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SJAM First Aid at Workplace study materials
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SJAM First Aid at Workplace practice questions

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Question 1Scene assessment, safety and the chain of survival

On arriving at a worker who has collapsed beside a conveyor, what should you do first as part of the scene assessment?

  1. Move the worker to the canteen before checking for danger
  2. Start chest compressions immediately without checking the surroundings
  3. Ask the worker to stand up and walk to the first aid room
  4. Check the scene is safe before you approach the casualty Correct answer.

Explanation

Scene assessment begins with danger: you must not become a second casualty. Check for moving machinery, electricity, traffic, fire or toxic hazards and control them before approaching. Only when the scene is safe should you check response, breathing and circulation and activate help.

Question 2Scene assessment, safety and the chain of survival

In the chain of survival for a workplace cardiac arrest, which action comes first?

  1. Early defibrillation using an automated external defibrillator
  2. Early advanced care and transport to hospital
  3. Early recognition and call for emergency help Correct answer.
  4. Early post-resuscitation care in intensive care

Explanation

The chain of survival starts with early recognition of cardiac arrest and activation of the emergency response. Without that first link, CPR, defibrillation and advanced care are delayed or never started. Each later link depends on someone recognising the emergency and calling for help.

Question 3Scene assessment, safety and the chain of survival

Which number should be called to activate the Malaysian emergency services from a workplace landline?

  1. 111
  2. 112
  3. 999 Correct answer.
  4. 991

Explanation

In Malaysia, 999 is the national number for police, fire and ambulance. It works from landlines and is the standard number to request emergency medical help from a workplace. Mobile phones may also use 112, but the national service is reached through 999.

Question 4Scene assessment, safety and the chain of survival

A worker is found unresponsive inside a sealed underground tank. A strong chemical smell is present. What is the most appropriate action?

  1. Open the tank and wait at the opening for the worker to crawl out
  2. Stay clear, raise the alarm and call specialist confined-space rescue Correct answer.
  3. Lower a rope and ask the worker to tie it around themselves
  4. Enter quickly and drag the worker out by the arms

Explanation

A sealed tank with a chemical smell may contain a toxic gas or lack oxygen, so entry is immediately dangerous. Untrained rescuers who enter become casualties and add to the emergency. Keep clear, raise the alarm and request specialist confined-space rescue through the emergency services.

Question 5Scene assessment, safety and the chain of survival

You are about to help a colleague with a bleeding forearm. Which personal protection is most appropriate before contact?

  1. A high-visibility vest and safety helmet
  2. Disposable gloves and eye protection Correct answer.
  3. A face mask only
  4. No protection because the bleeding is minor

Explanation

Any contact with blood or body fluids requires body substance isolation. Disposable gloves protect your hands, and eye protection guards against splashes during bleeding control. Wash hands afterwards and report any exposure.

Question 6Scene assessment, safety and the chain of survival

An AED arrives while CPR is in progress on a worker in cardiac arrest. What should you do?

  1. Apply the pads over thick clothing to save time
  2. Finish two more minutes of CPR before opening the AED
  3. Turn on the AED and follow its prompts Correct answer.
  4. Wait for the ambulance crew to operate the AED

Explanation

The AED should be turned on as soon as it arrives and its prompts followed without interrupting CPR for long. Bare and dry the chest before applying pads, and continue compressions while the AED analyses and charges. Early defibrillation is a key link in the chain of survival.

Question 7Scene assessment, safety and the chain of survival

A worker has fallen from a ladder and is lying on the floor complaining of neck pain. There is no fire or other hazard. What should you do?

  1. Lift the worker onto a trolley and take them to the clinic
  2. Keep the worker still and support the head and neck Correct answer.
  3. Remove the helmet and turn the head to the side
  4. Sit the worker up and give water

Explanation

A fall from height with neck pain raises suspicion of spinal injury. Keep the worker still and support the head and neck in line with the body unless there is immediate danger. Call for emergency help and monitor breathing while waiting.

Question 8Scene assessment, safety and the chain of survival

While clearing a first aid kit after an incident, you find a used needle on the floor. What is the safest action?

