CPR sequence—adult victim Implementation of the first three links in the chain of survival is crucial

to successful resuscitation in the dental environment. Survival from out-of-hospital SCA is most likely
when “good” BLS is administered and defibrillation occurs within 3 to 5 minutes of collapse. The
2010 Guidelines for BLS for healthcare providers has incorporated some significant changes. Once
the healthcare provider recognizes that the victim is unresponsive with no breathing or no normal
breathing (i.e., only gasping) the emergency response system (i.e., 9-1-1) should be activated. After
activation, rescuers should immediately begin CPR. Early CPR improves the likelihood of successful
resuscitation, and yet CPR is often not provided until the arrival of professional emergency
responders. Chest compressions are an especially critical component of CPR because perfusion
during CPR depends on these compressions. Therefore, chest compressions should retain the
highest priority and be the initial action when starting CPR in the adult victim of sudden cardiac
arrest. The phrase “push hard and push fast” emphasizes some of these critical components of chest
compression. High-quality CPR is important not only at the onset but throughout the course of
resuscitation. Defibrillation and advanced care should be interfaced in a way that minimizes any
interruption in CPR.

Step 1: RECOGNITION of unconsciousness.

Stimulate the victim by gently shaking the shoulders and shouting the victim’s name. Lack of
response to sensory stimulation establishes a diagnosis of unconsciousness. There are many possible
etiologies for the loss of consciousness , most of which do not lead immediately to respiratory and
cardiac arrest. However, prompt management of unconsciousness from any cause follows the
identical format—P→C→A→B. A differential diagnosis of unconsciousness is reached by assessing
patient response or lack of response to each of these steps.

Step 2: summon assistance and P—position the victim.

The rescuer will not want to treat the victim alone; therefore, assistance should be sought as soon as
unconsciousness is recognized. Members of the office emergency team should report to the scene of
the emergency, bringing with them the emergency drug kit, oxygen, and the AED. They should be
prepared to assist in any manner necessary. Because we have not yet determined whether cardiac
arrest has occurred, we do not yet require activation of the EMS system, just the dental office
emergency team, unless considered necessary by the treating doctor. The patient is placed into the
supine position—the head and chest of the victim are parallel to the floor with their feet elevated
slightly (10 degrees) to facilitate return of blood from the periphery. The contoured dental chair with
its back positioned parallel to the floor accomplishes this positioning.

Step 3: C—assessment of circulation and chest compression, if needed.

Studies have shown that both lay rescuers and healthcare providers have difficulty detecting a pulse.
Healthcare providers also may take too much time to check for a pulse. The healthcare provider
should take no more than 10 seconds to check for a pulse (e.g., carotid) and, if the rescuer does not
definitely feel a pulse within that time period, the rescuer should start chest compressions. Thirty
compressions are delivered rapidly, at a rate of at least 100 per minute, compressing the chest of an
adult at least 5 cm (2 inches) and allowing complete recoil of the chest after each compression.
Thirty compressions should take approximately 18 seconds. The technique of chest compression is
described more fully below.

Step 4: A—assessment and maintenance of airway.

The healthcare provider should use the head tilt–chin lift maneuver to open the airway of a victim
with no evidence of head or neck trauma (unlikely if the victim is in the dental chair). Although the
head tilt– chin lift technique was developed using unconscious, paralyzed adult volunteers and has
not been studied in victims of cardiac arrest, clinical and radiographic evidence as well as a case
series have shown it to be effective. The rescuer places one hand on the victim’s forehead and their
other hand on the bony prominence of the chin (symphysis). The head is extended backward,
stretching the tissues in the neck and lifting the tongue off the posterior wall of the pharynx
(Figure 30-6). Head tilt–chin lift is the single most important procedure in airway maintenance. Step

5: B—breathing. Step 5a: B—assessment of breathing and ventilation, if needed.

