Hyperventilation: why a paper bag should no longer be your first response

Someone is breathing rapidly and shallowly, becoming dizzy and feeling tingling in their fingers: for generations, the classic response has been the same — “breathe into a bag”. Yet this approach has gradually been abandoned in modern first aid training — and for good reason.

Why the bag is no longer the standard

Breathing in and out of a closed bag increases CO₂ levels in the blood, which can indeed reduce the symptoms of hyperventilation. The problem: if the cause of the rapid breathing is not hyperventilation — but, for example, an asthma attack, a heart problem, a pulmonary embolism or a severe allergic reaction — the bag actually lowers oxygen levels further, just when the body needs more oxygen. A response intended to help can then have the opposite effect.

The difficulty: hyperventilation resembles other, more serious problems

Rapid breathing, a pounding heart, dizziness and chest tightness occur with hyperventilation, but also with heart problems or lung conditions. Even doctors cannot always immediately tell the difference — they rely on additional tests such as an ECG or blood tests. As a first aider on the scene, you do not have that certainty, and that is precisely why “breathing into a bag” is now discouraged as a routine response: you cannot rule out an underlying problem with certainty.

What should you do instead?

• Stay calm and offer reassurance. Your calmness often already helps the person feel calmer.
• Guide their breathing by demonstrating slow, calm breathing yourself, so the person can follow that pace.
• Unsure, or is there no rapid improvement? Call 112. Describe what you see: breathing, colour, consciousness, and whether the person has a known condition (asthma, heart problems, allergy).
• Never force it. Never push a bag against someone's face if they resist.

This is not a substitute for first aid training: the precise approach may vary according to your training provider's current guidelines. When in doubt, “keep them calm and call 112” is always a safe choice.

Source: Gezondheid en Wetenschap – Hyperventilation