What do I do if someone collapses and is not breathing?

Out-of-hospital cardiac arrest is survivable and the thing that decides it is whether a bystander starts compressions in the first minutes. Most people who do not start say afterwards that they were not sure whether it was needed. The two checks below are how you become sure, and they take under fifteen seconds.

Safety

Step by step

1. Check the scene is safe before you go near.Traffic, live electricity, water, gas, fire, a machine still running. Deal with the hazard or stay clear and ring 999. A rescuer who becomes a second casualty makes the situation twice as bad.
2. Check for a response.Kneel beside them, shake their shoulders gently and ask loudly, are you all right. If they respond, they are breathing — leave them where they are if it is safe, work out what is wrong, and get help if they need it.
3. Shout for help and open the airway.If there is no response, shout for anyone nearby. Place one hand on their forehead and gently tilt the head back, and use two fingertips under the point of the chin to lift it. That lifts the tongue clear of the airway, which is what an unconscious person's airway needs.
4. Look, listen and feel for normal breathing, for up to ten seconds.Look for the chest rising, listen at their mouth, feel for breath on your cheek. Take the full ten seconds — this is the check people rush.
5. Know what agonal gasping looks like.In the first minutes of cardiac arrest a person often makes occasional noisy, irregular gasps. It is not breathing, it is a sign of cardiac arrest, and mistaking it for breathing is the single commonest reason a bystander does not start CPR. Occasional gasps mean start.
6. If they are breathing normally: recovery position and 999.Roll them onto their side with the airway open, ring 999, and stay with them. Keep checking that they are still breathing, because an unconscious person's condition can change.
7. If they are not breathing normally: 999 and compressions, now.Ring 999, put the phone on speaker so your hands are free, ask for an ambulance and say the person is not breathing. Send anyone nearby for a defibrillator. Start compressions without waiting for anything.
8. Give compressions properly.Heel of one hand in the centre of the chest, the other hand on top with fingers interlocked, arms straight, shoulders over your hands. Press down 5 to 6cm and let the chest come all the way back up. Aim for 100 to 120 a minute.
9. Decide about rescue breaths honestly.If you are trained and willing, give two rescue breaths after every 30 compressions. If you are not, give continuous compressions and do not stop. Compression-only CPR is far better than no CPR, and reluctance about breaths must not delay the compressions.
10. Use a defibrillator as soon as one arrives.A public access defibrillator gives spoken instructions and will not shock someone who does not need it. Turn it on, follow what it says, and keep compressions going while the pads are being placed.
11. Keep going.Until the ambulance service takes over, until a defibrillator is ready to analyse, or until the person clearly starts to wake and breathe normally. If someone else is there, swap every couple of minutes — good compressions are exhausting, and tired compressions get shallow.

Tips

• The 999 call handler will talk you through compressions, count with you, and tell you where the nearest defibrillator is. Put the phone on speaker and let them help.
• Do a face-to-face course. St John Ambulance, the British Red Cross and many local providers run short ones, and practising compressions on a manikin is worth more than any amount of reading.
• Find out now where the nearest public access defibrillator is. There is a national register, and the answer is often a village hall or a supermarket a few hundred metres away.

Common mistakes

• Waiting to be certain before starting — Compressions on someone who turns out not to need them do far less harm than no compressions on someone who does. Certainty is not available in the first minute and waiting for it is what costs lives.
• Treating occasional gasps as breathing — Agonal gasping is a sign of cardiac arrest. It looks and sounds like an attempt to breathe, and it is the reason a great many bystanders stand and watch.
• Not pressing hard enough — Effective compressions are much harder than people expect and 5 to 6cm is deep. Shallow compressions circulate very little blood.
• Stopping to check for a pulse — Finding a pulse reliably is difficult even for professionals, and the time spent looking is time without circulation. Not breathing normally is the trigger; a pulse check is not part of it.

If it doesn't work

Questions people ask