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Employee Collapses at Worksite - OHC Interview Answer

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PART 1 - IMMEDIATE RESPONSE BY MANAGEMENT / SUPERVISOR / FIRST RESPONDER

Step 1 - Ensure Scene Safety

• Do not rush in blindly. Check for ongoing hazards (electricity, fumes, chemicals, machinery)
• Shout or use PPE before approaching
• Switch off machinery/isolate power if needed
• Call for help - shout loudly or use radio/intercom

Step 2 - Call for Help Simultaneously

• Alert the OHC / Medical Officer immediately
• Activate the site emergency response system
• Designate one person to call OHC/ambulance and one to stay with the victim
• Do not leave the victim alone

Step 3 - Check Responsiveness

• Tap the shoulders and shout: "Are you okay?"
• If unresponsive - proceed as cardiac/medical emergency

Step 4 - Check Breathing and Pulse (within 10 seconds)

• Look for chest rise, feel for breath
• Check carotid pulse
• If no pulse + not breathing → Start CPR immediately

Step 5 - Start CPR (if no pulse/breathing)

• 30 chest compressions : 2 rescue breaths (30:2 ratio)
• Rate: 100-120 compressions/minute
• Depth: at least 5 cm (2 inches)
• Continue till MO arrives or victim recovers
• Use AED (Automated External Defibrillator) if available on site

Step 6 - Recovery Position (if breathing but unconscious)

• Turn the victim on their side (left lateral)
• Keep airway open
• Do not give anything by mouth

Step 7 - Do NOT Move the Victim Unnecessarily

• Unless there is immediate danger at the site
• Suspect spinal injury if there was a fall - support neck

Step 8 - Gather Information for MO

• Name, age, designation of the employee
• What was he doing before collapsing
• Any witnessed seizure, chest pain, breathlessness before collapse
• Any known illness (diabetes, hypertension, heart disease)
• Exact time of collapse

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PART 2 - MEDICAL OFFICER (MO) RESPONSE ON ARRIVAL

Step 1 - Rapid Primary Survey (ABCDE Approach)

Step 2 - Check Blood Glucose Immediately

• Hypoglycemia is a very common and easily reversible cause of collapse at worksite
• If BSL < 70 mg/dL → give 25 ml of 50% dextrose IV stat
• If IV not feasible → glucagon 1 mg IM/SC

Step 3 - 12-Lead ECG (if available at OHC)

• Rule out Acute MI, arrhythmia, heart block
• If ST elevation (STEMI) present → activate cardiac catheterization protocol, call 108/ambulance

Step 4 - IV Access + Blood Samples

• Establish 2 large-bore IV lines
• Draw blood for: CBC, RBS, RFT, LFT, electrolytes, cardiac enzymes (Troponin I/T)
• Start IV fluids (Normal Saline/Ringer's Lactate) if hypotensive

Step 5 - Oxygen Therapy

• All collapsed patients → O2 by face mask
• Target SpO2 > 94%
• Pulse oximetry monitoring

Step 6 - Detailed History and Clinical Examination

• Chest pain, palpitation, breathlessness (cardiac cause)
• Sweating, trembling before collapse (hypoglycemia)
• Head injury, seizure (neurological)
• Chemical/fume exposure on site (toxic/industrial cause)
• Heat exposure - temperature, humidity (heat stroke)
• Drug/alcohol use

• Pupils (equal, reacting?)
• Signs of head injury
• Skin - pallor, cyanosis, sweating, rash
• Abdomen
• Limbs for injuries

Step 7 - Identify the Cause and Treat

Step 8 - Stabilize and Decide on Transfer

• If stable - monitor at OHC, reassess every 15 mins
• If unstable or serious (MI, stroke, cardiac arrest, poisoning) - shift to nearest hospital immediately via 108/ambulance
• Call hospital ahead to prepare emergency team (pre-alert call)
• Accompany patient if severity demands, or send trained paramedic

Step 9 - Documentation (Mandatory)

• Time of collapse, time of reaching OHC, all vitals recorded
• Treatment given with dose and route
• Referral letter with full history and treatment summary
• Incident report as per factory/industrial regulations
• Report to plant manager / safety officer

Step 10 - Post-Incident Actions (MO's Role)

• Root cause analysis - WHY did the employee collapse?
• Review: Was it work-related? (occupational disease/accident)
• Notify under Factories Act / ESI / ESIC if required
• Check if other employees at same workstation are at risk
• Recommend return to work fitness assessment before rejoining

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KEY POINTS TO SAY IN THE INTERVIEW

