Most people feel helpless to act when someone nearby is in cardiac arrest because they either don't know how to administer cardiopulmonary resuscitation (CPR) or it has been too long since their last training. CPR is a lifesaving technique that is useful in many emergency situations, such as when someone has a heart attack or a near drowning experience.
The majority of people who experience cardiac arrest pass away before making it to the hospital, but medical experts say if more people were familiar with CPR then more lives could be saved. Real events have taught us that on-the-spot or immediate CPR can double and sometimes tripe a person’s chance of survival.
You don't have to be an expert in CPR to save a life, but attending a CPR class should be added to your to-do list. Recommendations for people untrained in CPR but find themselves next to someone in cardiac arrest include performing hands-only CPR in the form of chest compressions until paramedics arrive.
All of Jeff Ellis Management's lifeguards are extensively trained in CPR in the event that such a technique is needed. Drowning is a frequent cause of cardiac arrest and naturally it's a concern for every aquatic facility. A highly trained lifeguard is capable of providing lifesaving CPR for someone who is experiencing cardiac arrest. That is why we require our lifeguards to undergo continuous CPR training.
Basic Life Support Sequence and Component Matrix
Based upon the 2015 CPR and Emergency Cardiac Care Guidelines
The following sequence is provided for Healthcare Provider level Basic Life Support care when a person of any age is found on land, apparently unresponsive.
- Quickly check the scene for safety, correct if unsafe (if possible). Put on exam gloves (standard precautions).
- Shake and shout, "Are you ok?"
- Activate the EAP / Contact EMS. If the guest is unresponsive. Retrieve BLS equipment, including AED and Supplemental Oxygen.
- Check for breathing and pulse at the same time for up to 10 seconds. Quickly position head in an open airway position, get low and close while at the same time check for a pulse at the carotid artery in the neck (brachial artery in the arm for infants) for up to 10 seconds. Pulse must be clearly felt (if the rescuer is uncertain or pulse is hardly detectable, assume no pulse). Breathing must be "normal" without gasping. If not normal or weak, assume no breathing. If the patient is definitely breathing but is unresponsive, place in the recovery position and monitor until EMS arrives.
- If a definite pulse is found but no breathing: Begin Rescue Breathing appropriate for the age of the patient (see matrix), reassessing pulse/breathing after approximately 2 minutes. If a pulse is found during reassessment, continue rescue breathing, reassessing pulse every 2 minutes.
- If no pulse is found: Begin CPR - 30 Chest Compressions followed by 2 ventilations (15:2 for multiple rescuers working on a child or infant patient). Switch compressors every 2 minutes (for multiple rescuers). When an AED is available, immediately turn on, properly attach, and follow the prompts. After each shock is advised and delivered or if no shock advised, immediately resume CPR until prompted to stand clear by the AED to reanalyze (approximately 2 minutes). Continue with CPR after each analysis/shock or no shock. Switch compressors at least every 2 minutes or when the compressor is fatigued.
- Ventilations do not go in: If while providing ventilations (during rescue breathing or CPR cycles), visible chest rise is not achieved, quickly re-tilt and attempt a second ventilation. If the second ventilation does not go in, immediately begin 30 chest compressions. After the compressions, quickly check the mouth. If an object is seen, finger sweep (suction if fluid) and attempt two ventilations. Repeat until ventilations are successful. Once visible chest rise is achieved with a ventilation attempt, continue with the care previously being administered.
