When to start
The person in front of you is not breathing. Or they are breathing in a way that sounds wrong. A single gasp every ten seconds. A long pause. A sound like a snore coming from somewhere deep. That is not breathing. That is the body's last attempt.
You have about ten seconds to decide, and three things to decide on.
- 1Are they unresponsive? Tap their shoulders firmly. Ask loud enough for a neighbour to hear. If they do not respond, move on.
- 2Are they not breathing normally? Look at the chest for no more than ten seconds. If it is not rising and falling in a clear rhythm, assume no.
- 3Do you have time to check a pulse? If you are not trained, the American Heart Association says skip it. If you are trained, spend no more than ten seconds.
If all three are true, start.
Before you begin, call 911 or tell someone else to. Put the phone on speaker. The dispatcher will coach you while you work.
Hands-only CPR
This is the method the American Heart Association recommends for untrained bystanders and for anyone who is not comfortable giving rescue breaths. No equipment. No memorization. Compressions only.
- 1Call 911. Or have someone else call. Put your phone on speaker so the dispatcher can talk you through it.
- 2Get them flat on their back, on a hard surface. Move them if you have to. A floor is fine. A mattress is not.
- 3Kneel beside their chest. Line your shoulders directly above their sternum.
- 4Put the heel of one hand on the center of the chest, between the nipples, on the lower half of the breastbone. Put your other hand on top. Interlace your fingers. Lift them off the ribs.
- 5Push straight down, hard. At least two inches deep for an adult. Use your body weight, not your arms.
- 6Push fast. 100 to 120 compressions per minute. The tempo of "Stayin' Alive" by the Bee Gees, or "Another One Bites the Dust" if you prefer a worse joke.
- 7Let the chest come all the way back up between compressions. Full recoil. If you lean on the chest, the heart cannot refill.
- 8Do not stop. Compressions end when paramedics take over, when an AED is attached and ready to deliver a shock, or when the person starts breathing on their own.
The ten seconds that matter
Most people check for a pulse. Most people waste the ten seconds that mattered.
Bystander CPR doubles or triples the chance of living through an out-of-hospital cardiac arrest [1]. Without it, under ten percent of people make it home [2]. Most cardiac arrests happen at home, which means the first person who could keep someone alive is usually standing three feet away, wondering if they remember enough.
Hands-only CPR is as effective as conventional CPR with rescue breaths for adults who collapse outside a hospital.
Test Your Decision-Making
Your coworker suddenly slumps forward at their desk during a meeting. You rush over and shake their shoulders, but they do not respond. You tilt their head back and see they are not breathing normally, just occasional gasps. What should you do first?
Be honest. No one's watching.
What most people get wrong
Three failures, in rough order of how often they cost lives.
They hesitate. They check for a pulse for thirty seconds when the guideline is ten. They try to remember the compression-to-breath ratio. They wait for someone more qualified. The person on the floor does not get those seconds back.
They push too soft. Real CPR is not gentle. The American Heart Association describes two inches of depth for a reason. If you are not pushing hard enough to worry about the ribs, you are not pushing hard enough.
They stop too often. Every pause costs a measurable amount of blood flow to the brain. The guideline is to keep compressions going until a paramedic, an AED, or the person's own breathing takes over. Not to check. Not to talk. Not to look up.
The question is not whether you remember CPR. The question is whether you do it. The people who save lives are not the ones with the best technique. They are the ones who started while everyone else was deciding.
The willingness test
CPR is not a memory test. It is a willingness test.