Contrary to popular belief, the purpose of resuscitation is not to “revive” a person who has died. The purpose of resuscitation is to prevent brain death and a decline of the patient’s current state. The act of resuscitation postpones brain death by “replacing” the actions of the heart.

The factors that significantly increase the chances of patient survival after resuscitation are:

• Rapid detection of cardiac arrest.
• The start of effective chest compressions as soon as possible.
• Providing electric shock, if needed, as soon as possible.

When performing CPR, administering chest compressions is the most important aspect that benefits the patient, so we will strive to reach the patient as quickly as possible and perform them as efficiently as possible, as explained later on.

First, ensure the safety of the responder and patient. If necessary and possible, leave the endangering object/situation.

What could endanger our personal safety?

• Fires
• Presence of electricity
• Bystanders and curious onlookers
• Terror attacks
• Alternative vehicles

Checking consciousness –

*** It is important to execute this step quickly and move on to the next step to start chest compressions as quickly as possible ***

We evaluate the level of consciousness by the AVPU scale:

Alert                Fully conscious

Voice              Only responds to voice

Pain                 Only responds to pain

Unresponsive  Unable to respond at all

We will evaluate the level of consciousness in two stages:

First Stage – Verbal Test

• We will try to gauge the patient’s responsiveness through speech and shoulder contact to stimulate the patient: Asking the patient, “Sir? How do you feel?” and clapping our hands by their ear.
• If the patient answers clearly and matter-of-factly, we can define the patient as fully conscious.
• If the patient moves or mutters a non-substantive answer, the patient can be defined as responding to voice only.

Second Stage – Physical Examination

• The responder should press the trapezius muscles with significant force (“the massage muscle”, between the shoulder and the neck).
• If the patient responds with a movement or murmur, the patient can be defined as semi-conscious.
• If the patient is unresponsive, we will declare the patient unconscious and immediately move on to the next step.

At this step we will do three things simultaneously:

• We will ask a bystander to dial 101.
• We will ask another bystander to quickly look for a defibrillator (a resuscitation device; we will explain its function later on).
• We will place a hand on the patient’s chest, look at their abdomen, and look for a rise and fall of the chest area (a sign that the person is breathing). If the patient is not breathing or not breathing properly, this means that the patient has no pulse (or their pulse will be lost very soon).
• Next, we need to expose the patient’s chest and evaluate whether they are breathing properly. (It is of utmost importance to distinguish agonal/terminal breaths – slow and superficial breaths which are ineffective. If the patient is breathing ineffectively they will be considered not breathing).
• If the patient is breathing independently and at a steady rhythm, we will continue treatment according to procedures for syncope (fainting).
• If the patient is not conscious and not breathing/breathing abnormally, we will move on to the next step in the procedure.