Imagine this: You are walking through the pedestrian zone, shopping, or waiting for the bus - and suddenly a person beside you silently collapses to the ground. No scream, no dramatic fall like in a movie. Just gone. Motionless. No longer breathing.
In 2024, an estimated around 136,000 people in Germany suffered a sudden cardiac arrest outside a hospital - an average of 370 cases per day. These are not abstract figures. This is the colleague on the way to lunch. The mother in the supermarket. The elderly man on the park bench.
Out-of-hospital cardiac arrest is one of the most dangerous and time-critical emergencies of all. And yet, by no means does every bystander who could help respond. Why is that - and what can be done about it? In this article, we explore these questions using verified facts, concrete recommendations for action, and a look at what other countries do better.
The frightening truth: What happens in the first few minutes?
Before we talk about hesitation, we need to understand why these minutes are so crucial. The human body can withstand a great deal - but not a lack of oxygen in the brain.
Without functioning cardiac activity, vital organs suddenly stop receiving oxygen. Brain cells already begin to suffer irreversible damage after just a few minutes. In Germany, emergency services do arrive at the scene in an average of just under 6.19 minutes after the alarm is raised - but biologically speaking, that is still too long if no one acts in the meantime. What matters is this: These 6 minutes are the pure travel time. The valuable minutes that pass before the emergency is recognized and the emergency call is made are added on top. In reality, 10 to 12 minutes often pass between the collapse and the arrival of the professionals - time during which only you, as a first responder, can preserve the chance of survival.
Every minute of delay reduces the chance of survival by around 10 percent. Specifically, this means that someone who waits ten minutes without doing anything has, statistically speaking, virtually no chance of handing the person over alive. The time between cardiac arrest and the arrival of emergency services is biologically critical. This is precisely where a single person can make the difference between life and death.
What is the actual survival rate?
The figures are sobering, but important to know. One third of patients reach the hospital with a return of spontaneous circulation. The discharge rate, and therefore the survival rate, has remained stable at just under 11 percent for years.
This means: Of 100 people who suffer a cardiac arrest in the street or in their own home, around 89 statistically do not leave the hospital alive.
And there is encouraging news: Of the 11 percent of patients who leave the hospital alive, around 70 percent show good neurological recovery. This means that those who survive cardiac arrest generally also have a good quality of life. The crucial question, therefore, is not only whether someone survives - but whether anyone acts in time in the first place to make this 11-percent chance possible.
Who is actually nearby when it happens?
A widespread misconception is that cardiac arrests occur mainly in public places - in the marketplace, during sports, or on public transport. In reality, the situation is different. While almost 16 percent of cases occur in public places, a good 70 percent of cardiac arrests occur in a domestic setting. Up to 45 percent of all cardiac arrests are witnessed by family members, friends, or other people.
This means: In seven out of ten cases, the first potential rescuer is a family member, friend, or neighbor - someone who knows and loves the person and yet often does not act. This makes the question of hesitation even more urgent.
Why do first responders hesitate - the psychology of inaction
Research on bystander resuscitation repeatedly shows the same pattern: People want to help. They know in the abstract that they should help. And yet they do not act. What happens in their minds during those decisive seconds?
There is not just one reason for hesitating, but an entire web of fears, uncertainties, and social dynamics. Scientists have studied these patterns - and the findings help develop targeted counterstrategies.
Fear of mistakes and legal consequences
One of the most common reasons for hesitating is the fear of doing something wrong. What if you break a rib? What if you make the situation worse? Many people fear causing more harm by intervening than by doing nothing.
The reality clearly disproves this fear: The only real mistake is not starting. Rib fractures caused by chest compressions do happen - but a broken rib heals; a brain without oxygen does not. Anyone who does nothing during a cardiac arrest is acting wrongly. In Germany, the legal situation is clear: Anyone who acts to the best of their knowledge in an emergency enjoys legal protection. No one needs to fear going to court because of a broken rib.
Shock and panic in an acute situation
Cardiac arrest is not a familiar sight for most people. The situation of resuscitation often puts laypeople under acute stress. Many first responders are already overwhelmed by the unfamiliar situation — and uncertainty about the exact resuscitation procedure further reinforces the paralysis. The first-aid course was often years ago, and the steps can no longer be recalled. Precious time passes because someone is thinking — instead of pushing.
The good news: For precisely this situation, the new 2025 ERC guidelines have simplified the assessment of breathing even further. The message is: Check briefly and decisively — if the person is not breathing or not breathing normally (and gasping does not count as normal breathing!), call 112 immediately and begin chest compressions. The emergency dispatcher will guide you through the entire process during the call. You do not need to know anything by heart — you just need to start.