1. "I will use ABCDE approach for primary assessment"
2. "Rule out hypoglycemia first - it is the most common reversible cause"
3. "Cardiac arrest management - high-quality CPR + early defibrillation (chain of survival)"
4. "Heat-related illness is very common at industrial sites especially in summer"
5. "All incidents are documented and reported as per Factories Act"
6. "The MO must coordinate with site safety officer and management"
7. "Pre-hospital stabilization then transfer with pre-alert to receiving hospital"

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CHAIN OF SURVIVAL (mention this - it impresses interviewers)

1. Early recognition and call for help
2. Early CPR
3. Early defibrillation (AED)
4. Advanced life support (by MO/hospital)
5. Post-resuscitation care

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AED Usage - Step by Step (for OHC MO Interview)

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First - What is AED?

Key point to say: "AED is designed to be used even by a layperson - it gives voice instructions automatically"

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When to Use AED?

• Patient is unconscious
• Patient is not breathing normally (absent or gasping)
• No pulse detected
• i.e., suspected Cardiac Arrest

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STEP-BY-STEP AED USAGE

Step 1 - Ensure Scene Safety

• Check for water, electricity, hazards
• Do not use AED in water/rain - move victim to dry area first
• Remove victim from metal surfaces if possible

Step 2 - Confirm Cardiac Arrest

• Tap shoulders: "Are you okay?"
• Check breathing (look, listen, feel - 10 seconds)
• Check carotid pulse (10 seconds)
• If no response, no pulse, no breathing → Call for help + Get AED

Step 3 - Call for Help / Activate Emergency

• Shout for help
• Call 108 / hospital emergency
• Send someone to fetch AED
• Start CPR immediately while AED is being brought

Step 4 - Power ON the AED

• Open the AED case
• Press the ON button (some models power on automatically when you open the lid)
• AED will give voice prompts - follow them step by step

Step 5 - Expose the Chest

• Remove clothing completely from the chest
• Dry the chest if wet (sweat/water) - use a towel or cloth
• Remove any medication patches (e.g., GTN patches)
• If patient has a pacemaker - place pad at least 2 cm away from the device
• If patient has a hairy chest - shave if razor available, or press pad firmly

Step 6 - Attach the AED Pads (Electrodes)

Diagram on every AED pad shows exact position - follow it

• Press pads firmly to ensure good skin contact
• Plug the pad connector into the AED machine

Step 7 - AED Analyzes Heart Rhythm

• AED will say: "Analyzing heart rhythm - do not touch the patient"
• Stand clear - nobody should touch the patient
• AED takes 5-15 seconds to analyze

Step 8 - Shock Advised OR No Shock Advised

If SHOCK ADVISED:

• AED says: "Shock advised - charging"
• Ensure no one is touching the patient
• Loudly say: "STAND CLEAR - I'm going to shock"
• Visually check - no one touching patient
• Press the flashing SHOCK button
• Patient will have a sudden jerk/muscle contraction - this is normal

If NO SHOCK ADVISED:

• AED says: "No shock advised"
• This means rhythm is NOT VF/VT (may be asystole or PEA)
• Immediately resume CPR - AED cannot treat asystole

Step 9 - Immediately Resume CPR After Shock

• After delivering shock, immediately start CPR (30:2) - do not check pulse first
• Continue CPR for 2 minutes
• AED will re-analyze after 2 minutes automatically
• Repeat the cycle

Step 10 - Continue Until

• Patient shows signs of life (breathing, moving, opens eyes)
• Advanced life support team (hospital) arrives and takes over
• You are physically exhausted and no one to relieve you
• A doctor certifies death

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AED Pad Placement - Visual Points to Remember

RIGHT side:            LEFT side:
Below right            Below left armpit
collarbone             (lateral chest wall)

    [Pad 1]                [Pad 2]
  Right sternal            Left apex
    border

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Special Situations - Important for Interview

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Energy Levels (Know This!)

Most modern AEDs are biphasic - they automatically select the right energy

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Key Points to Say in Interview

1. "Power ON → Pads ON → Stand Clear → Analyze → Shock → CPR" - this sequence is the core
2. "AED treats only shockable rhythms - VF and pulseless VT"
3. "CPR should not be stopped for more than 10 seconds for any reason including AED analysis"
4. "After shock, always resume CPR immediately without checking pulse"
5. "AED gives voice prompts - follow them without panic"
6. "Early defibrillation within 3-5 minutes of collapse gives 50-70% survival"
7. "Every minute without defibrillation, survival decreases by 10%"

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Remember the CHAIN OF SURVIVAL

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OHC EMERGENCY MANAGEMENT - COMPLETE GUIDE

