You may see someone collapse in the street, or a loved one or neighbour at home. Without knowing why they have collapsed, actions within the first few seconds and minutes may save their life, so it’s worth being prepared.
First things first, look after yourself, make sure the area around them is safe for you to walk into – live electric wires, noxious chemicals, fire. If it’s unsafe, you should avoid being another casualty, and instead dial 999 for an ambulance.
Second, check for signs of life. This can be done by calling their name to see if they respond and by gently shaking their shoulders. If there is still no response, you can check for signs of breathing by tilting their head back and look for their chest rising or by placing your cheek near their mouth and feeling for their breath. You can listen for a pulse if you feel confident doing this – it's most accurate to find one of the carotid arteries on the neck – but don’t waste time if you haven’t been trained.
If you do not think that they are breathing, you or someone nearby should call for an ambulance immediately.
The next thing you need to do is start chest compressions – this is CPR (cardiopulmonary resuscitation). These are given with hands interlocked and using the palm of the hand to push firmly down the middle of the chest and then release. This is done at a regular rate and fast rate, to encourage blood to pump around the body and keep the most vital organs alive. Don't over-think it, just get stuck in.
If you don't have anyone around to help, the best thing you can do for your casualty is to call 999 immediately. Without help on its way, your casualty will not survive.
If you don’t feel confident in CPR (cardio-pulmonary resuscitation), the ambulance call handler can talk you through things step-by-step.
It can also feel empowering to take a first aid course or basic life support training to practise these skills in case you ever need them. The British Red Cross and St John’s Ambulance are two providers for local courses.
People have seen this on TV shows and it’s such a worry to people, especially with strangers, as it feels too intimate or unhygienic, that it has put people off getting involved at all. This fear has only been compounded in the latest COVID-19 pandemic.
Therefore this requirement has been removed unless you feel confident or you have a medical kit nearby that include a special device that goes around their mouth and you breathe into.
So rescue breaths are not essential in adults, and individuals can continue with chest compressions instead.
In adults, chest compressions are essential as it’s likely their heart has stopped before their breathing stops. With children it’s the other way around: they are more likely to have a respiratory arrest before a cardiac arrest, so rescue breaths are more important to keep them alive.
It’s hard to know how fast to do chest compressions or how deep. You need to press at least a few centimetres down (or a third of the chest depth), quick and forceful, with the heel of your hand, and allow the chest to return to inflated level before repeating. Compressions are forceful, you are trying to do the job of the heart in pushing blood around the body, and hopefully kick-starting it into action again – it's nothing like we see on TV dramas where they barely work up a sweat. It’s possible you may even break a rib – a broken rib is a small price to pay for saving someone’s life.
In terms of how fast to go, in such a serious situation this may seem trite, but a good pace is at the rate of the Bee Gee’s Staying Alive song – this is actually taught on Life Support courses.
You should not stop chest compressions until professional help arrives. Again, contrary to the impression given in films and on TV, giving proper chest compressions is very physically draining, you will quickly work up a sweat and feel out of breath. Most people find it hard to keep going for longer than 1 to 2-minute cycles.
Therefore, again, you need to look after your own health first. If someone else is there, take it in turns, but try to make the change-overs as smooth as possible so as not to interrupt the flow of compressions - every second counts.
If you start suffering any ill health, you need to call the ambulance crew back and wait for health. If your casualty starts breathing or shows signs of life, stop the compressions, talk to them calmly to reassure them and call the ambulance crew back.
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