The CARE CERTIFICATE

Basic
Life
Support
Last updated September 2021 v1.2

What you need to know

 Standard
THE CARE CERTIFICATE WORKBOOK
 Legislation
and basic life
support
Introduction

The information in
standard 12 provides
knowledge about the
administration of basic
life support.

The information in standard 12 provides knowledge about the administration

of basic life support.

You should also be provided with practical training by your employer to be

able to put the knowledge from this workbook into practice in order to be
able to carry out basic life support competently.

Basic Life Support (BLS)

Basic life support comprises the following elements:

 Initial assessment.
 Airway maintenance and breathing.
 Cardiopulmonary Resuscitation (CPR).

When approaching a casualty, an initial casualty assessment should be

conducted; this initial assessment is called a primary survey. The primary
survey is a systematic process of approaching, identifying and dealing with
immediate and/or life-threatening conditions. The primary survey can be
remembered by the acronym DRABCD (or the easy way to remember: Doctor
ABCD).

Further training beyond the Care Certificate

Where an employer wishes to provide training that goes beyond these

minimum requirements for the Care Certificate such as the use of an
Automated External Defibrillator (AED) or an Emergency First Aid at Work
course we would encourage this but these are not necessary in order to meet
the requirements of the Care Certificate.

Completion of this standard will not provide you with the competence to
become a first aider. In order to achieve this you would be required to
undertake specific first aid
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qualifications within your workplace. Whether you need this qualification will
be dependent on your job role and your employer’s assessment of first aid
needs.

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 D R A B C D
Danger Response Airways Breathing Call 999/Circulation Defibrillation

Prior to Open the airway If an AED arrives,

If possible, After opening Call an ambulance (999/112)
approaching switch it on and
approach the the airway look, Ask a helper to call otherwise
the casualty, follow the spoken
casualty Place the listen and feel call yourself, stay with the
ensure the or visual
from their casualty onto for normal casualty when making the
safety of prompts. An AED is
feet as this their back. breathing for no call if possible, activate
the casualty, used in conjunction
prevents Open the airway more than 10 speaker function on the
yourself and with CPR.
hyperextensi using the head- seconds phone to aid communication
any
on tilt- chin lift with ambulance service.
bystanders.
of the neck method
from a
responsive (place your hand
casualty. Use on their
the AVPU scale forehead and
when checking gently tilt back
for a response. the head; with Helpful Hint Send someone to get an AED
your fingertips Noisy Gasps if available and staff are
under the point In the first trained to use it.
of the casualties few minutes If you’re on your own do not Helpful Hint
chin, lift the chin after a Compression only
to open the
airway)
A – Alert – Is the casualty cardiac normally and prepare to leave the casualty.
moving/talking?
arrest, a start CPR. Start CPR
- No – Proceed to V
casualty may
V – Voice – Do they respond to
appear to fit and
speech - No – Proceed to P
may be barely
P – Place – Place your hand on
breathing or
their shoulders and gently
taking
shake them asking ‘Are you
infrequent, slow
alright?’, if NO response then
noisy gasps. Do
proceed to U Casualty not breathing
not confuse this
U – Unresponsive – Assume the Commence CPR (30
with normal
casualty is unresponsive. compressions 2
breathing.
breaths)
If in any
(Provided there is no further danger, Depth of compression
doubt that
leave in the position found and try to 5-6cm at a rate of
breathing is
find out what is wrong, get help 100-120 compressions
normal, act as if
if needed.) per minute.
not breathing
 CPR. casualty who is compressions only. These minute and to a
If you are unable, not trained to, not breathing, should be continuous at a depth of
or are give chest rate of 100– 120 per 5–6 cm.
unwilling to give breaths for a

Adult If casualty is breathing normally but still unresponsive,

place into the recovery position if safe to do so, check for
The ‘P’ in the acronym AVPU is sometimes also referred to as ‘Pain’, meaning to further injuries (conduct a secondary survey). Check
cause a minor pain to see if the person responds. Examples include pinching the breathing regularly, if the casualty deteriorates or stops
ear lobes or finger tips. breathing normally, be prepared to commence CPR
immediately.
Cardiopulmonary resuscitation (CPR)
Cardiopulmonary resuscitation (CPR) should be administered to a casualty who
is not breathing normally and who shows no signs of life. CPR is a method of
combining chest compressions with ‘effective rescue breaths’ in order to
artificially circulate blood and to put air into the lungs. The depth of
compressions is as follows:

