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CPR & First Aid Reference

The Observatory Almanac — Section 14.1

Important: This guide is for reference and training support only. Take a certified first aid/CPR course from the Red Cross, American Heart Association, or equivalent organization. Guidelines update periodically — verify with current official sources.

CPR (Cardiopulmonary Resuscitation)

Before You Begin — Scene Safety & Assessment

  1. Ensure scene safety — Look for hazards (traffic, fire, downed wires, unstable structures). Do not become a second victim.
  2. Check responsiveness — Tap shoulders firmly, shout "Are you okay?"
  3. Call for help — If unresponsive, shout for someone to call emergency services (911 in USA). If alone, call yourself (speakerphone).
  4. Get an AED — Send someone to retrieve one if available.
  5. Check for breathing — Look for chest rise, listen, feel for breath. Do this for no more than 10 seconds.
  6. Check for pulse — (Healthcare providers) Carotid artery (neck) for adults, brachial artery (inner upper arm) for infants. 5–10 seconds maximum.

If the person is unresponsive, not breathing normally (or only gasping), and has no detectable pulse — begin CPR.

Adult CPR (Age 8+, or puberty and older)

Ratio: 30 compressions : 2 rescue breaths

Step 1 — Position - Lay the person on their back on a firm, flat surface. - Kneel beside the person at chest level.

Step 2 — Hand Placement - Place the heel of one hand on the center of the chest (lower half of sternum). - Place your other hand on top, interlacing fingers. - Keep fingers off the ribs.

Step 3 — Compressions - Straighten your arms. Lock elbows. Position shoulders directly over hands. - Compress the chest at least 2 inches (5 cm) but no more than 2.4 inches. - Push hard and fast: 100–120 compressions per minute (roughly the tempo of "Stayin' Alive" by the Bee Gees). - Allow full chest recoil after each compression — do not lean on the chest. - Minimize interruptions to compressions. Pauses should be under 10 seconds.

Step 4 — Rescue Breaths (if trained and willing) - After 30 compressions, open the airway using head-tilt/chin-lift: tilt the forehead back, lift the chin. - Pinch the nose closed. - Create a seal over the mouth. - Give a breath over 1 second — watch for chest rise. - Give a second breath. - Resume compressions immediately.

If unwilling or unable to give rescue breaths: Perform compression-only CPR. This is acceptable for adult bystander CPR and is better than nothing.

Continue until: - An AED arrives and is ready - Emergency services take over - The person shows obvious signs of life (breathing, moving purposefully) - You are physically unable to continue

Child CPR (Ages 1–8, or pre-puberty)

Key differences from adult: - Use one hand or two fingers for smaller children; adjust for child's size. - Compress 2 inches (5 cm) — about 1/3 of chest depth. - Ratio: 30:2 (same); if two rescuers present, use 15:2. - Rescue breaths are strongly recommended — pediatric cardiac arrest is often respiratory in origin. - If alone with no phone: perform 2 minutes of CPR first, then call 911. - Use 1–2 hands depending on child size; goal is 1/3 chest compression depth.

Airway: Neutral position (not hyperextended like adults — a child's airway is more easily kinked).

Infant CPR (Under 1 year)

Key differences:

Compressions: - Use 2 fingers (index + middle finger) on the center of the chest, just below the nipple line. - Two-thumb encircling hands technique (preferred for two rescuers): wrap both hands around the infant's chest, place thumbs side by side over the sternum. - Compress 1.5 inches (4 cm) — about 1/3 chest depth. - Rate: 100–120 per minute. - Ratio: 30:2 (lone rescuer); 15:2 (two healthcare providers).

Rescue Breaths: - Cover both mouth and nose with your mouth. - Give small puffs (only enough to see chest rise — infant lungs are tiny). - Do not over-inflate.

Responsiveness check: Tap the bottom of the foot rather than the shoulders.

If alone: 2 minutes of CPR before leaving to call 911.

AED (Automated External Defibrillator)

AEDs are available in many public spaces — airports, malls, gyms, schools, offices. They are designed for untrained layperson use.

How to Use an AED

Step 1 — Turn it on - Open the case. The AED will begin talking. - Press the power button if required (some power on automatically when opened).

Step 2 — Attach the pads - Expose the chest. Dry it if wet. Remove excessive chest hair if possible (shave or use second pad set to pull off hair). - Place pads as shown in the diagram on the AED or pads themselves: - One pad: upper right chest (below collarbone) - Other pad: lower left side (below and to the left of the heart) - Plug in the connector if not pre-connected.

