Hands-Only CPR / Stayin’ Alive Part 1

Using you skills as a Bystander

Most people would like to save someones life if they could do so safely, but the biggest deterrent for a bystander to Not initiate CPR in public is fear of giving mouth-to-mouth to a stranger. Now, especially with COVID-19 amongst us, we can avoid doing the scariest part of CPR: giving mouth-to mouth breaths.

In most CPR class curriculums there is no mention of Hands-OnlyTM CPR and people are left thinking that the best thing to do when a person needs CPR is to deliver the breaths after compressions. This would be fine if the world was made up with only your friends and family, but what about the people you don’t know? People often ask me if Hands-OnlyTM is something new as they didn’t hear of it in their last CPR class?

Compressions only was first introduced in 2008 by the Sarver Heart Center in Arizona, and in 2010 The American heart Association (AHA) switched the order of CPR from breaths first to compressions: ABC switched to CAB (Compression Airway Breathing) and the Hands-OnlyTM campaign began.

In Sudden Cardiac Arrest (SCA) a person stops breathing and there is no pulse. The heart quivers and shakes in an irregular rhythm, called Ventricular Fibrillation. This chaotic rhythm cannot pump blood to the body and a person will suffer irreversible brain damage in as little as 4-6 minutes if compressions are not started. A defibrillator is needed in order to restore a normal rhythm back to the heart.

The AHA video below on Hands-OnlyTM CPR encourages people with no training to jump-in and start compressions. Although this might not be the person you want doing compressions on you-they can still save your life!

The important thing to remember is that Hands-OnlyTM CPR is intended for certified individuals, as well.

For a witnessed SCA in an adult there is still plenty of oxygen remaining in a person’s bloodstream so starting Compressions keeps that oxygenated blood flowing to vital organs until an AED can be used to restore a normal rhythm back to the heart.

Rest assured that Continuous Chest Compressions, AKA Hands OnlyTM CPR, has been proven to be even more effective than conventional CPR (compressions and breaths) for an adult, witnessed SCA. The Sarver Heart Center at the University of Arizona has gone so far as to say that continuous chest compressions can double a persons chance of survival. (See Video Below).


Every interruption in chest compressions decreases a person’s chance of survival. When we are not pushing on the chest to create a heart beat a person is essentially dying. Compressions are physically demanding and after 100-200 you need to switch with another person. If they are not trained you can quickly coach them on how to do effective compressions.

Children, Infants, drowning victims, and unresponsive choking victims would be an indication for certified individuals to consider giving breaths. Also, for an adult, unwitnessed, Cardiac arrest consider giving breaths as they are starved for oxygen. However, even if you are certified you can do compressions only in all situations if you don’t have a pocket mask.

At what point would it be important to consider giving breaths when performing compressions only?

The American Heart Association states that there are several minutes of oxygen remaining in the bloodstream after a person collapses from SCA. You can bet that we can safely do compressions only until a person’s skin turns cyanotic (bluish), or with darker skin individuals the lips will turn grey and the palms turn bluish. Cyanosis occurs when the oxygen saturation in the blood drops below 85% and most likely this would be longer than seven (7) minutes.

I often hear people say that they would give mouth-to-mouth to a stranger believing that breaths are going to benefit them more. This is true in some situations, but definitely not for an adult, witnessed SCA.

What do you say to the person that is insisting that you give two breaths mouth-to-mouth on the street?

Other than giving them “the bird” since you are using two hands to do compressions you might say, “go right ahead and have a nice trip to the hospital.”

Barrier devices are necessary to protect us from secretions and vomitus. I think you can see now, more than ever that Hands-OnlyTM CPR would be the best choice for SCA and that Mouth-to-mouth breathing is reserved for friends and family.

A pocket mask will be attached to the AED in a kit with gloves, however, the only safe way to deliver breaths with regard to COVID is with the Bag-Valve-Mask only found in medical settings. You could do Hands-onlyTM CPR in all situations until EMTs arrive, and remember that mouth-to mouth breathing is always intended for friends and family.

If you have never taken a CPR class before then watching The American Heart Association (AHA) video below is your first step to saving a life. Now, your next step is to Get CPR certified to learn high-quality CPR. In considering CPR Classes make sure that it is appropriate for you whether you are learning how to save family and friends, or to fulfill a requirement for work.


By Roy Gordon, NREMT/CPR, BLS Instructor


Learn more about our
American Heart Association
CPR certification in San Francisco,
and how to save-a-life performing high quality CPR!

As a reward for getting certified with us at Revive CPR we include a rescue Breathing key-chain with every AHA certification class ( a $10 value).

Revive CPR Training San Francisco