Section 2: CPR/AED Lecture Guide

Transcription

1 Section 2: Table of Contents Introduction... 2 Chain of Survival... 3 CPR Overview... 4 C-A-B... 5 Recovery Position... 8 CPR Barriers... 8 Using an AED... 9 Adult CPR Child CPR Infant CPR Special Considerations-CPR Special Considerations-AED AED Safety How Would You REACT Responding to Emergencies Legal Issues Protection from Infection Heart Attack Stroke Adult / Child Choking Infant Choking How Would You REACT The Lecture Guide is the primary resource to guide the Instructor through the lecture and move the course along smoothly. The layout follows the layout of the Student Workbook, with similar topic headings. Add statistics or points of interest to the Lecture Guide to customize your presentation. 1. The box under each topic heading indicates: a. DVD Chapter to show at the beginning of the topic. Sometimes you will show multiple DVD chapters, then pause to discuss or practice them. b. DEMONSTRATE: The Instructor demonstrates on a manikin, student volunteer, or him or herself. c. PRACTICE: Skill for students to practice. A skill that is tested will say (Skill ) next to it. Skill Check Option 1: Use Skill Sheets to check off each step of a skill as your student successfully demonstrates it. Option 2: Use a Skill Summary to check off a completed skill. d. SUPPLIES: Equipment or supplies needed to teach each topic. 2. Some topics are optional depending on what certification will be given. a. e.g. Using an AED, Child CPR, Infant CPR, Infant Choking Care 3. A dotted line separates the topic introduction from the rest of the topic. 4. Gray shaded boxes that say Senior are only taught with the workbook, CPR, AED and First Aid for the Senior Community. 5. Gray shaded boxes that say Child are only taught with the workbook, CPR and First Aid for Childcare Providers. 6. Review How Would You REACT? pages with your students. The questions have the correct answers in bold. The scenarios will vary according to the details you give the students. Visit www. emssafety.com/login for suggested scenario responses. You may also substitute your own scenarios which apply more specifically to the needs of the students and workplace. 1

2 CPR Introduction Instructor Introduction Introduce yourself; give your qualifications and experience. Questions are welcome. Locations of bathrooms, exits, etc. Provide breaks during the course. Why are you here? Your workplace or profession requires it You want to learn for your own knowledge Why should you learn CPR/AED? Most CPR is performed out of the hospital. Overcome barriers to act: o Fear of doing the wrong thing or hurting someone o Fear of catching a disease o Panic or not knowing what to do Goal: Respond safely, confidently and effectively in an emergency. What will you learn today? Quickly recognize an emergency CPR on an Adult victim CPR on a child and infant victim (optional) Using an AED (optional) Emergency response for heart attack, stroke, and choking How will you learn? DVD, workbook, lecture, demonstration, hands-on practice, discussion o Emphasize skills and confidence-building over lecture Must pass skills and written exam to receive a course completion card. o Instructor s job is to help you learn and pass this course. o Card is valid for up to 2 years. 2 years is too long to remember everything in an emergency. Must review and refresh your learning periodically. o Receive access for 2 years to a digital workbook online. Let Instructor know privately if: Any medical or physical conditions that may limit your participation Latex allergy (unless all classroom supplies are latex-free) Follow state, local, and workplace regulations and policies. Some first aid treatments may be restricted by state, local, or workplace regulations. o e.g. AED use on infants 2 CPR Introduction 2011 EMS Safety Services, Inc.

3 Chain of Survival DVD Ch: 1 DEMONSTRATE: PRACTICE: SUPPLIES: Learning Objectives Understand the term Sudden Cardiac Arrest. Identify the five steps of the chain of survival for adults. Key Concepts Heart disease is the leading cause of death in the U.S. Heart disease can lead to Sudden Cardiac Arrest (SCA). o SCA occurs when the heart suddenly stops beating. o The person becomes unresponsive (can t wake up). o Breathing soon stops too. o Brain damage begins in 4-6 minutes. o Complete brain death occurs within 10 minutes. The chain of survival is a series of actions that give SCA victims the best chance at survival. Calling 9-1-1, starting CPR early and quickly using an AED have the greatest impact on survival of SCA. Activate EMS Recognize cardiac arrest. Call or send a bystander if available. The earlier EMS is activated, the more likely the person will survive. Early CPR Start CPR with chest compressions. Compressions restore the flow of oxygen to the person s brain. Quality compressions are directly linked to SCA survival. Early Defibrillation A defibrillator can restart the heart of an SCA victim. When you call 9-1-1, EMS responders bring a defibrillator to the scene. An automated external defibrillator (AED) is used by citizen rescuers before professional rescuers arrive. Early Advanced Care Advanced care, also known as advanced life support, is provided by EMS responders on scene and en route to the hospital. Advanced care includes airway management, drug therapy, and cardiac monitoring in addition to CPR and defibrillation. The goal is to restart the heart and stabilize the person for post-arrest care. Post-Arrest Care Comprehensive care begins once the heart is beating and stabilized. Chain of Survival 3

