MD Acumen · PLAB 2 OSCE / CPSA course · free practice resources
Practice case P2-40 · Manikin or simulator · with a healthcare assistant
Collapsed in the ward corridor — the first five minutes
You are walking along a surgical ward corridor when a healthcare assistant shouts for help. A 66-year-old patient has collapsed on the floor outside the bathroom. A manikin lies on the floor.
Reviewed and kept current
Station family: Practical procedure on a manikin — a collapsed patient on the ward · 8-minute station · 1 min 30 s reading · Last editorial review: 16 October 2026 · Next scheduled refresh: 11 April 2027.
Candidate instructions
Read this as you would outside the room
You have 1 minute 30 seconds to read, then 8 minutes. Candidates: everything below this section is folded away — leave it closed until you have finished the station.
| Information | |
|---|---|
| Your role | Foundation Year 2 doctor on the surgical ward. The hospital’s emergency call number is 2222. A team will arrive in a few minutes. The ward emergency equipment is in the corridor and the trolley is being fetched. |
| Patient | Mr Raymond Driscoll, 66 — day 2 after a laparoscopic right hemicolectomy; was walking to the bathroom with the healthcare assistant. |
| What you see | The patient (a manikin) is lying on his back on the corridor floor. Healthcare assistant Ollie Baxter is kneeling beside him: “He just went down, doctor — he’s not answering me.” |
| Set-up | A resuscitation manikin on the floor and the ward’s emergency equipment, including a pocket mask. The healthcare assistant will fetch whatever you ask for. You will be told each finding as you check for it, and when simulated time has passed. |
Your task
•
Assess Mr Driscoll and act on what you find, saying aloud everything you do, check and ask for.
•
Use the healthcare assistant and the equipment as you would on a real ward.
•
When the resuscitation team arrives, hand over to the team leader.
Folded away
For the actor and the examiner
1 · Actor script — role player only
Candidates: do not open until you have consulted.
How to run this station
- Three people if you can: the role player is Ollie, the healthcare assistant; the examiner reads the findings as the candidate checks each one, operates or voices the training AED, keeps time and marks. With two, the role player reads the findings as well.
- Real-time rules. Compressions are real: the candidate compresses the manikin at the right rate and depth for about 40 seconds of real time, and the examiner then announces “that’s two minutes of CPR” and the AED prompts a rhythm analysis. The AED analysis and shock take about 10 seconds of real time. AED: Ollie brings it 15 seconds after he is asked, and the examiner hands over the pads. Trolley, oxygen cylinder and bag-valve-mask: 30 seconds after the trolley is asked for. Breaths are given with the pocket mask, then the bag-valve-mask with oxygen when it arrives — two-person technique if the candidate asks Ollie to squeeze the bag.
- Team arrival. At 5:30 of real station time — or at 4:30 if no shock has yet been delivered — the examiner announces “the resuscitation team has arrived — hand over”, and gives the simulated time (about 9 minutes after collapse, or about 6 minutes if the 4:30 rule applied). The simulated clock (collapse 0; CPR by about 1 minute; shocks at about 3 and 5; return of circulation at about 7) is announced by the examiner; the real clock decides when the station ends. The examiner is the team leader and listens; after the handover the candidate is asked one question: “anything we need to know before we take over?”
- No manikin or AED? Use a rolled blanket or a cushion on the floor and ask the candidate to talk through and mime every step — hand position, depth, rate, pad positions (shown on their own chest or a drawing), standing clear. The marking is the same.
Persona and manner — Ollie Baxter, healthcare assistant
- Ollie, 24, a healthcare assistant in his first year on the ward. Frightened, pale, but willing: you do exactly what the doctor asks, as fast as you can, and repeat each instruction back (“2222, adult cardiac arrest, Ward 7 corridor — going now”).
- You know where the AED, the oxygen and the resuscitation trolley are, and you can fetch them. You have done the trust’s basic life support training once. You can do chest compressions if asked and shown, and you can squeeze the bag if the doctor holds the mask.
