What to do

1. 

   Danger. Before approaching the casualty, always make sure the area is safe.

2. 

   Response. Check if the casualty is responsive or unresponsive. As you approach them, introduce yourself and ask them questions to see if you can get a response. Kneel next to their chest and gently shake their shoulders, asking, ‘Are you OK?’, ‘Can you open your eyes?’.

   • If the casualty opens their eyes, or gives another gesture, they are responsive.
   • If they do not respond to you in any way, they are unresponsive and should be treated as quickly as possible.
   • If there is catastrophic bleeding (massive amounts of blood pouring, gushing, or spurting from a significant injury) this must be dealt with before moving on to the airway.
   • Treat catastrophic bleeding by applying direct pressure to the wound before managing their airway.  Call 999 or 112 for emergency help.
3. 

   Airway. Next, you need to check that the airway is open and clear. Open the airway by placing one hand on the forehead to tilt the head back and use two fingers from the other hand to lift the chin.

    

4. 

   Breathing. You now need to check if the casualty is breathing normally. Keep the airway held open, place your ear above their mouth and look down at their chest. Listen for sounds of breathing and see if you can feel their breath on your cheek. Watch to see if their chest moves. Do this for no more than 10 seconds.

   Please note:

   During the first minutes of cardiac arrest, about half of casualties will do something called 'agonal gasping'.  They can open their mouths, extend their neck and take usually slow, sometimes noisy gasps.  This is not normal breathing and, in a patient with no signs of life, is a sign of cardiac arrest.

   • If they are unresponsive and not breathing normally, you need to call 999 or 112 for emergency help and start CPR straight away. Ask a helper to find and bring a defibrillator (AED).
   • If they are responsive and breathing normally move on to circulation.
5. 

   Circulation. Once you have established that they are breathing normally, look and check for any signs of severe bleeding.

   • If they are bleeding severely you will need to control and treat the bleeding by applying direct pressure to the wound. Call 999 or 112 for emergency help.
   • If they are unresponsive and breathing normally but with no bleeding, put them in the recovery position and call 999 or 112 for emergency help.