Hands-only CPR

1. Check that it is safe for you to go close. Tap the person on the shoulder and shout loudly, asking if they are all right.
2. If they do not respond and are not breathing, or are only gasping, shout for help and call for an ambulance, or ask someone else to. Put the phone on speaker so that you can listen to the operator while your hands are busy.
3. If someone is with you, ask them to fetch a defibrillator (AED) if there is one nearby.
4. Lay the person flat on their back on a firm surface, such as the floor, and kneel beside their chest.
5. Place the heel of one hand on the middle of the chest, on the lower half of the breastbone. Put your other hand on top and interlock your fingers. Lean forward so that your shoulders are directly above your hands, and keep your arms straight.
6. Push down hard and fast, about 5 to 6 centimetres each time, at about 100 to 120 presses a minute, which is roughly two every second. Let the chest rise fully between presses.
7. Do not stop. Keep going until the ambulance team takes over, the person starts to move, cough or breathe normally, or you are too tired to carry on. If someone else is there, swap every minute or two, with as short a pause as you can.
8. When a defibrillator arrives, switch it on and follow its instructions exactly.

What not to do:

• Do not wait to see whether the person recovers by themselves. Call and start straight away.
• Do not stop to feel for a pulse. Only health professionals are asked to do this.
• Do not press on the chest of someone who is awake, breathing normally, coughing or moving.
• Do not shake the person or move their neck.
• Do not lean on the chest between presses. Let it come fully back up each time.
• Do not stop pressing for longer than you have to, for example to change places.

CPR (cardiopulmonary resuscitation) is for someone whose heart or breathing has stopped. Gasping, where a person gulps for air, is not normal breathing, so treat it as no breathing. If a person does not respond and is not breathing normally, treat it as a possible cardiac arrest.

If the person answers you, moves on purpose or is breathing normally, they do not need chest compressions. Stay with them, watch their breathing and arrange medical help.

A defibrillator, also called an AED (automated external defibrillator), is a machine that checks the heart's rhythm and gives a shock only if one is needed. Use it as soon as you can. The machine decides whether a shock is needed, not you.

• Switch it on and follow its instructions exactly.
• Bare the chest so that the pads can be stuck on. Thin clothing does not need to come off for chest compressions alone, but it does for a defibrillator.
• Carry on with chest compressions while the pads are being put on.

There may not be a defibrillator close by. Chest compressions on their own are still worth doing.

For an adult who has suddenly collapsed, chest compressions on their own are very effective and are the recommended way for a bystander to give CPR. India's guideline for ordinary bystanders, called compression-only life support, rests on the same idea, and it notes that many people are hesitant to give mouth-to-mouth breaths.

If you have been trained in full CPR and are willing to give breaths, the usual pattern is two rescue breaths after every 30 presses. Someone who has drowned needs breaths too, so trained rescuers give them. Not having training is no reason to hold back from pressing on the chest.

This guide is for adults and older teenagers. Babies and children are different. When a child's heart stops, the cause is usually a problem with breathing, so they usually need rescue breaths as well as chest compressions. How deep to press, and with how many hands or fingers, also changes with size.

If a baby or child collapses, call for an ambulance, or ask someone to, and put the phone on speaker. The operator can talk you through what to do while you work. If anyone nearby has first aid training, ask them to take over.

If you look after babies or young children, a first aid course that includes baby and child CPR is the best way to learn the steps before you ever need them.