It is essential that nutrients taken into the body are converted into energy, which is required by all organs within the body. The brain must receive a constant supply of air; after three to four minutes of deprivation, brain function will begin to fail, consciousness will be lost, breathing and heartbeat will eventually arrest and death may result.

Three elements are involved in getting air to the brain. The air passage or 'Airway' must be open so air can enter the body. 'Breathing' must take place so the air can enter the blood and the blood must travel around the body ('Circulation').

The processes of breathing and circulation are described in later sections; this section tells the Healer what they can do to assist a casualty whose breathing and/or heart has stopped. The techniques used to sustain life in the absence of spontaneous breathing and a heartbeat are known as CardioPulmonary Resuscitation or CPR for short.

Assessment of the Casualty

On reaching a casualty, you must assess whether you or the patient is in danger and whether they are conscious or not. After acting appropriately to remove any inherent dangers you should question the patient if conscious. If unconscious, you should immediately check the airway, breathing and circulation using this aide memoire:

'A' is for Airway

An unconscious casualty's airway may be narrowed or blocked, making breathing difficult and noisy, or impossible. The most likely reason being is that muscular control in the throat is lost, which allows the tongue to sag back and block the throat. Place two fingers under the point of the casualty's chin, lift the jaw. At the same time, place the other hand on the casualty's forehead and tilt the head back. Tilting the casualty's head back and lifting the chin will open the airway, lifting the casualty's tongue from the back of the throat so that it does not block the passage. Sometimes this simple action can restore breathing. If not, check inside the mouth for any obstructions, removing them. If head or neck injuries are suspected, handle the head carefully and tilt it only enough to open the airway.

'B' is for Breathing

You should put your face close to the casualty's mouth and look, listen and feel for breathing. Look for chest movements, listen for breathing sounds and feel for the breath on the cheek. Do this for five seconds before deciding breathing is absent.

'C' is for Circulation

If the heart is beating adequately it will generate a pulse in the neck ('carotid' pulse) where the main carotid arteries pass up to the head. These arteries lie on either side of the larynx, between the Adam's apple and the 'strap muscle' that runs from behind the ear across the neck to the top of the breastbone. With the head tilted back, feel for the Adam's apple with two fingers on one side. Slide the fingers to one side into the gap between the Adam's apple and the strap muscle and feel for the carotid pulse. Feel for five seconds before deciding the pulse is absent.

You should be prepared to act on your findings. The following points are useful to remember in these situations:

Start artificial ventilation and chest compressions.

Give artificial ventilation.

Treat any life-threatening injury and then place in the casualty in the recovery position.

Treat as appropriate.

The Recovery Position

Any unconscious casualty should be placed in the recovery position as this prevents the tongue from blocking the throat and allows fluids to drain safely from the mouth, thus reducing the risk of the patient inhaling stomach contents. If a you have to leave an unconscious patient, ensure that the patient is in the recovery position. The following steps assume the casualty is lying on their back. Not all the steps will need to be performed if they are lying on their side or front. Before turning remove any spectacles and bulging items from their pockets.

Kneeling beside the casualty, open their airway by tilting and lifting the chin. You should then straighten the casualty's legs and place the arm nearest you at right angles to the body, elbow bent and with the hand palm uppermost. The arm furthest away should be placed across the chest and you should hold the hand, palm outwards, against the casualty's nearer cheek. Next, the thigh most distant to you should be grasped and the knee pulled up, keeping the foot flat to the ground. Roll the casualty over towards you, using the knee as a lever and protecting the casualty's head with a hand held against their cheek. Your knees can be used as a rest to ensure the casualty doesn't roll too far or too fast. Tilt the head back to make sure the airway stays open and adjust the hand under the cheek, if necessary, so that the head stays in a tilted position. Adjust the upper leg, if necessary, so that both the hip and the knee are bent at right angles.
If the patient is suffering from spinal injuries or has a broken limb, more people may be required to turn them, using blankets and pillows as supports where necessary.

