European Resuscitation Council guidelines

This section is based on the European Resuscitation Council Guidelines

Recognising cardiac arrest can be difficult. The mechanism of an unwitnessed collapse or a collapse that occurred away from contact – players do not “faint” on the Rugby pitch - should always be assessed with cardiac arrest in mind. All such casualties should be initially approached via the DR ABC and MILS system. When assessing responsiveness ask, “Can you hear me?” and touch the casualty gently. Assess the airway and breathing as described and decide if the player needs to be moved.

To decide if a cardiac arrest has occurred in an unresponsive player, the key assessment is whether the player is breathing “NORMALLY”. This needs to be interpreted in context as the player may have been sprinting the length of the pitch just before the collapse and so you would expect them to be breathing rapidly and with symmetrical chest movement. Once the airway has been opened with a gentle jaw thrust or head tilt chin lift (see Chapter 1), breathing should be assessed for up to TEN SECONDS via placing your cheek close to the casualty's mouth and using the LOOK, LISTEN, FEEL assessment.

The LOOK, LISTEN, FEEL assessment

Place your cheek near the casualty's mouth and…

LOOK for the chest wall moving. LISTEN for air going in and out. FEEL the air on your cheek as they breathe.

Allow TEN SECONDS to decide if they are breathing normally or not. If not, start CPR and ensure help is on its way.

If you are not sure, start CPR.

If you decide the casualty is not breathing NORMALLY, then you should start chest compressions.

People in cardiac arrest can still gasp a little, but the breathing is weak, irregular and ineffective – a bit like a fish out of water.

If you are NOT SURE if they are breathing NORMALLY, then you should start chest compressions.

You should call for help with any unresponsive casualty, but if you decide that the casualty is in cardiac arrest, then it is worth asking if there is an AED available and if anyone else is trained in CPR. Doing high quality CPR for any length of time is exhausting, so having a second person to take turns means the quality is likely to remain higher.


  • Shout for help.
  • Ask someone to bring an AED.
  • Check to see if other bystanders are trained in CPR who can help you.

No pulse checks

Note that checking pulses is now seen as very difficult and even unreliable unless you do it regularly – particularly in what will be a very stressful situation. As a result, pulse checks are no longer recommended.

Be confident about your decision making for cardiac arrest and do not be afraid to do CPR and use an AED. The overall survival for out of hospital cardiac arrests without basic life support and defibrillators is only about 6%. However, if CPR is performed and an AED used on the scene within a few minutes, the survival can be as high as 60%. So, definite decision making is key and you are far better off to “overcall” a situation as cardiac arrest, only to be proved wrong (you can do little harm), than to delay and find the casualty is dead before anyone is brave enough to do anything.