Two Rescuer CPR

Assess

Assess the Scene
  • Determine 
    • If it is safe to help
    • Number of patients
    • if you will need additional assistance from EMS
    • What personal protective devices are readily available to you
Assess the Patient
  • Check the person for responsiveness
  • Tap on patient’s shoulder and shout “Are you okay?”
  • Look at the patient’s chest and face
  • Determine if the patient is breathing normally
    • Agonal breathing is NOT normal breathing and needs care
Activate EMS
  • Call 911 or direct a bystander to call 911 and return
  • Caller should give dispatcher patient’s location, details of emergency situation including how many patients are injured and what treatment is occurring 
  • Request AED machine, if available
Check Pulse
  • Primary checks for pulse (about 10 seconds)
  • Adult and Child
    • In the carotid artery in the neck
  • Infant
    • In the brachial artery, inside the upper arm
  • If unable to locate a pulse, do not waste valuable time searching, immediately begin CPR
  • Use the C-A-B Order

C-A-B Order

Rescuers should assume cardiac arrest has occurred when encountering adults who have collapsed or are found unconscious. Immediately call or have a bystander call 911 and begin CPR.  

Use the C-A-B (Compressions-Airway-Breathing) Order
  • Begin 30 Compressions
  • Open Airway with head tilt–chin lift and check breathing, AT THE SAME TIME
  • Give 2 rescue Breaths 

Adult 2 Rescuer CPR

Primary rescuer (ventilator) and secondary rescuer (compressor) begin CPR after determining responsiveness and checking for pulse. 
  • Secondary rescuer calls for a switch after ever 5 CPR cycles of 30 compressions, at a rate of 100-120 per minute, and 2 rescue breaths (about every 2 minutes)
  • Primary rescuer (at the head) finishes 2 rescue breaths, BEFORE moving into position to begin compressions
  • Switch should take no more than 10 seconds
  • Recheck pulse every 2 minutes
***If primary rescuer starts CPR alone, the secondary rescuer should take over compressions when he or she arrives

Primary (Ventilator) Rescuer
  • At the head of patient
  • Determines responsiveness
  • Checks pulse
  • Begins compressions
Secondary (Compressor) Rescuer
  • At the chest of patient
  • Activates EMS
  • Calls for switch (every 5 CPR Cycles)
  • Administers first 2 rescue breaths

Child and Infant 2 Rescuer CPR

Primary rescuer (ventilator) and secondary rescuer (compressor) begin CPR after determining responsiveness and checking for pulse.  
  • Secondary rescuer should call for a switch after every 10 CPR cycles of 15 compressions, at a rate of 100-120 per minute, and then 2 rescue breaths (about every 2 minutes)
  • Primary rescuer (at the head) finishes 2 rescue breaths, BEFORE moving into position to begin compressions
  • Switch should take no more than 10 seconds
  • Recheck pulse every 2 minutes
***If primary rescuer starts CPR alone, the secondary rescuer should take over compressions when he or she arrives

Primary (Ventilator) Rescuer
  • At the head of patient
  • Determines responsiveness
  • Checks pulse
  • Begins compressions
    • Child (under the onset of puberty): One hand on the breastbone (sternum)
    • Infant: 2 thumbs at the breastbone, under the nipple line, with hands encircling chest
Secondary (Compressor) Rescuer
  • At the chest of patient
  • Activates EMS
  • Calls for switch (every 5 CPR cycles)
  • Administers first 2 rescue breaths

Bag Valve Mask

If a bag-valve mask is available

  • Attach it to a source of oxygen (set at 12-15L/min)
  • If oxygen is not available remove the residual bag reservoir and use room air
  • Use the “C-E” or “2 thumbs up” technique to seal the bag valve to the patient’s face
  • Use remaining fingers from both hands to hold the jaw of the patient up to seal the mask
  • Squeeze the bag fully so that the patient’s chest rises.  
  • When the patient’s chest rises stop squeezing the bag to avoid over inflation and avoid the risk of forcing air into the stomach.  
  • Ventilate at 
    • 1 breath every 6 seconds for and adult
    • 1 breath every 6 seconds for a child or infant
  • If advanced air-way is in place, perform 1 breath every 6 seconds and avoid hyperventilating the patient
  • In some instances, an adult mask turned upside down can be used for an infant. 

If a bag-valve mask is NOT available or ineffective

  • Revert to using mouth to mask or face shield delivery method for rescue breaths