Box 1

Verify scene safety.

Rationale: When you come across someone displaying symptoms of cardiac arrest, your first
priority is to ensure the safety of both yourself and the individual in distress by assessing the
scene.

Box 2
Check for responsiveness.
Rationale: By tapping the victim and shout “HEY! HEY! Are you OK?” This step involves
determining the person's consciousness status and evaluating the appropriate actions to take in
such circumstances.

Shout for nearby help.

Rationale: Instructing a bystander to contact emergency services (such as dialing 911 or the local
emergency number) is a means of notifying the professional response team.

Activate the emergency response system via a mobile device (if appropriate).
Rationale: A well-structured emergency response strategy can ensure that the emergency
response team can promptly and effectively address the situation.

Get an AED and emergency equipment (or send someone to do so).

Rationale: For individuals with a shockable heart rhythm, the chances of survival decrease by
10% with each passing minute without defibrillation. However, when CPR is administered
promptly along with the use of an AED, the potential for survival can increase significantly,
reaching up to 40%.

Box 3
Look for no breathing or only gasping and check pulse (simultaneously).
Rationale: Increased heart rate leads to heightened respiration, as a faster heartbeat consumes
additional energy and supplies the body with greater oxygen levels.

Is a pulse definitely felt within 10 seconds? If the person is breathing normally and has a pulse,
proceed to Box 3a.
Rationale: Observe the chest for 5 to 10 seconds to assess whether there is any absence or
unusual pattern in breathing.

If the person is not breathing normally but has a pulse, proceed to Box 3b.
Rationale: Placing an individual in the recovery position serves the dual purpose of maintaining
an open and unobstructed airway while also preventing the risk of choking due to potential vomit
or fluids.

If the person is not breathing or is only gasping and no pulse is felt, proceed to Box 4.
Rationale: If a pulse cannot be detected within 10 seconds, the initial rescuer should promptly
initiate CPR, commencing with chest compressions, as the absence of a pulse may indicate that
the victim's heart has ceased functioning.

Box 3a
Monitor the person until emergency responders arrive.
Rationale: Here are the instructions to follow: With the person lying on their back, kneel on the
floor next to them. Position the arm closest to you at a 90-degree angle to their body, with the
palm facing upward, directed toward their head. Gently place their other hand under the side of
their head, ensuring the back of their hand is in contact with their cheek.

Box 3b
Provide rescue breathing, 1 breath every 6 seconds or 10 breaths per minute.
Rationale: When you provide breaths to the victim by blowing into their mouth, you are
replenishing the oxygen levels in their bloodstream. This oxygen infusion is essential for
sustaining the function of critical organs and keeping them alive.

Check pulse every 2 minutes; if no pulse, start CPR.

Rationale: 30 compressions followed by 2 breaths, known as “30:2” for 5 sets of 30:2 is about 2
minutes. Thus every after CPR, check pulse

If it is a possible opioid overdose, administer naloxone if available per protocol.

Rationale: Death resulting from an opioid overdose can be averted through the prompt provision
of basic life support and the timely application of naloxone, a medication capable of reversing
the opioid overdose's effects when administered promptly..

Box 4
Start CPR
Rationale: Initiating CPR at the earliest possible moment is crucial, as the sooner it begins, the
greater the likelihood that the victim will survive and recover without enduring lasting
disabilities.

Perform cycles of 30 compressions and 2 breaths.

Rationale: The Guidelines suggest a revised compression-to-ventilation ratio of 30:2 and
modifications in AED utilization. This adjustment underscores the overarching emphasis on
prioritizing chest compressions above all other actions.

Use the AED as soon as it is available.

Rationale: Initial research indicated a tendency toward improved survival rates when Basic Life
Support (BLS) ambulance providers employed AEDs in cases of out-of-hospital cardiac arrest.

Box 5
The AED arrives.

Box 6
The AED checks the rhythm. Is the rhythm shockable?

If Yes, the rhythm is shockable, proceed to Box 7.

Rationale: Shockable rhythms are irregular heart rhythms that result from abnormalities in the
heart's electrical conduction system.

If No, the rhythm is nonshockable, proceed to Box 8.

Rationale: PEA is categorized as a "nonshockable" cardiac rhythm, implying that the use of a
defibrillator cannot correct it. Without prompt treatment, PEA leads to sudden cardiac death
within a matter of minutes.

Box 7
Give 1 shock. Resume CPR immediately for 2 minutes (until prompted by the AED to allow
rhythm check).
Rationale: When dealing with a shockable rhythm, medical professionals use paddles to
administer an electric shock to the patient, aiming to assist in the restoration of a regular heart
rhythm.

Continue until advanced life support providers take over or the victim starts to move.
Rationale: The rescuer should persist with cardiopulmonary resuscitation until one of the
following circumstances occurs: the individual shows a response or starts to breathe regularly.

Box 8
Resume CPR immediately for 2 minutes (until prompted by the AED to allow rhythm check).
Rationale: It's crucial to initiate CPR as soon as possible because the earlier it begins, the higher
the chances of the victim surviving and recovering without enduring lasting disabilities.

Continue until advanced life support providers take over or the victim starts to move.
Rationale: The rescuer should keep performing cardiopulmonary resuscitation until one of the
following situations occurs, the individual shows a response or starts to breathe normally.
Reference:
AHA journal. November 28, 2005. Part 4: Adult Basic Life Support.
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.105.166553

Joffe, C. (2021). Why Have CPR Guidelines and Instructions Changed Over the Years? Get CPR
Done Blog.
https://www.getcprdone.com/get-cpr-done-blog/why-have-cpr-guidelines-and-instructions-chang
ed-over-the-years

World Health Organization. (2023). Emergency responses to opioid overdose. Opioid overdose.
https://www.who.int/news-room/fact-sheets/detail/opioid-overdose.

HR Services Scotland. (2021). CPR & AED: The Importance of First Aid Training. HR Services
Scotland. https://www.hrservicesscotland.co.uk/cpr-aed-the-importance-of-first-aid-training