Question: Why Dont We Check ABC’s Anymore?

In this blog,

I answer a question that came in about why we don’t teach lay rescuers to check for pulses after AED shock. This student thought that we were trying to trick them but in reality, the new standards are what may be tricky. Here’s my answer, I hope it helps.

Hi Shelley,

Thank you for taking the time to comment about the training. I’m writing In regards to your question about AED use and then checking for “signs of life” vs checking for Airway, Breathing and Circulation. Id like to assure you that as wrong as it may seem to do CPR without checking for pulses first, the training you received from ProFirstAid.comis based upon the latest guidelines set forth by the American Heart Association and are correct.

The old standards were to shock with AED Training and then assess for Airway, Breathing and Circulation, if no pulse give CPR. The new standards have eliminated pulse checks for lay rescuers in order to simplify and hopefully reduce pulse check “mistakes”. This is designed to shorten time from arrival of help to first chest compression.

Now, if your feeling a little confused, don’t feel bad… many of us do when there are changes. Be assured that most people who are unconscious, not breathing normally and have received a shock are most probably in cardiac arrest and CPR is called for. Besides, studies show that chest compressions when not needed rarely ever cause severe harm. Better to error on the side if giving CPR.

This however, is the reason for change in training and per the AHA standards it is accurate.

I’d be happy to explain further and in more details if you like.

Best Wishes,

Roy Shaw, paramedic, instructor

Question Answered Regarding Aggresive Chest Compressions and Unconscious Choking Patient

Screenshot-2013-12-04-14.22A really good question came in regarding the choking unconscious protocol.  The question was basically this.

Q:  The way the objective is taught regarding choking patients, you progress to chest compressions once the person loses consciousness with or without a pulse.  I can understand that and have taught that to my staff BUT those with ACLS certification quickly point out that ACLS still stresses that you do not do chest compressions in a patient with a pulse.  I am reviewing my ACLS and I can see the confusion.  As I see it, the key is in what you have available to you and in an unconscious choking vs respiratory arrest but I would like to better explain it and to do that I need to make my peace with it too.

Lastly,  In response to your training question regarding choking unconscious patient.  I know it’s hard to understand some of the changes that take place from time to time with the ILCOR and AHA recommendations.

A:  I’ll try and make sense of this particular skill.  Once we asses for unconsciousness or lower the unconscious choking patient down to the floor, and after calling 911, we’re going to begin 30 chest compressions immediately and then open the airway, check for obstruction or object in mouth and sweep it out if we see it.

If we don’t see it, we will attempt two breaths, if breaths don’t go in, we will reposition the head tilt and chin lift and try two more breaths(ideally with a one way valve mask in place).  If breaths do not go in, we will give 30 more chest compressions and then check mouth for object. Repeat until object is clear, airway is open or help arrives and takes over.  If at some point, we sweep an object  out and the breath goes in, we then check for a carotid pulse for no more than 10 seconds, if no pulse and no normal breathing…begin CPR.   If there is a pulse but patient is not spontaneously breathing, begin rescue breathing at 1 breath every five seconds.

Explanation:  The immediate chest compressions are due to a philosophy that the patient was already choking while conscious and instead of assuming that it came out after unconsciousness, we assume that it’s still blocking the airway.  The only thing we need to do if not already done, is activate the EMS or 911 system.  Then after 30 chest compressions, we check for produced obstruction.

Remember, even in ACLS, we are now less concerned about pulses and more concerned about time from non circulating heart activity or arrest to time of first compression. In other words, if we are not able to detect pulses or are unsure, but the patient is unresponsive and not breathing “normally” (agonal) the science and research is promoting aggressive cardiac compressions and minimization of time between arrest and first compression from CPR.  In this scenario, if the choking patient is in cardiac arrest, then they will benefit from  receiving 30 chest compressions before we check the airway.

Therefore, in theory, we’ve potentially circulated some residual oxygen to the brain and other vascular organs.  If the patient is not in cardiac arrest but simply still choking, the compressions should assist in relieving the obstruction and studies have shown that injury due to non-needed compressions is minimal.  This is why the emphasis on aggressive chest compressions.

I hope this helps anyone else who may have had the same question!

When A Bike Crash Gives More Than A Road Rash!

Hello Everyone,

It’s been almost three weeks since my last episode was posted!  Just for the record…it’s partly because I’ve filled my Hard Disk and was short by about 4GB of RAM.  Seriously though, after suffering some technical problems I’m back in swing and hope to have several new posts in the next few days.  I’m also working on a new RoyOnRescue format to freshen things up and keep them moving in a direction that you would like to see them go.  In this episode, I cover a topic that was brought to me by a person who saw a road cyclist crash.  They were in bad condition and she wasn’t sure what to do.  I thought I’d take a minute to answer this while I upgrade my hardware on the old MacBook and rest before continuing work on the new style creation for the new upcoming year.  I hope this is helpful.  Keep the questions and comments coming and if you have a story that you’d like to share and get the RoyOnRescue point of view, please email

Thanks and keep on rescuing!


Email Questions and Answers Part 1

Hello Everyone!

In this episode of RoyOnRescue, Roy takes some time to catch up on different emailed questions and comments that have come in over the last few months.  The two different emailed questions that were answered were; “won’t laying a person down while choking only make it worse?” and “I thought we were always suppose to control arterial bleeding before beginning cpr!”.   Roy takes his time to discuss these two different topics and explain the reasons why we do what we do in rescue in detail.

