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This is a reference, not a substitute for training. Compressions have to be practiced to be delivered at the right depth and rate under stress. Read it now so the sequence is familiar.
1. Check the scene
Look for anything that would make you a second casualty: traffic, electricity, fire, unstable water. You cannot help if you are hurt.
2. Check responsiveness
Tap the shoulders firmly and shout. For an infant, tap the sole of the foot. No response means proceed.
3. Call for help and get an AED
Send a specific person: point at them and say what you want. If you are alone with an adult, call emergency services yourself first, then start compressions. Put the phone on speaker.
4. Check breathing
Take no more than about ten seconds. Agonal gasping is not breathing and is a sign of cardiac arrest, not of recovery. If breathing is absent or only gasping, begin compressions.
5. Compressions
- Heel of one hand on the centre of the chest, other hand on top, fingers interlocked
- Shoulders directly over your hands, arms straight
- At least 2 inches deep for an adult, no more than 2.4 inches
- 100 to 120 per minute
- Let the chest recoil fully between compressions. Incomplete recoil is a common and costly error
- Minimise interruptions
6. Rescue breaths
If trained and willing, 30 compressions to 2 breaths. Tilt the head, lift the chin, seal, and breathe until the chest visibly rises over about one second. If you are unwilling or untrained, compression only CPR is far better than nothing.
7. Use the AED as soon as it arrives
Turn it on and follow the voice prompts. Bare and dry the chest. Do not touch the patient while it analyzes or shocks. Resume compressions immediately after a shock.
8. Continue
Until the person shows signs of life, until emergency services take over, or until you are physically unable. Swap the compressor about every two minutes, because quality falls off fast.
Practice this in a CPR Class.
What are the most common CPR mistakes?
The errors that most reduce effectiveness are consistent and fixable:
- Compressing too shallow. Two inches on an adult is deeper than most people expect and deeper than most untrained rescuers deliver.
- Not allowing full recoil. The chest has to come all the way back between compressions or the heart does not refill.
- Long interruptions. Every pause drops the pressure that has been built up, and it takes several compressions to rebuild it.
- Waiting for certainty. Time spent deciding whether the person is really in arrest is time without circulation.
- Stopping too early. Continue until emergency services take over or the person shows clear signs of life.
When do you stop CPR?
You stop when a professional takes over, when the person starts breathing normally and moving purposefully, when an AED instructs you to stand clear for a shock, or when you are physically unable to continue. Exhaustion is a real limit, which is why swapping rescuers every two minutes matters when more than one person is present.
Occasional gasping is not a reason to stop. It is common during effective CPR and does not mean the person has recovered. Look for normal breathing and purposeful movement, not a single breath or a twitch.
How does the checklist change for a drowning?
Drowning is a breathing emergency, so the standard sequence is adjusted. Give rescue breaths early rather than relying on compressions alone, because the underlying problem is a lack of oxygen rather than a heart rhythm that needs shocking.
Do not attempt to drain water from the lungs by pressing on the abdomen or turning the person upside down. It does not work, it delays compressions, and it raises the risk of vomiting and aspiration. Get the person out, check breathing, and start. This is one of several places where lifeguard training and bystander training diverge, and it is covered in a Lifeguard Training Class.
How do you check the scene before you start?
The first item on the checklist exists because rescuers get hurt. Before approaching, look for traffic, water, electricity, fire, unstable ground, chemicals and any aggression from people nearby. A rescuer who becomes a second patient has made the situation worse rather than better.
In aquatic settings the specific hazards are the water itself and the deck. Do not enter deep water to reach an unresponsive person unless you are trained and equipped, and be aware that a wet tiled deck is where responders slip while carrying equipment. Move the patient to a firm dry surface before starting compressions, because compressions on a soft or moving surface lose most of their depth.
Put on gloves if they are within reach, and use a barrier device for rescue breaths if you have one. Neither should delay compressions by more than a few seconds, and neither is a reason to withhold CPR if you have nothing.
Frequently asked questions about CPR response checklist
What is the correct CPR compression rate?
One hundred to one hundred and twenty compressions per minute, which is roughly two per second. Many people find it easier to hold the tempo against a familiar song. Rate matters, but depth and full chest recoil matter just as much and are missed more often.
How deep should chest compressions be?
At least two inches for an adult, about two inches for a child, and about one and a half inches for an infant. Do not exceed two and a half inches on an adult. Most untrained rescuers compress far too shallow rather than too deep.
What is the compression to breath ratio?
Thirty compressions to two rescue breaths for a single rescuer with any age of patient. With two trained rescuers working on a child or infant, the ratio changes to fifteen compressions to two breaths. Untrained bystanders helping an adult should do compressions only.
Should you use an AED on a child?
Yes. Use pediatric pads and a pediatric setting if the device has them and the child is under eight or under about fifty five pounds. If only adult pads are available, use them rather than not defibrillating, placing one on the chest and one on the back.
Reviewed by Jackie Stern, Lifeguard Instructor, Firefighter and EMT. Jackie Stern has taught lifeguarding for more than 20 years and works as a firefighter, EMT and swim instructor. She reviews course content, prerequisites and rescue standards against current certification requirements.