Collapse Beside a Moving Forklift Aisle
At 09:15 in a packaging plant, a 42-year-old male operator collapses face-down beside a conveyor. The guard, Sunil, reaches him within 40 seconds. The man does not respond to shouting or shoulder shaking; he is breathing with occasional gasps about every 6 seconds, and his lips look grey. A pallet truck is 2 m away and a forklift is still moving in the next aisle. The nearest AED is in the security cabin 60 m away, and a second guard is at the gate. The plant nurse is on leave; the ambulance was called by a passer-by two minutes ago and is 8 minutes away. Twelve workers have gathered, one is filming on a phone, and a supervisor says "lift him onto the bench and give him water."
1. What is the likely diagnosis, and what should Sunil do in the first 60 seconds?
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Diagnosis: cardiac arrest. An unresponsive person with occasional gasps every ~6 seconds is not breathing normally - agonal gasps are a sign of arrest, not recovery.
First 60 seconds:
- Scene safety - stop the forklift in the next aisle and keep the pallet truck clear; a rescuer down is a second casualty.
- Check response - shout and shake shoulders; no response.
- Shout for help and send the second guard for the AED with a clear instruction: "AED from the security cabin, bring it here now."
- Open the airway, check breathing for no more than 10 seconds - the gasps confirm arrest.
- Start chest compressions immediately - centre of chest, 5–6 cm deep, 100–120 per minute, 30 compressions to 2 breaths.
Do not: give water, sit him up, lift him onto the bench, or delay compressions while searching for a pulse for minutes. The supervisor's instruction is unsafe; Sunil should say so and keep working.
2. How should Sunil organise the twelve bystanders and use the AED?
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Assign each bystander one task, by name or by pointing:
- One to bring the AED from the cabin 60 m away and return at a run.
- One to confirm the ambulance call, give the exact gate location and send someone to meet it.
- One to move the forklift traffic and clear a route for the stretcher.
- One to keep the crowd back and stop the phone filming - dignity and privacy matter, and the footage may become evidence.
- One to note times: collapse at 09:15, compressions started, AED arrived, shocks delivered.
AED use: switch on, bare and dry the chest, attach pads as shown, clear everyone before analysis and shock, follow the voice prompts, resume compressions immediately after the shock. Do not stop to argue with the supervisor.
Handover to EMS: time of collapse, time CPR began, number of shocks, AED prompts, any change in the patient's condition.
3. If he starts breathing normally before the ambulance arrives, what changes in Sunil's actions?
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If he starts breathing normally: check for 10 seconds that breathing is regular, then place him in the recovery position on his side, head tilted back, mouth downward, so vomit can drain. Keep the AED pads attached and the AED on if it has been used - do not remove them - and monitor breathing continuously until the ambulance arrives.
Do not give food or drink, let him stand or walk, or leave him alone. Keep him warm, note the time breathing returned, and hand over: "Collapsed at 09:15, CPR started, one shock, breathing normally from about 09:19, recovery position."
If breathing stops again, restart CPR immediately. Report the incident and preserve the AED recording.