When a person suddenly collapses, swift, clear action can significantly influence the outcome. Brain damage can begin minutes after a person stops breathing or their heart stops beating, making immediate intervention necessary. Understanding the sequence of steps empowers any bystander to become the first link in the chain of survival. This action begins with assessing the environment.
Securing the Scene and Checking for Consciousness
The first priority is ensuring the rescuer’s personal safety before approaching the victim. A quick scan of the environment is necessary to check for hazards like traffic, downed electrical wires, fire, or chemical spills. If the scene is unsafe and the danger cannot be easily removed, the victim must be moved to a safer location before assessment begins.
Once the scene is safe, determine the victim’s level of consciousness using the “tap and shout” method. The rescuer firmly taps the person’s shoulder while shouting, “Are you okay?”. If the person responds, they are conscious and should be monitored while awaiting professional help. If there is no response, the person is unresponsive, requiring immediate action.
Activating Emergency Medical Services
Immediately after determining the person is unresponsive, activate the emergency medical system by calling 911 or the local emergency number. If others are present, delegate this task by pointing to a specific individual and instructing them to call for help and retrieve an Automated External Defibrillator (AED). This direct approach prevents the bystander effect.
If the rescuer is alone, they must call themselves, ideally using a speakerphone to keep their hands free for intervention. The dispatcher requires clear information, including the exact location and the nature of the problem. Staying on the line is helpful, as the dispatcher can provide instructions for CPR until professional help arrives.
Evaluating Breathing and Circulation
After the emergency call is placed, the rescuer must quickly assess the person’s breathing to determine the need for Cardiopulmonary Resuscitation (CPR). The rescuer should open the airway using the head-tilt/chin-lift maneuver, which moves the tongue away from the back of the throat. The rescuer then looks for chest rise, listens for breath sounds, and feels for air movement for no more than ten seconds.
A person who is not breathing or is only exhibiting abnormal breathing patterns should be treated as though they are not breathing at all. This abnormal pattern is known as “agonal breathing,” presenting as gasping, snorting, or shallow breaths. Agonal breathing is a reflex triggered by a lack of oxygen and is a sign of sudden cardiac arrest. Lay rescuers should focus only on normal breathing, as checking for a pulse is often inaccurate and causes delays.
Initiating Rescue Measures
If the person is unresponsive and not breathing normally, immediate rescue measures must be initiated, starting with chest compressions, to circulate oxygenated blood to the brain and vital organs. High-quality CPR involves pushing hard and fast in the center of the chest at a rate between 100 and 120 compressions per minute. Compressions should be at least two inches deep for an adult, ensuring the chest fully recoils after each push.
If the rescuer is trained in CPR, they should follow the sequence of 30 compressions followed by two rescue breaths, minimizing interruptions. For those untrained, hands-only CPR (continuous chest compressions) is recommended and effective. Using an AED as soon as one becomes available is important, as the device provides voice prompts and delivers an electrical shock to restart the heart. These measures must continue without interruption until emergency medical personnel take over or the person shows signs of life.