  1. Push it into a cardboard box with your foot
  2. Recap the needle and place it in the general waste bin
  3. Use gloves and place it in a rigid sharps container Correct answer.
  4. Leave it for the cleaning staff to remove

Explanation

Used needles are sharps and must be handled with gloves and placed directly into a rigid, puncture-resistant sharps container. Never recap, bend or break a needle, and never put it in general waste or a cardboard box. If no container is available, isolate the area and call the responsible person.

Question 9Scene assessment, safety and the chain of survival

A worker is receiving CPR after an electric shock from a portable machine. The machine is still switched on and a colleague is about to touch the casualty. What should you do first?

  1. Throw water on the machine to cool it
  2. Shout at the colleague to start compressions immediately
  3. Pull the casualty away by the ankles
  4. Stop the colleague and isolate the power at the source Correct answer.

Explanation

The electrical supply must be isolated before anyone touches the casualty, or the rescuer may also be electrocuted. Stop the colleague from contacting the worker, switch off and unplug or lock off the machine at the source. Then call for help and start first aid only when the scene is safe.

Question 10Scene assessment, safety and the chain of survival

Why is early defibrillation emphasised in the chain of survival for workplace cardiac arrest?

  1. It guarantees a return of spontaneous circulation on the first shock
  2. It replaces the need for chest compressions once applied
  3. It can be used safely on a conscious worker with chest pain
  4. Survival falls with each minute of delay from collapse to shock Correct answer.

Explanation

Defibrillation is time-critical because the chance of survival falls with every minute between collapse and shock. CPR helps maintain circulation and buys time, but it does not replace defibrillation. The AED should be used as soon as it is available and safe to apply.

Question 11Scene assessment, safety and the chain of survival

When you phone 999 for a collapsed worker, which information should you give the operator first?

  1. The worker's medical history and allergies
  2. The worker's home address and next of kin
  3. The name of the company safety officer
  4. The exact location of the incident and a callback number Correct answer.

Explanation

The emergency dispatcher must know where to send help and how to contact the caller if the line drops. Give the precise workplace location, a callback number, and a brief description of what happened before other details.

Question 12Scene assessment, safety and the chain of survival

An unresponsive worker is breathing normally and has no suspected spinal injury. What should you do while waiting for the ambulance?

  1. Start chest compressions immediately
  2. Leave them flat on their back and wait outside
  3. Place them in the recovery position and monitor breathing Correct answer.
  4. Give them sips of water to keep them hydrated

Explanation

The recovery position helps keep the airway open and reduces the risk of aspiration in an unresponsive casualty who is breathing. Stay with the worker and keep checking that breathing remains normal until help arrives.

Question 13Scene assessment, safety and the chain of survival

In the chain of survival, which link comes immediately after early CPR?

  1. Early recognition and call for help
  2. Early defibrillation Correct answer.
  3. Safety check of the scene
  4. Post-resuscitation care

Explanation

The chain of survival moves from recognition and calling for help, to early CPR, then early defibrillation. Defibrillation is the link that follows chest compressions in a cardiac arrest.

Question 14Scene assessment, safety and the chain of survival

A collapsed worker is unresponsive and making occasional gasping sounds. How should you interpret this?

  1. The worker is in cardiac arrest and needs CPR Correct answer.
  2. The worker is breathing adequately and should be monitored
  3. The worker is having a seizure and should be restrained
  4. The worker is choking and needs back blows

Explanation

Occasional gasping sounds, known as agonal gasps, are not normal breathing and are a recognised sign of cardiac arrest. Treat the worker as being in cardiac arrest, start CPR, and use an AED as soon as it is available.

Question 15Scene assessment, safety and the chain of survival

At a workshop incident, one worker is bleeding heavily from the thigh and another is shouting in pain with a deformed wrist. Who should be treated first?

  1. Neither, until the ambulance arrives
  2. The worker with the deformed wrist
  3. The worker who is shouting loudest
  4. The worker with heavy bleeding from the thigh Correct answer.

Explanation

Life-threatening bleeding takes priority over an isolated limb deformity because uncontrolled blood loss can quickly become fatal. Control the bleeding while someone else calls emergency services.

Question 16Scene assessment, safety and the chain of survival

Where should you place the AED pads on an adult worker in cardiac arrest?