 Adult: 5–6 centimetres (similar to the short side of a credit card) using both
hands.
 Child (1 year to onset of puberty): – compress at least one third of the
chest’s depth (5cm), using one hand.
 Infant (0–1 years of age) – compress at least one third of the
chest’s depth (4cm), using two fingers.

The rate of compression should be 100–120 compressions per minute. 30

chest compressions should be administered prior to moving on to breaths
(called ‘expired air ventilation’).

After completing 30 chest compressions, two effective breaths should be

administered directly into the casualty’s mouth, or in the case of an infant, into
their mouth and nose. Each breath should take one second to complete and the
casualty’s chest should rise as in normal breathing; this is known as ‘effective
rescue breathing’. Turn your head and watch the chest rise and fall, then
administer the second breath.

Please note: CPR must be practiced in a simulated environment as part of the

Care Certificate training arranged by your employer. The use of this workbook
alone is not sufficient to provide you with the skills to perform CPR, and is not
sufficient to achieve the competences required for award of the Care Certificate.

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 D R A B C D
Danger Response Airways Breathing Call 999/Circulation Defibrillation

Prior to Open the airway

INFANT After opening Call an ambulance (999/112) If an AED
approaching the
1. Talk to the the airway look, Ask a helper to call otherwise call arrives, switch
child or infant,
infant. Place the listen and feel yourself. If you are on your own it on and follow
ensure their
2. Gently stimulate infant/child onto for normal perform CPR for 1 min before the spoken or
safety, your
the infant. their back. breathing for no going for help visual prompts.
safety and the
3. If a Open the airway more than 10 (5 initial rescue breaths before An AED is used
safety of any
response is using the head- seconds starting chest compressions). in conjunction
bystanders.
gained, check tilt- chin lift Stay with the casualty when with CPR.
for further method making the call if possible or if
injuries able to carry the infant or child
(secondary survey) (place your hand whilst summoning help, activate
and contact the on their speaker function on the phone to
emergency forehead and aid communication with
services if gently tilt back ambulance service.
required. the head; with Send someone to get an AED if
your fingertips Helpful Hint available
CHILD under the point Noisy Gasps
1. Talk to the child of the infants/ In the first Casualty not breathing
2. Gently stimulate child’s chin, lift few minutes Commence CPR, 5
the child and ask the chin to open after a initial rescue breaths
loudly ‘Are you the airway) cardiac arrest, a (30 compressions
alright?’. casualty may be 2 breaths)
3. If a barely breathing Depth of compression
response is or taking 4 cm for an infant, 5 cmfor a
gained, check infrequent, slow child at a rate of 100-120
for further noisy gasps. Do compressions
injuries not confuse this per minute.
(secondary survey) with normal
and contact the breathing. If in
emergency any doubt that
services if
required.
Helpful hint breathing is normal, act as if not breathing normally
and prepare to start CPR.

Infant and child

If the infant or place into so, check for further injuries (conduct a secondary
child is breathing the recovery survey). Check breathing regularly, if the casualty
normally but still position if deteriorates or stops breathing normally, be prepared
unresponsive, safe to do to commence CPR immediately.

The free emergency telephone number across the UK is 999. It can be used to request ambulance, police or fire service help, and in some
places also HM Coastguard and/or local mountain rescue services (the 999 operator will ask you which service you want to be put through
to). If you need to use a locked mobile ’phone whose unlock number you don’t know, you should still be able to dial 999 on it. The European
emergency number, 112, also works in the UK—calls to it automatically divert to the 999 service.
 Obstructed airway (adult)
The main aim of the respiratory system is to supply oxygen to all parts of the
body. Breathing is essential to life.