|Component of Care||Adults
(Adolescence and older)
(1 year of age to adolescence)
(Less than 1 year of age, excluding newborns)
|Scene Safety, Recognition||Determine scene safety. Check for responsiveness: "Tap and shout"||Determine scene safety. Check for responsiveness: "Tap and shout"||Determine scene safety. Check for responsiveness: "Tap and shout"|
|Guest Position for Assessment and Care||Safely position guest on back. Articulate the guest's head to open the airway and allow for assessment.||Safely position guest on back. Articulate the guest's head to open the airway and allow for assessment.||Safely position guest on back. Articulate the guest's head to open the airway. Expose guest's arm to allow for assessment.|
|Rescuer Positioning for Assessment||Get low to the guest. Locate the carotid artery in the neck while lowering your head near the mouth of the guest.||Get low to the guest. Locate the carotid artery in the neck while lowering your head near the mouth of the guest.||Get low to the guest. Locate the brachial artery in the arm while lowering your head near the mouth of the guest.|
|Simultaneous Assessment: Pulse/Breathing||Look down the guest's body and listen for normal breathing while feeling for a pulse for a maximum of 10 seconds.||Look down the guest's body and listen for normal breathing while feeling for a pulse for a maximum of 10 seconds.||Look down the guest's body and listen for normal breathing while feeling for a pulse for a maximum of 10 seconds.|
|Pulse is definitely found, No Breathing*||Begin Rescue Breathing with a mask attached to oxygen. 1 breath every 5 seconds.||Begin Rescue Breathing with a mask attached to oxygen. 1 breath every 3 seconds.||Begin Rescue Breathing with a mask attached to oxygen. 1 breath every 3 seconds.|
|Pulse is not found or there is uncertainty*||Begin CPR. 30 Chest compressions followed by 2 breaths using a mask w/O2. Attach AED as soon as available.||Begin CPR. 30 Chest compressions followed by 2 breaths using a mask w/O2. Attach AED as soon as available.||Begin CPR. 30 Chest compressions (fingers) followed by 2 breaths using a mask w/O2. Attach AED as soon as available.|
|Multiple Rescuer Response*||CPR Ratio: 30:2, alternating compressors every 2 min AED prompt or fatigue onset. Ventilations: BVM w/O2 can be used for delivery.||CPR Ratio: 15:2, alternating compressors every 2 min AED prompt or fatigue onset. Ventilations: BVM w/O2 can be used for delivery.||CPR Ratio: 15:2 (thumbs), alternating compressors every 2 min AED prompt or fatigue onset. Ventilations: BVM w/O2 can be used for delivery.|
|Chest Compressions: Quality||Depth: 2-2.4in. (5-6cm). Rate: 110 target, at least 100 comp/min. Recoil: Allow full recoil. Interruptions in care, max 10 seconds target.||Depth: 1/3 depth of body (2in / 5cm). Rate: 110 target, at least 100 comp/min. Recoil: Allow full recoil. Interruptions in care, max 10 seconds target.||Depth: 1/3 depth of body (1.5in / 4cm). Rate: 110 target, at least 100 comp/min. Recoil: Allow full recoil. Interruptions in care, max 10 seconds target.|
|Ventilation delivery: Quality||Duration: About 1 second Volume: Adequate for chest rise and no more.||Duration: About 1 second Volume: Adequate for chest rise and no more.||Duration: About 1 second Volume: Adequate for chest rise and no more.|
*Note that standard precautions should be taken before providing primary care.
PRIORITY OF CARE, "CAB":
- Compressions - If after determining that the patient is suffering from cardiac arrest (no pulse), early chest compressions provide the patient with immediate care that may provide the best opportunity for a successful outcome. In team management (multiple rescuers) situations, it allows for one rescuer to begin care, without delay while other team members retrieve and prepare equipment (such as oxygen, BVM, and AED). Evidence shows that oxygen levels in the blood tend to be high during the first few minutes after cardiac arrest. As such, immediate opening of the airway and ventilation techniques performed first does not improve the outcome during cardiac arrest when compared to chest compressions.
- Airway - The rescuer no longer "looks, listens and feels for breathing" after opening the Airway. The Airway is opened to deliver ventilations during appropriate times during the BLS sequence (see "Breathing")
- Breathing - If a patient does not have a pulse, the first two Ventilations will be delivered after 30 compressions. If the patient does have a definite pulse and no obvious signs of normal breathing, Ventilations are delivered using the appropriate Rescue Breath to seconds' ratio for the age of the patient for approximately two minutes, followed by reassessment of the pulse. Breathing is never directly assessed, beyond what can be obviously observed by looking at the chest during a quick check during the initial check for responsiveness. Gasping and other breathing like (but ineffective) behavior, such as Agonal breathing will not be interpreted as Normal Breathing. If Agonal breathing is observed by the rescuer, appropriate BLS care must be continued.
