Working hand-in-hand with basic first aid procedures should also be a good understanding of the practices and procdures of Cardiopulmonary resuscitation (CPR) and Automatic External Devices (AED) such as defibrillators for those times when a paddler is rendered unconscious because of drowning, heart attack, heart failure, head trauma, heat-related illnesses, hypothermia or electrical shock. In such cases it is critically important to know how to open airways, start or keep the lungs of the injured paddler functioning and restore consciousness to the victim.

The American Red Cross offers classes in First Aid, CPR and AED at very reasonable rates, and frequently offers group discounts if ten or more people sign up for one class. Paddling clubs often coordinate group training efforts. Class sizes are limited so that a high level of effectiveness and proper instruction can be achieved. It is highly recommended that paddlers get initial training in First Aid and CPR, then take refresher courses every 2-3 years to maintain competency, especially since these techniques are so critically important, yet so infrequently used or practiced.

Cardiopulmonary resuscitation (CPR) is an emergency procedure which is attempted in an effort to return life to a person in cardiac arrest. It is useful for those who are unresponsive with no breathing or only gasps. It may be attempted anywhere and anytime the need to restore a pulse and breathing occurs.

CPR involves chest compressions at a rate of at least 100 per minute in an effort to create artificial circulation by manually pumping blood through the heart. In addition, the rescuer may provide breaths by either exhaling into the victim's mouth or utilizing a device that pushes air into the lungs of the victim. The process of externally providing ventilation is termed artificial respiration. Current recommendations place emphasis on high quality chest compressions over artificial respirations, and a method involving only chest compressions is recommended for untrained rescuers.

CPR alone is unlikely to restart the heart. The main purpose of CPR is to restore partial flow of oxygenated blood to the brain and heart, and then maintain that flow until professional medical assistance arrives to take over. It may delay tissue death and extend the brief window of opportunity for a successful resuscitation without permanent brain damage. An administering of an electric shock to the heart, termed defibrillation, is usually needed to restore a viable heart rhythm. Defibrillation is only effective for certain heart rhythms, namely ventricular fibrillation or pulseless ventricular tachycardia, rather than asystole or pulseless electrical activity. CPR may, however, induce a shockable rhythm. CPR is generally continued until the person regains return of spontaneous circulation or is declared dead.

CPR training: CPR is being administrated while a second rescuer prepares for defibrillation. The importance of high quality CPR (sufficient rate and depth without excessively ventilating) was emphasized in the 2010 guidelines of the American Heart Association and International Liaison Committee on Resuscitation. The order of interventions was changed for all age groups except newborns from airway, breathing, chest compressions (ABC) to chest compressions, airway, breathing (CAB.) An exception to this recommendation is for those who are believed to be in a respiratory arrest (drowning, etc.)

If an advanced airway such as an endotracheal tube or laryngeal mask airway is in place delivery of respirations should occur without pauses in compressions at a rate of 8-10 per minute. The recommended order of interventions is chest compressions, airway, breathing (or CAB) in most situations with a compression rate of at least 100 per minute in all groups. Recommended compression depth in adults and children is about 5 cm (2 inches) and in infants it is 4 cm (1.5 inches. As of 2010, the Resuscitation Council (UK) still recommends ABC for children. As it can be difficult to determine the presence or absence of a pulse the pulse check has been removed for lay providers and should not be performed for more than 10 seconds by health care providers. In adults, rescuers should use two hands for the chest compressions, while in children they should use one, and with infants two fingers (index and middle fingers.)

Compression only (hands-only) CPR is a technique that involves chest compressions without artificial respiration. It is recommended as the method of choice for the untrained rescuer or those who are not proficient, as it is easier to perform and instructions are easier to give over the phone. In adults with out-of-hospital cardiac arrest, compression-only CPR by the lay public has a higher success rate than standard CPR. The exceptions are cases of drownings, drug overdose, and cardiac arrest in children. Children who receive compression only CPR have the same outcomes as those who received no CPR. The method of delivering chest compressions remains the same, as does the rate (at least 100 per minute.) It is hoped that the use of compression only delivery will increase the chances of the lay public delivering CPR.

Used alone, CPR will result in few complete recoveries, and those who do survive often develop serious complications. Estimates vary, but many organizations stress that CPR does not "bring anyone back"; it simply preserves the body for defibrillation and advanced life support. However, in the case of "non-shockable" rhythms such as Pulseless Electrical Activity (PEA), defibrillation is not helpful, and the importance of CPR rises. On average, only 5-10% of people who receive CPR survive. The purpose of CPR is not to "start" the heart, but rather to circulate oxygenated blood, and keep the brain alive until advanced care (especially defibrillation) can be initiated. As many of these patients may have a pulse that is impalpable by the layperson rescuer, the current consensus is to perform CPR on a patient who is not breathing.

Studies have shown that the importance of immediate CPR followed by defibrillation within 3-5 minutes of sudden ventricular fibrillation cardiac arrest improves survival. In cities where CPR training is widespread and defibrillation by EMS personnel follows quickly the survival rate is about 30 percent. In cities without those advantages the survival rate is only 1-2 percent. In the wilderness the lower rate would be expected unless a group is equipped with a portable defibrillator and skilled in its use. If carried, then every person in the group should be oriented to its proper use before the trip begins.

Compression-only CPR is less effective in children than in adults, as cardiac arrest in children is more likely to have a non-cardiac cause. In a 2010 prospective study of cardiac arrest in children (age 1-17), for arrests with a non-cardiac cause administration by bystanders of conventional CPR with rescue breathing yielded a favorable neurological outcome at one month more often that did compression-only CPR.

CPR is used on people in cardiac arrest in order to oxygenate the blood and maintain a cardiac output to keep vital organs alive. Blood circulation and oxygenation are required to transport oxygen to the tissues. The brain may sustain damage after blood flow has been stopped for about four minutes and irreversible damage after about seven minutes. Typically, if blood flow ceases for one to two hours, the cells of the body die. Because of that CPR is generally only effective if performed within seven minutes of the stoppage of blood flow. The heart also rapidly loses the ability to maintain a normal rhythm. Low body temperatures, as sometimes seen in near-drownings or hypothermia cases, prolong the time the brain survives. Following cardiac arrest, effective CPR enables enough oxygen to reach the brain to delay brain death, and allows the heart to remain responsive to defibrillation attempts.

CPR is only likely to be effective if commenced within 6 minutes after the blood flow stops, because permanent brain cell damage occurs when fresh blood infuses the cells after that time, because the cells of the brain become dormant in as little as 4-6 minutes in an oxygen deprived environment, and the cells are unable to survive the reintroduction of oxygen in a traditional resuscitation. Hypothermia seems to protect the heat and brain by slowing down metabolic and physiologic processes, greatly decreasing the tissues' need for oxygen. There are cases where CPR, defibrillation, and advanced warming techniques have revived victims after substantial periods of hypothermia.

In ANY case where there is a loss of heartbeat and respiration CALL 9-1-1 IMMEDIATELY, if at all possible. In the event a person loses heartbeat and respiration in the wilderness where professional medical assistance may be many hours or days away the chances of survival are greatly reduced. The importance of having group members who are trained, skilled and euipped for medical emergencies in a wilderness setting cannot be overemphasized.