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Emergency life support for adults

Published by Bupa's health information team, September 2009.

This factsheet is for people who would like to learn how to carry out emergency life support, or who would like information about it. For simplicity the injured person (casualty) is referred to in the male gender throughout.

Emergency life support is a set of actions that can keep a casualty alive until professional help arrives. Actions include performing cardiopulmonary resuscitation (CPR) on people who may have stopped breathing or whose heart has stopped.

About emergency life support

A person's heart or breathing can stop as a result of a heart attack, drowning, an electric shock or other injuries. If this happens, their organs don't receive a supply of oxygen-rich blood and this will soon lead to irreversible damage.

CPR involves giving chest compressions and rescue breaths (mouth-to-mouth breathing). Sometimes this can restart the heart and breathing. More commonly, for example after a heart attack, CPR circulates enough blood around the body to slow down organ damage.

Emergency life support can make the difference between life and death. Giving CPR to someone who has just had a cardiac arrest can double or even triple their chance of survival. A cardiac arrest is when a sudden disturbance in the heart's rhythm causes the heart to stop beating or to beat so slowly that it can't support life.

You can learn basic life-saving skills, including CPR, at a local training centre.

Chain of survival

A rapid response is a crucial part of emergency life support. This is called the 'chain of survival' and involves:

  • recognising an emergency situation and calling for an ambulance
  • immediately performing CPR if the casualty isn't breathing - to buy time before paramedics arrive
  • defibrillation to restart the heart
  • early post-resuscitation care - prompt hospital treatment will increase the casualty's chance of recovery

What to do in an emergency

Stay calm and remember you can only do your best. First, assess the situation and make sure the area is free of hazards, particularly anything that may have caused the injury to the casualty - it's very important not to become a casualty yourself.

If you have had first aid training, let others know and ask if anyone else has had training too - working together, you have a better chance of offering the best help. Also nominate someone to stand by in case you need to ask them to call for emergency help.

Once you have assessed the situation, it's important to quickly check the casualty's responses by talking to him. Ask him to perform an action - such as opening his eyes - as he may not be able to talk to you, for example if he has had a stroke.

If you don't get a response, gently shake his shoulders and continue to speak to the casualty. Make sure that you direct your voice to both ears in case he is deaf in one.

If the casualty is conscious, put him in the recovery position. However, use your judgement - if the casualty has been in an incident, such as a road accident, it may be best not to move him in case he has broken bones or a back or neck injury.

If necessary, ask your nominated bystander to call the emergency services and inform them that you have a conscious adult male who is breathing. It's important to ask your bystander to come back to confirm help is on the way.

You may need to perform CPR if the casualty is unconscious.

Recovery position

The recovery position helps to keep the airway clear and allows fluid to drain from the mouth. To put a casualty lying on his back in the recovery position:

  • place the arm closest to you at right angles to his body, with elbow bent and palm facing up
  • cross the other arm over his body and hold the back of his hand against his cheek nearest to you
  • grasp the far leg above the knee and pull it up so the knee is bent
  • pull the leg towards you so the casualty is now lying on his side facing you
  • check his airway and that he is breathing regularly

Cardiopulmonary resuscitation (CPR)

There are three parts to CPR.

  • Open the airway.
  • Check whether the casualty is breathing normally - if not, send for an ambulance.
  • Start chest compressions - do a sequence of 30 chest compressions and two rescue breaths.

Airway

A casualty can only breathe if his airway is clear. An airway can be blocked when a person is unconscious and, for instance, their tongue falls to the back of their throat. To open a casualty's airway:

  • place two fingers under the point of his chin
  • put your other hand on his forehead
  • lift his jaw and tilt his head back slightly

How cardiopulmonary resuscitation is carried out

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Breathing

Next, check if the casualty is breathing normally in a continuous rhythmical way.

  • Listen for his breathing by placing your ear next to his mouth.
  • Look to see if his chest is moving up and down.
  • Feel for the casualty's breath against your cheek.

You need to listen, look and feel for up to 10 seconds before deciding if the casualty is breathing normally.

