How to Perform Hands-Only CPR: Simplifying CPR for Bystander Assistance

Learn about the concept of Hands-Only CPR, its simplicity, and its potential to be a game-changer in saving lives worldwide in this article. Hands-Only CPR is a revolutionary technique that eliminates the hesitation that often accompanies traditional CPR, empowering bystanders to take immediate action and offer a lifeline to those in critical need.

Hands-Only CPR is a simplified life-saving technique used in cardiac emergencies, focusing solely on chest compressions without mouth-to-mouth resuscitation.The development of this approach aims to motivate greater intervention by bystanders, as it addresses concerns about the complexity and hygiene of traditional CPR methods. Crucially, Hands-Only CPR can significantly increase the survival chances of cardiac arrest victims by allowing immediate and easy-to-perform assistance. Here are the 3 simple steps of Hands only CPR:

1. Check for responsiveness

2. Call 911

3. Start chest compressions

Blood Pressure Category
Systolic (Upper)
Diastolic (Lower)
Health Risks
Less than 120 mm Hg
and Less than 80 mm Hg
Low risk of heart disease or stroke
Maintain healthy lifestyle (diet, exercise, no smoking)
120-129 mm Hg
and Less than 80 mm Hg
Doubled risk of cardiovascular complications
Make lifestyle changes (lose weight if overweight, increase physical activity, limit alcohol)
Hypertension Stage 1
130-139 mm Hg
or 80-89 mm Hg
Increased risk of heart attack, stroke, kidney disease
Lifestyle changes and potentially medication under doctor's guidance
Hypertension Stage 2
140 mm Hg or Higher
or 90 mm Hg or Higher
High risk; can lead to heart failure, vision loss, dementia
Medication required in addition to lifestyle changes as recommended by doctor
Hypertensive Crisis
Higher than 180 mm Hg
nd/or Higher than 120 mm Hg
Immediate danger of life-threatening complications
Seek emergency medical care immediately
Cardiac Arrest
Heart Attack
Sudden loss of heart function, leading to collapse
Blockage in a coronary artery, affecting blood flow to the heart muscle
Interruption of blood flow to the brain, leading to brain damage
Main Cause
Electrical malfunction of the heart
Blockage in coronary arteries
Blockage or rupture of blood vessels in the brain
Circulation Affected
Entire body
Heart muscle
Brain tissue
105Sudden collapse, unconsciousness, no pulse
Chest pain or discomfort, shortness of breath
Sudden numbness or weakness, confusion, trouble speaking or understanding speech/73
Emergency Response
Immediate CPR and defibrillation
Activate emergency medical services, chew aspirin
Activate emergency medical services, FAST assessment (Face, Arms, Speech, Time)
CPR, defibrillation
Thrombolytic therapy, angioplasty, stenting
Thrombolytic therapy, clot retrieval,
Long-term Management
Implantable cardioverter-defibrillator (ICD), medication management
Medication management, lifestyle changes, cardiac rehabilitation
Medication, rehabilitation, lifestyle changes
Dependent on prompt CPR and defibrillation, underlying health conditions
Dependent on extent of heart muscle damage, effectiveness of intervention
Dependent on severity of brain damage, rehabilitation progress
Risk Factors
Previous heart conditions, arrhythmias, electrolyte imbalances
Atherosclerosis, high cholesterol, hypertension, smoking, diabetes
Hypertension, diabetes, smoking, high cholesterol, atrial fibrillation

Step 1: Check for responsiveness

First, confirm that the person in distress, hereafter referred to as the 'victim,' is unresponsive and exhibits abnormal breathing patterns. Tap the adult victim's shoulder and ask, "Are you OK?" loudly. If available, use protective gloves or similar safety gear before examining the victim, ensuring your safety while providing aid.


Step 2: Call 911

If the victim is not responding, activate the emergency medical services by calling 911 or ask another bystander to call.


