Basic life support

Basic life support (BLS) is the level of medical care which is used for patients with life-threatening
illnesses or injuries until the patient can be given full medical care at a hospital. It can be provided by
trained medical personnel, including emergency medical technicians, paramedics, and by laypersons who
have received BLS training. BLS is generally used in the pre-hospitalsetting, and can be provided without
medical equipment.

Many countries have guidelines on how to provide basic life support (BLS) which are formulated by
professional medical bodies in those countries. The guidelines outline algorithms for the management of a
number of conditions, such as Cardiac arrest, choking and drowning. BLS generally does not include the
use of drugs or invasive skills, and can be contrasted with the provision of Advanced Life Support (ALS).
Most laypersons can master BLS skills after attending a short course. Firefighters and police officers are
often required to be BLS certified. BLS is also immensely useful for many other professions, such
as daycare providers, teachers and security personnel. Emergency medical technicians also provide BLS,
but at an advanced level. This typically includes patient assessment, patient transport, preventative
immobilization, using cervical collars, splinting limbs, full body splints, using long spine boards,
administration of select medication, oxygen therapy, nasal cannulas, combitubes, BVMs, etc.

CPR provided in the field buys time for higher medical responders to arrive and provide ALS care. For this
reason it is essential that any person starting CPR also obtains ALS support by calling for help via radio
using agency policies and procedures and/or using an appropriate emergency telephone number. An
important advance in providing BLS is the availability of theautomated external defibrillator or AED, which
can be used to defibrillation or delivery. This improves survival outcomes in cardiac arrest cases.

Basic life support consists of a number of life-saving techniques focused on the medicine "ABC"s of pre-
hospital emergency care:

 Airway: the protection and maintenance of a clear passageway for gases (principally oxygen and
carbon dioxide) to pass between the lungs and the outside of the body
 Breathing: inflation and deflation of the lungs (respiration) via the airway
 Circulation: providing an adequate blood supply to the body, especially critical organs, so as to
deliver oxygen to all cells and remove carbon dioxide, via the perfusion of blood throughout the body.

Healthy people maintain the ABCs by themselves. In an emergency situation, due to illness (medical
emergency) or trauma, BLS helps the patient ensure his or her own ABCs, or assists in maintaining for
the patient who is unable to do so. For airways, this will include maintaining optimal angles or possible
insertion of oral (Oropharyngeal airway) or nasal (Nasopharyngeal airway) adjuncts, to keep the airway
unblocked (patent). For breathing, this may include artificial respiration, often assisted by
emergency oxygen. For circulation, this may include bleeding control or Cardiopulmonary Resuscitation
(CPR) techniques to manually stimulate the heart and assist its pumping action. In each case, the BLS
provider is trained to detect ABC problems and attempt to correct them.

Adult BLS sequence

 Ensure that the scene is safe.

 Assess the victim's level of consciousness by asking loudly "Are you okay?" and by checking for
the victim's responsiveness to pain (AVPU).
 Activate the local EMS system by instructing someone to call 9-1-1. If an AED is available, it
should be retrieved and prepared.
 If the victim has no suspected cervical spine trauma, open the airway using the head-tilt/chin-
lift maneuver; if the victim has suspected neck trauma, the airway should be opened with thejaw-
thrust technique. If the jaw-thrust is ineffective at opening/maintaining the airway, a very careful head-
tilt/chin-lift should be performed.
 Assess the airway for foreign object obstructions, and if any are visible, remove them using
the finger-sweep technique. Blind finger-sweeps should never be performed, as they may push
foreign objects deeper into the airway.
 Look, listen, and feel for breathing for at least 5 seconds and no more than 15 seconds.
 If the patient is breathing normally, then the patient should be placed in the recovery position and
monitored and transported; do not continue the BLS sequence.
 If patient is not breathing normally, and the arrest was witnessed immediately before assessment,
then immediate defibrillation is the treatment of choice.[1]
 Attempt to administer two artificial ventilation's using the mouth-to-mouth technique, the mouth-
to-mask technique, or a bag-valve-mask (BVM). Verify that the chest rises and falls; if it does not,
reposition (i.e. re-open) the airway using the appropriate technique and try again. If ventilation is still
unsuccessful, and the victim is unconscious, it is possible that they have a foreign body in their
airway. Begin chest compressions, stopping every 30 compressions, re-checking the airway for
obstructions, removing any found, and re-attempting ventilation.
 If the ventilation's are successful, assess for the presence of a pulse at the carotid artery. If a
pulse is detected, then the patient should continue to receive artificial ventilation's at an
 appropriate rate and transported immediately. Otherwise, begin CPR at a ratio of 30:2 compressions
to ventilation's at 100 compressions/minute for 5 cycles.
 After 5 cycles of CPR, the BLS protocol should be repeated from the beginning, assessing the
patient's airway, checking for spontaneous breathing, and checking for a spontaneous pulse.
Laypersons are commonly instructed not to perform re-assessment, but this step is always performed
by healthcare professionals (HCPs). If an AED is available after 5 cycles of CPR, it should be
attached, activated, and (if indicated) defibrillation should be performed. If defibrillation is performed,
5 more cycles of CPR should be immediately repeated before re-assessment.
 BLS protocols continue until (1) the patient regains a pulse, (2) the rescuer is relieved by another
rescuer of equivalent or higher training (See Abandonment), (3) the rescuer is too physically tired to
continue CPR, or (4) the patient is pronounced dead by a medical doctor.[1]
 At the end of five cycles of CPR, always perform defibrillation (AED), and repeat assessment
before doing another five cycles.
 CPR continues indefinitely, until the patient is revived, or until the caregiver is relieved, or
discharged by a higher medical authority
 The CPR cycle is often abbreviated as 30:2 (30 compressions, 2 ventilation's or breaths). Note
CPR for infants and children uses a 15:2 cycle when two rescuers are performing CPR (but still
uses a 30:2 if there is only one rescuer)

