Heart Massage for Restoring Circulation : In cases of breathing failure, you should check that the casualty's heart is still beating. This is especially important with victims of electric shock or, poisoning where heart failure is a particular hazard. 'This check can be carried out by feeling the pulse at the wrist or neck or by applying an ear to the ; victim's chest. Other symptoms are widely dilated pupils and a grey colour of the skin.

The heart massage is done as follows:

(1) If a heart beat cannot be detected, place the casualty on his/her back on the floor (hard surface).

(2) Strike the upper left chest forcibly in the middle of the sternum or breast bone region with a closed fist. This may result in resumption of normal heart beat, for instance, in electric shock cases.

(3) If the heart still does not beat, cardiac massage is to be given by using the procedure given below.

(4) The position for massaging is 1-2" (or two finger width) above the bottom end of sternum.

(5) Place the heel of one hand on this point and the other hand on the top of it. Interlock the fingers to keep away from the victim's rib. Only the heel of your hand should make contact with the chest so that excess pressure may not be applied.

(6) Keep your elbows straight and lean forward.

(7) Then start pushing with the force of both your hands one above the other.

Apply steady smooth pressure to depress victim's sternum 1%" to 2".

(8) Then relax pressure maintaining the position of the hands.

(9) Give 15 such chest compressions and then two quick lung inflations by mouth-to-mouth breathing.

(10) Continue this process four times in a minute - namely -

- 60 chest compressions (1 5 at a time for four times)

- 8 lung inflations (2 at a time for four times)

The steps (9) and (1 0) are valid if there is a single person doing resuscitation. If there are two persons doing resuscitation, one may give chest massage and the other may give mouth-to-mouth breathing such that for five compressions there is one mouth-to-mouth breathing. The process of resuscitation in both the above cases, has to be continued till the heart beat resumes or until medical help arrives or the casualty reaches hospital.