First Aid and Emergencies

For basic life support, think ABC: A irway, B reathing, and C irculation, in that order. You must establish an open airway to help the victim breathe. Then you must give rescue breaths before you can begin the chest compressions, which will help circulate blood for a victim whose heart has stopped beating.

Step 1: Check for consciousness. Tap the victim on the shoulder and shout, "Are you okay?"

If the victim does not respond:

• Adult (age 9 and older): Call 911 or emergency services immediately (have someone else make the call if possible). Then proceed to Step 2.

• Infant or child through 8 years: Check to see if the infant or child is breathing (Step 2). If the infant or child is not breathing, open the infant or child's airway (Step 3) and give rescue breaths for 1 full minute (Step 4). Then call 911 or emergency services. If the child is small enough, carry him or her to the telephone with you so you can continue to give rescue breaths.

Step 2: Check for breathing. Look, listen, and feel for breathing for 5 seconds. Kneel next to the victim with your head close to his or her head.

• Look to see if the victim's chest rises and falls.

• Listen for breathing sounds, wheezing, gurgling, or snoring.

• Put your cheek near the victim's mouth and nose to feel whether air is moving out.

If the victim is not breathing (or if you can't tell), roll the victim onto his or her back. If the victim may have a

spinal injury, gently roll the victim's head, neck, and shoulders together as a unit until the victim is on his or her back.

Step 3: Open the airway.

• Kneel next to the victim. Clear any foreign material from his or her mouth with your fingers.

• Place one hand on the victim's forehead and tilt his or her head back gently. If the victim is an infant, take care not to tilt its head back too far.

• Place the fingers of your other hand under the victim's chin, and lift it.

• Look, listen, and feel for breathing for 5 seconds .

Sometimes, just opening the airway will allow the victim to breathe. If the victim does not start breathing, begin rescue breathing immediately.

Airway: Position the victim's head to open the airway.

Step 4: Begin rescue breathing.

• Pinch the victim's nostrils shut using the thumb and forefinger of the hand you have on the victim's

  forehead. With your other hand, continue lifting the victim's chin to keep the airway open.

• Take a deep breath and place your mouth over the victim's mouth, making a tight seal. For an infant, place your mouth over the baby's mouth and nose. As you blow air into the victim, watch to see if his or her chest rises.

  Breathing: Blow air in slowly; look to see if chest rises.

• If the first breath does not go in, try tilting the victim's head again and give another breath. If the second breath does not go in, suspect choking. Begin the choking rescue procedure (Heimlich maneuver) . See Choking Rescue Procedure (Heimlich Maneuver).

• Take 1.5 to 2 seconds to give each breath. Between rescue breaths, remove your mouth from the victim's mouth and take a deep breath. Wait for the victim's chest to fall as the air goes out of his or her mouth.

• Give the victim 2 full breaths. Then check for circulation.

Step 5: Check for circulation. Locate the carotid artery in the victim's neck:

• Keep the victim's head tilted. Find his or her voice box or Adam's apple. Slide the tips of your index and middle fingers into the groove beside it.

• Feel for a pulse for 5 to 10 seconds.

If there is no pulse , begin chest compressions. See Step 6.

If there is a pulse, continue to give rescue breaths until help arrives or until the victim starts to breathe on his or her own. If the victim starts breathing again, he or she still needs to be seen by a health professional.

Give rescue breaths:

• Adult (age 9 and older): 1 breath every 5 seconds

• Infant or child through 8 years: 1 breath every 3 seconds

Step 6: Begin chest compressions. Adult (age 9 and older):

• Kneel next to the victim. Use your fingers to locate the end of the victim's breastbone (sternum), where the ribs come together. Place 2 fingers at the tip of the victim's sternum. Place the heel of the other hand next to your fingers (on the side closest to the victim's face).

  Put your hand 2 fingers'-width above the bottom of the victim's breastbone.

• Place your other hand on top of the one that you just put in position. Lock the fingers of both hands together, and raise the fingers so they don't touch the victim's chest.

• Straighten your arms, lock your elbows, and centre your shoulders directly over your hands.

• Press down in a steady rhythm, using your body weight and keeping your elbows locked. The force from each thrust should go straight down onto the sternum, compressing it 3.75 to 5 cm (1.5 to 2 inches). It may help to count "one and two and three and four...," giving 1 downward thrust each time you say a number. Lift your weight, but not your hands, from the victim's chest each time you say "and." Give 15 compressions.

• After 15 compressions, open the victim's airway as in Step 3, and give 2 full, slow breaths.

• Repeat the 15 compressions-2 breaths cycle 4 times (1 minute); then check the victim's pulse again. If there is still no pulse, continue to give chest compressions and rescue breaths until help arrives or until the victim's pulse and breathing are restored.

  Chest Compressions: Keep your shoulders directly over your hands with your elbows straight as you give chest compressions.

Child (age 1 through 8 years) :

• Position the heel of one hand 2 fingers'-width above the tip of the sternum. Press with less force than you would for an adult, compressing the sternum 2.5 to 3.75 cm (1 to 1.5 inches).

• Give 5 chest compressions. Then open the airway as in Step 3 and give 1 rescue breath. Repeat the 5 compressions-1 breath cycle 12 times (1 minute); then check the victim's pulse again. If there is still no pulse, continue to give chest compressions and rescue breaths until help arrives or until the victim's pulse and breathing are restored.

Infant (younger than 1 year):

• Place 2 fingers on the baby's sternum, about 1 finger-width below an imaginary line connecting the nipples. Press with gentle force, compressing the sternum about 1.25 to 2.5 cm (0.5 to 1 inch).

• Give 5 chest compressions. Then open the airway as in Step 3 and give 1 rescue breath. Repeat the cycle of 5 compressions and 1 breath 12 times (1 minute); then check the victim's pulse again. If there is still no pulse, continue to give chest compressions and rescue breaths until help arrives or until the victim's pulse and breathing are restored.

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