BASIC LIFE SUPPORT

Basic life support (BLS) is the level oI medical care which is used Ior patients with liIe-
threatening illnesses or injuries until the patient can be given Iull medical care at a hospital. It
can be provided by trained medical personnel, including emergency medical
technicians,paramedics, and by laypersons who have received BLS training. BLS is generally
used in the pre-hospital setting, and can be provided without medical equipment.
Many countries have guidelines on how to provide basic liIe support (BLS) which are Iormulated
by proIessional medical bodies in those countries. The guidelines outline algorithms Ior the
management oI a number oI conditions, such as cardiac arrest, choking and drowning. BLS
generally does not include the use oI drugs or invasive skills, and can be contrasted with the
provision oI Advanced LiIe Support (ALS). Most laypersons can master BLS skills aIter
attending a short course. FireIighters and police oIIicers are oIten required to be BLS certiIied.
BLS is also immensely useIul Ior many other proIessions, such
as daycare providers, teachers and security personnel.
CPR provided in the Iield increases the time available Ior higher medical responders to arrive
and provide ALS care. An important advance in providing BLS is the availability oI
the automated external deIibrillator or AED. This improves survival outcomes in cardiac
arrest cases.
Basic liIe support consists oI a number oI liIe-saving techniques Iocused on the medicine
"ABC"s oI pre-hospital emergency care:
Airway: the protection and maintenance oI a clear passageway Ior gases (principally oxygen
and carbon dioxide) to pass between the lungs and the atmosphere.
Breathing: inIlation and deIlation oI the lungs (respiration) via the airway
Circulation: providing an adequate blood supply to tissue, especially critical organs, so as to
deliver oxygen to all cells and remove metabolic waste, via the perIusion oI blood
throughout the body.
Healthy people maintain the ABCs by themselves. In an emergency situation, due to illness
(medical emergency) or trauma, BLS helps the patient ensure his or her own ABCs, or assists in
maintaining Ior the patient who is unable to do so. For airways, this will include manually
opening the patients airway (Head tilt/Chin liIt or jaw thrust) or possible insertion oI oral
(Oropharyngeal airway) or nasal (Nasopharyngeal airway) adjuncts, to keep the airway
unblocked (patent). For breathing, this may include artiIicial respiration, oIten assisted by
emergencyoxygen. For circulation, this may include bleeding control or Cardiopulmonary
Resuscitation (CPR) techniques to manually stimulate the heart and assist its pumping action.

BLS IN THE UNITED STATES
BLS in the United States is generally identiIied with Emergency Medical Technicians-Basic
(EMT-B). However, the American Heart Association's BLS protocol is designed Ior use by
laypeople, certiIied Iirst responder, EMT-B, and to some extent, higher medical Iunctions. It
includes cardiac arrest, respiratory arrest, drowning, and Ioreign body airway obstruction
(FBAO, or choking). EMT-B is the highest level oI healthcare provider that is limited to the BLS
protocol; higher medical Iunctions use some or all oI the Advanced LiIe Support (ALS)
protocols, in addition to BLS protocols.
The algorithm Ior providing basic liIe support to adults in the USA was published in 2005 in the
journal Circulation by the American Heart Association (AHA).
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The AHA uses Iour-link "Chain oI Survival" to illustrate the steps needed to resuscitate a
collapsed victim:
Early recognition oI the emergency and activation oI emergency medical services
Early bystander CPR, so as not to delay treatment until arrival oI EMS
Early use oI a deIibrillator
Early advanced liIe support and post-resuscitation care
Bystanders with training in BLS can perIorm the Iirst 3 oI the 4 steps.
Basic LiIe Support 2011 Guideline
Steps in resuscitation are now DRS ABCD - Check Ior anger
- Check Ior Response
- S` has been added Ior Send Ior help
- A` directs rescuers to open the Airway
- B` directs rescuers to check Breathing but no need to deliver rescue breaths
- C` directs rescuers to perIorm 30 Compressions to patients who are unresponsive and not
breathing normally, Iollowed by 2 rescue breaths
- ` directs rescuers to attach an AED as soon as it is available and Iollow prompts
The major change is that in the patient who is unresponsive and not breathing normally, CPR
commences with chest compressions rather than rescue breaths. II unwilling / unable to perIorm
rescue breathing, then perIorm compression only CPR, as any attempt at resuscitation is better
than no attempt and should be encouraged.

