By Bob Lujano

As a person living with a physical disability, I have been involved in adapted recreational activities, as well as competitive wheelchair sports, for over 30 years. I never encountered a cardiac issue while involved in recreation and sport; however, on August 12th, 2017, I experienced a heart attack while at work.

Since people with disabilities are more likely to develop secondary health conditions as they age (CDC, 2025), my heart attack could easily have happened while I was participating in a recreational or competitive sport. With that in mind, it is important for anyone to know how to address a cardiac situation, while in sport, exercise, or even at work. It is even more imperative for people with disabilities to be aware of their increased risk for secondary health conditions.

Performing CPR for wheelchair users, whether they are the ones receiving or administering aid, requires some important adaptations while maintaining the core.

Before offering help to someone who needs CPR, it’s good to know about the Good Samaritan Law. This law helps protect people who try to assist in an emergency, like giving CPR, from being held legally responsible if something goes wrong. The details can vary by state, but the goal is the same: to encourage people to act when someone’s life is at risk. You can learn more in the Good Samaritan Laws: State-By-State Analysis from the SAFE Project.

CPR Adaptations for Athletes with Disabilities

An important adaptation to consider would be whether to perform CPR in or out of the sports wheelchair. (Cross, 2025) Here’s a breakdown of the key differences and considerations as provided by Dr. Irfa M. Asif, the associate dean for primary care and rural health and professor and chair of the Department of Family and Community at the University of Alabama at Birmingham (UAB).

The following information is for educational purposes only. It is not a substitute for formal, hands-on CPR and first aid training from a certified organization like the American Heart Association (AHA) or the American Red Cross. In any emergency, your first action should be to call 911 or your local emergency number. For detailed instructions on how to perform CPR, please visit: The American Red Cross Training Services Webpage.

Scene Assessment & Safety

• Check for hazards (traffic, electrical, fire, debris).
• Protect yourself first to safely help the athlete.
• Check responsiveness: Tap and ask, “Are you okay?”
• Call Emergency Medical Services (EMS) by dialing 9-1-1 and find an automated external defibrillator (AED) immediately.

Pulse & Breathing Checks

• Standard: check breathing & pulse ≤10 seconds.
• Amputees: check carotid pulse if extremities unavailable.

Positioning the Person

• Transfer to the floor if possible:
  • Lock brakes, tilt chair, unfasten belts.
  • Use safe lifting techniques (2 rescuers if needed).
• If transfer is unsafe:
  • Perform compressions while seated.
  • Tilt power chairs if possible.

CPR Technique Adaptations

• Hands-only CPR acceptable: 100 compressions/min.
• Compression locations: standard right upper chest / left lower ribs.
• Alternative placement: anterior-posterior if chest access is blocked.
• High-risk conditions: fragile bones or scoliosis use compressions at standard depth.
• Minimize pauses; follow AED prompts.

AED Use & Pad Placement

• Standard pad placement: right upper chest & left lower ribs.
• Consider anterior-posterior pads placement when chest access is blocked by a seated shell, straps, or a colostomy bag: use anterior-posterior placement.
• Implanted devices: shift pads ≥1 inch away.
• Sweat or moisture: wipe chest before applying pads.

Consider CPR variations for:

• Tracheostomy / laryngectomy
• C-spine fusion / halo
• High-level spinal cord injuries

The goal for variations would be to identify barriers that limit access to the chest for effective CPR. If barriers exist, the responder should attempt to achieve the closest possible approximation to chest contact. This measure provides a means of circulation until the AED pads can be applied, which is the most effective intervention for restoring cardiac rhythm.

Wheelchair-Specific Adaptations

• Lock brakes, tilt, and use the emergency switch on power chairs.
• Two-rescuer transfer recommended for heavy or complex chairs.
• Do not delay compressions if transfer is impossible.

Team Preparation & Drills

• Include athletes with disabilities in every emergency scenario.
• Assign AED and care roles; athletes can assist if able.
• Drill in tight spaces (locker rooms, bus aisles, gyms).
• CPR training programs should include modules tailored for individuals with mobility limitations. (RedCross, 2025)
• Employers and organizations should ensure ADA-compliant training environments. (Network, 2025)

High-Level Spinal Cord Injury Considerations

• Expect autonomic dysreflexia (AD); continue compressions.
• Treat complications after ROSC; do not pause CPR.

AD is a medical emergency in people with spinal cord injuries at or above T6, triggered by stimuli like a full bladder or bowel. It causes sudden headache, high blood pressure, sweating, and flushing above the injury, while areas below remain cold and dry.

Key Takeaways

• Preparation, equipment, and team roles are critical.
• Adapt CPR to wheelchair, spinal, and other disability considerations.
• Minimize interruptions and follow AED prompts for optimal survival.

Overall, as adapted sports and recreation have become a mainstay for people with disabilities, please make sure that all medical precautions are taken into consideration. These efforts can make adapted sport participation an enjoyable endeavor. Have a great time!

Resources

To visit, click the organization name.

• Administering Adapted CPR to Athletes with Disabilities.
  • This five-minute video provides instructions on how to perform CPR.
• Responding to SCA in Adapted Athletics.
  • Resources include videos, handouts and quick guides to performing CPR in adapted athletics.
• American Heart Association (AHA).
  • Offers comprehensive guides, videos, and printables on CPR, first aid, and AED use for adults, children, and infants. Ideal for both beginners and professionals.
• American Red Cross.
  • Provides step-by-step instructions for performing CPR on adults, with illustrations and tips for emergencies. It also includes info on rescue breathing and AED use.
• National Safety Council (NSC).
  • Provides training courses for workplace safety and the general public. Includes online and in-person certification programs, with a focus on real-world emergencies.
• University of Washington.
  • Free online guides and mobile-friendly instructions for adult, child, and infant CPR. Includes downloadable charts and safety tips.

References:

1. Centers for Disease Control and Prevention. (2025, April 14). Disability and health. https://www.cdc.gov/disability-and-health/conditions/index.html
2. Cross, R. (2025, August 28). How to perform CPR. American Red Cross. https://www.redcross.org/take-a-class/cpr/performing-cpr/cpr-steps
3. Network, A. N. (2025, August 28). ADA training. https://adata.org/ada-training
4. Red Cross. (2025, August 28). Get trained. https://www.redcross.org
5. UAB Medicine. (2025, September 10). Athlete para-CPR guide [Unpublished manuscript].