On this page
- If this is happening right now
- Attack, arrest, faint — you do not have to tell them apart
- The first sixty seconds: call, check, start
- Hands-only CPR, taught plainly
- The cough-CPR forward is a myth — delete it
- What not to do
- The law is on your side
- The golden hour, and what the ambulance is actually buying
- Awareness is not certification — go and learn it properly
- Related
- Frequently asked questions
If this is happening right now
Stop reading and call 108 if the person in front of you is not responding, or is not breathing normally — occasional noisy gasps are not breathing. The ambulance is free, the number works across Tamil Nadu and Kerala, and the person who answers will stay on the line and talk you through what to do. Put the phone on speaker and set it down beside you so both your hands stay free. If the person is awake and talking but has chest pain or heaviness, go to Chest pain or heart attack — what to do now →. If one side of the face or body has suddenly gone weak, or speech has become strange, go to Stroke emergency — BE-FAST →. Everything below is for the minutes before anyone medical reaches you.
Attack, arrest, faint — you do not have to tell them apart
In this district almost any sudden collapse is called an “attack”, and that one word hides several very different things. A heart attack is a blocked artery starving heart muscle; the person is usually awake, in pain, sweating. A cardiac arrest is the heart stopping as a pump — the person drops, does not respond, and stops breathing properly within seconds. A heart attack can turn into an arrest, which is exactly why chest pain is never a wait-and-watch. A stroke usually leaves the person conscious but weak on one side. A fit, a very low sugar (blood glucose), heat and dehydration after a morning in the fields, or a simple faint in a crowded bus stand can all look alike for the first thirty seconds. Here is the relief: you are not being asked to sort them out. Two questions decide everything you do — does the person respond, and is the chest moving with normal breathing?
The first sixty seconds: call, check, start
- Call 108 first. Do not hunt for a pulse, do not run for water, do not phone a relative before the ambulance. Say where you are with a landmark — the church, the junction, the estate gate — and say “someone has collapsed, not responding”. Put the phone on speaker.
- Check response. Shout their name, tap and shake both shoulders firmly. A person who groans, moves or opens their eyes is responding.
- Check breathing. Look along the chest for up to ten seconds. Normal breathing is quiet and regular. Single noisy gasps every few seconds are not breathing — they are a dying reflex, and many bystanders wrongly take them as a good sign.
- Start compressions the moment the answer is “no response, no normal breathing”. Do not wait for permission from anyone on the phone.
- Send one person to the road to flag the ambulance in, unlock the gate and clear the doorway. In narrow lanes and estate roads this alone saves minutes.
- Note the time it started. The hospital will ask, and for a stroke that single fact changes what treatment is still possible.
Hands-only CPR, taught plainly
Get the person flat on their back on the floor — not on a cot, not on a mattress, which swallows every push. Kneel beside the chest. Place the heel of one hand in the centre of the chest, on the breastbone between the nipples, put your other hand on top and interlock your fingers. Keep your arms straight and your shoulders directly above your hands, so the push comes from your body weight rather than your elbows. Now push hard and fast — about 5 to 6 centimetres deep in an adult, 100 to 120 times a minute, which is roughly two pushes every second. Let the chest come all the way back up between pushes; the heart refills only when you release. Count aloud, or push to the beat of a fast familiar song. No mouth-to-mouth is needed — this is what hands-only CPR means, it is endorsed by the American Heart Association for an adult who collapses in front of you, and the blood still carries usable oxygen for those first minutes. If two of you are there, swap every two minutes, because proper compressions exhaust an adult far faster than anyone expects. Ribs sometimes crack under correct compressions. Keep going. A cracked rib heals; an untreated arrest does not.
The cough-CPR forward is a myth — delete it
Every few months the same message circulates: you are alone, you feel a heart attack starting, cough hard and repeatedly and you can save yourself. It is not true, and it is one of the few pieces of health misinformation that directly costs lives. The technique it was copied from belongs to a monitored hospital setting — a doctor watching the heart trace in real time, telling a patient who is fully awake to cough during a brief, specific rhythm problem. It has never been a treatment for a blocked artery, and a person who has already collapsed cannot cough at all. The harm is not the coughing itself; it is the delay. Every minute without compressions after an arrest lowers the chance of survival substantially. Someone with chest pain should be sitting still and calling 108, not exerting themselves on the advice of a forward. When this message reaches your family group, reply with the number 108.
