Adult Hands-Only CPR Training Protocol:

For Adult Hands-Only CPR (cardiopulmonary resuscitation) training, instructors must explain the
following material:

● Definition of cardiac arrest:

○ Define cardiac arrest as the termination of heart’s ability to pump blood
○ Explain that it can be caused by a variety of mechanisms: such as a heart attack,
overdose, drowning, and underlying heart structural defects
○ Explain that cardiac arrest can happen to anyone, at any time, without any warning
● Definition of CPR:
○ Define CPR as providing chest compressions to pump oxygen to vital organs until the
heart can be restarted to beat on its own.
○ Explain CPR as a necessity for a victim to have any chance of surviving a cardiac arrest
● Definition of defibrillation:
○ Define defibrillation as shocking the heart in the hope of resetting electrical abnormalities
that cause the cardiac arrest
● Hands-only CPR vs. conventional CPR
○ Emphasize that compressions are by far more important than breathing for the patient
during cardiac arrest. This is especially true for witnessed arrests, where the victim still
has oxygen in their blood.
○ Explain that bystanders performing conventional CPR focus too much on breathing for a
victim, and not enough on providing chest compressions. Furthermore, the breaths they
do give are often inadequate.
○ Highlight that hands-only CPR has a higher survival rate than conventional CPR when
performed by bystanders
● Recognizing cardiac arrest
○ Describe the criteria of cardiac arrest
■ A victim needs CPR if they are unresponsive and not breathing
■ A victim needs CPR if they are unresponsive and agonal breathing, or “gasping”
for air with pauses in between
■ A victim may shake around for a few seconds before going unconscious and
either not breathing or agonal breathing. They still need CPR if they do not begin
breathing again.
○ Emphasize that a bystander should not try to feel for a pulse as many get it wrong and
withhold CPR incorrectly, and they may waste valuable time trying to find a pulse
○ Explain that a bystander should not worry about injuring a victim. Injuries sustained
from CPR are treatable, organ damage from prolonged lack of oxygen is not.
○ Explain that a bystander need not worry about litigation for incorrectly performing CPR.
Good Samaritan laws are in-place to prevent this.
○ Highlight that a bystander should not worry about touching a female's chest if they need
CPR. Many bystanders withhold CPR from females that need it for fear of
touching/exposing their chest.
 ○ Summarize that the risk of withholding CPR when needed outweighs the risk of injuring
someone who receives unneeded chest compressions.

● Performing Hands-Only CPR

○ Describe the importance of checking for scene safety prior to entering an emergency
scene
○ Explain that bystanders should direct someone to call 911. If no one is around, they
should call and put their phone on speaker so that both hands are free to perform CPR -
this is important to get help quickly and because the dispatcher can help with CPR
○ Explain that if the bystander determines the victim is in cardiac arrest and needs CPR,
they should do the following:
■ Attempt to re-position the victim so that they are lying on their back on a hard,
flat surface
■ Position themselves at the side of the victim so that they are perpendicular to the
center of the victim’s chest
■ Ensure they are in a “tall-kneel” position
■ Place the heel of one hand on the center of the victim’s chest, on the sternum /
breastbone and between where the victim’s nipple line would usually be
■ Place their other hand on top of the first hand
■ Ensure elbows are locked
■ Ensure arms are perpendicular to the surface of the patient’s chest
■ Begin administering compressions at a rate of around twice per second, or about
110 BPM
● Suggest using the beat of “stayin’ alive” or “baby shark”
■ Compress as hard as they can, at least 2 inches
■ Fully recoil after each compression
○ Explain that bystanders, if in a public place, should direct someone else in the area to try
and find an AED (refer to AED protocol)
○ If it is not possible to reposition the patient safely:
■ If the patient is lying face down (prone), it is reasonable to attempt CPR on the
back. Place hands on the middle of the back just below the shoulder blades, then
perform compressions as described above.
■ If the patient cannot be moved to their back or prone position, the bystander will
need to wait for more help to arrive. If possible, recruit other bystanders to move
the patient and begin CPR.
■ If it isn’t possible to do CPR but AED pads can be correctly applied, this should
be done. (This scenario is probably quite rare).
● When to stop CPR
○ Explain criteria for stopping CPR:
■ If bystander becomes too tired to continue and there is no one to switch-off
compressions with, or the scene becomes unsafe
■ If a higher-trained health-care providers assumes patient care
■ If the victim begins to moan, push them away, or breathe normally
During training, the following statistics can be quoted:

● Sudden cardiac arrest is the 3rd leading cause of death in the USA and kills 356,000 annually.
● The average EMS response time in the USA is 8 minutes.
● Every one minute a cardiac arrest victim does not receive CPR, survival drops by 10%.
● Pushing .5 inches shallower than 2 inches decreases survival by 23%
● Males receive 6% more CPR in public than females, and have a 7.5% higher chance of survival.
● Bystander conventional CPR has a 9.4% survival to discharge rate, whereas bystander hands-only
CPR has a 11.5% survival to discharge rate.
● 70-80% of out-of-hospital cardiac arrests happen at home.