A cardiac arrest victim is not responsive. Breathing is absent or is not normal. Agonal gasps are
common early after sudden cardiac arrest and may be confused with normal breathing. Rescuers
should start chest compression immediately if an adult victim is unresponsive and is not breathing or
not breathing normally (i.e., only gasping).The previous recommendation of “look, listen, and feel for
breathing” to aid recognition is no longer recommended.

Step 5b: rescue breathing.

In the absence of effective respiratory movement, rescue breathing is started. Several techniques of
rescue breathing are discussed in Chapter 5; however, in this section only one—mouth-tomask
ventilation—is considered. Other techniques may also be used, but no technique of rescue breathing
is effective unless a patent airway is maintained throughout the ventilatory process. Most devices
employed in rescue breathing require advanced training. To perform mouth-to-mask ventilation,
head tilt–chin lift must be maintained. The mask is held in position with one or two hands as needed,
maintaining both an airtight seal and patent airway. The rescuer’s mouth is placed on the breathing
port of the mask and air is forced into the victim until the chest is seen to rise. Masks usually have a
one-way valve that directs exhaled air away from the rescuer. The rescuer positions himself or
herself at the victim’s side, enabling a lone rescuer to both give breaths and perform chest
compressions. The mask is placed on the victim’s face with the narrow portion over the bridge of the
nose and the wider part in the cleft of the chin (Figure 30-7). Seal the mask against the victim’s face:
using the hand that is closer to the top of the victim’s head, place the index finger and thumb along
the border of the mask while placing the thumb of the other hand along the lower margin of the
mask (Figure 30-8). The remaining fingers of the hand closer to the victim’s neck are placed along
the bony inferior border of the mandible, which is then lifted. Head tilt– chin lift is then performed
to establish a patent airway. While head tilt–chin lift is maintained, press firmly and completely
around the outside margin of the mask to obtain an airtight seal. Deliver air over 1 second to make
the victim’s chest visibly rise.

If breathing is absent or inadequate, two breaths are delivered with the chest visibly rising with each
breath. Effective rescue breathing is noted by expansion of the victim’s chest. In a normal adult, the
minimum volume of air should be 800mL/breath but need not exceed 1200mL/breath for adequate
ventilation. Exhalation is passive, with the rescuer removing his or her mouth from that of the victim,
taking in a breath of fresh air, and watching the chest fall. Following the delivery of two breaths in
the cardiac arrest victim, chest compression is immediately restarted
(30 compressions). This cycle is continued for 2 minutes, after which the pulse is rechecked. If an
apneic victim has a palpable pulse, it is necessary to continue with rescue breathing only (P→A→B).
In the adult victim, rescue breathing is delivered at a rate of one breath every 5 to 6 seconds (10 to
12 breaths per minute).

Step 6: defibrillation.