CPR - PUSH FAST, PUSH HARD:
- Compression rate of at least 100 compressions in 60 seconds. A recommended method of maintaining the correct compression pace is to think of the beat in the song "Staying Alive" by The Bee Gees which is about 100 beats per minute.
- Compressions for ADULTS should be at least 2 inches deep.
- Compressions for CHILDREN and INFANTS should be about 1/3 the depth of anterior-posterior diameter of the patient’s chest. Compressions must allow for the full recoil of the chest in order to be fully effective.
- Rescuers should perform 30 chest compressions in about 18 seconds.
- Rescuers continue compressions and ventilations sequence until an AED is available or until EMS arrives and takes over care. Rescuers responding in teams switch out who is performing compressions every two minutes or whenever there is a change in care or equipment (such as AED arrival) to help ensure maximum effectiveness and reduce rescuer fatigue.
- The time period between each set of compressions must be minimized. It should only take a few seconds to deliver two effective ventilations and then return to the next set of compressions.
- Rescuers perform the Jaw Thrust with head tilt technique with a Seal Easy Mask or Bag Valve Mask to quickly open the airway to deliver ventilations to patients without a suspected spinal injury. If spinal injury is suspected, the Jaw Thrust without head tilt technique should be used.
- A ventilation should be provided for a duration of about 1 second during CPR ventilations and Rescue Breathing.
- Over ventilation is to be avoided as it may cause complications, such as vomiting due to gastric inflation which will delay continued CPR care. Over ventilation also decreases the overall effectiveness of the care due to the increase in intrathoracic pressure, decreasing the venous return of blood to the heart which reduces the overall cardiac output.
- Bag Valve Mask equipment with oxygen requires two rescuers to operate effectively (one to place the mask on the mouth and monitor/maintain an open airway while the other rescuer delivers ventilations by squeezing the bag while monitoring for visible chest rise). If two rescuers are not available to operate (or one is needed for compressions, AED set up, etc.), it is more effective for the remaining rescuer to utilize a pocket mask with oxygen supplementation, if available.
- Care must not be delayed while setting up equipment. Chest compressions (or rescue breathing if appropriate) should be continued until equipment ready and rescuers are prepared to assist.
- Rescuers retrieve the AED (and other BLS equipment) as soon as an unresponsive patient is discovered.
- The AED equipment must be applied as soon as it is available when treating a patient without a definite pulse.
- Care is interrupted only long enough to prepare the patient for AED placement (removal of clothing, shaving if excessively hairy, etc.)
- If the patient is wet, he or she must be quickly dried off (chest area) and precautions should be taken to keep the chest area dry during care (rescuers who are wet should avoid chest compressions until they are dry).
- The rescuer / rescuer team must apply the electrode pads, following the AED manufacturer’s instructions. Pediatric pads / dose attenuator are recommended for Child and Infant patients, but if these are not available, adult pads are acceptable.
- Rescuers must follow AED prompts. If analysis indicates a shock is advised, the shock should be delivered and CPR, beginning with chest compressions must be immediately resumed. If analysis indicates no shock advised, CPR, beginning with chest compressions must be immediately resumed. Some AEDs may prompt for reassessment of breathing and/or pulse during subsequent analysis due to being programmed at the 2005 ECC standard for basic prompting. Rescuers should immediately resume compressions after each analysis followed by a shock or no shock delivery.
- Rescue teams must coordinate and practice quick, efficient hands on/hands off transitions to reduce the amount of time between shocks delivery and chest compressions.
- Evidence supports first opening the airway and attempting ventilations prior to removal of an unresponsive patient during a water rescue. Upon extrication, the standard "CAB" would resume (See BLS Protocols for an unconscious guest in the water).