Collapse at a Loading Dock
At 3:40 p.m., you are a security guard at a busy distribution center. A 58-year-old truck driver collapses near dock 3. You are trained in CPR and AED use. He is unresponsive, gasping occasionally, and has no normal breathing; you check his carotid pulse for no more than 10 seconds and feel none. His skin is pale and sweaty. Forklifts are moving about 20 feet away, and a coworker yells that the man has a pacemaker. Another worker tries to pour water into his mouth. The AED cabinet is 40 feet away; you know the code. A second guard is directing truck traffic nearby.
1. What are your immediate priorities, including scene safety and initial assessment?
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First make the scene safe. Signal the second guard or a supervisor to stop forklift traffic and keep vehicles away from the patient. Put on gloves if available. Do not let anyone give an unresponsive person water. Tap and shout, check breathing and pulse for no more than 10 seconds, and confirm that the gasping is not normal breathing. Send someone for the AED and tell them the cabinet code; call 911 or direct a specific person to call and report the exact dock number, the patient’s condition, and that CPR is in progress.
Do not move the patient unless there is an immediate hazard. Position him on his back on a firm surface. If there is vomit or fluid, protect the airway as trained. Assign one person to keep the area clear and one to meet EMS at the gate. The pacemaker report does not change the decision to start CPR; it only affects AED pad placement.
2. What CPR and AED sequence should you follow, and how does the pacemaker affect it?
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Begin chest compressions immediately: center of the chest, at least 2 inches deep, 100 to 120 compressions per minute, allowing full recoil. If you are alone, use 30 compressions to 2 breaths; if a second trained rescuer is available, switch to 30:2 and rotate every two minutes to reduce fatigue. Use the AED as soon as it arrives. Turn it on, follow the prompts, expose and dry the chest, and apply pads in the standard anterolateral position. If the implanted pacemaker is visible or palpable, avoid placing a pad directly over the device-shift the pad a few inches away while keeping the standard orientation-but do not delay shock delivery to search for it.
Clear everyone before analysis and shock, and resume compressions immediately after a shock. The AED will advise whether a shock is needed. A pacemaker does not make the patient shock-proof and does not prohibit AED use. Continue until EMS takes over, the patient starts breathing normally, or you are too exhausted to continue.
3. What should you report and hand off to EMS and your supervisor?
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Give EMS a concise handoff: the patient’s age and approximate weight, when he collapsed, what you observed, when CPR started, how many cycles or minutes of CPR, whether an AED was applied, how many shocks were delivered, the AED prompts, any return of spontaneous circulation, and any known medical history such as the pacemaker. Report whether he vomited, whether water was given, and any injuries from the fall. Include the names of rescuers and the time EMS arrived.
For your supervisor, document the incident start time, location, witnesses, traffic control, equipment used, and any malfunction. Preserve the AED data if policy allows. Do not disclose the patient’s identity or medical information to people who do not need it. Follow up on the AED battery and pads so the unit is returned to service. If the coworker who tried to give water is upset, arrange a brief supervisor contact, but keep the focus on the patient and the factual record.