First Aid and CPR Study Guide (US) 2026

First aid and CPR courses in the US

There is no single government first aid or CPR exam in the US. Training organizations, such as the American Heart Association (AHA) and the American Red Cross, run courses and issue certificates. Many courses end with a written test and a hands-on skills check.

Course content follows two main sets of guidelines: the 2025 AHA Guidelines for CPR and Emergency Cardiovascular Care, and the 2024 Guidelines for First Aid, written by the AHA and the American Red Cross together.

At work, OSHA rule 29 CFR 1910.151 says that if there is no infirmary, clinic or hospital near the workplace, a person or persons must be adequately trained to give first aid, and first aid supplies must be readily available. Where eyes or body may be exposed to corrosive materials, there must be facilities for quick drenching or flushing.

Check, Call, Care

The American Red Cross teaches three emergency action steps.

The three emergency action steps.

Check the scene for safety, then check the person.
Call 911, or have someone call, and get an AED.
Care for the person until EMS takes over.

Check

Make sure the scene is safe. Look for traffic, fire, electricity or other dangers.
Form a first impression and put on gloves or other PPE if they are right there.
Check responsiveness with shout, tap, shout.
Check breathing for no more than 10 seconds, and look for life-threatening bleeding.

If the person is awake, tell them your name and ask if you can help.

Call

Call 911 if the person is unresponsive, is not breathing normally, or has another life-threatening problem. If others are nearby, send one person to call 911 and bring an AED. If you are alone with a cell phone, call 911, put the phone on speaker and start CPR right away.

Care

Give the care you are trained to give until EMS arrives. After you finish, wash your hands with soap and water for at least 20 seconds, or use a sanitizer with at least 60% alcohol.

CPR for adults, children and infants

If an adult is unresponsive and not breathing or only gasping, assume cardiac arrest. Slow, irregular gasps are called agonal breathing. They are not normal breathing.

Hand and body position for adult compressions.

The center of the chest, on the lower half of the breastbone.
Heel of one hand there, other hand on top, fingers laced.
Shoulders directly over your hands, elbows locked, pushing straight down.

Adult compression depth: at least 2 inches (5 cm), but not more than 2.4 inches (6 cm). The scale is in centimeters.

Push down at least 2 inches (5 cm), but not more than 2.4 inches (6 cm).
Let the chest come all the way back up. Do not lean on it.

Put the person on their back on a firm, flat surface.
Push at 100 to 120 compressions per minute.
Keep any pause to less than 10 seconds.
If you are trained and willing, give 30 compressions, then 2 breaths. Open the airway with the head-tilt/chin-lift. Each breath takes about 1 second and should make the chest rise.
If the first breath does not go in, re-tilt the head and reseal before the second breath.
For a person with obesity, use the same technique and push harder if needed to reach the right depth.

Hands-Only CPR

If you are untrained or unwilling to give breaths to an adult, use compression-only (Hands-Only) CPR: call 911, then push hard and fast in the center of the chest until help arrives.

Children and infants

An infant is younger than about 1 year (not a newborn). A child is from about 1 year until puberty. After puberty, use adult CPR. For infants and children, breaths plus compressions improve survival, so give breaths if you can. If you cannot, compression-only CPR is still better than nothing.

	Adult	Child	Infant (under 1 year)
Hands	Two hands, lower half of breastbone	One or two hands	Heel of one hand, or two thumbs with hands encircling the chest
Depth	At least 2 in (5 cm), not more than 2.4 in (6 cm)	About 2 in (5 cm), one-third of chest depth	About 1.5 in (4 cm), one-third of chest depth
Rate	100 to 120 per minute	100 to 120 per minute	100 to 120 per minute
Ratio, one rescuer	30:2	30:2	30:2
Ratio, two rescuers (usually health care providers)	30:2	15:2	15:2

The 2025 guidelines also use a single Universal Chain of Survival for adults and children, in and out of the hospital.

Using an AED

Give CPR until an AED arrives and is applied. Turn it on and follow the prompts.

Front-and-side (anterolateral) pad placement for an adult.

One pad on the upper right chest, just below the collarbone.
The other pad on the lower left side, below the armpit.

Pads go on the bare chest. A bra can be moved aside rather than removed.
Pads may also go front and back (anteroposterior).
For children and infants under 8, use pediatric pads or an attenuator if available. If not, use adult pads, making sure they do not touch.
Make sure nobody touches the person while the AED analyzes or shocks.
Resume compressions right after a shock.

Choking

If the person can cough forcefully, let them keep coughing and watch closely. If they cannot speak, cough or breathe, often clutching the throat, the airway is severely blocked. Call 911.

Abdominal thrusts for a choking adult or child.

Stand close behind the person, one foot between their feet.
Fist, thumb side in, just above the navel and well below the breastbone.
Grab your fist with your other hand.
Give quick thrusts inward and upward.

Who	Severe choking care (2025 AHA)
Adult	Cycles of 5 back blows, then 5 abdominal thrusts
Late pregnancy, or you cannot reach around	Cycles of 5 back blows, then 5 chest thrusts
Child	Cycles of 5 back blows, then 5 abdominal thrusts
Infant	Cycles of 5 back blows, then 5 chest thrusts. No abdominal thrusts.

If the person becomes unresponsive, start CPR beginning with compressions and make sure 911 has been called. Before giving breaths, remove an object only if you can see it. Do not do blind finger sweeps.

The recovery position

The 2024 first aid guidelines say the recovery position is reasonable for a person who is less alert from a non-injury cause and breathing normally. If you suspect a neck, back, hip or pelvis injury, leave the person in the position you found them unless the area is unsafe.

