First Aid / CPR / AED

Exam blueprint

Sourced from AHA Heartsaver First Aid CPR AED Provider Manual + American Red Cross First Aid/CPR/AED Participant's Manual (2020 Guidelines, 2024 Focused Update)

• Scene safety + emergency action steps10%
• Adult CPR + compressions18%
• Child + infant CPR12%
• AED operation + special situations15%
• Choking — conscious + unconscious10%
• Bleeding control + shock10%
• Medical emergencies (cardiac, stroke, allergic, diabetic, seizure)15%
• Environmental + soft-tissue injuries10%

1. 01Scene safety + emergency action

   ~45min

   Before you ever touch a patient, you check the scene, get help, and decide what role you play. The order matters — rescuers who skip Step 1 become Patient #2.

   • Check — Call — Care

     The Red Cross emergency action steps are CHECK the scene and the person, CALL 9-1-1 (or have someone else call), and CARE for the person. CHECK is not optional. Look for hazards: oncoming traffic, downed power lines, fire, chemical spills, unstable structures, scaffolding above. If the scene is unsafe, you do not enter — you call 9-1-1 from a safe distance and wait for trained responders. A dead rescuer cannot help anyone. Only after the scene is safe do you check responsiveness with a tap-and-shout (adults/children) or a foot-tap (infants).

     Reference: Red Cross First Aid/CPR/AED Participant's Manual Ch. 1

   • When and how to call 9-1-1

     Call 9-1-1 immediately for: unresponsive person, no normal breathing, severe bleeding, possible heart attack/stroke, severe allergic reaction, possible spine injury, severe burns, drowning, electrocution, or any condition that gets worse fast. If a bystander is available, point at them specifically ("YOU in the blue shirt — call 9-1-1 and bring back an AED"). Vague directions to "someone" call result in nobody calling — the bystander effect is real. Stay on the line; the 9-1-1 dispatcher is a trained resource and may walk you through CPR.

     Reference: AHA Heartsaver Provider Manual Part 2

   • Consent + body substance isolation

     Get verbal consent from a responsive adult before providing care: "I know first aid. May I help you?" If the person is unresponsive, an adult, or a minor without a parent present, consent is IMPLIED. Refuse care only if the person clearly says no. Always assume bodily fluids are infectious — wear gloves if available, use a CPR breathing barrier (pocket mask or face shield) for rescue breaths, and wash hands with soap and water afterward. If you have an open cut on your hand, do not provide direct care without protective barriers.

   Practice questions (2)

   1. 1. You arrive at a jobsite to find an electrician collapsed next to a panel with a smoking wire still in his hand. First action?

      • A.Pull him away from the wire and start CPR
      • B.Call 9-1-1 from a safe distance and do NOT touch him until power is confirmed off✓ correct
      • C.Pour water on the wire to cool it down
      • D.Wait for him to wake up

      A live electrical source makes the scene unsafe. Touching the patient or anything conducting can electrocute you instantly. Call 9-1-1, alert someone to kill power at the breaker or disconnect, and wait for confirmation. Pulling him with bare hands risks your life; water conducts electricity and makes the hazard worse; waiting alone wastes time he may not have.

   2. 2. You point to the crowd and shout "someone call 9-1-1!" — three minutes later you discover nobody did. What did you do wrong?

      • A.You should have called yourself
      • B.You should have pointed at a specific person and given a specific task✓ correct
      • C.You should have used a phone tree
      • D.Nothing — bystanders are unreliable

      The bystander effect: when responsibility is diffused across a group, individuals assume someone else will act. Pointing at a specific person ("you in the red hat — call 9-1-1, then come back") assigns responsibility and produces action. Calling yourself is correct only when alone — if you have rescuers available, your job is patient care and delegation.

2. 02CPR + AED — adult, child, infant

   ~90min

   Compression depth, rate, and ratios. AED pad placement and the special cases (wet skin, hairy chest, pacemaker, pediatric pads). High-quality CPR is the single biggest predictor of survival.

   • Adult CPR — 30:2 at 100-120 bpm, 2 inches deep

     For an unresponsive adult who is not breathing or only gasping: start chest compressions immediately. Hands centered on the lower half of the breastbone, arms straight, shoulders directly over hands. Compress AT LEAST 2 INCHES (5 cm) but NOT MORE THAN 2.4 INCHES (6 cm), at a rate of 100-120 COMPRESSIONS PER MINUTE (the tempo of "Stayin' Alive" or "Another One Bites the Dust"). Allow full chest recoil between each compression — leaning on the chest reduces venous return. Compression-to-ventilation ratio is 30:2 for a single rescuer.

