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The Lifesaving Power of CPR: A Deep Dive into its Basics and Mechanism
Each year in Australia, around 26,000 people have an out-of-hospital cardiac arrest. About 12 per cent of those treated by an ambulance survive to hospital discharge. Most cases happen at home, at work, or on the sporting field, in front of someone who could help. Survival depends on what that person does in the first few minutes, well before paramedics arrive.
Cardiopulmonary resuscitation, or CPR, is the technique that keeps a person alive until medical help can take over. This guide walks through how to do CPR in Australia using the current Australian Resuscitation Council (ARC) steps, so you know what to do if it ever falls to you. For the broader context, see our guide to first aid in Australian schools and community organisations.
How to do CPR in Australia in short: If a person is unresponsive and not breathing normally, call Triple Zero (000), place the heel of one hand on the lower half of their breastbone, and push down at least 5 cm at a rate of 100 to 120 compressions per minute. After 30 compressions, give two rescue breaths if you're trained to. Continue until help arrives or the person recovers. The full ARC steps are below.
When CPR is needed
Start CPR when a person is unresponsive and not breathing normally. That's the only test the ARC asks bystanders to make. Don't check for a pulse, that's a clinical skill that's easy to get wrong under pressure.
A person who is occasionally gasping is not breathing normally. Start CPR.
If someone is choking and then stops responding or breathing, the same applies. Call 000 and start CPR. Chest compressions can also help dislodge the obstruction.
Don't stop to think about whether to begin. The risk of starting CPR on someone who doesn't need it is small. The cost of not starting on someone who does is fatal.
The DRSABCD action plan
DRSABCD is the ARC's action plan for every life-threatening emergency. Each letter is a step, and the steps are done in order.
- D for Danger. Check the area is safe for you, others, and the person on the ground. Power lines, traffic, fire, water all matter. You can't help if you become a second casualty.
- R for Response. Squeeze the shoulders firmly. Ask loudly, "Are you alright? What's your name?" No meaningful response means move to the next step.
- S for Send for help. Call Triple Zero (000) and ask for an ambulance. Put your phone on speaker so you can keep both hands free. If others are present, ask one to call while you start, and ask another to find an AED (an automated external defibrillator, covered further down).
- A for Airway. Tilt the head back slightly and lift the chin to open the airway. Clear anything visible from the mouth. Don't sweep for things you can't see.
- B for Breathing. Look at the chest, listen and feel for normal breathing for no longer than 10 seconds. Gasping doesn't count.
- C for CPR. If breathing is absent or abnormal, start chest compressions.
- D for Defibrillation. Use an AED as soon as one arrives. Switch it on and follow the spoken prompts.
How to give chest compressions
Place the heel of one hand on the lower half of the breastbone, the centre of the chest. Put your other hand on top, fingers interlocked. Arms straight, shoulders directly over your hands.
Push hard. The ARC depth target is at least 5 cm for an adult, around 5 cm for a child, and 4 cm for an infant. Rough guide: one-third of the chest depth at each compression.
Push fast. The rate is 100 to 120 compressions per minute, just under two per second. The chorus of "Stayin' Alive" is famously the right tempo. "Baby Shark" works too, if that's more your speed.
Let the chest come fully back up between compressions. The recoil is part of the cycle. Compressing again before the chest rebounds reduces blood flow.
Swap with another rescuer every two minutes if you can. Effective compressions are tiring, and tired compressions are shallow ones.
The 30:2 ratio and rescue breaths
After 30 compressions, give two rescue breaths. The ratio is 30:2 for every age group, adults, children, and infants.
Open the airway with a head tilt and chin lift. Pinch the nose closed, seal your mouth over theirs, and breathe in over about one second. Watch for the chest to rise. Give two breaths, then return to compressions. Pause compressions as briefly as you can. Long pauses cost blood flow to the brain.
If you're not trained in rescue breaths, or you're unwilling to give them, do compression-only CPR (also called hands-only CPR). Continuous compressions are far better than nothing, and the ARC actively encourages bystanders to use this approach when rescue breaths aren't on the table. The most common mistake at this point is not doing anything, not the choice of which technique.
There's one case worth flagging. Drowning is a respiratory event rather than a heart-rhythm one, which is why rescue breaths matter more in a drowning patient than in most adult cardiac arrests. ANZCOR Guideline 9.3.2 asks you to follow standard 30:2 CPR with breaths included.
