Electrocution and Bystander CPR in a Bakery
At a bakery in Port Harcourt, a 27-year-old maintenance worker is found lying beside an industrial dough mixer. He is unresponsive, has a small burn on his right hand and is making occasional gasping sounds. A colleague says the worker was 'thrown back' after touching a control panel; the machine is still running and a bare wire is visible at the panel. The colleague wants to pull him away and splash water on his face. A first-aider arrives with a broken torch, no gloves and no pocket mask. The nearest AED is in the security office 40 metres away, and the site emergency number rings unanswered. An ambulance has been called on a mobile phone but there is no confirmed arrival time. The floor is wet with dough wash and the main isolator is in a locked cabinet; the key is with the shift supervisor, who is searching for it. Two other workers are filming on their phones.
1. What is the correct sequence of actions in the first two minutes?
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Make the scene safe first. Do not touch the worker until the mixer is isolated; the bare wire and wet floor make electrocution a continuing risk. Instruct someone to find the shift supervisor and key, or trip the isolator by the authorised route, and call the emergency number again or use another phone. Put on gloves if available; a pocket mask is desirable but do not delay CPR for it. Check response and breathing. Occasional gasping is not normal breathing; treat it as cardiac arrest. Start chest compressions at 30:2 and send for the AED. Do not splash water on his face, do not pull him by the arm and do not let bystanders crowd or film. If he starts breathing normally, place him in the recovery position and keep monitoring. Hand over the burn and the electrical exposure to the ambulance crew.
2. How should the first-aider manage the airway and use the AED?
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Open the airway with head tilt and chin lift, unless a neck injury is suspected, and check for normal breathing for no more than 10 seconds. Give 30 compressions at a rate of 100-120 per minute, depth about 5-6 cm in an adult, then 2 rescue breaths if trained; use the pocket mask if it arrives, otherwise compression-only CPR is better than stopping. Switch on the AED as soon as it arrives, expose and dry the chest, attach pads as shown, and follow the voice prompts. Do not touch the patient during analysis or shock. Resume compressions immediately after the shock or the 'no shock' prompt. Minimise interruptions. If the patient shows signs of life, stop compressions, check breathing and place him in the recovery position; continue to monitor until handover.
3. What follow-up and site actions are needed after the emergency?
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Give a clear handover to the ambulance crew: time of collapse, electrical contact, burn, CPR and AED shocks. Preserve the scene and the panel for investigation, and do not re-energise until an electrician has isolated and tested it. Report the incident, review the lockout/tagout and maintenance arrangements, and check why the emergency number was unanswered. Replace the broken torch, stock gloves and pocket masks, and make sure the AED is accessible and its battery and pads are in date. Train workers in scene safety and CPR, and address the filming bystanders through a clear emergency policy. The worker's burn needs medical review, and his fitness to return should be assessed. The investigation should focus on the bare wire, the wet floor and the absence of a safe isolation procedure.