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Emergency life support

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This factsheet is for people who would like to learn how to carry out emergency life support, or who would like information about it. For simplicity the injured person (casualty) is referred to in the male gender throughout.
 
Emergency life support is a set of actions that can keep a casualty alive until professional help arrives. Actions include performing cardiopulmonary resuscitation (CPR) on people who may have stopped breathing or whose heart has stopped.

About emergency life support
Chain of survival
What to do in an emergency
How to open the airways
Recovery position
Cardiopulmonary resuscitation
How a cardiopulmonary resuscitation is carreid out
Automated external defibrillators

About emergency life support

 
A person's heart or breathing can stop as a result of a heart attack, drowning, an electric shock or other injuries. If this happens, their organs don't receive a supply of oxygen-rich blood and this will soon lead to irreversible damage.
 
Cardiopulmonary resuscitation (CPR) involves giving chest compressions and rescue breaths (mouth-to-mouth breathing) to a person who has stopped breathing or whose heart has stopped. In some cases, this can restart the heart and breathing. More commonly, for example after a heart attack, CPR circulates enough blood around the body to slow down organ damage.
 
Emergency life support can make the difference between life and death. Giving CPR to someone whose heart has stopped can double or even triple their chance of survival. If you aren’t trained in emergency life support then giving chest compressions only can increase the chance of survival.
 
You can learn basic life-saving skills, including CPR, at a local training centre.
 

Chain of survival

 
A rapid response is a crucial part of emergency life support. This is called the ‘chain of survival’ and involves:
 

  • early recognition of the emergency and calling for an ambulance – to prevent cardiac arrest
  • immediately performing CPR if the casualty isn’t breathing – to buy time
  • early defibrillation – to restart the heart
  • early post-resuscitation care – to restore quality of life

 

What to do in an emergency

 
Stay calm and remember you can only do your best. First, assess the situation and make sure the area is free of hazards, particularly anything that may have caused the injury to the casualty, such as live overhead cables. You should never put yourself at risk and if there is no one else present, then shout for help.
 
If you have had first aid training, let others know. Also nominate someone to stand by in case you need to ask them to call for emergency help.
 
Once you have assessed the situation, it’s important to quickly check the casualty's responses by talking to him. Ask him to perform an action – such as opening his eyes – as he may not be able to talk to you.
 
If the casualty responds, leave him in the position that you found him. If necessary, ask your nominated bystander to call the emergency services and inform them that you have a conscious adult male who is breathing. You should monitor his condition regularly until help arrives or he has recovered.
 
If you don’t get a response, gently tap his shoulders and continue to speak to him. Make sure that you direct your voice to both ears. Don’t move the casualty’s head or neck. You will then need to check his airway and breathing.
 

Airway

The casualty can only breathe if his airway is clear. An airway can be blocked when a person is unconscious and their tongue falls to the back of their throat. To open a casualty’s airway, complete the following actions.
 

  • Place two fingers under the point of his chin.
  • Put your other hand on his forehead.
  • Lift his jaw and tilt his head back slightly.
  • Remove any obvious debris that might be blocking the airway.

How to open the airways

Breathing

Next, keeping the airways open, check if the casualty is breathing normally in a continuous rhythmical way.
 
·       Look to see if his chest is moving up and down.
·       Listen for his breathing by placing your ear next to his mouth.
·       Feel for the casualty's breath against your cheek.
 
You need to look, listen and feel for up to 10 seconds before deciding if the casualty is breathing normally.
 
If the casualty is breathing normally, then place him in the recovery position  and frequently check his breathing before you get emergency help. If the casualty isn’t breathing or isn’t breathing normally (for example, if he takes infrequent gasps) you will need to get emergency help and then begin CPR. If the casualty is a baby (up to one year) or a child (aged one to puberty) you should carry out one minute of CPR before calling for emergency help.
 
Ask your nominated bystander to call for emergency help or, if you’re alone, then you should call. Only leave the casualty if there is no other way of getting help. If the casualty isn’t breathing, tell the bystander to bring an AED (automated external defibrillator) if available.
 
