First aid

1. Check safety and responsiveness

Approach only when it is safe. Ask loudly whether the person can hear you and gently shake their shoulders. If they do not respond, call 112 or 999 immediately, preferably using speakerphone. Ask someone to bring an AED.

2. Assess breathing

Start assessing breathing while waiting for the call to be answered. Open the airway by tilting the head back and lifting the chin. Assess breathing for no more than 10 seconds. Occasional gasps and irregular gasping are not normal breathing. Unresponsiveness and absence of normal breathing mean that CPR must be started. The dispatcher will help you assess the situation.

3. Start CPR

Place the heel of one hand in the centre of the chest, on the lower half of the breastbone; place your other hand on top. With straight arms, give compressions 100–120 times per minute, to a depth of 5–6 cm. Allow the chest to return to its original position. If you know how and are able to, give 30 compressions and 2 breaths. Otherwise, give continuous compressions.

4. Use an AED

Switch on the AED and follow its instructions. Attach the pads to the bare chest as shown in the diagrams. No one may touch the casualty during analysis or a shock. When prompted by the device, immediately resume CPR, including when no shock is advised. Continue until help takes over, normal breathing returns, you are exhausted or danger arises.

When the person is breathing normally

A person with a reduced level of consciousness who is breathing normally and does not need CPR may be placed on their side in the recovery position. In the case of agonal breathing, start CPR; do not use the recovery position. After an injury, do not routinely change the person's position; follow the dispatcher's instructions. Follow the dispatcher's instructions and continuously monitor breathing. If it becomes abnormal, start CPR. Do not give food or drinks to an unconscious person.

Severe bleeding

Call for help. Put on gloves if you can. Apply firm pressure to the bleeding site through a dressing or clean material. Maintain pressure and follow the dispatcher's instructions. Do not remove an object embedded in a wound; apply pressure around it. A tourniquet may be needed for massive bleeding from a limb that is not stopped by pressure; practise using one during training.

What to tell the dispatcher

Give the address, building, floor and room, the number of casualties and whether they respond and breathe normally. Answer questions and stay on the line. If someone is available to help, ask them to go and meet the emergency responders.

Why the first minutes matter

First aid means recognising danger, calling for help and acting within your skills. The heart provides blood flow, the lungs exchange gases and the nervous system controls bodily functions. In cardiac arrest, the brain quickly loses its oxygen supply. Compressions maintain some blood flow, rescue breaths supply oxygen and an AED can stop certain abnormal heart rhythms. BLS means basic life support; do not wait to identify the exact cause before starting it.

The chain of survival

Early recognition and calling for help, prompt CPR, defibrillation and further treatment form interconnected stages of saving a life. A bystander can initiate the first three. After normal breathing returns, the person still needs supervision and medical care. Do not promise a specific chance of survival: the outcome depends on factors including the cause, timing and quality of the response.

How to assess breathing and perform compressions

After opening the airway, look for chest movement, listen near the mouth and nose and feel for breath on your cheek — for no more than 10 seconds. A rescuer without medical training should not waste time looking for a pulse. To perform compressions, kneel beside the chest, interlock your fingers and position your shoulders over your hands, keeping your elbows straight. Allow the chest to recoil after each compression without lifting your hands away. Minimise interruptions. If there are two rescuers, switch who performs compressions about every two minutes, without unnecessary delay.

Two rescue breaths

If you know how and are able to give them, after 30 compressions open the airway, pinch the soft part of the nose and seal your mouth over the casualty's mouth. Blow for about one second, just until the chest visibly rises. Allow it to fall and give the second breath. The pause for breaths should not exceed 10 seconds. If the chest does not rise, improve the head tilt and seal; remove only a visible, easily accessible foreign object. Do not sweep blindly inside the mouth with a finger or prolong attempts — return to compressions. If you are not giving rescue breaths, provide compression-only CPR.

The recovery position step by step

• Use it for reduced consciousness with normal breathing when there is no indication for CPR and no suspected injury. Call for help. If injury is present or you are unsure, follow the dispatcher's instructions; keeping the airway open takes priority.
• 1. Kneel beside the person. Place the nearer arm at a right angle to the body, bent at the elbow, with the palm facing upwards.
• 2. Bring the farther arm across the chest and hold the back of that hand against the casualty's nearer cheek.
• 3. With your other hand, grasp the farther leg above the knee and bend it, keeping the foot on the ground. Pull the knee to roll the person towards you onto their side, keeping the hand supported against the cheek.
• 4. Position the upper leg securely, bent at the hip and knee. Tilt the head back to keep the airway open; direct the mouth downwards. Monitor breathing and protect the person from becoming cold. Do not leave them alone.
• Do not treat occasional gasps as normal breathing. If breathing becomes abnormal, roll the person onto their back and start CPR.

Adult choking: coughing or severe obstruction

Ask whether the person is choking. If they can cough effectively, breathe and speak, encourage coughing and monitor them. Do not routinely give back blows at this stage or offer water. Inability to speak, breathe or cough effectively means action is needed. Ask another person to call 112/999; if you are alone and the first series of blows and thrusts does not help, call for help using speakerphone.

Adult choking: up to 5 back blows and up to 5 thrusts

• 1. Stand to the side and slightly behind, support the chest and lean the person forwards. Give up to five firm blows with the heel of your hand between the shoulder blades. Check the effect after each one; stop when the obstruction is removed.
• 2. If this does not help, stand behind the person, put your arms around them and place your fist between the navel and the lower end of the breastbone. Grasp your fist with your other hand and give up to five sharp inward and upward thrusts.
• 3. Alternate sets of up to five back blows and up to five thrusts until the obstruction clears or the person loses consciousness. For someone who is visibly pregnant, or whose abdomen you cannot encircle, chest thrusts are used instead of abdominal thrusts; seek the dispatcher's guidance.
• 4. If the person becomes unresponsive, carefully lower them to the ground, make sure help has been called and begin CPR. Before rescue breaths, remove only a visible and accessible foreign object. Do not insert fingers blindly.
• 5. After successful abdominal or chest thrusts, medical assessment is needed because of the risk of injury. This sequence applies to adults; do not use abdominal thrusts on an infant.

Bleeding: escalating help

Maintain firm direct pressure. Once bleeding is controlled, secure a pressure dressing. For life-threatening bleeding from a limb that pressure does not stop, use a tourniquet in accordance with your training and the dispatcher's instructions: 5–7 cm above the wound, not over a joint. Tighten until the bleeding stops, record the time and do not loosen it yourself. A haemostatic dressing requires correct application and pressure. Do not substitute a thin cord for a tourniquet. Protect the casualty from becoming cold and monitor breathing.

Talking to a conscious casualty: SAMPLE

If it does not delay urgent help, ask about symptoms (S), allergies (A), medications (M), past medical history (P), the last meal or drink (L) and the events surrounding the incident (E). Pass the information to rescuers. Do not take a lengthy history instead of controlling bleeding or calling for help, and do not give arbitrary medicines.

Dividing tasks and fear of helping

Designate one specific person to make the call, another to fetch an AED and another to wait for rescuers. Clearly state where the incident is. Put on gloves if available; use a breathing barrier according to your skills. Fear of mouth-to-mouth contact should not prevent calling for help, performing compressions or using an AED. After a difficult incident, you may need to talk and receive support. Practise CPR and choking techniques on suitable equipment with an instructor, not by applying forceful pressure to a healthy classmate.

Check your knowledge

Work through these short scenarios. Check each answer separately.