AHA BLS Provider common mistakes
AHA BLS Provider · Understand the traps and how to avoid them.
Starting chest compressions before confirming unresponsiveness and absent or abnormal breathing, or skipping the breathing check entirely and going straight to compressions.
Test anxiety and the emphasis on 'minimize interruptions' lead candidates to rush the assessment, and agonal gasping is mistaken for normal breathing or the check is skipped because it feels like a delay.
What to do instead
Practice a scripted, timed sequence: tap and shout, simultaneously check breathing and pulse for no more than 10 seconds, and treat gasping as not breathing. Rehearse until the assessment is automatic before compressions begin.
Compressing too shallow or too slow, or leaning on the chest between compressions so full recoil never occurs.
Candidates focus on the count and forget depth, rate, and recoil; fatigue and poor body mechanics cause leaning, and many have never seen feedback on actual depth or recoil.
What to do instead
Use a CPR feedback device or metronome in practice, position shoulders over hands, and consciously lift hands slightly while keeping contact. Target 2 to 2.4 inches (5 to 6 cm) at 100 to 120 per minute with complete recoil.
Pausing compressions for long periods to give breaths, check a pulse, or reposition, letting hands-off time exceed 10 seconds.
Candidates prioritize perfect ventilation or rechecking over chest compression fraction and do not realize how quickly a pause grows while they fumble with a barrier device or AED pads.
What to do instead
Time every pause in practice. Assign roles so one rescuer sets up the AED or airway while another compresses, and keep any interruption under 10 seconds.
Giving adult rescue breaths with too much volume or force, or failing to open the airway adequately before ventilating.
Candidates equate visible chest rise with a big breath and forget head-tilt/chin-lift, so air enters the stomach or the airway stays obstructed.
What to do instead
Practice head-tilt/chin-lift first, then deliver a breath over about 1 second just until the chest begins to rise. Use a bag-mask with two rescuers when available and watch for gastric inflation.
Applying AED pads in the wrong position, over clothing or a medication patch, or leaving the pads touching each other.
Candidates rush under scenario pressure, do not expose and dry the chest, and have not practiced pad placement on a manikin torso with landmarks.
What to do instead
Memorize landmarks: one pad below the right clavicle, one on the left lateral chest below the armpit. Always bare and dry the chest, remove patches, and confirm pads do not touch.
Touching the patient or continuing compressions while the AED analyzes or delivers a shock.
Adrenaline and the desire to keep hands on the chest cause rescuers to forget the clear-the-patient step, and team members may not hear or heed the command.
What to do instead
Verbalize and physically clear: say 'Clear!' loudly, look at the patient, and confirm no one is in contact before pressing analyze or shock. Assign one person to enforce the clear.
Delaying the first shock or failing to immediately resume compressions after a shock is delivered.
Candidates wait to see whether a rhythm converts or pause to reassess, not realizing that immediate post-shock compressions are the priority.
What to do instead
Drill the rule: shock, then immediately resume compressions for about 2 minutes before any rhythm or pulse recheck. Do not delay shocking to finish other tasks.
Using adult compression depth, rate, or a lone-rescuer sequence on a child or infant instead of the pediatric approach.
Candidates overlearn the adult algorithm and default to it, forgetting pediatric depth (about one-third the chest AP diameter), the 15:2 ratio for two rescuers, and the infant two-finger or two-thumb technique.
What to do instead
Practice pediatric-specific skills separately: two fingers or two thumbs encircling for infants, one or two hands for children, and 30:2 lone rescuer versus 15:2 with two rescuers. State the patient's age aloud in scenarios.
Failing to activate the emergency response system or send for an AED early, or neglecting to phone for help in a pediatric arrest.
Candidates fixate on the resuscitation and assume someone else will call, and in pediatric scenarios they may not know that help should be summoned while CPR is ongoing.
What to do instead
Build a habit of assigning a specific person: 'You in the blue shirt, call 911 and get the AED.' In pediatric arrest, provide about 2 minutes of CPR before leaving a lone child to activate help if no phone is available.
Poor team communication: giving unclear or overlapping orders, not identifying a team leader, and failing to use closed-loop communication during a resuscitation.
Candidates practice solo skills but have little experience in multi-rescuer scenarios, so roles blur and messages are not confirmed, causing duplicated or missed tasks.
What to do instead
Practice with explicit roles (compressor, airway, AED, leader), use closed-loop communication ('Give epinephrine' - 'Giving epinephrine now'), and have the leader state a plan aloud. Include a scenario where an opioid overdose is suspected and naloxone and CPR are coordinated.