The sudden collapse of a child is a deeply unsettling and high-stress event that demands immediate and effective action. In these moments of crisis, the ability to remain calm and follow a clear, sequential plan can significantly impact the outcome. This article provides a structured guide, outlining the necessary steps for a witness to transition from initial shock to providing immediate, life-sustaining care.
Securing the Scene and Checking for Responsiveness
The initial step is to ensure the safety of the environment for both the collapsed child and the rescuer. Before approaching, rapidly assess the scene for hazards like traffic, live electrical wires, or unstable structures. If the area presents an immediate danger, the child should be moved only if necessary and safe, prioritizing their safety from the external threat.
Once the scene is secure, determine the child’s level of consciousness using the “tap and shout” method. For a child, gently tap the shoulder while speaking loudly, asking if they are okay. For an infant, check responsiveness by gently tapping the soles of the feet.
If the child does not respond, they are unresponsive. The rescuer must immediately check for breathing and a pulse simultaneously. Look for the rise and fall of the chest or any abnormal breathing, such as gasping, for no more than ten seconds. If the child is unresponsive and not breathing normally, or if there is no visible pulse, immediate emergency intervention is required.
Activating Emergency Services and Seeking Assistance
The timing of calling for professional help differs between adult and pediatric emergencies, especially for a single rescuer. If the child’s collapse was sudden and witnessed, it is likely a primary cardiac event. The rescuer should immediately call the emergency number and retrieve an Automated External Defibrillator (AED) if one is nearby.
If the collapse was unwitnessed, or if the child is an infant or young child, the cause is often a respiratory issue leading to cardiac arrest. In this scenario, the single rescuer should provide two minutes of immediate care, including five cycles of cardiopulmonary resuscitation (CPR), before pausing to call for help. This “care first” approach prioritizes oxygen delivery, as the underlying problem is typically a lack of oxygen.
If another person is present, delegate one rescuer to call emergency services and locate an AED, while the other immediately begins intervention. When speaking to the dispatcher, relay the exact location, the child’s approximate age, a brief description of what happened, and the child’s current condition. This clear communication ensures appropriate emergency resources are dispatched quickly.
Administering Life Support Interventions
If the child is unresponsive and not breathing, life support must begin immediately, ideally under the guidance of the emergency dispatcher. Position the child flat on their back on a firm surface to ensure effective chest compressions. Cardiopulmonary resuscitation (CPR) involves repeating cycles of chest compressions and rescue breaths.
Compressions must be performed at a rate of 100 to 120 per minute, which is the standard rate for all ages.
Compression Depth and Technique
The required compression depth varies by age:
- For a child (one year to puberty), the depth should be about two inches, or approximately one-third the depth of the chest, using the heel of one or two hands.
- Infant compressions (under one year) require a depth of about one and a half inches, often accomplished using two fingers.
For a single rescuer, the ratio is 30 compressions followed by two rescue breaths, regardless of the child’s age. Rescue breaths are necessary for children and infants because pediatric cardiac arrest is often caused by a lack of oxygen.
Choking and Bleeding
If the child’s airway is obstructed by a foreign body, and they are conscious but unable to cough effectively, the intervention changes to the choking protocol. For children over one year, this involves cycles of five back blows followed by five abdominal thrusts. Infants under one year require five back blows alternating with five chest thrusts. If severe bleeding is present, apply direct pressure to the wound using a clean cloth or hand to minimize blood loss while continuing life support interventions.
Monitoring and Transitioning Care
The rescuer must continue the cycle of compressions and breaths without interruption until the child shows obvious signs of life, an AED becomes available, or professional help arrives to take over. If an AED is brought to the scene, apply it immediately, following the device’s audible instructions. Pediatric pads, which deliver an attenuated shock, should be used for children up to eight years old, but adult pads can be used if pediatric ones are unavailable.
Once emergency medical services (EMS) arrive, the rescuer’s role transitions to information provider. Provide a concise summary of the event, including when the collapse occurred, the child’s condition upon arrival, and what interventions were performed and for how long. The rescuer should remain available to EMS for follow-up questions.