Heat Stroke, a Diesel Sheen, and a Smoking Worker
At 14:20, the temperature is 43°C with high humidity at a coastal jetty. A guard finds a colleague collapsed beside a mooring bollard. The man is confused, has hot dry skin, a rapid weak pulse, and is breathing. The water cooler 20 m away is empty. The nearest shaded first-aid room is 80 m back along the jetty. At the same time, a diesel hose connection at the next berth is dripping; a thin sheen about 2 m wide is spreading toward a surface drain that leads to the sea. A small pump is running nearby, and two workers are smoking about 15 m away. The guard has a radio, a first-aid kit, and one absorbent pad. No ambulance is on site. The guard is alone at the jetty head.
1. What is the first priority, and what should the guard do in the first two minutes?
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The collapsed colleague is the first priority. Confusion, hot dry skin, a rapid weak pulse in 43°C heat point to heat stroke, which can be fatal within minutes. The diesel spill is serious, but it is a slow drip and a 2 m sheen, not an immediate fire.
In the first two minutes: shout for help and use the radio to call control for an ambulance and backup, giving the jetty location and 'heat stroke, confused casualty'. Move the man into the shade of the first-aid room or a nearby structure if he can be moved safely; do not leave him in the sun. Start cooling at once: loosen or remove excess clothing, wet the skin with water, fan him, and place cool packs or wet cloths at the neck, armpits, and groin if available. Check that he is breathing and keep his airway clear. Do not give him water while he is confused. Ask control to send someone to the spill and to stop the pump and smoking, but do not leave the casualty to do it yourself.
2. How should the collapsed colleague be treated while help is coming?
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Treat for heat stroke, not just exhaustion. Continue active cooling while waiting for the ambulance: shade, removed clothing, water on the skin, fanning, and cool packs. Do not use ice directly on the skin or plunge him into cold water if he is confused, because that can worsen shivering and agitation; use steady cooling and monitor. Check breathing and response every few minutes. If he becomes unconscious but is breathing, place him in the recovery position. If breathing stops and you are trained, start CPR and send for the AED if one is available.
Do not give fluids by mouth while he is confused or drowsy, because of choking risk. If he becomes fully alert, give small sips of cool water, not alcohol or caffeine. Record the time cooling started, the symptoms, and any change. Keep him shaded and do not let him walk back to work. Hand over all observations to the medical team: confusion, hot dry skin, weak pulse, and the empty water cooler. The empty cooler is part of the incident and should be reported, not hidden.
3. How should the diesel spill be handled without neglecting the casualty?
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Delegate the spill; do not abandon the casualty. By radio, tell control: 'Diesel drip at berth X, sheen 2 m toward surface drain, stop the pump if safe, stop smoking, send absorbent and a spill kit.' Ask the two workers to extinguish their cigarettes immediately and move upwind; if they are close enough to hear, tell them from where you are. If another trained person arrives, hand over the casualty's cooling and go to the spill; otherwise stay with the casualty and keep control informed.
At the spill, if it can be done without leaving the casualty: stop the transfer or close the valve, place the absorbent pad at the drain to block the sheen, and do not wash it into the sea with water. Do not use water on diesel. Keep ignition sources away. Once the casualty is with the ambulance crew, secure the hose, contain the drain, and report the quantity and cause. The priority is life, then fire prevention, then environmental containment. Record both events separately and recommend a water cooler refill schedule and hose inspection.