Quality standards for cardiopulmonary resuscitation practice and training

Introduction and overview - Quality standards



Resuscitation Council (UK) AC  PC  PDC  MH
Royal College of Physicians of London 
Royal College of Anaesthetists    
Intensive Care Society     
College of Emergency Medicine 
Council for Professionals as Resuscitation Officers  
Faculty of Intensive Care Medicine 
Paediatric Intensive Care Society  
Royal College of General Practitioners  
Royal College of Nursing    
Royal College of Paediatrics and Child Health  
Royal College of Psychiatrists    MH
Quality Standards contributing organisations logos

The organisations listed above have all contributed to this Introduction and Overview document.   

Contributing organisations to the Acute Care standards are indicated with the symbol  AC
Contributing organisations to the Primary Care standards are indicated with the symbol  PC
Contributing organisations to the Primary Dental Care standards are indicated with the symbol
Contributing organisations to the Community Hospitals Care standards are indicated with the symbol  CHC
Contributing organisations to the Mental Health standards are indicated with the symbol  MH

The Resuscitation Council (UK) Patient Advisory Group has advised on this document. 

Working group members:

Jasmeet  Soar (Chair), Resuscitation Council (UK)
Mick Colquhoun, Resuscitation Council (UK)
Tracey Courtnell, Resuscitation Council (UK)
Peter-Marc Fortune, Paediatric Intensive Care Society
Jamie Fulton, Resuscitation Council (UK)
David Gabbott, Royal College of Anaesthetists
Matthew Griffiths, Royal College of Nursing
Susan Hampshire, Council for Professionals as Resuscitation Officers
Fiona Jewkes, Royal College of General Practitioners
K-L Kong, Resuscitation Council (UK)
Sarah Mitchell, Resuscitation Council (UK)
Ian Maconochie, Royal College of Paediatrics and Child Health
Jerry Nolan, Resuscitation Council (UK)
Gavin Perkins, Faculty of Intensive Care Medicine
David Pitcher, Royal College of Physicians, Resuscitation Council (UK)
Steven Searle, College of Emergency Medicine
Gary Smith, Royal College of Physicians, Intensive Care Society
Richard Williams, Royal College of Psychiatrists

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Other quality standards documents

A roadmap for the other documents which comprise the quality standards for cardiopulmonary resuscitation practice and training is shown below. Also included below are hyperlinks to access the other quality standards documents.

Quality Standards document map


1. Introduction and scope

Healthcare organisations have an obligation to provide a high-quality resuscitation service, and to ensure that staff are trained and updated regularly and with appropriate frequency to a level of proficiency appropriate to each individual’s expected role.

This document provides quality standards for cardiopulmonary resuscitation practice and training in the following settings:

  1. Acute care - mainly acute hospitals
  2. Primary care - general practice (including out-of-hours services)
  3. Primary dental care - excluding conscious sedation for which there are existing standards
  4. Community hospitals care - * (Documents currently in development)
  5. Mental health - inpatient care.

The aim of these standards is to:

  1. Improve care and outcomes for patients who are deteriorating, or suffer cardiorespiratory arrest in a healthcare setting.
  2. Update existing quality standards with a particular emphasis on simplification to improve implementation.
  3. Provide new standards for community hospital care and mental health inpatient care.

Whenever possible, reference will be made to existing national guidance.

These standards update and replace:

  1. Cardiopulmonary Resuscitation - Standards for clinical practice and training. A joint statement from The Royal College of Anaesthetists, The Royal College of Physicians of London, the Intensive Care Society and the Resuscitation Council (UK). October 2004. Revised June 2008.
  2. Cardiopulmonary Resuscitation Guidance for clinical practice and training in Primary Care. Resuscitation Council (UK). July 2001.
  3. Medical Emergencies and Resuscitation - Standards for clinical practice and training for dental practitioners and dental care professionals in general dental practice. Resuscitation Council (UK) July 2006. Revised and updated February 2012.

There are numerous types of setting where clinical care is provided. This guidance does not provide standards for every possible setting or scenario. The standards in this document can be used to help guide development of standards in clinical settings that are not included in this document. Guidance relating to other settings may be added in the future.

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2. Core standards

The same core standards apply in all settings to ensure that:

  1. the deteriorating patient is recognised early and there is an effective system to summon help in order to prevent cardiorespiratory arrest.
  2. cardiorespiratory arrest is recognised early and cardiopulmonary resuscitation (CPR) is started immediately.
  3. emergency assistance is summoned immediately, as soon as cardiorespiratory arrest is recognised, if help has not been summoned already.
  4. defibrillation, if appropriate, is attempted within 3 minutes of identifying cardiorespiratory arrest.*
  5. appropriate post-cardiorespiratory-arrest care is received by those who are resuscitated successfully. This includes safe transfer.
  6. implementation of standards is measured continually and processes are in place to deal with any problems identified.
  7. staff receive at least annual training and updates in CPR, based on their expected roles.
  8. staff have an understanding of decisions relating to CPR.
  9. appropriate equipment is available for resuscitation.