- You do not suggest what to do, name a rhythm or say the word “arrest”. If the doctor does nothing for ten seconds, look at them: “What do you want me to do, doctor?”
Opening line — say this verbatim
- “He just went down, doctor — he was walking back from the toilet and he went grey and dropped. He’s not answering me.”
Volunteer freely if given the space
- He is Raymond Driscoll, bed 4, day 2 after his bowel operation; he had been “fine, chatty” until a few minutes ago.
- You pressed the emergency buzzer by the bathroom before you shouted.
Only if asked
- What happened just before: on the way back from the toilet he stopped, put his hand on his chest and said it felt tight; he asked you for “his spray” — he does not have one on the ward. You were going to find the nurse when he went grey and collapsed. If the doctor asks only “did he fall?”: “He just went down.”
- He has not hit his head — he went down on his side, slowly.
- He has a cannula in his left hand. He is on “blood-thinning injections” for the operation. He had his tablets this morning; you do not know what they are. No allergies that you know of. The nurse in charge has his chart.
- Nobody else is in the corridor; the nurse in charge is with another patient at the far end of the ward and has heard the buzzer.
- You do not know whether he has a DNACPR form — “I don’t think so; he was walking about.”
Impact on daily life — for Ollie, once the team has taken over (only if asked)
- You have never seen anyone collapse before; your hands are shaking.
- You are worried you should have fetched the nurse the moment he said his chest was tight — “is this my fault?”
- You are due to finish at two and you have college tomorrow; you do not want to let anyone down by going home early.
Ideas, concerns and expectations — Ollie, after handover
- Idea: that he had a heart attack because he said his chest was tight.
- Concern: that you did something wrong by walking him to the toilet, and that you should have called earlier.
- Expectation: to be told what happens now, and whether you can stay with him.
Cues to deliver, timed
- Within the first 20 seconds, if the doctor has not yet checked for a response or asked for help: “Shall I get someone, doctor?”
- Once the doctor finds no normal breathing: wait five seconds; if no one has been asked to call 2222 or fetch the defibrillator: “Do you want me to call the arrest number?”
- During the first cycle of compressions, if the AED has not been asked for: “The defib’s on the wall just there, doctor.”
- At each “two minutes” announcement, if the doctor is compressing and has not swapped: “Shall I take over the compressions?”
- At 5:30 of real station time (4:30 if no shock has yet been delivered): the examiner announces the resuscitation team’s arrival, with the simulated time, and takes the handover as team leader.
- Safety challenges, once each: if the doctor goes to press the shock button without saying “stand clear” or checking that nobody is touching him — keep your hand on his arm until told to move; if oxygen is left flowing over the chest at the shock — “The oxygen’s still on him, doctor”; if the doctor checks a pulse for longer than about 10 seconds — “Do you want me to start pressing, doctor?”
If the doctor summarises (or hands over) and asks whether you want to add anything
- If the chest tightness has not come out: “One thing — just before he went down he said his chest felt tight and asked me for his spray. I didn’t get a chance to tell anyone.”
- If it has: “Can I stay with him? And — did I do something wrong?”
How to respond — as Ollie
- Clear instructions with one task at a time (“Ollie, press the emergency buzzer again, then ring 2222 and say adult cardiac arrest, Ward 7 corridor, then bring the defib from the wall”): you repeat them back and go. If three tasks come at once with no order: “Which first, doctor?”
- If asked to put out the 2222 call: “What do I say?” Then repeat exactly what you are told; you never add the word “arrest” unless the doctor says it.
- If shown where to put your hands and asked to take over compressions, you do so — counting aloud; you let the doctor correct your rate or depth.
- If the doctor keeps talking to you and to Raymond while working, you steady. If the doctor gives an instruction without using your name, or says nothing to you for 20 seconds while working, you stand still and say nothing further.
- After the team takes over, if the doctor speaks to you — what happened, that you did the right things, that you can stay nearby and that someone will talk to you afterwards: you nod and breathe. If nobody speaks to you: you stand against the wall, white, and say nothing.