  1. One on the forehead and one on the abdomen
  2. One on the upper right chest and one on the lower left side Correct answer.
  3. Both pads on the back, side by side
  4. Both pads on the centre of the chest, one over the other

Explanation

Standard adult AED placement is one pad on the upper right chest below the clavicle and the other on the lower left side of the chest. This position allows the current to pass through the heart.

Question 17Scene assessment, safety and the chain of survival

Two first aiders are with a worker in cardiac arrest. One is doing chest compressions. What is the most useful action for the second first aider?

  1. Record the exact time each compression is given
  2. Retrieve the AED and prepare it for use Correct answer.
  3. Take over compressions every 30 seconds regardless of fatigue
  4. Go to the car park to guide the ambulance

Explanation

The second first aider should get the AED and apply it as soon as possible while emergency services are being activated. Early defibrillation is time-critical in cardiac arrest.

Question 18Scene assessment, safety and the chain of survival

When is it appropriate to move a casualty before the ambulance arrives?

  1. Only when there is an immediate danger such as fire or traffic Correct answer.
  2. Whenever the casualty asks to be moved to a more comfortable place
  3. Whenever you need to clear the floor for cleaning
  4. Only after you have checked vital signs for 10 minutes

Explanation

Movement can worsen spinal or internal injuries, so a casualty should generally be kept still. Move them only when staying put exposes them to immediate danger, such as fire or moving traffic.

Question 19Scene assessment, safety and the chain of survival

A worker with an implanted pacemaker is in cardiac arrest and an AED is available. What should you do?

  1. Use paediatric pads instead of adult pads
  2. Do not use the AED because a pacemaker makes it ineffective
  3. Place one pad directly over the pacemaker to interrupt it
  4. Place pads at least 8 cm from the pacemaker Correct answer.

Explanation

An implanted device can interfere with AED analysis and current delivery, so the pads should be kept at least 8 cm away from the generator. The AED can still be used, and you should follow its prompts.

Question 20Scene assessment, safety and the chain of survival

An AED has been applied to a worker in cardiac arrest and it advises 'no shock'. What should you do next?

  1. Give two rescue breaths and then stop CPR
  2. Remove the pads and check for a pulse for 2 minutes
  3. Resume chest compressions immediately and follow the AED prompts Correct answer.
  4. Wait for the ambulance without touching the worker

Explanation

A no-shock advisory means the AED has not detected a shockable rhythm, but CPR must continue to maintain circulation. Resume chest compressions immediately and follow the AED prompts for further analysis.

Question 21Scene assessment, safety and the chain of survival

While you are giving first aid to a worker, a forklift starts moving towards the treatment area. What does the principle of dynamic risk assessment require you to do?

  1. Stop, reassess the danger, and make the area safe before continuing care Correct answer.
  2. Continue treatment and ask a bystander to watch the forklift
  3. Ignore the forklift because the casualty needs uninterrupted treatment
  4. Move the casualty only after you have finished the current bandage

Explanation

Dynamic risk assessment means hazards are reviewed continuously, not only when you first arrive. If a new danger appears, care is paused long enough to control it, because an injured rescuer cannot help anyone. Treatment resumes once the scene is safe again.

Question 22Scene assessment, safety and the chain of survival

In first aid, what does the term 'chain of survival' describe?

  1. The steps for bandaging a wound without causing infection
  2. The sequence of actions that improves survival from cardiac arrest Correct answer.
  3. The order in which workplace injuries must be reported to the safety officer
  4. The route an ambulance takes from the workplace to the hospital

Explanation

The chain of survival is the set of key actions that, taken promptly one after another, give a cardiac arrest casualty the best chance of survival. It includes early recognition and calling for help, early CPR, early defibrillation, and post-resuscitation care. A weak link reduces the chance of a good outcome.

Question 23Scene assessment, safety and the chain of survival

Why is the mechanism of injury important during the scene assessment of a workplace accident?

  1. It identifies which worker was responsible for the accident
  2. It helps predict the type and severity of possible injuries Correct answer.
  3. It shows whether the casualty is allergic to medication
  4. It replaces the need to check the casualty's breathing

Explanation

The mechanism of injury is how the harm occurred, such as a fall from height, a crush, or contact with electricity. Knowing this helps the first aider anticipate hidden injuries and decide what urgent help is needed. It does not replace the primary assessment of responsiveness and breathing.