When cardiac arrest occurs in the dental office, the office emergency team will respond by attending
to the victim (check for pulse—not more than 10 seconds—then chest compressions, ventilations as
needed), while a second person activates EMS (i.e., calls 9-1-1), and another brings the AED, oxygen
cylinder, and emergency drug kit to the site of the emergency. Chest compressions and ventilations
are delivered at a ratio of 30:2, with compressions being delivered at a rate of “at least 100 per
minute” and a depth of compression of at least 5cm (2 inches) for the adult, allowing the chest to
recoil completely between compressions. All BLS providers should be trained to provide
defibrillation because VF is a common and treatable initial rhythm in adults with witnessed cardiac
arrest.123 For victims with VF, survival rates are highest when immediate bystander CPR is provided
and defibrillation occurs within 3 to 5 minutes of collapse.17,18,25,98,124,125 Rapid defibrillation is
the treatment of choice for VF of short duration, such as for victims of witnessed out-of-hospital
cardiac arrest, as would likely occur in the dental office environment. Performing chest compressions
while another rescuer retrieves and activates (turns on) the defibrillator improves the probability of
survival.126 After about 3 to 5  minutes of untreated VF, some animal models suggest that a period
of chest compressions prior to defibrillation may be of benefit.127 In 2 randomized controlled trials
in human adults with out-of-hospital VF/pulseless ventricular tachycardia (VT), a period of 1.5 to 3
minutes of CPR by EMS before defibrillation did not improve return of spontaneous circulation or
survival rates regardless of EMS response interval.128,129 Two other randomized controlled
trials130,131 also found no overall differences in outcomes. However, in these two studies
subgroups of patients with the EMS response interval intervals longer than 4 to 5 minutes showed
increased survival to hospital discharge with a period of CPR prior to defibrillation.130,131
Healthcare providers in facilities with AEDs available on-site should administer CPR until the AED
arrives. It should then be used as soon as it becomes available.132 CPR specifics—activating EMS
EMS should be activated after the pulse check, if not already done. Communities in the United States
use the emergency number 9-1-1.* Information given to the EMS dispatcher should include the
following: 1. Location of the emergency (with names of cross streets, if possible) 2. Number of
telephone from which the call is made 3. What happened (e.g., heart attack, seizure, accident) 4.
Number of persons who need help 5. Condition of the victim(s) 6. Aid being given to the victim(s) 7.
Any other information requested To ensure that EMS personnel have no more questions, the caller
should hang up only when told to do so by the EMS operator. If more than one rescuer is available,
one person is sent immediately to activate the EMS, returning with the emergency drug kit, oxygen,
and AED. Eisenberg et al.133 showed that the shorter the time interval between collapse and the
initiation of BLS and ACLS, the greater the likelihood of survival for the victim of cardiac arrest
(Table 30-4.) The likelihood of survival from out-of-hospital SCA decreases at a rate of between 7%
and 10% per minute from time of collapse to delivery of defibrillation.
Adult Basic Life Support 2020 International Consensus on Cardiopulmonary Resuscitation and
Emergency Cardiovascular Care Science With Treatment Recommendations

CPR SEQUENCE

1. Firm Surface for CPR

We suggest performing manual chest compressions on a firm surface when possible.
because this reduces the risks of shallow compressions attributable to performing CPR on a
soft surface. On the other hand, moving a patient onto a hard surface can be a major barrier
to CPR, and the importance of performing CPR on a firm surface needs to be weighed
against the likelihood of significant delay in providing CPR.
We suggest against moving a patient from a bed to the floor to improve chest compression
depth. In considering whether to transfer a patient from a hospital bed to the floor to
improve compression depth, the task force considered that the risks of harm (eg,
interruption in CPR, risk of losing vascular access for intravenous lines, and more confined
space) to the patient and resuscitation team outweighed any small improvement in chest
compression depth, leading to a weak recommendation against routine use of this practice.

2. Starting CPR ( C-A-B Compared with A-B-C)

We suggest commencing CPR with compressions rather than ventilation in adults with
cardiac arrest
n. For all outcomes, starting CPR with compressions resulted in faster times to key elements
of resuscitation (rescue breaths, chest compressions, completion of first CPR cycle
3. CPR Before Call for Help
We recommend that a lone bystander with a mobile phone should dial EMS, activate the
speaker or other hands-free option on the mobile phone, and immediately begin CPR with
dispatcher assistance, if required
4. Duration of CPR Cycles (2 Minutes Versus Other)
We suggest pausing chest compressions every 2 minutes to assess the cardiac rhythm
5. Check for Circulation During BLS
Outside of the ALS environment, where invasive monitoring is available, there are
insufficient data about the value of a pulse check while performing CPR. We therefore do
not make a treatment recommendation regarding the value of a pulse check

Part 5: Adult Basic Life Support 2010 American Heart Association Guidelines for
Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Basic life support (BLS) is the foundation for saving lives following cardiac arrest. Fundamental
aspects of BLS include immediate recognition of sudden cardiac arrest (SCA) and activation of the
emergency response system, early cardiopulmonary resuscitation (CPR), and rapid defibrillation with
an automated external defibrillator (AED). Initial recognition and response to heart attack and stroke
are also considered part of BLS

