When a cardiac arrest strikes, every second counts. The sooner chest compressions begin, the better a patient’s chances for survival—especially with shockable rhythms like ventricular fibrillation. Yet despite the urgency, responders still face delays. Why? Because cardiac arrest doesn’t always look the way we expect it to. And when recognition is delayed, so is care. That delay—sometimes just a minute or two—can be the difference between life and death.
For newer EMS providers, the challenge is even steeper. Agonal breathing, often described as gasping, snorting, or “weird breathing,” may not immediately register as a red flag. Seizure-like activity, common in the earliest moments of VFib, can be misread as a primary neurological event. These atypical signs—found in as many as 40% of out-of-hospital cardiac arrests—can distract from the real diagnosis. It’s easy to hesitate. But hesitation costs time.
And time is (heart) muscle.
Training helps, no question. Targeted education on seizure-vs-syncope differentiation and high-fidelity simulation can reduce uncertainty and teach pattern recognition. But even the best-trained provider will struggle if their gear isn’t ready. When you finally make the decision to act—when you decide this is cardiac arrest—you don’t want to be fumbling for your BVM, your AED pads, or your airway kit. You want your hands already moving. You want your tools within arm’s reach.
Cardiac arrest calls don’t wait for ideal conditions. They don’t announce themselves with textbook symptoms. They happen fast, and they happen ugly. So we train to recognize agonal breathing not as “signs of life” but as a call to action. We train to reframe seizure activity not as a neurological issue, but as a potential cardiac collapse. And most importantly, we train to act now, not after we second-guess, and not after we search for missing gear.
Veteran medics know their kit like the back of their hand. For new providers, gear layout and muscle memory are just as critical as clinical knowledge. If you’re not sure where your suction is, or you have to think twice about where you stowed your pads, that’s seconds lost.
Recognition and readiness go hand in hand. You need both. Recognize the signs—even when they’re not typical—and be ready to move the instant you do. That’s how lives are saved. That’s how outcomes improve. And that’s how we meet cardiac arrest not with hesitation, but with confident, decisive care.