In certain situations, mouth to mouth respiration cannot be given e.g. when the face is damaged, the lower jaw is fractured, or the lips and mouth have been burned by a poison. In such cases, manual methods are used.
Arm-lift/back-pressure method (Holger Nielsen)
1. Place the victim on the ground, face down, the forehead resting on the back of the overlapping hands.
2. Keep the head straight, so as to keep air passages completely open and free.
3. Kneel near the victim’s head, placing one knee near his head and the opposite foot by the side of the corresponding side elbow. The knee and foot may be alternated from time to time.
4. Place both hands over the lower parts of the victim’s shoulder blades, the fingers spread and the thumbs near midline. Keep the arms and forearms straight, lean forward so as to apply pressure by the weight of the upper part of the body.
5. Count one-two and then lean back, sliding hand to just above elbows of the patient, as you count three.
6. Grasp the arms of the victim near the elbows and lift them up, keeping upper limbs straight. Count four-five and then lower patient’s arms back to original position as you count six.
7. Then start all over again.
This method is not suitable if the patient has injuries of the chest wall or fractures of the arms.
Hip lift back pressure method
1. Place the victim face down, forehead resting on the back of the uninjured hand.
2. Keep the head straight.
3. Straddle the patient at the level of his hip, placing one knee and the other foot on the ground.
4. Then bend forwards and catch the bony pelvis with both hands.
5. Bend backwards keeping the upper limbs straight, such that the hips are lifted 10-15 cm above the ground, while you count one-two-three.
6. Lower the hips to the ground and slide the hands to the middle of the back just up to the tips of the shoulder blades, fingers spread and thumbs near midline, as you count four.
7. Rock forwards keeping your upper limbs straight so as to apply pressure till resistance is felt. Count five-six-seven.
8. Release the pressure gradually and slide the hands back beneath the hips again as you count eight.
9. Repeat the whole process 10 times a minute.
Arm-lift/chest pressure method (Silvester)
1. Place the patient face upwards.
2. Place a folded blanket under his shoulders to raise them so that the head falls backwards.
3. Kneel near the head.
4. Grasp his forearms near his wrists, cross them over to the lower part of the chest and then lean forward to press the crossed arms for 2 seconds.
5. Then pull the arms upwards and outwards with a sweeping movement and place them on the ground by your own knees for 3 seconds.
6. Repeat the cycle 1 2 times a minute.
This method is useful when the victim cannot be placed face down. It is more effective than the prone pressure method.
Prone pressure method (Schafer)
1. Place the victim in prone position, head turned to one side, resting on the back of over lapped hands.
2. Kneel by his side at the level of the hips.
3. Place the hands on the lower part of the back, the wrists almost touching, thumbs forward and fingers opposed.
4. Keep your upper limbs straight as you lean forwards so as to apply pressure by the weight of the body.
5. Then rock backwards to release the pressure.
6. Repeat the cycle 12 times a minute.
Tilting or rocking method
1. Place the victim on a stretcher or a plank and strap him to it. Rock him alternately in 45° head low and 45° head high positions.
2. Perform this 12 times a minute.
Rocking can be done on a high bench, a fence or piled up rocks. This method is particularly suitable for infants and children who can be manually rocked.