CPR & First Aid curriculum

Before you touch anyone, look for whatever hurt them, because it may still be active. A downed wire or gas leak can injure you next, and then responders have two people to save. A quick scan also tells you how many people are hurt and what likely happened, which is what a dispatcher will ask about.

Each of these can injure a rescuer who rushes in. Traffic calls for a safe place to stop, a wire or gas leak calls for the utility or fire service, and a violent scene calls for police. Beginners often go straight to the person and miss the danger, so if you cannot make the scene safe, stay back and call for trained help.

The order exists so you do not lose time or become a victim yourself. You size up the scene and the person, bring in emergency services, then start the care you are trained to give. When someone else is nearby, calling and care happen at once, so the sequence sets priorities and does not force a pause.

Tap the shoulder firmly and call out a question such as "Are you all right?" An answer or a deliberate movement counts as a response. A gasp, a gurgle or a brief jerk does not, because a person in cardiac arrest can still do those. Be brisk: this is a quick check, and if there is no real response you look at breathing right away instead of repeating it.

Location comes first, because a dropped call can still bring help if the address is known. Then say what happened, how many people are hurt, and whether each person is awake and breathing. Stay on the line until told to hang up: dispatchers often have more questions and can talk you through care.

In a crowd, a general "someone call 911" often means nobody does, since each person assumes another will. Point at one person, describe them, and give one task: "You in the red jacket, call 911." Send a different person for the AED, and ask them to come back and confirm, so you know it happened.

CPR takes both hands, so a phone at your ear forces a choice between talking and compressing. Put it on speaker and set it near the person's head. A lone rescuer with a phone then does not have to leave the person, and the dispatcher can count aloud and correct what you are doing.

Dispatchers are often trained to spot a likely cardiac arrest from the caller's description, then explain where to put the hands and how to keep pushing. This matters because a caller who might otherwise just wait can start moving blood before crews arrive. You do not need a certificate to follow these instructions.

The idea is that survival depends on a series of steps, each weak without the one before. Someone recognizes the arrest and calls, compressions keep blood moving, a shock can restore a rhythm, advanced care follows, and recovery continues long after the hospital. The earliest links happen before professionals arrive, so they rest with bystanders.

This first pass looks only for what can kill within minutes. A person who is unresponsive and not breathing normally needs CPR, and heavy bleeding needs firm pressure now. Beginners lose time on a visible but minor injury, such as a deformed arm, while missing the quiet problem: someone who has stopped breathing.

Only when immediate dangers are under control do you gather details. Ask what happened and about allergies, medicines and medical conditions, and look for a medical alert tag. Then work logically from head to toe for injuries the person may not have noticed. If a life threat appears during this check, stop and deal with it.

On the back, the tongue can block the throat and vomit can pool and be inhaled. Rolling the person onto their side lets fluids drain from the mouth and keeps the airway more open. It is only for someone breathing normally: a person who is not breathing needs CPR on their back, and you keep checking because breathing can stop.

Moving a person with a possible neck or back injury could worsen damage to the spinal cord, so you usually leave them where they lie. Immediate danger, such as fire or rising water, changes that, and so does a need for CPR that cannot be done in place. A life threat outweighs the injury risk, so move them, supporting the head and neck if you can.

A person's condition can change without warning, and someone who is breathing now may stop. Stay with them, keep rechecking whether they respond and breathe normally, and note any change and when it happened. If breathing stops, start CPR. A common mistake is treating the call for help as the end of your job.

Crews need what they cannot see: what you found, when it started, what you did, and how the person changed. Give times if you know them, such as when someone collapsed or whether an AED gave a shock. Keep going until a trained responder clearly takes over, rather than stopping the moment they walk in.

A responsive adult who can make decisions has the right to accept or decline help. Say who you are, what you think is wrong and what you would like to do, then ask. Permission may be a simple nod. Touching someone who has said no can create legal exposure as well as distress, even when your intent is to help.

The law generally presumes that a person who cannot answer would want life-saving help, so you may act without permission. Teaching usually extends this to someone too confused or impaired to decide. The presumption ends if the person wakes and refuses, so keep talking to them and explain what you are doing as they come around.

A child generally cannot give legal consent, so you ask a parent or guardian if one is there. With no guardian available and a real emergency, you treat consent as implied and act, rather than delaying to find one. Rules on older minors vary by state, so teaching focuses on this simple split.

A responsive adult who can make decisions may decline care even when you think it is a bad choice. You cannot force it, but you can still call emergency services and wait close by, since the person may change their mind or lose consciousness. If they do become unresponsive, consent is then implied and you can act.

These state laws generally shield a volunteer from liability for honest mistakes made while helping in an emergency. Common conditions are that you act in good faith, stay within your training, avoid gross negligence, meaning reckless disregard for safety, and do not expect payment. Details differ by state, but most cover ordinary bystanders, so having no certificate is not a reason to hold back.

In most US settings, an ordinary passerby has no general legal duty to start first aid, though some states add exceptions. A duty can arise from a job, such as lifeguard, EMT or designated workplace responder, or from a relationship, as with a parent and child. If a job includes first aid, the expectation comes with the role.

Abandonment means leaving a person who still needs help after you have begun care, without handing them to someone of equal or higher training. You may stop if a qualified responder takes over, the scene turns dangerous, or you are physically exhausted. Beginners sometimes worry this forbids stopping at all, and it does not.

Blood can carry infections such as hepatitis B, hepatitis C and HIV, so you treat all blood and body fluids as potentially infectious, whoever the person is. Disposable gloves, eye protection, and a mask or barrier device for breaths put a layer between you and the exposure. If exposure happens, wash the area and get it checked promptly.

A few simple items cover most needs: gloves protect your hands, gauze and bandages held with tape cover a wound, wipes clean the skin, scissors cut, and a short guide reminds you how. A workplace kit should also reflect the injuries likely there. The common failure is neglect, so someone needs to check it on a schedule, replace old stock, and keep it where people can reach it.

Helping in an emergency is frightening, and afterward a rescuer may replay it, sleep or concentrate poorly, or swing between worry, low mood and irritability. These are expected responses and not a sign of having done something wrong, and for most people they ease as time passes. When they linger or get in the way of work or home life, professional help is the usual step.

These two signs are enough, so you do not need a diagnosis before acting. Usually the person has dropped suddenly, does not react when you shake and shout, and is either not breathing or only gasping. Starting CPR on someone who turns out not to be in arrest carries far less risk than waiting on someone who is.

Gasping or gurgling, called agonal breathing, comes from reflexes in a failing brain and moves little air. It can look reassuring, and beginners may read it as a sign the person is breathing. Treat it as no breathing: call for help and begin compressions right away.

Feeling for a pulse is harder than it looks, especially under stress, and people often miss one that is there or feel one that is not. Time spent searching is time with no blood flow, so the decision rests on response and breathing instead. If the person does not respond and is not breathing normally, start CPR without hunting for a pulse.

