Pediatric BLS Two Rescuer Algorithm

This algorithm outlines the steps for two rescuers dealing with a pediatric emergency involving an unresponsive child or infant, emphasizing coordination and efficiency to maximize the chances of recovery.

Initial Response and Scene Safety

Ensure Safe Scene: First, ensure that the environment is safe for both the responders and the victim.

Check Responsiveness: One rescuer checks the child’s responsiveness by tapping and loudly asking, "Are you alright?" while observing for any facial cues or movements.

Activate Emergency Response System (ERS): The second rescuer activates the ERS and retrieves an Automated External Defibrillator (AED) and any other necessary emergency equipment.

Assessment and Immediate Actions

Assess Pulse and Breathing: The first rescuer checks for a pulse (brachial pulse in infants, carotid or femoral pulse in children) and observes breathing for 5-10 seconds.

If Pulse Is Present but Breathing Is Abnormal: Begin rescue breathing at a rate of 1 breath every 3-5 seconds (12-20 breaths per minute), adjusting to the child's needs based on observed chest rise and overall responsiveness.

If No Pulse or Abnormal Breathing: Start CPR immediately.

CPR and AED Deployment

Begin CPR:

Rescuer 1: Starts CPR with a compression-to-breath ratio of 30:2.

When Second Rescuer Arrives: Adjust to a 15:2 compression-to-breath ratio to optimize the resuscitation effort and minimize fatigue.

Use AED As Soon As Available: As soon as the AED is brought to the scene, apply it to the child and follow the voice prompts.

If Rhythm Is Shockable: Deliver one shock, then immediately resume CPR for 2 minutes before rechecking the rhythm.

If Rhythm Is Not Shockable: Continue CPR without interruption for 2-minute intervals, rechecking the rhythm as prompted by the AED.

Ongoing Monitoring and Support

Monitor Patient Continuously: Both rescuers should continue to monitor the patient’s pulse and breathing, adapting their approach based on the child’s response to interventions.

Continued Resuscitation Efforts: Continue CPR and rescue breathing as necessary until advanced life support (ALS) providers arrive or the child shows signs of recovery.