     Reference: AHA 2020 Guidelines Part 3 — Adult Basic Life Support

   • Pediatric CPR — child vs. infant differences

     CHILD (1 year to puberty): same 30:2 ratio for single rescuer (15:2 for two rescuers). Compress with one or two hands to AT LEAST 1/3 the depth of the chest — about 2 inches. Same 100-120 bpm rate. INFANT (under 1 year): use TWO FINGERS or two-thumb-encircling-hands technique on the lower breastbone just below the nipple line. Compress AT LEAST 1/3 chest depth — about 1.5 inches. Same rate, same 30:2 single-rescuer ratio. For pediatric arrest, the most likely cause is RESPIRATORY (drowning, choking) — so unlike adults, you start with 2 RESCUE BREATHS before compressions if you witnessed sudden collapse versus a respiratory event.

     Reference: AHA 2020 Guidelines Part 4 — Pediatric Basic Life Support

   • AED — turn on, attach, follow prompts

     When an AED arrives, turn it ON FIRST and follow the voice prompts. Bare the chest (cut clothing if needed) and dry it with a towel — water on the chest creates a path for the shock around the heart. Apply pads: one upper-right (just below the clavicle), one lower-left (lateral to the breastbone, below the nipple). For PEDIATRIC patients under 8 years (or < 55 lbs), use PEDIATRIC PADS if available — these reduce the energy delivered. If pediatric pads are not available, ADULT PADS are acceptable. CLEAR the patient before shock: "I'm clear, you're clear, oxygen clear" and visually verify nobody is touching. Resume compressions IMMEDIATELY after the shock — do NOT pause to check pulse.

     Reference: AHA 2020 Guidelines Part 6 — Defibrillation

   • AED special situations — pacemaker, jewelry, pregnancy, water

     PACEMAKER/ICD (visible bump under the skin near the clavicle): place the pad AT LEAST 1 INCH AWAY from the device, do not place pads directly over it. JEWELRY/MEDICATION PATCHES: remove patches with a gloved hand and wipe the area before applying pads (a fentanyl patch on the chest can deflect the shock or burn the skin). PREGNANCY: use the AED normally — the shock will not harm the fetus, and saving the mother saves the fetus. STANDING WATER: drag the patient to a dry surface before delivering a shock — wet contact path can shock you and bystanders. CHEST HAIR: if the pads will not stick, press them down hard, OR use a second set of pads to rip the hair off, OR (some AED kits include) use a razor.

   Practice questions (3)

   1. 1. Adult CPR compression rate per AHA 2020 Guidelines?

      • A.60-80 per minute
      • B.80-100 per minute
      • C.100-120 per minute✓ correct
      • D.140-160 per minute

      100-120 compressions per minute is the AHA range. Below 100 produces inadequate forward blood flow; above 120 the chest does not have time to recoil and venous return drops. The "Stayin' Alive" / "Another One Bites the Dust" tempo trick lands you near the middle of this window.

   2. 2. Adult CPR compression depth?

      • A.1 inch
      • B.At least 1.5 inches
      • C.At least 2 inches but not more than 2.4 inches✓ correct
      • D.3 inches or until you feel a rib break

      AHA 2020 guidance: AT LEAST 2 inches (5 cm) but NOT MORE THAN 2.4 inches (6 cm). Too shallow does not generate forward flow; excessively deep causes intra-thoracic injury without survival benefit. Rib fracture is common and acceptable during effective CPR but is not the depth target.

   3. 3. You arrive with an AED and find the patient lying in a small puddle of rainwater on a concrete slab. Action?

      • A.Apply pads and shock — water does not affect AED operation
      • B.Drag the patient to a dry surface, then proceed with the AED✓ correct
      • C.Wait for the puddle to evaporate
      • D.AEDs are contraindicated in any wet environment

      Standing water can conduct the shock to the rescuer and to bystanders touching the same wet surface. Drag the patient a few feet to dry concrete and continue. AEDs work fine after the patient is in a dry area; waiting wastes survival minutes; the device is not absolutely contraindicated, only the wet contact path.

3. 03Choking + bleeding control

   ~60min

   Conscious vs. unconscious choking. Direct pressure, tourniquets, and hemostatic dressings — the three tools of the Stop the Bleed era.

   • Conscious choking — adult, child, infant

     A choking adult or child clutches the throat (the universal sign) and cannot speak, cough, or breathe. Ask "are you choking?" — a person with a partial obstruction who can cough should be encouraged to keep coughing. For complete obstruction in a CONSCIOUS adult or child: deliver 5 BACK BLOWS between the shoulder blades with the heel of your hand, then 5 ABDOMINAL THRUSTS (Heimlich) above the navel and below the breastbone — alternate until the object comes out or the person becomes unresponsive. For INFANTS (under 1 year): 5 back blows + 5 CHEST THRUSTS (two fingers on the breastbone) — abdominal thrusts can rupture the liver in an infant. For OBESE or PREGNANT patients, use chest thrusts instead of abdominal.