The airway can be obstructed in a variety of ways including foreign bodies

(food or other items), allergic reactions, asthma, blood, vomit and infections.
An obstruction can cause minor or major breathing difficulties and, in severe
circumstances, may cause the casualty to become unconscious and
unresponsive.

Someone who is choking will have either a partial or complete obstruction of

the airway. The severity of the blockage will determine the difficulty in
breathing.

Recognition

 Grasping at the throat area.

 Difficulty in breathing and speaking.
 Difficulty in crying or making a noise.
 Redness of the face.
 Eyes enlarged and watering.
 Displaying distress.

Treatment

 This should not be carried out by any worker who has not successfully
completed formal practical training provided by their employer.
 Encourage the casualty to lean forward and cough.
If the obstruction remains:
 administer a maximum of 5 sharp blows between the shoulder blades.
If the obstruction still remains:
 administer a maximum of 5 abdominal thrusts (or chest thrusts for an infant).
 If the obstruction is still not relieved, call for help and continue
alternating five back blows with five abdominal thrusts.
 Start CPR if the casualty becomes unresponsive:
 Support the casualty carefully to the ground.
 Immediately call the ambulance service.
 Begin CPR with chest compressions.

Obstructed airway (infant and child)

An obstruction can cause minor or major breathing difficulties and, in severe
circumstances, may cause the infant or child to become unconscious or
unresponsive.

Recognising a choking infant or child

 Grasping at the throat area.

 Difficulty in breathing and speaking (in the case of a child).

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 Difficulty in crying or making a noise.
 Redness of the face.
 Eyes enlarged and watering.
 Displaying distress.

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With a complete obstruction the infant or child may show the above signs but
also the skin colour may develop a blue/grey tinge; they will get progressively
weaker and eventually they will become unconscious.
Treating a choking infant

Consider the safest action to

manage the choking child:
 If the infant is coughing
effectively, then no external
manoeuvre is necessary,
monitor continuously.
 If the infants’ coughing is, or is
becoming, ineffective, shout
for help immediately and
determine the infant’s
conscious level.

Conscious choking infant

 If the infant is still conscious

but has absent or ineffective
coughing, give back blows.
 If back blows do not relieve
choking, give chest thrusts.
These manoeuvres create an
‘artificial cough’ to increase
intrathoracic pressure and
dislodge the foreign body.

Back blows

 Support the infant in a head-downwards, prone position, to enable

gravity to assist removal of a foreign body, a seated or kneeling first
aider should be able to support the infant safely across their lap.
 Support the infant’s head by placing the thumb of one hand at the angle
of the lower jaw, and one or two fingers from the same hand at the same
point on the other side of the jaw.
 Do not compress the soft tissues under the infant’s jaw, as this will
exacerbate the airway obstruction.
 Deliver up to 5 sharp back blows with the heel of one hand in the middle
of the back between the shoulder blades.
 The aim is to relieve the obstruction with each blow rather than to give all 5.
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Chest thrusts

 Turn the infant into a head-downwards supine position. This is

achieved safely by placing your free arm along the infant’s back and
encircling the occiput with your hand.
 Support the infant down your arm, which is placed down (or across) your thigh.
 Identify the landmark for chest compression (lower sternum
approximately a finger’s breadth above the xiphisternum i.e. lowest part
of the breastbone).
Deliver up to 5 chest thrusts. These are similar to chest compressions, but
sharper in nature and delivered at a slower rate.
 The aim is to relieve the obstruction with each thrust rather than to give all 5.

Following chest thrusts reassess the infant:

 If the object has not been expelled and the infant is still conscious,
continue the sequence of back blows and chest thrusts.
 Call out, or send, for help if it is still not available.
 Do not leave the child at this stage.

If the object is expelled successfully, assess the infant’s clinical condition. It is

possible that part of the object may remain in the respiratory tract and cause
complications. If there is any doubt, seek medical assistance.

Helpfu l Hint
Under no circumstances should abdominal thrusts be performed on an infant. These must

Treating a choking child

Consider the safest action to manage the choking child:

 If the infant is coughing effectively, then no external manoeuvre is
necessary, monitor continuously.
 If the infants’ coughing is, or is becoming, ineffective, shout for help
immediately and determine the infant’s conscious level.

