Isn’t “Not Breathing Normally” Still Breathing? Maybe Not.

ConfusedHello Everyone,

I had a great comment come through the student comment section this week and thought it might help others if I shared my response.

So, the student asked,
” Some questions on your test seemed to give incomplete or misleading information, in my opinion. Such as the one referring to a man who is unresponsive and not breathing normally. The answer to pass was to give them 30 chest compressions yet if someone is not breathing NORMALLY it leads me to believe that they are breathing and the first thing I would want to do is try and figure out why the breathing is not normal. Not give them chest compressions. Have I checked for a heartbeat? I wouldn’t give chest compressions unless I couldn’t detect a pulse.” Student

Here was my response. I hope it helps.

Dear “Student”,

There were a couple of changes in this 2010 ECC/ILCOR and American Heart Association release from the guidelines of 2005. One was that if the person is unresponsive and not breathing “normally” we begin chest compressions. Pretty aggressive I know but this is what the guidelines suggest as best practice. Secondly, basic first aid providers no longer check for pulses in the unresponsive victim. Now, when a lay-rescuer comes upon a person who is unconscious, not breathing or not breathing “normally”, they are to activate EMS(call 911) and begin chest compressions at a rate of at least 100 per minute and at least 2 inches deep. This is to continue for 30 compressions only interrupted long enough to give two full breaths after the head tilt chin lift and then back to the chest compressions. The rescuer is not to stop this process unless the patient begins to respond and become conscious, begins breathing normally again, an AED is available, or if EMS arrives and takes over. CPR is to be provided fast and hard with as few interruptions as possible. So there you have it as stated by the new and latest ECC/ILCOR guidelines.

Now, for my subjective slant on the whole deal. I say, don’t feel bad if you’re a little frustrated. As a licensed paramedic, instructor trainer for CPR, First Aid, ACLS and PALS, it still a bit hard for me to watch the latest recommendations and guidelines put forth by the International Liaison Committee On Resuscitation”. It was hard to watch them throw the proverbial “baby out with the bath water” if you will. I for one believe that people can learn how to perform effective and more advanced assessment if given the correct learning mechanisms by which to learn and retain the information in order to use it well during a real rescue situation. I believe that people are more than capable of providing optimal CPR and First Aid which would include pulse checks. I think that there can be times, though maybe rare, where checking for pulses would be helpful in determining the correct next steps especially when dealing with patients suffering from low blood sugar, or a hard hit to the head which temporarily knocks them unconscious and they stop breathing for some time. I also wonder about the person who has been in cardiac arrest for some time. The person is certainly permanently dead and any resuscitation efforts will not change the patients status because they’ve been dead for more than half an hour or longer. Does the rescuer still perform CPR and Rescue Breathing because the person is not moving, not breathing or not breathing normally? Very difficult for me to believe that a rescuer would have to perform CPR on a person with rigor mortis while waiting for the EMS providers to arrive and confirm time of death.

But, the ECC/ILCOR recommendations were based on some evidence, though from my findings I admit not much, that more people would benefit from these simplified procedures than would suffer any ill consequence. So they made the change.

What helps me to deal with the changes when I don’t agree with them, is that the changes were made by the ILCOR group to “simplify” the procedures of CPR and to hopefully encourage more people trained or not, to get involved and hopefully make a difference in saving more lives. If this is indeed the case and we’ll know in a few years, than I guess it’s worth the bit of frustration that some of us must suffer.

I hope this helped. Please let me know if you have any further questions.

Best Wishes,


RoyOnRescue Answers Question About Assessing Breathing

In this post, I answer a question from a professional who has been training lay rescuers and wants to update their students to the new 2010 suggested guidelines.

The following excerpt is taken from the original email.
Greetings from India,

“We teach first aid and CPR (to the layperson/non medical person)in New Delhi, India and are reading the new guidelines so that they can be incorporated in the new year.  I know the handbooks will be out in the first quarter but would like to start adding the 2010 guidelines sooner.
A couple of questions- your input would be appreciated.
1. Do we carry on with AVPU
2. As checking for breathing is being de-emphasized – how are first aiders to tell if breathing is present or not. From what i can figure out- look, listen feel is not to be used now.”

Merry Christmas and Happy New year.

Kind Regards,

New Delhi

The following is my response:

Hello Student,

Thank you for reaching out as I hope to be of assistance.  Regarding the new updates for 2010 and how it relates to training the lay public.

1.  Q:  “Do we carry on with AVPU?”
A:  Yes and No.  Yes in so much as we are always kind of asking ourselves, “Is this person awake? Are they Verbal? Do they respond to pain(not that we should be causing any pain)? Are they unresponsive?  But I have to say no, because we are checking to see if the person appears to be breathing or breathing normally?  This does not fit in the AVPU scale for a level of consciousness.  We must also remember that AVPU is an advanced medical training and the ECC/ILCOR recommendations do not teach lay rescuers to use AVPU anywhere in the curriculum.

2.  Q: With assessment for breathing being de-emphasized and the elimination of the “Look, Listen, and Feel” part of assessment, what is the best way to train lay rescuers to assess for breathing?
A:  This is a great question.  Under the new guidelines, assessment for breathing is performed by looking for the following:  Is the persons chest moving like in breathing?  Does the person appear to be breathing normally?   If the person is not breathing normally, and the chest is not rising and falling, the rescuer will initial emergency medical services and begin CPR starting with 30 chest compressions at least 2 inches deep and at a rate of at least 100 per minute.