ANZCOR strongly discourages compression-only CPR for a drowning patient and treats it as a temporary stopgap only, used until someone willing and able to give breaths can take over. The underlying problem is a lack of oxygen, and pushing blood around without adding breaths doesn't address it.
Using an AED
AEDs are designed for the person standing closest to the patient, not the person with the most training. That's the whole point. The device will only deliver a shock when the heart's rhythm calls for one, so it can't be misused on someone who doesn't need it.
When an AED arrives, switch it on. Follow the voice prompts. Most ask you to expose the chest, attach the pads as shown on the diagram, and stand clear while the device analyses the rhythm.
If you're told to shock, press the button when prompted and resume compressions immediately. If the device tells you no shock is advised, keep going with CPR. Continue this loop, two minutes of CPR followed by one rhythm check, until help arrives or the person starts to recover.
Adult cardiac arrest is usually caused by a problem with the heart's electrical rhythm, which is exactly what the AED is designed to fix. Getting one to the patient quickly matters more for an adult than for an infant or small child, where the arrest is more often a breathing problem.
Public-access AEDs are turning up in more Australian workplaces, schools, sporting clubs, and community spaces every year. The GoodSAM app maps registered AED locations across Australia and is integrated with Triple Zero in several states. If you're responsible for a setting that has one, knowing where the nearest unit lives is part of the job, and registering your own AED with GoodSAM is a quick win.
CPR for children and infants
Infant CPR is the bit no parent wants to think about. The good news is the steps are the same as for an adult: 30 compressions to two breaths, a rate of 100 to 120 per minute, full recoil between compressions. The technique and pressure shift with the size of the patient.
For a child aged one to puberty, compress with the heel of one hand to a depth of about 5 cm. For an infant under one year, use two fingers in the centre of the chest, just below the nipple line, to about 4 cm. Give smaller breaths rather than full adult breaths and watch for the chest to rise.
On phones, the rule is the same at every age. Ring Triple Zero, put it on speaker, and start CPR with the operator on the line. Stay with the patient. The dispatcher keeps the ambulance moving and will talk you through it. The DRSABCD sequence is the same for adults, children, and infants.
If an AED is available, use it. Many units have paediatric pads or a child mode setting; use those for a child under eight if you have them. If you only have adult pads, use them anyway. An adult-sized shock is far better than no shock. On a small body, place one pad on the front of the chest and the other on the back so the pads don't overlap.
When to stop
Keep going until one of the following happens:
- Paramedics arrive and take over.
- The person starts breathing normally or shows clear signs of life.
- You're physically unable to continue.
- The scene becomes unsafe.
That last one matters. Effective CPR is hard work, and so is honest assessment of when to step back.
Four things people worry about
You might break a rib. Possibly. Rib fractures and bruising are common with effective compressions, and they're recognised as acceptable consequences. The survival benefit of CPR sits far above the risk of these injuries.
You might be sued. Every Australian state and territory has Good Samaritan protections that cover a person who gives assistance in good faith and without expectation of payment. Acting under those rules is supported by law.
You haven't done it in a long time. Skills decay quickly, and that's normal. A CPR refresher takes a couple of hours through a registered training organisation. St John Ambulance and Australian Red Cross run accredited courses across the country. If it's been more than twelve months, consider booking one. The course is the difference between freezing up and stepping in.
You're worried about how you'll feel afterwards. CPR is hard, particularly if the person doesn't survive. That weight can stay with you. If you've been through it and need to talk it through, your GP is a good first stop, and Lifeline (13 11 14) is available any time, day or night.
Make CPR part of how your community works
Cardiac arrest doesn't usually happen in hospitals. It happens at home, on the field, at the school gate. The people most likely to give CPR are family, coaches, teachers, and committee volunteers. The case for training more of them is straightforward.
If you run a school or a sporting club, get your team CPR-trained, check your defibrillator works, and make sure people know where it is. Pair that with a properly stocked sports club kit or the right first aid kit for your school and the basics are in place.
We've supplied defibrillators and AED accessories along with the rest of the gear schools and community organisations need to be ready since 2011. If you're not sure what your setting needs, ring the team at the Murphy Street shop on 03 5443 2239. We're happy to talk it through.
The full ARC steps are published as Australian Resuscitation Council Guideline 8, with drowning-specific guidance in ANZCOR Guideline 9.3.2. Both are worth a read if you want the technical detail behind the bystander summary above.