4 Provided by doctors, nurses, therapists and many others. To improve the chance of continued survival with the least amount of disability. Child The chain of survival is slightly different for children, since the cause of cardiac arrest is most often related to breathing difficulty. The pediatric chain of survival emphasizes prevention and chest compressions. 1. Prevention of arrest 2. Early CPR 3. Activate EMS 4. Early Advanced Care 5. Post-Arrest Care DISCUSS: 1. Why is activating EMS the first link in the chain of survival? 2. Are AEDs located in your community or workplace? Where? 3. Why does the bystander have the biggest impact on survival of SCA? CPR Overview DVD Ch: 2 DEMONSTRATE: PRACTICE: SUPPLIES: Learning Objectives Identify the most important component of CPR. Learn the requirements for quality chest compressions. Understand why an AED is used. Key Concepts Cardiac arrest = no heartbeat, no oxygen to the brain or other vital organs. CPR provides oxygen to the brain to keep it alive. Cardiopulmonary Resuscitation CPR combines external chest compressions with rescue breathing. Rescue breaths fill a person s lungs with oxygen. Chest compressions squeeze the heart between the breastbone and spine to move blood. Rescue breaths and compressions provide oxygenated blood to keep the brain alive. Good quality chest compressions are the most important part of CPR. The components of good quality compressions: 1. Push the center of the chest hard and fast. 2. Minimize interruptions to chest compressions. 3. Allow full chest recoil (expansion) between each compression. 4 CPR Overview 2011 EMS Safety Services, Inc.

5 What is an AED? AED stands for automated external defibrillator. It is a computerized device that can analyze a person s heart rhythm and deliver a shock. The AED can restore a person s heartbeat to a normal rhythm. AEDs are safe and easy to use. AEDs use voice and visual prompts to guide the rescuer s actions. Ventricular Fibrillation Ventricular fibrillation (V-fib) occurs when the heart is overwhelmed by electrical activity. o Usually related to a lack of oxygen to the heart muscle. o Lethal within minutes if not treated. The victim is unresponsive with no heartbeat or breathing. CPR can restore the flow of oxygen, but will not stop V-fib. Defibrillation (an electrical shock to the heart) is the only treatment for V-fib. CPR extends the amount of time that an AED can be used successfully. How an AED works The AED detects V-fib, then sends a powerful electrical current through the heart. The shock briefly resets the heart s electrical activity. This allows the heart to resume a normal heart rhythm and hopefully start beating normally again. Sum it up The sooner an AED is used after SCA, the more likely it will be successful. Seconds count! Compressions-Airway-Breathing DVD Ch: 3, 4 DEMONSTRATE: Establish response Adult C-A-B sequence PRACTICE: Establish response Adult C-A-B sequence SUPPLIES: Adult manikin CPR practice barrier Learning Objectives Understand how to check for response and when to activate EMS. Perform the C-A-B sequence correctly. Know when to use an AED and how two rescuers can split the tasks of AED and CPR. Identify the modified H.A.IN.E.S. recovery position and when to use it. Key Concepts C-A-B stands for Compression, Airway, and Breathing. This is the best sequence of rescuer actions for CPR. o In the first few minutes after cardiac arrest the victim s body still has oxygen-rich blood. o Starting CPR with chest compressions circulates the oxygen already in the body, eliminating the need to start with rescue breaths. The C-A-B sequence is used for unresponsive victims of all ages. Compressions-Airway-Breathing 5