Be sure to join Roy in Part 1 of several parts as he works his way through a list of different topics that have been sent in by viewers like you.

Remember,  If you’ve got a question or comment that you would like Roy to answer or give  a response, please send it via email to:  Be sure to follow Roy on twitter at:  @royonrescue

Remember, your actions make a bigger difference than you realize and you can change the course of history.

Keep On Rescuing,

The RoyOnRescue Team

Heat Wave!

Hello Everyone!

In this RoyOnRescue Video blog, Roy takes a look at the record breaking heat that most of the Country has been experiencing and gives a few tips on recognition and treatment of heat related emergencies like; heat exhaustion, heat stroke, dehydration, electrolyte problems etc.  So learn what to do, and how to survive the severe summer heat.  Don’t miss this episode of RoyOnRescue!

P.S.  Below, I’ve included some really clear signs and symptoms of heat related injuries, compliments of WebMD.  Click on the WebMD link for more information.


What Are the Symptoms of Heat-Related Illnesses?

Heat cramp symptoms include:

  • Severe, sometimes disabling, cramps that typically begin suddenly in the hands, calves, or feet
  • Hard, tense muscles

Heat exhaustion symptoms include:

Recommended Related to First Aid

  • Fatigue
  • Nausea
  • Headaches
  • Excessive thirst
  • Muscle aches and cramps
  • Weakness
  • Confusion or anxiety
  • Drenching sweats, often accompanied by cold, clammy skin.
  • Slowed or weakened heartbeat.
  • Dizziness
  • Fainting
  • Agitation

Heat exhaustion requires immediate attention but is not usually life-threatening.

Heat stroke symptoms include:

  • Nausea and vomiting
  • Headache
  • Dizziness or vertigo
  • Fatigue
  • Hot, flushed, dry skin
  • Rapid heart rate
  • Decreased sweating
  • Shortness of breath
  • Decreased urination
  • Blood in urine or stool
  • Increased body temperature (104 to 106 degrees)
  • Confusion, delirium, or loss of consciousness
  • Convulsions

Heat stroke can occur suddenly, without any symptoms of heat exhaustion. If a person is experiencing symptoms of heat exhaustion or heat stroke, GET MEDICAL CARE IMMEDIATELY. Any delay could be fatal. Seek emergency medical care for anyone who has been in the heat and who has the following symptoms:

  • Confusion, anxiety, or loss of consciousness
  • Very rapid or dramatically slowed heartbeat
  • Rapid rise in body temperature that reaches 104 to 106 degrees Fahrenheit
  • Either drenching sweats accompanied by cold, clammy skin (which may indicate heat exhaustion); or a marked decrease in sweating accompanied by hot, flushed, dry skin (which may indicate heat stroke)
  • Convulsions
  • Any other heat-related symptom that is not alleviated by moving to a shady or air-conditioned area and administering fluids and salts

Tribute To Rescue And Survival

In this episode, I wanted to take a moment to focus on the success of rescue attempts. Though it’s no guarantee that anyone will survive no matter how hard we try to save their lives, from time to time…they do.

And this is a video that celebrates survival. Don’t forget to celebrate the caring enough to try, no matter what the outcome too.


They’re Choking And I Can’t Get Them Out Of The Wheelchair!

Maybe you work with patients that are wheelchair bound and may, at times, be too large or have disabilities that limit your ability to get them out of the wheelchair in a hurry. Especially when they begin to choke during meal time. I received a phone call message regarding this very situation and though we had a great discussion about what to do for the patient over the phone, the person I was talking with thought it would be a great idea for it to be made into a video training. So, here you go Maria! I hope it helps.

Best Wishes,


Why CPR During Traumatic Cardiac Arrest Doesn’t Work Very Often

In this episode of RoyOnRescue, Roy talks about why cardiac arrests secondary to traumatic injuries, especially rapid deceleration accidents are so hard to resuscitate.  Roy goes a bit  more in depth about how every deceleration or rapid acceleration accident really is more like three different collisions.  Car hits wall, body hits car and organs hit inside of the body…that’s 3.  Now take a closer look at how it happens in this episode of RoyOnRescue.

Follow Up Answer Based On Question Regarding “How To Find The Brachial Pulse”

Hello Everyone,

Great follow up question came in on how to locate the “brachial” artery.

It’s located on the inside of the upper arm between the biceps and triceps muscle along the humerus bone.   Use the flat part of your four fingers to press moderately against the inside of  the arm at this location.  This is a skill that needs practice with a baby who has pulses so as to be confident when looking for a brachial pulse on a child without a pulse.  Remember, when in doubt, if the patient is unconscious, not breathing normally and appears dead…we treat them as they are.  Begin CPR!

Hope it helps.


Tornadoes and How To Survive.

“I don’t Think We’re In Kansas Anymore Toto!”  This was a famous line from a very good and classic movie, The Wizard Of Oz.  However, many people experience tornados each year and suffer great loss and damage as a result.  In this video blog post, Roy Shaw, EMT-paramedic and host of RoyOnRescue will share video clips of real tornados caught on video and some ideas on how to protect yourself your loved ones and others during the watch and warning phases of a devastating storm like a tornado.  It’s spring and it’s tornado season.  You won’t want to miss this episode.

Here’s a link from OSHA about how to prepare your workplace for a tornado.  Tornado Safety Link