Life-threatening emergencies: cardiac arrest, choking, bleeding

1Cardiac arrest: cardiopulmonary resuscitation

A casualty who is unresponsive and not breathing normally is in cardiac arrest. Every minute without chest compressions sharply reduces their chances of survival.

• Casualty on their back, on a firm surface. Hands one on top of the other in the centre of the chest.
• Compressions 5 to 6 cm deep in adults, at a rate of 100 to 120 per minute, letting the chest rise fully.
• If you are trained and willing: 30 compressions then 2 rescue breaths. Otherwise, continuous compression-only CPR is already very useful.
• Continue until help arrives, normal breathing returns or you are exhausted; swap every two minutes if there are several of you.

Child: one or two hands, about one third of the depth of the chest. Infant: two fingers, about 4 cm. In children, arrest is often caused by breathing problems: rescue breaths are important if you are trained.

2The defibrillator and the recovery position

An automated external defibrillator (AED) analyses the heart rhythm and delivers a shock if needed. Switch it on and follow the voice prompts; attach the pads to the bare, dry chest; nobody touches the casualty during analysis and shock; resume compressions as soon as the device tells you to. Find out in advance whether your office, the airport or the nearby hospital has one.

A casualty who is unresponsive but breathing normally is placed in the recovery position: on their side, head tilted back, mouth pointing down so that vomit can drain. Check their breathing regularly: if it stops, roll them onto their back and start resuscitation.

3Choking: clearing the airway

A foreign body (food, small object) can block the airway.

• Mild obstruction: the person coughs, speaks, breathes. Encourage them to cough and do nothing else.
• Severe obstruction: they cannot speak, cough effectively or breathe, and often clutch their throat. Give 5 back blows between the shoulder blades with the person leaning forward; if unsuccessful, give 5 abdominal thrusts (fist just above the navel, pull inwards and upwards). Alternate 5 and 5.
• Infant: 5 back blows, face down along your forearm with the head lower, then 5 chest thrusts with two fingers. No abdominal thrusts.
• If the casualty becomes unresponsive: call for help and start resuscitation.

4Severe bleeding and shock

Catastrophic bleeding can kill within minutes. Gloves if possible, then firm direct pressure on the wound, with your hand or a thick dressing; do not release it to look. Add more dressings on top if blood soaks through.

If direct pressure is not enough or not possible on a limb (amputation, several casualties, inaccessible wound), apply a tourniquet: 5 to 7 cm above the wound, never over a joint, tightened until the bleeding stops. Write down the time it was applied and never loosen it yourself. An improvised tourniquet (wide strip of cloth and a stick) is less effective than a commercial one: field vehicles should carry one.

Shock (pale, cold, clammy skin, rapid pulse, agitation then drowsiness) often follows bleeding: lay the casualty down, cover them, reassure them, give nothing to eat or drink and monitor them until evacuation.