6 DEMONSTRATE: Using an AED* Establish response and call First try to establish a response from the person. o Approach from the victim s side. o Tap the shoulder and shout, Are you all right? o Do not shake the victim. Look for eye opening, moaning, or talking. If no response: o Send a bystander to call 9-1-1, get an AED if available, and quickly return. o Go yourself if no bystander is available. Turn the victim face up if needed. Scan the chest for breathing for 5-10 seconds. If there is no breathing or the victim is only gasping, start compressions. C: Compressions Immediately provide 30 chest compressions. Use a firm, flat surface. Only remove clothing if it interferes with compressions. To perform compressions: Location: Center of the chest, between the nipples Use 2 hands: Place the heel of one hand on the chest, and the heel of the other hand on top. Push hard: At least 2 down for adults. Push fast: At least 100 compressions per minute. Ensure full recoil: Chest should expand fully between each compression. Minimize interruptions: 30 compressions hard and fast without stopping. Tip Most rescuers do not compress hard enough. Sounds of air escaping the lungs may be heard during compressions. Don t confuse this with breathing. A: Airway Before giving rescue breaths the airway has to be opened. Quickly position the victim s head using the head tilt/chin lift to open the airway. The head tilt/chin lift lifts the tongue off the back of the throat to allow for passage of air. To perform a head tilt/chin lift: Place 1 hand on the victim s forehead and apply firm, backward pressure with your palm, tilting the head back. Place 2 or 3 fingers of your other hand near the chin. o Keep your fingers on the bony part of the jaw, not on the throat. Tilt the head back while lifting the jaw upward to bring the chin forward. 6 Compressions-Airway-Breathing 2011 EMS Safety Services, Inc.

7 B: Breathing Provide 2 effective rescue breaths and quickly resume compressions. Rescue breaths fill the lungs with oxygen, and compressions deliver it. Watch for chest rise with each breath; stop when the chest starts to rise. About 1 second per breath. To give 2 rescue breaths: Maintain the head tilt/chin lift. Pinch the nose. Inhale a regular-size breath. Seal the victim s mouth with yours. (You will use a CPR practice barrier.) Breathe into the mouth for about 1 second. Watch for chest rise. Lift mouth off and repeat for 2 nd breath. Quickly resume chest compressions after giving rescue breaths.! It should take less than 10 seconds to stop compressions, open the airway and give 2 breaths, then resume compressions. Do not give too much air. This reduces the effectiveness of chest compressions. Repeat the C-A-B Sequence. Continue the sequence of 30 compressions, open airway, give 2 breaths, until: o AED is powered on, pads are applied and it is prompting you to stop CPR. o EMS or bystanders are ready to relieve you. o The victim begins to move. CPR is performed in cycles. o One cycle is 30 compressions followed by 2 breaths (30:2). o Five cycles of CPR can be performed in approximately 2 minutes.! If the chest won t rise, the most likely cause is the tongue blocking the person s airway. Repeat the head tilt/chin lift and attempt 1 more breath. Resume chest compressions. When to Use an AED Use the AED as soon as it is available. When a 2 nd rescuer is present: o 1 st rescuer continues CPR. o 2 nd rescuer powers on the AED and applies the pads. Switch roles of CPR provider and AED operator when the AED prompts you to stop CPR. o Get into position and wait for the next AED prompt. o Avoids rescuer fatigue and improves quality of compressions. If an AED is not available, switch performing CPR about every 2 minutes (5 cycles): o Rest o Observe the CPR provider and give feedback on compression quality. Pushing hard or fast enough. Compressions-Airway-Breathing 7

8 Recovery Position Use the modified H.A.IN.E.S. recovery position: If you must leave to get help. If fluids or vomit block the airway. DISCUSS: Could I really do it? Sum it up Starting CPR with chest compressions circulates the oxygen still in the blood and gives the victim the best chance of survival. Give quality compressions by: o Pushing hard and fast. o Minimizing interruptions to compressions. Take no more than 10 seconds to open the airway and give breaths. o Allowing the chest to fully expand between each compression. Don t keep your weight on the victim s chest. CPR Barriers DVD Ch: 5 DEMONSTRATE: CPR barriers PRACTICE: CPR barriers SUPPLIES: Adult manikin CPR practice barrier Learning Objectives Identify how a CPR barrier may help prevent exposure to blood or body fluids during rescue breathing. Learn the two types of CPR barriers for citizen rescuers and how to use them. Key Concepts The risk of catching a disease with rescue breaths is extremely low. It is common to be uncomfortable with the thought of giving mouth-to-mouth rescue breaths. CPR barriers can help prevent exposure to blood or body fluids. Create a barrier between the victim and rescuer while allowing for the passage of air. CPR Face Mask Molded plastic mask that may require quick assembly and insertion of filter/valve. Covers mouth and nose so the rescuer does not have to pinch the person s nose. Prevents back flow; directs exhaled air away from the rescuer. Select the correct size: Base (wide end) does not extend past the chin. Top of mask (narrow end) does not extend past the bridge of the nose. 8 CPR Barriers 2011 EMS Safety Services, Inc.

