You’ve Reached the Scene of Someone in Respiratory Distress--Now What?

Advanced cardiac life support (ACLS) can provide life-saving treatment to individuals experiencing respiratory cardiac arrest or another medical emergency. Once you’re certified in ACLS, how can you tell (1) if it’s the most appropriate response and (2) how best to perform it within the situation? A scene must be evaluated for safety, the individual experiencing the medical emergency must be quickly assessed and the emergency response system must be activated before ACLS measures can be used effectively and purposefully. This process is called the “primary survey” and it consists of four important questions:

Is the area safe?
The primary survey begins with a safety assessment. If you’re first on the scene, begin with a survey for any dangers that could affect you, the individual experiencing the medical emergency or others. When approaching a situation involving an unresponsive person, consider the following questions:
- Is the scene safe?
- Is additional help available?
- Is there adequate resuscitation equipment?
- Is personal protective equipment (PPE) necessary?
If a scene isn’t safe, exercise caution to prevent any additional harm to you, the individual or any bystanders. Although it may be difficult to stop in the middle of an emergency resuscitation, whenever possible take the time to put on gloves or any other part of your PPE.
Is the individual responsive?
In order to determine what level of care a person may need, the second step of the primary survey is implemented: determine if the individual is unresponsive; look, listen and feel.
- The first, and sometimes most revealing, way to determine the responsiveness of a person is to look at them. A bluish hue, especially around the lips, indicates hypoxemia and possible cardiac respiratory arrest due to lack of oxygen. Also, notice if there is any swelling around the lips, mouth or tongue.
- Listen to an individual’s breathing; noisy respirations may be a sign of airway obstruction.
- Feel for any evidence of airflow. Touch the person’s shoulder while making loud shouting noises to try to obtain a response while feeling for any sort of air or breathing movement.
Is emergency help available?
Next, activate the emergency response system by yelling for help or calling 911 for assistance. The most successful resuscitations are performed by an emergency team, and therefore one should be notified as quickly as possible. Each situation involving respiratory arrest requires different management and it’s up to the healthcare professional to determine the best response.
Are you prepared to perform CPR or defibrillation?
ACLS training will empower you with the skills to analyze the cause of the emergency, determine the treatment(s) needed and take advanced clinical steps to restore normal breathing and heartbeat.

The primary survey shouldn’t be conducted only upon first arrival at the emergency; the same information should be reassessed routinely throughout the resuscitation.

Health Ed Solutions' certification and recertification for advanced cardiac life support (ACLS) course will not only prepare participants to manage an emergency scene, but will also teach advanced resuscitation techniques often required for patients of cardiac respiratory arrest. ACLS is a resource for medical professionals and others who want to be prepared for a medical emergency and cardiac assessment.

The information included in this article is based on the 2020 guidelines for CPR, first aid and advanced cardiovascular care. Read more about how the 2020 guidelines impact ACLS training online.