Ready Hands · Seoyeon Kim
Chapter 3: When Someone Collapses
What Can Happen
A care worker is helping a woman in her seventies at a day centre. They are walking slowly from the lunch table to the lounge when the woman stops, says that she feels strange, and sinks to the floor. The care worker manages to soften the fall, but now the woman lies on her back with her eyes closed and does not answer when the care worker says her name. Other people in the room turn to look, and somebody asks loudly what has happened. The care worker kneels beside the woman and knows that the next minute matters more than anything else.
Finding a person who has collapsed is frightening, but a few clear steps tell you what to do. First you check for danger, then you find out whether the person responds, and then you check whether the person is breathing normally. Those checks decide everything that follows. This chapter explains, step by step, how to check a person who has collapsed and how to place a person who is breathing in the recovery position. It also explains why occasional gasping is not normal breathing, how to watch the person until help arrives, and what to do when the person is in a wheelchair, in bed or outside on a hot day.
Step by Step: Checking a Person Who Has Collapsed
Step 1. Check for danger before you go close. Look for traffic, electricity, water, fire, broken glass, a hot surface or anything that could fall. In a bathroom, look especially for water on the floor and for electrical appliances near water. Make the area safe if you can do so without risk, and put on disposable gloves if they are in your hand, but do not delay your checks to look for them.
Step 2. Check whether the person responds. Kneel beside the person, level with the shoulders, and speak loudly and clearly, using the person's name if you know it: "Can you hear me? Open your eyes." At the same time, gently tap both shoulders. A person with hearing loss may not hear your voice, so the tap and your face close to theirs matter too. Never slap the person or shake them hard. If the person answers, opens their eyes or moves, leave the person in the position you found them, as long as there is no danger, and try to find out what is wrong. Ask about pain and what happened, call for help if it is needed, and check on the person again regularly.
Step 3. If the person does not respond, shout for help. A loud call of "Help, I need help here" brings other people who can call and fetch things. In a care home or a day centre, also use the alarm or call system that your workplace has for emergencies. If someone comes, ask that person to call the emergency number now and to bring a defibrillator if there is one nearby. If you are alone, take out your phone and have it ready on speaker, so that you can call the moment you have checked the breathing.
Step 4. Open the airway. If the person is not already on their back, turn the person gently onto their back. Place one hand on the forehead and gently tilt the head back. Then put the fingertips of your other hand under the bony point of the chin and lift the chin. In a person who does not respond, the tongue can fall back and block the throat, and this simple movement lifts it clear. If you can see something in the mouth that you can easily lift out, remove it, but do not search inside the mouth with your fingers. Dentures that fit well can stay in place, but loose dentures that may block the airway should be removed gently.
Step 5. Check breathing for no more than 10 seconds. Keep the airway open and put your face close to the person's mouth and nose while you look along the chest. Look for the chest rising and falling, listen for the sound of breath, and feel for breath on your cheek. Count the seconds silently so that the check does not last too long. Decide whether the breathing is normal: regular and easy, not just an occasional gasp.
Step 6. Decide what to do next. If the person is breathing normally, place the person in the recovery position, as the steps later in this chapter explain, and make sure the emergency number has been called. If the person is not breathing normally, or if you are not sure, call the emergency number at once with the speaker on, send someone for a defibrillator, and start CPR. Chapter 4 explains CPR and the defibrillator step by step.
Step 7. Stay with the person and keep checking. Watch the breathing all the time while you wait for help, and tell the operator about any change. If the person was breathing but then stops breathing normally, start CPR straight away. Keep talking calmly to the person, even if the person does not seem to hear. Ask onlookers to give you space, and cover the person if their clothing has moved.
Normal Breathing, Gasping and Watching the Person
Normal breathing is regular and quiet, and you can see the chest or the stomach rise and fall in an even rhythm. It may be slower or faster than your own, but it keeps going without long pauses. Snoring or gurgling sounds can mean that the airway is partly blocked, often by the tongue or by fluid in the mouth. If you hear these sounds, check that the head is still tilted back and the chin lifted, or place the person in the recovery position so that fluid can drain from the mouth.
In the first minutes after the heart stops, a person may still make occasional gasps. These gasps are often slow, noisy and irregular, and the person may seem to be breathing deeply once and then not at all. Occasional gasping is not normal breathing. First aid courses teach you to treat a person who is gasping in this way as a person who is not breathing normally: call the emergency number and start CPR. When you are in doubt, act as if the breathing is not normal, because starting CPR quickly gives the person the best chance.
A short burst of jerking movements, which can look like a seizure, can also happen when the heart stops. After any such movement, check the breathing again with the airway open. If the person is not breathing normally, start CPR even if the person moved a moment before. If you describe what you see to the emergency operator, the operator can help you decide quickly.
Once the person is breathing and the call has been made, your most important task is to watch. Keep checking the breathing, the colour of the skin and any sound the person makes. Tell the operator if the person starts to wake, becomes harder to wake, vomits or stops breathing normally. If the person vomits while lying on their back, turn the person onto their side at once so that the vomit can drain from the mouth.