The simplification of assessment for breathing was brought by confusion of agonal respirations vs. regular gas exchanging breathing.  The hope is that if a rescuer notices that the person is not breathing normally, help will be called and initiation of CPR will not be delayed.

For those of us who worry that too many victims will receive CPR when it is not necessary and thereby suffer unnecessary injuries, one must be aware of the scientific studies that show that “only two percent of people receiving CPR suffered any injury at all from CPR when it was not needed.  But the advantages of early initiation of CPR without delay, has been shown to improve survival with minimal risk of injury but with great increase of benefit.(

Please note that all update training is available for free at:

Thank you for your email and please let me know if you need any further assistance.

Best Wishes and Merry Christmas!

Roy Shaw, EMT-Paramedic

Asthma Attack and No Medication!

One of the scariest feelings is not being able to breath.  This is exactly what is happening during a severe asthma attack.  I received an email from a person who stated that they have been trained in CPR and First Aid multiple times and though it covers the basics of asthma it never really talks about what to do in depth.  They gave me a scenario where a person may be having an asthma attack and EMS is quite some ways away.  What’s worse, there isn’t any medication for the asthma attack!  Now what?

In this episode we take a look at what asthma is, and how we can confidently handle it even if there isn’t any medications and EMS/911 is delayed.

Asthma Guide
Asthma Symptoms Training (Allergic Reactions)

Surviving A Flood

Flooding causes many problems with people who experience them.  From drowning to hypothermia and fractures to contaminated drinking water.  In this episode, Roy talks about the massive flooding that has affected the Tennessee region and what types of injuries and illness floods can bring.

ABC News and Video of Tennessee Flood

Snake Bites Part 2 of 2

In Part 1 of Snake Bites we talked about the different kinds of poisonous snakes that pose a risk for serious danger. Remember we were talking about an Emergency Responder who who had emailed me? She helps out with California High Desert Racing and the medical response team and is having some issues with Poisonous snake bites and 35-45 minute response times. This due to being so far away from civilization. In part 1 of this response video blog, we took a look at the different types of rattlesnakes that are causing problems, how they might kill a person and how we as rescuers could make the difference between life and death. In this second part, we will get to the bottom of the correct treatment strategy in order to save a snake bite victims life and limb.

Snake Bites Part 1 of 2

An Emergency Responder who helps out with California High Desert Races is having some issues with Poisonous Snake Bites and slow response times due to being so far away from civilization. In this response video blog, we take a look at the different types of rattlesnakes that are causing problems, how they might kill a person and how we as rescuers could make the difference between life and death.

Agonal Respirations Kind Of Look Like Sleep Apnea!

As I reflected on yesterdays video blog; “Gasping for Life”, I thought I should expound on what real agonal respirations really are and maybe even find some examples for you to see or hear.   Well, let me tell you this has turned out to be more difficult than I imagined.   As I searched the internet for some medical records of what I have seen during episodes of agonal respirations all I could find was one well intentioned but non realistic version of agonal respirations while everything else was simply informational.   I then began thinking about the times I had seen low blood sugar patients or postictal seizure patients and thought…I bet a good snoring respiration would be close!

After some time, I found an actual serious sleep apnea(OSA) case and thought I would include the link in the video blog for you to see.   Though this is not exactly what agonal respirations look or sound like, it is a far cry closer than other replications I found and will at least get the idea across that any form of agonal or distressed drive to breath is not oxygenating the body well and should be treated with Rescue Breathing or Full CPR depending on the symptoms.

I hope this helps clear up any confusion and please let me know if you would like me to expound on anything else relating to this video blog.

Best Wishes,
Roy Shaw, EMT-P

Actual Video Of Sleep Apnea (Warning! This video could be disturbing.  Viewer discretion advised.)

Gasping For Life!

If an unconscious person is gasping but not breathing normally should you call 911 and leave them alone, or should you begin aggressive CPR?  In this Video Blog, Roy Shaw, EMT-P tells a true story about how a child may have died due to not having life saving CPR because she was showing signs of agonal breathing.  This caused the rescuer to stop the life saving CPR and ended tragically.
Watch this Video Blog to learn what agonal breathing is and how to respond to it.

When Is Cell Phone A Weapon?

Viewer Discretion Is Advised Due to Graphic Nature!

In this episode of Roy on Rescue, Roy Shaw had received an article on his desk from  It was an article that talked about the growing danger of drivers who are using not only there cell phones to talk, but to text message while driving.  After Roy interviewed a full time professional dispatcher from  a leading ambulance provider, and heard the same message, he decided to write this article and include this most disturbing yet realistic video.

Viewer discretion is advised! Graphic reproductions of actual car crash injuries are included in this video.  The desire of showing this video is not to create anxiety for anxiety sake, but to create a disturbing awareness that will change behaviors while driving vehicles.  We all have loved ones that drive everyday.  Even if we as drivers don’t use the phone while driving, that doesn’t stop the driver in front of you, beside you or in back of you!

Let’s create a new and safer environment and prevent needless accidents…Now.

If after you view this video you decide to show it to your teenage drivers, please educate them to the graphic nature and then talk about the public service announcement after you view it together.

Please spread the word.  Everyone’s life may depend on it.

Roy Shaw would like to specially thank the United Kingdom for producing such a realistic and educational Public Service Announcement in this fight against accidents and cell phone misuse.

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