Introduction

This chapter contains the guidelines for out-of-hospital, single rescuer, adult basic life support (BLS). Like the other guidelines in this publication, it is based on the document 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations (CoSTR), which was published in October 2010. Basic life support refers to maintaining airway patency and supporting breathing and the circulation without the use of equipment other than aprotective device. It is important that those who may be present at the scene of a cardiac arrest, particularly lay bystanders, should have learnt the appropriate resuscitation skills and be able to put them into practice. Simplification of the BLS sequence continues to be a feature of these guidelines, but, in addition, there is now advice on who should be taught what skills, particularly chest-compression-only or chest compression and ventilation. Within this advice, allowance has been made for the rescuer who is unable or unwilling to perform rescue breathing, and for those who are untrained and receive

telephone advice from the ambulance service. Guidelines 2000 introduced the concept of checking for ‘signs of a circulation’. This change was made because of the evidence that relying on a check of the carotid pulse to diagnose cardiac arrest is unreliable and time-consuming, mainly, but not exclusively, when attempted by non-healthcare professionals.9 Subsequent studies have shown that checking for breathing is also prone to error, particularly as agonal gasps are often misdiagnosed as normal breathing.10 In Guidelines 2010 the absence of normal

breathing continues to be the main sign of cardiac arrest in a non-responsive victim. Once cardiopulmonary resuscitation (CPR) has started, it is now recommended that the rescuer should only stop CPR if the victim shows signs of regaining consciousness, such as coughing, opening his eyes, speaking, or moving purposefully, as well as breathing normally.