The American Heart Association now recommends that chest compressions be the first step for rescuers to revive victims of sudden cardiac arrest. For more than 40 years, the guidelines have stressed the importance of clearing the victim's airway as the first step in cardiopulmonary resuscitation, or CPR. Now, with a change effective today, the first step is to start compressions. "We need to get that blood that already has oxygen into the brain and the heart muscle," said Julie Nace, a nurse and paramedic for American Medical Response, an ambulance company that also runs CPR and first aid clinics in San Bernardino and Riverside counties. "A lot of people are just not comfortable doing mouth-to- mouth," said Anthony Pena, a firefighter/paramedic based at the San Bernardino County Fire Department's Lake Arrowhead station. "They may not do it right. They may be worried about chance of cross-contamination. This gets down to just doing the compressions." Pena trains other fire department members in CPR and advanced cardiac life support. In previous guidelines, the heart association recommended looking, listening and feeling for normal breathing before starting CPR. Now, compressions should start immediately on anyone who is unresponsive and not breathing normally. Rescuers should give chest compressions at a rate of at least 100 times per minute, Nace said. Those who feel comfortable giving mouth-to-mouth should give two breaths and 30 compressions. "But don't worry about whether the air went in. Just get back to compressions," Nace said. "Push hard, push fast and you will do more good than harm," said Dr. Kevin Parkes, emergency department director for San Antonio Community Hospital in Upland and medical director for fire departments in Ontario, Rancho Cucamonga and Chino. Of the 300,000 Americans whose hearts stop beating each year, less than 8 percent survive to live a relatively normal life, Nace said. The heart association hopes to double or triple those odds with the new protocol, said Nace, who is on a regional committee for the organization. Chest compressions will move oxygenated blood to the brain and heart muscles, where it will do the most good. Without oxygen, brain cells begin to die within minutes, and they don't grow back, Nace said. The new guidelines stress that compressions push the chest in at least 2 inches in adults and children, Nace said. Ribs may be broken, especially in the elderly, but ribs, unlike the brain, can repair themselves, she said.