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1. HYPERTENSION (High BP at OHC)

Definition (Say this first)

• Normal BP: <120/80 mmHg
• Hypertension: ≥140/90 mmHg
• Hypertensive Urgency: BP >180/120 mmHg - NO end organ damage
• Hypertensive Emergency: BP >180/120 mmHg - WITH end organ damage (brain, heart, kidney, eye)

Assessment at OHC

• Recheck BP after 5 min rest in both arms
• Use correct cuff size
• Rule out white coat hypertension

• Headache, vomiting, visual disturbances → Brain
• Chest pain, breathlessness → Heart
• Decreased urine output → Kidney
• Blurred vision → Eye

• HR, SpO2, temperature, RBS, ECG if available

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Management

CASE A - Asymptomatic High BP (Stage 1 or 2, no symptoms)

• Seat comfortably, calm the patient
• Repeat BP after 15-30 min rest
• Advise low salt diet, avoid caffeine/smoking
• If already on medication - check compliance
• Refer to physician for antihypertensive initiation/adjustment
• Do NOT give emergency drugs for asymptomatic mild-moderate hypertension

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CASE B - Hypertensive Urgency (>180/120, no organ damage)

• Oral medications - do NOT lower BP too rapidly
• Tab Amlodipine 5-10 mg oral OR
• Tab Clonidine 0.1-0.2 mg oral OR
• Tab Labetalol 100-200 mg oral
• Target: Reduce BP by 25% over 24-48 hours (NOT rapidly)
• Observe for 1-2 hours at OHC
• Refer to physician same day

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CASE C - Hypertensive Emergency (>180/120 + organ damage)

• IMMEDIATE TRANSFER to hospital
• While arranging transfer:
  • O2 by mask
  • IV access - 2 large bore
  • IV Labetalol 20 mg slow IV over 2 minutes OR
  • IV Nitroglycerine infusion (if cardiac involvement)
  • Do NOT give sublingual nifedipine (dangerous - rapid drop)
  • Monitor ECG, SpO2 continuously
• Pre-alert receiving hospital

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2. HYPOTENSION (Low BP at OHC)

Definition

• BP < 90/60 mmHg OR
• Systolic drop >20 mmHg from baseline
• Shock = Hypotension + End organ hypoperfusion

Common Causes at OHC (Remember HIDE)

• H - Heat exhaustion / Heat stroke
• I - Internal bleeding / Injury
• D - Dehydration / Drugs (antihypertensives overdose)
• E - External bleeding / Electrolyte imbalance / Epilepsy / Embolism

Assessment

• BP both arms, HR, RR, SpO2, Temperature
• Check capillary refill time (>2 sec = poor perfusion)

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Management

Step 1 - Position

• Lay flat with legs elevated 15-30 degrees (Trendelenburg-like)
• Except in cardiogenic shock - semi-recumbent position

Step 2 - Airway and Oxygen

• O2 by face mask 10-15 L/min
• Maintain SpO2 >94%

Step 3 - IV Access and Fluids

• 2 large bore IV cannulas (16-18G)
• IV Normal Saline 500 ml bolus fast - repeat if needed
• Reassess BP after each bolus
• Target systolic BP >90 mmHg

Step 4 - Identify and Treat Cause

• Vasovagal - Lay flat, legs up, oral fluids if conscious, usually self-limiting
• Dehydration/Heat - IV fluids + ORS, cooling measures
• Anaphylaxis - Adrenaline 0.5 mg IM immediately (see below)
• Bleeding - Pressure bandage, urgent surgical referral
• Sepsis - IV antibiotics after cultures, fluid resuscitation

Step 5 - Monitor and Transfer

• BP every 5-10 minutes
• If not responding to 1-2 L fluid → immediate transfer
• Pre-alert hospital

Anaphylactic Shock (Special - Very Important for OHC)

1. Remove allergen / stop causative drug
2. Adrenaline (Epinephrine) 0.5 mg (0.5 ml of 1:1000) IM into outer thigh - FIRST and most important step
3. O2 high flow
4. IV fluids fast
5. IV Hydrocortisone 200 mg
6. IV Chlorpheniramine 10 mg
7. Nebulized Salbutamol if bronchospasm
8. Repeat adrenaline after 5 min if no response

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3. HYPOGLYCEMIA (Low Blood Sugar)

Definition

• Blood sugar < 70 mg/dL (symptomatic)
• Severe: < 54 mg/dL OR unconscious patient

