CPR Basics for a Collapsed Adult: Hands-Only Steps Until Help
If an adult collapses, does not respond and is not breathing normally, you do not need mouth-to-mouth to help. Call 1122, 112 or 108 on speaker, put the heel of your hand in the centre of the chest and push hard and fast, 100 to 120 times a minute, 5 to 6 cm deep, without stopping until help arrives. That is hands-only CPR, and it roughly doubles the chance the person leaves hospital alive. Here is exactly how to do it, what an AED is, and when not to start.
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Hands-only CPR is for a person who is unresponsive and not breathing normally. It is not for someone who has fainted and is breathing, who has had a seizure and is breathing, or who is drunk and snoring. Occasional gasps, a snort every few seconds or a rattling noise are not normal breathing; treat that as not breathing and start. Look at the chest for no more than 10 seconds. If you are unsure whether they are breathing, start compressions; pressing on a beating heart for a minute does far less harm than waiting on a stopped one. A proper course teaches this on a manikin. Do one.
Cardiac arrest is not a heart attack, and that changes what you do
A heart attack is a blocked artery. The person is usually awake, in pain, sweating, frightened. They need a hospital fast, not chest compressions. Sit them down, loosen clothing, call an ambulance. The signs, including the quiet ones in women and diabetics, are in this heart-attack guide.
Cardiac arrest is the heart stopping. The person drops, goes silent, does not respond, does not breathe normally. From that moment the brain has about 4 minutes before damage begins, and no ambulance in Lahore, Karachi, Delhi or a village reaches anyone in 4 minutes. The only thing that keeps blood moving in those minutes is a bystander pressing on the chest. That is you.
A heart attack can turn into a cardiac arrest, which is why you stay with a person who has chest pain and watch them until the ambulance arrives.
Hands-only CPR: the steps until help arrives
- Check the scene for 2 seconds: traffic, live wires, water, fire. You cannot help if you become the second casualty.
- Check response. Tap both shoulders firmly and shout “Are you okay?” close to the ear. No movement, no sound, no eye opening means unresponsive.
- Shout for help and point at one person: “You, call 1122 and put it on speaker. You, find an AED if there is one.” If you are alone, call yourself, on speaker, phone on the floor beside you.
- Check breathing for up to 10 seconds. Tilt the head back gently with one hand on the forehead, lift the chin with two fingers, and watch the chest. Normal breathing is regular and quiet. Gasps, snorts or nothing at all mean start CPR.
- Position. Person on their back on a hard surface (floor, not bed). Kneel beside the chest. Pull open or cut the shirt so you can see the breastbone.
- Hand placement. Heel of one hand on the centre of the chest, on the lower half of the breastbone, between the nipples. Other hand on top, fingers laced and lifted off the ribs. Arms straight, elbows locked, shoulders directly above your hands.
- Push hard. 5 to 6 cm deep in an adult, about a third of the chest. Let the chest rise fully between pushes without lifting your hands off. Half-depth compressions do almost nothing.
- Push fast. 100 to 120 a minute. Count out loud “one and two and three and”, or push to the beat of a fast song at a walking-run pace; most people find about two pushes per second.
- Don’t stop. Every pause drops the blood pressure you have built. No stopping to check a pulse, wipe sweat or answer a question. If someone else is there, swap every 2 minutes with a gap of under 5 seconds; tiredness makes compressions shallow before you feel it.
- Keep going until an ambulance crew takes over, an AED tells you to stop, the person clearly wakes and breathes normally, or you physically cannot continue.
Ribs may crack under your hands. That is a broken rib, which heals, on a person who was otherwise dead. Adjust your hand position if it has slipped, and continue.
Why no mouth-to-mouth?
When an adult’s heart stops suddenly, the blood already carries a few minutes of oxygen. The problem is that nothing is pumping it. Compressions alone move that oxygen to the brain; pausing to give breaths, especially badly, loses more than it gains for an untrained rescuer. Bystanders who are told “just push” start sooner and do it better than those worried about breathing into a stranger’s mouth.