Conscious choking child

 If the child is still conscious but has absent or ineffective coughing, give back blows.
 If back blows do not relieve choking, give abdominal thrusts. These
manoeuvres create an ‘artificial cough’ to increase intrathoracic pressure
and dislodge the foreign body.

Back blows (In a child over 1 year)

 Back blows are more effective if the child is positioned head down.
 A small child may be placed across the rescuer’s lap as with an infant.
 If this is not possible, support the child in a forward-leaning position and
deliver the back blows from behind.
 Give 5 sharp blows between the shoulder blades with the heel of the other hand.

If back blows fail to dislodge the object, and the child is still conscious, use
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abdominal thrusts.

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Abdominal thrusts for children over 1 year:

 Stand or kneel behind the child. Place your arms under the child’s arms
and encircle their torso.
 Clench your fist and place it between the umbilicus (naval) and the ribcage.
 Grasp this hand with your other hand and pull sharply inwards and upwards.
 Repeat up to 4 more times.
 If the obstruction is still not relieved continue alternating 5 back
blows with 5 abdominal thrusts.

Start CPR if the child becomes unresponsive

 Support the child carefully to the ground.
 Immediately call the ambulance service.
 Begin CPR with chest compressions.

Confidentiality

Anyone who is responsible for the storage of records and information must
be aware of their responsibilities under the General Data Protection
Regulation 2016 and, if relevant, the Freedom of Information Act (FOI) 2000.

Record keeping

Depending on your specific job role, there will be information and records
that will require completion should an infant, child or adult be involved in an
accident, or become ill whilst in the health or social care setting.

This recorded information in the accident book can:

 help to identify trends

 help to control health and safety risks
 be used for reference in future first aid needs assessments
 prove useful for investigations.

Please refer to your employer’s policy and procedures and forms. If you
need further clarity, speak with your manager.

Refresher training
Refresher training should be conducted regularly. It is good practice to
complete a refresher session on basic life support annually. This is not a
condition of completion for the Care Certificate.

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The CARE CERTIFICATE

Basic
Life
Support

What do you know now?

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 Standard
THE CARE CERTIFICATE WORKBOOK
 Activity 12.1a

Basic life support

Complete the
following sentence
with the missing
words.

knowledge competently practical

practice employer

You should be provided with practical training by your employer

to be able to put this knowledge
into practice and in order to be

able to carry out basic life support competently.

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 Activity 12.2

Basic life support

consists of four
List - This term means to identify the main point
elements. From the list
below can you find two
of them? (Place ticks
beside the two.)

✔ Initial assessment (primary survey)

Expired air ventilations

Secondary survey

✔ Airway maintenance and breathing

✔ CPR

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 Activity 12.3

Link the word on the

left to the correct
description on the
right.

We need to open this to check for breathing.

Danger

We need to check for no more than 10

Response
seconds for this.

This should be used alongside CPR.

Defibrillation

Prior to approaching the

Airway
casualty visually check the
area for

Breathing If not breathing commence

Use the ‘AVPU’ scale when checking for this.

Call
999/Circulation

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 Activity 12.4

Answer the question by

filling in the blanks using
the numbers provided.

100-120
20 10

999 30 2

Seconds to take to check normal breathing

10

Rate of compressions given per minute during CPR

100-120

3. Number of breaths given in a cycle of CPR

4. Number dialled for ambulance services

999

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 Activity 12.5

Regarding a choking
casualty (adult): please
place the following in
order of action by
labelling
them 1–4.

2 Give up to five back blows

4 Start CPR if the casualty becomes unresponsive

1 Encourage the casualty to cough

3 Give up to five abdominal thrusts

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Change log

Date of change Location in document Original content Amended content

September 2021 Page 6, If the obstruction is still If the obstruction is still

Treatment not relieved, continue not relieved, call for help
section, Fifth alternating five back and continue alternating
bullet point. blows with five abdominal five back blows with five
thrusts and call for help. abdominal thrusts.