Cardiopulmonary Resuscitation (CPR) is a life-saving technique designed to manually circulate blood and oxygen when a person’s heart or breathing has stopped. While prompt intervention can double or triple a victim’s chance of survival, many bystanders hesitate due to a fear of causing harm if the person does not need it. This concern is valid, as performing chest compressions on a person whose heart is still beating can lead to serious complications. However, the risk of withholding CPR from someone in cardiac arrest is far greater. Understanding the potential physical consequences, legal protections, and proper assessment steps can empower rescuers to act with confidence.
Potential Physical Injuries Caused by Unnecessary CPR
The forceful, rhythmic pressure required for effective chest compressions can cause immediate injury, especially when applied to a person who is not in cardiac arrest. The most common physical consequence involves the skeletal structure of the chest, resulting in rib fractures and sternal injuries. Fractures occur in a high percentage of patients receiving CPR, whether necessary or not.
The sternum (breastbone) is frequently fractured, and sternocostal separation—the separation of the ribs from the cartilage—is also common. In older adults or those with conditions like osteoporosis, bones are more fragile, making fractures more likely even with proper technique. Applying this significant force to a person whose circulatory system is functioning can also disrupt the heart’s natural rhythm, which is a serious complication.
Beyond skeletal damage, deep compressions can cause bruising and lacerations to internal organs beneath the chest cavity. The liver and spleen are particularly vulnerable to injury, and in rare cases, this can lead to internal bleeding. Another risk of performing compressions on a conscious individual is inducing vomiting. If the person inhales the stomach contents, aspiration pneumonia can result, introducing fluid and bacteria into the lungs.
Legal Protections Under Good Samaritan Laws
A primary fear for many bystanders is the potential legal liability resulting from injuries caused while attempting to help, particularly if the aid was later deemed unnecessary. Good Samaritan laws provide a legal shield for individuals who voluntarily provide reasonable assistance during an emergency. These laws exist in most jurisdictions to encourage bystanders to intervene without the fear of being sued for unintended injury.
The protection generally covers rescuers who act in good faith and without the expectation of financial reward. This means that if a person fractures a victim’s rib while attempting to save their life, the rescuer is legally protected from liability. However, this protection is not absolute and is withdrawn if the rescuer is found to have acted with gross negligence or willful misconduct.
Gross negligence involves an extreme departure from what a reasonably prudent person would do. For example, performing CPR while intoxicated or using equipment far outside one’s training may constitute gross negligence and remove the legal protection.
Recognizing When CPR is Truly Necessary
The best way to avoid performing unnecessary CPR is by conducting a swift and accurate assessment of the person’s condition. CPR is indicated only when an individual is unresponsive and not breathing normally. The initial step is to check for responsiveness by gently tapping the person and shouting, “Are you okay?”
If there is no response, the next step is to observe for normal breathing for no more than 10 seconds. It is essential to distinguish between normal breathing and agonal breaths, which are gasping or labored breaths that can occur immediately after the heart stops. Agonal breaths are not considered effective breathing and are actually a sign that cardiac arrest has occurred.
If the person is unresponsive and not breathing normally, or is only taking agonal breaths, CPR should be initiated immediately after calling for emergency services. Conversely, if the person is unresponsive but breathing normally, they should be placed in the recovery position, and CPR should be withheld. The proper assessment ensures that compressions are applied only when necessary.