Breaths matter more in three situations, and a course teaches them: drowning, where the lungs have no oxygen to begin with; children and babies, whose arrests usually start with breathing failure; and any arrest that has gone on for a long time before you arrived. If you are trained, the rhythm is 30 compressions, then 2 breaths of about 1 second each, watching the chest rise, then straight back to compressions. If you are not trained, hands-only is still far better than nothing in all three.
The AED: what it is and why to ask for one
An AED (automated external defibrillator) is a box with two sticky pads and a voice. It reads the heart rhythm and, if the heart is quivering rather than pumping, gives a shock that can restart it. You cannot shock someone by mistake; it only fires if the rhythm needs it. You cannot use it wrongly if you follow the voice. Airports, large mosques, gyms, malls, big offices and some schools now have one in a glass case near the entrance.
- Turn it on (open the lid or press the green button) while another person keeps compressing.
- Bare and dry the chest. Wipe sweat or water off with a shirt. Shave or move very thick hair if a razor is in the kit.
- Stick the pads exactly as pictured on them: one high on the right side of the chest below the collarbone, one on the left side below the armpit. Press them firmly.
- “Analysing, do not touch the patient.” Everyone takes their hands off. Say it out loud.
- If it says shock, shout “Clear”, check nobody is touching, press the flashing button.
- Straight back to compressions the instant the shock is given, or if it says no shock advised. The machine will re-check every 2 minutes; keep pressing until it tells you to stop.
Leave the pads on even if the person wakes up. The ambulance crew will want them.
Children and babies, briefly
A child’s arrest usually follows drowning, choking, a bad asthma attack or a severe infection, so breaths matter more than in adults. The compression rules change with size. For a child of 1 to 8 use one hand, or two if the child is big, and press about a third of the chest depth, roughly 5 cm. For a baby under 1 use two fingers in the centre of the chest, just below the nipple line, pressing about 4 cm. Same speed, 100 to 120 a minute. If you are trained, give 5 initial breaths, then continue at 30 compressions to 2 breaths; if you are not, do compressions alone and keep going. A choking child who goes limp is handled with compressions plus a look inside the mouth between every set; the full method is in the choking guide.
Slapping the face, sprinkling water, pressing thumbs into the pressure point above the lip, rubbing the feet, shoving a shoe or onion under the nose. Every one of these belongs to fainting, where the person is breathing and will wake on their own. None of them moves blood. In a real arrest they cost the minutes that decide everything. The older instinct that was right: someone always stayed and shouted for help.
Myth: you can be sued or blamed for cracked ribs
People hesitate for three reasons, and none holds up. First, fear of harm: a person in cardiac arrest is already as bad as it gets, and compressions on someone whose heart is actually beating cause bruising at worst. Second, fear of infection from mouth contact: hands-only needs no mouth contact. Third, fear of blame: in Pakistan and India there is no realistic risk of action against a bystander helping in good faith, and Good Samaritan protections exist in Indian law for road accident helpers. Doing nothing is the only outcome that guarantees death.
Practise the rate on a cushion tonight
Kneel over a firm cushion, lock your elbows, and push while counting to 30 out loud at two pushes per second. That is 15 seconds. Now do it for 2 minutes. Your shoulders will burn, and you will understand why rescuers swap. Then teach one other person in the house, because the person most likely to collapse near you is family, and the person doing CPR on you will be them.
When home care is enough and when it never is
A person who stumbles, goes pale and drops but is breathing has probably fainted; lie them flat, raise the legs, and the first-minute steps are in the fainting guide. A diabetic who is sweaty, shaky and confused but awake needs sugar, not compressions; the 15-gram rule for low sugar covers that. Someone collapsed in the heat with hot skin and confusion needs cooling on the way to hospital, as in the loo lagna guide. In all three, check breathing first, and if breathing stops at any point, the answer becomes compressions.