Step 3: Start chest compressions

  • Place the heel of one hand on the center of the victim's chest, just below the nipple line.
  • Place the other hand on top of the first hand, interlocking the fingers.
  • Keep your arms straight, and position your shoulders directly over your hands.
  • Press down firmly and quickly, allowing the chest to recoil between compressions.
  • Aim for a depth of at least 2 inches deep (5 centimeters) and compress the chest at a rate of around 100-120 compressions per minute. This rate of compressions helps maintain blood circulation and is vital for the victim's chances of survival during sudden cardiac arrest.
  • After each compression, allow the chest to fully recoil. Do not lean on the chest between compressions to ensure proper blood flow.
  • Continue performing high quality chest compressions at the recommended rate until professional help arrives or the victim shows signs of life, such as breathing, moving, or responding.


What is Hands only CPR?

Hands-Only CPR, a form of compression-only CPR, is an efficient and streamlined method for immediate assistance in cases of sudden cardiac arrest, a specific and critical type of medical emergency. Unlike traditional CPR, which involves both chest compressions and mouth-to-mouth rescue breaths, Hands-Only CPR focuses solely on chest compressions, making it more accessible and less intimidating for bystanders to administer during emergencies.


What is the Difference Between Hands only CPR and Traditional CPR?

Both Hands-Only and Traditional CPR are essential in cardiac emergencies, but they differ in methods and specific applications. Hands-Only CPR is designed for simplicity and accessibility. It's particularly recommended for untrained bystanders who witness an adult suddenly collapse in a non-hospital setting. This method has gained popularity due to its ease of use and because it eliminates concerns about performing mouth-to-mouth resuscitation, thus reducing bystander hesitation.

On the other hand, Traditional CPR combines chest compressions with artificial ventilation (mouth-to-mouth resuscitation). This method is more comprehensive and is particularly effective in cases where the victim is a child, has drowned, or has suffered from respiratory issues leading to cardiac arrest. While Traditional CPR is more complex and generally requires training to perform effectively, it can provide vital support to the victim's breathing and circulation. Both methods are crucial, but the choice of technique often depends on the rescuer's training and the specific circumstances of the cardiac emergency.


What is the Purpose of Hands only CPR?

The primary purpose of Hands-Only CPR is to provide immediate, life-saving intervention to individuals experiencing sudden cardiac arrest. Sudden cardiac arrest occurs when the heart suddenly stops beating effectively, leading to a lack of blood flow to vital organs, including the brain. Without prompt intervention, cardiac arrest can be fatal within minutes. Cardiopulmonary Resuscitation, including Hands-Only CPR, aims to buy time by maintaining blood circulation until advanced medical help arrives, increasing the chances of the victim's survival.


What are the Benefits of Using Hands only CPR?

Using Hands-Only CPR offers several significant benefits, making it a valuable and accessible life-saving technique for anyone to perform during cardiac emergencies. Here are some of the key benefits:

  1. Ease of Administration: Hands-Only CPR eliminates the need for mouth-to-mouth resuscitation, which can be a barrier for many people in providing immediate aid. This simplification encourages more bystanders to step in and perform CPR, as it no longer requires specialized training in rescue breaths.
  2. Increased Bystander Participation: By removing the hesitation associated with mouth-to-mouth resuscitation, Hands-Only CPR encourages more people to take action during a cardiac emergency. The timely initiation of chest compressions significantly improves the victim's chances of survival.
  3. Maintaining Blood Circulation: The fundamental objective of CPR is to sustain blood flow to essential organs, particularly the brain, in the event of a cardiac arrest, thereby preserving vital functions. Hands-Only CPR effectively achieves this by providing continuous chest compressions, ensuring oxygen-rich blood is circulated throughout the body.
  4. Higher Chance of Survival: Studies have shown that Hands-Only CPR can be just as effective as traditional CPR for adult victims of sudden cardiac arrest. Early initiation of chest compressions, even before professional help arrives, can double or triple the chances of survival.
  5. Wider Public Awareness: The simplicity of Hands-Only CPR has allowed for broader dissemination of the technique through public service campaigns and educational programs. As more people are aware of this method, more lives can potentially be saved.

