• Choking Relief (FBAO): For conscious adults and children with severe foreign-body airway obstructions, the AHA now recommends alternating cycles of 5 back slaps followed by 5 abdominal thrusts (moving away from previous recommendations like the LifeVac). For infants, use cycles of 5 back slaps followed by 5 chest thrusts, specifically utilizing the heel of one hand in the center of the chest.

• Universal Chain of Survival: The previous separate chains have been consolidated into a single universal six-link chain of survival covering both adults and children in in-hospital and out-of-hospital settings.

• Opioid Overdoses: The use of opioid antagonists (such as naloxone/Narcan) is formally integrated into the adult BLS algorithms for suspected opioid-related respiratory or cardiac arrest.

• Ventilation & Rescue Breaths:
• Give enough tidal volume to produce visible chest rise while strictly avoiding hypoventilation and hyperventilation.
• For respiratory arrest (pulse present), provide 1 breath every 6 seconds (about 10 breaths per minute).
• High-Quality Chest Compressions:
• Continue prioritizing high-quality compressions with minimal interruptions (10 seconds or less for healthcare providers).
• Perform compressions with the patient's torso roughly at the level of the rescuer's knees.
• Avoid mechanical chest compression devices (such as the LUCAS device) in most routine scenarios in favor of hands-on compressions.

Terminology Updates: Standardized terms differentiate "lay rescuers" (previously bystanders), "breaths" (for lay rescuers providing assisted breathing), and "ventilations" (for healthcare providers using medical devices).

Choking (Foreign Body Airway Obstruction):

• New Sequence: For severe choking in conscious adults, start with 5 back blows alternating with 5 abdominal thrusts (instead of abdominal thrusts alone). [1, 2, 3]
• Special Cases: Use chest thrusts instead of abdominal thrusts if the person is in late-stage pregnancy or if abdominal thrusts are impractical.

Drowning Response:

• Breaths First: For adults or children in cardiac arrest caused by drowning, start CPR with breaths before applying an AED. Drowning is primarily hypoxic (oxygen-deprived), making early rescue breaths critical. [1]

AED Use and Pad Placement:

• Reducing Barriers: To encourage faster defibrillation and reduce hesitation (especially for women), you do not need to completely remove clothing or undergarments. It is reasonable to adjust clothing to place AED pads directly on the skin while maintaining dignity. [1]
• Imperfect Placement: Successful defibrillation can still occur even if pad placement is slightly off; the priority is rapid delivery of the shock.

• Hands-Only vs. Breaths CPR:

  • Trained vs. Untrained: Rescuers trained and willing to give breaths should deliver compressions and breaths together. If untrained or unable to give breaths, Hands-Only CPR (continuous chest compressions) remains fully endorsed as far better than doing nothing. [1]

  Chain of Survival:

  • Unified Framework: A single, standardized Chain of Survival now applies across all age groups and settings to streamline early recognition, CPR, defibrillation, and post-arrest recovery

• Infant & Child CPR Changes

• Infant Compressions: The traditional 2-finger technique is eliminated. Rescuers should use the 2-thumb-encircling-hands technique (preferred with 2 rescuers) or the heel of 1 hand.
• CPR Ratios: Start with chest compressions using a 15:2 (BLS two-rescuer only) or 30:2 (single-rescuer) ratio; conventional CPR with breaths is preferred over compression-only.

• Choking & Defibrillation Highlights

  • Choking Protocols: For infants, use 5 back blows alternating with 5 chest thrusts (abdominal thrusts are avoided). For children, cycle 5 back blows and 5 abdominal thrusts until clear or unresponsive.
  • AED & Training: Apply pediatric-attenuated AED settings with single-shock protocols, and note that individuals 12 and older can effectively learn CPR and AED use

Choking (Foreign-Body Airway Obstruction)

• Conscious Adults & Children: Use cycles of 5 back blows followed by 5 abdominal thrusts, starting with back blows. (Use chest thrusts if abdominal thrusts are not practical, such as in late pregnancy).
• Infants: Use 5 back blows followed by 5 chest thrusts using the heel of one hand in the center of the chest. Abdominal thrusts are not recommended for infants.

Opioids and Overdoses

• Naloxone Guidance: Emphasizes lay-rescuer access, administration, and legal protection for using naloxone during suspected overdoses. [1, 2]

Temperature & Hyperthermia First Aid

• Life-Threatening Hyperthermia: Recommends cold or ice water immersion (1–5°C) for severe heat stroke to achieve a rapid cooling rate.

Stroke Recognition for First Aid

The American Heart Association (AHA) and American Stroke Association guidelines emphasize recognizing stroke symptoms early and acting immediately. While CPR and basic life support protocols have major updates (such as choking changes and infant compression techniques), stroke first aid continues to center around the B.E. F.A.S.T. warning model and rapid emergency activation.

What to Look For: B.E. F.A.S.T.

• B — Balance: Sudden loss of balance, dizziness, or trouble walking.
• E — Eyes: Sudden vision changes or trouble seeing in one or both eyes.
• F — Face: One side of the face droops or feels numb; ask the person to smile to check for an uneven smile.
• A — Arm: One arm is weak or numb; ask the person to raise both arms to see if one drifts downward.
• S — Speech: Slurred speech, difficulty speaking, or trouble understanding speech; ask them to repeat a simple phrase.
• T — Time: Note the exact time symptoms started and call 911 immediately—even if symptoms go away.

Key First Aid Actions

• Call 911 right away: Do not wait to see if symptoms improve. Every minute of a stroke destroys millions of brain cells. [1, 2]
• Note the time: Write down or remember the exact time the person was last seen acting normally or when symptoms first began, as this dictates medical treatment windows. [1]
• Keep the person safe: Lay or sit them down in a comfortable, safe position. Do not give them anything to eat, drink, or any medications (like aspirin), because the stroke could be hemorrhagic (bleeding) rather than ischemic (clot). [1, 2]
• Monitor breathing: Be prepared to start CPR if the person becomes unresponsive and stops breathing normally.