Do not
- Start compressions, fetch the defibrillator, call 2222 or give oxygen until you are asked to (apart from the timed cues).
- Say the words “cardiac arrest”, “VF” or “heart attack” — except “heart attack” in your concerns after the handover.
- Volunteer the chest tightness unless asked what happened before the collapse, or invited to add anything.
Findings to give the candidate — only if asked for
This is a simulation. Give each finding only when the candidate checks for it, except the time announcements and the team’s arrival, which are given unprompted (see the timed cues). The AED speaks its own prompts; if it is a training AED with no voice, the examiner reads the prompts. (Where a separate examiner is present, the examiner reads the findings and keeps time; the role player is the healthcare assistant only.)
Response: no response to voice or to shaking the shoulders. Airway: clear; no vomit. Breathing (look, listen, feel): an occasional gasp — one in ten seconds — nothing else. Carotid pulse (if felt for): none. Simulated time (the examiner announces it at each step, and the candidate quotes it at handover): collapse = 0; CPR should start by about 1 minute; first shock about 3 minutes; second shock about 5 minutes; return of circulation at the third analysis, about 7 minutes after collapse. AED, first analysis (as soon as the pads are on): “Shock advised.” After the first shock and two minutes of CPR — second analysis: “Shock advised.” After the second shock and two minutes of CPR — third analysis: “No shock advised” (wording varies by device; a training AED may say “continue CPR” — the examiner gives signs of life only when the candidate checks): he gasps, then breathes; a carotid pulse is present; he remains unresponsive. (If the candidate has not re-checked, the HCA says “Doctor, I think he’s breathing.”) Observations if asked after that: pulse 108, SpO₂ 91% on 15 L oxygen, BP 96/60, GCS 5. If compressions have not started within a minute of finding no normal breathing: no gasps; everything else unchanged.
2 · Examiner mark sheet — generic scheme plus the key facts for this case
Domain marks — with the key facts that earn a 4 at this station
| Domain (GMC wording) · key facts for this case | 1 | 2 | 3 | 4 | Score |
|---|---|---|---|---|---|
1 · Data gathering, technical and assessment skills
| ☐ | ☐ | ☐ | ☐ | /4 |
2 · Clinical management skills
| ☐ | ☐ | ☐ | ☐ | /4 |
3 · Interpersonal skills
| ☐ | ☐ | ☐ | ☐ | /4 |
| Station total | /12 |
Domain score (educational construct):
| Score | Descriptor |
|---|---|
| 1 | Unsatisfactory (did not achieve safe FY2 standard) |
| 2 | Borderline (just achieving minimum safe FY2 standard) |
| 3 | Satisfactory (competent and safe FY2 standard) |
| 4 | Good (exceeds FY2 standard) |
This 1–4 domain score and its descriptors are an Acumen educational construct: the GMC publishes the three marking domains and the four-mark maximum, but not the descriptors its examiners use, and it does not publish station mark sheets. See Legal & Regulatory.
Marks are 1 to 4 in each domain; the generic descriptor for each mark is on the mark scheme page, and the structure of the eight minutes is on the 8-minute station page. The full standard for this case is in section 3 and the GMC feedback statements, with examples from this case, are in section 4. The examination findings that the role player gives — only if the candidate asks for them — are at the end of section 1.
3 · Expanded station-specific marking standard — what earns 4, 3, 2 and 1 here
The top row is the full picture of what a competent FY2 could do at this station, including the working diagnosis with its justified differentials, the safety-net and the follow-up; lower rows describe how performance falls away. It is a debriefing aid, not a checklist to recite: nobody says every line in eight minutes, and a 4 is a judgement that the essentials — the italic key facts on the mark sheet — were done well, in plain language and at the patient’s pace. Acumen training standard — the GMC does not publish station mark sheets.
