How to Do the Kiss of Life

by JoHarrington

They are unconscious, not breathing and without a pulse. Would you know how to perform CPR? A qualified First Aider demonstrates.

Cardiopulmonary resuscitation (CPR) can break ribs. But when the alternative is death, who worries about a few bones?

Knowing how to do CPR really can be the difference between life and death. It's a nightmare situation, which nobody wants to be in. Yet it's best to be prepared in case you ever find yourself in such an emergency.

I trained as a First Aider in the early '90s. I've consistently renewed my certificate every few years since, and I was once the primary First Aid person for a whole university campus. Let me teach you how to perform CPR.

When Should you Perform CPR?

Two thirds of all people suffering from cardiac arrest never receive life-saving CPR. Why? Because bystanders are too afraid of 'doing something wrong'.

Is the individual:

  • Unconscious and unresponsive?  (Not reacting to sound, touch, being shaken etc.)
  • Not breathing?  (Put your cheek close to their mouth, can you feel exhaled air?)
  • Without a pulse? (Slide two fingertips alongside their Adam's apple. Anything?)

You absolutely should perform CPR right now. 

You are in a potentially fatal situation, so there's no room to worry about doing something wrong.  Not acting is far more dangerous than performing the kiss of life in these circumstances.

If this is an emergency, just read the titles. Instructions are given in the subtitles.
The main body of each section merely explains what's going on and/or provides supplementary information.

Step One: Call the Emergency Services

The point of CPR is to buy time for the paramedics to arrive. If they're not coming, then you're helping nobody.

Image: Emergency telephone callIf you aren't alone, then ask a friend/bystander to call the emergency services. Ask them to tell you when the ambulance is coming.

It's been known for random people to simply walk away without making the call.

You don't really need to know that ETA (it'll be 4 minutes on average). You're just asking for information to be returned to you, so you can be certain that the call was made.

If you are unsure if the emergency services are coming, call again. Better twenty alerts than none.


Step Two: Open the Airways (A - Air)

Turn the individual until they're lying on their back. Put your two fingertips under their chin, and your other hand flat on their forehead. Tilt their head backwards.
Image: Opening a blocked airway
Image: Opening a blocked airway

It's possible that the lack of breathing may have been caused by blocked airways. By tilting the head upwards, while they are lying on their back, it automatically opens up those airways.

If the blockage isn't too big (or it was the tongue), then this will be enough to allow them to start breathing again.  If that is the case, then put them into the recovery position and give yourself a hearty pat on the back.

Step Three: Two Rescue Breaths (B - Breath)

Tilt their chin back with your hand. Gently pinch their nostrils together, cover their mouth with your own. Exhale a normal breath. Wait for their chest to rise. Repeat.

You don't need to breathe too hard into the individual's mouth. Just enough to watch the chest rise and fall. A normal breath, which lasts about a second, will be perfectly adequate.

If anybody starts mithering that you're doing it in the wrong order, just ignore them. 

I'm telling you the ABC (Airways, Breathing, Circulation) method, but there's been a massive campaign by the American Heart Association to go for CBA (Circulation, Breathing, Airways) instead. As far as I can ascertain, that's largely because people were so busy worrying about looking like they're snogging a stranger, that they talked themselves out of performing CPR.

Starting with chest compressions meant they were committed before they got to the socially impolite stage, thus were less likely to back out.

Other campaigns, like the Hands Only CPR one across two continents, took out entirely the requirement to give rescue breaths.  It was hoped that more people would prefer to save lives that way, instead of fretting what other people were thinking about them.

In short, various people learn different ways to do this. As long as you're doing one of them, it really doesn't matter which one!

