4.4 Two-Rescuer Pediatric BLS

Initial Assessment

1. Verify Scene Safety: Ensure the area is safe for both rescuers and the victim.
2. Check for Responsiveness:
   • For a child: Tap the child’s shoulder and shout, “Are you okay?”
   • For an infant: Tap the bottom of the infant’s foot and shout, “Are you okay?”
3. Assign Rescuer Roles:
   • First rescuer: Begins resuscitation immediately.
   • Second rescuer: Activates the Emergency Response System (ERS) (e.g., calls 911 or mobilizes Advanced Life Support (ALS) team).
4. Scan for Breathing: Observe the victim’s chest for rise and fall for no more than 10 seconds. If there are no visible signs of normal breathing, assume cardiac arrest.

Checking for a Pulse

• It may be difficult to detect a pulse in small-bodied victims, so if a pulse is not detected within 10 seconds, begin CPR immediately.

Rescue Breathing (If Pulse is Present, But No Normal Breathing)

Rescue breathing provides assisted breaths to an unresponsive victim who has a pulse but is not breathing.

• Provide 1 breath every 3–5 seconds (about 12 to 20 breaths per minute).
• Each breath should be given over 1 second and should result in visible chest rise.
• Recheck the pulse approximately every 2 minutes.

When to Begin CPR

If the victim is not breathing and has no pulse, begin CPR immediately.

Child Chest Compressions

• Perform compressions at a rate of 100 to 120 per minute (think of the rhythm of the song "Staying Alive").
• Push hard and fast, at least 1/3 of the chest diameter (about 2 inches or 5 cm).
• Allow the chest to fully recoil before beginning the next compression.

Rescue Breaths

• After every 15 compressions, pause for no more than 10 seconds to allow the second rescuer to open the airway using the head tilt-chin lift technique.
• Give 2 breaths, each lasting 1 second. The chest should visibly rise with each breath.

Continue 15:2 Compression-to-Breath Ratio

• Continue performing compressions and breaths at a ratio of 15:2.
• Switch positions every 5 cycles or 2 minutes to avoid fatigue.

Switching Roles to Prevent Fatigue

To maintain high-quality compressions, rescuers should switch roles every 2 minutes (or 5 cycles of 15:2).

Step-by-Step Role Switch

1. Rescuer 2 (airway) signals: “Switch after this cycle.”
2. After the 15th compression, Rescuer 1 moves to the head to take over ventilations.
3. Rescuer 2 immediately begins compressions.
4. The switch should take less than 5 seconds to minimize interruptions.

Key Benefits of Two-Rescuer CPR

• Reduces rescuer fatigue, ensuring consistent high-quality compressions.
• Allows better airway management, especially with a bag-mask device.
• Minimizes hands-off time, maximizing survival outcomes.