Activating the Emergency Response System

Emergency medical dispatch is an integral component of the EMS response. Bystanders (lay
responders) should immediately call their local emergency number to initiate a response
anytime they find an unresponsive victim. Because dispatcher CPR instructions substantially
increase the likelihood of bystander CPR performance and improve survival from cardiac
arrest, all dispatchers should be appropriately trained to provide telephone CPR instructions.
When dispatchers ask bystanders to determine if breathing is present, bystanders often
misinterpret agonal gasps or abnormal breathing as normal breathing. This erroneous
information can result in failure by 911 dispatchers to instruct bystanders to initiate CPR for
a victim of cardiac arrest. To help bystanders recognize cardiac arrest, dispatchers should
inquire about a victim’s absence of consciousness and quality of breathing (normal versus
not normal). Dispatchers should be specifically educated in recognition of abnormal
breathing in order to improve recognition of gasping and cardiac arrest. Notably, dispatchers
should be aware that brief generalized seizures may be the first manifestation of cardiac
arrest. Dispatchers should recommend CPR for unresponsive victims who are not breathing
normally because most are in cardiac arrest and the frequency of serious injury from chest
compressions in the nonarrest group is very low.
In summary, in addition to activating professional emergency responders, the dispatcher
should ask straightforward questions about whether the patient is conscious and breathing
normally in order to identify patients with possible cardiac arrest. The dispatcher should also
provide CPR instructions to help bystanders initiate CPR when cardiac arrest is suspected.
Because it is easier for rescuers receiving telephone CPR instructions to perform Hands-Only
(compression-only) CPR than conventional CPR (compressions plus rescue breathing),
dispatchers should instruct untrained lay rescuers to provide Hands-Only CPR for adults with
SCA. While Hands-Only CPR instructions have broad applicability, instances remain when
rescue breaths are critically important. Dispatchers should include rescue breathing in their
telephone CPR instructions to bystanders treating adult and pediatric victims with a high
likelihood of an asphyxial cause of arrest (eg, drowning). The EMS system quality
improvement process, including review of the quality of dispatcher CPR instructions
provided to specific callers, is considered an important component of a high-quality
lifesaving program.

1. Location of the emergency (with names of cross streets, if possible)

2. Number of telephone from which the call is made
3. What happened (e.g., heart attack, seizure, accident)
4. Number of persons who need help
5. Condition of the victim(s)
6. Aid being given to the victim(s)
7. Any other information requested
To ensure that EMS personnel have no more questions, the caller should hang up only when
told to do so by the EMS operator.

Adult BLS Sequence

The steps of BLS consist of a series of sequential assessments and actions, which are
illustrated in the new simplified BLS algorithm (Figure 1). The intent of the algorithm is to
present the steps of BLS in a logical and concise manner that is easy for all types of rescuers
to learn, remember and perform. These actions have traditionally been presented as a
sequence of distinct steps to help a single rescuer prioritize actions. However, many
workplaces and most EMS and in-hospital resuscitations involve teams of providers who
should perform several actions simultaneously (eg, one rescuer activates the emergency
response system while another begins chest compressions, and a third either provides
 ventilations or retrieves the bag-mask for rescue breathing, and a fourth retrieves and sets
up a defibrillator).

Part 3

Step 1: RECOGNITION of unconsciousness.

