“Hands Only CPR” or “Heel Only CPR”

It may take anywhere from 10 minutes to 15 minutes for Fire and EMS to arrive and take over CPR.  That is a long time without circulation of blood.  Some people can’t get down on the floor to perform chest compressions.  Some People fatigue sooner than others doing “Hands Only CPR“.  Just the same; Some people have more upper body strength than lower body strength and visa versa.   If I have a student that is unable to do hand only chest compressions due to fatigue or lack of upper body strength and are alone waiting for paramedics to arrive; I encourage them to use “Heel Only CPR” by using the heel of one’s foot instead. Some patients are large enough that your arms may not be long enough or you might not be able to reach across the patient’s chest enough to get your shoulders right over your hands.  Not being able to get your shoulders right over your hands may make it difficult to go the right depth of at least 2 inches 5 cm.   A person shouldn’t have to die because of lack of ability.  If there is a will trust me there is a way.  Try “Heel only CPR”!!    Others agree with me…visit others that also teach teach “Heel Only CPR


Increase Survival 5% when only 2 Rescuers are present


After teaching the 2015 AHA Guidelines for a year now and using the CCF Compression Fraction, this is what I have learned.


Unavoidable time off the chest is :

  1.  When giving breaths after 30 compressions
  2.  When the rhythm is checked
  3.  Shocking Patient
  4.  Moving a patient out of danger or so you can perform chest compressions
  5.  Putting in a advanced airway

In the 2010 AHA guidelines BLS Healthcare Providers were expected to go 2 minutes or 5 cycles of CPR at the right rate and depth.  Those who did were awarded a AHA Healthcare Provider completion card.   2015 AHA Guidelines have changed.  Research has shown that the average single rescuer fatigued after the first 30 compressions. The same depth as they did at the start of the two minutes decreased.   This caused less oxygenated blood circulation to the heart and brain.

Now rescuers are encouraged to go 2 minutes or 5 cycles before switching and to switch sooner if needed or fatigued.   The AHA tells us to minimize time off the chest to less than 10 seconds at a time; with more focus on high quality CPR. 

This is great; except, if there is more times that a rescuer is needing to switch over the length of the code. 

Every time two people switch there is a lag in compression to the accepted time of less than 10 seconds. 

Every second counts, even these couple seconds in between switching compressors.  If you just switch after 2 minutes only… this is perfect time for the AED to do “It’s” rhythm analyses.  The new BLS Provider video tells us the AED can take between 5 – 15 seconds to analyze the heart’s rhythm. This gave rescuers plenty of time to switch.  

After timing hundreds of students during code team scenarios.  Some students take anywhere from 2-7 seconds to switch.  Some students can go the full two minutes at the correct rate and depth.  Others need to switch sooner.  Thus creating less survival according to the CCF.

I had a student that fatigued in the middle of 30 compressions.  I watched another student rescuer take over the number where the student stopped without any hesitation or interruption in chest compressions. “It clinked at that moment!!!”  Why not!  The students continued performing the ration is still 30:2 but took over each other’s numbers when switching. Increasing a higher CCF than they would have had they not taken over each other’s numbers…. It is very hard to explain without showing you. At first it seemed wrong ….this is not taught in the video.  But after adopting this for 2 rescuer techniques and seeing the higher survival and the feedback from students is amazing!!  Adopting this method has added some other added benefits as well.

The fatiguing 1st (student) Rescuer finishes their 30th compression. States loudly, “Switch!” Then gets ready to start chest compressions.  1st (student) Rescuer continues to perform chest compressions soon after the 2nd (student) Rescuer is done giving the two breaths using the bag mask and is able to take over the position of chest compressor.

The 2nd (student) Rescuer gives 2 breaths; then quickly gets into the proper position for chest compressions and leans in and takes over for the fatigued 1st (student) Rescuer who is still performing chest compressions.

