Black Flag EMS Scenario Saturday: Collapse at the Construction Site
- John Gomez
- Oct 4
- 2 min read
The EMS Case:
It’s 1430 hours when your crew is dispatched to a construction site for a worker who “passed out.” On arrival, you find a 45-year-old male lying supine on the ground near a scaffolding setup. His coworkers state he suddenly dropped while carrying materials and did not fall from height. They report he had been “sweating a lot” and complaining of feeling dizzy before collapse.
Scene Details:
Environment: Hot afternoon, direct sun, heavy PPE on multiple workers.
Patient: 45-year-old male, found supine, no obvious external trauma.
Initial Impression: Unresponsive, shallow rapid respirations, profuse sweating.
Vitals:
HR: 142 (tachycardic)
BP: 84/60
RR: 32 shallow
SpO2: 89%
Skin: Hot, moist, pale
GCS: 6 (E1, V1, M4)
History:
Witness report: No fall, no seizure activity. Complained of dizziness and chest tightness. Collapsed after heavy exertion.
PMH/meds: Unknown.
No trauma noted.
Your Task:
Develop your differential, prioritize interventions, and prep for transport. How do you balance heat illness, possible ACS, and altered LOC? What’s your airway plan, and how aggressively do you cool versus resuscitate circulatory collapse?
Black Flag EMS M&M (Morbidity & Mortality Review)
BLS Considerations:
Airway: Shallow respirations need immediate support — airway positioning, OPA/NPA, and BVM with high-flow O2.
Cooling: Rapid passive cooling (remove PPE, shade, fans if available). Avoid ice packs directly until ALS arrives.
Circulation: Shock is present. Keep supine, monitor vitals closely, prepare for CPR if he deteriorates.
ALS Considerations:
Airway: Anticipate rapid deterioration; consider advanced airway if mental status worsens. RSI complicated by hypotension.
Circulation: Tachycardia with hypotension points to shock — consider fluid bolus. Heat exhaustion/stroke may coexist with ACS — cardiac monitoring essential.
Cooling: Begin active cooling — IV fluids (cooled if possible), cold packs in axillae/groin, remove from heat.
Cardiac: Obtain 12-lead as soon as feasible to evaluate ACS versus arrhythmia from heat stress.
Diagnosis Discussion:
This patient likely presents with heat stroke complicated by possible ACS (given chest tightness). The environment and presentation strongly support heat illness, but ruling out cardiac event is critical. Rapid recognition and aggressive management of both airway and cooling are priorities.
Expected Interventions (ALS):
Immediate airway management with BVM and O2.
Initiate IV access, administer fluid bolus (cold NS if available).
Begin active cooling (fans, cold packs, chilled IV fluids).
Continuous cardiac monitoring, 12-lead ASAP.
Prep for transport with hospital pre-alert for possible heat stroke/ACS.
Your Turn:
At your certification level, how would you handle this? Do you cool aggressively on scene or focus on rapid transport? Do you call a STEMI alert, a heat stroke alert, or both?
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