Step Four: Chest Compressions (C - Circulation or Chest)

Kneel. Place the heel of one hand over the sternum (where chest forks in the middle). Cover with other hand. Shoulders straight above. Press hard and fast, 15 times.
Image: How to perform chest compressions
Image: How to perform chest compressions

More detailed instructions for chest compressions:

  1. Kneel alongside the individual, adjacent to their chest.
  2. Use your fingertips to pinpoint the place where the ribcage meets in the middle. This will be centrally between the two nipples, then slightly down the torso. 
  3. Mark that soft spot where the ribcage forks with your middle finger.
  4. Place your index finger down above it.
  5. Place the heel of your other hand down alongside your index finger. THIS is the exact, optimum position to administer chest compressions.
  6. Lift up your marker fingers, then place the heel of that second hand on top of the first.
  7. Interlock the fingers of both hands. This will lift them away from the person's chest. You only need the two palm heels applying pressure. (If you leave your fingers down, they will be right over the ribs, not the sternum. That's how ribs get broken. Don't fret if you accidentally do that. Ribs can get fixed. Dead people can't.)
  8. Lean forward, until your shoulders are directly over your hands, and your arms are straight and braced.
  9. Press down hard. If you need the measurements, then the perfect pressure is to a depth of 1.5"-2" (or 4-5cm). But this really isn't the time to get a ruler out. 'Hard' works best, because the chest SHOULD depress further than you think right and proper. Just go for it.
  10. Compress the chest thirty times, then give another two rescue breaths (step 3).
  11. Keep the cycle going - thirty chest compressions, two rescue breaths, thirty chest compressions, two rescue breaths, and so on.

The rules are always changing.  Some trainers go for 15 compressions, then two breaths. Others say 30 compressions, then two breaths. And the Hands Only CPR campaign tells you to keep on compressing without bothering about the breaths. 

As long as you're doing something, then it's all good.  Personally, I'm still with 30 compressions and 2 breaths. Those who don't follow suit aren't wrong either.

Do CPR to a Chorus of Nellie the Elephant

Honestly! I've been passing First Aid examinations since about 2005 with the help of Nellie the Elephant. Previously I went for the 1812 Overture.

Nellie the Elephant packed her trunk
And said goodbye to the circus;
Off she went with a trumpety-trump
Trump, trump, trump.

You learned it in kindergarten. The chorus above (just a single iteration) is precisely fifteen beats, and at the exact speed for doing great chest compressions. Repeat it - or continue into the second part of the chorus - for another fifteen beats, giving you a perfect thirty overall.

Just press down hard upon every beat, while you sing this in your head. Then give two more rescue breaths, and back for another chorus.

Step Five: Repeat 30 Compressions/2 Breaths, Until Person Revives or Paramedics Tell You to Stop

Note that this doesn't say, 'until paramedics arrive', but when they actually indicate to you that it's alright to cease CPR.

Image: ParamedicTrained medics can tell at a glance whether you're 'doing it right'.

If you are, then there is no good reason for them to stop you. They might as well take the extra few seconds to settle down, get their defibrillator out and apprise themselves fully of the situation. You are keeping their patient alive throughout.

The only times that paramedics will stop you immediately upon their arrival are:

  • If you are exhausted (CPR is exercise);
  • If you are really messing it up.

The second won't apply if you've taken the steps above.

How to Perform CPR - CPR Demonstration

Note that this American First Aider does more than was described within the remit of this article. It's exactly how I'd have done it too.

I agree with 99% of what this US First Aider does and says, despite us learning our skills in different countries under different laws.  The 1% disagreement is solely at the end, when he states that you should stop after a certain time.

One of my old First Aid trainers told us that the record for keeping someone alive is 18 hours. CPR was performed in a remote location by a group of men, on a friend who'd been trapped under ice in a lake. It took nearly a day for two of their fellows to reach a location where emergency services could be alerted, then led back to the place where a marathon CPR session was still underway.

That man's friends refused point blank to give up on him. It was a good call. He survived and later regained consciousness in a hospital. Because his circulation was maintained, he suffered no lasting ill-effects, not even brain damage.

My rule is strictly that recounted in step five:  continue CPR until a paramedic (or doctor or nurse) tells you to stop, or else another First Aider is able to take over to afford you a break.

