What are the initial steps to take in a medical emergency?

Initial Steps in a Medical Emergency

The first critical step in any medical emergency is to ensure scene safety, then immediately assess the victim's responsiveness by tapping their shoulder and shouting, while simultaneously checking for normal breathing—if the person is unresponsive with absent or abnormal breathing (only gasping), immediately activate the emergency response system (call 911) and begin CPR. 1

Scene Safety and Initial Assessment

• Always ensure the scene is safe before approaching the victim to protect yourself from hazards or threats 1
• Check for responsiveness by tapping the victim on the shoulder and shouting "Are you all right?" 1
• Healthcare providers should simultaneously check for breathing and pulse (within 10 seconds), while lay rescuers focus on responsiveness and breathing 1, 2

Immediate Activation of Emergency Services

• If the victim is unresponsive, immediately call 911 (or your local emergency number) before proceeding with further care 1
• When calling 911, keep the phone on speaker mode at the victim's side so you can follow dispatcher instructions while providing care 1
• Be prepared to answer the dispatcher's questions about location, number of victims, their condition, and type of aid being provided 1
• Do not hang up until the dispatcher instructs you to do so 1

Critical Signs Requiring Emergency Activation

The following findings mandate immediate 911 activation 1:

• Unresponsiveness or new confusion
• Absent breathing or only gasping respirations (agonal breathing indicates cardiac arrest) 1, 2
• Severe or life-threatening bleeding
• Evidence of allergic reaction (hives, facial swelling, difficulty breathing)
• Persistent vomiting or diarrhea
• Pallor, weakness, lethargy, or absent pulses

Immediate Life-Saving Interventions

For Cardiac Arrest (Unresponsive + No Normal Breathing)

If no definite pulse is felt within 10 seconds AND the patient has only gasping or no breathing, assume cardiac arrest and immediately begin high-quality CPR 1, 2:

• Start chest compressions immediately at a rate of 100-120 compressions per minute 1, 2
• Push hard and fast with compression depth of at least 2 inches (5 cm) 1
• Allow complete chest recoil after each compression 1
• Minimize interruptions in compressions 1

Compression-to-ventilation ratio:

• Untrained lay rescuers: Provide continuous chest compressions only (Hands-Only CPR) and follow dispatcher instructions 1
• Trained lay rescuers: 30 compressions to 2 breaths 1
• Healthcare providers: 30 compressions to 2 breaths until advanced airway placed, then continuous compressions with 1 breath every 6 seconds 1

Defibrillation

• Retrieve an AED (automated external defibrillator) as soon as possible if one is nearby and accessible 1
• When 2 rescuers are present, one should begin CPR while the second activates 911 and retrieves the AED 1
• Turn on the AED, follow prompts, and resume chest compressions immediately after any shock 1

Dispatcher-Assisted Care

Emergency medical dispatchers play a critical role in guiding untrained bystanders through CPR 1:

• Dispatcher CPR instructions substantially increase the likelihood of bystander CPR performance and improve survival from cardiac arrest 1
• All dispatchers should be trained to provide telephone CPR instructions 1
• Follow the dispatcher's step-by-step guidance until EMS arrives 1

Common Pitfalls to Avoid

• Do not delay calling 911 to "assess the situation further"—immediate activation is critical for survival 1
• Do not confuse gasping (agonal breathing) with normal breathing—gasping occurs in 40-60% of cardiac arrest victims and indicates the need for immediate CPR 1, 2
• Do not check for breathing before ensuring scene safety—your safety comes first 1
• Do not waste time checking for a pulse if you are not trained—lay rescuers should focus on responsiveness and breathing only 1
• Do not remove clothing before starting compressions—chest compressions should be provided as soon as possible 1

Special Considerations

For healthcare providers encountering an unconscious patient with gasping and severe respiratory compromise 2:

• Provide bag-valve-mask ventilation with 100% oxygen at 1 breath every 6 seconds (10 breaths/minute) while preparing for intubation 2
• Maintain oxygen saturation ≥94% 2
• Consider immediate tracheal intubation for airway protection 2

The key to survival in medical emergencies is the "chain of survival": early recognition, early access to EMS, early CPR, and early defibrillation 3. Each minute of delay decreases survival, making immediate action the single most important factor in saving lives 1.