2.3 One-Rescuer & Multi-Rescuer Adult CPR

2.3 One-Rescuer & Multi-Rescuer Adult CPR

Adult CPR uses the same quality targets in every setting. Additional rescuers do not change the 30:2 ratio before an advanced airway; they allow compressions, ventilation preparation, AED use, and coordination to occur more efficiently.

One-rescuer adult sequence

After confirming scene safety:

1. Check responsiveness and call for help.
2. Activate the emergency response system and obtain an AED. If a phone is available, use speaker mode so you can remain with the patient.
3. Check breathing and a carotid pulse simultaneously for no more than 10 seconds.
4. If the person is not breathing normally and has no definite pulse, begin CPR.
5. Give 30 compressions at 100-120/min and at least 2 inches (5 cm) deep, avoiding depths over 2.4 inches (6 cm).
6. Open the airway and give 2 breaths, each over about 1 second with visible chest rise.
7. Continue 30:2 cycles and use the AED as soon as it arrives.

If no barrier device is available, follow dispatcher and local guidance. High-quality compressions should not be abandoned while the rescuer waits for equipment.

Add the AED

Turn on the AED and follow its prompts. Expose the chest, attach the pads, and connect them if required. Continue compressions while the pads are applied when feasible. Clear everyone during rhythm analysis and shock delivery. Immediately after a shock—or after a no-shock message—restart CPR beginning with compressions.

The AED generally repeats analysis about every 2 minutes. Do not insert an unnecessary pulse check after every shock. Reassess when the patient shows signs of life or when the organized-care protocol directs it.

Multi-rescuer organization

As help arrives, the first rescuer gives a concise handoff and assigns roles:

Use closed-loop communication. A named rescuer repeats the assignment and reports when it is complete. Team members should correct shallow compressions, leaning, excessive ventilation, or unsafe AED contact immediately and respectfully.

Ratio before and after an advanced airway

For adult CPR without an advanced airway, use 30 compressions to 2 breaths with one rescuer or with a team. The compressor pauses briefly for the 2 breaths.

When an advanced airway has been placed by an appropriately trained provider, compressions become continuous at 100-120/min. The ventilation rescuer gives 1 breath every 6 seconds without pausing compressions. BLS rescuers support that pattern but do not delay CPR for advanced-airway placement.

Efficient compressor changes

Plan to switch compressors about every 2 minutes, commonly during AED analysis, or sooner if quality falls. The incoming compressor should be in position before the pause. Count down the last few compressions when helpful, switch quickly, and use the same lower-sternum landmark. Keep the interruption under 10 seconds.

Do not use “5 cycles” as a rigid substitute for timing. Cycle duration varies. An AED prompt, timer, or team coordinator provides a more reliable signal.

When to stop CPR

Continue until one of the following occurs:

• The patient shows signs of life and a pulse assessment confirms circulation.
• A higher-level team takes over.
• The scene becomes unsafe.
• The rescuer cannot continue because of exhaustion and no replacement is available.
• An authorized clinician acting under applicable protocol directs cessation.

A BLS provider should not improvise a termination rule based on arrest duration, age, or an AED no-shock message.

Common sequence errors

• Waiting for a second rescuer before starting compressions.
• Switching to 15:2 merely because two rescuers are present; 15:2 is the two-rescuer infant/child ratio.
• Pausing compressions while the AED pads are being unpacked.
• Taking longer than 10 seconds to rotate compressors.
• Checking a pulse routinely after every AED analysis.

The exam distinction is simple: adult CPR remains 30:2 before an advanced airway. More rescuers improve role sharing and pause management, not the pre-airway ratio.

Team rehearsal

Run the same adult scenario first alone and then with three rescuers. In the team round, name the compressor, airway rescuer, and AED rescuer, use closed-loop commands, and plan a compressor switch at the next analysis. Compare how long compressions stop in each round. The sequence is successful when added personnel shorten equipment delays and pauses without changing the pre-airway 30:2 ratio or distracting the first rescuer from immediate CPR.