If you’re in any doubt as to whether or not the casualty’s breathing is normal, act as if he isn’t breathing.
 

Recovery position

If you don’t suspect injury and the casualty is unconscious but breathing, you can place him in the recovery position to keep the airway clear and allow fluid to drain from his mouth. For a child or adult lying on his back, take the following actions.
 

  • Place the arm closest to you at right angles to his body, with elbow bent and palm facing up.
  • Cross the other arm over the casualty’s body and hold the back of his hand against his cheek nearest to you.
  • Grasp the far leg above the knee and pull it up so the knee is bent.
  • Pull the leg towards you so the casualty is now lying on his side facing towards you.
  • Make sure the casualty’s airway is open and check his breathing regularly until emergency help arrives.

 
For babies less than one year old a different recovery position is needed. If a baby is unconscious and breathing, hold him on his side in your arms, head tilted downward, with his head lower than his tummy. This prevents him from choking on his tongue or vomit.
 

Cardiopulmonary resuscitation

 
A casualty who isn’t breathing needs cardiopulmonary resuscitation (CPR), which is a combination of chest compressions and rescue breaths. There are a few differences in CPR for adults, children and babies. However, the adult CPR technique can be used on children. For a child or baby who isn’t breathing, initially perform five rescue breaths. If the child or baby still isn’t breathing normally, carry out 30 compressions followed by two rescue breaths until emergency help arrives. For an adult who isn’t breathing, start by performing 30 compressions followed by two rescue breaths and continue until help arrives. If you aren’t trained in emergency life support, then you should just perform chest compressions.
 
 

Compressions

 

  • Move the casualty so he is lying on his back on a firm surface.
  • Kneel beside the casualty's chest.
  • Place the heel of your hand on the centre of the chest
  • Place your other hand on top and interlock your fingers.
  • With your arms straight, press down 5 to 6cm (this is one compression).
  • After each compression, release the pressure on the chest, but keep your hands in contact.
  • Do compressions at a rate of 100 to 120 compressions per minute (the compress and release parts take about the same time). You will need to do 30 compressions for one cycle of CPR.

 
For children, you should place one or two hands on the centre of the chest (depending on the size of the child) and with the heel of your hand, press down at least one-third of the depth of his chest (5cm). For babies, you should use two fingers in the middle of the chest and press down at least one-third of the depth of his chest (4cm).
 
 
 

Rescue breaths

At the end of the 30 chest compressions, you should perform two rescue breaths to deliver oxygen into the casualty's lungs if you’re trained in emergency life support. For children and adults, you should perform the following actions.
 
·       Place two fingers under his chin and gently lift it to open the airway.
·       Pinch the nose closed.
·      Take a normal breath.
·      Seal your mouth over the casualty's and breathe out steadily into his mouth for around one second.
·       Watch for his chest to rise and fall.
·      Repeat once more.
 
For babies, you should seal your lips around the mouth and nose. Blow gently into the lungs, looking along the chest as you breathe. Fill your cheeks with air and use this amount each time.
 
Repeat the cycle in the ratio of 30 chest compressions to two rescue breaths until:
 
·      qualified help arrives
·      the casualty starts showing signs of regaining consciousness and breathing normally
·      you become exhausted
·      you have help from another person who can perform CPR
 
Doing chest compressions is very tiring so if you have help, take turns doing CPR – swap every one to two minutes so neither of you gets too tired. This will increase the efficiency of your CPR.
 
If you’re not able or willing to breathe into the casualty's mouth, you can just do the chest compressions without a pause for the rescue breaths. This is much better than doing nothing at all. Only stop to check the casualty if he begins to show signs of regaining consciousness, such as opening his eyes, speaking or coughing and starts to breathe normally.

How cardiopulmonary resuscitation is carried out

Automated external defibrillators

 
Automatic external defibrillators (AEDs) are machines designed to be operated by members of the public. They are available in public places such as offices, shopping centres, railway stations and on aeroplanes. AEDs analyse a casualty's heart rhythm through pads connected to the chest area, and deliver an electric shock if needed. They give spoken instructions and are easy for people without training to use. If no shock is needed then you should continue CPR.
 