Artificial Ventilation

If a casualty has stopped breathing but still has a pulse, ten breaths of artificial ventilation should be given, before assessing any other conditions present. Artificial ventilation should continue at the rate of ten breaths per minute, until the casualty begins to breathe on their own. Check for a pulse after every ten breaths.

If both the breathing and pulse are absent, you must combine artificial ventilation with chest compressions. A later section on CPR explains this.

Mouth-to-Mouth Ventilation

With the casualty lying flat on their back, first remove any obvious obstruction from the mouth. Open the airway by tilting the head and lifting the chin as described earlier. Close the casualty's nose by pinching it between your index finger and thumb. Then take a full breath and place your lips around the casualty's mouth making a good seal. Blow into the casualty's mouth until the chest is seen to rise. It takes about two seconds for full inflation. After removing your lips from the casualty's mouth, you should allow the chest to fall fully. Deliver subsequent breaths in the same manner.

If the chest does not rise:
If you are unsuccessful in getting breaths into the chest, then you should check that the head is tilted back far enough, there is a firm seal around the casualty's mouth, the nostrils have been closed completely and that the airway is not obstructed by vomit, blood or a foreign body. To remove obstructions from the mouth, sweep a finger around the inside of the mouth. Be careful to avoid the back of the throat if doing this to a young child.

If this fails, treat as for choking.

Other Forms of Artificial Ventilation

In situations such as rescue from water or where mouth injuries make a good seal impossible, you may employ the mouth-to-nose method of artificial ventilation. Here, ensure the mouth is closed and then make a tight seal over their nose with your mouth. It may be necessary to open the mouth to let the breath out. In the water, give two breaths every fifteen seconds. This will give you time to tow the casualty to shore.

Restoring the Circulation

If there is no pulse, the heart has stopped. The Healer must provide an artificial circulation by performing chest compressions which will send blood to the brain. To be of any use to the brain, the blood must be aerated and thus must be combined with artificial ventilation in the way laid out in the section on CPR.

With the casualty lying flat on their back, kneel beside them and find one of their lowest ribs using your index and middle fingers. Then, slide your fingers upwards to the point in the middle, where the rib margins meet at the breastbone. Next, place your middle finger over this point and your index finger on the breastbone (sternum) above, before placing the heel of your other hand on the breastbone. Then slide it down until it reaches your index finger. This is the point for applying pressure. The heel of the first hand is placed on top of your other hand and the fingers interlocked. Leaning well over the casualty with arms straight, press down vertically on the breastbone to depress it approximately one and a half to two inches, before releasing the pressure; do not remove your hands. The pushing down on the breastbone causes pressure changes within the chest that expel blood from the heart chambers. As the pressure is released, the chest rises and replacement blood is 'sucked' in to refill the heart. Fingers should be kept clear of the chest so that the pressure is not applied over the ribs. Some Healers find it helpful to count 'one and two and…' to keep time. Repeat the compressions and aim for a rate of approximately eighty compressions per minute.

The Sequence of CPR

When a casualty has no pulse and is not breathing, you must combine artificial ventilation with chest compressions. The sequence is known as CPR or CardioPulmonary Resuscitation. Two people are optimal at the scene of such an incident, because when the first becomes tired, the second can take over. Also if on is untrained, it is possible in this time interval for the first Healer to show them. It is not recommended for two people to work on resuscitation of a casualty at the same time, unless they have been trained to do so and have worked previously as a team.

For One Healer

Open the casualty's airway by tilting and lifting the chin and give two breaths of artificial ventilation. Then move your hands to the casualty's chest and give fifteen chest compressions. Return to the head and give two more ventilations. Give further fifteen compressions. Do not interrupt breathing to check circulation unless there are signs of returning circulation, such as decreasing blueness (cyanosis) of the lips. If a pulse is confirmed, check breathing and if still absent continue with artificial ventilation. Check the pulse after after every ten breaths and be prepared to restart chest compressions if it disappears. Once they start to breath themselves, place in the recovery position and re-check the breathing and pulse every three minutes until the casualty is stabilized.

For Two Healers

Whilst one gives one breath of air, the other should give five chest compressions. Pause to ensure that the casualty's chest rises but don't wait for it to fall before continuing with chest compressions.

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