How Schools Should Respond To Cardiac Emergencies: Guide

A school that has a rehearsed plan for sudden cardiac arrest can act within seconds instead of scrambling. This guide walks through how schools should respond to cardiac emergencies, from the first 30 seconds after a collapse to the handoff to EMS, and then through the preparation that makes that response possible. Before you start, secure support from administration, compile a list of staff who hold current CPR certification, and make sure there is a budget line for AEDs (automated external defibrillators) and training. Without those three things, the plan stays on paper.

Step 1: Recognize Sudden Cardiac Arrest Right Away

Sudden cardiac arrest is an electrical failure. The heart's rhythm becomes chaotic or stops, so it can no longer pump blood to the brain and body. A heart attack is different: a blocked artery starves part of the heart muscle of blood, but the person is usually awake and breathing. A heart attack can trigger cardiac arrest, but staff who wait for chest pain or other heart attack symptoms before acting will lose critical time.

Teach staff to look for three things together:

• The person collapses suddenly.
• The person does not respond when tapped and shouted at.
• The person is not breathing, or is only gasping.

That gasping is called agonal breathing: slow, irregular, snoring or gurgling breaths that can continue for several minutes after the heart stops. Bystanders often take it for normal breathing and hold back. Make it explicit in training that gasping does not count as breathing.

The most common mistake is waiting to see whether the student will shake it off. Some people in cardiac arrest have brief seizure-like jerking at the start, which can make staff think they are watching a seizure or a faint. If someone is unresponsive after a collapse and not breathing normally, treat it as cardiac arrest until proven otherwise. Starting CPR on someone who turns out not to need it carries far less risk than delay.

Also make clear that this is not only an athlete problem. Arrest can happen to students, teachers, coaches, custodians, parents, and visitors. Exercise is a common trigger, so gyms and fields deserve special attention, but collapses also happen in classrooms, hallways, and cafeterias.

Step 2: Call 911 and Send Someone for the AED

The first person on the scene should shout for help and assign jobs out loud, pointing at individuals rather than addressing the crowd. "You, call 911 and stay on the line. You, bring the AED. I'm starting CPR." Named roles prevent the pause where everyone assumes someone else is handling it.

The three roles are:

1. Caller: dials 911 (or the local emergency number) and stays on the line.
2. AED runner: retrieves the nearest AED and brings it to the person.
3. Compressor: starts CPR immediately.

The caller should give the exact location: building, floor, room or field, and the entrance EMS should use. Campuses are confusing to outsiders, so a second person should be sent to meet the ambulance and guide responders to the spot. If your school uses room numbers, field names, or building letters that are not on a standard map, say so in your plan and train staff to use the names dispatchers will recognize.

One mistake to design out of your plan is the call to the front office first. Many schools have a habit of notifying the office, which then calls 911. That relay adds delay and can garble the location. Staff should call 911 directly from a cell phone or classroom line, then notify the office afterward so administrators can activate the rest of the plan.

Keep the phone on speaker and set it down next to the person. Dispatchers are trained to coach callers through CPR, count compressions aloud, and tell rescuers when to use the AED. That guidance is especially useful for a staff member who has not practiced recently.

Step 3: Start High-Quality CPR Immediately

CPR (cardiopulmonary resuscitation) keeps blood moving to the brain and heart until a shock can restore a normal rhythm. Quality matters as much as speed. Under the American Heart Association's 2020 guidelines, which remain the base for current training, rescuers should push hard and fast in the center of the chest at a rate of 100 to 120 compressions per minute. For adults and large teens, that means a depth of at least 2 inches, and allowing the chest to fully recoil between compressions. Confirm with your trainer whether the AHA has issued updated guidance since, as the association periodically revises its recommendations.

For younger children, compress about one-third of the depth of the chest, roughly 2 inches in most children and about 1.5 inches in infants. Cardiac arrest in young children is more often caused by a breathing problem than by a heart rhythm problem, so rescue breaths matter more for them. Trained rescuers should give breaths along with compressions for infants and children, using a pocket mask or barrier device. If no one present is trained or willing to give breaths, compression-only CPR is still far better than nothing.

Compressing is tiring, and quality drops faster than most people expect. Rotate compressors about every 2 minutes, and make the switch quick so compressions pause for as little time as possible. The person taking over should be kneeling in position and ready before the swap.

Two habits to discourage:

• Repeated pulse checks. Pulse checks are unreliable for untrained rescuers and interrupt compressions. If the person is unresponsive and not breathing normally, keep going.
• Moving the student. Do not carry or drag the person to the nurse's office or another room. Do CPR where they fell unless the scene is unsafe, such as a hazard from traffic, fire, or water.

Continue CPR until the AED is ready to analyze, EMS takes over, or the person starts to move and breathe normally.

Step 4: Use the AED as Soon as It Arrives

AEDs are designed for untrained bystanders. The device talks you through each step, so the main job is to open it and follow the voice prompts. Keep compressions going while someone prepares the device.

1. Turn the AED on, or open the lid, which powers most models.
2. Bare the chest. Cut or pull away clothing, including sports bras with metal clasps if they block pad placement.
3. Attach the pads as shown in the pictures on the pads. Use pediatric pads or the pediatric mode for children under 8 if your device has them. If it does not, adult pads are better than no shock.
4. Let the AED analyze the rhythm. Everyone must stop touching the person.
5. If a shock is advised, make sure everyone is clear and press the shock button.
6. Resume CPR immediately after the shock, or right away if no shock is advised, and follow the prompts.