*Circumstances where this standard may not be achievable are included in the relevant section.

3. Methods

A working group was set up by the Resuscitation Council (UK). Stakeholder organisations nominated individuals to the working group. Existing standards in each area were identified and, where needed, the existing standards were updated. Updates were based on consensus from working group members.

The evidence for specific aspects of resuscitation practice comes from Resuscitation Council (UK) Guidelines 2015. The process used by the Resuscitation Council (UK) to produce the 2015 Resuscitation Guidelines was accredited by the National Institute for Health and Clinical Excellence (NICE) (http://www.resus.org.uk/guidelines-and-guidance).

The first draft was sent to organisations for comment and approval. The drafts and final version were also reviewed and commented on by the Resuscitation Council (UK) Patient Advisory Group.

A draft of each standard was posted on the Resuscitation Council (UK) website for at least 4 weeks. Feedback was reviewed by the working group and consensus reached on responses to any issues raised. Final documents were approved by the working group.

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4. Implementation

Where appropriate, each section contains links to implementation tools or examples of good practice. Each section also contains guidance on measures to assess adherence to standards.


  1. The term ‘MUST’ has been used when the consensus is that the standard promotes normal practice and is obligatory.
  2. The term ‘SHOULD’ has been used when the consensus is that the standard promotes normal practice.
  3. The term ‘RECOMMENDS’ is used when the consensus is that the standard promotes best practice.

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5. Supporting information

  1. Care Quality Commission.    http://www.cqc.org.uk
  2. European Resuscitation Council Guidelines.   http://www.cprguidelines.eu
  3. High Quality Care For All. NHS Next Stage Review Final Report. Department of Health. June 2008.
  4. International Liaison Committee on Resuscitation. http://www.ilcor.org
  5. Nolan J, Soar J, Eikeland H. The chain of survival. Resuscitation. 2006 Dec;71(3):270-1.
  6. The NHS Constitution for England (2012 Edition)
  7. Resuscitation Council (UK). http://www.resus.org.uk
  8. Resuscitation Council (UK) Guidelines. http://www.resus.org.uk/guidelines-and-guidance

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6. APPENDIX: Conflict of interest declaration

 Name Details
Jasmeet Soar (Chairman)
Consultant in Anaesthetics & Intensive Care Medicine,
North Bristol NHS Trust, Southmead Hospital,
Bristol BS10 5NB
Editor, Resuscitation (paid honorarium)
Chair ERC ALS working group lead (unpaid)
ILCOR ALS Taskforce co-chair (unpaid)
National Cardiac Arrest Audit steering group (unpaid)
Mick Colquhoun
c/o Resuscitation Council (UK),
5th Floor Tavistock House North, Tavistock Sq, London WC1H 9HR
Tracey Courtnell
Senior Resuscitation Officer (Community and Mental Health),
Oxford Health NHS Foundation Trust, Chancellors Court, 4000 John Smith Drive, Oxford Business Park, Cowley Oxford OX4 2EX
Peter-Marc Fortune
Consultant Paediatric Intensivist,
Royal Manchester Children's Hospital,
Oxford Road,
Manchester M13 9WL
Trustee, Advanced Life Support Group (ALSG)
Chair of ALSG PaNSTaR course
Chair of ALSG Human Factors Working Group
Board member of NW Simulation Education Network
Jamie Fulton
Consultant in Medicine,
Derriford Hospital,
Plymouth PL6 8DH
IMPACT Curriculum Committee
David Gabbott
Consultant Anaesthetist,
Gloucestershire Royal Hospital, Great Western Rd, Gloucester
NCEPOD assessor (unpaid)
Matt Griffiths
Advanced Nurse Practitioner,
c/o Resuscitation Council (UK), 5th Floor Tavistock House North, Tavistock Sq, London WC1H 9HR
Consultant adviser RCN
Visiting Professor, Birmingham City University
Consultant adviser, Cumberlege Connections
Sue Hampshire
Senior Resuscitation Officer,
c/o Resuscitation Council (UK), 5th Floor Tavistock House North, Tavistock Sq, London WC1H 9HR
Fiona Jewkes
Clinical Author, NHS Pathways, RBDT Connecting for Health, Vantage House, 40 Aire Street, Leeds LS1 4HT
Clinical Author for NHS Pathways (full time) (paid)
Teaching for military on paediatric emergency care (paid)
Consultant to Viro Pharma (paid)
Chair Pre-hospital Paediatric Life Support (unpaid)
BASICS education subcommittee (unpaid, but honorarium for teaching on a course)
Hon. Company Secretary Joint Royal Colleges Ambulance Liaison Committee (unpaid)
Paediatric Lead JRCALC guidelines (unpaid)
Board Member for Faculty of Pre-hospital Emergency care (unpaid)
Examiner for Diploma in Immediate Medical Care Examination (honorarium)
KL Kong
Consultant Anaesthetist,
City Hospital,
Dudley Road,
Birmingham B18 7QH
Member, Sandwell and West Birmingham NHS Trust Resuscitation Committee
Ian Maconochie
Consultant in Paediatric Emergency Medicine,
St Mary’s Hospital,
London W2 1NY
Royal College of Paediatrics:
- Officer for Clinical Standards - Registrar
- Member of the Clinical Standards Committee
- Member of the Intercollegiate Fever DH study (demitted)
College of Emergency Medicine, Member of the Clinical Standards Committee (demitted)
European Resuscitation Council,
National director for EPLS- WGG
Children Action Prevention Trust (demitted),
Trauma Care charity, Trustee
Emergency Planning Clinical Advisory Group (DH) (EPCLAG) (disbanded), Member