Question 24Scene assessment, safety and the chain of survival

You are alone at a remote part of a worksite with an adult worker who is unresponsive and not breathing normally. You have a mobile phone with signal. What should you do?

  1. Carry the worker to the site office to find a landline
  2. Start CPR and stop after two minutes to look for help
  3. Wait for a colleague to arrive before calling for an ambulance
  4. Call 999, activate the speakerphone, and begin CPR without delay Correct answer.

Explanation

For an adult in cardiac arrest, the priority is to activate emergency help and start CPR as soon as possible. Using the speakerphone allows the dispatcher to give instructions while chest compressions continue. Moving the casualty wastes time and may worsen any injuries.

Question 25Scene assessment, safety and the chain of survival

Several people are crowding around a collapsed worker in a loading bay. What is the most effective use of these bystanders?

  1. Ask one person to call 999 and another to fetch the AED Correct answer.
  2. Ask them to lift the worker onto a nearby bench
  3. Ask all of them to stand closer and watch what you do
  4. Ask them to leave the site immediately without giving any instructions

Explanation

Bystanders can be directed to specific tasks that speed up the emergency response. Sending one person to call 999 and another to fetch the AED keeps the area clearer and avoids duplicated calls. Unnecessary lifting can cause harm and should not be assigned to untrained bystanders.

Question 26Scene assessment, safety and the chain of survival

A worker in cardiac arrest is lying in a pool of water on a workshop floor. An AED is available. What should you do before applying the pads?

  1. Pour more water on the chest to improve electrical contact
  2. Do not use the AED because water makes defibrillation impossible
  3. Apply the pads directly to the wet chest and continue
  4. Move the worker from the water if safe, then dry the chest Correct answer.

Explanation

Water on the chest can make the shock arc across the skin instead of passing through the heart, and it increases risk to rescuers. Move the casualty out of standing water if it is safe, then dry the chest before attaching the pads. CPR should continue while this is done.

Question 27Scene assessment, safety and the chain of survival

What is the main purpose of early CPR in the chain of survival?

  1. To shock the heart back into a normal coordinated rhythm
  2. To remove fluid from the casualty's lungs and airway
  3. To prevent infection at the site of the injury
  4. To keep oxygenated blood flowing to the brain and heart Correct answer.

Explanation

Chest compressions maintain a circulation of oxygenated blood to the brain and heart while the casualty is in cardiac arrest. This buys time until a defibrillator and advanced care are available. CPR alone is unlikely to restart the heart, but it greatly improves the chance that defibrillation will succeed.

Question 28Scene assessment, safety and the chain of survival

A distressed relative is shouting and trying to pull you away from an injured worker. What is the most appropriate action?

  1. Stop first aid and argue with the relative until they calm down
  2. Physically restrain the relative and continue treating the worker
  3. Stay calm, ask them to step back, and give a clear task Correct answer.
  4. Leave the worker and walk away from the scene

Explanation

A calm, firm approach and a specific task can reduce agitation and keep the scene safe. If the relative remains violent, withdraw to a safe distance and call for security or police. The casualty should not be left alone if it is safe to stay.

Question 29Scene assessment, safety and the chain of survival

What does an AED actually do when it delivers a shock to a worker in cardiac arrest?

  1. It restarts a completely stopped heart like a mechanical pump
  2. It clears blocked coronary arteries and restores blood supply
  3. It stuns the heart's chaotic electrical activity so a normal rhythm may return Correct answer.
  4. It increases the heart rate by delivering a small electrical current

Explanation

The shock briefly depolarises the heart muscle, which can stop chaotic fibrillation and allow the heart's own pacemaker to resume a coordinated rhythm. It does not restart a flat line or open blocked arteries. CPR and advanced care remain essential after the shock.

Question 30Scene assessment, safety and the chain of survival

In the chain of survival, what is the purpose of the post-resuscitation care link?

  1. To provide advanced care after the heart starts beating again Correct answer.
  2. To teach workers how to perform chest compressions
  3. To decide whether an incident needs to be reported
  4. To check and maintain the workplace AED batteries

Explanation

Post-resuscitation care begins once spontaneous circulation returns and focuses on stabilising the casualty, protecting the brain, and treating the cause of the arrest. It is delivered by advanced medical teams, not by first aiders alone. It is the final link that supports recovery after the immediate emergency.