Watch the chest and face for normal breathing as you look for a response, rather than as a separate long step. Long checks are a common beginner error: the rescuer hopes to see something while blood flow stays at zero. If you cannot tell whether breathing is normal, treat it as not normal and start. Courses set a short time limit on this check, and uncertainty is never a reason to use more of it.

In a heart attack, a blocked artery cuts blood to part of the heart muscle, and the person is usually awake with the heart still beating. In sudden cardiac arrest, a rhythm problem stops the heart from pumping, and the person collapses. A heart attack can trigger an arrest, so call 911 for both, and start CPR and get an AED as soon as the person is unresponsive and not breathing normally.

Stack the second hand over the first and bring your shoulders above them with straight arms, so your body weight does the work instead of your arm muscles. Hands set too low or off to one side do less and can cause more damage. The middle of the chest puts the force over the breastbone, and it is close enough to start: do not lose time hunting for a perfect spot.

Aim for a steady pace. Too slow and too little blood moves; too fast and the heart has less time to refill between pushes, and the chest may not rise fully. Nervous rescuers tend to speed up or drift, which is why pacing gets so much attention in training. Keep the rhythm constant rather than pushing in bursts.

Depth is what squeezes blood out of the heart, and shallow compressions are a very common error, since pushing this hard feels wrong to a beginner. Lock your elbows and use your body weight so your arms do not tire as quickly. Push straight down rather than at an angle, which wastes force.

The heart refills while the chest rebounds, so each release is part of the work. If you stay pressed down, less blood returns and the next compression has less to pump. Keep your hands in contact with the chest, but take your weight off it completely before the next push.

Leaning is a habit of tired rescuers: weight stays on the chest between pushes, often without their noticing. Pressure inside the chest stays high and less blood flows back into the heart, which leaves less for the next compression. Check that your weight lifts off each time, and swap out if you are too tired to do this.

On a mattress or couch, some of your push sinks the bed instead of squeezing the chest, so the real depth can be less than it feels. A firm surface is better, and a floor beats a bed. Even so, do not hold off starting while you look for one: begin at once where the person lies, as long as they are on their back.

Blood flow drops almost immediately when compressions pause, and it takes several pushes to build pressure back up. Breaths, pad placement and rescuer swaps are the usual culprits, so plan them to take little time. Keep a pause within the limit your training sets, and resume before doing anything else.

This measure is how teams judge interruptions: of the total minutes of an arrest, compressions should fill as much as possible. A crew can push perfectly and still do poorly if pauses add up. The goal is a high share, and current training gives the target figure.

Depth and recoil fade before the rescuer feels tired, so do not wait until someone says they need a break. When a second person is present, trade places at the interval your training sets and make the switch fast. If you are alone, keep going as well as you can until help arrives.

Compressions move the oxygen already in the blood and breaths refill it, so this pattern balances the two. It is for rescuers with training. Someone without training who is helping a teen or adult can skip the breaths and keep pushing. Keep the pause brief, since little blood moves while breaths are being given.

Chest rise is your feedback that air reached the lungs, and more than that adds nothing. If the chest does not rise, reposition the head rather than blowing harder. Long, forceful breaths raise pressure in the chest, can push air into the stomach, and stretch the pause in compressions.

Air that does not go to the lungs can go down the esophagus, the tube to the stomach. A stomach full of air presses up against the lungs and makes vomiting more likely, which can block the airway. Too much ventilation also raises pressure in the chest and reduces blood return to the heart, so gentle breaths work better.

In an unresponsive person the tongue and soft tissues fall back and can block the throat. Tilting the head back and lifting the chin pulls them forward so air can reach the lungs. Then you pinch the nose closed and check that the chest rises. If it does not rise, poor positioning is the first thing to fix.

A barrier reduces contact with saliva and other fluids, and a one-way valve keeps exhaled air going in the right direction. A rescuer needs to practice with the device, because a poor seal leaks air and wastes time. If you have none and do not want to give breaths, compressions alone are still far better than no CPR at all.

It means compressions with no breaths, which removes both the skill barrier and the reluctance some people feel about mouth-to-mouth. Blood still holds some oxygen early in a sudden arrest, so circulating it is the priority. Push on the center of the chest until help arrives or normal breathing returns. A child needs breaths as well, but if you cannot give them, pushing still beats doing nothing.

An asphyxial arrest is one caused by lack of oxygen, so the blood is already low in oxygen when the heart stops. Compressions alone then circulate blood with little oxygen left in it. That is why drowning, a breathing failure and most child arrests call for both compressions and breaths if you are trained and able to give them. If you cannot give breaths, still push.

Signs of life include normal breathing, purposeful movement or a response. Otherwise keep going, since you cannot judge at the scene who can be saved. A rescuer is not expected to endanger themselves or go beyond their physical limit, and stopping for those reasons is not a failure.

A pregnant person in cardiac arrest gets CPR and an AED like any other adult, because the fetus depends entirely on the mother's circulation. Beginners sometimes hesitate for fear of harming the pregnancy, and that delay is the larger danger. Tell the dispatcher about the pregnancy, since it changes the advanced care the crew will prepare.

Adequate depth can crack ribs or the breastbone, particularly in older adults, and you may feel or hear it. Rib injuries heal, while stopped compressions mean no blood flow. If you feel a crack, check your hand position and continue. Fear of hurting someone is a common reason people push too gently.

Outside a hospital, roughly nine in ten cardiac arrests end in death, frequently within minutes, and late treatment is a big reason why. Someone already on the scene is the only person who can close that gap, by calling 911, starting CPR and using an AED. About half of these arrests hit people with no known heart problem, so you cannot tell in advance who will need this help.

Age bands exist because body size and arrest causes change, so technique changes with them. Exact age often is not known in an emergency, and you do not need it. Judge by size and apparent development, and avoid delaying care to decide. Once puberty has started, adult technique applies.

Children's hearts are usually healthy, so arrest most often follows breathing failure from something like choking, drowning or a severe respiratory illness. By the time the heart stops, oxygen in the blood is already low. That is why breaths are part of the sequence for a child, though if you cannot give them, compressions alone still beat doing nothing.

Using a proportion instead of a fixed figure scales the push to the child, since a toddler and a ten-year-old differ so much in size. Picture the chest from front to back and aim to compress about a third of that distance. Beginners often go too shallow, out of fear of hurting a small body.

An infant's chest is small and flexible, so a push that would be shallow on an adult can be deep enough here. Depth is taught as a proportion of the chest rather than by feel alone, and manikins with feedback help you learn it. Courses give the figure; without one in mind, still press firmly, since timid pushes move little blood, and a dispatcher can coach you.

The goal is reaching the right depth, not following a fixed hand count. A small child may need just one hand, with the other kept free to hold the head position. A larger child or a smaller rescuer may need two hands, as on an adult. If one hand is not reaching depth, add the second.

An adult hand position does not fit an infant, so training teaches a smaller contact point at the center of the chest, just below an imaginary line between the nipples. Pressing too low risks the soft upper belly. The recommended hand and finger method has been revised over time, so learn the one your current course shows. Without that training, follow the dispatcher and do not wait.

