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 person isn’t breathing – to buy time
- early defibrillation – to restart the heart
- effective advanced life support – to maintain the heart rhythm
- early post-resuscitation care – to restore quality of life
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 person. These could include live overhead cables or traffic. You should never put yourself at risk and if no one else is there with you, 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 person'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 he 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 without moving his neck and continue to speak to him. Always speak loudly and clearly to the person. You will then need to check his airway and breathing.
The person 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 the 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 his airway.
Next, keeping the airways open, check if the person 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 his breath against your cheek.
You need to look, listen and feel for up to 10 seconds before deciding if the person is breathing normally.
If the person is breathing normally, then place him in the recovery position and frequently check his breathing before you get emergency help. If the person isn’t breathing or isn’t breathing normally (for example, if he takes infrequent gasps), call for emergency help and then begin CPR. See our frequently asked questions for more information about normal breathing. If the person 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 person if there is no other way of getting help. If the person isn’t breathing, tell the bystander to bring an automated external defibrillator (AED) if one is available.
If you’re in any doubt as to whether or not the breathing is normal, act as if he isn’t breathing.
If you don’t suspect injury and the person is unconscious but breathing, you can place him in the recovery position. This will keep his airway clear and allow any fluid to drain from his mouth. For a child or adult lying on his back, take the actions shown in the illustration below.
If the person is in the recovery position for more than 30 minutes, move him onto his other side to relieve pressure on his lower arm. Only do this if he has no injuries that prevent you moving him.
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 helps to prevent him from choking on his tongue or vomit.
A person who isn’t breathing needs 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.
- Move the person so he is lying on his back on a firm surface.
- Kneel beside the person's chest.
- Place the heel of your hand on the centre of his 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 his 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). With the heel of your hand, press down at least one-third of the depth of his chest. 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.
At the end of the 30 chest compressions, you should perform two rescue breaths to deliver oxygen into the person'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 his nose closed.
- Take a normal breath.
- Seal your mouth over the person'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 his mouth and nose. Blow gently into his lungs, watching for his chest to rise as you breathe into his mouth. See our frequently asked questions for more about carrying out CPR on children. Repeat the cycle in the ratio of 30 chest compressions to two rescue breaths until either:
- professional help arrives
- the person starts showing signs of regaining consciousness and breathing normally
- you become exhausted
- you have help from another person who can perform CPR and take over from you
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, but it’s important to minimise any delay each time you swap over.
If you’re not able or willing to breathe into the person'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 person if he begins to show signs of regaining consciousness, such as opening his eyes, speaking or coughing and starts to breathe normally. For more information about rescue breathing, see our frequently asked questions.
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 person'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 also learn how to use an AED at a local training centre.
Can I catch anything from doing mouth-to-mouth breathing (rescue breaths)?
The chance of you catching an infection from giving rescue breaths is very small. However, if you don't want to do mouth-to-mouth breathing, you can still just give chest compressions.
When you're in a situation where you need to give rescue breaths, you may feel 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 breathing. Some people don’t like the idea of doing rescue breaths and may 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. Nobody 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. It’s better to carry out chest compressions alone until help arrives than doing nothing.
How can I tell if a person's breathing is normal?
Normal breathing is consistent, regular and rhythmical. It's effortless and quiet. You should see the chest rise and if you place your cheek next to the person's mouth, you should feel their breath on your skin. If you're in any doubt whether a person's breathing is normal, act as if it isn't.
A person may gasp for air if they have had a cardiac arrest where the heart has stopped or is beating so slowly that it can't support life. When a person struggles to breath like this, it’s called agonal gasps. People performing emergency life support frequently misunderstand this and think that the person is breathing normally.
Up to four out of 10 people who have a cardiac arrest will make 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. It’s important to remember that if you're in any doubt whether the person is breathing normally. Assume he isn't and start CPR.
How long does first aid training take and do I need to be retrained once I've gone on a course?
There are a number of different first aid courses to choose from. 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. It’s recommended that you keep your skills up-to-date, so you may want to do a refresher course.
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.
If I can't remember the correct sequence and technique for child CPR, will I harm the child performing the adult technique?
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.
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.
What should I do if a baby is choking?
Many parents are anxious about the prospect of their baby choking. Babies may choke on liquids (usually milk curd or mucus) or other objects, such as buttons and small toy parts. Babies may not chew, swallow and breathe in the right order. This can lead to your baby choking. The two main ways to dislodge blockages are by giving back blows and chest thrusts.
If a baby is choking, they won’t be able to cry or make any noise to alert you that they are in distress. To dislodge the object you will need to carry out the following.
- Hold the baby face down along your forearm. Make sure their head is at a lower level than their bottom so that the blockage can drain out easily.
- Using the heel of your hand, give five firm blows in between the baby’s shoulder blades to dislodge the object from the airway
- Check quickly between each blow to see if the object has come out.
If this doesn’t work, you will need to carry out chest thrusts.
- Turn the baby on to its back and place two fingers in the middle of the baby’s chest.
- Push inwards and upwards up to five times. Chest thrusts squeeze the air out of the baby’s lungs to dislodge the blockage.
- Check quickly between each thrust to see if the object has come out.
If the object is still blocking the baby’s airway, repeat the back blows and chest thrusts. If the baby is still choking after three cycles, call the emergency services for help.
What should I do if a child or adult is choking?
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 (aged over one year) or adult can't breathe and the object is large, there are two main ways to get it out. They are by giving blows to their back or by using abdominal thrusts (which used to be called the Heimlich manoeuvre).
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, it can block their airways so much that 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 clutch at their neck. Choking can happen to anyone but for simplicity we have referred to the person choking as a man 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. You won’t need to carry out all five back blows if the object comes out after the first ones. Follow the steps below to carry out back blows effectively.
- 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.
To carry out abdominal thrusts, use the following process. As with back blows, aim to give up to five abdominal thrusts, but stop as soon as the object comes out.
- 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 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 one. It's important to be aware that the treatment for babies is different. See our FAQ for information about how to help a baby if they are choking.
- St John Ambulance
020 7324 4000
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- St John Ambulance
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