The necessary first step in the treatment of cardiac arrest is immediate recognition. Bystanders may
witness the sudden collapse of a victim or find someone who appears lifeless. At that time several
steps should be initiated. Before approaching a victim, the rescuer must ensure that the scene is safe
and then check for response. To do this, tap the victim on the shoulder and shout, “Are you all
right?” If the victim is responsive he or she will answer, move, or moan. If the victim remains
unresponsive, the lay rescuer should activate the emergency response system. The health care
provider should also check for no breathing or no normal breathing (ie, only gasping) while checking
for responsiveness; if the healthcare provider finds the victim is unresponsive with no breathing or
no normal breathing (ie, only gasping), the rescuer should assume the victim is in cardiac arrest and
immediately activate the emergency response system

If a victim is unconscious/unresponsive, with absent or abnormal breathing (ie, only gasping), the
healthcare provider should check for a pulse for no more than 10 s and, if no definite pulse is felt,
should assume the victim is in cardiac arrest.The benefit of providing CPR to a patient in cardiac
arrest outweighs any potential risk of providing chest compressions to someone who is unconscious
but not in cardiac arrest. It has been shown that the risk of injury from CPR is low in these patients

Step 2: summon assistance and P—position the victim.

After cardiac arrest is recognized, the Chain of Survival continues with activation of the emergency
response system and initiation of CPR. The prompt initiation of CPR is perhaps the most important
intervention to improve survival and neurological outcomes. Ideally, activation of the emergency
response system and initiation of CPR occur simultaneously. In the current era of widespread mobile
device usage and accessibility, a lone responder can activate the emergency response system
simultaneously with starting CPR by dialing for help, placing the phone on speaker mode to continue
communication, and immediately commencing CPR. In the rare situation when a lone rescuer must
leave the victim to dial EMS, the priority should be on prompt EMS activation followed by immediate
return to the victim to initiate CPR.

We suggest performing manual chest compressions on a firm surface when possible. because this
reduces the risks of shallow compressions attributable to performing CPR on a soft surface. On the
other hand, moving a patient onto a hard surface can be a major barrier to CPR, and the importance
of performing CPR on a firm surface needs to be weighed against the likelihood of significant delay in
providing CPR.

We suggest against moving a patient from a bed to the floor to improve chest compression depth. In
considering whether to transfer a patient from a hospital bed to the floor to improve compression
depth, the task force considered that the risks of harm (eg, interruption in CPR, risk of losing vascular
access for intravenous lines, and more confined space) to the patient and resuscitation team
outweighed any small improvement in chest compression depth, leading to a weak recommendation
against routine use of this practice.

Step 3: C—assessment of circulation and chest compression, if needed.

Recognition of cardiac arrest by healthcare providers includes a pulse check, but the importance of
not prolonging efforts to detect a pulse is emphasized.

Thus, healthcare providers are directed to quickly check for a pulse and to promptly start
compressions when a pulse is not definitively palpated

Healthcare providers are trained to deliver both compressions and ventilation. Delivery of chest
compressions without assisted ventilation for prolonged periods could be less effective than
conventional CPR (compressions plus ventilation) because arterial oxygen content decreases as CPR
duration increases. This concern is especially pertinent in the setting of asphyxial cardiac arrest.11
Healthcare providers, with their training and understanding, can realistically tailor the sequence of
subsequent rescue actions to the most likely cause of arrest. During manual CPR, rescuers should
perform chest compressions to a depth of at least 2 inches, or 5 cm, for an average adult while
avoiding excessive chest compression depths (greater than 2.4 inches, or 6 cm).

Step 4: A—assessment and maintenance of airway.

A patent airway is essential to facilitate proper ventilation and oxygenation. A healthcare provider
should use the head tilt–chin lift maneuver to open the airway of a patient when no cervical spine
injury is suspected. Airways can be used to maintain a patent airway and facilitate appropriate
ventilation by preventing the tongue from occluding the airway. Incorrect placement, however, can
cause an airway obstruction by displacing the tongue to the back of the oropharynx. The rescuer
places one hand on the victim’s forehead and their other hand on the bony prominence of the chin
(symphysis). The head is extended backward, stretching the tissues in the neck and lifting the tongue
off the posterior wall of the pharynx

5: B—breathing. Step 5a: B—assessment of breathing and ventilation, if needed.