Provider-level courses give more breaths relative to compressions when two trained people work on a child, because oxygen is usually the underlying problem and a second rescuer can deliver breaths quickly. One person compresses and the other manages the airway. Use the ratio from current training, and do not apply it to a single lay rescuer.

A child's arrest usually starts with low oxygen, so early breaths and compressions take priority over a slightly earlier call. If you have a phone, you avoid the choice entirely: call on speaker while you start. If you must leave, courses set how long that first period lasts; do not skip it, then go, and consider carrying a small child with you.

A sudden collapse in an adult usually means an electrical heart problem, and a shock is the treatment that can reverse it. With no one else around and no phone, you go for help and an AED before starting; with a phone, call on speaker and start at once. A witnessed sudden collapse in a child follows the same logic, since it also suggests a heart rhythm problem.

An infant has a large head and a soft windpipe, so tilting the head far back, as on an adult, can narrow the airway instead of opening it. The goal is a gentle position with the face looking straight up. If the chest does not rise with a breath, adjust the head slightly and try again.

An infant's lungs hold very little, so an adult-sized breath overfills them. Use a small puff from your cheeks and stop when the chest starts to rise. You often cover the mouth and nose together, since both are so close. Extra air goes to the stomach, where it can cause vomiting and press on the lungs.

A baby just born is moving from fluid-filled lungs to breathing air, so the problem is nearly always lack of breathing instead of a heart rhythm. Care therefore focuses on warming, stimulating and getting air into the lungs. A lay rescuer present at a birth should call 911 and follow the dispatcher's instructions.

These causes share an upstream problem: oxygen delivery fails before the heart does. Severe asthma or a respiratory infection is a common route in, and so is an obstructed airway. Because the decline is often gradual, a child may be helped well before arrest, which is why spotting distress early matters.

Look for hard work to breathe, such as the skin pulling in between the ribs, flaring nostrils or grunting. A blue tint around the lips and unusual drowsiness or confusion mean oxygen is running short. Children can compensate for a time and then worsen fast, so call for help early. A child who turns quiet and drowsy is not improving.

Several things change with a child, such as depth, hand position and the need for breaths, but the speed of the pushes does not. That leaves one rhythm to learn, so you do not adjust your tempo for age. Put your attention on depth and full recoil, which are the elements that really do depend on size.

A child's chest rebounds easily, but only if you let it. Keeping weight on the chest between pushes limits how much blood returns to the heart, just as in an adult. With one hand or a small contact point it is easy to stay pressed down without noticing, so consciously lift your weight off after each push.

The need to spot an arrest, get help and use an AED holds at every age, and so does the pace of compressions. What changes is the contact point, how deep you push, how much air you give, how central breaths are, and for a lone rescuer with no phone, when to leave to call. When unsure of age, acting with imperfect technique beats not acting.

Many childhood emergencies can be headed off before CPR is ever needed. Safe sleep means a firm, flat, level surface and no soft bedding or toys that could smother a baby. Constant adult attention near water, a fence or gate around a pool, and locked storage for medicines and chemicals work the same way: they stop the event itself.

Child pads, where the device has them, reduce the energy delivered to suit a small body. Not having them should not stop you, because a shock with adult pads beats no shock for a child in a shockable rhythm. Make sure the pads do not touch; on a small chest this may mean one on the front and one on the back.

Tell the crew when the child collapsed or stopped responding, what came before it, such as choking, a fever or a fall, and what you have done so far. Known conditions, allergies and medicines also help, and a caregiver may have these. Because the cause often shapes treatment, a short and accurate timeline is very useful.

The device makes the rhythm decision, so you never have to read a heart tracing yourself. That takes much of the fear out of using one. A semi-automatic unit tells you to press a button to give the shock, while a fully automatic one gives it on its own after warning you to stand clear.

In ventricular fibrillation the lower heart chambers quiver without pumping, and in pulseless ventricular tachycardia they beat too fast to move blood. A shock halts that abnormal activity so a normal rhythm can return. A heart with no electrical activity at all is not helped by a shock, so the AED will advise continuing CPR.

The voice instructions walk you through each step, so pressing the power button first means you are guided from the beginning. Beginners sometimes try to recall the steps from memory or search for the pads first, and lose time. Turn it on, listen, and do what it says, including when it tells you to stop compressions.

Delay lowers the chance that a shock will work, so finishing a cycle of compressions first is not a reason to wait. With two rescuers, one keeps pushing while the other bares the chest and puts the pads on. Once the pads are on, compressions stop only when the device tells you to.

This diagonal placement puts the heart between the pads, so the current crosses it. The pads usually show a picture of where each one goes, so use it if you forget. A common error is putting the side pad too far forward on the front of the chest, instead of around on the ribs below the armpit.

Current follows the easiest path, so touching pads send it between them and away from the heart. This is mostly a risk on a small chest, where two adult pads may overlap. When the chest is too small to keep them apart, one pad goes on the front and the other on the back.

Movement and contact can add electrical noise that the device may misread, so analysis works best on a still body. Stop compressions when prompted, step back, and tell others to do the same. This pause is necessary, but it is brief: be ready to start pushing the moment the device says so.

The shock can pass into anyone touching the person, so you check with your eyes and also say it out loud, such as "Everyone clear." Look along the length of the body for hands, and for someone still giving breaths. Both steps are quick, and a busy scene makes it easy to miss someone's hand.

A heart that has just been shocked rarely pumps well right away, so it still needs your help. A no-shock message does not mean the person is fine, only that the rhythm is not one a shock can treat. In either case return to compressions at once unless the person shows signs of life, and let the device prompt its next check.

Child pads, or a key or switch on some AEDs, lower the energy the device delivers to suit a smaller heart and body. Devices differ, so read the pad package and the machine's prompts. The age or weight cut-off comes from the device and your current training. A reduced dose is a preference, since a full dose still beats no shock.

A manual defibrillator lets a trained provider set the energy, so it comes first when a provider has one. Most lay rescuers will not, so a dose-reducing AED is the realistic choice, and an AED without one still comes ahead of no shock at all. Shockable rhythms are uncommon in infants, but when one is present, a shock is what treats it.

If an AED has no child pads, adult pads are acceptable, since a shockable rhythm needs a shock whatever the person's size. Beginners may hesitate because the pads look too big or the energy sounds too high, and that delay does more harm. Keep the pads from touching, and if needed place one on the front and one on the back.

On a small chest the usual pad sites may put the pads too close together or overlapping. Placing one on the center of the chest and the other between the shoulder blades, called anterior-posterior placement, keeps them apart and puts the heart between them. Medical teams may also use it on adults, but on a small child it is the practical fix.

Water conducts electricity, so pooled water or a soaked chest can divert the current away from the heart and toward a rescuer. Move the person to a drier spot if they are lying in water, and wipe the chest before the pads go on, since pads also need dry skin to stick. Rain alone is not a reason to hold off.

Pads need skin contact, and thick hair can hold them away so the device reports a poor connection. Press down hard first. If the message continues, pull those pads off to remove hair and apply a spare set, or shave the spot if a razor is in the kit. Do not waste time searching for a razor.

