If you are alone and come across a child who is down, follow the steps below. If someone else is immediately available to assist, use the ‘Two Rescuer’ sequence.

Stay Safe: If you come upon a child who may need CPR, look around and make sure you and the child are in a safe place. If the child is in water or on a road, try to move the child to a safer area. If you are in a safe area, do not try to move the child as he/she may have other injuries that you cannot see. Simply roll him/her over onto his back. Make sure the child is on a firm surface, in case compressions are needed.

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Assess the Victim: To quickly assess the victim, shake his shoulder and yell at him. Check for breathing. If he/she is not breathing, or is not breathing normally (i.e., only gasping), shout for help. Activate the Emergency Response System and Find an AED: Yell for help. If someone responds, tell him/her to call for help by dialing 9-1-1. If you are in an area where an AED may be available, tell him/her to go find the AED. Make sure you tell the person to return to assist you as soon as possible. If you are alone and witnessed the child collapse, call for help by dialing 9-1-1 and run to get the AED if you know where one is nearby. If you do not know where an AED is, begin CPR immediately after dialing 9-1-1.

Begin CPR

1. Check for a pulse on the side of the neck. Feel for a pulse for at least 5 seconds but NO MORE THAN 10 seconds. To check for a carotid pulse, slide 2 or 3 fingers into the groove between the traches (windpipe) and the neck muscles at the side of the neck. Alternately, you can check for a pulse in the femoral artery located in the groin. To do this, place two fingers in the inner thigh, part way between the pubic bone and the hip bone, just below the crease where the leg joins the abdomen. Remember, do not feel for a pulse for more than 10 seconds.
2. If there is no pulse or the pulse is less than 60 /minute with signs of poor perfusion* (or if you are unsure if there is a pulse), begin CPR starting with chest compressions. Provide 30 chest compressions, followed by two breaths. NOTE: If you are not comfortable giving rescue breathing and/or you do not have a mask available, do ‘Compression Only’ CPR.
   1. Use the heel of one hand on the lower half of the breastbone in the middle of the chest.
   2. Place the other hand on top of the first hand.
   3. Straighten your arms and lock your elbows so that your body weight is over your hands.
   4. The most important part of CPR is to remember to push HARD and FAST. Each compression should be one-third the depth of the chest or approximately two inches deep and the rate should be 100-120 compressions per minute.
   5. Be sure to let up on the pressure on the sternum after each compression (chest recoil) so the chest can re-expand and blood can flow back into the heart. The purpose of CPR is to help the blood flow through the heart and into the rest of the vital organs; if you allow the chest to fully re-expand, more blood will flow into the heart and will be available to deliver to the rest of the body.
   6. Count out loud as you do compressions. When you have done 30 compressions, try to open the victim’s airway by doing a head tilt/chin lift. Note that if you are doing ‘Compressions Only’ CPR, you can skip this step.
      1. With your non-dominant hand, push on the victim’s forehead to tilt the head back.
      2. With your dominant hand, place your fingers under the bony part of the lower jaw and gently lift the jaw to bring the chin forward. Be sure you lift up on the bony part of the jaw and not the soft tissue under the jaw so you don’t block the victim’s airway. Do not use your thumb to lift the jaw. Allow the victim’s mouth to remain slightly open.
      3. If you think the person’s neck may be injured, avoid the head tilt/chin lift and use the jaw thrust maneuver if you have been trained to do so. Instructions for performing a jaw thrust are provided later in the unit.
   7. If you have a barrier device to use between your mouth and the child’s face, use it. Although the risk of infection from performing CPR is very, very low, it is recommended to use a barrier device when providing CPR. This includes the use of face masks. Give each breath slowly – each breath should last one second. Make sure the chest rises with each breath. Repeat, giving a second breath.
   8. Start another cycle of chest compressions. Remember, push HARD and FAST. Alternate chest compressions (30) and breaths (2) until help arrives.

*Signs of poor perfusion: this refers to a lack of blood flow that results in certain visible signs, including pale skin color or bluish discoloration of the skin. Fingers, earlobes, lips and nail beds may look bluish or light gray. Sometimes there may be mottling, which is a mixture of a purplish or blotchy red-blue coloring on the extremities (arms or legs).

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