If someone isn’t breathing, call 911 immediately, then start CPR. Every minute without action reduces their chance of survival, so speed matters more than perfection. Any attempt at CPR is better than no attempt.
Check for Responsiveness First
Tap the person firmly on the shoulders and shout, “Are you okay?” If they don’t respond, look at their chest for movement. You’re checking for normal, steady breathing, not occasional gasps. Gasping (irregular, labored gulps of air) can happen in the first minutes after the heart stops, and it does not count as breathing. If you see gasping or no chest movement at all within about 10 seconds, treat the person as not breathing and begin CPR.
Many bystanders hesitate because they’re unsure whether the person is breathing normally. If you’re not confident it’s normal breathing, act as if it isn’t. Starting CPR on someone who turns out to be breathing is far less dangerous than doing nothing for someone whose heart has stopped.
Call 911 and Start Chest Compressions
Call 911 (or have someone nearby call) before you start CPR. Put the phone on speaker so the dispatcher can talk you through it. If an automated external defibrillator (AED) is nearby, send someone to grab it.
For an adult or teen who has collapsed, the American Heart Association recommends Hands-Only CPR if you haven’t been trained in rescue breaths. It has two steps: call 911, then push hard and fast in the center of the chest. Place the heel of one hand on the center of the breastbone, put your other hand on top, and lock your elbows straight. Compress at least 2 inches deep at a rate of 100 to 120 pushes per minute. A helpful reference: that’s roughly the tempo of the Bee Gees’ “Stayin’ Alive.”
Hands-Only CPR has been shown to be as effective as traditional CPR with breaths during the first few minutes of a sudden cardiac arrest in adults. Don’t worry about doing it perfectly. Cracked ribs happen even when professionals perform CPR. The goal is to keep blood circulating to the brain and organs until paramedics arrive.
When Rescue Breaths Matter
If you’re trained in CPR with rescue breaths, the standard ratio is 30 chest compressions followed by 2 breaths, repeated in cycles. Tilt the person’s head back gently, lift the chin, pinch the nose shut, and blow into the mouth just enough to see the chest rise. Each breath should take about one second.
Rescue breaths are especially important in certain situations. For infants, children, drowning victims, and people who collapse from a drug overdose or breathing problem, the cause is often a lack of oxygen rather than a heart rhythm issue. Chest compressions alone won’t address that. The AHA specifically recommends full CPR with breaths for these cases. In drowning, airway and breathing take priority over compressions because the core problem is oxygen deprivation. Guidelines recommend 5 initial rescue breaths before starting compressions for a drowning victim, compared to the usual 2 breaths in standard CPR.
CPR for Infants and Children
For a baby under one year old, use two fingers (not your whole hand) placed on the center of the chest, just below the nipple line. Push down about 1.5 inches, which is roughly one-third the depth of the infant’s chest. The compression rate is the same as for adults: 100 to 120 per minute. After every 30 compressions, give 2 gentle breaths covering both the baby’s mouth and nose with your mouth.
For children ages 1 through puberty, use one or both hands depending on the child’s size, compressing about 2 inches deep. The 30:2 ratio applies the same way. If two trained rescuers are present for a child, they can switch to a 15:2 ratio, which provides more frequent breaths.
How to Use an AED
AEDs are designed for untrained people. Open the lid (many turn on automatically), and follow the voice prompts. Remove clothing from the person’s chest, make sure the skin is dry, then peel the backing off the two adhesive pads and stick them to the bare chest in the positions shown on the pads. The AED will analyze the heart rhythm and tell you whether a shock is needed. If it advises a shock, make sure no one is touching the person and press the button. Then immediately resume chest compressions. For anyone over age 8 or 55 pounds, use the adult pads.
Don’t pause compressions for more than 10 seconds at a time. If you’re alone and need to retrieve an AED, weigh the distance. If it’s more than a short jog away, keep doing CPR until help arrives.
If You Suspect an Opioid Overdose
Signs of an opioid overdose include extremely slow or absent breathing, blue or grayish lips and fingertips, pinpoint pupils, and unresponsiveness. If naloxone (commonly sold under the brand name Narcan) is available, give it as quickly as possible. Don’t wait for paramedics to arrive. Naloxone comes as a nasal spray that requires no training: insert the nozzle into one nostril and press the plunger. Even after giving naloxone, continue CPR if the person still isn’t breathing. The drug can take a few minutes to work, and its effects may wear off before the opioid does.
What to Do Once Breathing Returns
If the person starts breathing on their own but remains unconscious, place them in the recovery position to keep their airway clear. With the person on their back, kneel beside them. Extend their nearest arm out at a right angle with the palm facing up. Take their far arm and fold it so the back of their hand rests against the cheek closest to you. Use your free hand to bend their far knee to a right angle, then pull that knee toward you to carefully roll them onto their side. Their head should rest on the folded hand, and their bent leg prevents them from rolling face-down.
Tilt the head back slightly and lift the chin to keep the airway open. Check that nothing is blocking the mouth. Stay with them and keep monitoring their breathing until paramedics take over.
Legal Protections for Bystanders
Every U.S. state has some form of Good Samaritan law protecting bystanders who provide emergency care in good faith. If you crack someone’s ribs during CPR (which happens regularly, even in hospitals), these laws provide a legal defense against a lawsuit. The protection covers the kind of honest mistakes a reasonable person might make while trying to help. It does not cover reckless or intentionally harmful behavior, but if you’re genuinely trying to save someone’s life, the law is on your side.