Collapse in the OPD Waiting Area
At 11:20 a.m. a 60-year-old man collapses in the OPD waiting area. You are the nearest GDA. He does not respond when you call his name. He is lying on his back on the floor. You see occasional gasping breaths, about 6 per minute, and no obvious chest rise. A security guard is nearby, and a wheelchair is two metres away. There is no AED in the OPD; the nearest one is in the emergency department, four minutes away. A relative offers water and tries to lift the patient's head. The doctor is not in the room. You have a mobile phone and a first-aid box. Another patient is shouting for help.
1. What is your sequence of actions in the first two minutes?
Read the worked answer
- Check response: shout his name and gently shake his shoulders. He does not respond.
- Shout for help: tell the security guard to call the emergency team and bring the AED from the emergency department. Ask another person to keep the relative back.
- Open the airway with head tilt and chin lift, unless you suspect neck injury. Look, listen and feel for normal breathing while checking the carotid pulse for no more than 10 seconds.
- Recognise that gasping is not normal breathing. Occasional gasps at 6 per minute with no pulse or with no normal breathing means cardiac arrest until proven otherwise.
- Start chest compressions immediately: centre of the chest, heels of both hands, arms straight, push down 5–6 cm at 100–120/min, allow full recoil, minimise interruptions. If trained, give 30 compressions to 2 rescue breaths; if not trained or unwilling, do compression-only CPR.
- Send for the AED and ambulance. Continue CPR until the AED arrives, the patient shows signs of life, or a trained responder takes over.
Why: time to compression is the key factor in survival. The GDA does not need to diagnose the cause; the recognition of unresponsiveness plus abnormal breathing is enough to act.
2. How would you hand over to the ambulance or emergency team, and what information matters most?
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Use SBAR and keep it brief while compressions continue or immediately after transfer of care:
- Situation: 60-year-old man collapsed in the OPD at 11:20 a.m.; unresponsive; gasping breaths; CPR started at about 11:21 a.m.
- Background: identity unknown; no known medical history available; relative present; no AED in the OPD; AED requested from emergency department.
- Assessment: no normal breathing, no pulse when checked; compressions ongoing; no water given; no unnecessary movement.
- Recommendation: needs AED, advanced life support and ambulance transfer; relative should be kept informed and away from the resuscitation area.
Also report:
- Number of cycles or approximate duration of CPR.
- Any change: return of breathing, movement, vomiting or airway difficulty.
- Time the emergency team was called and when they arrived.
Why: clear times and interventions help the receiving team continue treatment and document the event. Do not give a long story; give the facts they need.
3. What should you not do in this situation, and why?
Read the worked answer
- Do not give water or food. He cannot swallow safely; water can cause aspiration.
- Do not let the relative lift his head or sit him up. This can worsen airway obstruction and delay CPR.
- Do not delay compressions to search for a pulse repeatedly or to look for an AED yourself. Send someone else.
- Do not stop CPR to argue with bystanders. Ask security to manage the crowd.
- Do not move him to a wheelchair or bed unless there is immediate danger and you can move him without interrupting compressions.
- Do not slap him, splash water or use home remedies. These do not treat cardiac arrest.
- Do not assume gasping means he is breathing normally. Agonal gasps are a sign of arrest.
If breathing returns: place him in the recovery position, keep the airway open, monitor breathing continuously and wait for the emergency team. Document the timeline and what was done.