A patch under a pad can block the current or cause a burn, and the medicine on it can reach your skin, so use gloves or a cloth if they are handy. Peel it off, wipe the area, and put the pad on the cleaned spot. Do this quickly, since a patch is no reason to delay the shock.

Some people have a small device under the skin of the upper chest that can pace the heart or shock it. A pad placed over it can block part of the shock, so shift the pad to the side of the bump. An implanted defibrillator may deliver its own shock, which should not stop you from using the AED if the person remains in arrest.

What matters is the electrical path, so a pad should not sit on metal, and nobody should be touching the person. A necklace or a bra underwire can stay as long as the pad does not touch it, and an AED can generally be used on a metal surface. Beginners lose time removing items that do not matter.

The battery and pad electrodes are what let the machine read a rhythm and give a shock, so neither is optional. A device can sit on a wall for years, so someone must own the job of checking its status and expiry dates and swapping parts. Replacements should be approved accessories made for that model.

This steady loss is why a bystander's first minutes count for so much, since waiting for a crew can use up most of the window. Compressions slow the loss by keeping some blood moving until a shock can be given, so neither one should wait for the other. Courses may quote a rate of decline, but the working point is simple: start now.

A second person goes for the device while you keep pushing, because compressions are the only blood flow the brain is getting. When it arrives, keep compressing while someone else turns it on and places the pads, and stop only when told. If you are alone and an AED is within easy reach, get it and use it at once; if it is not, stay and push.

Busy public sites such as arenas, transit hubs, campuses and workplaces keep a unit close enough to reach before a crew arrives. These public models are built for people with little training and talk the user through each step. A device helps only if people can find it, so posted signs point the way, and some workplaces build it into their first aid plan.

Air is still moving, and a strong cough is the best tool for clearing the object, so let it work. Most people with a partial block get it out themselves. Stay with them and watch closely. A weakening cough or failing speech means the block has become severe, and your approach changes.

Striking the back of someone who can still cough may shift the object and seal an airway that was partly open. So rescue steps wait until the airway is fully blocked or the cough has failed. The urge to do something is strong, and here the useful action is to encourage, watch and be ready, then act at once if the cough fades or the person cannot breathe.

With little air moving, the cough weakens or makes no sound, the person cannot answer, and breathing may sound high-pitched or stop. The universal sign, hands clutching the throat, is a strong clue. This is the point to act at once, because the brain cannot go long without oxygen.

A question such as "Are you choking?" sorts out the two situations: someone who can answer still has air moving, and someone who can only nod or shake their head likely does not. It also works as a quick request for permission. Other illnesses can look similar, so the answer helps you pick the right response.

Support the chest with one arm and lean the person forward, so a dislodged object moves toward the mouth and not deeper. Each blow should be a separate, forceful attempt to clear the object, rather than a pat. Beginners tend to hit too softly. Stop as soon as the person can breathe or cough forcefully.

Standing behind the person, you place a fist just above the navel and well below the breastbone, grasp it with the other hand and pull sharply. The thrust raises pressure under the diaphragm and forces air from the lungs, working like an artificial cough. Hands set too high can injure the ribs or organs beneath them.

Switching techniques gives you a new chance to move an object that did not move with the first approach. Keep alternating, stopping only if the object comes out, the person starts to breathe or cough forcefully, or they collapse. Courses set the count per set, but forgetting it is no reason to pause. A failed first attempt is not a reason to stop.

Some courses start with back blows, while others have led with thrusts or used them alone, since the techniques combine in more than one accepted way. The shared principle matters more than the order: act fast, keep repeating, and move to CPR if the person goes unresponsive. If you are trained, use what you were taught; if not, a firm attempt beats waiting to recall the right order.

If you cannot get your arms around the waist, or the abdomen is enlarged by late pregnancy, pushing on the belly is ineffective or risky. The fist moves up to the center of the breastbone and you pull straight back. The goal is the same: a sudden rise in chest pressure that drives air upward.

Lock the wheels first so force does not push the chair away. You may be able to reach around from behind, or you may need to kneel or work around the chair's back. Some chairs make that hard, and moving the person to the floor usually takes help. Do not give up on the technique because the setup looks awkward.

The infant lies face down along your forearm with the jaw supported, so gravity helps and the slaps land between the shoulder blades. You then turn the baby face up, still with the head low, and give thrusts on the breastbone. Keep alternating until the object comes out or the baby stops responding, then start CPR. Courses set the count per set, but forgetting it is no reason to pause.

Contraindicated means a treatment should be avoided because it can do harm. An infant's liver and other belly organs are large for the body and poorly protected by the ribs, so a thrust there can injure them. Back slaps and chest thrusts are the taught alternatives. Under stress a rescuer can reach for the adult move, so this one is worth drilling.

Support the person down to avoid a fall and call for help if no one has. Begin with compressions, which raise chest pressure and may move the object, so they serve two purposes. Continue as for any arrest, adding a look in the mouth before breaths, and do not go back to thrusts while the person is unresponsive.

After compressions the object may have moved up to where you can see it. A quick look takes almost no time and can change what you do next, since a visible object can be removed and breaths will then work. If nothing is visible, give the breaths and carry on. Do not lengthen the pause to search deeply.

A finger sweep means running a finger through the mouth in hope of finding something. Done blind, it can push the object deeper and turn a partial blockage into a complete one, and it can injure the throat. The risk is greater in infants and small children because their airways are so narrow. If you can see it and reach it, lift it out.

A person choking alone has no one to thrust for them, but the same mechanism still works. They can put a fist above the navel and pull in and up with the other hand, or lean hard over a firm edge so it presses the same spot. A forceful cough can help too. Dial 911 if a phone is within reach, though clearing the airway cannot wait for the call.

Thrusts can injure organs or ribs even when they work, and a person may feel fine at first. Someone who received abdominal or chest thrusts should be seen by a health professional afterward. The same goes for a lingering cough, trouble breathing or a sense that something is still stuck, since a piece may have stayed behind.

Young children are especially at risk, and round or firm foods such as grapes, nuts and hot dogs fit an airway closely, as do toy parts and coins. Cut food small, have a child sit to eat, and keep small objects out of reach. Running or playing while eating adds risk because attention is not on chewing.

Context is the first clue: choking tends to start suddenly during eating or play. Anaphylaxis, a severe allergic reaction, may follow a food, sting or medicine and can bring throat swelling and wheezing, so a meal does not rule it out. Asthma often brings wheezing and coughing in someone with a known history. Each needs a different response, and all can need 911.

With another person present, send them to call while you start, so nothing waits. Alone with a phone, put it on speaker and act while you call, since the obstruction will not wait either. A person who keeps choking or goes unresponsive always needs emergency help, and so does anyone who needed thrusts and still has symptoms.

These signs mean blood is leaving faster than the body can compensate, and a person can lose consciousness quickly. Blood that keeps flowing through clothing or spreads on the ground counts, even with no spurting, because veins can bleed heavily too. Beginners often judge by how the wound looks; judge by how much blood has been lost.

