Passenger collapse on a regional route
On a two-lane regional road near Veles, a 68-year-old passenger standing in the aisle suddenly collapses. The bus is a 48-seat category D coach with 31 passengers, including a nurse off duty. The driver is 6 km from the next town and 2 km from a safe gravel pull-off. The passenger is unresponsive, breathing noisily, and has a weak pulse; there is no visible bleeding. A companion says the man has diabetes and takes medication. The driver has a first-aid kit and a fire extinguisher, but has not yet called emergency services. The road has no hard shoulder, and traffic is moderate. The driver's mobile phone has signal. The nurse offers help. The driver's tachograph shows 20 minutes of driving since the last break.
1. What should the driver do in the first 2 minutes?
Read the worked answer
First, stop the bus safely. The gravel pull-off is 2 km away, but the passenger is unresponsive; if the bus can reach the pull-off within a minute or two without delaying care, do so. If not, stop on the road with hazard lights, parking brake on, and engine off. Call 112 immediately: give the road number, direction, nearest kilometre marker or town, the patient's age, unresponsive state, noisy breathing and weak pulse, and that a nurse is present. Do not move the patient unless there is immediate danger. Check breathing and pulse; if breathing is present but the patient is unresponsive, place him in the recovery position on his side, ensuring the airway is open. Loosen tight clothing. Do not give food or drink, especially with suspected diabetes. Ask the nurse to monitor breathing while the driver controls the scene. Keep passengers back and open a window or door for ventilation. Do not crowd the patient.
2. How should the driver manage the scene and passengers while waiting for the ambulance?
Read the worked answer
The driver remains responsible for the whole bus. Ask a responsible passenger to place a warning triangle about 50 m behind the bus on the two-lane road if it is safe to do so, and to signal traffic. Keep hazard lights on. The nurse can assess the patient, but the driver should not leave the bus unattended. Gather useful information: the companion's account, medication, ID, and the time of collapse. Record the time of the 112 call and the patient's condition. If the patient stops breathing, start CPR immediately; use an AED if one is available and the nurse is competent. Do not move the patient into a seated position or give oral fluids. When the ambulance arrives, give a handover: what happened, time, changes, and what was done. Keep passengers informed and ask them to remain seated unless evacuation is necessary. If the bus blocks traffic, move it only after the patient is stabilized and with police/ambulance agreement.
3. What post-incident actions are required?
Read the worked answer
After the incident, the driver should notify the operator, complete the company incident report, and preserve tachograph data and any CCTV. The driver should note witness names and contact details, but not discuss fault or liability with passengers or on social media. The first-aid kit should be restocked and the incident reviewed. If the passenger was standing while the bus was moving, the operator should review whether standing was permitted on that route and whether the driver's driving contributed; that is an investigation matter, not a roadside judgement. The driver should also consider their own wellbeing and report any shock. The vehicle should not continue the service until the scene is cleared and the bus is safe. Cooperation with police and ambulance is required, but the driver should give facts, not opinions. The incident should be used to check emergency procedures and passenger communication.