The psychological barrier to mouth-to-mouth ventilation
And then there is ventilation. For many, it is the greatest mental barrier. Studies show that lay rescuers are significantly more willing to perform chest compressions than mouth-to-mouth ventilation. Disgust, fear of infection transmission, and a lack of confidence in their own ability are cited as major obstacles. These factors often cause rescue breaths to begin late or not at all — with noticeable consequences for the chances of survival.
Against this background, simple barrier systems were developed that significantly lower the psychological threshold. One such aid is the single-use emergency resuscitation face shield in a soft case from Medicalcorner24. Made of PE film with a one-way valve, the shield prevents direct mouth-to-mouth contact, can always be carried on a key ring thanks to its integrated key ring, and is immediately at hand in an emergency — without lengthy searching or repacking. A small aid with a major impact on the willingness to help.
The bystander effect: When many watch, no one acts
Social psychologists have known about this phenomenon for decades: The more people observe an emergency, the less likely it is that any one of them will intervene. Everyone thinks someone else will act. Everyone waits. And that costs time that is not available.
The only effective response in such a situation is to address someone directly. Point to a specific person and say clearly: "You in the red jacket - call 112 now!" Then: Start pressing. Do not wait or look to see whether someone else will respond. Act.
Germany compared with Europe - where do we stand?
The development in Germany is encouraging - but the road ahead is still long. After years of stagnation, resuscitation care in Germany is moving forward again - and in the right direction: In 2024, both the rate of resuscitation performed by first responders and the rate of telephone-assisted CPR increased.
In the reference group, the rate of resuscitation performed by first responders increased from 50.7 percent in 2023 to 55.4 percent in 2024. In the overall dataset, the rate was 52.0 percent, around two percentage points higher than the previous year. This is real progress - and a sign that awareness campaigns are effective.
Nevertheless: By international standards, Germany still lags behind numerous European neighbors.
What do Scandinavians do differently?
Looking north shows what is possible. According to the official information sheet on bystander CPR from the German Federal Ministry of Health, other European countries such as Norway, the Netherlands, and Sweden already achieve rates of approximately 70 to 80 percent. This is neither a coincidence nor a cultural peculiarity - it is the result of consistent political decisions.
Denmark provides a clear example: through national initiatives - such as introducing resuscitation training in schools and launching a wide-ranging information campaign - the bystander CPR rate rose from 20 percent in 2000 to over 45 percent by 2010. Today, CPR practice is a compulsory part of the curriculum in Denmark and Norway from sixth grade onward. Apps such as "Heartrunner" are also used there to alert registered first responders via push notification when a cardiac arrest is reported in their immediate vicinity. The result: In some regions of Scandinavia, the bystander CPR rate is now over 70 percent. Not through new medications or expensive technology - but through consistent training, digital networking, and a society that systematically promotes it.
What this means for Germany
The conclusion is clear: By teaching resuscitation measures early in schools and taking a few additional steps, we could save the lives of 10,000 more people every year, according to Professor Bernd Böttiger, Chairman of the German Resuscitation Council. 10,000 lives - equivalent to about 27 lives saved every day. The solution is not in the hospital. It is on the street, in the supermarket, in the stairwell.
What you can do: Chest compressions step by step
Theory is of little use if you do not know how to begin in an emergency. That is why here is a practical guide - based on the current 2025 ERC guidelines (European Resuscitation Council), the leading European standard for resuscitation.
Step 1 - Check for safety and speak to the person
Go to the person affected. Speak to them loudly and gently shake their shoulder. Are they unresponsive and not breathing normally? Then act immediately.
⚠️ Important notice - for an emergency:
Agonal breathing - irregular, gasping, or struggling breaths - is not a sign that someone is breathing. It is a clear clinical sign of cardiac arrest. Many people hesitate at precisely this point because they think: "But they are still breathing." That is the most dangerous misconception.
The rule of thumb in the 2025 ERC guidelines is: If you are unsure whether the person is breathing normally - treat it as cardiac arrest and begin chest compressions immediately. Do not wait. Do not look. Push.
Step 2 - Call 112
Call 112 immediately or clearly and directly ask a specific person nearby to do so. The emergency dispatch center will actively guide you through the next steps. The new guidelines emphasize even more strongly the role of the dispatch center in recognizing cardiac arrest and providing telephone instructions for resuscitation. You do not have to know everything yourself - the dispatch center is your real-time guide.
Step 3 - Begin chest compressions
Place the person on a firm, level surface. If they are on a bed or sofa, be sure to move them onto the floor — on a soft mattress or cushion, the force of your chest compressions is lost without effect. Place the heel of one hand in the center of the chest (breastbone), put the other hand on top, and interlock your fingers. Press evenly and forcefully with your arms straight: 100 to 120 times per minute, to a depth of 5 to 6 cm. This corresponds to the rhythm of the song "Stayin' Alive" by the Bee Gees — which is in fact the official memory aid of the ERC.