Nothing on this page replaces a certified course. A four-hour basic life support class from Rescue 1122, the Red Crescent, the Indian Red Cross, St John Ambulance or a hospital’s training wing lets you feel real depth and pace on a manikin that clicks when you press hard enough, and covers breaths, children and the AED properly. It is the single most useful afternoon in the whole of Desi Remedies.
CPR questions people search
How many compressions per minute for CPR?
100 to 120 a minute, about two pushes a second, for adults, children and babies alike. Slower than 100 does not build enough pressure; faster than 120 does not let the chest refill. Counting out loud in a steady “one-and-two-and” keeps most people in range.
How deep should chest compressions be?
5 to 6 cm in an adult, which is about a third of the chest and more than most beginners push. In a child about 5 cm, in a baby about 4 cm. Let the chest come all the way back up between pushes.
Is CPR without mouth-to-mouth really effective?
Yes for an adult who collapses suddenly. Compressions alone keep oxygenated blood moving for the first minutes, and untrained bystanders who do hands-only CPR give the person a better chance than those who stop to attempt breaths. Breaths add value in drowning, in children and if you are trained.
How do I know if someone needs CPR?
They do not respond to shouting and a firm shoulder tap, and they are not breathing normally when you watch the chest for up to 10 seconds. Gasping, snorting or gurgling is not normal breathing. Do not spend time hunting for a pulse; start.
What is the ratio of compressions to breaths?
30 compressions to 2 breaths, for a trained rescuer, at any age. Each breath is about 1 second, just enough to see the chest rise. Untrained rescuers skip the breaths and compress continuously.
What should I do first, call or start CPR?
Both, at once: put the phone on speaker and start compressions while the operator talks. If others are present, one calls and one compresses. For an adult who collapsed in front of you, getting the call out matters because only an ambulance or an AED can restart the heart; your compressions buy the time.
How long should I keep doing CPR?
Until a trained crew takes over, the person breathes and moves, an AED tells you to stop, or you are too exhausted to press properly. Swap with someone every 2 minutes if you can. People have been revived after long periods of good bystander CPR; do not stop early because “it isn’t working”.
What if I break a rib?
Reposition your hands in the centre of the chest if they have slipped, and keep going. Cracked ribs are common during effective CPR, especially in older people, and heal. A stopped heart does not.
Can I do CPR on a bed?
Not well. A mattress absorbs your pushes, so the chest barely moves. Slide the person to the floor first. In a hospital or if the person is too heavy to move, put a board or tray under the back if one is at hand, and push harder.
Should I do CPR if the person is breathing but unconscious?
No. Roll them into the recovery position (on their side, head tilted back, top knee bent to stop them rolling), call for help, and watch the breathing constantly. Start compressions only if breathing stops or turns into gasps.
Does CPR restart the heart?
Rarely on its own. What it does is keep the brain and heart supplied with blood until a defibrillator shock or hospital treatment restarts the rhythm. That is why the AED and the ambulance are called at the start, not after CPR “fails”.
Can a child or a small woman do CPR on a big man?
Yes. Depth comes from body weight through locked elbows, not arm strength. Kneel close, shoulders above the hands, and drop your weight. Swap with someone stronger every 2 minutes if possible, but never leave the chest untouched while waiting for someone bigger.
Is there a CPR emergency number in Pakistan and India?
In Pakistan dial 1122 for Rescue 1122 (some cities also have Edhi and Chhipa ambulances). In India dial 112, the single emergency number, or 108 for the ambulance service. Put the call on speaker and let the operator coach you through compressions.
Where can I take a CPR course?
Rescue 1122 community training, the Pakistan Red Crescent, the Indian Red Cross, St John Ambulance India, and the training departments of large hospitals all run basic life support courses lasting a few hours. Workplaces and schools can request a group session.