9 If a pediatric mask is unavailable, rotate an adult mask so that the narrow end is over the infant s Tip mouth. DEMONSTRATE: CPR face mask 1. Press mask onto face. 2. Lift the chin to open the airway. 3. Breathe into the mask and watch for chest rise with each breath. CPR Face Shield Small, flexible plastic piece with a filter or valve that fits over the person s mouth. Pinch the nose over or under the face shield. Can be stored in keychain pouch with gloves, close to rescuer at all times. DEMONSTRATE: CPR face shield 1. Place over face with filter or valve over person s mouth. 2. Lift the chin to open the airway. 3. Pinch the nose. 4. Breathe into the filter or valve and watch for chest rise with each breath. Sum it up Do not let locating or assembling a CPR barrier delay the start of compressions. Do not over-ventilate. It reduces the effectiveness of CPR. PRACTICE: Adult C-A-B sequence with CPR barrier Using an AED (optional) DVD Ch: 6 DEMONSTRATE: Using an AED PRACTICE: Using an AED (Skill ) SUPPLIES: AED trainer Adult manikin Skill Sheet 1 Instructor Note: This topic is required for AED certification. Learning Objectives Demonstrate the proper techniques for using an AED. Understand the importance of clearing a victim prior to giving a shock. Key Concepts AEDs are easy to use. AEDs can be used on adults, children and infants. Follow local protocols for age-specific AED guidelines if they differ from this course. Power on the AED Basic AED sequence: 1. Power on the AED. Using an AED 9

10 2. Apply pads. 3. Follow AED prompts. DEMONSTRATE: Turning on the AED Power on the AED. Place the AED near the victim s head. Power on the AED first. It will guide all rescuer actions. o There are many types of AEDs. Most power on by: Pushing a button. Opening the lid to access the pads. The AED will perform a quick self check. Apply AED Pads DEMONSTRATE: Proper pad placement The AED will prompt rescuer to apply pads to the person s bare skin. If 2 rescuers: o Expose the chest. o Wipe the chest dry of any moisture. o Apply the pads according to the pictures on the pads. Right side of the chest, just below collarbone Lower left side of the chest 1 st rescuer performs CPR. 2 nd rescuer operates the AED. o Applies pads around CPR provider s hands while CPR is in progress. Do not stop CPR until AED prompts rescuer to stop. After pads are applied: AED prompts rescuer to stop CPR. AED analyzes the heart s electrical rhythm. Do not touch or move the person while the AED is analyzing. Shock or No Shock AED will state shock advised or no shock advised. If no shock is advised, the AED will prompt the rescuer to resume chest compressions. If a shock is advised, the rescuer must clear the victim first. Clear the victim and shock Touching the victim or their clothing when a shock is delivered can injure a rescuer. Clear the victim before shocking. o Loudly state, Clear! or Everybody clear! o Look up and down the entire victim. o Ensure no one is touching the person or their clothing. Press the shock button. 10 Using an AED 2011 EMS Safety Services, Inc.

11 o Some AEDs will shock automatically without pressing a button. o All AEDs will announce when it is safe to resume chest compressions. Resume Compressions Immediately resume CPR starting with chest compressions. The AED will analyze the heart rhythm every 2 minutes. If a second trained rescuer is available, switch CPR providers each time the AED prompts rescuers to stop CPR. o One rescuer rests o Other rescuer gets in position for CPR o Person closest to the AED continues to operate the unit as needed AED Use on Children For AED use: o A child is considered 1-8 years old. o An infant is < 1 year old. Children and infants require less electrical current to shock the heart into a normal rhythm. Some AEDs come with specialized equipment to reduce the amount of energy delivered when using it on a child or infant. o Child/Infant Pads o Energy reducer or attenuator o Pediatric key or switch If pediatric equipment is not available, use the standard AED equipment. Pad placement for small children and infants: Pads should not touch or overlap. Use front-to-back AED pad placement if needed. Do not cut or fold pads to fit. DEMONSTRATE: Complete AED sequence PRACTICE & SKILL CHECK: Using an AED* Instructor Note: Use Skill Sheet 1 - Using an AED & Adult CPR. Instructor option: Practice using an AED now. Check skills later at the same time as Adult CPR. *Required for AED Certification Adult CPR DVD Ch: 7 DEMONSTRATE: Adult CPR PRACTICE: Adult CPR (Skill ) SUPPLIES: Adult manikin CPR practice barrier Skill Sheet 1 Learning Objectives Identify the age range for adult CPR. Adult CPR 11

