4.5 Two-Rescuer Pediatric BLS

Scene Safety & Initial Response

1. Ensure scene safety for both rescuers and the child or infant.
2. Check for responsiveness:
   • Child: Tap the shoulder and shout, “Are you okay?”
   • Infant: Tap the foot and observe for any response.
3. Rescuer 1: Remains with the victim and begins assessment.
4. Rescuer 2: Activates the Emergency Response System (ERS) and retrieves the AED and emergency equipment.

Assess Breathing and Pulse

• Observe the chest for no more than 10 seconds for signs of breathing.
• Check for a pulse:
  • Child: Use the carotid pulse.
  • Infant: Use the brachial pulse.
• If there is , begin CPR immediately.

Rescue Breathing (If Pulse is Present)

• Provide 1 breath every 3–5 seconds (12–20 breaths per minute).
• Reassess the pulse every 2 minutes.
• Begin CPR if the pulse is lost or breathing becomes absent.

Chest Compressions

• Compressions should be performed at a rate of 100–120 per minute.
• Compress the chest to a depth of 1/3 of chest diameter:
  • Child: ~2 inches (5 cm)
  • Infant: ~1.5 inches (4 cm)
• Allow full chest recoil after each compression.

Compression-to-Breath Ratio

• Use a ratio of 15 compressions to 2 breaths (15:2) when two rescuers are present.
• Switch roles every 5 cycles or 2 minutes to reduce fatigue and maintain compression quality.
• Minimize interruptions in compressions to less than 10 seconds.

Switching Roles

1. Rescuer 1 (compressions): Completes a full cycle of 15 compressions.
2. Rescuer 2 (airway): Delivers 2 rescue breaths, then announces the switch.
3. After breaths: Rescuer 1 moves to the head to take over airway and breaths.
4. Rescuer 2 immediately begins compressions. The transition should take less than 5 seconds.

Benefits of Two-Rescuer Pediatric BLS

• Enables high-quality, uninterrupted compressions
• Reduces rescuer fatigue
• Improves airway and ventilation effectiveness
• Allows for timely switching and reassessment