Pressing on the wound squeezes the damaged vessels shut and gives a clot time to form, and it needs no equipment beyond gauze or a clean cloth. Steady force matters more than the material. Lean your body weight through straight arms, because tired fingers ease off without you noticing, and get someone to call 911 while you press.

Clots form far more easily once flow is held back, so lifting a hand to peek can restart the bleeding. Find where the blood is actually coming from, which may be deep in a wound, and press there rather than over the general area. Severe bleeding needs 911 from the start. For an ordinary cut, pressure that has not worked after 10 minutes is the point to get medical care.

Blood coming through means pressure is not yet winning, so stack fresh gauze on the old and press harder. The bottom layer has the beginnings of a clot stuck to it, and pulling it away reopens the wound. Beginners tend to change the dressing to look at the wound, which costs the progress already made.

The band stops flow in a whole limb by squeezing the artery against bone, so it trades some risk to the limb for the person's life. That is why it is kept for bleeding that threatens life on an arm or leg, and with massive blood loss the decision is made fast. It cannot work on the trunk, neck or groin, where no limb can be encircled above the wound.

Blood reaches a limb wound from the trunk side, so the band must sit on that side to cut off supply. Over an elbow or knee the bones and tendons shield the artery from compression, and the bleeding continues. Use the distance from the wound that your current training teaches, and move up the limb when the wound site is unclear.

Strong pain is expected, because enough force to close an artery also compresses nerves and muscle. A band left loose is worse than none, since it can block the veins that drain the limb while arterial blood keeps arriving, and bleeding increases. Tell the person it will hurt, and do not ease off because they ask you to.

The hospital team needs to know how long the limb has gone without blood, because tissue damage grows with time and shapes what they do next. A person may be unconscious or handed between crews, so memory is unreliable. Note the time somewhere visible, such as on the band or on the skin, and tell the crew at handoff.

Releasing it can restart bleeding that was just stopped and can send waste built up in the limb back into circulation, which needs monitoring and treatment to manage. A rescuer cannot provide either. If bleeding continues, the usual step is to tighten further or add a second band, not to loosen the first.

A cord, wire or thin belt cuts into skin and usually cannot press evenly enough to close an artery, while the pain limits how hard you can pull. A wide band of folded cloth spreads the force, and a sturdy rod twisted in it adds the tightening power hands lack. Direct pressure or packing often beats a poor improvised band.

Packing brings pressure to the bleeding vessel itself when a wound is too deep or awkward for pressure from the surface. Gauze is fed into the wound until it is full, then pressed hard and held. The mistake is laying gauze on top of a deep cavity, which leaves the bleeding point untouched while the dressing just soaks.

These cavities hold organs and open spaces, so gauze cannot compress a bleeding vessel against bone and may push into vital structures. Bleeding inside them needs a surgeon, so a rescuer covers the wound and calls for urgent transport. Packing is taught for limbs and for the junctions where limbs meet the trunk.

These are the places where a large vessel passes from trunk to limb or neck, and a standard tourniquet cannot be placed above the wound there. Severe bleeding at these sites is therefore controlled by packing the wound and pressing hard. Large vessels sit close to the surface here, so these wounds can become fatal quickly.

An object lodged in the body may be pressing on the vessel it damaged, so removal can release bleeding that nothing outside can control. Pad around it with bulky dressings and secure them so it cannot shift. Apply pressure around the object rather than on it. Removal belongs in a setting where a surgical team can manage what follows.

Cooling slows tissue damage and may keep repair possible, but direct contact with ice can freeze the tissue and ruin that chance. That is why the part is wrapped, sealed, and then set in a cold container. Controlling the person's bleeding always comes first, and the part should travel with them so the hospital can decide.

Leaning forward lets blood run out of the nose where you can see it. Tilting back sends it down the throat, where it can irritate the stomach, trigger vomiting or threaten the airway, and it hides how much is being lost. The old advice to look up or lie down still circulates, and it is wrong.

Most nosebleeds start from small vessels low at the front of the septum, the wall between the nostrils, so pinching the soft part below the bone presses directly on them. Pinching the bony bridge does nothing. Releasing every minute to look disturbs the clot, so hold steadily for the full time your training teaches.

Rinsing with clean water carries away dirt and bacteria, which is a key step in preventing infection in a small cut. Stop any bleeding with steady pressure from gauze, then apply a bandage to keep the area clean. Harsh chemicals are not needed, because they can damage the tissue that is trying to heal.

Medical care is needed for a wound that is deep or gaping, that came from a dirty or rusty object, or that is still bleeding after 10 minutes of steady pressing. Dirt you cannot remove counts too. Location matters as well, as with the face or a hand, because scarring and function are at stake. Size can mislead, since a small puncture can hide serious depth.

The bacteria are common in dirt and animal waste and get in through burns and deep wounds, a nail through the foot being the classic case. The disease locks muscles, including the jaw, and needs hospital treatment. Routine adult boosters come every 10 years, and a dirty or deep wound can call for one sooner, so a bad wound prompts a check of when the last one was given.

Mild redness and soreness are normal for the first days of healing, so the warning sign is change: redness that grows, pain that worsens rather than eases, or pus. Fever suggests the infection is affecting the whole body and needs prompt care. Red streaks running away from a wound are a reason for urgent assessment.

The body can hide a large blood loss in the abdomen, chest, pelvis or thigh, so a calm-looking person can still be deteriorating. Suspect it after a crash or fall when there are signs of shock but little visible blood. A rescuer cannot stop this bleeding, so the job is to recognize it early and call for help.

Blood and oxygen are failing to reach the organs. The body responds by narrowing skin vessels and speeding the heart, which explains the cool, pale skin and fast, weak pulse, and confusion appears as the brain receives less. Shock from allergy or infection can leave the skin warm instead. The mistake is waiting for a low reading or collapse. Early signs alone warrant an emergency call.

A rescuer cannot reverse shock, so the aim is to stop further loss while help arrives. Bleeding control comes first, since bleeding is a common cause. Lying flat helps blood reach the brain, unless it makes breathing harder, and warmth limits heat loss. Food and drink are withheld because the person may vomit, lose consciousness or need surgery.

Lifting the legs was long taught as a way to return blood to the heart, but any benefit is small and short-lived, and it must never delay the steps that matter. It can also hurt someone with a leg, hip or spine injury, or make breathing harder. Follow your current training on whether to do it at all. Laying the person flat, controlling bleeding and calling for help come first.

Pressure, squeezing or fullness are common descriptions, often more than sharp pain, and the feeling tends to persist for more than a few minutes or fade and come back. It can spread to an arm, the back, the neck or jaw, or high in the belly. People often mistake it for indigestion, which is why they delay, and a cold sweat or lightheadedness can come with it.

Crushing chest pain is not universal. Some people have only shortness of breath, unusual tiredness, or discomfort in the jaw or back, and unexplained fatigue is more common in women. Older adults and people with diabetes are more likely to have silent or mild heart attacks, so the absence of chest pain does not rule one out.

