Assessing the Situation
Check the scene for danger before helping. If you come across a child who is unconscious, you need to quickly make sure there are no dangers to yourself if you choose to help them. Is there a car exhaust running? Are there dangerous fumes? Is there a fire? Are electrical lines down? If there is anything that could endanger you or the victim, see if there is something you can do to counteract it. Open a window, turn off the stove, or put out the fire if possible. However, if there is nothing you can do to counteract the danger, move the victim. The best way to move the victim is by placing a blanket or a coat underneath their back and pulling on the coat or blanket. If there is a chance the child has suffered a spinal injury, 2 people should move them to prevent any twisting of the head and neck. If you don’t think you can get to the child without putting your own life in danger, call emergency services and wait for help.
Check the child for consciousness. Tap their shoulder and say in a loud, clear voice, "Are you okay? Are you okay?" If they respond, they are conscious. They may have just been sleeping, or they could have been unconscious. If it still appears to be an emergency situation—for example, if they are having trouble breathing or they appear to be fading in between consciousness and unconsciousness—call for help and begin basic first aid. Use the child’s name, if you know it. For example, say, “Kim, can you hear me? Are you okay?” If necessary, take measures to prevent or treat shock. The child may be in shock if you notice symptoms such as clammy skin, rapid breathing, or a grey or blue tint to their lips or fingernails.
Feel for the child’s pulse. If the child is unresponsive, the first thing to do is check their pulse. If the child does not have a pulse, you need to begin CPR immediately. Do not check their pulse for more than 10 seconds. If the victim does not have a pulse, their heart is not beating and you will need to perform chest compressions. To check the neck (carotid) pulse, feel for a pulse on the side of the victim's neck closest to you by placing the tips of your first 2 fingers beside their Adam's apple. Be aware that the Adam's apple is usually not visible on a girl, and may not be very visible on a boy who has not yet gone through puberty. To check the wrist (radial) pulse, place your first 2 fingers on the thumb side of the victim's wrist. Other pulse locations are the groin and ankle. To check the groin (femoral) pulse, press the tips of 2 fingers into the middle of the groin. To check the ankle (posterior tibial) pulse, place your first 2 fingers on the inside of the ankle.
See if the child is breathing. Even if the child has a pulse, you’ll still need to do CPR if they aren’t breathing. Lay them flat on their back, if you can move them safely. Then, tilt their head back slightly and lift their chin. Put your ear close to their nose and mouth and listen for sounds of breathing for no more than 10 seconds. If you don’t hear breathing, get ready to perform CPR rescue breaths. If you hear occasional gasps, this still isn’t considered normal breathing. You’ll still need to perform CPR if the child is gasping for breath.
Begin CPR as quickly as possible. If you see someone whose heart has stopped beating or who has stopped breathing, reacting quickly and performing rescue breathing and CPR could save their life. When someone starts CPR before an ambulance arrives, the patient has a considerably better chance of surviving. Being able to respond quickly by performing CPR, which can help get oxygenated blood back flowing to the brain, is essential. If the child has a pulse but is not breathing, only perform rescue breathing, not chest compressions. A human brain can typically go for around 4 minutes without oxygen before suffering permanent brain damage. If the brain goes without oxygen for between 4 and 6 minutes, the chances of brain damage rise. If the brain lacks oxygen for 6 to 8 minutes, brain damage is probable. If the brain is without oxygen for over 10 minutes, brain death is probable.
Performing CPR
Perform CPR for 2 minutes before calling for help. Once you have quickly assessed the situation and checked the consciousness and circulation of the victim, you need to act very quickly. If there is no pulse, you must begin CPR immediately, and continue it for 2 minutes (which is about 5 cycles of CPR). Then, call for Emergency Medical Services. If you are alone, it is important to start CPR before calling for help. If someone else is there, ask them to call emergency services or send them for help. If you are alone, do not call until you have completed 2 minutes of CPR. Dial your local emergency number. Call 911 in North America, 000 in Australia, 111 in New Zealand, 112 by cell phone in the EU (including the UK) and 999 in the UK. If possible, send someone else to get an AED (Automatic External Defibrillator) if there is one in the building or nearby.
