Chest Pain on I-65 Near Elizabethtown
At 14:05 you are driving a 54-passenger coach southbound on I-65, nine miles north of Elizabethtown, Kentucky, at 65 mph. You have 41 passengers. A 68-year-old passenger in row 12 tells you he has crushing chest pain, is sweating, and feels nauseated; his companion says he has a history of heart trouble. The right shoulder is narrow and bounded by a guardrail, and light rain is falling. The next scheduled stop is 40 minutes away. An AED is in the overhead bin at the front, and a first aid kit is by the door. Dispatch is on the radio but has not called 911. Traffic is moderate, with trucks passing close to the shoulder. The passenger is awake and breathing, but he looks pale and frightened. You must decide whether to continue, where to stop, and what care to provide while waiting.
1. Do you continue to the next stop or stop on the shoulder? Explain the trade-off.
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Treat this as a possible heart attack and stop as soon as you can do so safely. Nine miles to Elizabethtown is too far; the passenger needs EMS now. Use mirrors and signals, slow gradually, and pull onto the right shoulder or as far off the travel lane as the guardrail allows. Put on hazard flashers, set the parking brake, and tell dispatch to call 911 with the exact mile marker, direction, bus description, and number of patients. Do not let the passenger walk to the front or off the bus. Do not continue to the scheduled stop. If the shoulder is too narrow to be safe, move only to the nearest exit or wide spot, but do not drive 40 minutes. Keep the bus stationary until EMS arrives unless there is a fire or traffic threat.
2. What care do you provide while waiting for EMS?
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Have the companion stay with the passenger. Help the passenger sit or recline, loosen tight clothing, and keep them calm. Do not give food or drink; do not give aspirin, nitroglycerin, or any medication unless the patient takes their own prescribed medicine and you are trained to assist. Bring the AED and first aid kit to the passenger, but apply the AED only if the passenger becomes unresponsive and is not breathing normally; otherwise monitor breathing and be ready to start CPR. Send a passenger or crew member to the front door to meet EMS and clear an aisle. Keep other passengers seated and quiet. If the passenger becomes unresponsive, check breathing and pulse, start CPR if trained, and follow dispatcher instructions.
3. What do you tell the other passengers and dispatch, and what do you document afterward?
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Tell the passengers that there is a medical emergency, that EMS has been called, and that the bus will wait. Ask them to stay seated and keep the aisle clear; do not spread speculation about the diagnosis. Give dispatch updates: location, passenger condition, EMS arrival, and whether the schedule will be delayed. After EMS takes over, get the passenger's name and emergency contact if available, the names of witnesses, and the times of the complaint, stop, 911 call, and EMS arrival. Complete an incident report and notify the carrier. Do not discuss the passenger's condition with other riders. If EMS advises transport to a hospital, follow company policy for securing the bus and continuing the trip with a relief driver.