Heart muscle dies while the artery stays blocked, so every minute of delay costs tissue. Paramedics can start treatment on arrival, and they can respond if the heart stops, which a car ride cannot do. Call even when unsure. The common error is waiting to see whether it passes, or driving instead of calling.

Most heart attacks come from a clot forming on a ruptured plaque in a coronary artery, and aspirin makes platelets less likely to add to it. Chewing lets it enter the blood faster than swallowing it whole. It is only for someone awake and able to swallow, is skipped with an aspirin allergy or active bleeding, and never replaces or delays the emergency call.

The drug widens blood vessels, which eases the heart's workload but can drop blood pressure sharply. That is why it is not shared: someone else's prescription may be dangerous for a person with low pressure or who has taken an erectile dysfunction drug recently. A rescuer may help a person use their own, and still calls for help.

It is a quick check anyone can run: ask for a smile, ask for both arms raised, and ask for a simple phrase repeated. One abnormal result is enough to call, because brain cells begin dying within minutes. Sudden trouble seeing, severe headache or loss of balance can also mean stroke, even when these three checks look normal.

Clot-dissolving and clot-removal treatments are limited to a window after symptoms begin. If someone wakes with symptoms or is found that way, the clock starts when they were last seen normal, not when they were found. Note that time and pass it to the crew, along with a witness who can confirm it.

Most strokes come from a blocked vessel, but some come from a vessel that has burst, and the two look alike from the outside. Only brain imaging can separate them. Aspirin makes bleeding harder to stop, so it could worsen a bleeding stroke. This is the key difference from heart attack care, and beginners often mix the two up.

A stroke can weaken the muscles that swallow, even when the person seems alert and asks for water. Food, drink or pills may then go into the lungs and cause pneumonia. Swallowing is tested in the hospital before anything is given, so a kind offer of a drink or a pill is the thing to avoid.

Signs that vanish may mean a transient ischemic attack, or TIA, in which a blockage clears before causing permanent damage. A TIA leaves a much higher risk of a full stroke, and nobody at the scene can tell a TIA from a stroke that is still developing. People often cancel the call because they feel better, which is the error.

The danger is breathing that slows or stops, since these drugs depress the part of the brain that drives it. That also explains the blue or purple lips and pale, cold skin. Choking or gurgling sounds are a warning, not snoring to ignore. A person who cannot be woken and is breathing poorly should be treated as a possible overdose, and 911 called.

The drug pushes opioids off the receptors they act on and holds those sites, so slowed or stopped breathing can recover quickly. The prefilled nasal spray needs no assembly and suits bystanders, while injectable forms use a needle, usually into muscle. Read the product instructions and call 911 as well, since the drug does not end the emergency.

Strong opioids such as fentanyl may need more than one dose to restore breathing, so a person who stays unresponsive may not have had enough. Follow the product directions for timing, and keep supporting breathing in between. Do not assume that a failed first dose means opioids were not involved.

Its action fades in about 30 to 90 minutes, and many opioids outlast that. A person who wakes up can slip back into slowed breathing once it wears off, so one recovery does not end the emergency. Someone has to watch them without a break until a crew takes over, even if they feel fine and want to leave.

The drug needs circulation to reach the brain and takes time to act, while oxygen starvation is doing damage now. So someone with no normal breathing gets CPR at once and a 911 call, with naloxone added as soon as it can be given without a long interruption. Searching for a kit while nobody is doing CPR is the mistake to avoid.

Someone without opioids in their system gets no effect from it, so giving it to a person who turns out to have another problem is not expected to harm them, and suspicion alone is enough. In someone dependent on opioids it can bring on sudden withdrawal, with sweating, nausea and vomiting, which is unpleasant but far less dangerous than the overdose. Allergic reactions are rare.

This is a fast, whole-body allergic reaction. Hives plus wheezing or vomiting after an exposure fits the pattern, and throat swelling or fainting alone is enough, even without any rash. Beginners often wait for a rash, yet skin signs can be absent. Foods, medications and stinging insects are the classic triggers.

The drug tightens leaky blood vessels and opens the airways, so it treats the two things that kill in anaphylaxis. The thick thigh muscle absorbs it quickly, and removing clothing only wastes time. Delay is the classic error: it is given as soon as a serious reaction is suspected, and emergency services are called as well.

An antihistamine may calm itching and hives, which can make a person look better while the airway or blood pressure is still failing. Its onset is also far too slow for a reaction that can become fatal quickly. Reaching for one first is a common and dangerous delay, even when the symptoms seem mild at the start.

Symptoms can return after apparent recovery with no new exposure, sometimes as severely as the first time, and epinephrine wears off in the meantime. That is why someone who has received it still goes to the hospital for observation. Feeling completely well after the injection does not make it safe to stay home.

One injection does not always hold a severe reaction, because the drug is short-acting and the reaction may be stronger than the dose. Carrying two auto-injectors exists for this reason. If breathing or circulation remain poor and help has not arrived, a further dose in the other thigh is taught, using the timing from your current training.

In an attack, swelling and tightening narrow the airways, and sitting upright makes breathing muscles more effective. A quick-relief inhaler opens the airways and should be used as soon as symptoms start, following the person's action plan if they have one. Panic speeds breathing, so a calm voice is part of the care.

Being too breathless to finish a sentence means little air is moving. Blue or gray lips or drowsiness suggest oxygen is falling, and medicine that does not bring relief means the attack is outrunning treatment. All of these call for 911. Quieter wheezing can also mislead, since it can mean less air is moving, not more.

A seizure is a burst of disordered electrical firing in the brain, and a bystander cannot stop it by force, so the job is to prevent injury while it runs its course. Move hard objects away and put something soft under the head. Holding a person down can cause muscle or joint injuries without shortening the seizure at all.

The tongue cannot be swallowed, since it is attached at its base. Forcing in a spoon, a wallet or fingers can break teeth, cut the mouth, block the airway or injure the rescuer. A bitten tongue does heal. The real airway step is easing the person onto one side so saliva can drain out.

A typical seizure ends within 30 seconds to 2 minutes and leaves no lasting damage. Past 5 minutes it becomes a medical emergency called status epilepticus. Time feels distorted while you watch one, so check a clock at the start. The figure also helps clinicians decide on treatment afterward.

Past 5 minutes is an emergency for a single seizure, and several in a row without waking between them is just as urgent. A first seizure has an unknown cause that must be found. Injury, a seizure in water, pregnancy, or trouble breathing or waking afterward each add their own risk. A person with known epilepsy who recovers normally from a typical short seizure may not need an ambulance.

Afterward the person is often drowsy and confused for a while, in what is called the postictal state. Lying on the side lets saliva or vomit drain from the mouth. Stay nearby, speak calmly, and tell them what happened. Give no food or drink until they are fully alert, because swallowing may not have recovered yet.

Glucose is the brain's main fuel, so low levels bring on confusion and mood change, while shaking, sweating and hunger come as the body reacts. These signs come on quickly, unlike high blood sugar, which builds up slowly. The behavior can pass for drunkenness, so look for clues such as a diabetes device or medicines.