12 Understand when to activate EMS and get an AED for an adult victim. Demonstrate adult CPR using the C-A-B sequence. Key Concepts Always check the scene for safety first. If the scene is safe, establish a response. If unresponsive and not breathing, provide CPR using the C-A-B sequence. Age for adult CPR: signs of puberty and older. Males: Facial or underarm hair Females: Signs of breast development Check the scene for safety first. Survey the scene and size-up potential hazards. Do not enter if scene does not appear safe. Call and follow dispatcher instructions. If the scene is safe, establish response. DEMONSTRATE: Adult CPR Establish Response and Activate EMS Tap the shoulder and shout, Are you all right? If unresponsive: Send a bystander to activate EMS (call 9-1-1), get the AED and quickly return. Go yourself if no bystander is available. Check breathing: 5-10 seconds If the victim is face down, carefully log roll the person face-up. Scan the chest for breathing. If there is no breathing or only gasping, start compressions. o If you are unsure if the victim is breathing, start CPR. C: Compressions Use a firm, flat surface. Only remove clothing if it interferes with compressions. Provide 30 Chest Compressions Location: Center of the chest, between the nipples Use 2 hands: Place the heel of one hand on the chest, and the heel of the other hand on top. Push hard: At least 2 down for adults. Push fast: At least 100 compressions per minute. Ensure full recoil: The chest should expand fully between each compression. Minimize interruptions: Perform 30 compressions hard and fast without stopping! Keeping your arms straight directs the force of compressions down into the chest and reduces Tip rescuer fatigue. 12 Adult CPR 2011 EMS Safety Services, Inc.

13 A: Airway Quickly open the airway with the head tilt/chin lift. Place one hand on the victim s forehead and apply firm, backward pressure with your palm, tilting the head back. Place 2 or 3 fingers of your other hand near the chin. B: Breathing o Keep your fingers on the bony part of the jaw, not on the throat. Tilt the head back while lifting the jaw upward to bring the chin forward. Provide 2 effective rescue breaths. Maintain the head tilt/chin lift. Pinch the nose and breathe into the mouth for about 1 second. Watch for chest rise. Repeat for the 2 nd breath. Continue CPR Quickly resume compressions. Provide continuous cycles of 30 compressions followed by 2 breaths. If there are 2 rescuers: o Switch roles of CPR provider and AED user every 2 minutes when the AED prompts you to stop (about 5 cycles). o Rest between roles as CPR provider. o Give feedback to the CPR provider on the quality of compressions. Defibrillation Keep the CPR provider on pace with compression rate (100/min). Use clapping or other reminders. Instruct the compressor to push harder (at least 2 ) if too shallow. Encourage the CPR provider to keep going. Use the AED as soon as it is available. If a 2 nd trained rescuer is present, have that person use the AED. o Place near the victim s head. o Power on the AED and follow prompts. o Apply pads. o Press the shock button if prompted. o Immediately resume compressions after the shock. Continue CPR and AED use until the victim begins to move. Reduce the risk of vomiting with rescue breaths by providing just enough air to cause the chest Tip to rise. Adult CPR 13

14 DISCUSS: 1. What is the best way to activate EMS at home? At work? 2. What do you do if the chest won t rise with the 1 st rescue breath? 3. What is the most important part of CPR: airway management, rescue breathing or chest compressions? PRACTICE & SKILL CHECK: Adult CPR with a barrier Instructor Note: Use Skill Sheet 1 - Using an AED & Adult CPR. Child CPR (optional) DVD Ch: 8 DEMONSTRATE: Child CPR PRACTICE: Child CPR (Skill ) SUPPLIES: Adult or Child manikin CPR barrier Skill Sheet 2 Learning Objectives List some common causes of respiratory arrest in children. Identify the age range for child CPR. Understand when to activate EMS and get an AED when you are alone with a child victim. Demonstrate child CPR using the C-A-B sequence. Key Concepts Instructor Note: This topic is required for Child CPR certification. Cardiac arrest in a child usually has a different cause than cardiac arrest in an adult. o Adults: Heart disease, heart attack o Children/infants: Respiratory arrest Common causes of respiratory arrest in children include injury, poisoning, choking, drowning and asthma. It is important to recognize and react to the signs of a child in distress before it leads to cardiac arrest. Age for child CPR: 1 year old to just before puberty. Check the scene for safety first. If the scene is safe, establish a response. DEMONSTRATE: Child CPR Establish Response and Activate EMS Tap the shoulder and shout, Are you all right? If unresponsive: Send a bystander to activate EMS (call 9-1-1), get the AED and quickly return. If you are alone with an unresponsive child, do not leave. o Stay with the child and yell for help. Check breathing: 5-10 seconds If the child is face down, carefully log roll face up. 14 Child CPR 2011 EMS Safety Services, Inc.

