Collapse at the Customer Service Desk
At 16:20 a man of about 58 collapses in front of the customer service desk of a busy mall. He is on his back, unresponsive, and making occasional gasping, snoring sounds. A crowd of about 25 people forms within seconds. His wife says he has diabetes, has had chest pain since morning, and takes tablets for blood pressure. A bystander is already unscrewing a bottle of water to pour into his mouth; another is trying to lift him into a sitting position; a third is shouting that the guard should check his pulse for a full minute before doing anything. The AED cabinet is at the security cabin about 90 seconds away, and a second guard is on duty there. The ambulance control room gives an estimated arrival of nine minutes. The mall's CCTV covers the service desk, and the AED has a data-recording module.
1. What do you do in the first two minutes, and why?
Read the worked answer
1. Scene safety and response. Kneel beside him, tap his shoulders and shout, "Sir, are you all right?" No response means he cannot protect his own airway.
2. Shout for help and give clear, named instructions. "You in the blue shirt - call 108 now and come back and tell me you called. You in the white shirt - run to the security cabin, tell the guard to bring the AED, and bring it here yourself if he is busy." Pointing at individuals prevents the crowd effect where everyone waits for someone else.
3. Open the airway and look for normal breathing for no more than 10 seconds. Occasional gasping, snoring sounds are agonal breathing - that is not normal breathing. An unresponsive adult who is not breathing normally is in cardiac arrest until proved otherwise.
4. Start chest compressions immediately. Heel of the hand on the centre of the chest, second hand on top, arms straight, 5–6 cm deep, 100–120 per minute, full recoil, minimal interruptions. Give 30 compressions then 2 rescue breaths with a barrier device if one is available; if you are not trained or willing to give breaths, do compression-only CPR - it is far better than nothing.
5. AED on arrival. Switch it on and follow the voice prompts; bare and dry the chest, attach pads as shown on the pictures, keep everyone clear during analysis, deliver the shock if advised, then resume compressions at once.
Chest pain since morning plus collapse suggests a cardiac cause, but the treatment is decided by what you see - unresponsive, not breathing normally - not by a diagnosis.
2. How do you deal with the bystanders' suggestions - water, sitting him up, a full minute of pulse checking - without wasting time?
Read the worked answer
Handle them in one or two sentences each, while your hands keep working.
- Water: "Don't put anything in his mouth - he cannot swallow and he will choke." An unresponsive person has no protective airway reflex; fluid goes into the lungs, causes vomiting and aspiration, and makes resuscitation far harder. The same applies to tablets, including his blood-pressure or diabetes medicines. Nothing by mouth.
- Sitting him up: "Leave him flat, don't move him." He collapsed, so there may be a head or spinal injury; sitting him up reduces blood return to the heart in someone who may already be in arrest, and lifting him disrupts compressions. Keep him supine on a firm, flat surface.
- A minute of pulse checking: "No - he's not breathing normally, we start now." Lay rescuers frequently mistake their own pulse for the casualty's, and a minute of searching for a pulse is a minute without circulation. Health authorities no longer ask lay rescuers to check a pulse at all: unresponsive plus not breathing normally equals start CPR.
- Turn the crowd into help: ask two people to clear a space and keep the exit route open for the stretcher, ask one to meet the ambulance at the mall entrance, and ask the wife to stay close and give his name, age and medical history. Give her something useful to do - it reduces panic and gives you information for the handover.
Tone matters as much as content: short, calm instructions spoken while compressions continue, not a debate.
3. What do you hand over and record when the ambulance arrives?
Read the worked answer
Handover, in one organised minute:
- Time he collapsed, how he was found (unresponsive, gasping), and the time CPR started.
- What was done: compressions, ratio, number of cycles, whether a barrier device was used, and any change in his condition.
- AED: attached at what time, how many shocks and at what times, and whether the machine prompted "no shock advised". Leave the pads on - the receiving team will want them.
- History from the wife: about 58 years old, diabetic, blood-pressure medication, chest pain since morning. Name, age, next of kin and contact number if she can give it.
- Continue CPR until the ambulance crew physically take over - do not stop when you hear the siren.
Record immediately, while it is fresh: a factual entry with 24-hour times - 16:20 collapse, 16:22 CPR started, 16:24 second guard dispatched, 16:26 AED attached, and so on. Note who did what, who called 108, and the names and phone numbers of the wife and two reliable bystanders. Avoid opinion and diagnosis ("he had a heart attack"); record observations ("unresponsive, not breathing normally").
Preserve evidence: the AED stores an ECG and event record - do not delete it, and note its serial number and who took custody. Note the CCTV camera covering the service desk and its time offset, and preserve that footage; do not release it to the media or to onlookers, only to police or the agency with a signed receipt in the register. In a death or serious injury, the logbook and footage may be the only independent account of how quickly the response happened.