Perhaps the most frightening thing for a rescue worker is to have a victim's heart stop. CPR, which stands for cardio pulmonary resuscitation, is the technique that has been developed for a first aid provider in that unenviable position.

Some unpleasant CPR facts: One should remember that CPR is almost never successful. When a victim's heart is restarted, it is usually due to the arrival of more professional equipment, for example, a defibrillator, which electrically shocks the heart into starting again. (These are familiar to most people who watch ER as those paddles that Carter got shocked with, and as those things whose use is usually proceeded by the word "CLEAR!") Also, in the course of CPR, the victim's ribs are almost invariably broken. This is why the Good Samaritan Act is so important; if you break someone's ribs in trying to save their life, they can't survive and sue you for your college tuition. Of course, we must not forget that the Good Samaritan Act is only in effect if you are Officially Certified!! (Hint: Get certified; buddy, because if you're not, you're outta luck.)

CPR (Cardio Pulmonary Resuscitation)

CPR-Adult Victim

If, during the primary survey, you determine that the victim is not breathing, give 2 slow breaths, and then determine that the victim has no pulse, you must begin CPR.

Correct Hand Position: First, kneel next to the victim's chest. Find the notch at the tip of the breastbone where the lower ribs meet the sternum, called the xyphoid process. Remember, if you push directly down on this puppy, you will likely rupture the victim's liver and perhaps a few other vital organs, and all the CPR in the world couldn't help him then. Place your middle finger on this notch, and place your index finger down next to your middle finger. That way, you are at least a good two fingers away from the xyphoid danger spot. Next, place the heel of your other hand on the victim's sternum next to your index finger. Place your other hand directly on top and interlace your fingers. Straighten your arms and lock your elbows. Your shoulders should be directly over your hands. Each chest compression should push the sternum down 1 1/2-2 inches.

Count aloud("one and two and three..." etc.) as you do the compression, maintaining a smooth, steady rhythm. When you give breaths, be sure to open the victim's airway with a head tilt and a chin lift.

Do cycles of 15 chest compressions and 2 slow breaths.

After 4 continuous cycles, check for a pulse. If there is no pulse, continue CPR, beginning with chest compressions and rechecking for a pulse every few minutes. If you do find a pulse, check for breathing. If the victim has a pulse but is not breathing, go to Rescue Breathing.

CPR-Child Victim

If, during the primary survey, you determine that your child victim is not breathing, give 2 slow breaths, and determine that the victim has no pulse, you must begin CPR.

Correct Hand Position: First, kneel beside the victim's chest. Find the notch where the lower ribs meet the sternum, called the xyphoid process. Remember; don't ever push directly down on it!! If you don't remember why, go over Adult CPR until you never forget. With your middle finger, place your index finger down next to your middle finger, and place the heel of the same hand directly above where you had your index finger. Place your other hand gently on the child's forehead to maintain an open airway. Lock your elbow and push straight down, with your shoulder directly over your hand. Each compression should push the sternum down 1-1 1/2 inches. Count aloud ("one and two and three..." etc.) as you do the compressions, maintaining a smooth, steady rhythm. When you give breaths, be sure to open the victim's airway with a head tilt and a chin lift.

Do cycles of 5 chest compressions and 1 slow breath.

After you do CPR for 1 minute (about 12 cycles), check for a pulse. If there is no pulse, continue CPR, beginning with chest compressions and rechecking for a pulse every few minutes. If you find a pulse, check for breathing. If the victim has a pulse but is not breathing, go to Rescue Breathing.

CPR-Infant Victim

If, during the primary survey, you determine that your infant victim is not breathing, give 2 slow breaths, and determine that the victim has no pulse, you must begin CPR.

Correct Hand Position: First, kneel beside the infant, placing one hand on his or her head to maintain an open airway. Imagine a line across the infant's chest between the infant's nipples. Place your index finger on the sternum just below this imaginary line; then, place the pads of the next two fingers on the sternum next to your index finger. If you can feel the notch where the lower ribs meet the sternum, called the xyphoid process, move your fingers up a little bit. Remember why? Good. Raise your index finger, and use the pads of the two fingers next to your index finger to compress the infant's chest 1/2-1 inch. Maintain a smooth steady rhythm while doing compressions. Be sure to do a very slight head tilt and chin lift to open the airway when giving breaths.

Do cycles of 5 chest compressions and 1 breath.

After 1 minute of continuous CPR (about 12 cycles), check the brachial pulse. If there is no pulse, continue CPR, beginning with chest compressions and rechecking for a pulse every few minutes. If you find a pulse, check for breathing. If the victim has a pulse but is not breathing, go to Rescue Breathing.

When to Stop CPR

• if another trained person takes over CPR for you
• if more advanced medical personnel take over
• if you are exhausted and unable to continue
• if the scene becomes unsafe
• if the victim's heart starts beating