You can use an AED safely and effectively without any previous training. You can learn how to use an AED at a local training centre.
 

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This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.
 
Please anchor jump links to all H2 headings
 
If I can't remember the correct sequence and technique for child CPR, will I harm the child by performing the adult technique?
How long does first aid training take and do I need to be retrained once I’ve gone on a course?
Can I catch anything from doing mouth-to-mouth breathing (rescue breaths)?
What should I do if an adult is choking?
How can I tell if a casualty’s breathing is normal? 
 

If I can't remember the correct sequence and technique for child CPR, will I harm the child by performing the adult technique?

 

Answer

No, doing something will assist the child. If you can’t remember the correct sequence and technique, call for an ambulance and then perform CPR to the best of your ability.
 

Explanation

Many children don’t receive resuscitation because rescuers are afraid that they will cause harm to the child. Resuscitation can significantly improve the likelihood of the child surviving. It’s far better to use the adult CPR sequence for resuscitation of a child than to do nothing. Even doing chest compressions or ventilation breaths alone may be better than doing nothing at all.
 
  

How long does first aid training take and do I need to be retrained once I’ve gone on a course?

 

Answer

There are a number of different first aid courses. These vary in training time and content. The type of training course you choose will depend on what you want to achieve from the course.
 

Explanation

Most basic first aid courses are for a minimum of three hours, but some last up to three days. The shorter courses aim to teach you basic life saving skills. Longer courses will train you in first aid for people of all ages and different situations.
 
There is no recommended length of training time for a first aid course. However, it’s important that you learn the basic skills of first aid so you can help to save someone’s life.
 
It’s recommended that you keep your first aid skills up-to-date, particularly if you have a duty to respond to an emergency at work. Your employer may offer refresher training.
 
 

Can I catch anything from doing mouth-to-mouth breathing (rescue breaths)?

 

Answer

The chance of developing an infection from giving rescue breaths is very small. However, if you don't want to do mouth-to-mouth breathing, just give chest compressions.
 

Explanation

When you're in a situation where you need to give rescue breaths you may find that you're reluctant to do so because you're worried about catching an infection. If you haven’t been trained in emergency life support then you don’t need to worry about giving mouth to mouth, Some people don’t like the idea of doing rescue breaths and find it difficult to perform mouth-to-mouth breathing on a complete stranger. You may also not want to do rescue breaths if the person has vomited or is bleeding around the mouth or lips.
 
The chance of catching an infection after giving someone mouth-to-mouth breathing is small. A very small number of people in the world have developed tuberculosis (TB) or severe acute respiratory distress syndrome (SARS) after giving rescue breaths to someone. No one has ever become infected with human immunodeficiency virus (HIV) as a result of giving rescue breaths.
 
You can buy face shields and masks that allow you to do mouth-to-mouth breathing without making direct contact with the person's face or mouth.
 
If you don't want to do mouth-to-mouth breathing, just give chest compressions. During the first few minutes after someone collapses the oxygen levels in the body stay high, so chest compressions alone can help to keep the blood flowing around the body until more help and equipment arrive.
 
 

What should I do if a child or adult is choking?

 

Answer

If someone is choking, it means that an object has got stuck at the back of their throat and he or she may be having trouble breathing. Your aim is to get the object out and, if you need to, get medical help quickly. If the child (over 1 year) or adult can't breathe and the object is large, the two main ways to get it out are by giving blows to the back or by using abdominal thrusts (which used to be called the Heimlich manoeuvre).
 

Explanation

Choking is the body’s response to an object that is stuck and blocking the back of the throat or causing the muscles there to go into spasm. This means that the person may be unable to breathe properly. If the object is large enough, the person may become unconscious and stop breathing. This is why it's important to be able to recognise when someone is choking and be able to take the right steps to help.
 
Choking often happens when someone is eating and many people will look distressed and clutch at their neck. Choking can happen to anyone but for simplicity we have referred to the person choking in the male gender throughout.
 
