The phrase “Annie, Are You OK?” is a foundational prompt in basic life support (BLS) training, used as the universal first step in assessing a potentially unconscious person. This question serves as a verbal and physical stimulus to determine the individual’s level of responsiveness. The “Annie” reference is a nod to “Resusci-Anne,” the name of the original CPR training mannequin developed in the early 1960s, whose face was modeled after a death mask of an unknown woman found in the River Seine. This initial assessment establishes whether a medical emergency exists and dictates the sequence of subsequent life-saving actions. Without confirming unresponsiveness, a rescuer cannot proceed to call for emergency services or begin cardiopulmonary resuscitation.
The Critical First Step: Checking for Responsiveness
Before approaching any person who appears to be in distress, the rescuer must first ensure the scene is safe. This involves quickly scanning the environment for hazards like traffic, fire, or downed electrical wires. Prioritizing the rescuer’s safety is essential before moving closer to the individual.
The next action is to check for a response using both verbal and physical stimulation. The rescuer should loudly shout, “Are you OK?” or a similar direct question. Simultaneously, the rescuer should gently tap or shake the person’s shoulder. This dual-stimulus approach quickly determines if the person is conscious, alert, or completely unresponsive.
If the person responds by moving, speaking, or opening their eyes, they are considered responsive, and CPR is not necessary. If there is no reaction, the individual is treated as unresponsive, signifying a severe medical emergency. This rapid assessment prevents unnecessary physical intervention, such as chest compressions, on a person who may only be asleep or temporarily stunned.
Activating Emergency Services and Checking Breathing
Once unresponsiveness is confirmed, the rescuer must call for help and check for normal breathing. For an adult, the rescuer or a designated bystander must immediately activate the emergency response system, typically by calling 911 or the local emergency number. If a bystander is present, they should be instructed to make the call and, if possible, retrieve an automated external defibrillator (AED).
The rescuer must quickly assess the victim’s breathing by looking for the chest to rise and fall, which should take no more than 10 seconds. This visual check determines if the person is breathing normally or is experiencing only occasional, ineffective gasps, which are not considered normal breathing. Lay rescuers should focus on this visible sign rather than attempting to check for a pulse, which can be difficult and time-consuming.
If the person is unresponsive and not breathing normally within 10 seconds, cardiac arrest is presumed. The rescuer must then initiate physical intervention. This critical decision point bridges the gap between assessment and the start of life-sustaining chest compressions. The entire sequence must be executed rapidly to minimize the delay before starting CPR.
Initiating Physical Intervention (Compressions and Breaths)
Once unresponsiveness and abnormal breathing are confirmed, the rescuer must immediately begin the adult CPR protocol, focusing on chest compressions. The victim should be placed on a firm, flat surface to ensure compressions are effective. The rescuer places the heel of one hand on the center of the breastbone, placing the other hand on top and interlocking the fingers.
Compressions must be delivered hard and fast, aiming for a rate between 100 and 120 compressions per minute. The depth should be at least 2 inches, but not exceeding 2.4 inches, to effectively pump blood. It is important to allow the chest to fully recoil between each compression, ensuring the heart can refill with blood to maximize blood flow.
For trained rescuers, compressions are interrupted after every 30 compressions to provide two rescue breaths, establishing the standard 30:2 compression-to-ventilation ratio. Rescue breaths are delivered by tilting the head back, lifting the chin, pinching the nose, and breathing into the mouth for about one second until the chest visibly rises. Minimizing interruptions in chest compressions is a priority, as continuous blood flow to the brain and vital organs significantly improves the chance of survival.
Adapting the Protocol for Children and Infants
The core principles of CPR remain the same, but the protocol must be adapted for children and infants due to anatomical and physiological differences. The initial check for responsiveness is gentler: the rescuer taps a child’s shoulder or flicks an infant’s sole. Since cardiac arrest in pediatric victims often relates to breathing problems, rescue breaths are a more prominent component of their care.
If a lone rescuer finds an unresponsive child or infant and the collapse was unwitnessed, the protocol requires performing 2 minutes of CPR first before calling emergency services. This “care first” approach prioritizes immediate oxygen delivery, as oxygen deprivation is typically the primary issue. The compression depth is reduced for infants to about 1.5 inches, or approximately one-third the depth of the chest, using two fingers on the breastbone.
For a young child, the compression depth is about 2 inches, and the rescuer may use one or two hands depending on the child’s size. While the compression rate remains 100 to 120 per minute, the compression-to-ventilation ratio changes to 15 compressions followed by two breaths when two rescuers are present. These adjustments ensure the intervention is appropriately forceful for the smaller, more fragile body, maximizing effectiveness while minimizing injury risk.