Bystander CPR: You never know when you may need it
Kevin Schulz, MD, associate professor of emergency medicine, EMS Fellowship director at McGovern Medical School at UTHealth Houston, and EMS physician director for the city of Houston. (Photo by Rustin Rawlings)
Welcome to “Ask the Expert,” a UTHealth Houston news series where our leading experts examine pressing health challenges. In this edition, we address why learning bystander CPR can help save lives and what to do if someone experiences cardiac arrest.
According to the American Heart Association, only about half of Americans say they would feel confident performing CPR in an emergency. Many people worry they might do something wrong, injure the person, or face legal consequences. Others assume someone else will step in.
Those concerns are understandable, but when a person’s heart stops, doing something is almost always better than doing nothing. Cardiac arrest can happen anywhere: at home, at work, at a sporting event, or in a grocery store. The actions taken by bystanders in the first few minutes can make the difference between life and death. In fact, more than 70% of out-of-hospital cardiac arrests happen in the home, and odds are that the life you save will be a family member or someone you know.
What is bystander CPR?
Bystander CPR is emergency life support given by an ordinary person to someone experiencing sudden cardiac arrest before professional medical help arrives. Bystander CPR is fast, hard compressions to the center of the chest using the hands at a rate of 100 to 120 beats per minute. Mouth-to-mouth breathing is not needed in this type of CPR.
Why is it important to act fast?
Every year, around 350,000 people in the United States experience cardiac arrest outside of a hospital. Bystanders starting chest compressions early in a cardiac arrest save lives. Immediate bystander CPR more than doubles the survival rate of patients whose hearts stop outside the hospital. Immediately starting CPR is the single most important thing that a bystander can do if someone suffers cardiac arrest, along with calling 911 and using an automated external defibrillator, AED, if one is available.
CPR helps keep blood flowing to the brain and vital organs until professional help arrives. Without that circulation, permanent damage can occur within minutes. If CPR is delayed until emergency responders arrive, the chances of that patient having a positive outcome are much lower, but if bystander CPR is started, they increase significantly. Immediate bystander CPR is critically important and can be done by almost anyone to help save a life.
How do I know if someone needs CPR?
The first step is determining whether the person is responsive. If someone suddenly collapses, appears unconscious, and is not breathing normally, it’s time to act, because their life likely depends on it.
Checking for responsiveness by tapping the person and shouting. If they do not respond and are not breathing normally, or are only gasping, call 911 immediately or direct someone nearby to call.
Many people mistake occasional gasps for signs that a person is still okay, but occasionally gasping is not normal breathing and can be a sign of cardiac arrest. If in doubt, call 911 and start chest compressions. It is safer to do chest compressions on someone who is not in cardiac arrest than to delay starting compressions on someone whose heart has stopped.
If an automated external defibrillator is available, send someone to retrieve it while CPR is started. Modern automated external defibrillators provide simple voice instructions and are designed for use by everyday people. They can significantly improve survival when used quickly.
What are the steps of quick CPR?
For most adults who suddenly collapse or who cannot be woken up and aren’t breathing normally, hands-only CPR is recommended. It’s simple, effective, and something anyone can do.
- Call 911 or have someone nearby call. Stay on the line with 911, because they can give you important instructions and talk you through providing CPR.
- Place the heel of one hand in the center of the chest and your other hand on top.
- Push hard and fast, allowing the chest to fully recoil between compressions.
- Aim for a rate of 100 to 120 compressions per minute, roughly matching the beat of songs like “Stayin’ Alive.”
- Continue compressions until trained first responders arrive, an AED is ready to use, or the person begins to respond.
The most important thing is to start CPR as soon as you recognize it’s needed. People often hesitate because they’re afraid of making a mistake, but delayed CPR is far more harmful than imperfect CPR.
Does CPR differ between infants, adults, and older adults?
The basic principle remains the same regardless of age: Maintain circulation until help arrives. However, there are some important differences.
For adults, hands-only CPR is appropriate in most situations.
For infants and young children, cardiac arrest is more often caused by breathing problems, so breathing for the patient becomes more important. If you’ve received formal CPR training, you should follow the age-specific guidelines you’ve learned. If not, start with hands-only CPR and listen to the instructions given by the 911 dispatcher.
For older adults, it’s true that chest compressions can sometimes result in broken ribs—but a broken rib is something that can heal. Untreated cardiac arrest is far more dangerous.
Regardless of a person’s age, immediate action is critical. The goal is to keep oxygenated blood moving through the body until emergency responders can take over.
The bottom line
Bystander CPR saves lives. You don’t need to be a healthcare professional to make a difference. Recognizing cardiac arrest, calling 911, starting chest compressions, and using an AED if one is available can give someone their best chance of survival.
Everyone should learn CPR before an emergency occurs, because you never know when you’ll need it. The person whose life depends on CPR could be a friend, a family member, a coworker, or a complete stranger. Anyone can do CPR and save a life, but CPR training can give you hands-on practice and the confidence to act in an emergency. A few minutes of training today could help you save a life tomorrow.
The following expert commentary can be used by journalists and media organizations in their own publications and news coverage.
Please attribute all quotes to Kevin Schulz, MD, professor of emergency medicine at UTHealth Houston and EMS physician director for the city of Houston.
For media inquiries or to suggest future health topics, contact UTHealth Houston Media Relations at [email protected] or 713-500-3030.