Rolling a person onto their side.

Place the near arm out at a right angle, elbow bent.
Bring the far arm across and hold the back of the hand against the near cheek.
Bend the far knee up, foot flat on the ground.
Roll the person toward you onto their side and tilt the head back to keep the airway open.

Bleeding and shock

For life-threatening bleeding, call 911 and press firmly on the wound. If pressure is not enough, use a tourniquet on an arm or leg, or pack the wound with gauze where a tourniquet cannot be used, such as the groin.

Controlling serious bleeding from a limb.

Apply firm, direct pressure with a pad over the wound.
Hold a dressing in place with a roller bandage.
If bleeding is still life-threatening, tighten a tourniquet above the wound, between the wound and the body.

Tighten the tourniquet until the bleeding stops.
Do not loosen or remove it. Leave that to medical professionals.

Shock means the organs are not getting enough blood. Signs include pale, cool, clammy skin, a fast pulse, fast breathing and confusion. Call 911 and treat the cause. If there is no injury, raising the feet about 6 to 12 inches may be reasonable while you wait.

Burns and injuries

Cooling a heat burn under running water.

Cool or cold (not freezing) running water.
The burned skin sits under the water.
Cool for at least 10 minutes, ideally 20 minutes.

Cool a burn for at least 10 minutes, ideally 20. Cooling may still help up to 3 hours after the burn.
Do not use ice or ice packs.
Avoid cooling beyond 40 minutes, because the person can get too cold.
If there is no water, use a clean compress that is cool or cold, but not freezing.

For a possible broken bone, keep the part still and supported in the position found. Put a cloth between any ice pack and the skin. Call 911 for a bone sticking out of the skin. Anyone with a possible concussion should stop activity and be checked by a health care provider.

Sudden illness

Stroke

Use F.A.S.T.: Face drooping, Arm weakness, Speech difficulty, Time to call 911. Some hospitals and courses use BE-FAST, which adds Balance and Eyes (vision changes). Call 911 right away.

Heart attack

Call 911 for chest pain. An alert adult with chest pain not caused by injury may chew 162 to 325 mg of aspirin while waiting, unless they are allergic or have been told not to take it.

Asthma

Help the person use their prescribed inhaler, with a spacer if possible. If no spacer is available, a 500-mL plastic bottle or a paper cup can be used as an improvised spacer.

Anaphylaxis

Help the person use their epinephrine auto-injector in the outer thigh and call 911. If there is no response and EMS is more than 5 to 10 minutes away, a second dose may be considered.

Low blood sugar

If the person is awake and can swallow, give sugar. Glucose tablets are preferred. Call 911 if they cannot swallow, have a seizure, or do not improve within 10 minutes. Never give food or drink to someone who is not fully awake.

Seizures

Protect the person from injury. Do not restrain them or put anything in their mouth. Call 911 if the seizure lasts more than 5 minutes, it is a first seizure, it happens in water, the person is injured, pregnant or an infant under 6 months, has trouble breathing, or does not return to normal within 5 to 10 minutes.

Poisoning and opioids

Call the Poison Help line at 1-800-222-1222 for advice. Call 911 if the person is unresponsive or has trouble breathing. For a suspected opioid overdose with abnormal breathing, call 911, give CPR and give naloxone if available.

Heat, cold and water emergencies

Exertional heat stroke: the best cooling method is putting the body, up to the neck, in cold water. Call 911.
Hypothermia: move the person to a warm place, remove wet clothing and use blankets. Warm showers or baths can be harmful if the person is drowsy.
Frostbite: if thawing with water, use lukewarm water at 99°F to 104°F (37°C to 40°C).
Fainting: help the person sit or lie down. Call 911 if they do not improve in 1 to 2 minutes.
Drowning: do not go into the water unless trained. Reach or throw something that floats. On land, start CPR, and give breaths if trained, because drowning starts with a lack of oxygen.

Bites, stings and skin contact

The 2024 first aid guidelines also cover some common outdoor problems. These questions sometimes appear in course tests.

Ticks: remove the tick as soon as possible. Grasp it close to the skin with tweezers and pull upward with steady pressure. The longer a tick stays attached, the higher the risk of illness.
Bee, wasp and hornet stings: remove a stinger left in the skin as soon as possible. A sting to the eye should be checked by a medical professional. Watch for signs of anaphylaxis and call 911 if they appear.
Snake bites: call 911 for any bite from a snake that may be venomous. Keep the person and the bitten limb still, and remove rings, watches or tight clothing. Do not use ice, suction, electric shock or a tourniquet.
Poison ivy, oak and sumac: wash the skin with soap and water as soon as possible. Washing right away removes the most plant oil; waiting even 10 minutes removes much less.

How to prepare for the course test

Course tests check that you know what to do first and the key numbers. Many questions describe a short scene and ask for the best next step. Think in order: Is the scene safe? Is the person responsive? Are they breathing normally? Has someone called 911 and gone for an AED?

If a person is unresponsive and not breathing normally, the answer is almost always: call 911, get an AED and start compressions.
Watch the age in each question. Infants (under about 1 year) get chest thrusts for choking, not abdominal thrusts, and compressions about 1.5 inches deep.
Remember what not to do: no ice on burns, no blind finger sweeps, no food or drink for someone who is not fully awake, nothing in the mouth during a seizure, and never loosen a working tourniquet.
Keep going with CPR until EMS takes over, the person starts to breathe normally or move, you are too exhausted to continue, or the scene becomes unsafe. Pause only briefly when the AED analyzes or shocks.