15 Scan the chest for breathing. If there is no breathing or only gasping, start chest compressions. C: Compressions Use a firm, flat surface. Only remove clothing if it interferes with compressions. Provide 30 Chest Compressions Location: Center of the chest, between the nipples Use 1 or 2 hands: Place the heel of one hand on the chest. To use 2 hands, place the heel of the other hand on top. Push hard: About 2 down for children. Push fast: At least 100 compressions per minute. Ensure full recoil: The chest should expand fully between each compression. Minimize interruptions: Perform 30 compressions hard and fast without stopping! Tip If you become fatigued using one-handed compressions, switch to 2 hands. A: Airway Quickly open the airway with the head tilt/chin lift. Place one hand on the victim s forehead and apply firm, backward pressure with your palm, tilting the head back. Place 2 or 3 fingers of your other hand near the chin. o Keep your fingers on the bony part of the jaw, not on the throat. Tilt the head back while lifting the jaw upward to bring the chin forward. B: Breathing Provide 2 effective rescue breaths. Maintain the head tilt/chin lift. Pinch the nose and breathe into the mouth for about 1 second. Watch for chest rise. Repeat for the 2 nd breath. If the 1 st breath does not enter, reopen the airway and attempt a 2 nd breath, then resume com-!pressions. Continue CPR Quickly resume compressions. Continue cycles of 30 compressions to 2 breaths. Child CPR 15

16 Call (activate EMS) If you are still alone after 2 minutes, stop CPR and go activate EMS and get an AED if one is close by. Return quickly and resume CPR until EMS arrives or the child begins to move. If EMS is already activated, provide continuous cycles of 30 compressions followed by 2 breaths. Place in the recovery position if you have to leave to get help. Use an AED as soon as it is available. PRACTICE & SKILL CHECK: Child CPR* Instructor Note: Use Skill Sheet 2 - Child and Infant CPR. *Required for Child CPR Certification Infant CPR (optional) DVD Ch: 9 DEMONSTRATE: Infant CPR PRACTICE: Infant CPR (Skill ) SUPPLIES: Infant manikin CPR barrier Skill Sheet 2 Instructor Note: This topic is required for Infant CPR certification. Learning Objectives Identify common causes of respiratory arrest in infants. Identify the age range for infant CPR. Understand when to activate EMS when you are alone with an infant victim. Demonstrate infant CPR using the C-A-B sequence. Key Concepts Cardiac arrest in infants usually results from respiratory arrest. Common causes of respiratory arrest in infants include choking, injury, Sudden Infant Death Syndrome (SIDS), and respiratory illness. Age for infant CPR: Up to 1 year old based on an infant s body weight and size. Check the scene for safety first. If the scene is safe, establish a response. DEMONSTRATE: Infant CPR Establish Response and Activate EMS. Tap the bottom of the foot and shout at the infant. If unresponsive: Send a bystander to activate EMS (call 9-1-1) and quickly return. If you are alone with an unresponsive infant, do not leave. o Stay with the infant and yell for help. Check breathing: 5-10 seconds 16 Infant CPR 2011 EMS Safety Services, Inc.