ADULT BLS SEQUENCE
Ensure that the scene is saIe.
Assess the victim's level oI consciousness by asking loudly "Are you okay?" and by checking
Ior the victim's responsiveness to pain (AVPU).
Activate the local EMS system by instructing someone to call 9-1-1. II an AED is available, it
should be retrieved and prepared.
II the victim has no suspected cervical spine trauma, open the airway using the head-tilt/chin-
liIt maneuver; iI the victim has suspected neck trauma, the airway should be opened with
the jaw-thrust technique. II the jaw-thrust is ineIIective at opening/maintaining the airway, a very
careIul head-tilt/chin-liIt should be perIormed.
Assess the airway Ior Ioreign object obstructions, and iI any are visible, remove them using
the Iinger-sweep technique. Blind Iinger-sweeps should never be perIormed, as they may push
Ioreign objects deeper into the airway.
Look, listen, and Ieel Ior breathing Ior at least 5 seconds and no more than 10 seconds.
II the patient is breathing normally, then the patient should be placed in the recovery
position and monitored and transported; do not continue the BLS sequence.
II patient is not breathing normally, and the arrest was witnessed immediately beIore
assessment, then immediate deIibrillation is the treatment oI choice.
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Attempt to administer two artiIicial ventilations using the mouth-to-mouth technique, or
a bag-valve-mask (BVM). The mouth-to-mouthtechnique is no longer recommended, unless a
Iace shield is present. VeriIy that the chest rises and Ialls; iI it does not, reposition (i.e. re-open)
the airway using the appropriate technique and try again. II ventilation is still unsuccessIul, and
the victim is unconscious, it is possible that they have a Ioreign body in their airway. Begin chest
compressions, stopping every 30 compressions, re-checking the airway Ior obstructions,
removing any Iound, and re-attempting ventilation.
II the ventilations are successIul, assess Ior the presence oI a pulse at the carotid artery. II a
pulse is detected, then the patient should continue to receive artiIicial ventilation's at an
appropriate rate and transported immediately. Otherwise, begin CPR at a ratio oI 30:2
compressions to ventilation's at 100 compressions/minute Ior 5 cycles.
AIter 5 cycles oI CPR, the BLS protocol should be repeated Irom the beginning, assessing the
patient's airway, checking Ior spontaneous breathing, and checking Ior a spontaneous pulse.
Laypersons are commonly instructed not to perIorm re-assessment, but this step is always
perIormed by healthcare proIessionals (HCPs). II an AED is available aIter 5 cycles oI CPR, it
should be attached, activated, and (iI indicated) deIibrillation should be perIormed. II
deIibrillation is perIormed, 5 more cycles oI CPR should be immediately repeated beIore re-
assessment.
BLS protocols continue until (1) the patient regains a pulse, (2) the rescuer is relieved by
another rescuer oI equivalent or higher training (See Abandonment), (3) the rescuer is too
physically tired to continue CPR, or (4) the patient is pronounced dead by a medical doctor.
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At the end oI Iive cycles oI CPR, always perIorm assessment via the AED Ior a shockable
rhythm, and iI indicated, deIibrillation, and repeat assessment beIore doing another Iive cycles.
The CPR cycle is oIten abbreviated as 30:2 (30 compressions, 2 ventilation's or breaths). Note
CPR Ior infants and children uses a 15:2 cycle when two rescuers are perIorming CPR (but still
uses a 30:2 iI there is only one rescuer). Two person CPR Ior an inIant also requires the "two
hands encircling thumbs" technique Ior the rescuer perIorming compressions.