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Blood Pressure Chart by Age

Age Group
Min Systolic/Diastolic
Normal Range
Max Systolic/Diastolic
1-12 months
Consult pediatrician if outside normal range. Cuff sizing is critical.
1-5 years
High BP in children may indicate underlying condition. Lifestyle factors.
6-13 years
Obesity, family history increase risk. Promote healthy habits early.
14-19 years
Adolescent rise normal. Rule out secondary causes if elevated.
20-24 years
Stressors, medications may impact. Start monitoring if high-normal.
25-29 years
Dietary changes, exercise for elevated readings. Birth control effects.
30-39 years
110/77 - 111/78
122/81 - 123/82
134/85 - 135/86
Monitor closely if readings increasing with age.
40-49 years
112/79 - 115/80
125/83 - 127/84
137/87 - 139/88
Lifestyle changes proven to reduce hypertension risk.
50-64 years
116/81 - 121/83
129/85 - 134/87
142/89 - 147/91
White coat effect common. Home monitoring advised.
65+ years
130+ Systolic Risk
Frailty, medications, conditions factored in management.

When is Hands-Only CPR Appropriate to Use?

Hands-Only CPR is appropriate to use in adult victims (adolescents and older) who have collapsed due to sudden cardiac arrest and are unresponsive, not breathing, or not breathing normally. It is essential to quickly assess the situation and determine if the victim is in cardiac arrest before initiating Hands-Only CPR. If the victim is a child or an infant, traditional CPR with rescue breaths is still recommended, as they may experience cardiac arrest due to different underlying causes.


How Long do You Perform Hands-Only CPR on a Victim?

Continuous hands-only CPR should be maintained until healthcare providers arrive or the person regains consciousness. To prevent exhaustion, it is crucial to have someone else step in to perform high quality chest compressions, allowing you to take breaks. By implementing a rotation of rescuers during hands-only CPR, the chances of sustaining effective compressions, maximizing blood circulation to vital organs, and achieving a favorable outcome for the victim are significantly increased.


What are the current guidelines from the American Heart Association (AHA) and the Red Cross for Hands-Only CPR?

Here are the important guidelines for Hands-Only CPR that are often emphasized by organizations like the American Heart Association (AHA) and the Red Cross:

  1. Depth and Rate of Compressions: Compressions should be at least 2 inches deep for adults, but not more than 2.4 inches. The rate should be 100 to 120 compressions per minute.
  2. Minimizing Interruptions: Try to minimize interruptions in chest compressions. Quick pauses for breaths in traditional CPR or to check for signs of life should be as brief as possible.
  3. Allowing Chest Recoil: After each compression, it's important to allow the chest to fully recoil (return to its normal position) before the next compression. This helps the heart refill with blood between compressions.
  4. Avoiding Excessive Ventilation: If you are trained and choose to give rescue breaths, avoid giving them too forcefully or too quickly, as this can cause complications.
  5. Using an AED: If an Automated External Defibrillator (AED) is available, it should be used as soon as possible. Follow the AED's voice prompts and continue CPR until the AED instructs otherwise or professional help takes over.


Can Hands-Only CPR be performed on children and infants?

No, Hands only CPR cannot be performed on children and infants. Hands-Only CPR is primarily recommended for use on teenagers and adults who experience sudden cardiac arrest. For children and infants, the situation is different, and the American Heart Association (AHA) and other health organizations typically recommend a different approach:

  1. Children (Ages 1 to Puberty): For children, it's advised to use a combination of chest compressions and rescue breaths (traditional CPR). This is because cardiac arrests in children are more likely to be due to respiratory issues, which means they may benefit more from both chest compressions and breaths to support oxygenation.
  2. Infants (Under Age 1): Infants require a specific technique for CPR. Rescuers should use two fingers to perform compressions (instead of the whole hand or two hands) and should also provide gentle rescue breaths. The anatomy and physiology of infants are significantly different from older children and adults, necessitating these modifications.


What is the role of hands-only CPR in the chain of survival?

Hands-Only CPR plays a vital role in the chain of survival by providing prompt and continuous chest compressions during sudden cardiac arrests. Its ease of use encourages bystander participation, leading to early intervention and improved survival rates. Studies have shown that Hands-Only CPR, without rescue breaths, can double or triple a victim's chances of survival.

According to the American Heart Association's 2015 report, more than 356,000 individuals in the United States experienced Out-of-Hospital cardiac arrest (OHCA), with nearly 90% resulting in fatalities.Its widespread awareness and accessibility empower untrained individuals to take life-saving action until professional help arrives.

Despite evidence showing that victims who receive bystander CPR are 2.5-3 times more likely to survive, the percentage of CPR performed by bystanders for OHCA victims remains significantly low. Shockingly, only 18% of Americans have received current CPR training, while approximately 65% have undergone CPR training at some point.