Question 31Scene assessment, safety and the chain of survival

You are the first person to reach a worker who has collapsed in a chemical store. What should you do before you approach the worker?

  1. Move the worker out of the chemical store to the corridor
  2. Ask the worker to stand up and walk
  3. Start chest compressions straight away
  4. Check for hazards that could harm you Correct answer.

Explanation

Scene safety comes first: you cannot help if you become a casualty yourself. Before approaching, look for chemical spills, fumes, electrical hazards, fire, traffic and other dangers, and only enter if it is safe. If the scene is unsafe, call for help and keep others away.

Question 32Scene assessment, safety and the chain of survival

You are about to treat a worker with a bleeding cut on the forearm. Which precaution best protects you from blood-borne infection?

  1. Wear disposable gloves Correct answer.
  2. Wash your hands only after the bleeding stops
  3. Use a face mask as the main protection
  4. Ask the worker whether they have an infection

Explanation

Disposable gloves provide a barrier against blood and other body fluids and are the minimum precaution for contact with a bleeding casualty. Hand washing after glove removal is also important, but it does not replace gloves during treatment. Asking about infection is unreliable because many carriers do not know or may not disclose.

Question 33Scene assessment, safety and the chain of survival

In the chain of survival, what should a workplace first aider do first when a worker is found unresponsive?

  1. Apply an AED as soon as it arrives
  2. Recognise the emergency and call for help Correct answer.
  3. Place the worker in the recovery position immediately
  4. Start chest compressions without checking the worker

Explanation

The first link is early recognition and activation of the emergency response system. The first aider confirms the worker is unresponsive, shouts for help and calls the emergency services or asks someone else to call. CPR and defibrillation follow once help is on the way.

Question 34Scene assessment, safety and the chain of survival

A worker has collapsed beside a live electrical control panel. What is the first priority?

  1. Pull the worker away from the panel by the arm
  2. Start CPR on the worker immediately
  3. Throw water on the panel to cool it
  4. Isolate the power before touching the worker Correct answer.

Explanation

Electricity can pass through you if you touch a casualty who is still in contact with a live source. The power must be isolated, or the worker moved using a non-conductive object only if this can be done safely. Only then should you assess and treat the worker.

Question 35Scene assessment, safety and the chain of survival

A worker has fallen from a ladder and complains of back pain but can move all limbs. Should you call the emergency services?

  1. Yes, but only after the worker agrees to be transported
  2. No, because the worker can move all limbs
  3. No, wait to see whether the pain settles
  4. Yes, call and report the fall and suspected spinal injury Correct answer.

Explanation

A fall from height with back pain raises concern for spinal injury even if limb movement is normal. Emergency services should be called and the worker kept still until they arrive. Waiting for pain to settle or relying on limb movement can delay treatment and risk worsening a spinal injury.

Question 36Scene assessment, safety and the chain of survival

A worker is lying unresponsive inside a tank that may contain toxic gas. What should you do?

  1. Enter quickly and drag the worker out
  2. Do not enter; call for specialist rescue Correct answer.
  3. Ventilate the tank with a fan and then enter
  4. Ask another worker to enter with you

Explanation

A confined space with possible toxic gas is an unsafe scene that requires trained rescuers with breathing apparatus and safe entry procedures. Entering without protection can quickly overcome you and create a second casualty. Raise the alarm, call the emergency services and keep others from entering.

Question 37Scene assessment, safety and the chain of survival

A cyclist has been knocked down in a workplace car park and is lying in the roadway. What should you do to protect the scene?

  1. Move the cyclist to the pavement before doing anything else
  2. Stand in the road and wave your arms
  3. Turn off all lights so drivers are not blinded
  4. Park a vehicle with hazard lights on to warn traffic Correct answer.

Explanation

The scene must be made safe before treatment so that approaching vehicles do not hit the casualty or rescuers. A vehicle with hazard lights, warning triangles or cones can alert drivers and create a protected area. Only then should you approach and assess the cyclist.

Question 38Scene assessment, safety and the chain of survival

How should you check whether an adult worker is responsive?