17 If the infant is face down, carefully log roll face up. Scan the chest for breathing. If there is no breathing or only gasping, start chest compressions. C: Compressions Use a firm, flat surface. Only remove clothing if it interferes with compressions. Provide 30 Chest Compressions Location: Center of the chest, just below the nipple line. Use 2 fingers. Push hard: About 1½ down for infants. Push fast: At least 100 compressions per minute. Ensure full recoil: Chest expands fully between each compression. Minimize interruptions: Perform 30 compressions hard and fast without stopping! A: Airway Overextending the infant s airway can actually close it. Quickly open the airway with the head tilt/chin lift. Place one hand on the infant s forehead and apply firm, backward pressure with your palm, tilting the head back. Place 2 or 3 fingers of your other hand near the chin. o Keep your fingers on the bony part of the jaw, not the throat. Tilt the head back while lifting the jaw upward to bring the chin forward. Do B: Breathing not over-extend the infant s airway. Maintain a neutral or slightly extended position. For infants, breathe into the mouth and nose at the same time. Provide 2 effective rescue breaths. Maintain the head tilt/chin lift. Breathe into the mouth and nose for about 1 second. Watch for chest rise. Repeat for the 2 nd breath. Continue CPR Quickly resume compressions. Continue cycles of 30 compressions to 2 breaths. Call (activate EMS) If you are still alone after 2 minutes, stop CPR and go activate EMS. Infant CPR 17

18 o Consider carrying a small child or infant to the phone if there is no trauma. Return quickly and resume CPR until EMS arrives or the infant begins to move. If EMS is already activated, provide continuous cycles of 30 compressions followed by 2 breaths. Use an AED as soon as it is available. PRACTICE & SKILL CHECK: Infant CPR* Instructor Note: Use Skill Sheet 2 - Child and Infant CPR. *Required for Infant CPR Certification Special Considerations - CPR DVD Ch: DEMONSTRATE: PRACTICE: SUPPLIES: Learning Objectives Understand how cold temperatures and electric shock can change a rescuer s response to cardiac arrest. Identify how to reduce the likelihood of vomiting associated with rescue breathing, and know what to do if vomiting occurs. Learn when to stop CPR. Identify alternative techniques to CPR. Key Concepts Certain situations may affect your response to cardiac arrest, such as hypothermia and electrical emergencies. Keep CPR going as long as possible. In cold environments: A hypothermic victim may have more time before brain damage occurs. Do not assume it is too late to begin CPR. Electrical shock may cause immediate respiratory or cardiac arrest. Scene safety is most important. Shut off the power source first. Make sure the scene is safe before approaching the victim. Vomiting A person in cardiac arrest will often vomit. If the victim vomits, roll the person to the side, sweep out the mouth, roll back and continue CPR. Reduce the risk of vomiting with rescue breaths by providing just enough air to cause the chest to rise. 18 Special Considerations - CPR 2011 EMS Safety Services, Inc.

19 When to Stop CPR Only stop CPR if: The victim begins to move or breathe. The AED directs you to stop. The scene becomes unsafe. You are physically exhausted and unable to continue. Professional rescuers arrive and are ready to take over. The victim is pronounced dead by a qualified person. CPR Alternatives Alternative techniques to CPR can be used if needed: Compression-only CPR o Only for adult victims. o Continuous chest compressions without rescue breaths. o Exchange of oxygen occurs with the force of compressions. o Used by dispatchers for untrained rescuers who call o Can also be used for adult victim if rescuer is unable or unwilling to provide rescue breaths. Mouth-to-Nose Rescue Breathing o Use if the victim s mouth or jaw is severely damaged. o Holding the mouth closed prevents air from escaping. o Make a seal and exhale into the victim s nose. Mask-to-Stoma Rescue Breathing o Use for a victim with a stoma (surgical opening at the base of the throat). o Can be performed with a mask or mouth-to-stoma. o Pinch the nose closed if possible to prevent air escape. o Make a seal around the stoma and exhale; watch for chest rise. Special Considerations AED (optional) DVD Ch: DEMONSTRATE: Status indicator AED accessories PRACTICE: SUPPLIES: AED trainer or AED Instructor Note: This topic is required for AED certification. Learning Objectives Identify actions to take if chest hair or objects interfere with AED pad placement. Discuss AED maintenance and troubleshooting. Key Concepts There are situations that may alter the rescuer s actions when applying AED pads. Special Considerations AED 19