| Mark | Domain 1 · Data gathering, technical and assessment skills | Domain 2 · Clinical management skills | Domain 3 · Interpersonal skills |
|---|---|---|---|
| 4 |
|
|
|
| 3 | Arrest recognised within 10 seconds, help and 2222 called with the right information, good-quality compressions and 30:2 ventilation; one of the swap at two minutes, the oxygen, the pre-collapse history or the check on Ollie missing. | AED used promptly and correctly with everyone clear, cycles kept, ROSC recognised and a structured handover given; one of the oxygen-away check, the post-ROSC ECG, the differentials or the documentation missing. | Clear leadership and a kind word to Ollie at the end; instructions occasionally stacked, or one challenge missed. |
| 2 | Arrest recognised but slowly — a long pulse check, or a history taken before compressions start; compressions too shallow or too fast and not corrected; 2222 call vague (“call for help”) until Ollie asks what to say. | AED used but late (the pads applied after the first cycle only when Ollie points at the wall), or compressions stopped for long periods while the pads go on; pulse checks between analyses; handover unstructured; no plan after ROSC. | Competent but silent — compressions done well but Ollie left guessing; instructions vague (“get the stuff”); nothing said to Ollie afterwards. |
| 1 | Disorganised; no airway opening; compressions started only after prompting; no call for the team. Or unsafe: agonal gasps taken as breathing and the patient left in the recovery position; or no compressions within a minute of finding no normal breathing; or the resuscitation team never called. | AED not used until prompted repeatedly; compressions stopped for long periods; no handover beyond “he collapsed”. Or unsafe: shocks with someone touching the patient or oxygen flowing over the chest; or does not use the AED at all; or stops CPR to take a history; or leaves the patient after ROSC without monitoring. | Flustered, shouting or frozen; Ollie ignored or blamed. Or unsafe: blames Ollie in front of the team (“why didn’t you get someone?”), or dismisses his safety challenge and shocks anyway. |
4 · GMC feedback statements — where underperformance was identified — with case-specific examples
A feedback statement marks where underperformance was identified in the consultation. With PLAB 2 results the GMC may attach any combination of the ten statements to a station — none, one or several. The right-hand column shows what each one looks like at this station. Record the statements that applied in the practice log.
| GMC feedback statement | Underperformance it signals (generic) | Case-specific examples |
|---|---|---|
| 1 · Consultation | Disorganised or unstructured consultation | Takes a history from Ollie before touching the patient; checks pulse, then breathing, then pulse again; no recognisable sequence, no handover structure. |
| 2 · Issues | Key issues or priorities not recognised | Does not recognise that gasping without a pulse is cardiac arrest, or that the task is CPR and defibrillation now — treats it as a faint and waits for him to come round. |
| 3 · Time | Poor time management | Ninety seconds of checking before compressions; the AED is not on until minute four; no handover before the bell. |
| 4 · Findings | Abnormal findings or results, or their implications, not identified | Is told “an occasional gasp” and no carotid pulse, and puts him in the recovery position; is told “shock advised” and asks for a pulse check first; misses Ollie’s account of the chest tightness and the anticoagulant. |
| 5 · Examination | Physical examination or use of instruments not competent | Hands on the wrong part of the chest, shallow or slow compressions not corrected, no recoil; pads on over the gown or in the wrong position; breaths with no head tilt and no seal; pulse checks between cycles. |
| 6 · Diagnosis | Working diagnosis or differential diagnoses not correct | “He collapsed” with no diagnosis; cannot say why this is probably a coronary cause rather than a pulmonary embolism or bleeding after surgery. |
| 7 · Management | Management plan not reflecting current best practice | No 2222 call, or “call someone” with no content; AED used only when Ollie points to it; shocks without clearing or with the oxygen on the chest; after return of circulation — no oxygen, no monitoring, no ECG; nothing said about what to do if he arrests again; Ollie not debriefed. |
| 8 · Rapport | Rapport and sensitivity to the patient’s feelings and concerns not shown | Silent and frantic; shouts at Ollie; after the team arrives, walks away without a word to him. |
