The Medical Emergency on a Service Call SOP

Purpose

When someone collapses on a job, the first two minutes decide most of the outcome, and they are the minutes in which an untrained person is most likely to rush into a basement full of carbon monoxide, grab someone still touching a live conductor, or spend ninety seconds deciding whether to call. This SOP fixes the order: make sure the scene will not take the tech down too, get 911 moving, compress or position, bring the AED, hand off, and leave a record the office can rely on.

Scope

Covers: anyone on site (customer, household member, visitor, crew) who becomes unresponsive, stops breathing normally, seizes, or shows signs of a heart attack, stroke or serious injury.

Does not cover: the trace afterwards when a combustion appliance may have caused the collapse (see related: The Customer Collapsed and the Furnace Was Running), first-aid treatment of minor injuries and AED maintenance (see related: First Aid + AED on the Jobsite), a customer in emotional crisis who is physically well (see related: The Customer in Crisis on a Call SOP), or a customer found dead on arrival, which is a police matter from the first moment.

Roles and responsibilities

The handoff that fails most is the second person: nobody told to meet the ambulance means medics hunting for a basement door.

Procedure

1. Read the scene before you touch anyone

Stop at the threshold of the room and check three things in this order: your personal CO monitor reading, whether the person is touching or lying across anything electrical, and whether you smell gas or see smoke. Acceptance: CO monitor below 35 ppm (the NIOSH recommended exposure limit, an 8-hour average, which most shops use as the leave-now alarm), no contact with wiring, a panel, a tool or wet equipment, no gas odor. Wrong looks like: the monitor alarming, a person slumped against a water heater or a disconnect, a rotten-egg smell. Stop rule: if the monitor alarms or you smell gas, do not enter; go outside and run step 2 from there, telling the dispatcher it may be carbon monoxide or gas so the fire department brings breathing apparatus. If the person may be in contact with a live conductor, do not touch them; open the breaker or disconnect only if you can reach it without touching the person or anything they are touching. Hazard: becoming the second victim; CO and electrical contact both drop rescuers.

2. Call 911 before you assess anything else

Call on speaker so your hands stay free, or point at one specific adult and say "You, call 911 now." Give the full street address with any unit or gate code first, then: "Unresponsive adult, I'm a service tech on site." Acceptance: the dispatcher has repeated the address back to you correctly. Wrong looks like: a dropped call, no signal in a basement or crawlspace, a dispatcher who has the wrong town. Stop rule: if the call drops, move to the nearest door or window and call again; if there is still no signal, send the second person to a neighbor or use a landline, and start step 3 while they go. Do not hang up until the dispatcher tells you to. Hazard: if there is a gas odor, the phone call happens outside, not in the room.

3. Check responsiveness and breathing, no longer than ten seconds

Tap the shoulders firmly and shout their name or "Are you OK?" Watch the chest for normal breathing for no more than ten seconds. Put on nitrile gloves from your kit if they are at hand, but do not delay for them. Acceptance: you can say one of two things out loud: "breathing normally" or "not breathing normally". Wrong looks like: occasional gasps, snoring sounds or gulping with long gaps. That is agonal breathing, a reflex of a heart that has stopped, and it counts as not breathing. Stop rule: not breathing normally goes straight to step 4; breathing normally goes to step 6. If unsure, treat it as not breathing. Hazard: body fluids; gloves when available, and keep your face away from vomit.

4. Start hands-only CPR and send for the AED

Get the person flat on their back on a firm surface. Heel of one hand on the center of the chest, other hand on top, arms straight, and push hard and fast: at least 2 inches deep at 100 to 120 compressions a minute, letting the chest come all the way back up each time. Send the second person for the AED (on the truck, if the shop carries one, or one the dispatcher locates). Acceptance: compressions continuous, with any pause under ten seconds, and a count you can keep (to the beat of a song at about 110 a minute). Wrong looks like: shallow pushes on a soft mattress, stopping to check for a pulse. Stop rule: if you tire, swap with another adult every two minutes without stopping; stop only when the AED tells you to, the person starts breathing normally, or paramedics take over. Hazard: a cracked rib is a normal result of good compressions and not a reason to stop; overexertion in heat or a cramped space is, so swap rather than slow down.

5. Use the AED the moment it arrives

Power it on and follow the voice prompts. Bare the chest, dry it with a towel or your sleeve if wet, and place the pads where the pictures show. Keep compressing until the AED says to stop. When it says it is analyzing or about to shock, say "Clear" loudly and confirm nobody is touching the person. Acceptance: pads attached and the device analyzing within about a minute of its arrival. Wrong looks like: pads over a medication patch or a bulge under the collarbone (a pacemaker), the person lying in water or on a metal grate. Stop rule: move the person off standing water or metal before shocking; peel off any medication patch with a gloved hand; place a pad at least an inch from a pacemaker bulge. If the device reports a fault, go back to continuous compressions. Hazard: a shock passes through anyone touching the person or a shared puddle; nobody touches them during analysis and shock.