Glucose tablets or juice raise blood sugar quickly, while chocolate is slower because fat delays absorption. After 15 minutes the level is checked again, and if it is still low, or the person is no better and no meter is at hand, the same amount is repeated. Waiting matters, since eating more in a panic overshoots. This is only for someone awake who can swallow, and anyone worsening needs 911.

Low blood sugar can injure the brain within a short time and may turn fatal, while a small sugar dose given to someone whose level is actually high does little harm in the short term. So you do not need a meter reading first. The condition is that the person is awake and able to swallow safely.

Someone who cannot protect their airway may inhale food or liquid, so sugar by mouth is off the table however low their level may be. Roll them onto their side and call emergency services. Severe lows are treated with glucagon, a hormone given by nasal spray or injection, if a kit is available and you have been shown how to use it.

Blood flow to the brain has dropped for a moment, so lying flat usually brings the person around. If breathing is not normal, start CPR and call 911, and also call if they do not wake quickly. Once awake, they stay lying down for 10 to 15 minutes. Most faints are harmless, but one with chest pain, an odd heartbeat or during exercise may be a heart problem and needs immediate care.

A panic attack can produce a pounding heart, chest pain, breathlessness and a fear of dying, which overlap with a heart attack, and even clinicians need tests to separate the two. Young age or an anxious history does not settle it. If you cannot tell, treat it as cardiac and call 911, because being wrong that way costs little.

The first question is immediate danger, to the person or to others: if life is at risk, call 911. In the US, the 988 Suicide and Crisis Lifeline takes calls and texts from anyone who is struggling or thinking of suicide. Stay with them, listen without arguing, and do not promise to keep it a secret. Asking directly about suicide does not plant the idea.

Heat keeps damaging tissue after the source is gone, so cooling limits how deep the burn gets and eases pain. Start at once and keep the water running for minutes, not seconds, as long as your training teaches. A clean dry cloth then goes over it. Beginners often stop too soon, or reach for ice, which injures the skin further. A serious burn also needs 911.

Ice narrows blood vessels and can freeze skin that is already injured. Butter and greasy ointments trap heat and contaminate the wound, and they must be scrubbed off later. An intact blister is a sterile cover over raw skin, so breaking it opens the way to infection. These home remedies persist because they feel soothing at first.

Skin is the body's barrier against infection and fluid loss, and a burn breaches it, so covering protects the wound and reduces pain from moving air. Tight wraps are a problem because burned tissue swells. Fluffy cotton sheds fibers that stick to the wound, while a clean sheet or loosely laid dry gauze does the job without harm.

Burned tissue swells quickly, and a ring, watch or tight sleeve then acts like a band that cuts off circulation to the fingers or limb. Removing it early is easy, while later it may need cutting off. The same reasoning applies to belts and shoes. Clothing stuck to the burn is left in place for the hospital to remove.

Location matters because scarring in these areas can limit movement, sight, or normal function, and face burns may also threaten the airway. Size matters because large burns lose fluid and raise infection risk. Someone's own palm is a rough measuring tool for burn area. Young children and older adults are referred more readily.

A burn through all skin layers destroys the nerve endings, so the worst spot may hurt least. The surface can be white, charred or leathery, it feels dry, and pressing does not make it pale, while a partial-thickness burn blisters, looks wet and hurts. Beginners take the lack of pain as good news, when it means deep damage that needs hospital care.

The substance keeps burning while it stays on the skin, so removal is the treatment. Dry powder is brushed off first, because water can spread it or react with it. Then contaminated clothing comes off and plenty of water keeps flowing, for a long time rather than a quick rinse, as your training teaches. Do not try to neutralize it with another chemical, and protect yourself from exposure.

A person still in contact with a live source can shock you, so the current must be cut before you touch them. Small entry and exit marks on the skin can hide extensive damage to muscle and other deep tissue along the current's path. The heart rhythm can also be disrupted, so every significant shock deserves evaluation.

Hot gases and toxic smoke injure the airway lining, which swells over the following hours, so someone talking normally now may struggle to breathe later. Warning signs include soot around the nose or mouth, singed facial hair, a hoarse voice and coughing. Anyone with these needs emergency evaluation even if their skin looks unharmed.

In the US, Poison Control at 1-800-222-1222 advises on the exact substance and on whether an emergency room is needed, which avoids guessing. Have the container handy so you can read it out. Someone who has collapsed, cannot breathe or is unresponsive needs 911 first, because they cannot wait for a phone consultation.

A corrosive burns the throat a second time on the way back up, and petroleum products can be inhaled into the lungs, where they do serious damage. Making someone vomit also removes little of the poison and can delay real treatment. Ipecac syrup, once kept in home first-aid kits, is no longer recommended for this reason.

Charcoal binds some substances in the gut, but it does nothing for many others, such as alcohols and metals, and it can be inhaled if the person vomits or is drowsy. It also blackens the stomach and can obscure later examination. Whether it helps depends on the poison and the timing, so the decision belongs to Poison Control or a clinician.

The gas binds to hemoglobin far more tightly than oxygen, starving tissues even though breathing looks normal. It has no odor or color, and its headache and dizziness pass for flu. Several people ill in one building is a major clue. Get out before helping anyone else, since rescuers can be overcome too, and do not go back inside.

The body is still cooling itself but is losing fluid and salt faster than it can replace them, which causes the fast, weak pulse, weakness and headache. Get the person somewhere cooler, take off extra layers, and give small sips of water or a sports drink if they are awake and not vomiting. It can progress to heat stroke, so confusion or worsening symptoms call for emergency care.

The body's temperature control has failed, and heat is injuring the brain and other organs, which is why this is an emergency. Confusion, odd behavior, seizures or collapse are the key signs. Hot, dry skin is the textbook picture and still counts, but someone overheated by hard exertion may be soaked in sweat, so sweating does not rule it out. Call 911 and begin cooling.

Many sign lists show hot, dry skin, and that does mark heat stroke when present, but it misses active people who overheat while still sweating. Confusion or strange behavior in a hot setting points to the brain being affected, and that makes it an emergency. Treat a person who is not thinking clearly as having heat stroke, call 911 and cool them, whatever their skin looks like.

Organ damage depends on how hot the body gets and for how long, so the time above a dangerous temperature is what must be cut. Where a medical team and cooling are on site, as at some sports events, they cool first and then move the person. Elsewhere, start any cooling you can while emergency services are on the way.

Water draws heat from the body far faster than air, and it reaches most of the skin at once, so a tub of cold water beats fans or spot cooling. If no tub is available, soak clothing or cover the person with cold, wet towels and ice packs. The person's airway must be kept above the water, and someone must stay alongside.

Heat loss has outrun heat production, and a core temperature below 95 degrees F is a medical emergency. The slide is slow and dulls judgment, so people often do not see it in themselves. A companion stumbling, slurring or growing unusually sleepy in cold, wet conditions should be taken seriously.

