BLS stands for Basic Life Support. In the United States, this type of certification is for those in the medical field. If you’re a healthcare provider or someone in a rescue profession, the CPR certification you most likely need is BLS.

Those who probably don’t need BLS certification—but who do need a form of CPR training—include teachers, coaches, personal trainers, childcare providers, and safety officers in various workplaces. In other words, people who may find themselves in a position where they’re responsible in case of an emergency, but whose job doesn’t normally include providing emergency care.

Here’s a look at some of the jobs you can get with BLS certification in more detail.

Doctors and nurses.

Everyone looking to become a doctor or nurse will need to get BLS certification. This isn’t always the highest level of emergency life support certification you’ll need; some medical professionals, especially those working in critical care and emergency medicine, also get the Advanced Cardiac Life Support (ACLS) certification. BLS, however, is the certification for medical providers across the board.

Medical assistants.

BLS-certified medical assistants are common in most hospital and healthcare settings. Medical assistants work alongside doctors and nurses, taking vital signs, administering medication, giving injections to patients, and discussing medical histories. While they aren’t usually the first line of response for emergency care, they’re likely to be on hand when that care is needed, and need to know how to provide basic life support in case of an emergency.

Dentists.

Dentists are required to complete a certain number of continuing education hours to renew their license every few years—the exact number of hours and years varies by state. BLS certification is required, and if the course is approved by the Dental Board in the state where you work, getting recertified may count as continuing education.

Paramedics and EMTs.

Medical professionals who are first on the scene of an accident will regularly be called upon to use their basic life support skills. BLS certification is usually the initial level of training for EMTs, with paramedics and advanced paramedics holding training in more advanced forms of life support and emergency care.

Firefighters.

Anyone in the “professional rescuer” field will need a BLS certification, as their job requires delivering lifesaving emergency care. That includes both professional and volunteer firefighters, who are usually required to hold an EMT qualification. Some fire departments require their professional firefighters to be certified paramedics.

Police officers.

Police officers aren’t medical providers, but they are often the first on the scene in volatile situations as well as accidents. Every second counts when it comes to lifesaving care, so police officers need to be able to provide it immediately as the first to arrive in an emergency.

The specific requirements vary by state, but police officers may be required to hold a CPR and First Aid certification or a BLS certification. If you’re not sure, the BLS certification is more advanced than general CPR, and would be accepted in all states.

If you’re in the medical field or in a rescue profession, the certification you’re likely to need is BLS. Every profession is different, of course, and requirements may be affected by state law, industry standards, or individual employers. If you’re in doubt, a BLS certification for healthcare providers should be accepted anywhere CPR knowledge is required.

It’s one of the biggest fears laypeople have about delivering CPR—what if you actually do more damage to the patient than good? What if you break a rib? It does happen—and more often than you’d think.

How common are broken ribs as a result of CPR?

Chest compressions need to be performed at a depth of about 2 inches in order to do the patient any good—in adult patients, of course. Any less than that and you won’t be moving the blood around the body effectively. However, it takes a surprising amount of force—about sixty pounds of it, to be exact—to compress a human chest that much.

So, yes—it’s actually fairly common for ribs to break during CPR. The conventional wisdom is that about 30% of patients suffer fractures or breaks during CPR. However, a 2015 study published in Resuscitation suggested that this percentage is quite a bit higher. The study analyzed autopsy data from 2,148 patients who received CPR for non-trauma-related cardiac arrest, and the statistics were as follows:

• Skeletal chest injuries were found in 86% of men and 91% of women.
• 59% of the men and 79% of the women had sternum fractures.
• 77% of the men and 85% of the women had rib fractures.
• 33% of the men and 12% of the women had sternocostal separations.

Who is most at risk of breaking a rib during CPR?

It’s clear from the above data that women are more likely to receive skeletal chest injuries than men. In addition, the study found that older patients were more at risk of these kinds of injuries than younger. Existing health conditions such as osteoporosis, which weakens the bones, can also result in a higher chance of injuries.

On the other hand, physically large, robust, and even obese patients are less likely to suffer broken bones during CPR than those with a smaller frame.

In a different study—performed in Korea in 2012—it was found that patients who received CPR from a bystander were more likely to suffer bone injuries than those who got their CPR from a doctor or paramedic.

What should you do if you feel a rib break?

When you are performing CPR, you may hear a cracking sound or feel something crack or give beneath your hands. This is usually the cartilage in the sternum or ribs breaking, and not the ribs themselves. However, the ribs may also break, and this can be disconcerting for the rescuer.

As disturbing as this experience is, however, it is generally not advisable to stop if you feel a rib break or hear a cracking sound. True, broken ribs and other skeletal injuries can be painful and add to the patient’s recovery time—but it’s better than being dead, which will certainly happen if you stop CPR.

The bottom line is this: fear of breaking someone’s ribs or causing other injuries should not stop you from delivering CPR. Broken ribs heal, and Good Samaritan laws throughout the country protect bystanders who deliver CPR. You are extremely unlikely to find yourself facing legal consequences if the patient doesn’t like the way you delivered CPR after the fact, provided the actions you took were non-compensated, in good faith, and in keeping with your level of training.

