Emergency Procedures, First Aid & Basic Life Support
Key Takeaways
- The current AHA standard for adult chest compressions is a rate of 100 to 120 per minute at a depth of at least 2 in (5 cm), avoiding depths greater than 2.4 in (6 cm).
- Single-rescuer and two-rescuer adult CPR without an advanced airway uses a 30:2 compression-to-ventilation ratio.
- The unified AHA Chain of Survival has six links: Recognition & Emergency Activation, High-Quality CPR, Defibrillation, Advanced Resuscitation, Post-Cardiac Arrest Care, and Recovery & Survivorship.
- For a conscious, choking adult, rescuers alternate 5 back blows and 5 abdominal thrusts until the object is expelled or the person becomes unresponsive.
- RICE (Rest, Ice, Compression, Elevation) is the standard initial first-aid protocol for exercise-related sprains and strains.
Emergency Response Systems: Roles & Activating EMS
Every facility's written EAP assigns roles before an emergency happens: who calls EMS, who retrieves the AED and first-aid kit, who meets EMS at the entrance and directs them to the scene, and who manages bystanders. Activating EMS means calling as soon as an emergency is recognized, not after first aid has already been attempted, and giving the dispatcher the exact location, the nature of the emergency, the number of victims, and the victim's condition; the caller stays on the line until told to hang up. In a witnessed collapse, activation and compressions happen in parallel — a second staff member calls 911 and retrieves the AED while the first rescuer begins compressions immediately; care never pauses for the phone call.
Recognizing & Managing Common Exercise-Setting Emergencies
| Emergency | Key signs | Initial first aid |
|---|---|---|
| Hypoglycemia | Shakiness, confusion, sweating, weakness, irritability | If conscious and able to swallow, give fast-acting carbohydrate (juice, glucose tabs); activate EMS if unresponsive or not improving |
| Heat exhaustion → heat stroke | Heavy sweating, dizziness, nausea, headache; heat stroke adds altered mental status, hot skin, and possible collapse | Move to a cool area, remove excess clothing, cool actively (cold water immersion for suspected heat stroke); heat stroke is a medical emergency — activate EMS immediately |
| Hypothermia | Shivering, slurred speech, confusion, loss of coordination | Move to a warm, dry area, remove wet clothing, insulate, rewarm gradually; activate EMS for moderate-to-severe presentation |
| Syncope (fainting) | Lightheadedness, pale/clammy skin, brief loss of consciousness | Lay the client supine, elevate the legs, loosen restrictive clothing, monitor breathing and pulse; activate EMS if recovery is not rapid or an injury occurred |
| Sprains / strains | Pain, swelling, bruising, limited motion | RICE — Rest, Ice, Compression, Elevation |
| Bleeding | Visible external hemorrhage | Apply firm direct pressure with a clean dressing, maintain pressure, elevate if possible, use gloves under universal precautions |
| Choking (conscious adult) | Universal choking sign (hands clutching throat), unable to speak, cough, or breathe | Alternate 5 back blows and 5 abdominal thrusts until the object is expelled or the person becomes unresponsive |
| Cardiac arrest | Unresponsive, no normal breathing (or only gasping), no definite pulse within 10 seconds | Activate EMS, begin high-quality CPR immediately, apply the AED as soon as it arrives |
The AHA Adult Chain of Survival
The current AHA Guidelines for CPR and Emergency Cardiovascular Care use a single, unified six-link Chain of Survival that applies to any cardiac arrest, adult or pediatric, in-facility or out-of-hospital:
- Recognition & Emergency Activation
- High-Quality CPR
- Defibrillation
- Advanced Resuscitation
- Post-Cardiac Arrest Care
- Recovery & Survivorship
An EP-C operates squarely inside the first three links: recognize the arrest and activate EMS immediately, start compressions without delay, and apply an AED the moment one is available rather than waiting for EMS to arrive. Early bystander CPR and early defibrillation are the two links most strongly associated with survival to discharge, which is why every fitness facility should maintain an accessible, well-signed AED.
High-Quality Adult CPR: The Numbers
| BLS Parameter | Current AHA Standard |
|---|---|
| Pulse/responsiveness check | No more than 10 seconds; if no definite pulse, assume cardiac arrest |
| Compression rate | 100–120 compressions per minute |
| Compression depth (adult) | At least 2 in (5 cm); avoid depths greater than 2.4 in (6 cm) |
| Chest wall recoil | Allow complete recoil between compressions — do not lean on the chest |
| Compression-to-ventilation ratio | 30:2 (30 compressions : 2 breaths) for single-rescuer or two-rescuer CPR without an advanced airway |
| Rescue-breathing-only rate (pulse present, breathing inadequate) | 1 breath every 6 seconds (10 breaths/min) |
| Compressor rotation | Switch roles about every 2 minutes (~every 5 cycles of 30:2) to prevent fatigue-related depth decay |
| AED / defibrillation | Apply and use as soon as it is available; minimize interruptions to compressions |
For an untrained bystander, or a rescuer unwilling/unable to give breaths, compression-only (hands-only) CPR — continuous compressions at the same rate and depth with no pause for breaths — is an acceptable and effective alternative for a witnessed adult collapse. In all cases, the guiding principle is "push hard, push fast, allow full recoil, minimize interruptions."
EP Scope, Documentation & Legal Limits in an Emergency
An EP-C's emergency scope of practice is first aid, CPR, and AED use — not diagnosis or advanced medical treatment. Once EMS personnel arrive, the EP-C hands off care and gives a concise report: what happened, what actions were taken, and how the client responded. Every emergency, however minor, requires a same-day, objective incident report, and staff should also know the facility's building-wide evacuation plan (fire, gas leak, structural threat), which is distinct from the medical EAP covered in Section 12.1. Acting outside scope during an emergency — for example, assuming a collapse is "just dehydration" rather than activating EMS for an ambiguous presentation — creates the same negligence exposure discussed in Section 12.1, so when in doubt, the correct action is always to activate EMS and begin the appropriate first aid.
During adult CPR, what chest-compression depth does the current AHA standard specify?
A lone EP-C is performing single-rescuer adult CPR without an advanced airway in place. What compression-to-ventilation ratio should be used?
A conscious adult client is choking and cannot speak, cough, or breathe. What is the correct initial response?
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