If you are not trained in rescue breathing, perform only uninterrupted chest compressions. This so-called "hands-only CPR" is almost as effective as the combined method, especially in the first few minutes — and significantly lowers the psychological barrier for laypeople.
Step 4 — Rescue breaths (recommended, but optional)
If you feel confident performing mouth-to-mouth resuscitation, give two breaths after every 30 compressions: 30 compressions followed by 2 breaths are recommended. To do this, gently tilt the person's head back, pinch the nose closed with two fingers, and slowly and steadily blow air into the mouth — until the chest visibly rises.
Important: If you do not want to or cannot perform rescue breaths — leave them out. Uninterrupted chest compressions (hands-only CPR) are almost as effective in the first few minutes after cardiac arrest as the combination with rescue breaths. What matters is that you compress the chest at all. Rescue breaths are an additional component — but not a reason not to start.
If direct contact makes you uncomfortable — and that is a completely understandable reaction — a resuscitation mask with a one-way valve can help. It allows air to pass in only one direction, protects against the transmission of germs, and significantly lowers the psychological barrier.
Step 5 — Use an automated external defibrillator (AED)
Many people know it only from hospital dramas — yet AEDs are now found in more and more public buildings, shopping centers, gyms, and even at bus stops. An AED is a small, portable device that analyzes the heart through electrodes and delivers a controlled electric shock when necessary.
It's that simple:
- Send another bystander to get an AED — or get one yourself if you are alone and the emergency call has already been made.
- Turn on the device. It speaks to you — in clear, simple sentences.
- Attach the pads to the bare chest as shown in the illustration.
- Follow the instructions. The device decides for itself whether a shock is needed. If so: Press the button and immediately continue chest compressions.
Important: An AED is completely safe for laypeople. It will not deliver a shock when one is not needed. And every minute you bridge with chest compressions increases the chance that the AED can work. So keep pressing until the device tells you to pause briefly.
Step 6 — Do not stop until the emergency services arrive
Continue chest compressions without interruption. If you become exhausted, switch with another person every two minutes if possible. Do not stop until the emergency services take over or the affected person is clearly breathing independently again. Chest compressions performed by first responders are the first and most important link in the chain of survival — and this is exactly where you can make the decisive difference.
Well equipped: What belongs in every emergency bag
Knowledge alone does not save lives. Knowledge combined with the right aid at the right time — that can make the decisive difference. Anyone who regularly travels, drives a car, plays sports or simply demonstrates a sense of responsibility should always have a few basic first-aid products within reach.
The resuscitation mask as an everyday companion
Pocket-sized resuscitation films are practical aids that are often underestimated. The single-use emergency resuscitation mask fits in any trouser pocket and can be attached to your key ring with its key ring — exactly where you are. Not in the car. Not in the jacket pocket at home. But always with you. The one-way valve enables a controlled flow of air to the patient, prevents rebreathing and reliably protects against direct contact. A small product with a major psychological effect: People are noticeably more willing to perform resuscitation when they know they are protected.
More first-aid products for everyday life
Besides the pocket resuscitation mask, there are a number of other products that should not be missing from any well-equipped emergency bag: from disposable gloves and sterile dressing materials to portable AED devices. Especially for sports clubs, companies or elderly relatives at home, having your own AED can provide a decisive advantage in an emergency. In Medicalcorner24's first-aid range, you will find a carefully selected range of products for private individuals, companies and medical professionals — clearly organized, quality-tested and available for fast delivery.
What is different for children? A brief note
Most cardiac arrests affect adults — but children can also be affected. And here there is one crucial difference: In children, cardiac arrest is usually the result of respiratory arrest (e.g. from drowning or choking). The heart stops only because the body no longer receives oxygen.
The most important differences for first aiders:
- For children, begin with 5 rescue breaths before starting chest compressions.
- Use one hand to press (two fingers for infants) and only about 4 cm deep.
- The rate remains the same: 100 to 120 times per minute.
If you are unsure: Even for children, any chest compression is better than none. The emergency dispatcher on the phone will guide you precisely on what to do.
The most important message: Taking action is allowed — and required
We live in a society where people hesitate out of fear — because they are unsure, or feel that it is not their responsibility. But when someone suffers cardiac arrest, there is no question of who is responsible. Anyone who helps can become a lifesaver — regardless of whether they have prior knowledge.
“This development is encouraging and shows that the long-standing efforts among the public are having an impact,” explains Prof. Dr. Matthias Fischer from the German Resuscitation Registry. But progress must not be allowed to falter. For years, experts have been calling for regular resuscitation training for all age groups. Efforts to empower all sections of the population and all age groups to provide help in the event of cardiac arrest must be expanded and, wherever possible, established by law.