Medical advisor to a small company dealing with major incident equipment, approx. £1800 pa before tax
Medical advisor to a newly founded small company to produce media material on national guidelines (non-remunerated to date)
Work as an independent medical advisor to Youth Justice Board
Honoraria for EMJ, ADC and BMJ in associate editorial roles
Sarah Mitchell
Director, Resuscitation Council (UK), 5th Floor Tavistock House North, Tavistock Sq, London WC1H 9HR
Jerry Nolan
Consultant in Anaesthesia and Intensive Care Medicine,
Royal United Bath,
Combe Park,
Bath BA1 3NG
Editor-in-Chief, Resuscitation (paid Honorarium)
Vice Chair, European Resuscitation Council (unpaid)
Chair, National Cardiac Arrest Audit Steering Group (unpaid)
Council Member, Royal College of Anaesthetists (unpaid)
Council Member, College of Emergency Medicine (unpaid)
Board member, Intercollegiate Board for Training in pre-hospital Emergency Medicine (unpaid)
Co-editor, 2015 ILCOR Consensus on CPR Science (unpaid)
Partner in Circle Health (minor share holding)
Gavin Perkins
Professor of Critical Care Medicine,
University of Warwick, Warwick Medical School, Coventry, CV4 7AL
Heart of England NHS Foundation Trust, Birmingham B9 5SS
Employer - University of Warwick
Editor, Resuscitation
Grant recipient from NIHR for studies on quality of CPR and mechanical chest compression devices
Co-Director Research ICS
Medical Advisor, Qualsafe Ltd
Medical Advisor, RLSS (UK) (unpaid)
ERC course committees
David Pitcher
 Consultant Cardiologist, University Hospitals Birmingham NHS Foundation Trust.

Resuscitation Council (UK), 5th Floor Tavistock House North, Tavistock Sq, London WC1H 9HR
Chairman, Resuscitation Council (UK) (unpaid)
NHS Pathways Clinical Governance Group (unpaid)
Steven Searle
Consultant in Emergency Medicine,
St Richards Hospital,
Sussex PO19 6SE
Member of the College of Emergency Medicine Audit & Standards Committee (unpaid)
Member of the NICE Pneumonia working group (unpaid)
Gary Smith
Consultant in Intensive Care

Visiting Professor at Bournemouth University
Wife is a minority shareholder in The Learning Clinic (TLC) Ltd., which is the developer of VitalPAC, a clinical software system for identifying patient deterioration and escalating care. Professor Smith is an unpaid research advisor to TLC and has received reimbursement of travel expenses from TLC for attending symposia in the UK.
Co-developer of the Acute Life-Threatening Events - Recognition and Treatment (ALERT) course, which is owned and run by Portsmouth Hospitals NHS Trust (PHT). PHT receives payment for sales of the courses and course materials to other healthcare institutions. Professor Smith was an employee of PHT until 31/03/2011.
Past member of Royal College of Physicians of London’s National Early Warning Score Development and Implementation Group (NEWSDIG).
Past member of the NICE, NPSA and DH committees that set standards for aspects of care related to prevention and response to patient deterioration.
Paid external reviewer of Policy on Physiological Early Warning Score (PEWS) to Northern Ireland Northern Healthcare & Social Care Trust, 2010.
Co-Director of the annual International Rapid Response Systems conference and organiser of 2013 conference in UK.
Member of the Clinical Advisory Board of Cardiocity, an innovations company currently involved with patient monitoring.
Co-Director of RedRisk Ltd, a company developing educational materials.
Richard Williams
Professor of Mental Health Strategy, Welsh Institute for Health and Social Care
University of Glamorgan Honorary Professor
Humanitarian and Conflict Response Institute, Faculty of Humanities, University of Manchester
ConsultantChild and Adolescent Psychiatrist, Aneurin Bevan Health Board, NHS Wales Cymru, St Cadocs Hospital, Newport
NP18 3XQ
Convener Diploma in Medical Care of Catastrophes for the Society of Apothecaries of London (unpaid)
Member of the Intercollegiate Board for Training in Pre-Hospital Emergency Medicine (unpaid)
Presidential Lead Officer for Disaster Management for the Royal College of Psychiatrists (unpaid)

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November 2013

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