Those muscle tremors are how the body makes heat. As the core gets colder, shivering fails, and from then on the person keeps cooling unless warmed from outside. An unwary rescuer can read the stillness as recovery, especially when the person also seems calmer or stops complaining. In the cold, treat the loss of shivering as a sign of deepening hypothermia.

A very cold heart is electrically irritable, and a jolt can tip it into a fatal rhythm. So move the person horizontally and slowly, without letting them walk or struggle if the hypothermia is severe. Rough lifting or hurried stretcher work is the classic mistake, since the urge to rush works against the person in this situation.

Heat goes to the chest, armpits and back, where it reaches the core, with a barrier between any heat source and the skin to prevent burns. Replace wet clothing and insulate from the ground. Alcohol widens skin vessels, so it feels warming while increasing heat loss, and it also dulls the judgment of a person already at risk.

Cold sharply lowers the brain's need for oxygen, so a person with no detectable pulse may still be saved after an arrest that would be fatal at normal temperature. Pulses are also hard to find in the cold, so check carefully. Rescuers therefore keep going during transport, and the decision to stop belongs to a hospital team.

The injury is tissue freezing, and small exposed parts such as the nose, ears, fingers and toes go first. Look for pale or grayish-yellow skin that feels hard or waxy to the touch. Numbness is what makes it dangerous, because the person stops noticing the injury and keeps going. Serious cases can cost tissue or a limb, so these signs call for medical care.

Thawing and then refreezing causes more damage than staying frozen a little longer, so a person who must go back into the cold may be better left until safety is reached. Medical care comes first when it is close. If you do rewarm, use warm, not hot, water and finish the job. It is very painful, but slowing it down to spare the person can cost tissue.

Rubbing or massaging, including the old advice to rub with snow, damages frozen tissue further. Dry heat from a stove, a fire, a heating pad or a lamp is also unsafe, since numb skin cannot feel a burn developing. Body warmth works when warm water is unavailable, such as fingers tucked into an armpit, and walking on frostbitten feet adds injury.

A sprain is a stretched or torn ligament, which joins bone to bone, and a strain involves muscle or tendon. Early care aims to limit pain and swelling: resting, icing, wrapping and raising the part. Keep a cloth between ice and skin. An injury that looks deformed or cannot bear any weight needs assessment for a fracture.

Moving a broken bone causes pain and can damage nearby vessels and nerves, so a rescuer never tries to straighten it. A splint works by stopping movement at the joints on either side of the break. Rolled magazines or a board can serve, with padding. You cannot rule out a fracture by the ability to move, so assume one when unsure.

A broken bone or a tight splint can squeeze the vessels and nerves beyond it, so the fingers or toes tell you what the limb is getting. Cold, pale or numb skin means trouble. Checking beforehand gives you a baseline, and checking after shows whether the splint caused it. If things worsen, loosen the splint and report it.

When a bone breaks through the skin, bacteria have a direct path into it, which makes infection a major concern alongside bleeding. Cover the wound with a clean dressing and press around the bone rather than on it. Do not push it back in or rinse it inward, since either one carries contamination deeper. Splint it as it lies.

The mechanism raises suspicion before any symptom appears, because forces that violently bend, compress or jolt the neck can break vertebrae without obvious signs. Vehicle crashes and serious falls are the leading causes. A person may walk and talk with an unstable spine. Numbness, weakness or neck pain make the concern greater, but their absence does not rule it out.

Broken vertebrae can press into or tear the spinal cord, so needless movement risks making a recoverable injury permanent. Steadying the head in the position found is the usual teaching. Life comes before spine, though: move the person out of danger, roll them if they vomit, and position them for CPR if they need it.

A blow to the head or body shakes the brain inside the skull and briefly disturbs how it works. Loss of consciousness is not required, which many people get wrong. Symptoms can also appear days or weeks later. Ringing ears, dizziness and tiredness are common too, and the person may seem not quite themselves.

Another hit to a brain that is still recovering can do further harm, so play ends at once for anyone, and a young athlete goes back only after a concussion specialist clears it. Feeling fine on the sideline does not count as clearance. Everyday activity also comes back in steps, after a doctor agrees.

These point to pressure or bleeding inside the skull, which can build over hours after a person seemed fine. Also watch for trouble waking, seizures, slurring, growing confusion or agitation, poor coordination, and numb or weak limbs. Any of these means getting help immediately. Someone who is getting worse rather than better needs emergency care.

Venom spreads partly through the lymph system, which moves more with muscle activity, so stillness slows it. Swelling can be rapid, which is why rings and watches come off. Call emergency services, since antivenom is the real treatment and it is given in a hospital. Note the snake's look if you can, but never try to catch it.

Cutting damages tissue and adds infection risk, and suction devices remove almost no venom. Ice can worsen local tissue injury, and a tourniquet may concentrate venom in the limb while cutting off its blood supply. These methods survive from old films and outdoor lore, and they use up time that should be going toward reaching antivenom.

A honeybee's stinger stays in the skin with its venom sac attached, and it keeps pumping for a short time, so the sooner it comes out the less venom goes in. Scrape or pull, whichever is quickest, since worrying about squeezing just costs time. Then watch for breathing trouble or swelling away from the sting, which suggests anaphylaxis.

Gripping close to the skin avoids squeezing the body, and steady upward force makes it less likely the mouthparts break off. Removing it soon matters, since the longer a tick stays attached, the higher the chance of disease transfer. Skip nail polish, heat and petroleum jelly, which only delay removal. Clean the bite, then watch for rash or fever.

Bites push bacteria from the animal's mouth into the tissue, so thorough washing with soap and water is the first step and should happen soon. Infection can cause serious problems even from a small wound. A bite from a stray or wild animal raises rabies concerns, and because shots must start right away, the person needs medical care promptly.

A drowning person may grab and submerge anyone who comes close, so entering the water can create two victims. Reach with a pole or branch from a secure spot, or throw something that floats. Going in is left to people trained for it, even if you swim well. Shout for help or send someone to call 911 while you act.

Drowning rarely looks as it does in films, with waving and shouting. Someone struggling at the surface uses every breath to stay afloat, so they cannot call out, and their arms press down rather than wave. It can happen quickly and quietly, even near other people. A swimmer gone suddenly quiet and upright deserves a direct check.

Asphyxial means the heart stopped from lack of oxygen, not from a primary rhythm problem. Blood in a drowned person is already short of oxygen, so compressions alone move blood that carries little of it, which makes breaths central here. Bystanders unable or unwilling to give them should still do compressions, because some effort beats none.

Only a small amount of water usually reaches the lungs, and thrusts cannot remove it, so the belief that it must be drained first is mistaken. What the thrusts do reliably is delay breaths and bring up stomach contents, which can then be inhaled. Foam at the mouth is common too, and it should not stop you from starting CPR.

Water in the lungs can damage the lining that moves oxygen into the blood, and the effects may take time to appear. A person who seemed fine at the poolside may later cough persistently, breathe fast or grow unusually tired. Anyone rescued with symptoms should be assessed, and any new breathing difficulty later warrants emergency care.