When a person suddenly collapses, it is a profoundly unsettling event, but a quick and confident response can significantly increase their chances of survival. A sudden, unexpected collapse often indicates a medical emergency, such as sudden cardiac arrest, where the heart abruptly stops beating effectively. Your immediate, decisive actions are the most important factor in the chain of survival. This guide outlines the necessary steps to provide life-saving assistance until professional medical help arrives.
Scene Safety and Initial Assessment
Your first priority must be to ensure the environment is safe before you approach the person who has collapsed. Quickly scan the area for any hazards, such as moving traffic, downed power lines, fire, or unstable objects that could put you or the victim in danger. If the scene is unsafe, do not approach; instead, call emergency services immediately and inform them of the hazards present.
Once the scene is safe, approach the person and check for responsiveness by gently tapping their shoulders and shouting, “Are you okay?” If the person does not respond, they are unresponsive and require urgent intervention.
Next, determine if the person is breathing normally by looking for the rise and fall of the chest, listening for breath sounds, and feeling for air movement for no more than 10 seconds. Agonal gasps—noisy, irregular, or labored breaths—are not considered normal breathing and indicate a life-threatening emergency. If the person is unresponsive and not breathing normally, assume sudden cardiac arrest and prepare to initiate life support.
Activating Emergency Services and Securing Assistance
After determining the person is unresponsive and not breathing normally, the most time-sensitive action is to call for emergency medical services (EMS). If you are alone, call your local emergency number immediately and put the call on speakerphone so you can begin the next steps while talking to the dispatcher. If other people are present, clearly designate one person to make the call to the emergency dispatcher.
The designated caller must provide the exact location of the emergency, including the street address, cross streets, or any distinguishing landmarks. They must clearly state the nature of the emergency: an adult has collapsed, is unresponsive, and is not breathing normally. The dispatcher will provide instructions and guidance, including directions for performing cardiopulmonary resuscitation (CPR).
Simultaneously, ask a second bystander to locate an Automated External Defibrillator (AED) and bring it back quickly. These devices are often found in public places like airports, shopping centers, gyms, and large office buildings. Mobilizing both emergency services and an AED ensures that the two most effective interventions are en route while you begin hands-on care.
Immediate Life Support: CPR and AED Use
If the person is unresponsive and not breathing normally, you must begin chest compressions immediately to circulate oxygenated blood to the brain and other vital organs. For an adult who has collapsed suddenly, the standard recommendation for lay rescuers is “Hands-Only CPR,” which involves continuous, rapid chest compressions without rescue breaths. This method minimizes hesitation and interruption, prioritizing blood flow.
Performing Chest Compressions
To perform compressions, place the heel of one hand in the center of the person’s chest, directly on the breastbone, and place your other hand on top, interlocking your fingers. Position your shoulders directly over your hands and keep your arms straight to use your body weight. You must push hard and fast, compressing the chest at least 2 inches, but no more than 2.4 inches.
The recommended rate for chest compressions is between 100 and 120 compressions per minute. Allow the chest to fully recoil to its normal position after each compression before pushing down again. This recoil allows the heart to refill with blood, ensuring effective circulation.
Using the AED
As soon as an AED arrives, turn it on and listen carefully to the device’s clear voice prompts, which will guide you through the entire process. Quickly expose the person’s bare chest, wiping away any excessive moisture, and attach the electrode pads as shown in the diagrams on the pads themselves. Typically, one pad is placed on the upper right chest, and the other is placed on the lower left side below the armpit.
Plug the pad connector cable into the AED unit, and the device will automatically begin to analyze the person’s heart rhythm. During this analysis, it is essential that no one touches the person, as movement can interfere with the reading. The AED will then either advise a shock or instruct you to continue CPR.
If the AED advises a shock, loudly announce “Clear!” to ensure no one is touching the person, and then press the flashing shock button. The electrical shock is intended to reset a chaotic heart rhythm, such as ventricular fibrillation. Immediately after the shock is delivered, or if no shock is advised, promptly resume chest compressions for two minutes until the AED prompts you again to re-analyze the rhythm.
Transitioning Care and Providing Critical Information
You must continue performing high-quality chest compressions and following the AED’s prompts without interruption until one of three things occurs. First, the person shows an obvious sign of life, such as starting to breathe normally or moving purposefully. Second, another trained professional arrives and takes over the resuscitation effort. Third, you become too exhausted to continue maintaining the proper compression depth and rate, requiring a new rescuer to take over immediately.
If there are multiple bystanders, rescuers should switch every two minutes to prevent fatigue and maintain the effectiveness of compressions. The goal is to sustain the person until the highest level of care arrives.
When the emergency medical technicians (EMTs) arrive, transition care by stepping back and allowing them to take control of the scene. Provide them with a concise summary of the event, including the approximate time the person collapsed and the interventions you performed. Specifically mention when CPR was started, if an AED was used, and if any shocks were delivered, as this timeline is important for their subsequent medical treatment.