First, you need to find out whether the person is choking and how bad it is. Go up to him and ask if he is choking. If the object is small and the choking is mild, he will be able to answer you, breathe and cough. In these circumstances, you don't need to do anything apart from encouraging him to cough until the object comes out. If he can't speak to you and can only nod, the object may be large and the choking more severe. Other signs of severe choking are:
 
·       his breathing sounds wheezy or he can't breathe at all
·       when he tries to cough you can't hear anything
·       he becomes unconscious
 
Your aim now is to get the object out and get medical help quickly if necessary. To get the object out, you will need to dislodge it by using back blows and then, if necessary, by using a procedure called abdominal thrusts.
 
·       Give up to five back blows – these are sharp blows to the person's back. Stand slightly behind and to the side of him. Lean him forward so that the object will come out when it's loosened. Support him with one hand and then give up to five sharp blows between his shoulder blades with the other hand. In between each blow, check his mouth and remove any obvious blockage. If after five back blows the object hasn't come out and he is still choking, you need to do abdominal thrusts.
·       Give up to five abdominal thrusts – stand behind the person, wrap your arms around his waist and lean him forward slightly. Make a fist with one hand and place the thumb side of it against the upper part of his abdomen (tummy) between the bottom of his ribcage and his navel. Hold your fist with your other hand and pull it sharply inwards and upwards. Make sure you don't squeeze his ribcage by mistake. Do this five times, checking in between each thrust whether the object has come out.
 
Keep doing back blows followed by abdominal thrusts until the object comes out. If the object hasn't come out after three cycles of five back blows and five abdominal thrusts, call for emergency help. Keep giving back blows and thrusts until medical help arrives or the obstruction is cleared and he is breathing normally.
 
If you have used the abdominal thrusts, once the person has recovered it's important that he gets medical help straight away because abdominal thrusts can cause injury.
 
If he becomes unconscious, lower him gently to the floor, call for emergency help and start cardiopulmonary resuscitation (CPR) immediately.
 
The techniques described above are for treating adults and children over the age of 1. It's important to be aware that the treatment for babies is different.
 
 

How can I tell if a casualty’s breathing is normal?

 

Answer

Normal breathing is consistent, regular and rhythmical. It’s effortless and quiet. You should be able to see the chest rise and if you place your cheek next to the casualty’s mouth, you should feel their breath on your skin.
 
If you’re in any doubt whether a casualty’s breathing is normal, act as if it isn’t.

Explanation

A person who has had a cardiac arrest where the heart has stopped or is beating so slowly that it can’t support life, may gasp for air. These are called agonal gasps and people performing emergency life support frequently misdiagnose these for normal breathing.
 
Up to four out of 10 people who have a cardiac arrest have agonal gasps. They often occur in the first few minutes after sudden cardiac arrest and are a sign that you must start cardiopulmonary resuscitation (CPR) immediately. If you’re in any doubt whether the casualty is breathing normally, assume he isn’t and start CPR.

Further information

 
Sources

 

  • Cardiac arrest. British Heart Foundation. www.bhf.org.uk, accessed 7 March 2011
  • Heartstart. British Heart Foundation. www.bhf.org.uk, accessed 7 March 2011
  • The links in the chain of survival. American Heart Association. www.americanheart.org, accessed 7 March 2011
  • European resuscitation council guidelines for resuscitation. European Resuscitation Council, 2010. www.erc.edu
  • The primary survey. St John Ambulance. www.sja.org.uk, accessed 7 March 2011
  • Collapsed casualties. British Red Cross. www.redcross.org.uk, accessed 7 March 2011
  • The resuscitation guidelines 2010. Resuscitation Council UK, 2010. www.resus.org.uk
  • Resuscitation. British Red Cross. www.redcross.org.uk, accessed 7 March 2011
  • First aid training. British Red Cross. www.redcross.org.uk, accessed 7 March 2011
  • Choking. St John Ambulance. www.sja.org.uk, accessed 7 March 2011

 

 
Related topics

·       Emergency life support
·       Heart attack

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