Collapsed in the loading bay: the first 60 seconds
It is 06:40 and rain is blowing into the loading bay of a food distribution warehouse. You are the only trained first aider on shift. A supervisor shouts that a 45-year-old agency driver has collapsed beside a stack of pallets. From ten metres away you can see: the concrete floor is wet from an overhead leak; a forklift is idling with its driver standing over the casualty; a portable fan heater lies tipped on its side with its cable trailing through a puddle; the man is on his back and not moving. The forklift driver starts dragging the casualty by the shoulders so the ambulance can get through the gate. Two other workers are filming on their phones. Nobody has been sent to the site entrance, 200 m away, and the ambulance station is 12 km off. Your kit, with gloves and a pocket mask, is 40 m behind you.
1. Before you touch the casualty, what hazards does this scene present, and in what order do you control them? Explain the reasoning behind your order.
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There are four hazards and one of them can kill you before you reach the patient.
- Electricity and water. The heater is tipped with its cable in a puddle. Treat the puddle and the metalwork as potentially live. Send a worker to switch off at the bay breaker or socket, and tell them not to touch the cable itself. Confirm the heater is dead before anyone stands in that water.
- The forklift. It is running, the driver is distracted and the forks may be raised. Tell him to switch off, remove the key and stay with the machine.
- Slip hazard and bystanders. Barrier the wet floor against further foot traffic, stop the two people filming and give them jobs - one to bring the kit, one to the gate to meet the ambulance.
- The casualty's condition is only assessed once 1–3 are controlled: call his name, squeeze his shoulders, and look for normal breathing for no more than 10 seconds.
Why this order? The chain of survival begins with rescuer safety. A rescuer who is electrocuted or hit by a forklift becomes a second casualty and stops the response entirely. Controlling these three hazards takes seconds, not minutes, so it does not meaningfully delay CPR.
2. The forklift driver is already dragging the man. How do you manage him, and what do you include in your 999 call?
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Intervene physically but calmly - hand on his shoulder, eye contact, lower your voice. Acknowledge the urgency instead of arguing: "You're right that every minute counts, and I need your help to do this properly." Explain in one sentence that dragging a collapsed man by the shoulders across a wet floor risks a spinal injury and puts both of you in a wet area next to live equipment. Then give him a specific job so he is busy, not hovering: shut down and key out the forklift, and keep other traffic out of the bay.
You can control this scene in seconds, so there is no need to trade safety for speed. Call 999 on speaker phone and give:
- the full site address and the name or number of the gate the ambulance should use;
- a landmark or map reference, plus the fact that someone in hi-vis will meet them;
- one adult male, unresponsive, and whether he is breathing normally;
- what you are doing - assessment, CPR, AED on its way;
- the hazards present: forklift, water, electrical equipment;
- your callback number, and stay on the line as instructed.
3. Under what circumstances would you move this casualty yourself?
Read the worked answer
Only when the danger is immediate and cannot be removed from the casualty - not for convenience, not to speed up the ambulance, and not because the family or a manager is insisting.
Real triggers would be: a fire that is spreading through the bay with no way to knock it down; water rising in a flood situation; structural collapse or falling racking; a confirmed gas leak or toxic atmosphere; or a live electrical contact you cannot isolate and which you cannot reach to give CPR without being in the current path.
The judgement is a comparison of two risks. In an unresponsive casualty with no signs of life, the certain risk is death from hypoxia within minutes; the possible risk is a spinal injury. If the environment will kill both of you, move - that is the lesser harm. If you must move, keep the head and neck as aligned as possible, use three or four helpers and a blanket or board to slide or log-roll rather than lift, and record how and when it was done so the handover team knows spinal precautions were compromised.
Once the casualty is in a safe area, the priority immediately reverts to airway, breathing and CPR.