If the casualty isn't breathing or isn't breathing normally (for example if he takes infrequent gasps), it's important to get help. If you're in any doubt whether the casualty's breathing is normal, take the same action as if he isn't breathing.

Tell your nominated bystander to call for emergency help. Ask him or her to inform the emergency services that you have an unconscious adult male who isn't breathing. Again, make sure that you ask your nominated bystander to come back and confirm help is on the way.

If you're alone, go yourself to call an ambulance before you continue.

Compressions

A casualty who isn't breathing needs CPR and you will need to give chest compressions. The steps are as follows.

  • Move the casualty so he is lying on his back on a firm surface.
  • Kneel beside the casualty's chest.
  • Place the heel of your hand on the centre of his chest - for a male casualty place your hands in the centre of his chest between his nipples and for women at the top of the cleavage.
  • Place your other hand on top and interlock your fingers.
  • With your arms straight, press down 4 to 5cm (this is one compression).
  • After each compression, release the pressure on the chest, but keep your hands in contact.
  • Do compressions at a rate of 100 compressions per minute.

At the end of the 30 chest compressions, you must perform two 'rescue breaths' to deliver oxygen into the casualty's lungs.

  • Place two fingers under his chin and gently lift it to open the airway.
  • Pinch the nose closed.
  • Take a normal breath.
  • Seal your mouth over the casualty's and breathe out steadily into his mouth for one second.
  • Watch for his chest to rise and fall.

Repeat the cycle in the ratio of 30 chest compressions to two rescue breaths until:

  • qualified help arrives
  • the casualty starts breathing normally
  • you become exhausted

Doing chest compressions is very tiring so if you have help, take turns doing CPR - swap every two minutes so neither of you gets too tired. This will increase the efficiency of your CPR.

If you're not able or willing to breathe into the casualty's mouth, you can just do the chest compressions without a pause for the rescue breaths. This is much better than doing nothing at all.

How to open the airways

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Automated external defibrillators (AEDs)

A healthy heart contracts in response to the electrical activity of special cells in the heart. This electrical activity can become abnormal and the heart can either stop beating (cardiac arrest), or twitch irregularly (ventricular fibrillation, or VF for short). When this happens, the heart is unable to pump oxygen-rich blood around the body.

Defibrillators treat VF by delivering an electric shock to the chest. This can stop the abnormal electrical activity and restart the normal rhythmic heartbeat.

Automatic external defibrillators (AEDs) are machines designed to be operated by members of the public. They are sometimes available in public places such as offices, shopping centres, railway stations and on aeroplanes. AEDs analyse a casualty's heart rhythm through pads connected to the chest area, and deliver an electric shock if VF is detected. They give spoken instructions and are easy for people without advanced training to use.

It's crucial that the defibrillator is used promptly after a cardiac arrest. You can learn how to use an AED at a local training centre.

Related topics

Further information

Sources

  • Handley AJ, Koster R, Monsieurs K, et al. European Resuscitation Council guidelines for resuscitation 2005: section 2. Adult basic life support and use of automated external defibrillators, 2005. www.erc.edu
  • Heartstart UK. British Heart Foundation. www.bhf.org.uk, accessed 21 April 2009
  • The links in the chain of survival. American Heart Association. www.americanheart.org, accessed 21 April 2009
  • Nolan J. European Resuscitation Council guidelines for resuscitation 2005: section 1. Introduction, 2005. www.erc.edu
  • Resuscitation guidelines. Resuscitation Council (UK), 2005. www.resus.org.uk
  • Personal communication, Bart's city life saver's basic life support course, April 2009
  • Statement on the training required to use an automated external defibrillator. Resuscitation Council (UK), April 2009. www.resus.org.uk
  • Frequently asked questions about the national defibrillator programme. Department of Health. www.dh.gov.uk, accessed 21 April 2009
  • New guidelines for resuscitation (CPR). European Resuscitation Council, 28 November 2005. www.erc.edu
  • Arawwawala D, Brett S. Changes to the European Resuscitation Council cardiac arrest management guidelines - a commentary. Br J Cardiol 2006; 13:425-29. www.bjcardio.co.uk

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: September 2009

 

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