By incorporating Hands-Only CPR into public education and emergency response strategies, we can significantly impact the patient's chances of recovery and create a more resilient and life-saving community.


Why is Hands-Only CPR recommended for bystanders in emergency situations?

Hands-Only CPR is recommended for bystanders due to its simplicity, ease of learning, and effectiveness in emergency situations. IHands-Only CPR t involves only chest compressions, making it easier to remember and perform, especially for those untrained in traditional CPR methods. This approach reduces bystander hesitation, as it eliminates concerns about performing mouth-to-mouth resuscitation incorrectly or concerns about hygiene. Hands-Only CPR allows for immediate action, which is crucial in cases of sudden cardiac arrest, and has been shown to be as effective as traditional CPR in the initial minutes following an adult cardiac arrest. These factors make Hands-Only CPR a vital and accessible tool in emergency response.


How effective is Hands-Only CPR in saving lives during cardiac emergencies?

Hands-Only CPR has proven to be highly effective in saving lives during cardiac emergencies, particularly in out-of-hospital scenarios. According to a study, bystander CPR increases the likelihood of out-of-hospital cardiac arrest survival by more than two-fold. Its efficacy is rooted in several key aspects:

  • Timeliness of Intervention: In cases of cardiac arrest, the timeliness of intervention is crucial. Hands-Only CPR can be initiated immediately by bystanders, which is vital since the chances of survival decrease with each passing minute without CPR.
  • Simplicity and Accessibility: The simplicity of Hands-Only CPR means that more people are likely to feel confident in performing it. This increased confidence can lead to more bystanders intervening in a cardiac emergency, as opposed to hesitating or waiting for professional help.
  • Effectiveness in Early Minutes: Research has shown that Hands-Only CPR is particularly effective in the first few minutes following a sudden cardiac arrest. During this critical window, continuous chest compressions can maintain blood flow to the heart and brain, which is essential for survival.
  • Reduced Complications: By focusing solely on chest compressions, Hands-Only CPR reduces the risk of complications that can arise from rescue breaths, such as gastric inflation.


How has Hands-Only CPR impacted survival rates in cardiac arrest cases?

Hands-Only CPR has positively impacted survival rates in cardiac arrest cases by making it easier for bystanders to intervene. Its simplicity and effectiveness in the crucial early minutes following a cardiac arrest mean that more victims receive timely assistance, which is vital for survival. The widespread training and awareness of Hands-Only CPR have increased the number of people prepared to act in emergencies. Studies have shown that it's as effective as traditional CPR in the initial minutes, especially in witnessed cases. Additionally, it reduces the risk of complications associated with mouth-to-mouth resuscitation. Overall, Hands-Only CPR has significantly improved the chances of survival in cardiac arrest situations by enabling more immediate and effective bystander response.


How has the approach to Hands-Only CPR evolved over recent years?

The approach to Hands-Only CPR has evolved significantly over recent years, reflecting advancements in medical research and a better understanding of emergency cardiac care. Key developments include:

  1. Increased Emphasis and Promotion: Over the past decade, there has been a substantial increase in the promotion of Hands-Only CPR by major health organizations like the AHA. This shift came about due to studies showing that Hands-Only CPR can be as effective as traditional CPR in the first few minutes of a cardiac arrest, particularly for adults.
  2. Simplification of Guidelines: The guidelines for Hands-Only CPR have been simplified to encourage more bystander intervention. The focus has been on two key steps: calling emergency services and performing chest compressions. This simplification aims to reduce the hesitation and complexity associated with performing CPR, especially for untrained bystanders.
  3. Public Education Campaigns: There has been a significant increase in public education campaigns to raise awareness about Hands-Only CPR. These campaigns often use popular culture references (like the beat of a well-known song to maintain the correct rhythm of compressions) to make the learning process more engaging and memorable.
  4. Research and Evidence-Based Updates: Ongoing research into cardiac arrest and CPR techniques has led to periodic updates in the guidelines. For instance, the recommended rate and depth of chest compressions have been refined over time based on new evidence.
  5. Integration of Technology: The use of technology, such as mobile apps and online instructional videos, has become more prevalent in teaching Hands-Only CPR. These tools make learning more accessible and can provide guidance in real-time during an emergency.
  6. Focus on High School Training: Many regions have started to include CPR training, particularly Hands-Only CPR, as a part of high school education, recognizing the importance of equipping young people with these life-saving skills.
  7. Recognition of the Role of Automated External Defibrillators (AEDs): There's been an increased emphasis on the use of AEDs in conjunction with Hands-Only CPR. Public education includes information on identifying and using AEDs, which are becoming more widely available in public spaces.