| 9 · Listening | Verbal and non-verbal cues not used; poor active listening | Ignores “Shall I get someone, doctor?” and “The defib’s on the wall just there, doctor”; never asks Ollie what happened before, or whether he has anything to add, so the chest tightness is never passed on. |
| 10 · Language | Language or explanations not understandable; understanding not checked | To the team: “He VF’d, I shocked him twice, he’s got ROSC” — no name, no timings, no background; to Ollie: “he had a PEA-to-VF arrest with a likely STEMI aetiology.” |
5 · Examiner points of fact and guidelines
Points of fact the examiner should have to hand
- Resuscitation Council UK 2025 guidelines (published 27 October 2025, adapted from the European Resuscitation Council 2025 guidelines): the adult basic life support sequence is — suspect cardiac arrest in anyone who is unresponsive; call for help immediately (outside hospital: call 999 on speakerphone for any unresponsive person before assessing breathing — a 2025 change; in hospital: shout, emergency buzzer, and the 2222 call); assess breathing — slow or laboured breathing, agonal gasping or panting mean cardiac arrest; if in doubt, start CPR; compressions at 100–120 per minute, 5–6 cm deep, on the lower half of the sternum, full recoil, on a firm surface (do not move a patient off a bed — compress harder); 30:2 for trained rescuers, each breath just enough to make the chest rise; compression-only CPR for the untrained; use the AED as soon as it arrives, pads on bare skin, continue CPR while pads are attached, nobody touching during analysis or shock, resume compressions immediately after a shock or a ‘no shock’ prompt.
- In-hospital cardiac arrest (RCUK adult advanced life support 2025): all hospital staff should be able to recognise cardiac arrest rapidly, call for help, start CPR and defibrillate; hospitals use a standard 2222 cardiac arrest call number and have a resuscitation team that responds immediately; systems aim to defibrillate shockable rhythms within three minutes; CPR continues while the defibrillator is fetched and the pads applied; pauses in compressions under 5 seconds; antero-lateral pad position is the position of choice — the lateral pad in the mid-axillary line directly below the armpit (emphasised in 2025); remove any oxygen mask and keep it at least a metre from the chest before a shock; never defibrillate during manual compressions. Those experienced in pulse checks may add a carotid pulse check within the same 10 seconds; if there are no signs of life, or any doubt, treat as cardiac arrest. Check responsiveness and breathing for no more than 10 seconds (taught practice; confirm the exact wording against the RCUK 2025 in-hospital algorithm PDF). Treat any doubt as cardiac arrest.
- What the arriving team adds (RCUK ALS 2025): a manual defibrillator — first shock at least 150 J for biphasic waveforms (130–150 J pulsed biphasic), energy escalated for later shocks, or the highest setting if unknown; single shocks followed by two minutes of CPR; adrenaline 1 mg IV after the third shock in a shockable rhythm and as soon as possible in a non-shockable rhythm, then every 3–5 minutes; amiodarone 300 mg after three shocks and 150 mg after five; rhythm and pulse checks every two minutes; an advanced airway with waveform capnography; the four Hs and four Ts; no routine calcium, bicarbonate or steroids. The 2025 ALS guidance states there are no major changes from 2021, with greater emphasis on ventilation and pad placement.
- Return of spontaneous circulation: leave the pads on and the defibrillator on; ABCDE; high-flow oxygen initially, then titrate to a saturation of 94–98% once reliable readings are available; a 12-lead ECG at once — ST-elevation after a witnessed shockable arrest is an indication for urgent coronary angiography and primary PCI; avoid hypotension (RCUK post-resuscitation care 2025: systolic above 100 mmHg or mean arterial pressure 60–65 mmHg) and fever (37.5 °C or below); glucose and potassium checked; critical care review. The recovery position is for an unresponsive patient who is breathing normally and is not monitored — in hospital with the team present he stays supine with monitoring.
- Handover — SBAR (NHS England / NHS Improvement safety communication tool, used in RCUK ALS teaching): Situation, Background, Assessment, Recommendation; given in under a minute, with times (collapse, CPR started, each shock, ROSC), what has been given and what has not; the first responder stays until released. The RCUK ‘Systems saving lives’ 2025 chapter asks hospitals to record every arrest for the National Cardiac Arrest Audit, to have protocols for family presence during CPR, to use rapid response systems to prevent arrests, and to debrief teams.