A few practical points come up often. Wipe a wet chest dry before applying pads, because water prevents them from sticking. Remove medication patches from the chest and wipe the area. If you can see a lump under the skin from an implanted pacemaker or defibrillator, place the pad at least an inch away from it rather than directly over it. Leave the pads on after the shock, and leave the AED connected until EMS takes over.

Staff sometimes hesitate because they fear the AED could hurt someone who does not need a shock. It cannot. The device analyzes the heart rhythm and advises a shock only for rhythms that a shock can correct. If the person is not in a shockable rhythm, the AED will tell you no shock is advised, and you continue CPR.

Speed matters here. The American Heart Association emphasizes that early CPR combined with rapid defibrillation gives a person the best chance of survival, and that each minute without defibrillation lowers the odds. Use the AED as soon as it arrives, without waiting for EMS or a second opinion.

Step 5: Manage the Scene and Hand Off to EMS

While rescuers focus on CPR and the AED, a separate set of staff should control the environment. A cardiac emergency draws a crowd, and a crowd makes it harder for rescuers to work and harder on the students who watch.

Assign these roles:

• Student supervisor: moves nearby students away calmly and supervises them, ideally somewhere out of view of the scene. Keep their phones in pockets if possible, to limit video and rumors.
• EMS greeter: meets the ambulance at the entrance, holds doors, keeps elevators available, and clears a path. This person leads responders directly to the patient.
• Administrator in charge: contacts parents or guardians and coordinates the school's response.

When EMS arrives, one rescuer, ideally the person who knows the most, gives a brief report. Cover:

1. When the person collapsed.
2. When CPR started.
3. How many shocks the AED delivered.
4. Any known medical history or medications, such as a heart condition, allergies, or a known implanted device.

Keep it to the facts. Responders will take over compressions and the AED, so rescuers should keep going until told to stop.

Family notification should go through the designated administrator, by phone and in person if possible. Tell staff and students not to text or post about the incident, since parents who learn through social media may get false or alarming information first.

Finally, do not clear, reset, or power down the AED after the event. It records the heart rhythm, shocks, and timing, and that data helps hospital teams and the device manufacturer. Hand it over to EMS or retrieve the data through the manufacturer, and replace it with a spare in the meantime.

Step 6: Build the Plan Before an Emergency Happens

Everything above works only if it has been planned in advance. The American Heart Association publishes guidance on Cardiac Emergency Response Plans for schools, and it is a good template to start from. Your written plan should name who does what, with a backup for every role, since the person assigned may be absent or in another building.

Equipment placement

Aim to place AEDs so someone can reach a collapsed person and return with the device in about 3 minutes or less. Typical locations include:

• Gyms and athletic fields
• The main office
• The cafeteria
• Near auditoriums and event spaces

Mark each location on a campus map included in the plan and post copies where staff can see them. Check your state's rules too. Many states have school AED or CPR requirements, and these change, so verify the current requirements with your state education or health department as of 2026.

Training and teams

Train as many staff as you can in CPR and AED use, and make sure athletic staff and nurses hold BLS (Basic Life Support) certification, the professional-level course that covers team-based resuscitation. 360 Safety offers CPR and BLS training, as well as AEDs, tourniquets, and first aid supplies, so a school can handle training and equipment in one place.

Consider forming a dedicated response team to coordinate all of this, such as an AVIRT. Confirm the exact meaning and structure of that term with 360 Safety before adopting it in your plan, since groups use it differently.

Coverage beyond the school day

Plan for evening games, weekend tournaments, rentals of your facilities, and away trips. Decide who carries a portable AED to away events, who is trained at each event, and how visiting groups can find the nearest device.

Step 7: Drill, Maintain Equipment, and Review Every Event

A plan that has never been tested will fail in ways nobody predicted. Run at least one full cardiac emergency drill per year, using a manikin and a trainer AED if you have one. Time the interval from collapse to first shock, and note where the team stalled: unclear roles, a locked door, someone who could not find the AED, or confusion over the location given to 911.

Equipment checks

Check each AED monthly and log every check. Each time:

• Confirm the status indicator shows the device is ready.
• Inspect pad and battery expiration dates.
• Make sure spare pads are stored with the unit.
• Check that the rescue kit is complete: gloves, a razor, a towel, and a pocket mask.

Register every AED with your local EMS agency so dispatchers know where devices are, and follow the manufacturer's maintenance guidance.

Review and recovery

After any real event or drill, hold a debrief within days. Ask what worked, what slowed the team down, and what to change in the plan. After a real event, also offer emotional support to staff and students who were involved or watched. Witnessing a cardiac arrest is distressing even when the outcome is good, and counselors or employee assistance resources should be available.

Two failures turn up repeatedly. One is an AED stored in a locked room, an office that closes early, or a cabinet no one can open. The other is certifications that lapse unnoticed. Keep a roster with expiration dates and assign someone to track renewals.

Keeping the Plan Alive Through the School Year

Walk the campus and confirm that every AED is accessible and working, that every key staff member holds current CPR training, and that the plan has been practiced this school year. Where any of those fall short, fix it before the next event on your calendar. Then put the next drill and the next training renewals on the schedule, so readiness does not depend on anyone remembering.

Ready to put safety into action? Whether you need CPR certification, workplace safety training, or guidance on selecting and maintaining life-saving equipment such as AEDs, we're here to help. Our training programs and safety solutions are designed to help individuals and organizations respond confidently when every second counts. Schedule your training today and take the next step toward creating a safer, more prepared workplace and community.