The number one rule is: if someone is unresponsive and not breathing normally it does not automatically mean you do CPR. The CPR rules, in US first-aid guidelines, are that you would administer CPR on someone who is unconscious and not breathing, or breathing with gasping, but you would advise a person who is unconscious and breathing normally to be put in the recovery position, monitored closely, and that you call for assistance.
This differentiation is important because in a crisis the mechanism of an accidental injury may not be immediately apparent. A person can lose consciousness through a faint, fit, stroke, drug overdose, or choking or become apneic (cardiac arrest) . The first question that should be asked in such cases are not ” Are they breathing? “, but ” Are they unconscious? “.According to guidelines from both the American Heart Association and Red Cross it is essential that you rapidly check the level of consciousness and breathing, and that you then take the required action.
Definition: What CPR Actually Means
CPR is cardiopulmonary resuscitation, an emergency procedure to restart the function of the heart or breathing. CPR consists usually of compressions of the chest and sometimes breathing. According to the American Red Cross, CPR is conducted if a person is unconscious and not breathing or having gasps, while the AHA states to start BLS (basic life support) on an unconscious person if not breathing normally.
In simple terms CPR is to keep blood flowing in the body until the heart can restart again or if emergency care arrives to help the situation. It is imperative to have blood flowing to the brain as soon as possible as loss of oxygen to the brain for a few minutes will begin brain injury. This is why speed in this instance is important.
The Core Answer: When CPR Should Be Performed
In the US, you are supposed to perform CPR if someone is unconscious, unresponsive, and either not breathing or only gasp breathing. Red Cross says you should call 911 and give CPR when they do not respond, they are not breathing, or they are gasp breathing.
The American Heart Association state you should perform BLS if the person is unconscious and not breathing normally. A person unconscious and breathing normally would therefore not have CPR carried out and instead, the person should be put into the recovery position (if it is safe to do so), partly to maintain the airway and so they cannot choke on their own vomit.
Comparison Table: CPR or No CPR?
| Situation | What you may see | Best action | CPR needed? |
| Unresponsive and not breathing | No response, no chest movement, or only gasping | Call 911, start CPR, use AED as soon as available | Yes |
| Unresponsive but breathing normally | Person does not wake up, but chest rises normally | Place in recovery position if safe, monitor, call 911 | No |
| Unresponsive after choking and not breathing | Choking signs, then collapse | Begin CPR right away; compressions may help dislodge the object | Yes |
| Responsive but weak, dizzy, or faint | Awake, answers slowly, looks pale | Treat as urgent, call for help, watch breathing | No, unless breathing stops |
| Breathing but gasping only | Abnormal breathing, not normal air movement | Treat as cardiac arrest and start CPR | Yes |
What to Do in the First Few Seconds
No need to get it perfect on your first try. The American Red Cross advises that once the area has been checked for safety and the person is responsive, assess for breathing and other life-threatening issues by performing the fast “shout-tap-shout”. If unresponsive and not breathing, or taking only gasps, call 911 and search for an AED or send another person to search for an AED.
After calling for help and if an AED is coming, the person needs to be laid on their back on a hard, flat surface. Push hard in the center of the chest using the heel of one hand at a rate of 100-120 compressions per minute for a depth of 2 inches or more with full recoil between compressions in adults, 30 compressions with 2 rescue breaths (if trained and willing) and use an AED when available.
Why “Non-Responsive” Alone Is Not Enough
There are many situations where a person can be unresponsive and the decision to start CPR may not be indicated, fainting, seizure activity, head trauma, a person with diabetes and a low blood sugar level, stroke, the effects of drugs or alcohol and others. The key indicator is “breathing normally” – as per the AHA definition, in the event a person is unresponsive with normal breathing it may be acceptable to place the person in the recovery position, but in the case of an unresponsive person with an abnormal breathing pattern then basic life support needs to commence.
This is the reason why many first aid courses stress not to spend too much time ‘thinking’, but to ‘do’; check for responsiveness quickly and then without further hesitation, for the reasons stated above, it is recommended that in the case of an unresponsive adult it is appropriate to activate the emergency response system and begin chest compressions.
Recovery Position vs CPR
The recovery position is employed in patients who are unconscious and are breathing. The AHA proposes that putting a unconscious breathing person into the recovery side lying position may be safe. It keep the airway open and helps drain secretions from the airway. It may be useful if the person can breathe in regularly without an obstruction but cannot maintain his/her airway. CPR is employed if the person is no longer breathing, or is only gasping, as there is imminent threat to the brain and the heart, and the primary intervention must be chest compressions.
Quick Decision Table for Bystanders
| What you notice in the person | What it likely means | What you should do immediately |
| No breathing and no movement. | Probably cardiorespiratory arrest. | Call 911, begin CPR, attach the AED |
| No response, but normal breathing | Unconscious but not in arrest | Recovery position, monitor, call 911 |
| Gasping or abnormal breathing | Not normal breathing; may be arrest | Start CPR immediately |
| Choking before collapse | Airway obstruction may be the cause | Begin CPR if unresponsive and not breathing |
A Simple Step-by-Step Approach
A practical U.S. emergency response sequence looks like this:
- Ensure the situation is safe.
- Attempt to awaken by voice or by shaking.
- Check for breathing for a short amount of time-not much more than 10 seconds.
- If the person is not breathing or breathing normally (and thus is unresponsive), call 911 and begin CPR.
If there is a device called an AED available, use it. The sequence described is basic because it must be fast. Survival rate decreases with each minute during which a cardiac arrest is managed without CPR and defibrillation. The AHA states that bystander CPR and AED use are important links in the chain of survival after cardiac arrest.
Important Special Case: Choking
Even if choking causes unconsciousness, CPR is still indicated once there is unresponsiveness and lack of breathing. MedlinePlus recommends that you should start CPR for a choking unconscious person, because the compression of the chest could potentially dislodge the choking object. If the object is clearly visible and not embedded deep within the pharynx, it can be manually removed. However, if it’s stuck, it should not be retrieved.
This demonstrates the importance of training in CPR. It’s not possible to respond slowly when an emergency involving a choking patient might rapidly escalate into cardiac arrest.
What a Good Lay Responder Should Remember
The simplest, most powerful rule to remember: Unresponsive AND not breathing normally. –> CPR. Unresponsive and breathing normally. –> Recovery position and watch, no chest compressions. Both Red Cross and AHA agree on that critical first decision, which is why “checking breathing” and “activating emergency services quickly” are so stressed in first-aid training.
And one more thing: don’t bother being perfect. Do the check, call 911/emergency services, do your best. Blood with oxygen still has to get around until a superior solution is found.
Final Words
The US CPR guidelines are only going to suggest giving someone CPR if the unconscious person does not breathe or if they hyperventilate/gasp. If they are unconscious but breathe normally there is not any reason for CPR right now – put them in the recovery position, have someone call 911, and move on. If there is any doubt whether they are breathing normally or not, assume normal and move fast.