DANGER Check for danger to you, the group and the patient. Leave the patient in the position you found them unless it is unsafe.
-Check for a response.
-Shout out as you approach, ‘Can you hear me? Are you okay?’.
-Tap the patient’s shoulder or rub their sternum with your knuckles.
SEND FOR HELP
If the patient does not respond and you are on your own, call loudly for help. If you are not alone, ask someone to call emergency services and come back to tell you when they have done so. In the outdoor environment, this may mean setting up a mountain radio or trying to get mobile phone reception.
Check that the airway is open. Immediate opening of the airway is the first priority with an unconscious person, as their tongue can fall back across their throat, blocking their airway
• Remove any visible objects from the mouth, including vomit. Do not put your fingers in their mouth unless you are intentionally picking out an object that you can see.
• Open the airway, without moving the patient from their original position if possible. Turn them onto their back if necessary.
Use the head-tilt, chinlift method:
1. Place one hand on the patient’s forehead.
2. Place the fingers of your other hand on the bony part of their chin.
3. Tilt the head back and lift the jaw up. This will lift the tongue off the back of the throat.
4. Place 5cm of clothing as a pillow under an adult patient’s head to help open their airway. If you suspect the patient has a neck or spinal injury, do not use the head-tilt, chin-lift method.
Use the jaw-thrust technique to minimise any movement of the neck:
1. Position yourself at the top of the patient’s head, place one hand on each side of the patient’s head.
2. Grasp the angles of the lower jaw (just below the earlobes).
3. Lift the lower jaw forwards – the bottom teeth come forward of the upper teeth. BREATHING Check for breathing, without moving the patient.
Spend no more than 10 seconds doing this.
• Look: Can you see the chest rise and fall?
• Listen: Can you hear normal breath sounds (more than the occasional gasp)?
• Feel: Can you feel breath on your cheek or hand if you hold it close to the patient’s mouth and nose? Can you see moisture on a cold surface, such as a watch or glasses, if you hold it to their mouth and nose? If the patient is breathing, you can assume they have circulation. Do not do CPR. Agonal breathing, short irregular gasps for breath, is common in the first few moments after a cardiac arrest. It should not be mistaken for normal breathing. If agonal breathing is present, start CPR.
CPR If the patient is not breathing or there is only the occasional gasp, begin chest compressions: 1. The patient must be on their back on a firm, preferably flat surface for compressions to be effective. You may have to move the patient to achieve this. If you are on a slope, position the patient across, not down, the line of the slope.
2. Kneel next to the patient.
3. Position the heel of one hand in the centre of the chest, on an imaginary line between the armpits.
4. Place the heel of the other hand on top of the first.
5. Interlock the fingers to lift them off the chest. If it is easier for you, use the hand on top to grasp the wrist of the hand on the chest.
6. Push down vertically, by leaning forward so your shoulders, arms and hands are in a straight line.
7. Press the chest down firmly, approximately one-third of the depth of the chest, at least 5cm for most adults. Using a smooth, regular rhythm, do 30 compressions at a rate of 100 per minute (15 per 9 seconds, slightly fewer than 2 per second). Do not lift your hands off the chest between compressions.
8. Allow equal time for compression and recoil – chest recoil sucks the blood back into the chest and compression forces blood out to oxygenate the brain.
9. After every 30 compressions, do two rescue breaths.
10. Continue the cycle of two breaths to 30 compressions.
11. After every 3 minutes check for signs of life.
If there are no signs of life:
12. Give two breaths and continue the cycle. If the patient starts breathing, and can breathe without assistance, place them in the recovery position, insulated from the ground, and check their vital signs frequently. If they need help breathing, do rescue breaths.