Symptoms to Recognize

• Mild: Trembling, sweating, palpitations, anxiety, hunger
• Moderate: Confusion, difficulty speaking, blurred vision, weakness
• Severe: Unconscious, seizures, unresponsive

Management

CONSCIOUS PATIENT (Mild-Moderate)

• Give 15 grams of fast-acting carbohydrate:
  • 3-4 glucose tablets OR
  • 150 ml fruit juice OR
  • 4-5 teaspoons of sugar in water OR
  • 3 teaspoons of honey

• If still <70 → repeat step 1
• If >70 and improving → give a proper meal (complex carbohydrate + protein)

• Missed meal, excessive work/exercise, wrong insulin dose
• Advise patient, document

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UNCONSCIOUS / SEVERE PATIENT

• 25 ml of 50% Dextrose (D50) IV over 1-3 minutes
• OR 100 ml of 25% Dextrose IV
• OR 200 ml of 10% Dextrose IV

• Glucagon 1 mg IM or SC (stimulates liver to release glucose)
• Turn patient on side (recovery position)

• Target BSL > 100 mg/dL
• Start 10% Dextrose infusion to maintain levels

• Give oral food - biscuits, fruit juice, proper meal
• Monitor for recurrent hypoglycemia

• Patient remains unconscious after treatment
• Recurrent hypoglycemia
• Patient on long-acting sulfonylureas (glibenclamide) - hospital observation needed

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4. SEIZURES (Fits at OHC)

Types to Know

• Generalized tonic-clonic (grand mal) - most common at worksite
• Focal seizure
• Status Epilepticus - seizure lasting >5 minutes OR 2+ seizures without recovery in between - EMERGENCY

During a Seizure - What to Do

Step 1 - Protect the Patient (Do NOT restrain)

• Do NOT hold down forcefully
• Do NOT put anything in the mouth (not even fingers - myth!)
• Do NOT give water during seizure
• Remove nearby objects that can cause injury
• Cushion the head with something soft
• Loosen tight clothing around neck

Step 2 - Time the Seizure

• Note exact time seizure started
• If >5 minutes → Status Epilepticus - treat aggressively

Step 3 - Turn to Recovery Position

• After convulsions stop - turn to left lateral position
• Prevents aspiration of saliva/vomit

Step 4 - Check Airway

• Clear any secretions
• Insert oropharyngeal airway if available
• O2 by mask

Step 5 - Check BSL Immediately

• Rule out hypoglycemic seizure (very common at OHC in diabetic workers)
• If low BSL → treat hypoglycemia first

Step 6 - Drug Treatment

Seizure < 5 minutes:

• Usually self-limiting - supportive care only
• Do NOT rush to give drugs for brief seizure

Seizure > 5 minutes (Status Epilepticus):

• Diazepam 10 mg IV slow (over 2 min) OR
• Diazepam 10 mg rectal (if no IV access) OR
• Midazolam 10 mg IM (faster and easy at OHC)

• Phenytoin 15-20 mg/kg IV slow infusion (50 mg/min max)
• OR Sodium Valproate 20-30 mg/kg IV

• Transfer to ICU immediately
• May need RSI and intubation

Step 7 - Post-Seizure (Postictal) Care

• Patient will be confused, drowsy - this is normal (postictal state)
• Monitor vitals every 15 minutes
• Do NOT leave alone
• Let them recover quietly

Step 8 - Investigate

• BSL, electrolytes (Na, Ca, Mg), ECG
• History - previous epilepsy? Drug compliance? Alcohol? Head injury? Chemical exposure?

Step 9 - Transfer / Refer

• First episode seizure → hospital for full workup (CT brain, EEG)
• Status epilepticus → immediate hospital
• Known epileptic, brief seizure, fully recovered → can be managed at OHC, refer outpatient

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5. DROWSINESS / ALTERED CONSCIOUSNESS at OHC

Assess with AVPU Scale (Quick)

• A - Alert
• V - responds to Voice
• P - responds to Pain
• U - Unresponsive

Or GCS (Glasgow Coma Scale)

• Eyes (4) + Verbal (5) + Motor (6) = Total 15
• GCS ≤ 8 = Coma = Secure airway

Common Causes (AEIOU TIPS - Remember This)

Management

Step 1 - ABCDE Assessment

• Airway - open it, insert OPA if GCS ≤ 8
• Breathing - O2 by mask
• Circulation - IV access, BP, HR
• Disability - GCS, pupils, BSL
• Exposure - head injury? rash? chemical burns?

