When someone collapses and becomes unresponsive, the immediate seconds that follow are urgent. A person who is not breathing or is only gasping for air requires an immediate emergency protocol to sustain life until professional medical help arrives. Taking swift, informed action can significantly increase the chance of survival for victims experiencing sudden cardiac arrest. This guide is designed to empower any bystander to become a confident, life-saving first responder.
Securing the Scene and Assessing the Victim
The first action upon approaching a collapsed individual is to confirm the safety of the environment for yourself and the victim. Scan quickly for obvious hazards such as traffic, downed power lines, fire, or chemical spills that could endanger the rescuer. If the scene is not safe, you must either move the victim to a secure location or wait for trained professionals to manage the hazard.
Once safety is established, rapidly determine the person’s level of consciousness to confirm unresponsiveness. Use the “shout-tap-shout” technique: firmly tap the person’s shoulder and shout loudly, “Are you okay?” If they do not stir, speak, or react, they are considered unresponsive. This assessment should take no more than a few seconds, as time is vital in a cardiac emergency.
Immediately after confirming unresponsiveness, check for normal breathing by visually scanning the chest for rise and fall for a maximum of ten seconds. Differentiate between normal breathing and agonal gasps, which are noisy, irregular, or labored breaths that sound like snorting or struggling. Agonal gasps are a sign of cardiac arrest and must be treated identically to a complete absence of breathing.
Activating Emergency Medical Services (EMS)
Mobilizing emergency resources is the next step after confirming a lack of responsiveness and normal breathing. If you are alone, call the local emergency number (such as 911) right away before beginning any other interventions. If other people are present, point directly at one person and assign them the specific task of calling EMS to ensure the call is made without delay or confusion.
When speaking with the dispatcher, provide an exact location, including the street address, building name, and a specific description of where the victim is located. Clearly state that the person has collapsed, is unresponsive, and is not breathing normally. The dispatcher can provide life-saving instructions over the phone and should be kept informed of your actions.
Instruct the person who called to return with an Automated External Defibrillator (AED) if one is known to be nearby. Put the phone on speaker mode so you can communicate with the dispatcher while simultaneously moving on to the next phase of care. This delegation of tasks helps maximize the victim’s chance of survival by initiating interventions in parallel.
Good Samaritan Laws
Hesitation to act is a common concern among bystanders, often fueled by the fear of causing harm or facing legal repercussions. Good Samaritan laws are in place across most jurisdictions to provide civil legal protection to individuals who voluntarily provide reasonable assistance to a person they believe to be injured or in peril. These laws encourage bystanders to act in good faith without fear of liability, provided they act without gross negligence.
Providing Critical Life Support (CPR and AED)
The immediate delivery of high-quality chest compressions, known as Hands-Only CPR for untrained bystanders, is the most important life support intervention. The goal of compressions is to manually circulate oxygenated blood to the brain and heart until the heart’s rhythm can be restored. To begin, place the person on their back on a firm, flat surface and kneel beside their chest.
Position the heel of one hand on the center of the person’s chest, directly between the nipples, and place the heel of your other hand on top, interlacing your fingers. To ensure effective compressions, position your shoulders directly over your hands and keep your arms straight. Use your body weight rather than just your arm strength to apply the necessary force.
The correct rate for chest compressions is between 100 and 120 compressions per minute, which is approximately twice per second. For an adult, the depth of compression should be at least two inches, but not exceed 2.4 inches. Allow the chest to fully recoil to its normal position after each compression, as this permits the heart to refill with blood.
Minimize all interruptions to chest compressions, as stopping the flow of blood circulation even briefly reduces the intervention’s effectiveness. If there are multiple rescuers, switch the person performing compressions every two minutes to prevent fatigue and maintain quality. The dispatcher on the phone will guide you, but the rhythm of hard and fast compressions must be maintained.
Using the Automated External Defibrillator (AED)
If an AED arrives, turn it on immediately, as the device provides clear, step-by-step voice prompts. The AED delivers an electrical shock to reset a chaotic, non-pumping heart rhythm (ventricular fibrillation) to normal. The pads, found within the device’s case, must be applied to the person’s bare chest. Typically, one pad goes on the upper right side of the chest and the other on the lower left side below the armpit.
After the pads are connected, the AED will analyze the heart rhythm and instruct you to stand clear. If a shock is necessary, it will announce “Shock advised” and begin charging. Loudly announce “CLEAR!” and visually confirm that no one is touching the victim before pressing the shock button (if semi-automatic). Immediately after the shock is delivered, or if no shock is advised, promptly resume chest compressions.
Continue the cycle of CPR and following the AED’s prompts until one of three things occurs: the person begins to show obvious signs of life, such as moving or breathing normally; another trained person or EMS personnel takes over; or you become too exhausted to continue. The continuity of CPR and the rapid use of the AED offer the greatest chance of survival.