These advancements reflect a broader trend towards making life-saving techniques more accessible and effective for the general public, thereby increasing the chances of survival in cases of cardiac arrest.

Are there any risks associated with performing Hands-Only CPR?

Hands-Only CPR is a technique designed to simplify the process of cardiopulmonary resuscitation and increase the likelihood of bystander intervention in emergencies. While the risks associated with Hands-Only CPR are generally minimal, it's essential to be aware of a few considerations:

  • Rib Fractures or Injuries: The forceful chest compressions involved in Hands-Only CPR may, in rare cases, result in rib fractures or injuries, particularly in older adults or individuals with fragile bones. However, the potential risk of injury is generally considered outweighed by the benefits of performing CPR and trying to save a life.
  • Potential Discomfort: Individuals performing Hands-Only CPR may experience discomfort or fatigue, especially if they are not accustomed to the physical exertion required for chest compressions. Rescuers are encouraged to switch roles if needed to maintain effective and consistent chest compressions.

It's important to note that the risks associated with Hands-Only CPR are generally minimal compared to the potential benefits of increasing the chances of survival for someone experiencing cardiac arrest. The American Heart Association (AHA) and other health organizations emphasize the importance of immediate intervention and encourage bystanders to perform Hands-Only CPR if they are unwilling or unable to perform traditional CPR with rescue breaths.

What are the legal implications of performing Hands Only CPR?

Performing Hands Only CPR is typically protected by Good Samaritan laws in many jurisdictions. These laws provide legal immunity to individuals who provide emergency care in good faith and without gross negligence. Legal protections may extend to both trained and untrained bystanders, encouraging prompt intervention in cardiac emergencies. Consent is often implied in emergency situations. It's important to be aware of and follow the specific Good Samaritan laws in your jurisdiction for a better understanding of legal implications. Obtaining formal CPR certification can enhance legal protections and ensure effective assistance during a cardiac emergency.

How can I learn Hands-Only CPR?

Learning Hands-Only CPR is a valuable skill that can potentially save lives. Here's a step-by-step guide on how you can learn Hands-Only CPR:

  1. Online Resources: Many reputable organizations and health institutions offer free online resources and tutorials for Hands-Only CPR. Websites like the American Heart Association (AHA) and the Red Cross provide instructional videos and step-by-step guides.
  2. Mobile Apps: Some organizations have developed mobile apps that guide users through the process of Hands-Only CPR. These apps often include interactive features and demonstrations.
  3. Local Training Centers: Contact local health organizations, community centers, or fire departments. Many of these institutions offer CPR training courses, including Hands-Only CPR. Some may provide in-person training sessions or refer you to certified instructors.
  4. Community Workshops: Check for community workshops or events that focus on CPR training. These sessions are often conducted by healthcare professionals or certified trainers and may be offered free of charge.
  5. Certification Courses: Consider enrolling in a CPR certification course offered by organizations like the American Heart Association or the Red Cross. These courses usually cover both traditional CPR and Hands-Only CPR. Certification may be beneficial for those who want a more comprehensive understanding and documentation of their training.
  6. Practice with Mannequins: If possible, practice Hands-Only CPR on a mannequin. Many training centers provide hands-on practice during their courses, allowing participants to gain confidence in performing chest compressions.

Updating CPR Knowledge

Updating CPR knowledge is crucial because CPR guidelines and techniques, including Hands-Only CPR, can evolve over time based on the latest research and medical advancements. CPR guidelines are regularly reviewed and updated by organizations like the American Heart Association to ensure that the best practices are being followed to maximize survival rates during cardiac emergencies. Staying up-to-date with the latest guidelines through CPR re-certification and ongoing training allows individuals to learn about any changes in CPR techniques, hand placement for cardiac resuscitation, compression rates, or other important updates that can enhance the effectiveness of CPR.