Emergency life support

Published by Bupa's Health Information Team, March 2011.

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

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.

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

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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 actions shown in the illustration below.

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 (CPR)

A casualty who isn’t breathing needs CPR. CPR 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 either:

• 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.

Animation - How cardiopulmonary resuscitation is carried out

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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.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.