Collapsed Welder in a Fabrication Bay
At 09:40 in a fabrication bay, a 52-year-old welder collapses face-down beside a bench. You arrive within 90 seconds. He does not respond to a shout or shoulder shake. He is making occasional gasping sounds about every 8 seconds, and there is no obvious bleeding or seizure activity. The welding machine is still humming; an argon cylinder stands nearby and the floor is oily. A coworker has already rolled him face-up and is pressing hard and fast on the centre of the chest at about 140 compressions per minute, with visible recoil but shallow depth; a second coworker is shouting for a nurse. The AED is in the guardhouse 40 metres away, and the site nurse is off-site. Two first aiders are present, including you. The patient has no known allergies; a medical bracelet says 'hypertension'.
1. State your immediate actions in the first 60 seconds and explain how you would correct the coworker's compressions and ventilation with two rescuers.
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Immediate actions. Confirm scene safety first: stop the welding machine, keep sparks away from the oxygen/argon cylinder, and move the patient only if the oily floor or equipment makes CPR unsafe. Check response and breathing: gasping every 8 seconds is agonal, not normal breathing, so treat as cardiac arrest. Shout for help, activate the emergency response and AED, and tell the second coworker to bring the AED and call the site nurse/EMS. Correct compressions. Put the patient on a firm surface, expose the chest, place the heel of one hand on the lower half of the sternum and the other on top, keep arms straight, and compress at 100–120/min to 5–6 cm with full recoil. The coworker's 140/min is too fast and shallow; use a metronome or count aloud and switch compressors every 2 minutes. Ventilation. With two rescuers and no advanced airway, use 30:2; give each breath over about 1 second with a bag-mask or barrier device, just enough for visible chest rise. Avoid hyperventilation. Do not stop for the bracelet or history until the AED arrives; the bracelet is noted later.
2. The AED arrives. Describe pad placement, safety checks, and what you would do if the floor is wet and metal and the patient has a medication patch on the chest.
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Pad placement and safety. Dry the chest if sweaty, remove the hypertension patch from the chest and wipe the skin so it does not block contact or cause arcing, and place pads according to the diagrams: one below the right clavicle and one on the left lateral chest below the armpit. Wet/metal environment. Oily or wet metal is not an absolute contraindication, but move the patient off standing water if you can do so without delaying CPR; keep the pads from touching metal, dry the chest, and make sure no rescuer is touching the patient when the AED analyzes or shocks. Clear everyone and say 'clear' before pressing analyze/shock. After the shock. Resume compressions immediately, starting with chest compressions, and minimize interruption to less than 10 seconds. If no shock is advised, resume CPR and follow the AED prompts. Do not use an AED on a wet chest without drying, and do not place pads over the medication patch.
3. After 12 minutes, paramedics arrive and take over. What handover and documentation should you provide, and what legal boundary applies to your role?
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Handover. Give a structured report: time of collapse, initial findings (unresponsive, agonal gasps), time CPR started, compression quality and rescuer switches, AED applied, number of shocks and times, and any change in the patient. Mention the hypertension bracelet but do not speculate on cause. Documentation. Record objective facts, times, interventions, who did what, AED downloads if available, and the patient's response. Legal boundary. As a first aider, you may provide basic life support within your training and the site's emergency plan; you do not declare death, give drugs, or stop resuscitation on your own unless EMS/medical direction assumes care or you are physically exhausted and no relief is available. Obtain consent if the patient responds; in an unconscious arrest, proceed under emergency doctrine and document.