When two lifesavers arrive at a scene where a patient requires CPR, one lifesaver should commence DRSABCD while the second lifesaver sends for help, requesting Ambulance, additional equipment and personnel as required, e.g., defibrillator, oxygen, and additional lifesavers.
Operator 1:
- Check for danger and response simultaneously
- Ask Operator 2 to send for help
- Assess airway and breathing
- Start CPR
- Perform the initial 2 minutes of compressions, counting out loud at least the last five compressions to ensure operator 2 is ready to deliver rescue breaths
- Count out loud “one, two” as Operator 2 delivers rescue breaths, while hovering hands above the patient’s chest
- Re-start compressions after 2 seconds, whether the 2 breaths were successful or not
- Swap roles every 2 minutes (or earlier if fatigue)
- Ideally, at the time of AED/oxygen arrival, Operator 1 moves back to compressions on the patient’s right, with Operator 2 back to airway management, to allow for standardised equipment placement.
Operator 2:
- Send for help
- After the initial “Rescue Rescue Rescue CPR in progress at X” call for help, move to the patient’s head to deliver rescue breaths using a resuscitation mask
- Relay further information to SurfCom after the initial rescue communication has been made
- Deliver 2 rescue breaths after each 30 compressions, allowing 1 second per breath, watching for chest rise
- Swap roles every 2 minutes (or earlier if fatigue), using each rescuer’s own resuscitation mask if available
- Upon arrival of additional team members, without interrupting CPR, move back to the airway, providing jaw thrust and rescue breaths, with resuscitation mask in place
- Control the AED shock delivery protocol when prompted every 2 minutes.
It is recommended operators switch providing compressions at least every two minutes to prevent rescuer fatigue and deterioration in the quality of chest compressions. This should be done with minimal interruption to compressions, to maintain the 80% chest compression fraction. This role swap is demonstrated in the 2-person CPR video. Ideally, at the time of AED/Oxygen arrival, Operator 2 moves back to the airway, with Operator 1 back to compressions, to allow for standardised equipment placement.
Operator 2 (who is managing the patient’s airway) coordinates the roll if a patient regurgitates or vomits. They may be behind the patient’s head if they are using jaw-thrust method to maintain the patient’s airway.
Upon arrival of oxygen and the AED, these team members position themselves with the AED in the 2 o’clock position (to the patient’s left shoulder) and the oxygen in the 10 o’clock position (to the patient’s right shoulder) for standardised equipment placement.
Operator 3 (AED):
- Position themselves opposite Operator 1
- Place the AED in the 2 o’clock position, above the patient’s left shoulder
- Without interrupting CPR, work around Operator 1 to remove the patient’s clothing with shears, dry the chest, turn on the AED and apply AED pads to the patient’s chest, taking into account defibrillator safety steps
- Prepare to take over compressions once the AED is ready to analyse
- Throughout resuscitation, Operator 1 and 3 positions alternate who is providing compressions and when not performing compressions, take on role of scribe / radio operator / BVM squeezer (if ART holder present to supervise), or other roles as needed pending number of rescuers available.
Operator 4 (ART Holder):
- Position themselves between Operators 1 and 2
- Place the oxygen at the 10 o’clock position, above the patient’s right shoulder
- If able, insert an oropharyngeal airway
- Attach bag-valve-mask (BVM) to the resuscitation mask held by Operator 2
- Provide at least the first 2 breaths within the CPR cycle to ensure adequate seal / chest rise as Operator 2 holds the resuscitation mask in place
- Once an adequate seal has been obtained with the BVM, move to the Team Leader role at the patient’s feet to lead the resuscitation, including supervising BVM use by Operators 1 and 3 (when not performing compressions), providing guidance, feedback and leadership to the team and other roles as described in the ART course
- Note: oxygen does not need to be turned off during AED shock, simply hold the BVM away from the patient during shock delivery.
Qualified lifesavers may safely administer oxygen-aided resuscitation via a BVM during team CPR under the supervision of an ART holder.
When additional lifesavers are available to help, they may approach the CPR scene from the patient’s feet to introduce themselves to the team leader (ideally an ART holder) and confirm an ambulance has been called before proceeding as directed by the team leader, often taking over the compression roles in the positions of Operator 1 and Operator 3.