Agonal breathing is characterized by slow, irregular gasping respirations that are ineffective
for ventilation. Agonal breathing is described by lay rescuers with a variety of terms
including, abnormal breathing, snoring respirations, and gasping. Agonal breathing is
common, reported as being present in up to 40% to 60% of victims of cardiac arrest. In
patients who are unresponsive, with absent or abnormal breathing, lay rescuers should
assume the patient is in cardiac arrest, call for help, and promptly initiate CPR. These 2
criteria (patient responsiveness and assessment of breathing) have been shown to rapidly
identify a significant proportion of patients who are in cardiac arrest, allowing for immediate
initiation of lay rescuer CPR.

Step 5b: rescue breathing.

In this trained population it is reasonable for both EMS and in-hospital professional rescuers to
provide chest compressions and rescue breaths for cardiac arrest victims. This should be performed
in cycles of 30 compressions to 2 ventilations until an advanced airway is placed; then continuous
chest compressions with ventilations at a rate of 1 breath every 6 to 8 seconds (8 to 10
ventilations per minute) should be performed. Care should be taken to minimize interruptions in
chest compressions when placing, or ventilating with, an advanced airway. In addition, excessive
ventilation should be avoided. Deliver each rescue breath over 1 second. Give a sufficient tidal
volume to produce visible chest rise

During the first minutes of sudden VF cardiac arrest, rescue breaths are not as important as chest
compressions, because the oxygen content in the noncirculating arterial blood remains unchanged
until CPR is started; the blood oxygen content then continues to be adequate during the first several
minutes of CPR. In addition, attempts to open the airway and give rescue breaths (or to access and
set up airway equipment) may delay the initiation of chest compressions. These issues support the
CAB approach of the 2010 AHA Guidelines for CPR which recommends starting with Chest
Compressions prior to Airway and Breathing). For victims of prolonged cardiac arrest both
ventilations and compressions are important because over time oxygen in the blood is consumed
and oxygen in the lungs is depleted (although the precise time course is unknown).

A) Mouth-to-Mouth
To provide mouth-to-mouth rescue breaths, open the victim’s airway, pinch the victim’s
nose, and create an airtight mouth-to-mouth seal. Give 1 breath over 1 second, take a
“regular” (not a deep) breath, and give a second rescue breath over 1 second. Taking a
regular rather than a deep breath prevents the rescuer from getting dizzy or lightheaded and
prevents overinflation of the victim’s lungs. The most common cause of ventilation difficulty
is an improperly opened airway, so if the victim’s chest does not rise with the first rescue
breath, reposition the head by performing the head tilt–chin lift again and then give the
second rescue breath
B) Mouth-to-Barrier
Some healthcare providerand lay rescuers state that they may hesitate to give mouth-to-
mouth rescue breathing and prefer to use a barrier device. The risk of disease transmission
C) Mouth-to-Nose and Mouth-to-Stoma
Mouth-to-nose ventilation is recommended if ventilation through the victim’s mouth is
impossible (eg, the mouth is seriously injured), the mouth cannot be opened, the victim is in
water, or a mouth-to-mouth seal is difficult to achieve
Give mouth-to-stoma rescue breaths to a victim with a tracheal stoma who requires rescue
breathing. A reasonable alternative is to create a tight seal over the stoma with a round,
pediatric face mask
D) Ventilation With bag and Mask
Rescuers can provide bag-mask ventilation with room air or oxygen. A bag-mask device
provides positive-pressure ventilation without an advanced airway;
It is most effective when provided by 2 trained and experienced rescuers. One rescuer opens
the airway and seals the mask to the face while the other squeezes the bag. Both rescuers
watch for visible chest rise.160,162 The rescuer should use an adult (1 to 2 L) bag to deliver
approximately 600 mL tidal volume163–165 for adult victims. This amount is usually
sufficient to produce visible chest rise and maintain oxygenation. The healthcare provider
should use supplementary oxygen (O2 concentration 40%, at a minimum flow rate of 10 to
12 L/min) when available.
E) Ventilation with supraglottic airway
Supraglottic airway devices such as the LMA, the esophageal-tracheal combitube and the
King airway device.
 Ventilation with a bag through these devices provides an acceptable alternative to bag-mask
ventilation for well-trained healthcare providers who have sufficient experience to use the
devices for airway management during cardiac arrest
F) Ventilation with an Advanced Airway
When the victim has an advanced airway in place during CPR, rescuers no longer deliver
cycles of 30 compressions and 2 breaths (ie, they no longer interrupt compressions to
deliver 2 breaths). Instead, continuous chest compressions are performed at a rate of at
least 100 per minute without pauses for ventilation, and ventilations are delivered at the
rate of 1 breath about every 6 to 8 seconds (which will deliver approximately 8 to 10 breaths
per minute).
G) Passive Oxygen Versus Positive-pressure oxygen during CPR
H) Cricoid Pressure

