~ The first concern in any emergency situation: Check the area for Danger!
If the area is not safe to approach, stay back and call 9-1-1. Look for chemical spills, downed power lines, or any other unsafe environment. If the area is safe, then proceed to Step 1.
Step 1 ~ Check for Responsiveness (tap and shout ~ “Are you okay?!?”)
No response means immediate action is required. No response would be no obvious signs of responsiveness such as; movement, talking, coughing, or breathing. Gasping or inadequate breathing is treated as unresponsiveness as well and still requires immediate attention. Recognition of Sudden Cardiac Arrest is a KEY element in the links of survival.
*With children and infants, no crying is another sign of unresponsiveness.
Step 2 ~ Call 9-1-1/ Activate EMS ~ Retrieve the nearest AED. Responders should always request assistance from others at the scene to make the 9-1-1 call and/or to retrieve the AED unit. If a responder is alone, and does not suspect a breathing emergency, the responder should immediately call 9-1-1 and retrieve the AED themselves and then begin CPR. Once the call is connected, the dispatcher should help guide the responder. If the responder is trained in CPR, the responder should let the dispatcher know they are trained.
*The exception to this rule is in the case of children under the age of 8 years old, including infants. Most children and infants suffer respiratory related causes of arrest. Therefore, early CPR including rescue breaths provides the best chance of survival. If a responder is alone, it is recommended they first provide 2 minutes or 5 cycles of Child CPR before he/she calls 9-1-1 to activate EMS and/or retrieves an AED if one is nearby.
Make sure the casualty is lying face up on a hard surface. A soft bed or couch will not allow the responder to adequately perform chest compressions.
Step 3 ~ C: Compress Chest (for Adults and Children older than 8 years old)
- Position the heels of both hands at the center of the chest.
- For Children 1-8 years, position the heels of one or two hands (depending on the size of the child) at the center of the chest.
- For Infants 1 year and younger, position two fingers of one hand in the center of the chest one finger width below the nipple line.
- Deliver 30 compressions at a rate of at least 100 per minute.
- Compress chest at a depth of at least 2” (or 5 cm) deep.
- For Children 1-8 years, compress chest at a depth of 2” or 1/3 the depth of the chest
- For Infants 1 year and younger, compress chest at a depth of 1½” or 1/3 the diameter of the chest.
- Allow complete recoil after each compression to allow the heart to refill with blood.
- Do not delay starting chest compressions or interrupt the compressions once they are initiated. Compressions have the most positive effect if there are minimal or no interruptions.
- Begin high quality, fast & focused, chest compressions immediately.
Step 4 ~ A: Airway
- Open Airway
- Tilt head
- Lift chin
Tilting the head back and lifting the chin will move the tongue away from the back of the throat and allow an open airway.
*With an Infant 1 year old or younger, tilt head back slightly – do not overextend as this can close the airway on an infant or injure the infant.
Step 5 ~ R: Rescue Breathing (for Adults and Children older than 8 years old)
- Pinch nose
- Seal mouth
- For Infants 1 year and younger, seal infant’s mouth and nose with the responder’s mouth or rescue mask.
- Deliver two breaths about one second per rescue breath.
- For Infants 1 year and younger, deliver two puffs about one second per rescue breath. *Be careful not to use too much force, as an infant’s lungs are much smaller than an adult or child casualty’s lungs and can cause serious damage.
- Watch chest rise and fall to ensure breaths are going in.
- If the air does not go in, re-tilt the airway and try again.
While giving rescue breaths, ensure that the mouth is completely sealed and the nose pinched closed so the air goes into the casualty’s airway, without escaping through the nose and/or mouth.
Avoid giving excessive or rapid ventilations, as this may cause the casualty to vomit and aspirate the fluid into their lungs and/or may make the responder dizzy and light-headed.
Step 6 ~ E: External Defibrillation
- When the AED arrives on the scene or is available, a Rescuer should try to place the electrodes / pads on the casualty and turn on the AED without interruptions to CPR. Once the AED prompts are followed and the AED has been used to deliver a shock if need be, continue CPR until the AED indicates if any (further) shocks are needed. If no shock was advised in the beginning, keep the pads on the casualty while performing CPR so that CPR is not later interrupted to take pads off and/or put them back on for the AED to re-analyze the heart. Repeat until help arrives.
*Advancements in technology have made AEDs more user-friendly and simple to operate. Easy to follow audio and visual cues tell responders what to do when using an AED and most will instruct the responder through CPR as well. A shock is delivered only if the casualty needs it. There is no need to be concerned about shocking a person who does not need it.
Continue CPR until the responder is too exhausted to continue, it becomes too dangerous for the responder to continue, EMS arrives, or the casualty starts breathing. If an AED arrives on the scene after CPR has begun, the Responder should try to place the pads on the casualty and turn on the AED without interruptions to CPR as noted above. Use Child AED pads if the casualty is a child under 8 years of age or an infant. Once the prompts are followed and the AED has been used to either shock or not, continue CPR until the AED prompt indicates if any further shocks are advised. Repeat until help arrives.
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