3.3 Switching Roles to Reduce Fatigue

Effective CPR requires consistent high-quality chest compressions. However, prolonged compressions can lead to rescuer fatigue, reducing compression depth and rate. To maintain optimal CPR performance, rescuers should switch roles at regular intervals while minimizing hands-off time.

Why Role Switching Is Critical

• Prevents rescuer fatigue, which leads to shallower, slower compressions.
• Ensures consistent chest compression quality throughout resuscitation.
• Reduces interruptions in chest compressions, maintaining blood circulation.

When to Switch Roles

• Switch every 2 minutes (or after 5 cycles of 30:2 compressions).
• Switch sooner if the compressor is visibly fatigued.
• Perform role changes as efficiently as possible, with a goal of switching within 5 seconds.

How to Switch Roles Effectively

The role switch should occur smoothly to avoid delays in compressions. Follow these steps:

1. Rescuer 2 (ventilation provider) signals the switch: “Switch after this cycle.”
2. After the 30th (or 15th) compression, Rescuer 1 moves to the head and prepares to take over ventilations.
3. Rescuer 2 immediately starts compressions once the previous cycle ends.
4. The switch should occur without any delay in chest compressions.

Pro Tips for Seamless Role Switching

• Use the hover technique – The new compressor hovers their hands above the chest, ready to take over instantly.
• Rescuers should count compressions out loud to maintain rhythm and signal the switch.
• Practice switching roles regularly to build muscle memory and efficiency.
• If an AED is present, switch roles during rhythm analysis to take advantage of natural pauses.

What If More Rescuers Arrive?

As additional trained responders arrive, the resuscitation effort can transition into a team-based response (covered in the next lesson). Each person should be assigned a specific role to maintain efficiency.

Maintaining continuous, high-quality compressions is the most important factor in cardiac arrest survival. Next, we'll discuss how CPR evolves in a clinical setting when more rescuers are involved.