Step 3 — Clear and analyze - "Clear!" — Ensure no one is touching the person. - The AED analyzes the rhythm automatically. Do not touch the person during analysis.

Step 4 — Deliver shock (if advised) - "Clear!" again — ensure no one is touching. - Press the shock button when prompted. - Immediately resume CPR for 2 minutes before the AED re-analyzes.

Step 5 — If no shock advised - Resume CPR immediately. - Follow AED prompts.

Special notes: - Children under 8 / under 55 lbs: Use pediatric pads/key if available. If not, adult pads can be used (place one on chest, one on back). - Pacemaker/implanted device: Place pad at least 1 inch away from the device. - Medication patch on chest: Remove patch and wipe area before placing pad. - Wet surface: Move person to dry area if possible; AEDs are water-resistant but not waterproof.

Recovery Position

Use when a person is unconscious but breathing (to prevent airway obstruction by tongue or vomit).

  1. Kneel beside the person.
  2. Place the arm nearest you at a right angle to the body (elbow bent, palm up).
  3. Bring the far arm across the chest, hold the back of that hand against the near cheek.
  4. With your other hand, pull up the far knee so the foot is flat on the ground.
  5. Keeping hand against cheek, pull on the bent knee to roll the person toward you, onto their side.
  6. Adjust the top leg so the hip and knee are at right angles.
  7. Tilt the head back slightly to keep the airway open.
  8. Monitor breathing continuously.
  9. If unconscious for more than 30 minutes, roll to the other side.

Choking

Adult and Child (Over 1 Year) — Heimlich Maneuver

Mild choking (can cough, speak, breathe): - Encourage coughing. Do not interfere.

Severe choking (cannot cough effectively, cannot speak, cannot breathe, turning blue):

  1. Call 911 (or have someone call).
  2. 5 back blows: Stand to the side and slightly behind the person. Support the chest with one hand. Lean them forward. Deliver 5 firm blows between the shoulder blades with the heel of your other hand.
  3. 5 abdominal thrusts (Heimlich): Stand behind the person. Make a fist with one hand. Place it thumb-side in, just above the navel and well below the breastbone. Grasp your fist with your other hand. Give 5 quick, upward thrusts — pull sharply inward and upward.
  4. Alternate 5 back blows and 5 abdominal thrusts until the object is expelled or the person loses consciousness.

If the person loses consciousness: Lower them carefully to the ground. Call 911 if not already done. Begin CPR. Each time you open the airway to give a breath, look for the object — remove it only if visible (blind finger sweeps are not recommended).

Infant Choking (Under 1 Year)

Never use abdominal thrusts on an infant.

  1. Hold the infant face-down on your forearm, supporting the head. Keep head lower than body.
  2. 5 back blows: Use the heel of your hand to deliver 5 firm blows between the shoulder blades.
  3. Flip the infant face-up on your other forearm (sandwich position). Keep head lower than body.
  4. 5 chest thrusts: Use 2 fingers on the center of the chest, just below the nipple line. Give 5 downward chest thrusts.
  5. Alternate back blows and chest thrusts until object is expelled or infant loses consciousness.
  6. If infant loses consciousness: Begin infant CPR. Look for object before giving breaths.

Pregnant Person / Obese Person

  • Do not use abdominal thrusts.
  • Use chest thrusts instead:
  • Stand behind the person.
  • Place your fist on the center of the breastbone (sternum), not the lower tip.
  • Give firm backward thrusts.
  • Alternate 5 back blows with 5 chest thrusts.

Self-Choking

If alone and choking:

Abdominal self-thrust: 1. Make a fist. Place it above the navel. 2. Grasp with the other hand. 3. Thrust sharply inward and upward.

Use a firm object: - Position yourself above a chair back, counter edge, or railing. - Thrust your upper abdomen against the edge forcefully. - This can replicate the Heimlich force.

Severe Bleeding Control

Direct Pressure

  1. Protect yourself if possible (gloves, plastic bag, extra cloth).
  2. Apply firm, continuous direct pressure to the wound using a cloth, gauze pad, or clothing.
  3. Do not remove the material if it soaks through — add more on top.
  4. Maintain pressure for 10–15 minutes minimum without lifting to check.
  5. If bleeding is from a limb, elevate it above heart level while maintaining pressure.
  6. Once bleeding slows, secure with a bandage.

