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If a layperson or healthcare provider considers there are no signs of life, CPR should be started immediately. Feeling for a pulse is not a reliable way to determine if there is effective or inadequate circulation and the palpitation of the pulse is not the salted termination for the need for chest compressions. The presence or absence of sign of life such as response to stimuli, normal breathing rather than abnormal gasps or spontaneous movement must be looked for as signs of the circulatory assessment. If a healthcare provider does feel for a pulse in an unresponsive patient, they must be certain that one is present for them not to start CPR. In this situation, there is often other signs of life present. Lay rescuers should not be taught to feel for a pulse for the assessment of a need for CPR. The decision to start CPR should take less than 10 seconds from starting the initial assessment of the circulatory status and if they are still in doubt at that time, start CPR.

Although ventilation remains a very important component of CPR, rescuers who are unable or unwilling to provide breaths should be encouraged to perform at least compression-only CPR. A patient is far more likely to be harmed if the bystander does nothing. All providers should be encouraged to initiate CPR in children even if they haven't been taught particular paediatric techniques. CPR should be started with the compression ventilation ratio that is familiar. At the most, this will be 30 to 2. The paediatric modifications to adult CPR should be taught to those who care for children but are unlikely to have resuscitated them. The particular paediatric sequence, including the 15 to 2 ratio, is primarily intended for those with the potential to resuscitate children as part of their role.