Eleven in the morning, level four, and a man who was carrying formwork panels a moment ago is on the ground. Two colleagues reach him first. One is shouting his name. The other has a phone out, working out who to call and what to say. Everything that happens in the next five minutes was decided by whatever this site put in place months ago.

Sites plan the prevention side thoroughly and leave the response side to instinct. That imbalance shows in the moments after a collapse, when instinct produces a crowd around the casualty, several people calling different numbers, and nobody at the gate to bring the ambulance in. Response is a procedure, and like any procedure it works when it has been rehearsed.

The four steps MOM asks you to work in

The Ministry of Manpower (MOM) issued an advisory on emergency response for injured workers that sets out a deliberately simple order. Its value is that it stops responders skipping straight to treatment.

1. Ensure safety. Assess the area for danger such as fallen debris, fire or a confined space, and call for help

2. Assess for medical emergencies. Call 995 where the situation warrants it

3. Provide immediate assistance. Administer first aid, perform cardiopulmonary resuscitation (CPR) and use an automated external defibrillator (AED) if the worker is unresponsive, and avoid moving them unless there is immediate danger

4. Offer support and reassurance. If the person is conscious, provide comfort and stay with them until emergency services arrive

The first step is the one people skip, and it is the one that turns a single casualty into two. A responder who runs into an area where a load is still unstable, or where the cause of the collapse has not been identified, becomes part of the incident.

Who on your site is actually a first aider

The Workplace Safety and Health (First-Aid) Regulations are specific about this. Where more than 25 persons are employed in a workplace, first-aiders must be appointed and readily available during working hours, in a ratio of one first-aider for every 100 persons employed. Where shift work is carried out, that ratio has to be met on each shift.

Two further thresholds sit alongside it. Every workplace must have a sufficient number of first-aid boxes, and each floor of a building needs its own. Where more than 500 persons are at work, a first-aid room of a standard approved by the Commissioner is required unless the Commissioner permits otherwise. Keeping those boxes stocked and accessible is a running task, and the case for essential workplace first aid kits is easiest to make on the day one is needed.

The regulations also require that a first-aider has successfully completed a training course acceptable to the Commissioner, and undergoes such subsequent re-training as the Commissioner may require. Our occupational first aid course runs across 23.5 hours with both written and practical assessment, and covers CPR and AED use, because the practical half is what people fall back on when the theory has left them.

Making the 995 call count

The Singapore Civil Defence Force (SCDF) asks that 995 is used for genuine emergencies, listing cardiac arrest, seizures, breathlessness, loss of consciousness, excessive bleeding, major trauma and stroke among them. It also notes that roughly one in ten calls received is not an emergency, and each of those can delay a response to something that is.

Location is the detail that costs the most time. SCDF asks callers to give a specific address or postal code, or a nearby landmark such as a lamp post or bus stop number. On a large site, "the Tuas project" is not an address, so the postal code, gate number and level belong on an emergency card in every supervisor's pocket. Callers should also know that SCDF operations centre specialists are trained to give medical advice over the phone, including talking someone through CPR, so staying on the line is part of the treatment.

If the worker is not breathing

The sequence SCDF publishes starts with checking responsiveness. Tap the casualty on the shoulders and shout for their attention. If there is no response, get one person to call 995 and a second to fetch the nearest AED, so both happen at once instead of one after the other.

Open the airway using the head tilt and chin lift, then look, listen and feel for breathing. Where there is no normal breathing, chest compressions begin at a rate of at least 100 per minute and a depth of around five centimetres, continuing until the ambulance or the AED arrives or the casualty shows signs of life.

Written down, that reads as though anyone could do it. Under the noise of a live site, with a colleague on the ground and a crowd forming, people who have practised on a manikin behave very differently from those who have only read about it. That gap is the argument for hands-on assessment.

Getting the AED to the casualty, not the casualty to the AED

Minutes decide cardiac arrest outcomes, so an AED locked in an office two hundred metres away is a poor control. SCDF's myResponder app shows nearby AED locations and alerts community first responders to nearby medical emergencies, and public access units can be added to the national AED registry so they appear there.

• Mount AEDs where they can be reached quickly, and keep the route to them clear
• Put the AED locations on the site plan and in the induction, not only on a wall sign
• Check the readiness indicator and pad expiry on a set schedule, with the check recorded
• Encourage supervisors to install the myResponder app, which also carries a 995 button that sends location data
• Register any public access AED so that responders arriving from outside can find it

Guiding the ambulance in

Getting the crew to the gate is only part of the journey. Large sites are confusing to anyone who does not work on them, and hoarding, plant movements and access ramps all slow a stretcher down.

A site that has thought this through sends one person to the entrance the moment the call is made, keeps the access route clear, and has decided in advance where an ambulance can turn. That person does nothing else until the crew arrives. It costs one pair of hands and routinely saves minutes.

After the ambulance leaves

The site does not simply resume. The area should be left as it is until assessed, both because the cause may still be present and because an accurate account will be needed later.

The responders need attention as well. Colleagues who performed CPR on someone they work beside every day carry that home, and a short check-in a day or two afterwards is a reasonable thing for a supervisor to do.

Then comes the honest review. What worked, where the delay was, whether the AED was where people thought, whether the caller had the postal code. Each answer improves the next response, and the review is the only place they surface.

Conclusion

Nobody expects to use any of this, which is exactly why the sites that handle an emergency well are the ones that decided everything in advance: who calls, what they say, who meets the ambulance, where the defibrillator lives, and which trained people are on shift today. Under real pressure, people fall back to whatever they have practised.

If your team's practice could stand refreshing, we would be glad to help. Wong Fong Academy has trained Singapore's workforce since 2011, and our first aid classes are built around realistic scenarios with hands-on assessment. Look through the upcoming dates and register your team while places are open.

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