1,2,3,4, The 2nd (student) Rescuer; starts counting out loud and starts performing chest compressions where the 1st (student) Rescuer left off /following the last number stated out loud by 1st (student) Rescuer for the compression performed.  5, 6,7,8,9,10-30.

If the numbers are not taken over like this…adding 3-5 sec for each time it takes rescuers to switch between compressions.  Which lowers survival rate…

Code time 4 min before Code team arrives ….

Pauses in compressions 40 sec.

  • During the code the rescuers continued to perform chest compressions while the AED was charging… After light flashed; patient was cleared.  Shock was administered.  Compressor hovered above patient safe and ready after “Shocking”  was completed.
  • Airway was maintained the entire time cpr was being performed
  • Breaths were given over only for 1 sec each with just enough enough breath to make the chest rise.
  • Roles and Responsibilities we immediately established. Clear communication and Good teamwork dynamics were accomplished. Everyone new their limitations and communicated it.

83% chance of survival (2 rescuers up to Code team take over)

1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30.(Fatigued Rescuer)  “Switch”2 sec (paused) for breaths. 1,2,3,4,5,6,7,8,9,10, 11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30. 2 sec (paused) for breaths1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30.2 sec (paused) for breaths1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30.2 sec (paused) for breaths1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30.“Switch” 10 sec pause AED analyzing Shock advised1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30. 2 sec (paused) for breaths (fatigued Rescuer) “Switch”1,2,3,4,5,67,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30. 2 sec (paused) for breaths1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30. 2 sec (paused) for breaths 1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30.  2 sec (paused) for breaths (fatigued Rescuer) “Switch” 1,2,3,4,56,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30.2 sec (paused) for breaths Switch” 10 sec pause AED analyzing Shock advised 


A Step in the Right Direction… stopping the WAR on DRUGS

New research discovers the use of Opioids can cause brain damage resulting in Opioid Use Disorder.  To reduce the risk; establish public awareness, and enable treatment those with Opioid Use Disorder
5.524 (enrolled -Bill) Act  This Act may be cited as the “Comprehensive Addiction and Recovery Act of 2016”. To authorize the Attorney General and Secretary of Health and Human Services to award grants to address the prescription opioid abuse and heroin use crisis, and for other purposes. Washington on Monday, January 4, 2016.

AED LAWS / Risk Management

AED Laws for Washington

Washington State Law (RCW 70.54.310) requires medical direction to a person or entity purchasing an AED to ensure proper training and use of the device. Registering your AED will help connect you with a medical director.



OSHA PDF  Saving Sudden Cardiac Arrest Victims in the Workplace (AED) Automated External Defibrillators

Seattle and King County Automated External Defibrillator (AED) Site Documentation Form

A site visit is provided either by your local fire department or King County EMS to discuss:

  • Training guidelines
  • Post cardiac arrest event guidelines
  • Determine the number of AEDs and placement
  • Limited or open availability
    • Limited restricts access to the general public or limits access only to trained AED rescuers
    • Open accessibility is placing an AED so it is available to everyone
  • Secured or unsecured
  • Audio-visual alarm – activates lights and an audio alarm when the AED is removed
  • Automatic notification system – automatically notifies the local EMS/fire agency or in-house security
  • Assistance in completing AED registration forms and establishing procedures If an AED is used for a cardiac emergency, the following steps should be incorporated into your AED procedures:
    • Please contact the King County AED Program Manager at 206-263-8317 whenever the AED is opened and applied to a person. This is a critical step for you to take in helping EMS to improve care and treatment from sudden cardiac arrest, and thus increase the chances of survival.
    • Put the AED back in service by checking supplies-pads, towel, razor, gloves; check battery; and clean the AED.
    • Conduct an event review and provide emotional support to rescuers.

Substitute House Bill 1556 CPR/AED Instruction in High Schools 2013 Legislative Session Summary Medical Emergency Response Guidelines


WASBO Risk Management Committee Guidelines for Implementing an AED Program

Risk Management Essentials: A Self-Study Course for Medical Office Staf

By Roy MaurerMar 29, 2013