When an advanced airway (ie, endotracheal tube, Combitube, or laryngeal mask airway [LMA]) is in
place during 2-person CPR, give 1 breath every 6 to 8 seconds without attempting to synchronize
breaths between compressions (this will result in delivery of 8 to 10 breaths/minute). There should
be no pause in chest compressions for delivery of ventilations

Step 6: defibrillation.

Early Defibrillation With an AED After activating the emergency response system the lone rescuer
should next retrieve an AED (if nearby and easily accessible) and then return to the victim to attach
and use the AED. The rescuer should then provide high-quality CPR. When 2 or more rescuers are
present, one rescuer should begin chest compressions while a second rescuer activates the
emergency response system and gets the AED (or a manual defibrillator in most hospitals) (Class IIa,
LOE C). The AED should be used as rapidly as possible and both rescuers should provide CPR with
chest compressions and ventilations. Defibrillation Sequence ● Turn the AED on. ● Follow the AED
prompts. ● Resume chest compressions immediately after the shock (minimize interruptions).

All BLS providers should be trained to provide defibrillation because ventricular fibrillation is
a common and treatable initial rhythm in adults with witnessed cardiac arrest. For victims
with abnormal heart rhythm , survival rates are highest when immediate bystander CPR is
provided and defibrillation occurs within 3 to 5 minutes of collapse. Rapid defibrillation is
the treatment of choice for VF of short duration, such as for victims of witnessed out-of-
hospital cardiac arrest or for hospitalized patients whose heart rhythm is monitored.

Emergency medical dispatch is an integral component of the EMS response.

Bystanders (lay responders) should immediately call their local emergency
number to initiate a response anytime they find an unresponsive victim. We
recommend that a lone bystander with a mobile phone should dial EMS,
activate the speaker or other hands-free option on the mobile phone, and
immediately begin CPR with dispatcher assistance, if required. To help
bystanders recognize cardiac arrest, dispatchers should inquire about a
victim’s absence of consciousness and quality of breathing (normal versus not
normal). The dispatcher should also provide CPR instructions to help
bystanders initiate CPR when cardiac arrest is suspected. Dispatchers should
recommend CPR for unresponsive victims who are not breathing normally
because most are in cardiac arrest and the frequency of serious injury from
chest compressions in the nonarrest group is very low.

Answers to EMS 
1. Location of the emergency (with names of cross streets, if possible) 
2. What happened (e.g., heart attack, seizure, accident) 
3. Number of persons who need help 
4. EMS asks whether victim is conscious and breathing normally 
5. Recognition of cardiac arrest  
6. Dispatcher assisted CPR for laypersons 
7. Start of chest compressions 
8. EMS arrival 
To ensure that EMS personnel have no more questions, the caller should hang
up only when told to do so by the EMS operator.