     Reference: Red Cross First Aid/CPR/AED Participant's Manual Ch. 5

   • Choking patient becomes unresponsive

     If a choking patient loses consciousness: lower them to the ground, call 9-1-1 if not already done, and BEGIN CPR. Each time you open the airway to give breaths, LOOK in the mouth — if you see the object, sweep it out with a finger. NEVER do a blind finger sweep — you can drive the object deeper. Continue 30:2 CPR, looking each cycle, until EMS arrives or the object dislodges. The compressions themselves can pop the obstruction free, which is why you do not need to switch to a different technique.

   • Severe bleeding — direct pressure first

     For external bleeding the FIRST step is DIRECT PRESSURE on the wound with a clean cloth or sterile gauze, hard, with both hands if needed. Do NOT remove a soaked dressing — add another on top and keep pressing. Most external bleeding stops with sustained direct pressure. If pressure alone fails on an arm or leg wound and bleeding is life-threatening, apply a TOURNIQUET 2-3 inches above the wound (never on a joint), tighten until bleeding stops, mark the time on the patient's skin or tourniquet, and DO NOT REMOVE — wait for EMS. A properly applied tourniquet hurts; that is normal. Hemostatic gauze (QuikClot) is packed into the wound and held with pressure for 3 minutes — used when the bleed is in a junctional area (groin, armpit) where a tourniquet cannot be placed.

     Reference: Stop the Bleed American College of Surgeons B-Con program

   • Recognizing shock

     Shock is the body's response to inadequate circulation — it kills patients whose initial injury was survivable. Signs: pale, cool, clammy skin; rapid weak pulse; rapid shallow breathing; restlessness then drowsiness; nausea; thirst. Care: keep the person LYING DOWN; cover with a blanket to maintain body temperature (cold makes shock worse); do NOT give food or water (they may need surgery, and an aspirated stomach contents kill); reassure them. Elevating the legs is no longer routinely recommended — only if the person has no leg/spine/head injury and you are sure they need it. The most important treatment for shock is rapid transport to definitive care — call 9-1-1.

   Practice questions (2)

   1. 1. A coworker is choking on a sandwich and gives the universal sign. He is conscious and CANNOT cough. First action?

      • A.Wait for him to figure it out — he is conscious
      • B.Lay him down and start CPR
      • C.Stand behind him and deliver 5 back blows, then 5 abdominal thrusts✓ correct
      • D.Pour water down his throat

      Conscious choking with complete obstruction: 5 back blows + 5 abdominal thrusts, alternating. CPR begins ONLY when the person becomes unresponsive. Waiting allows hypoxic brain injury within minutes. Pouring water can cause aspiration and worsen the obstruction.

   2. 2. A worker has a deep arm laceration spurting blood. You apply direct pressure and after 2 minutes blood is still soaking through. Next?

      • A.Remove the dressing and reapply
      • B.Add another dressing on top and apply a tourniquet 2-3 inches above the wound✓ correct
      • C.Apply a tourniquet directly on the joint
      • D.Elevate the arm and wait

      Direct pressure failing on a life-threatening extremity bleed = tourniquet, applied 2-3 inches proximal to the wound but never directly over a joint (the artery slips around bone). Removing a soaked dressing breaks the developing clot. Joint placement does not occlude the artery. Elevation alone is insufficient for arterial bleeding.

4. 04Medical emergencies + environmental injuries

   ~75min

   Heart attack, stroke, allergic reaction, diabetic emergency, seizure, heat illness, and burns. Recognition is half the battle — most lay rescuers identify the wrong category.

   • Heart attack vs. cardiac arrest vs. stroke

     HEART ATTACK: blocked artery, heart muscle dying, patient is usually CONSCIOUS — chest pressure/pain (often radiating to left arm or jaw), shortness of breath, nausea, sweating. Call 9-1-1, have the person sit and rest, give one ADULT (325 mg) or 2-4 LOW-DOSE (81 mg) aspirin to chew (if no allergy and no bleeding contraindication). CARDIAC ARREST: heart has stopped pumping, patient is UNRESPONSIVE and not breathing — start CPR + AED. STROKE: brain artery problem, recognize with FAST: F)ace droop, A)rm drift, S)peech slurred, T)ime to call 9-1-1. Note the TIME OF SYMPTOM ONSET — clot-busting drugs work only within 4.5 hours. Never give food, water, or aspirin to a stroke patient.