A person who has simply fainted usually wakes again within a short time once lying flat on the ground. If the person does not wake quickly, follow the steps above as for any person who does not respond. Even when a person recovers fully from a faint, older people and people with health conditions should be checked by a doctor, and your workplace's procedures will say how to arrange this and how to report what happened. If you think the person has injured the neck or back in a fall, try to keep the head and neck still while you check, but an open airway and normal breathing always come first; Chapter 11 explains falls and head injuries.
Step by Step: The Recovery Position
Step 1. Kneel beside the person, who is lying on their back. Remove the person's glasses and any bulky objects from the pockets on the side you will roll them towards. Make sure both of the person's legs are straight.
Step 2. Place the arm nearest to you out to the side at a right angle to the body, with the elbow bent and the palm facing up. This arm will stop the person from rolling too far forward when you turn them. If stiffness or pain stops the arm from moving this way, place it as comfortably as you can, and never force a joint.
Step 3. Bring the person's other arm across the chest, and hold the back of that hand against the cheek nearest to you. Keep your hand on top of the person's hand, so that the head is supported as you turn.
Step 4. With your free hand, take hold of the person's far leg just above the knee and pull it up, keeping the foot flat on the ground. The bent leg works like a handle and makes the roll gentle and controlled.
Step 5. Keeping the person's hand pressed against the cheek, pull on the far leg to roll the person towards you onto their side. Roll slowly and smoothly, and make sure the face does not end up pressed against the floor. If another person can help, ask that person to support the head while you roll.
Step 6. Adjust the position so that it is stable and the airway stays open. Bend the upper leg so that the hip and the knee are at right angles. Tilt the head back gently to keep the airway open, and adjust the hand under the cheek so that the head stays tilted with the mouth pointing slightly down, which lets fluid drain out. If a stiff hip or knee cannot bend this far, support the upper leg with a cushion or a rolled coat so that the position stays stable.
Step 7. Call the emergency number if nobody has called yet, and keep checking the breathing regularly. Cover the person with a blanket or coat to keep them warm and to protect their dignity. If the person stays in this position for a long time, courses teach you to turn them onto the other side from time to time to protect the lower arm, as your course or the operator advises. If the breathing stops being normal, roll the person onto their back and start CPR.
A Person in a Wheelchair, in Bed or Outside in the Heat
Many people you support use a wheelchair, and a collapse can happen while they are seated. First put the brakes on, so that the chair cannot roll. If the person does not respond, support the head and open the airway by tilting the head back and lifting the chin, then check the breathing for no more than 10 seconds. If the person is not breathing normally, they need to be on their back on a firm surface for CPR, so lower them to the floor as gently as you can, with help if possible, while the operator guides you. If the person is breathing normally but you cannot move them safely, keep the head supported with the airway open, stay with them and tell the operator.
When a person collapses in bed, the same checks apply: response, airway and breathing. If the person is breathing normally, you can turn them onto their side in the bed so that the airway stays clear, making sure that they cannot roll off the edge. CPR needs a firm surface, and a soft mattress makes chest compressions much weaker. Your workplace's procedures will say what to do with the beds you use, for example whether to move the person to the floor, and your training at work will show you how to do it safely.
Moving a person from a chair or a bed to the floor is heavy work, and dropping the person could cause new injuries. Use the moving and handling methods your workplace teaches, ask for help from anyone nearby, and protect the person's head as they come down. Never risk your own back or the person's safety to save a few seconds when the person is breathing normally. When the person is not breathing normally, getting them flat for CPR is urgent, and the operator can tell you how to do it as well as you can.
A collapse outside on a hot day needs extra care. The ground, especially a pavement or a road surface in full sun, can be hot enough to burn skin, so put a coat, a blanket or a bag under the person's head and body if you can. If it is safe to move the person and you have help, move the person into the shade; if you cannot move them, make shade with an umbrella, a coat or your own body. Feel the person's skin. If the person is very hot, or was confused or acting strangely before collapsing, heatstroke may be the cause, so tell the operator and begin cooling as the operator advises; Chapter 7 explains heatstroke first aid step by step.
If a person collapses beside a road, your own safety and the person's safety from traffic come first. Stay on the pavement or the verge, keep away from moving vehicles, and ask other people to help you watch the traffic. Only move a person who has collapsed in the road if the traffic is a real danger and you can do it safely. Chapter 9 explains how to make a road scene safe.
Things to Check
Check that you can say the words for checking a response without thinking: the person's name, a loud and clear voice, and a gentle tap on both shoulders.
Check that you have practised opening the airway with the head tilt and chin lift on a manikin during a practical first aid course. If you have not, ask your workplace about a course.
Check that you can place a colleague in the recovery position smoothly, as your training at work allows. Practising with a partner makes the steps feel natural.
Check that you know how the brakes work on the wheelchair of each person you support, so that you can stop the chair from rolling in an instant.
Check your workplace's procedure for a person who collapses in bed or in a chair, including how to move a person to the floor safely for CPR.
Check that you take a light blanket or a large coat on hot-weather outings. It can protect a person from hot ground and give shade if they become unwell.
Check that you understand the difference between normal breathing and occasional gasping. Talking it through with a colleague or a trainer helps you recognise it in a real emergency.
Check that everyone at your workplace knows who sounds the alarm, who fetches the defibrillator and who meets the ambulance when someone collapses. Agreeing on these roles in advance saves time and confusion.