What not to do
Give nothing by mouth and put nothing into the mouth — no water, no sugar, no tablet, nothing during a fit. A drowsy or unconscious person cannot swallow safely and it goes into the lungs. Do not slap, shake violently or throw water on the face; it wastes time and tells you nothing. Do not move the person unnecessarily — the exception is real danger, such as traffic, water or a live wire, where you drag them clear first. If they are breathing normally but will not wake, roll them gently onto their side so the airway stays clear, and keep watching the breathing; if they may have fallen from a height or been hit by a vehicle, leave them where they are and wait for 108. And do not bundle a person who is not breathing into a car or auto — compressions cannot continue on a lap over a village road, and the ambulance crew can start treatment the moment they reach you.
The law is on your side
This is the real hesitation, and it deserves a plain answer: people in this region do not stop helping because they lack skill, they stop because they fear the police station, the hospital bill and the court date. India’s Good Samaritan protections settle that. Central guidelines upheld by the Supreme Court, later written into the Motor Vehicles Act, say that a bystander who helps a victim in good faith cannot be held liable in civil or criminal law for the outcome, cannot be forced to reveal their identity, must not be detained at the hospital, and is not responsible for paying for treatment. You may hand the person over and leave. Nobody has ever been punished in this country for pushing on a stranger’s chest. Doing nothing has no such protection — not legally, and not in the memory of the family standing beside you.
The golden hour, and what the ambulance is actually buying
“Golden hour” is not a slogan; it is arithmetic. In a heart attack, muscle dies steadily from the moment the artery blocks, and what can be salvaged shrinks by the hour — the difference between a full recovery and a weakened heart is often measured in how long the family debated at home. In a stroke, clot-dissolving treatment usually works only within about 4.5 hours of the symptoms starting, which is why noting the time matters as much as noting the symptoms. Your compressions buy the minutes; the ambulance buys the hours. Call 108 rather than driving yourself — the network knows which centre nearest you is equipped for the treatment that particular emergency needs, and it carries trained hands on the way. PPK Hospital, Marthandam runs a 24/7 emergency department and an ICU with ventilator support, with senior specialists available, so a collapsed patient can be stabilised and kept stable while the right definitive care is arranged.
Awareness is not certification — go and learn it properly
Reading this page makes you useful. It does not make you trained, and the difference shows up in the first thirty seconds of a real arrest, when hands that have practised on a mannequin simply start while everyone else is still saying “what happened, what happened”. Sit through a proper hands-on CPR class — fire and rescue services, larger hospitals, the Red Cross and St John Ambulance branches, colleges and many workplaces run short sessions, and an hour is usually enough for the basics. Families of high-risk patients should treat this as compulsory: if someone at home has diabetes, known heart disease, high blood pressure or a previous heart attack, the person most likely to perform CPR on them is you, in your own kitchen, at two in the morning during the monsoon when the road is slow. Learn it once. Practise the rhythm on a cushion occasionally. Keep 108 saved in every phone in the house.
Related
Chest pain or heart attack — what to do now → · Stroke emergency — BE-FAST and the 4.5-hour window → · Heart attacks before 40 — why young Indian hearts fail early → · Critical care at PPK Hospital, Marthandam →
Frequently asked questions
Put the person flat on the floor, place the heel of one hand in the centre of the chest with your other hand on top, keep your arms straight, and push down hard and fast — 100 to 120 pushes a minute, about two every second, letting the chest come all the way back up between pushes. No mouth-to-mouth is needed. Keep going until the ambulance team takes over.
No. The forwarded message telling you to cough hard and rhythmically to save yourself is a myth, and a harmful one. The technique it borrows from belongs to a monitored hospital setting with a doctor watching the heart trace in real time, in a patient who is still fully awake. Coughing does nothing for someone who has already collapsed, and the seconds it steals from calling 108 are the seconds that mattered.
No. India's Good Samaritan protections — issued as central guidelines, upheld by the Supreme Court and written into the Motor Vehicles Act — say a bystander who helps in good faith cannot be held liable for the outcome, need not reveal their identity, must not be detained at the hospital, and is not responsible for the bill. Fear of the police station still kills more people in this district than bad CPR ever will.
Then treat it as an emergency and call 108 — the ambulance team and the hospital will decide which it is. You are not being asked to diagnose anything. Your two questions are only these: does the person respond when I shout and shake their shoulder, and is the chest moving with normal breathing? Anything else is the hospital's job, not yours.
No. Give nothing by mouth to a person who is drowsy, confused or unconscious — not water, not sugar, not a tablet, and nothing during a fit — because it can go into the lungs instead of the stomach. Even when low sugar is the likely cause, an unconscious person needs glucose given by the medical team, not by hand. Call 108 and say what you suspect.