  1. Shout their name and gently shake their shoulders Correct answer.
  2. Splash cold water on their face
  3. Lift their eyelids and check whether the pupils react to light
  4. Press firmly on the breastbone

Explanation

For an adult, use a loud voice and a gentle shoulder shake to see whether they respond. This avoids unnecessary pain or injury while clearly testing consciousness. If there is no response, call for help and check breathing.

Question 39Scene assessment, safety and the chain of survival

A first aider starts CPR at once, but there is no AED on site and the ambulance will take 20 minutes. Which link in the chain of survival is most weakened?

  1. Post-resuscitation care
  2. Early recognition and call for help
  3. Early defibrillation Correct answer.
  4. Early CPR

Explanation

The absence of an AED removes the early defibrillation link, which is critical for a shockable rhythm such as ventricular fibrillation. CPR buys time by keeping blood flowing, but without defibrillation the chance of survival falls with every minute. Recognition and calling were completed, and post-resuscitation care is a later hospital link.

Question 40Scene assessment, safety and the chain of survival

A worker has collapsed near a leaking chemical drum. What is the safest way to approach the scene?

  1. Approach from upwind and stay out of the spill area Correct answer.
  2. Pour water on the drum to dilute the chemical
  3. Walk straight in and pull the worker clear of the drum by the arms
  4. Ask the worker to crawl towards you

Explanation

A chemical spill creates a hazard zone that may contain toxic fumes, splashes or fire risk. Approaching from upwind keeps fumes away from you and staying out of the spill area prevents contamination. Trained responders with protective equipment should deal with the chemical and rescue.

Question 41CPR and use of an automated external defibrillator (AED)

During CPR on an adult in cardiac arrest, at what rate should chest compressions be delivered?

  1. 100 to 120 per minute Correct answer.
  2. 130 to 150 per minute
  3. As fast as possible, with full chest recoil
  4. 60 to 80 per minute

Explanation

High-quality adult CPR uses a compression rate of 100 to 120 per minute, which gives enough forward blood flow while still allowing the heart to refill between compressions. Rates above this range usually reduce compression depth and prevent full recoil, while slower rates deliver too little circulation. Rescuers can keep the rate steady by counting aloud or following the metronome prompt of the AED.

Question 42CPR and use of an automated external defibrillator (AED)

For an adult casualty receiving CPR, how deep should each chest compression be?

  1. About 7 to 8 cm
  2. About 5 to 6 cm Correct answer.
  3. About 10 cm, until the ribs give way
  4. About 2 to 3 cm

Explanation

Adult compressions should depress the chest by 5 to 6 cm, which corresponds to roughly one third of the chest depth. Compressions that are too shallow produce little cardiac output, while excessive depth increases the risk of rib fractures, lung injury and internal organ damage without improving survival. The chest should be allowed to recoil fully after every compression.

Question 43CPR and use of an automated external defibrillator (AED)

A lone rescuer is performing CPR on an adult who collapsed in the workplace. Which compression-to-ventilation ratio should be used?

  1. 15 compressions to 2 breaths
  2. 50 compressions to 2 breaths
  3. 30 compressions to 2 breaths Correct answer.
  4. 5 compressions to 1 breath

Explanation

For adult cardiac arrest, a single rescuer gives 30 chest compressions followed by 2 rescue breaths. This 30:2 ratio continues until more trained help arrives or an AED is attached, and rescuers should change over roughly every two minutes to limit fatigue. The 15:2 ratio is used for children and infants when two rescuers are present, not for adults.

Question 44CPR and use of an automated external defibrillator (AED)

Where should the two AED pads be placed on an adult in cardiac arrest?

  1. One over the sternum and one over the left shoulder blade
  2. Right upper chest below the clavicle and left lateral chest below the armpit Correct answer.
  3. One on the upper abdomen and one between the shoulder blades
  4. Both pads on the front of the chest, one above the other over the sternum

Explanation

The standard adult anterolateral placement puts one pad below the right clavicle and the other on the left side of the chest, roughly level with the armpit. This position makes the shock current travel through the heart muscle. Pads must be applied to bare, dry skin and pressed down firmly so that no air pockets remain.