Wound Packing

For deep wounds (stab wounds, gunshot wounds): 1. Pack the wound tightly with gauze or clean cloth. 2. Apply firm direct pressure on top of the packed material. 3. Do not remove — this is for EMS to handle.

Tourniquet — When to Use

A tourniquet is appropriate for life-threatening limb bleeding that cannot be controlled by direct pressure, or when direct pressure is not feasible (multiple casualties, active scene).

How to apply: 1. Apply 2–3 inches above the wound (not on a joint). 2. If using a commercial tourniquet (CAT, SOFTT-W): Thread and tighten according to instructions; twist until bleeding stops. 3. If improvised (belt, strip of cloth, at least 1.5 inches wide — not rope or wire): Wrap twice, tie a half-knot, place a stick or pen on top, tie a full knot over the stick, twist until bleeding stops, secure the stick. 4. Note the time applied. Write it on the person's skin with a marker. 5. Do not remove the tourniquet — EMS must handle removal. 6. Do not cover the tourniquet.

A tourniquet left in place over 2 hours risks limb damage, but uncontrolled hemorrhage kills faster. Apply without hesitation when indicated.

Shock Recognition and Treatment

Shock is a life-threatening condition where the body cannot circulate enough blood to vital organs.

Signs and Symptoms

  • Pale, cold, clammy skin
  • Rapid, weak pulse
  • Rapid, shallow breathing
  • Altered mental status (confusion, agitation, drowsiness)
  • Nausea, vomiting
  • Thirst
  • Bluish lips or fingernails (late sign)
  • Loss of consciousness (severe)

Treatment

  1. Call 911.
  2. Lay the person flat on their back.
  3. Elevate the legs 8–12 inches unless head/neck/spine injury is suspected, or it causes pain.
  4. Keep them warm — cover with a blanket.
  5. Do not give anything to eat or drink.
  6. Loosen restrictive clothing.
  7. Monitor and reassure.
  8. Control any external bleeding.
  9. Begin CPR if they stop breathing.

Burns

Thermal Burns (Heat, Fire, Steam, Hot Liquids)

Severity: - First degree: Red, dry, painful (sunburn-like) - Second degree: Blisters, red/mottled, very painful, wet appearance - Third degree: White, brown, or black; leathery; may not be painful (nerve damage)

Treatment: 1. Stop the burning process: Remove from heat source. Remove clothing and jewelry near burn (unless stuck to skin). 2. Cool the burn: Run cool (not cold or ice) water over the burn for 10–20 minutes. Do not use ice — it causes further tissue damage. 3. Cover loosely: Use a clean, non-fluffy bandage or cling wrap. 4. Do not: Pop blisters, apply butter/toothpaste/oils, use fluffy cotton. 5. Seek medical attention for: burns covering large areas, burns on face/hands/genitals/joints, third-degree burns, burns in infants/elderly/immunocompromised, electrical or chemical burns.

Chemical Burns

  1. Brush off any dry chemical with a gloved hand or cloth (do not use water on dry chemical first — some chemicals react violently).
  2. Flush copiously with large amounts of running water for at least 20 minutes.
  3. Remove contaminated clothing.
  4. Do not try to neutralize with another chemical.
  5. Call poison control (USA: 1-800-222-1222) and 911.

Electrical Burns

  • There may be an entry wound and exit wound.
  • Internal damage is often far worse than the external burn suggests.
  • Do not touch the person if still in contact with electrical source — shut off power first.
  • Call 911 immediately. All electrical burns require evaluation.
  • Watch for cardiac arrhythmia, respiratory failure, internal burns.

Fractures and Sprains

Fracture (Broken Bone)

Signs: Pain, swelling, bruising, deformity, inability to use the limb, grinding sensation, bone visible (open fracture).

Treatment: 1. Call 911 for suspected spinal fractures, open fractures, or if transportation is needed. 2. Immobilize the injury in the position found — do not attempt to straighten. 3. Splint using padding and rigid material (board, rolled magazine, cardboard). Extend the splint to immobilize the joints above and below the fracture. 4. Secure the splint with bandages or strips of cloth — not so tight as to cut off circulation. 5. Check circulation distal to the injury (pulse, sensation, movement) before and after splinting. 6. Apply ice wrapped in cloth to reduce swelling. 7. Elevate if no spinal injury suspected. 8. Open fractures: Do not push bone back in. Cover with a clean, moist dressing.

Sprain

Signs: Pain, swelling, bruising, reduced range of motion.