Foreign body airway obstruction (choking)

• Assess the severity of airway obstruction. If the victim is able to speak and cough effectively, the
obstruction is mild. If the victim is unable to speak or cough effectively, or is unable to breathe or
is breathing with a wheezy sound, the airway obstruction is severe.

 If the victim has signs of mild airway obstruction, encourage him to continue coughing; do nothing
else.
 If the victim has signs of severe airway obstruction, and is conscious, give up to 5 back blows
(sharp blows between the shoulder blades with the victim leaning well forwards). Check to see if the
obstruction has cleared after each blow. If 5 back blows fail to relieve the obstruction, give up to
5 abdominal thrusts, again checking if each attempt has relieved the obstruction.
 If the obstruction is still present, and the victim still conscious, continue alternating 5 back blows
and 5 abdominal thrusts.
 If the victim becomes unconscious, lower him to the ground, call an ambulance, and begin CPR.
AVPU
The AVPU scale (Alert, Voice, Pain, Unresponsive) is a system by which a first aider, ambulance crew or
health care professional can measure and record a patient's responsiveness, indicating their level of
consciousness.

It is a simplification of the Glasgow Coma Scale, which assesses a patient response in three measures
- Eyes, Voice and Motor skills. The AVPU scale should be assessed using these three identifiable traits,
looking for the best response of each.

The AVPU scale has only 4 possible outcomes for recording (as opposed to the 13 possible outcomes on
the Glasgow Coma Scale). The assessor should always work from best (A) to worst (U) to avoid
unnecessary tests on patients who are clearly conscious. The four possible recordable outcomes are:[2]

 Alert - a fully awake (although not necessarily orientated) patient. This patient will have
spontaneously open eyes, will respond to voice (although may be confused) and will have bodily
motor function.
 Voice - the patient makes some kind of response when you talk to them, which could be in any of
the three component measures of Eyes, Voice or Motor - e.g. patient's eyes open on being asked
"are you okay?!". The response could be as little as a grunt, moan, or slight move of a limb when
prompted by the voice of the rescuer.
 Pain - the patient makes a response on any of the three component measures when pain
stimulus is used on them. Recognized methods for causing the pain stimulus include a Sternal
rub (although in some areas, it is no longer deemed acceptable), where the rescuers knuckles are
firmly rubbed on the breastbone of the patient, pinching the patient's ear and pressing apen (or similar
instrument) in to the bed of the patient's fingernail. A fully conscious patient would normally locate the
pain and push it away, however a patient who is not alert and who has not responded to voice (hence
having the test performed on them) is likely to exhibit only withdrawal from pain, or even
involuntary flexion or extension of the limbs from the pain stimulus. The person assessing should
always exercise care when performing pain stimulus as a method of assessing levels of
consciousness, as in some jurisdictions, it can be considered assault. This is a key reason why voice
checks should always be performed first, and the person assessing should be suitably trained.
 Unresponsive - Sometimes seen noted as 'Unconscious', this outcome is recorded if the patient
does not give any Eye, Voice or Motor response to voice or pain.
In first aid, an AVPU score of anything less than A is often considered an indication to get further help, as
the patient is likely to be in need of more definitive care. In the hospital or long term healthcare facilities,
caregivers may consider an AVPU score of less than A to be the patient's normal baseline.

In some emergency medical services protocols, "Alert" can be subdivided into a scale of 1 to 4, in which
1, 2, 3 and 4 correspond to certain attributes, such as time, person, place, and event. For example, a fully
alert patient might be considered "alert and oriented x 4" if he/she could correctly identify the time, their
name, their location, and the event.

Ambulance crews may begin with an AVPU assessment, to be followed by a GCS assessment if the
AVPU score is below "A."

The AVPU scale is not suitable for long-term neurological observation of the patient; in this situation,
the Glasgow coma scale is more appropriate.