Step 2 - Check BSL Immediately (MANDATORY)

• Give D50 if BSL < 70 mg/dL

Step 3 - Check Pupils

Step 4 - Check for Head Injury

• Scalp laceration, bruising, battle sign, raccoon eyes
• If suspected → cervical spine precautions

Step 5 - IV Thiamine (if alcohol suspected)

• Thiamine 100 mg IV before giving dextrose in suspected alcoholic
• Prevents Wernicke's encephalopathy

Step 6 - Specific Antidotes if Poisoning Suspected

• Naloxone 0.4-2 mg IV if opioid poisoning (pinpoint pupils, slow RR)
• Flumazenil 0.2 mg IV if benzodiazepine overdose (use cautiously)
• Atropine if organophosphate poisoning

Step 7 - Stabilize and Transfer

• GCS ≤ 12 or deteriorating → hospital transfer
• Maintain airway during transfer (recovery position or intubate)
• Continuous monitoring

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6. BURNS at OHC

Types of Burns at Industrial Site

• Thermal - flame, hot liquid, steam (most common)
• Chemical - acids, alkalis, industrial chemicals
• Electrical - high voltage contact
• Flash/Radiation - arc flash, UV

Severity Assessment

Degree of Burns

Rule of Nines (% Body Surface Area - BSA)

Palm of patient's hand = 1% BSA (useful for patchy burns)

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Management

IMMEDIATE - Remove the Cause

• Remove from fire/heat source
• Remove burning/hot clothing (cut, do not pull over face)
• Remove jewelry, watches, belts (swelling will come)

• Brush off dry chemical first
• Copious water irrigation for minimum 20-30 minutes - this is the most important step
• Do NOT try to neutralize acid with alkali or vice versa (exothermic reaction causes more damage)
• Remove contaminated clothing with gloves

• Do NOT touch patient until power is OFF
• Switch off power source first
• Check for cardiac arrhythmia (ECG mandatory)
• Watch for rhabdomyolysis - check urine color (dark = myoglobinuria)

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Step 1 - Cool the Burn

• Cool running water for 20 minutes within first 3 hours
• Water temperature: 15-25°C (cool, not ice cold)
• Do NOT use ice - causes vasoconstriction, worsens depth
• Do NOT use butter, oil, toothpaste, turmeric (common myths - cause infection)
• Cover with clean wet cloth after cooling

Step 2 - ABCDE Assessment

• Airway - facial burns, singed eyebrows/nasal hair, hoarse voice, stridor → inhalation injury → intubate early before airway swells
• Breathing - circumferential chest burns → escharotomy needed
• Circulation - large burns → massive fluid loss → IV access

Step 3 - Fluid Resuscitation (for burns >15% BSA)

4 ml × weight (kg) × % BSA burned = Total fluid in first 24 hours

• Fluid: Ringer's Lactate (preferred)
• Half the calculated volume in first 8 hours from time of burn
• Remaining half over next 16 hours

Step 4 - Wound Care

• Do NOT burst blisters (protective barrier against infection)
• Cover wound with clean, non-adherent dressing
• At OHC: sterile saline-soaked gauze or paraffin gauze
• Do NOT apply tight bandages

Step 5 - Pain Management

• IV Morphine 2-4 mg titrated OR
• IV Tramadol 50-100 mg OR
• Tab Paracetamol for minor burns

Step 6 - Tetanus Prophylaxis (Mandatory)

• Burns are tetanus-prone wounds
• Tetanus toxoid 0.5 ml IM if not vaccinated in last 5 years
• If no vaccination history → Tetanus Immunoglobulin (TIG) 250 units IM also

Step 7 - Antibiotics

• Not routinely needed acutely
• If infection signs present → start after wound swab culture

Step 8 - Criteria for Referral to Burns Centre

• Burns >10% BSA in adults (>5% in children/elderly)
• Any full thickness (3rd degree) burn
• Burns to face, hands, feet, genitalia, perineum, major joints
• Inhalation injury / airway burns
• Electrical burns (internal damage)
• Chemical burns to eyes
• Circumferential burns (limb, chest)
• Associated trauma
• Extremes of age, pregnancy, immunocompromised

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QUICK REFERENCE TABLE - All Conditions

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Golden Lines for Interview

1. "First step in any emergency - scene safety and ABCDE"
2. "Check BSL in every unconscious/drowsy/seizure patient"
3. "Never neutralize chemical burns - always dilute with water"
4. "In burns - no ice, no butter, only cool water"
5. "Parkland formula - 4 ml × kg × % BSA in first 24 hours"
6. "Tetanus prophylaxis is mandatory in all burns"
7. "Adrenaline IM is the first and most important drug in anaphylaxis"
8. "Do not lower BP too rapidly in hypertensive urgency"

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