R.I.C.E. Protocol: - Rest — Avoid using the injured area. - Ice — 20 minutes on, 20 minutes off. Never ice directly on skin. - Compression — Elastic bandage (not too tight — check circulation). - Elevation — Raise above heart level.

Drowning Response

  1. Ensure your safety — Do not jump in unless trained as a water rescuer. Extend a towel, rope, or pole; throw a flotation device; shout instructions.
  2. Get the person out of the water as safely as possible.
  3. Call 911.
  4. Check responsiveness and breathing.
  5. If unresponsive and not breathing: Begin CPR immediately — start with rescue breaths (drowning victims need oxygen first).
  6. Continue CPR until EMS arrives.
  7. All drowning victims require medical evaluation even if apparently recovered — secondary drowning can occur hours later.
  8. Keep the person warm (hypothermia risk).

Seizure Response

Do: - Stay calm and time the seizure. - Call 911 if: first seizure, seizure lasts more than 5 minutes, person doesn't regain consciousness, multiple seizures, person is injured, pregnant, or has diabetes. - Clear the area of hard/sharp objects. - Cushion the head with something soft. - Turn the person on their side if vomiting. - Stay with them until fully conscious. - Be calm and reassuring when they wake up (postictal state — confusion is normal).

Do not: - Restrain the person. - Put anything in their mouth (the tongue cannot be swallowed — this is a myth). - Give water/food/medication until fully conscious.

Diabetic Emergency

Hypoglycemia (Low Blood Sugar) — More Common Emergency

Signs: Shakiness, sweating, confusion, pale skin, rapid heartbeat, headache, hunger, irritability, loss of consciousness.

If conscious and able to swallow: 1. Give 15–20 grams of fast-acting sugar: - 4 glucose tablets - 4 ounces (half cup) of fruit juice or regular soda - 1 tablespoon of honey or sugar 2. Wait 15 minutes, recheck blood sugar. 3. Repeat if still symptomatic. 4. Once better, give a snack with protein.

If unconscious or unable to swallow: - Do NOT give anything by mouth (choking risk). - Place in recovery position. - Call 911. - If glucagon kit available and you're trained, administer.

Hyperglycemia (High Blood Sugar)

Signs: Frequent urination, excessive thirst, blurred vision, fatigue, fruity-smelling breath (diabetic ketoacidosis). - Less immediately dangerous than hypoglycemia. - Encourage water intake. - Seek medical attention.

Allergic Reaction / Anaphylaxis

Mild Allergic Reaction

Hives, itching, runny nose, watery eyes. — Oral antihistamine (diphenhydramine / Benadryl). Monitor closely.

Anaphylaxis (Severe, Life-Threatening)

Signs (may develop within seconds to minutes): - Throat/tongue swelling, difficulty swallowing - Difficulty breathing, wheezing - Hives, redness, itching over large area - Drop in blood pressure, dizziness, fainting - Rapid or weak pulse - Nausea, vomiting, abdominal cramps - Pale or bluish skin

Treatment: 1. Call 911 immediately. 2. Administer epinephrine (EpiPen) — this is the first-line treatment.

EpiPen Use

  1. Remove the auto-injector from its carrier.
  2. Pull off the blue safety cap (dominant hand).
  3. Place the orange tip against the outer mid-thigh (can inject through clothing).
  4. Push down firmly until a click is heard. Hold in place for 10 seconds.
  5. Remove. Rub the injection site for 10 seconds.
  6. Note the time of injection.
  7. Lay the person flat with legs elevated (unless breathing difficulty — then let them sit up).
  8. A second dose can be given after 5–15 minutes if symptoms return and EMS has not arrived.
  9. Even if symptoms improve, call 911. Anaphylaxis can have a biphasic reaction.

Heat Emergencies

Heat Cramps

Muscle cramps during or after exertion in heat. - Move to cool area. Rest. Drink sports drink or lightly salted water. Stretch and massage muscles gently.

Heat Exhaustion

Signs: Heavy sweating, cool/pale/moist skin, weak rapid pulse, nausea, headache, dizziness, fatigue, possible fainting.

  1. Move to cool environment (air conditioning or shade).
  2. Loosen or remove excess clothing.
  3. Apply cool, wet cloths to skin.
  4. Fan the person.
  5. Give cool water or sports drink if conscious and not nauseated.
  6. Monitor. If no improvement within 15 minutes or condition worsens → Call 911.

Heat Stroke (Medical Emergency)

Signs: High body temperature (103°F / 39.4°C or higher), hot/red/dry or damp skin, rapid/strong pulse, altered mental status (confusion, slurred speech, loss of consciousness).

