Basic Life Support and CPR

This video-enriched guide will teach you how to support an unconscious patient, including giving life-saving CPR and operating an automatic electronic defibrillator.

Basic Life Support and CPR

Basic life support means taking some basic steps to attempt to keep an unconscious patient alive until advanced medical care can be provided. If you encounter a person who appears to be unconscious, follow the steps known as DRS-ABCD:

D

Danger
Before approaching the patient, check that it is safe to do so. Examples of potential hazards include traffic and live electrical wires.

R

Response
Is the patient responsive? Shake the patient’s shoulders and exclaim loudly:

  • Can you hear me?
  • Open your eyes!
  • What’s your name?
  • Squeeze my hands!
You may find it useful to remember that the four questions above start with the letters: COWS.

S

Send for help
If the patient does not respond, call 000 if a phone is available. If no phone is present, ask a bystander to get to a phone to call an ambulance.

A

Airway
An unconscious patient may not be able to breath due to their tongue falling back in their throat or due to debris in their mouth. See the How to open the airway section below for further information.

B

Breathing
Check for breathing. More information on how to assess this is below. If the patient is not breathing regularly, commence CPR.

C

CPR
Cardiopulmonary resuscitation (CPR) pumps blood around the patient’s body, delivering vital nutrients to the brain and other organs. Learn more about CPR below.

D

Defibrillation
An automatic external defibrillator (AED) is a device that can deliver an electrical shock to effectively reboot the heart in some situations. Learn more about defibrillation below.

Open the airway

Gently open the patient’s mouth to see if there is any sign of debris. Remove any foreign body with your fingers. Loose dentures should be removed but dentures that are properly in place should be left in.

In most cases you should not roll the unconscious patient to the side because any movement could cause spinal damage. However, if the patient has been drowning or if there is vomit or other liquid in their mouth, then roll the patient onto the side and open the mouth slightly to allow gravity to drain the liquid, then carefully roll the patient back onto their back. When moving the patient, try to minimise movement of the neck. If possible, while moving the patient, get one person to hold the patient’s head to keep the neck aligned and immobile to the extent possible.

For children and adults (but not babies): Once you have cleared the mouth as outlined above, perform the head tilt/chin lift. To do this, place one hand on the forehead and use the other hand to lift the chin. Then tilt the head (not the neck) backwards. Avoid excessive force. This video shows how to do this:

For babies: Do not lift the chin or tilt the head as this can damage the baby’s windpipes. Instead, hold the baby’s head in a neutral position with the mouth slightly open. If this does not clear the airway, then tilt the head backwards very slightly to open the airway.

The video below shows the head tilt and chin lift technique as well as a technique called the jaw thrust which is a better option if the victim may possibly have a spinal or neck injury.

Breathing

Check whether the patient is breathing normally. Put your ear over the patient’s mouth to listen for regular breaths for 10 seconds. At the same time, check whether the patient’s chest is rising and falling regularly (indicating breathing). An agonal gasp does not count as breathing. Watch the video below to see what an agonal gasp looks like:

If the patient is not breathing regularly, commence CPR immediately.

If the patient is breathing, then place them into the recovery position. This video from St John’s Ambulance explains how:

Cardiopulmonary resuscitation (CPR)

First let’s learn the basics from Vinnie Jones:

You may have noticed that Vinnie did chest compressions but did not do any mouth-to-mouth breaths. This is an acceptable option if you are unwilling or unable to provide mouth-to-mouth breaths, or if you are concerned that the patient may be infectious. However, using both chest compressions and mouth-to-mouth breaths is preferable if possible.

CPR steps for adults and children

  • Lie the victim on their back on a flat, solid surface.
  • Place the heel of one hand in the centre of the patient’s chest (the lower half of the sternum is a good choice).
  • For adults and older children, place your other hand on top of the first to provide extra strength. For younger children, a single hand should provide sufficient strength.
  • Keeping your hand(s) in contact with the chest, compress the chest by about one third. This is quite a signifcant depth and you may break the patient’s ribs, but broken ribs are better than the alternative (death).
  • Compress the chest 30 times at a rate of 100 compressions per minute. In practical terms, this means you should compress 30 times to the beat of the Bee Gee’s Staying Alive. There are 30 beats in this part of the song:

    Ah, ah, ah, ah, staying alive, staying alive
    Ah, ah, ah, ah, staying alive, staying alive
    Ah, ah, ah, ah, staying alive, staying alive
    Ah, ah, ah, ah, staying alive

  • Once you have completed 30 compressions then stop the compressions, pinch the victim’s nose and breathe twice into the victim’s mouth. Don’t breathe too hard – just give two normal breaths at a normal rate. As soon as the breaths have been issued, do another 30 chest compressions.
  • Continue this 30:2 cycle – 30 compressions then 2 breaths. If there are other people around who also know CPR, then every 2 minutes swap the person doing the compressions. By swapping rescuers in this way, the quality of compressions is maintained.

Do not stop CPR until:

  • The victim responds or starts breathing normally;
  • You are too exhausted to continue;
  • A health care professional arrives and takes over CPR; or
  • A health care professional arrives and instructs you to stop CPR.

CPR steps for babies

The CPR procedure for babies is the same as for adults and children except for the following:

  • Instead of using a full hand (or hands) to perform chest compressions, place two fingers in the centre of the baby’s chest in line with both nipples.
  • When giving the baby mouth-to-mouth breaths, place your mouth over the baby’s nose and mouth. Give only a small breath or you may damage the baby’s lungs.

Defibrillation

An automatic external defibrillator (AED) is a device that can deliver an electrical shock to effectively reboot the heart in some situations. Early defibrillation is critical if the patient is unresponsive and not breathing. For some patients, their chance of survival drops by 10% for each minute that defibrillation is delayed.

This video from St John’s Ambulance shows how to use a defibrillator:

When using a defibrillator:

  • If possible, have one person fit the defibrillator pads while another continues CPR compressions.
  • Do not place the defibrillator pads over any implanted medical devices such as a pacemaker. Stay at least 8cm clear of such devices.
  • Stop compressions when the defibrillator says it is analysing (that is, analysing the heart rhythm).
  • For children under 8, use an AED with paediatric mode and paediatric pads if available. Otherwise use a standard adult AED.
  • Be certain that everyone is standing clear when you press the button to shock the patient. Nobody should be touching the patient at this time. Place your finger on the button then look at the patient and only press the button once you are sure nobody else is touching the patient.
  • If the patient remains unresponsive, resume CPR and repeat the defibrillation after 2 minutes. Continue this cycle until the patient becomes responsive or until emergency services arrive and take over.

Putting It All Together

This video shows the entire process. There is a minor difference in the approach used in this video, namely that the trainer uses a DR-ABCD approach rather than a DRS-ABCD approach. Both approaches are highly similar but the DRS-ABCD approach is recommended by the Australian Resuscitation Council so is generally preferred.

Disclaimer

The above information is provided in good faith for information purposes only. It does not constitute medical advice. For more definitive training in basic life support please attend a course from a certified provider.

References