- Prevention and recognition on the ward: chest tightness in a post-operative patient on the way to the bathroom is a reason to stop, sit him down and call the nurse and doctor — the ‘chain of prevention’ (education, monitoring with NEWS2, recognition, call for help, response). A healthcare assistant who hears chest pain should alert the nurse immediately; Ollie’s question “is this my fault?” is answered honestly: he pressed the buzzer, stayed with the patient and shouted for help, which is what the system asks of him.
- Reversible causes to think about after major surgery (RCUK special circumstances 2025): hypovolaemia from bleeding, hypoxia, hypo/hyperkalaemia, hypothermia; thrombosis — coronary or pulmonary; tension pneumothorax; tamponade; toxins. A witnessed collapse after chest tightness with a shockable rhythm points to a coronary cause; pulmonary embolism and haemorrhage more often present with a non-shockable rhythm.
- DNACPR: CPR is started unless a valid decision not to attempt it is known to the responders; the absence of a recorded decision in a mobile day-2 surgical patient means CPR. The team leader stops CPR only on the basis of futility judged by the team, not by the first responder (RCUK ethics guidance 2025).
- Staff welfare (RCUK 2025, education and systems chapters): rescuers, including lay and junior staff, may be distressed after a resuscitation attempt and benefit from a prompt, structured debrief and signposting to support — a hot debrief led by the team leader or resuscitation officer the same day, with Ollie included.
Where candidates lose marks at this station
- Taking a history from the healthcare assistant before checking for a response.
- Treating an occasional gasp as breathing and reaching for the recovery position.
- “Call for help” with no number, no words and no location.
- The AED left on the wall until Ollie points at it.
- Pressing the shock button without looking — Ollie’s hand on the arm, oxygen on the chest.
- Walking away from Ollie when the team arrives.
Guidelines for this station
- Resuscitation Council UK — Adult basic life support guidelines (2025)
- Resuscitation Council UK — Adult advanced life support guidelines (2025), including in-hospital cardiac arrest
- Resuscitation Council UK — 2025 guidelines: executive summary of the main changes since 2021
- Resuscitation Council UK — Post-resuscitation care guidelines (2025)
- Resuscitation Council UK — Systems saving lives guidelines (2025)
- Resuscitation Council UK — Quality standards: acute care (the 2222 call and the resuscitation team)
- NHS England — SBAR communication tool: implementation and training guide
6 · MLA content map tags for this case
| MLA content map | This station |
|---|---|
| Domain 1 · Areas of clinical practice | Acute and emergency |
| Domain 3 · Clinical and professional capabilities | Emergency and acute management plans · Performing procedures safely · Team working · Managing risk · Using guidelines and evidence |
| Domain 5 · Patient presentations | Cardiorespiratory arrest |
| Domain 6 · Conditions | Cardiac arrest |
| Station family | Practical procedures and prescribing — Practical procedure on a manikin — a collapsed patient on the ward |
7 · My marks and reflection — practice log form
Record your three domain marks, your station total, the GMC feedback statements that applied (where underperformance was identified), and what you will keep and change. The form is already labelled with this case and its web address; a copy of your entry is emailed to you, so your practice log builds up in your inbox and can be downloaded.
Record my marks and reflection for P2-40
Revision link for this case: mdacumen.com/plab-2-osce/case-40-collapsed-in-the-ward-corridor
Independence & scope. Independent, formative training material from MD Acumen Ltd. Not affiliated with, endorsed by, or delivered on behalf of the General Medical Council. The GMC does not publish its station mark sheets: every mark scheme and descriptor on these pages is an Acumen training tool calibrated to the GMC's published marking domains, feedback statements and the MLA content map. Practice scores are not a prediction of examination performance. Clinical content reflects UK guidance at the date of editorial review — always check the current guideline. All patients are fictional. This course never provides, and will never ask you to share, real GMC exam content — full regulatory statement: Legal & Regulatory.
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