4. Standard Operating Procedure for Adult Respiratory Emergencies

The following steps represent the non-negotiable, standardized protocol for responding to an unresponsive, non-breathing adult. This procedure must form the core of all workplace first aid training programs to ensure a competent and confident response during a life-threatening emergency.

1. Assess Safety and Consciousness: First, ensure the scene is safe for both you and the victim. Check for consciousness by gently shaking the victim’s shoulders and asking loudly if they are okay. If there is no response, immediately call for emergency medical services (e.g., 112) or direct a specific bystander to do so.
2. Open the Airway: Place the victim on their back on a firm, flat surface. Use the “head-tilt, chin-lift” maneuver: place one hand on the victim’s forehead and two fingers from your other hand on the bony part of their chin. Gently tilt the head back and lift the chin to open the airway, preventing the tongue from blocking it.
3. Check for Breathing (Look, Listen, Feel): Place your ear close to the victim’s mouth and nose and for no more than 10 seconds:
   • Look for the rise and fall of the chest.
   • Listen for any breath sounds.
   • Feel for the victim’s breath on your cheek.
4. Administer Rescue Breaths: If the victim is not breathing normally, proceed immediately. Pinch the victim’s nose shut with the hand that was on their forehead. Take a normal breath (deep enough to fill your lungs) and place your mouth over the victim’s, creating a complete seal. Deliver one steady breath for about 1 second, watching to confirm that the chest rises.
5. Repeat and Integrate with CPR: After the first breath makes the chest rise, remove your mouth and allow the chest to fall. Then, deliver a second rescue breath. After delivering the second rescue breath, immediately check for a pulse. If there is no pulse, begin the integrated Cardiopulmonary Resuscitation (CPR) cycle of 30 chest compressions followed by 2 rescue breaths. Compressions must be delivered to the center of the chest at a depth of 5-6 cm and a rate of 100-120 compressions per minute. This cycle must be continued without interruption.

This standard procedure is highly effective for adults, but it requires critical modifications when the victim is an infant.