     Reference: AHA Heartsaver Provider Manual Part 5

   • Anaphylaxis + EpiPen

     Severe allergic reaction (bee sting, peanut, shellfish, latex) can cause throat swelling, hives, wheezing, drop in blood pressure, and death within minutes. If the person has a prescribed EPINEPHRINE AUTO-INJECTOR (EpiPen, Auvi-Q), help them use it: remove cap, press firmly into the OUTER MID-THIGH (through clothing is fine), hold 3 seconds (Auvi-Q is 2 sec). Call 9-1-1 — even after epinephrine, symptoms can rebound and a SECOND DOSE may be needed in 5-15 minutes if breathing problems persist. Lay the person flat with legs raised (unless breathing trouble — then sit up). Many states have Good Samaritan laws covering lay administration of an auto-injector.

   • Diabetic emergency + seizures

     DIABETIC LOW BLOOD SUGAR (hypoglycemia): confusion, sweating, shaking, slurred speech, may look drunk. If the person is awake and can swallow, give 15 grams of fast sugar (4 oz juice, 3 glucose tabs, hard candy). Wait 15 minutes. Repeat if no improvement. If unresponsive, do NOT put anything in the mouth — call 9-1-1. SEIZURES: do not restrain, do not put anything in the mouth (cannot swallow tongue, but can lose teeth). Move sharp/hard objects away, cushion the head, time the seizure. Call 9-1-1 if seizure lasts > 5 minutes, repeats, occurs in water, in a person with no seizure history, or in a pregnant person. After the seizure (postictal phase), roll on side (recovery position), keep airway open, reassure as they wake up.

   • Heat illness + burns

     HEAT EXHAUSTION: heavy sweating, weakness, nausea, headache, normal-to-slightly-elevated temp. Move to shade/AC, remove excess clothing, apply cool wet cloths, give water if alert. HEAT STROKE: red hot dry OR sweaty skin, confusion, > 104°F core temp, possible loss of consciousness. LIFE-THREATENING — call 9-1-1 immediately, cool aggressively (cold water immersion if safe, ice packs to neck/armpits/groin), do not give fluids if altered mental status. BURNS: first remove from heat source, run cool (not ice) water over burn for 10-20 minutes, do NOT apply butter/ice/ointments. Cover with a clean dry cloth or sterile dressing. SECOND-DEGREE burn > 3 inches OR on face/hands/feet/genitals/major joint, OR ANY THIRD-DEGREE burn = call 9-1-1.

   Practice questions (3)

   1. 1. Coworker grabs his chest, says "this hurts bad," is sweating, and short of breath. He is awake. Best immediate action?

      • A.Start CPR — assume cardiac arrest
      • B.Call 9-1-1, have him sit and rest, offer chewable aspirin if no allergy/bleeding✓ correct
      • C.Drive him to the hospital yourself
      • D.Wait 30 minutes to see if it passes

      A conscious patient with chest pain is having a heart attack, not arrest. Aspirin (chewed, not swallowed whole) inhibits platelet aggregation and improves outcomes if given within minutes. CPR is for unresponsive non-breathing patients. Driving yourself bypasses paramedic care and the patient may arrest en route. Waiting is the most common reason heart attacks become fatal.

   2. 2. A worker drops a coffee, the right side of her face droops, and she slurs her words. Most important information to give 9-1-1?

      • A.Her age
      • B.Her medical history
      • C.The exact time symptoms started (or when she was last seen normal)✓ correct
      • D.Whether she has insurance

      tPA and thrombectomy decisions hinge on time of onset — clot-busting drugs work only within 4.5 hours and mechanical thrombectomy within 24 hours. EMS and the receiving hospital must know exactly when symptoms began. Age and history are useful but secondary; insurance is irrelevant to acute care.

   3. 3. A worker is stung by a bee, develops hives, and reports throat tightness and trouble breathing. He has an EpiPen. Where do you inject?

      • A.The buttock
      • B.The outer mid-thigh✓ correct
      • C.The upper arm muscle
      • D.The abdomen

      Outer mid-thigh (vastus lateralis) is the prescribed site — large muscle with rapid absorption and away from major nerves. Buttock fat slows absorption. Upper arm has nerve and vascular structures making it riskier and slower. Abdomen has no muscle to inject into and risks hitting organs.

External resources

• Official
  AHA CPR & First Aid — Heartsaver and BLS course resources ↗

  American Heart Association's official course portal. Download the Heartsaver First Aid CPR AED Provider Manual student materials, the 2020 Guidelines summary, and the 2024 Focused Update.

• Official
  American Red Cross — First Aid/CPR/AED training ↗

  Red Cross course catalog. The Adult and Pediatric First Aid/CPR/AED Participant's Manual is the parallel reference to the AHA Heartsaver manual; both bodies' certifications are equivalently accepted by employers.

• Third-party
  Stop the Bleed — American College of Surgeons ↗

  B-Con (Bleeding Control) program from ACS. Teaches the tourniquet + wound-packing skills now considered standard in workplace first aid kits. Free online primer plus in-person 90-minute classes.