It was a Tuesday at 05:59 at the Virgin Active Gym in Tygervalley when Wesley Craig, a lecturer in Emergency Medicine at the University of Cape Town (UCT), heard a loud thump from the treadmill area. He wondered if it could have been the sound of a cell phone that had dropped — not a remarkable sound in 2025.  

“There was equipment between the treadmill area and where I was, so I was initially not sure. However, my trainer was standing next to me, had seen a person on the ground, and rushed to push the panic button.  I realised that a man had fallen off the treadmill, was lying face down and appeared unconscious,” Wesley recounts.   

Wesley’s emergency care training immediately kicked in. Exhausted from his own workout, it took a few seconds for him to orientate himself. He turned the patient onto his back. The patient did not respond to verbal commands or painful stimuli, Wesley could not feel a pulse, and he noticed that the patient was turning a deep blue — almost purple.  

“His eyes were open, but he was just looking straight ahead, and his breathing was laboured and irregular.”    

Wesley explains that at the gym, when a person (in his case, his trainer) clicks a panic button, the gym staff rushes to the area with the medical equipment. But until help arrived, Wesley knew that he needed to begin chest compressions. He was soon joined by two doctors who were also attending the gym.  

The bystander effect has been described as a “diffusion of responsibility”, the idea that, if there are other people around, they will intercede, so your action as a witness is not necessary. But in a life-or-death situation, timing is crucial, and if all witnesses think that “someone else will step in”, it decreases the patient’s odds of survival. Wesley stresses that if a patient does not receive cardiopulmonary resuscitation (CPR) within four to six minutes of collapsing due to cardiac arrest, their death is almost guaranteed.  

The gym employees arrived with the medical equipment, including an automated external defibrillator (AED, a medical device designed for laypeople to use to shock erratic cardiac rhythms back into normal function). 

After one of the doctors took over CPR (a technique that combines chest compressions and rescue breaths, thus maintaining blood flow and oxygen to the patient’s brain), Wesley placed the two pads on the patient and allowed the AED to analyse the patient’s heart rhythm.  

AED devices are designed to verbally guide the user with instructions on removing clothing, placing the pads, staying clear of the patient for the rhythm analysis and on whether a shock is advised. In this case, the AED advised a shock, indicating that the patient had a potentially salvageable heart rhythm. The patient was cleared to ensure that no one was touching him, and a defibrillation shock was delivered with the quick press of a button. Chest compressions resumed immediately.    

Before they could do the next rhythm check (set for two-minute intervals), the patient sat up — at first in a dazed and confused state — and started mumbling. He eventually started speaking coherently. Surprisingly, the patient remarked that he was fine and wanted to go home. With guidance, he agreed to go to the hospital. A private emergency medical services (EMS) team arrived within 20 minutes to transport him for further care.

“I’m trained in it, but you don’t expect that to happen in front of you.”

Through conversation, it was discovered that the patient was 39 years old and had no known medical conditions or family history of health issues, which made his collapse even more frightening. A review of the camera footage confirmed that approximately three-and-a-half minutes had elapsed between the collapse and his regaining consciousness after resuscitative efforts.     

“I'm trained in it, but you don't expect that to happen in front of you,” Wesley says, when reflecting on the episode. Wesley has the patient’s details but is not aware of the final diagnosis.   

Wesley’s advice is not to be afraid to act and help someone in need, especially when others shy away. Checking for hazards, patient responsiveness, breathing (absence or irregularity) and beginning chest compressions early are the most important steps to potentially rescue a person who has gone into sudden cardiac arrest. He stresses that if you, as a witness, get these basics covered as soon as you notice a potential arrest, you greatly improve the person’s chances of survival.   

 A registered Emergency Care Practitioner, Wesley holds a Bachelor’s and Master’s Degree in Emergency Medical Care, both from the Cape Peninsula University of Technology. He recently submitted his PhD in Forensic Medicine at UCT.  

Since 2021, Wesley has been co-convening the PhD in Emergency Medicine within the Division of Emergency Medicine at UCT full-time. Owing to his adventurous spirit and enthusiasm for helping people, he still practises as a paramedic for various EMS organisations on an ad hoc basis. Moreover, he facilitates Emergency First Aid Responder (EFAR) training with Community Medics in collaboration with the Western Cape Department of Health and Wellness Emergency Medical Services.  

On the whole, Wesley sees low success rates with out-of-hospital cardiac arrest cases as arrests occur without witnesses, or bystanders cannot recognise the emergency or they fear causing harm.   

To Wesley, a sustainable EMS system anywhere in the world depends on witnesses taking action by stabilising the patient if trained, alerting those nearby, calling EMS and staying with the patient until professional help arrives, which in reality may take 20 minutes or longer.  

Importantly, conditions such as cardiac arrest, severe bleeding and choking become unsurvivable long before 20 minutes have passed, making first aid training and bystander action essential.