Be Prepared with CPR Masks and Resuscitators

The First Aider in the video uses one of these. I was taught to too. Health and safety, cuts risk of infection, blah blah. It's a nicety, NOT a necessity to performing CPR.
Practi-SHIELD CPR Training Shields (Box of 50), WNL Safety Products

JO'S CPR MOUTH-SHIELD! I have one of these in all four of my First Aid boxes, plus dotted around various handbags, purses and rucksacks. Never once actually got one out to use, apart from in my examinations!

View on Amazon

Pack of 5 Ambu Res-Cue Key Mini CPR Mask Keychains

This is a multi-pack of keychain CPR Masks so you have them where needed, or enough to share with family and friends. CPR masks are a must when performing CPR or rescue breathin...

View on Amazon

ADC ADSAFE Pocket Resuscitator

CPR pocket resuscitator with 15mm OD connector compatible with standard ventilation equipment . Safe for use on adults and pediatric patients. Disposable valve with 3M filtrete...

View on Amazon

CPR Mask Key Chain Kit (5-pack) - One-way Valve and Face Mask Shield You Against Infection & Cont...

Saves lives with CPR without putting yourself at risk of infection. This is a multi-pack of CPR Mask Key Chain kits, so you have them where needed, or enough to share with famil...

View on Amazon

Pocket Rescue Mask - Complete Mask

Diverts patient's exhaled air away from the rescuer and prevents mouth to mouth contact. Its clear design allows visibility to check victim's mouth for lip color and secretions....

View on Amazon

3 pack - CPR Shield Barrier Pocket Masks In KEYRING POUCH - 3 Pack

This CPR Mask is Constructed of Clear Medical Grade Vinyl Compact and High quality.

View on Amazon

NB  If you really do want to use a mouth-shield but haven't got one handy, then place a handkerchief or thin fabric over the individual's mouth. As long as air passes through the material, it's doing its job.

That job, by the way, is to reduce the risk of infection from mouth sores, or bleeding gums etc. Or to stop them accidentally vomiting into your mouth. Personally I like to think I'd notice the latter coming and shift myself out of the way.

British Red Cross - How to Perform CPR on Adults

As I hold a British Red Cross First Aid certificate, it goes without saying that this is precisely how I was taught to do the 'kiss of life'!

Free Apps for Learning CPR

Download these CPR apps for your smartphone, and have them there handy as emergency preparedness.

More First Aid Articles on Wizzley

A medical emergency could happen at any moment. The question is whether you have the knowledge to save lives. We should all have that.
Updated: 10/22/2014, JoHarrington
Thank you! Would you like to post a comment now?


Only logged-in users are allowed to comment. Login
JoHarrington on 09/25/2014

I could teach you now that you're here. You wouldn't be qualified, but you'd have some training. I've even got a big box of old bandages to practice with. :) Though it might be worth checking at your Uni. I got a free course back in the day at mine. It's always worth knowing too, or all the obvious reasons, plus the bonus of giving you the confidence in life.

Ember on 09/24/2014

Wow- it took em a while to read this one, but this is such a good article to have out there. I know getting training and a first aid certification is incredibly important, but I'm surprised I hadn't know at least the basics of CPR until reading this. I even lived with someone who was a lifeguard, who spoke with me regularly about the importance of knowing first aid/CPR.

JoHarrington on 08/14/2014

Thank you very much. <3

Telesto on 08/14/2014

Good article Jo.

JoHarrington on 08/09/2014

That is such a good idea! I really wish we had that here too. Our doll is also called Annie.

Tolovaj on 08/09/2014

I can't say how is now (I suppose there were no significant changes), but in our country everybody who wants to pass exam to get driving license must go through the course of first aid with an exam at the end. We performed the 'kiss of life' on the doll called Annie (Ancka) and this part was the most often the reason to fail the exam.

You might also like

First Aid: Would you Know What to Do?

A medical emergency could happen at any moment. The question is whether you h...

Would You Recognize the Symptoms of Hypothermia in Time to Sav...

If you've ever dithered, teeth chattering with the cold, you've been in the o...

Disclosure: This page generates income for authors based on affiliate relationships with our partners, including Amazon, Google and others.
Loading ...