ERC 2025 Updates (post-RKS manual)
Why this module exists
The RKS manual you are studying from was published July 2025 and is based on the ERC 2021 guidelines. The European Resuscitation Council released the 2025 Guidelines on 22 October 2025 in Rotterdam — three months after the RKS manual. Your exam will test you on the RKS manual content. Treat this module as professional currency, not exam material.
Chain of Survival — 2025 four-link version
- 1. Prevention + early recognition of cardiac arrest + activate 112
- 2. Early bystander CPR
- 3. Early defibrillation (AED)
- 4. Post-resuscitation care + recovery
- Big idea: the first 3–5 minutes after collapse are decisive — most survival is won or lost in that window.
Call 112 FIRST, then assess breathing (new)
Under 2025 BLS, if a person is unresponsive, call emergency services immediately — do not wait to confirm abnormal breathing. Put the phone on speaker; the dispatcher will help you identify abnormal breathing while you check. This reduces the 30–60% of cases where abnormal breathing (agonal gasps, seizure-like activity) is misread as "still breathing".
T-CPR — dispatcher-assisted resuscitation
The 112 call handler is now an active part of the resuscitation team. They are trained to: (1) help you identify cardiac arrest, (2) talk you through compressions, (3) guide you to the nearest AED. Always answer their questions — they speed up the response, not slow you down.
5 rescue breaths for drowning — now universal
In ERC 2021 the 5 initial rescue breaths protocol was taught specifically to lifeguards and water rescuers. In 2025 it is the standard for everyone for drowning. The RKS manual already teaches this — you are already current on this point.
Recognising abnormal breathing
- Agonal gasps — irregular, slow, gasping breaths (often mistaken for normal breathing)
- Seizure-like activity at the moment of collapse
- In athletes: breathing may look near-normal or panting initially
- If in doubt → treat as cardiac arrest, start CPR
CPR on a soft surface
Previously discouraged. 2025 position: if a hard surface is not immediately available, do not delay compressions — start on the soft surface. Effective compressions on a mattress are better than no compressions while you move the victim.
Paediatric — ABCDE and early recognition
For children, cardiac arrest is usually secondary to hypoxia (airway/breathing problem, shock, or neurological event), not a primary heart problem. ERC 2025 strengthens early recognition of the critically ill child using the structured ABCDE assessment to prevent arrest before it happens. The 5 breaths → 15:2 ratio is unchanged.
4Hs and 4Ts — reversible causes
- 4Hs: Hypoxia, Hypovolaemia, Hypo/Hyperthermia, Hypo/Hyperkalaemia (electrolytes)
- 4Ts: Tension pneumothorax, Tamponade (cardiac), Thrombosis (PE/MI), Toxins
- For drowning: hypoxia is the primary one. Hypothermia is the second to watch for.
What this means for you
For the RKS exam → follow the manual exactly. On duty as a water rescuer → call 112 first and put it on speaker, trust the dispatcher to help, and act inside the 3–5 minute window. Your existing drowning protocol (5 breaths, then 30:2) is fully aligned with ERC 2025.