CPR – what to do when someone collapses

When someone's heart stops outside hospital, survival depends more on what happens in the first few minutes than on anything done later. Brain damage begins within minutes. An ambulance cannot get there that fast, anywhere.

CPR keeps blood moving to the brain until a defibrillator or paramedics arrive. It roughly doubles or triples the chance of survival — and the most common reason it is not started is that bystanders are afraid of doing it wrong. Doing it imperfectly is enormously better than not doing it.

1. 1Check for danger — traffic, electricity, water, an unsafe scene. You are no use as a second casualty.
2. 2Check response: shout and shake the shoulders. No response, and not breathing normally? Act now.
3. 3Get help. Shout for someone specific, and get an ambulance called. Ask for a defibrillator if you are somewhere that might have one.
4. 4Put the person flat on their back on a firm surface.
5. 5Heel of one hand in the centre of the chest, other hand on top, fingers interlocked, arms straight, shoulders above your hands.
6. 6Push hard and fast — about 5 to 6 cm deep, around 100 to 120 compressions a minute. Let the chest come all the way back up between each one.
7. 7Do not stop. Keep going until paramedics take over, a defibrillator is ready, or the person clearly wakes up.

Occasional gasping is not normal breathing. It is common in the first minutes of cardiac arrest and is frequently mistaken for a sign of life — it is not, and CPR should be started.

In children and in drowning, the cause is usually lack of oxygen rather than a primary heart problem, so breaths matter more. If you are trained and willing, give five initial rescue breaths, then thirty compressions to two breaths.

• Child: one or two hands, compress about a third of the chest depth.
• Infant: two fingers in the centre of the chest, about a third of the depth.
• If you are unwilling or unable to give breaths, do compressions only. That remains far better than nothing.

An automated external defibrillator talks you through it and will not deliver a shock unless one is needed. You do not need training to use one, and using it early is the single biggest determinant of survival.

1. 1Turn it on and follow the spoken instructions.
2. 2Stick the pads on bare skin as shown on the diagrams.
3. 3Stand clear while it analyses, and while it shocks.
4. 4Resume compressions immediately after the shock without waiting to check.

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