6. If breathing, position and watch; do not move otherwise

If the person is breathing normally, roll them onto their side (the recovery position: top knee bent, head tilted so the mouth drains) unless they fell from height or you suspect a neck or back injury, in which case leave them as they lie and keep the head still. Do not give food, water or medicine. Acceptance: airway open, breathing checked again at least every minute until help arrives. Wrong looks like: breathing becoming irregular or stopping. Stop rule: if breathing stops, roll them onto their back and go to step 4. The only reason to move someone who may be injured is a threat to life where they lie: fire, water rising, or a CO reading. Hazard: dragging a person up stairs injures both of you; move them only as far as the nearest safe air, by the shoulders, along the floor.

7. Make the scene ready for the responders

The second person unlocks the door, turns on the porch light after dark, shuts pets away, clears tools from the path, and waves the ambulance in from the curb. Do not touch the appliance beyond the shutoff needed to stop an active hazard; the fire department or utility may need to see it as it was. Acceptance: one named person at the curb, a clear path from the street to the patient. Wrong looks like: medics searching for a crawlspace entrance, a dog loose at the door. Stop rule: if there is no second person, prop the door, keep doing CPR and tell the dispatcher which door to use. Hazard: a tech running to the truck mid-CPR leaves the patient with no compressions; stay with them.

8. Hand off and step back

When medics arrive, tell them in four facts: when the person collapsed, when CPR started, how many shocks the AED delivered, and anything you noticed (a smell, a reading, what they said before). Then step back. Call the office: "Medical emergency at the job, ambulance on scene, I'm OK." Acceptance: medics have the four facts; the office knows within ten minutes of the handoff. Wrong looks like: the tech following the ambulance to the hospital, or telling neighbors what happened. Stop rule: the customer's medical details are not yours to share; refer any questions to the family or the responders. Hazard: driving straight after a critical event; the tech sits for at least fifteen minutes before driving and does not take the next job without the manager's go-ahead.

9. Close the job safely and file the report

Do not resume the work that day. Leave the equipment as it was at the handoff, with any isolation in place; if a combustion appliance was involved, it stays off and red-tagged until the trace is done. The office files the incident report within 24 hours. Acceptance: report filed, appliance status recorded, next appointment covered by someone else. Wrong looks like: the job left half-open with a gas valve or a breaker in an unknown state. Stop rule: if the tech cannot confirm the state of every isolation, the manager sends someone to verify it before the end of the day. Hazard: leaving an appliance re-energizable without a tag invites a family member to turn it back on; tag it.

The record this produces

A one-page incident report, written by the tech and filed in the job file (not the customer-visible notes): time of collapse, time 911 was called, medics' arrival, CPR start and stop, AED shocks, the CO reading at the threshold, the equipment state at handoff, who met the ambulance, who was notified. The owner reads it at the 24-hour debrief and the insurer may ask for it. A time-stamped account written while fresh is also the tech's protection. It records what was done, never a diagnosis of the person.

Worked pass

A plumber is under the kitchen sink of a split-level at 2:10 pm. The customer's husband, about seventy, is at the counter. His wife screams; he is on the floor.

• Step 1: CO monitor reads 0 ppm. He is on tile, nowhere near the disposal wiring. No gas odor. Passed.
• Step 2: The plumber dials 911 on speaker at 2:11. The call drops after the address: the kitchen is half below grade. Failed. Stop rule applied: the plumber hands the phone to the wife and sends her to the front porch, where she redials and reaches dispatch at 2:12. The plumber starts step 3 while she goes. The dispatcher has the address repeated back by 2:13.
• Step 3: No response to a shout. Two gasps in ten seconds, then nothing. Agonal: not breathing normally.
• Step 4: Compressions start at 2:12 on the tile floor. The plumber tells the wife, still on the phone, to bring the AED from the truck cab; she is back at 2:14.
• Step 5: Pads on at 2:15, chest dry. The AED advises one shock at 2:15; "Clear" called, nobody touching. Compressions resume immediately.
• Step 6: Not reached; he did not resume normal breathing before medics arrived.
• Step 7: The wife props the front door and waits at the curb after the shock. The dog is shut in the laundry room.
• Step 8: Medics arrive at 2:20 and take over. The plumber gives them: collapse about 2:11, CPR from 2:12, one shock at 2:15, no smell, no reading. Office called at 2:24.
• Step 9: Water supply valves under the sink were already off; the plumber notes that and leaves the old trap disconnected with a bucket under it, tagged "do not use sink". Manager sends another plumber to finish the next day. Report filed at 4:40 pm.

The failed step cost about a minute; its stop rule is why step 3 started anyway.

References

• American Heart Association Guidelines for CPR and Emergency Cardiovascular Care (compression rate and depth, hands-only CPR for lay rescuers)
• NIOSH Pocket Guide to Chemical Hazards, carbon monoxide (recommended exposure limit of 35 ppm as an 8-hour average)
• See related: First Aid + AED on the Jobsite
• See related: The Customer Collapsed and the Furnace Was Running