Remember CAB. CAB is the basic process of CPR. It stands for Chest Compressions, Airway, Breathing. In 2010, the recommended sequence changed with chest compressions placed before airway opening and rescue breathing. Chest compressions are more critical for correcting abnormal heart rhythms (ventricular fibrillation or pulseless ventricular tachycardia), and because one cycle of 30 chest compressions only requires 18 seconds, airway opening and rescue breathing are not significantly delayed. Chest compressions, or hands-only CPR, is recommended if you have not been properly trained or are worried about performing mouth-to-mouth resuscitation on a stranger.
Position your hands over the child’s sternum (breastbone). When performing CPR on a child, the positioning of your hands is especially important, given that a child will be more fragile than an adult. Locate the child's sternum by moving 2 fingers to the bottom of their rib cage. Identify where the lower the ribs meet in the middle and then place the heel of your other hand on top of your fingers. Just use the heel of this hand to do the compressions.
Perform 30 compressions. Compress the chest, with your elbows locked, by pushing straight down about 2 inches (5.1 cm) deep. The smaller body of a child needs less pressure than an adult’s would. If you begin to hear or feel a cracking sound, that may indicate that you are pushing too hard. Continue, but apply less pressure with the compressions. Do 30 of these compressions, and do them at a rate of at least 100 compressions per minute if you are the only rescuer. Allow complete chest recoil after each compression. In other words, wait for the chest to expand completely before you push down again. Minimize pauses in chest compression that occur when changing providers or preparing for a shock. Try to limit interruptions to less than 10 seconds. If there are 2 rescuers, each should complete a round of 15 compressions. If you’re doing rescue breaths as well as compressions, do 2 breaths for every 15 compressions instead of every 30 compressions.
Make sure the airway is open. Place your hand on the child’s forehead and 2 fingers on their chin. Lift the chin gently with the 2 fingers while carefully pushing down on the forehead with your other hand. If you suspect a neck injury, gently pull the jaw upward rather than lifting the chin. Once you have done this you should look, listen, and feel for breathing. Put your ear close to the victim's mouth and nose and listen carefully for any signs of breathing. Watch for chest movement and feel for any breath on your cheek. If there are no signs of breathing, place a CPR breathing barrier or rescue mask (if available) over the victim's mouth.
Give 2 rescue breaths if the child isn’t breathing. Keeping the airway open, take the fingers that were on the child’s forehead and pinch their nose closed. Make a seal with your mouth over the victim's mouth and breathe out through your mouth for about one second. Make sure you breathe slowly, as this will make sure the air goes in the lungs and not the stomach. Make sure you keep your eye on the victim's chest. If the breath goes in, you should see the chest slightly rise and also feel it go in. If the breath goes in, give a second rescue breath. If the breath does not go in, reposition the head and try again. If it does not go in again, the victim may be choking. You'll need to do more chest compressions in this case. Keep in mind abdominal thrusts (the Heimlich maneuver) should only be performed on someone who is conscious.
Repeat the cycle of 30 chest compressions and 2 breaths. Do CPR for 2 minutes (5 cycles of compressions to breaths) before checking for signs of life, a pulse, or breathing. Continue CPR until someone takes over for you; emergency personnel arrive; you are too exhausted to continue; an AED is attached, charged, and the person running it asks you to clear the body; or pulse and breathing return. Don't forget to call the emergency services after the first 2 minutes of CPR. After you call them, continue to administer CPR until they arrive. If you’re working with a second rescuer, cut the number of compressions per 2 breaths in half. That is, one of you should do 15 compressions, followed by 2 breaths, then the other person should perform another 15 compressions and 2 breaths.
Use an AED to restart their heart if necessary. If an AED becomes available, turn on the AED, then place the pads as instructed (one over the right chest and another over the left side). Allow the AED to analyze the rhythm, and give one shock if indicated, after clearing everyone from the patient (yell "CLEAR!" first). Resume chest compressions immediately after each shock for another 5 cycles before reassessing. If the victim begins breathing, gently maneuver them them into the recovery position.
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