You don't have to be a doctor. You don't have to be a hero. You just have to start. Push. And don't stop.
Conclusion: Anyone can save a life — if they dare
Cardiac arrest is not a rare exception. It happens every day, everywhere, right in the midst of our communities — in homes, on pavements, in supermarkets. And in most cases, someone who could help is in the immediate vicinity.
The figures are clear: CPR by bystanders saves lives. Countries that systematically train their populations and specifically work to reduce inhibitions have survival rates three times higher. Germany is on the right track — but the pace must increase.
What can you personally do?
- ✅ Refresh your first-aid course every two years
- ✅ Talk to your family about what to do in an emergency - who calls 112, who starts compressions?
- ✅ Carry a compact CPR face shield on your key ring - so that the barrier to taking action is lower in an emergency
- ✅ Point to a specific person in an emergency and give clear instructions
- ✅ Just start - even without perfect technique, taking action is better than doing nothing
The emergency services are on their way. The dispatcher is on the phone. But the first few minutes belong to you.
Please note: This article is for general information and educational purposes. It does not replace medical training or professional first-aid instruction. Attend a certified first-aid course regularly and always consult a doctor or medical professional with medical questions.
FAQ - Frequently asked questions about cardiac arrest and resuscitation
What should I do if I find an unconscious person?
Speak loudly to the person and gently shake their shoulder. If they do not respond and are not breathing normally - or are gasping - call 112 immediately or have someone else call while you begin chest compressions yourself. Place both hands, one on top of the other, in the center of the chest and press firmly and rhythmically: at least 5 cm deep, 100 to 120 times per minute - and do not stop until the emergency services take over.
May I perform chest compressions as a layperson, even without training?
Yes, absolutely - and in Germany, you are even legally obligated to provide assistance if someone is in mortal danger (§ 323c StGB). Anyone who acts to the best of their knowledge in an emergency is legally protected from criminal consequences. A possible broken rib caused by vigorous chest compressions can be treated medically - brain damage caused by a lack of oxygen generally cannot. The only real mistake is not acting at all.
Do I have to provide rescue breaths during resuscitation - or are chest compressions alone sufficient?
The 2025 ERC Guidelines comprise the latest evidence-based guidelines for resuscitation throughout Europe: If you are not trained in rescue breathing, perform only uninterrupted chest compressions. This so-called “hands-only CPR” is nearly equivalent to the combined method, especially in the first few minutes after cardiac arrest. Anyone who feels confident and is willing to provide rescue breaths should give two breaths after every 30 compressions - ideally using a CPR face shield with a one-way valve for hygienic protection.
How high is the risk of infection from mouth-to-mouth resuscitation?
The actual risk of transmission through mouth-to-mouth resuscitation in an emergency is medically considered low - nevertheless, the psychological hesitation is real and understandable. To lower this barrier while also providing protection, experts recommend resuscitation masks or face shields. A disposable resuscitation face shield with a one-way valve allows air to pass only toward the patient and reliably protects the first aider from direct contact - small enough to fit on a key ring, yet large enough in an emergency.
Where can I take a first-aid course in Germany, and how often should I refresh my skills?
First-aid courses are offered throughout Germany by the German Red Cross (DRK), the Workers' Samaritan Federation (ASB), Malteser Hilfsdienst, and many other organizations - including compact online formats covering basic first-aid knowledge. Experts recommend a refresher every two years, as guidelines occasionally change and practical skills fade without regular practice. As a rule of thumb, anyone who has children, elderly relatives, or people with heart disease nearby should also specifically practice age-appropriate resuscitation techniques for children and older people.
What does the "chain of survival" mean - and what role does the first aider play in it?
The chain of survival is a medical concept describing the ideal sequence of life-saving measures: early recognition and calling emergency services → early chest compressions by bystanders → early defibrillation with an AED → continued professional care by the emergency medical services → follow-up care and rehabilitation. Every link in this chain is crucial - but without the first link, the bystander present who immediately begins chest compressions, all subsequent measures are much less effective. The first aider is not the last resort - they are the first and most important.
What is the difference between cardiac arrest and a heart attack?
These terms are often confused in everyday life - yet they describe fundamentally different events. A heart attack is caused by impaired blood flow to the heart muscle, usually due to a blocked blood vessel. The heart usually continues to beat, the person is conscious and responsive, and complains of chest pain, shortness of breath, or pain radiating to the left arm. Cardiac arrest, on the other hand, means that the heart has completely stopped beating - the person is unconscious, is not breathing, and needs immediate resuscitation. A heart attack can trigger cardiac arrest, but it does not have to. If in doubt, always call 112 and, if the person is unconscious, immediately begin chest compressions.