Question 45CPR and use of an automated external defibrillator (AED)

The AED announces that a shock is advised and begins to charge. What should the rescuer do immediately before pressing the shock button?

  1. Shout 'clear', check that nobody is touching the casualty, then press the shock button Correct answer.
  2. Pull the pads off before pressing the shock button to avoid burning the skin
  3. Keep performing compressions while the shock is delivered so no time is lost
  4. Ask a colleague to keep holding the face mask in place during the shock

Explanation

Everyone, including the rescuer, must be clear of the casualty before a shock is discharged. The rescuer should shout 'clear', visually check from head to toe that no one is in contact with the casualty or the bed, and only then press the button. Touching the casualty during discharge can cause the current to pass through the bystander.

Question 46CPR and use of an automated external defibrillator (AED)

A collapsed colleague is unresponsive and making occasional slow, noisy gasps. How should the rescuer interpret this?

  1. The gasping indicates choking, so give abdominal thrusts
  2. It is agonal gasping, not normal breathing, so start CPR Correct answer.
  3. The casualty is breathing adequately, so place them in the recovery position
  4. The casualty is only sleeping deeply and should be left undisturbed

Explanation

Occasional slow, noisy gasps in an unresponsive casualty are agonal breathing, a reflex that is common in the first minutes of cardiac arrest. It does not oxygenate the body and must not be mistaken for normal breathing. The casualty should be treated as being in cardiac arrest, with the emergency services activated, an AED attached and CPR started without delay.

Question 47CPR and use of an automated external defibrillator (AED)

When performing CPR on a small child, how deep should the chest be compressed?

  1. About one third of the chest depth, roughly 5 cm Correct answer.
  2. About 1 cm, using two fingers only
  3. About 8 cm, the same depth as for a large adult
  4. The full depth of the chest until the ribs fracture

Explanation

Paediatric compressions should depress the chest by about one third of its front-to-back diameter, which is roughly 5 cm in most small children. The rescuer should choose a technique that reliably achieves this depth, such as one or two hands for a child, while avoiding excessive force. Full recoil should be allowed after each compression.

Question 48CPR and use of an automated external defibrillator (AED)

An unresponsive casualty in cardiac arrest has a visible implanted pacemaker under the skin of the upper chest. How should the rescuer proceed with the AED?

  1. The AED should be used only after a clinician has switched the implanted device off
  2. Both pads should be placed directly on top of the device so the current passes through it
  3. Apply the pads in the normal positions but at least 8 cm clear of the device Correct answer.
  4. The AED must not be used, because the implanted device makes defibrillation unsafe

Explanation

An implanted pacemaker or defibrillator is not a reason to withhold defibrillation, because the shock is what may save the casualty's life. The pads should be placed in the usual positions but kept at least 8 cm away from the generator so that current does not arc across the skin or damage the device. Defibrillation should never be delayed while waiting for a clinician.

Question 49CPR and use of an automated external defibrillator (AED)

A casualty has just been pulled from a swimming pool and is in cardiac arrest with a wet chest. An AED is available. What is the correct action?

  1. Apply the pads at once to the wet chest and deliver the shock without delay
  2. Move the casualty to a dry area, dry the chest quickly, then apply the pads Correct answer.
  3. Wait for the chest to dry naturally before applying the pads
  4. Soak the pads in water first so that they conduct electricity better

Explanation

Water on the chest can make the shock current arc across the skin instead of passing through the heart, and standing water creates a hazard for everyone nearby. The casualty should be moved to a dry surface, the chest wiped dry quickly, and defibrillation carried out as soon as possible. Drying the skin takes only seconds and should not become a long delay.

Question 50CPR and use of an automated external defibrillator (AED)

During AED use on an adult, how long should chest compressions be interrupted for rhythm analysis and charging?

  1. Less than 10 seconds Correct answer.
  2. Up to 1 minute
  3. Up to 30 seconds
  4. As long as the AED needs to analyse the rhythm

Explanation

Pauses in chest compressions should be kept to less than 10 seconds, including the time the AED takes to analyse the rhythm and charge. Longer interruptions allow blood pressure to fall sharply and reduce the chance that a shock will restore a perfusing rhythm. Compressions should be resumed immediately whenever the AED prompts the rescuer to continue.