  1. Call 911 immediately.
  2. Move to cool area.
  3. Cool the person rapidly by any means available:
  4. Ice water immersion (most effective)
  5. Ice packs to neck, armpits, groin
  6. Wet sheets and fanning
  7. Do not give fluids to drink.

Cold Emergencies

Frostbite

Freezing of body tissue (fingers, toes, nose, ears, cheeks). Stages: Frostnip (skin red, numb, not yet frozen) → Superficial → Deep frostbite (frozen solid, waxy/grayish, blistering).

  1. Move to warm environment.
  2. Remove wet clothing and jewelry.
  3. Do NOT rub the affected area.
  4. Do NOT rewarm if there is risk of refreezing (walking on rewarmed frostbitten feet is better than thawing and refreezing).
  5. Rewarm in warm (not hot) water 98–102°F (37–39°C) for 15–30 minutes.
  6. Loosely bandage with sterile gauze between toes/fingers.
  7. Seek medical care.

Hypothermia

Core body temperature below 95°F (35°C).

Signs: Shivering (mild), confusion, slurred speech, drowsiness, loss of coordination, pale/blue skin, weak pulse, reduced shivering (severe — bad sign).

  1. Move to warm, dry environment.
  2. Remove wet clothing gently.
  3. Cover with blankets including head and neck.
  4. Apply warm packs to neck, armpits, groin (wrapped — not directly on skin).
  5. Give warm, non-alcoholic beverages if conscious and able to swallow.
  6. Handle gently — rough movement can trigger cardiac arrhythmia in severe cases.
  7. Call 911 for moderate to severe hypothermia.
  8. If no pulse: Begin CPR. Hypothermic patients have survived prolonged resuscitation.

Poison Ingestion

  1. Call Poison Control immediately:
  2. USA: 1-800-222-1222
  3. UK: 111
  4. They will guide you — do not wait for symptoms.
  5. Do NOT induce vomiting unless specifically directed by Poison Control. Vomiting can cause additional harm with some substances.
  6. Have the container or name of the substance ready when calling.
  7. If the person is unconscious, not breathing, or having seizures: Call 911.
  8. Follow Poison Control instructions precisely.

Eye Injury

Chemical Splash

  1. Flush immediately with large amounts of clean water for 15–20 minutes.
  2. Hold eyelids open with fingers if necessary.
  3. Remove contact lenses before or during flushing if possible.
  4. Flush from the inner corner outward (to avoid washing chemical into the other eye).
  5. Seek emergency medical attention even after flushing.

Foreign Object in Eye

  1. Do not rub.
  2. Try to flush out with clean water.
  3. If visible on white of eye: Use a damp cotton swab to gently remove.
  4. If object is embedded or on cornea: Do not remove. Cover both eyes with loose bandage. Seek immediate care.

Blunt Trauma

  • Apply a cold pack (wrapped) to reduce swelling.
  • Seek medical evaluation if vision changes, severe pain, or visible blood in eye.

Penetrating Object

  • Do not remove the object.
  • Cover with a cup or shield to protect without pressure.
  • Cover both eyes to reduce movement.
  • Seek emergency care immediately.

Tooth Knocked Out (Avulsed Tooth)

Speed is critical — reimplantation is most successful within 30 minutes.

  1. Handle by the crown (top), not the root.
  2. If dirty, rinse gently with milk or saline (do not scrub).
  3. Try to reimplant the tooth in the socket (adult teeth only — not baby teeth). Hold it in place by biting gently on a cloth.
  4. If reimplantation is not possible, store the tooth in:
  5. Milk (best available option)
  6. Saline solution
  7. The person's own saliva (between cheek and gum)
  8. Do not store in plain water (kills root cells)
  9. Get to a dentist or emergency room immediately.

Quick Reference Card

Emergency First Action Key Note
Cardiac arrest Call 911 + start CPR Push hard and fast
Choking (severe) 5 back blows + 5 abdominal thrusts Alternate until clear
Severe bleeding Direct pressure Don't remove soaked cloth
Anaphylaxis EpiPen + call 911 Even if better, go to ER
Seizure Clear area, time it, do not restrain Call 911 if >5 minutes
Heat stroke Cool immediately + 911 Ice water bath most effective
Hypothermia Warm slowly + 911 Handle very gently
Drowning CPR, breaths first All drowning = ER
Poisoning Poison Control first Do not induce vomiting

Section 14.1 — The Observatory Almanac

Emergency Quick Cards