Introduction: How to Perform Hands-Only CPR on Adults

Materials Needed: An AED (Automated External Defibrillator) with pads and a working battery.
When Appropriate: When an ADULT is found to be unresponsive (different instructions must be used for young children and infants).
Note: "Hands-Only" means that you will perform compressions (explained below) and will not give the person breaths. This is in accordance with the most updated training that emergency personnel receive. 

1.   When you find an unresponsive adult lying on the ground, speak loudly and try to awaken them by asking if they are okay or if they can hear you.
2.   If they are still unresponsive, have someone call 911.
       • If you are the only person at the scene, call 911 on your own.
3.   Verify their condition by checking for a pulse and assessing breathing,
       • To check for a pulse, place your index and middle finger along the side of the person’s neck next to the trachea, just below the jawbone. (See TOP Figure)
       • To assess breathing, place your ear over their mouth to listen for breathing while looking at their chest to see if it chest rises and falls. (See MIDDLE LEFT Figure)
4.   If the person is not breathing and has no pulse, have the person calling 911 ask the emergency operator if they know of an available AED located nearby. If one is available, have the caller retrieve the AED.
       • If there is no AED available, perform compressions as outline below until professional emergency personnel arrive at the scene.
       • If they are not breathing but do have a pulse, DO NOT follow the rest of these instructions. Simply look inside their mouth to see if anything is blocking their airway (remove the obstruction if there is one and if doing so is safe), and then wait for emergency personnel to arrive. 
5. While they retrieve the AED, initiate CPR by performing a series of 100 chest compressions at a rate of 100 compressions-per-minute.
       • To perform compressions, position yourself at the patient’s side in a kneeling position, place one hand on top of the other, interlock your fingers with your palm facing outward, and push on the lower portion of the sternum along the nipple line with the heel of the palm of your hand. (See MIDDLE RIGHT Figure)
              o Compress the patient’s chest keeping your arms straight and using your body weight to push the chest approximately 2 inches for adults per compression. Count the number of compressions out loud. Remember, “Push hard, push fast!” Following the beat of the Bee Gee’s song “Stayin’ Alive” is a good guide. However, if you are not familiar with that song, remember that 100 compressions per minute is a little less than 2 per second.                                                                                                                   
6.   Have another person assist with compressions, positioning themselves on the other side of the unresponsive person. Rotate who performs the compressions every 100 compressions to avoid fatigue. 
       • If you are the only one on the scene, perform continuous compressions on your own until someone else arrives to assist you.
7.   Before applying the AED, cut the shirt off the patient to expose the chest.
       • Continue to perform compressions while the AED is being used. Only stop doing compressions when these instructions specifically tell you do to so.
8.   After a minimum of 200 compressions have been performed and after the AED arrives at the scene, turn on the AED by pressing the green “On” button.
       • If the AED fails to turn on, check to see if a functioning battery has been placed in the battery compartment. If the issue is a faulty battery, have someone retrieve one D battery and place it in the battery compartment on the backside of the AED, following the instructions in the graphic located inside the compartment. 
9.  Follow the voice prompts of the AED.
10.  Connect the defibrillation pads (located on the back side of the AED) to the AED by plugging the plug end of the pads into the connector outlet. Peel pads away from the holding surface and apply the pads to the locations of the patient shown on the pad (patient’s right shoulder and left side) with the sticky side down. (See BOTTOM LEFT Figure)
11.   Once the pads have been applied and are connected to the AED, a voice prompt will indicate that analysis has begun and will advise you to “Stand Clear” meaning that nobody should be touching the patient.
12.  While the AED is analyzing, temporarily stop doing compressions and have everyone remove their hands from the patient.
13.  If the AED’s voice prompt indicates that a shock is advised, continue doing compressions while the AED is charging.
       • When the AED’s voice prompt states that it is ready, assure that everybody is clear of (not touching) the patient.
       • When shock is ready, and after assuring that everyone is clear of the patient, press the shock button. (See BOTTOM RIGHT Figure)
       • After the shock has been delivered, immediately resume CPR with a sets of 100 compressions.
14.  If the AED’s voice prompt indicates that a shock is not advised, immediately begin another set of 100 compressions.
       • Perform compressions until the AED analyzes again and prompts you to “Stand Clear” (approximately 2 sets of 100 compressions). The AED will perform regular analyses on its own, so you do not need to press any buttons for it to do this.
15.  Continue to perform alternating sets of 100 compressions, and to perform shocks as advised and by the AED as outlined above until either the patient regains consciousness and starts breathing or trained medical professionals relieve you of your duty.