Collapsed man at a village fair: CPR, crowd and handover
At a village fair, a 45-year-old man suddenly collapses. He is unresponsive, makes occasional gasping sounds, and has no obvious bleeding or injury. A crowd of about 40 people gathers; someone tries to pour water into his mouth, another wants to lift him onto a chair, and a third is filming. The nearest ambulance is 30 minutes away and mobile signal is weak. The only trained person present is a vocational health-care student carrying gloves, a pocket mask and a first-aid kit but no AED. The patient's wife says he has diabetes and had eaten poorly since morning. The student must act in the first few minutes and also manage the crowd, the phone call and the handover.
1. What are your first actions in the first two minutes, and what should you not do?
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Check safety, then check response by shouting and tapping the shoulders. If there is no normal response, open the airway and look, listen and feel for normal breathing for no more than 10 seconds. Occasional gasping is not normal breathing; treat it as cardiac arrest. Shout for help, send someone to call emergency services and fetch an AED if one can be found, and start chest compressions immediately: centre of the chest, hard and fast, about 100-120 per minute, with a ratio of 30 compressions to 2 ventilations using the pocket mask. Do not pour water into his mouth, do not lift him onto a chair, and do not delay compressions to search for a pulse or to test glucose. He is unresponsive and cannot swallow; water risks aspiration. Hypoglycaemia is possible given his history, but in an unresponsive patient with abnormal breathing, CPR takes precedence. If he begins breathing normally, place him in the recovery position and monitor continuously.
2. How do you organise bystanders, the emergency call and transport to give the patient the best chance?
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Give clear, single tasks to named people rather than shouting to the crowd. One person calls emergency services, states the location and landmark, says the patient is unresponsive and not breathing normally, and stays on the line. Another clears a space and keeps onlookers back. A third looks for an AED and a vehicle. Ask the wife quietly about diabetes, medicines and allergies while compressions continue. Do not wait 30 minutes doing nothing: if a safe vehicle is available, start transport towards the ambulance while CPR continues, but only with someone able to continue compressions. Stop bystanders from filming the patient's face and from crowding the airway. Keep the patient on a firm surface. If another trained person arrives, rotate compressors every two minutes to maintain quality. The best chance comes from uninterrupted, good-quality CPR and early defibrillation, not from moving him to a chair or giving oral fluids.
3. What information must be handed over, and how would you document the event afterwards?
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Use a structured handover: who the patient is, the time of collapse, what was found, what was done, and what changed. Say: unresponsive adult, gasping initially, CPR started at a specific time, number of cycles given, pocket-mask ventilation used, no AED available, no water given, and any recovery of breathing. Include the wife's account of diabetes and poor food intake, and any medicines found. Hand over the times of collapse, first compression and any change in condition. Document afterwards in the first-aid record or patient notes: date, time, place, history from bystanders, initial assessment, each intervention with times, response, who was informed, and where the patient was transferred. Record that consent was implied because the patient was unconscious. Note any refusal of help by family, and keep the record factual rather than blaming bystanders. Good documentation supports continuity and protects both the patient and the first aider.