no AED until the ambulance arrives. Give the key numbers and explain one modification you would make if you were unwilling or unable to give breaths.
Read the worked answer
Kneel at his side. Place the heel of one hand on the centre of the chest (lower half of the sternum), put the other hand on top, keep arms straight and shoulders over the hands. Compress 5–6 cm at a rate of 100–120 per minute, allow full chest recoil, and keep pauses under 10 seconds.
With a pocket mask and as a lone trained rescuer, give 30 compressions followed by 2 rescue breaths, each lasting about 1 second and just enough to make the chest rise. Do not stop to recheck the pulse. The helper can take over compressions every 2 minutes to reduce fatigue.
If I could not or would not give breaths, I would switch to continuous compression-only CPR. Compressions still circulate oxygenated blood, and uninterrupted compressions are far better than stopping. I would put the phone on speaker to follow dispatcher instructions.
The reasoning is that depth, rate, full recoil and minimal interruptions determine survival; the 30:2 ratio is the standard for a single rescuer with a mask.
3. The ambulance crew arrives at 11:56 and takes over. State what information you must hand over and one documentation entry you will make.
Read the worked answer
Handover using SBAR: a 58-year-old man with a witnessed collapse at 11:40, unresponsive with agonal gasps, CPR started at about 11:42, no AED available, 30:2 with a pocket mask, about seven cycles, no return of spontaneous circulation before the crew arrived, no known allergies or medicines, and his wife is present.
In the register I would record the time of collapse, the time CPR began and ended, the findings, the interventions, who was informed, and the transfer to the ambulance crew with their names. I would write facts, not opinions such as 'patient looked bad'. Accurate times matter for the receiving hospital and for the medico-legal record.