The truth is that CPR is a vigorous, sometimes violent procedure, and there is a high risk of injury to the patient—but injury is preferable than death. If your patient is lucky enough to survive after CPR, chances are they will thank you—and count a broken rib as a small price to pay for their life.

Hoosiers are know for their hospitality and willingness to help especially in an emergency. But many times fear of liability can be a concern when using and/or purchasing an AED for use. This applies individually who uses and AED as well as the organization or business who may want to purchase or make one available. Having a good understanding of what the law is can often quell those concerns. Below are some of the legislation for the state of Indiana that specifically protects users and owners of AED’s.

House Bill 1106 (2006)

A person or entity acquiring an AED must:

1. Ensure the AED is maintained and tested according to the manufacturer’s guidelines.
2. A person who gratuitously renders emergency care involving the use of an AED is immune from liability for any act or omission not amounting to gross negligence or willful or wanton misconduct.

An individual, business, or organization that allows a person who is an expected user to use an AED of the individual, business, or organization to in good faith gratuitously render emergency care is immune from civil liability for any damages resulting from an act or omission not amounting to gross negligence or willful or wanton misconduct by the user or for acquiring or providing the AED to the user for the purpose of rendering the emergency care.

A licensed physician who gives medical direction in the use of an AED or a national or state approved AED instructor of a person who gratuitously renders emergency care involving the use of an AED is immune from civil liability for any act or omission of the licensed physician or instructor if it:

1. Involves the training for or use of an automatic external defibrillator; and 2. Does not amount to gross negligence or willful or wanton misconduct.

Removes the use of an AED from the definition of basic life support.

House Bill 1116 (2007) Requires an individual to have training in CPR, removing obstructions to a person’s airway, and the Heimlich maneuver before obtaining an initial license as a teacher.

Establishes immunity from liability for certain acts or omissions by a teacher who has been trained in CPR, removing obstructions, and the Heimlich maneuver.

The BLS CPR algorithm is the basic protocol for performing CPR to an unresponsive victim. It’s the definition of high-quality, effective-as-possible CPR.

There are several different versions of this protocol. Medical professionals get a more complicated version than laypeople, and there are also different versions for adult and pediatric care. However, here are the parts of the algorithm that apply to everyone:

BLS CPR Algorithm for Healthcare Professionals

1. Wait no more than 10 seconds to start performing CPR on an unresponsive victim.
2. The compression rate should be 100-120 compressions per minute. This is about the tempo of “Stayin’ Alive” by the Bee Gees.
3. The depth of compression should be 2-2.4 inches for adults, about 2 inches for children aged 1 to adolescence, and 1.5 inches for babies.
4. Let the chest recoil completely after every compression.
5. Once you start giving CPR, don’t stop if possible—any interruptions to chest compressions should be minimized.
6. If you’re administering an AED shock, the pause between the last compression and the shock—and the pause between the last shock and the next compression—should be kept to under 10 seconds.
7. When delivering CPR, start chest compressions before rescue breathing. You should give a rescue breath after your first 30 compressions.
8. Watch the rise of the chest to see if your rescue breaths were effective.
9. Avoid any excess ventilation; this could result in vomiting, pneumonia, or aspiration.

BLS CPR Algorithm for Laypeople (Non-Medical Professionals)

The version for laypeople is a bit simpler, and emphasizes different things. Here are the details:

1. Check the victim’s responsiveness. If they are not breathing or not breathing normally—for instance, if they are gasping for breath—start CPR.
2. Call 911.
3. Get an automatic external defibrillator (AED), if there is one available.
4. The algorithm goes in a loop: CPR, rhythm check, and defilation.
5. Check the pulse before starting chest compressions for at least five seconds and no more than 10 seconds. If you can’t find a pulse or can’t tell if there is one, start compressions.
6. Push hard and fast in the center of the chest. Start chest compressions before rescue breathing; the ratio is 30 compressions to 2 rescue breaths. Let the chest recoil between compressions.
7. Chest compressions should be performed at a depth of 2-2.4 inches in adults, and at a rate of 100-120 per minute.
8. For rescue breathing, deliver 10 breaths per minute or one breath every six seconds. Each breath should last about one second; watch for the chest to ride to determine effectiveness. Avoid excessive ventilation.
9. Use the AED when you have one available. Use it to check the rhythm, then deliver a shock once every two minutes or five cycles.
10. This version includes rescue breaths and use of an AED, but the simplest form of CPR for laypeople is hands-only. All you do is push hard and fast in the center of the chest, to the tune of “Stayin’ Alive” by the Bee Gees.

Hands-only CPR has been found to be just as effective as the traditional variety when delivered by laypeople; in some circumstances, it’s even more effective.

In previous years, students were able to “challenge” a particular certification course without taking an instructor-led training or blended-learning course (as long as certain criteria were met). With the new PAM or Program Administration Manual release, the AHA no longer allows students to challenge a course. If you find a training location that offers this as an option it may not be an accepted certification. Below is the official statement on the subject effective September 21, 2017.

“The AHA no longer offers a “challenge” option, where students may complete course testing requirements without participating in an AHA instructor-led training or blended-learning course. To demonstrate proficiency in knowledge and skills, all students must complete a provider course every 2 years to maintain their course completion card.”

— Program Administration Manual, September 21, 2017 pg. 41