20 Very Hairy Chest A lot of chest hair can limit the contact between the AED pad and the victim s skin. The AED may not be able to read the person s heart rhythm. If the first set of pads is not working: o Press pads firmly onto the person s skin. o Remove with a quick motion. o Apply the second set of pads. If only one set of pads is available and the victim has a very hairy chest, quickly shave the areas of pad placement before applying pads. Implanted Devices Devices may include: o Pacemaker o Automated Internal Cardiac Defibrillator (AICD) o Medication administration port The device may appear like a small raised lump under the skin. Most implanted devices do not affect AED pad placement. If an implanted device is located in the area of AED pad placement: o Do not place the AED pad directly over the implanted device. o Adjust pad placement at least 1 from the device. Tip Use the AED even if a cardiac arrest victim is known to have a pacemaker or AICD. The person s implanted equipment may or may not be working. An AED can detect a pacemaker rhythm, analyze the heart s underlying problem, and deliver a life-saving shock. Medication Patches Medication is often embedded in an adhesive patch and applied to the skin. Do not place an AED pad over a medication patch. o Use a gloved hand to remove the patch. o Quickly wipe the chest clean with a towel or other absorbent cloth. Apply pads once the area has been wiped clean. Tip Move jewelry out of the way or adjust pad placement for body piercings. Do not take the time to remove jewelry. Do not leave jewelry or anything other than skin under the AED pads. Maintenance & Troubleshooting AED owners and operators should ensure the AED is ready for use at all times. Proper storage and inspection should be part of every AED program. DEMONSTRATE: AED status indicator, accessories 20 Special Considerations AED 2011 EMS Safety Services, Inc.

21 Storage An AED should be stored: Ready to use Missing accessories Troubleshooting An AED performs self checks daily or weekly and every time the AED is powered on. If a problem is detected before or during an emergency, the AED will let you know. During an emergency some troubleshooting areas may include: Check Pads: o Status indicator Ready o Current pads and battery (not expired) Close to trained rescuers o Most of the people, most of the time o Not locked up or hidden away o Visible signage; easy access o Common areas easy to describe to a bystander With accessories Inspection o Spare adult pads o Pediatric pads or adaptor o CPR barrier, gloves o Safety razor o Absorbent towel Most state and local regulations require an AED to be routinely checked for readiness. Perform regular inspections according to manufacturer and local protocols. Check for: Tip Status indicator shows Ready Primary and spare pads are not expired Battery is not expired Visible damage to the AED o Press down firmly on the pads, or replace the pads with a spare set. o Check the pad connection to the AED. Low battery: o Replace the battery. o Even in a low battery condition, an AED may be able to provide several shocks. o Refer to the AED manufacturer for more information. Movement: o Movement can disrupt the analysis of the heart rhythm. o When the AED is analyzing, do not touch or move the victim. If there is any problem with the AED that a lone rescuer cannot troubleshoot in less than 1 minute, discontinue AED use and continue CPR. Ask for another AED to be brought to the scene if possible. Special Considerations AED 21

22 DISCUSS: Who checks our AEDs? How do we know they are ready? AED Safety (optional) DVD Ch: DEMONSTRATE: PRACTICE: SUPPLIES: Instructor Note: This topic is required for AED certification. Learning Objectives Identify what actions to take if water or medical oxygen are present when using an AED. Key Concepts Using an AED during an emergency is safe; precautions should be taken to maximize safety. Consider rescuers actions when: o Clearing the victim o Water is present o The victim is using oxygen DISCUSS: What is wrong with this picture? Clearing the Victim Always clear the victim before delivering an AED shock. Loudly state clear or everybody clear and motion for people to move back. Ensure no one is touching the victim or the victim s clothes. Water Small amounts of water will not affect AED use. o e.g. Light rain or snow o Wipe the chest dry before applying pads. If the victim is lying in a pool or puddle of water: o Move to a dryer area. o Quickly dry the chest. o Ensure rescuers are not standing in water during AED use. Water on the victim s chest can interfere with defibrillation. o Quickly dry the chest before applying pads. o Ensure good contact with the skin. o A wet chest may cause the electricity from the AED to disperse before reaching the heart. Tip Good pad contact with dry skin will provide a more effective and directed shock to the heart. Press pads firmly to the chest. 22 AED Safety 2011 EMS Safety Services, Inc.

23 Oxygen Some people may use oxygen at home or out in the community. Concentrated, medical oxygen can be dangerous because it is combustible. If a person is wearing oxygen, turn it off and remove the mask or cannula from the person s face before using the AED. If oxygen is being used with rescue breaths, move the delivery device several feet from the victim before delivering a shock, then resume rescue breaths with supplemental oxygen. CPR at-a-glance Instructor Note: Students may use this page as a reference and for review. CPR at-a-glance 23

24 How Would You REACT? 1 QUESTIONS The most important part of CPR is quality: a. Rescue breathing b. CPR barrier masks c. Chest compressions d. Oxygen administration Home SCENARIOS You are at home when your neighbor knocks on your door and says her father was sleeping on the sofa, but now she can t wake him up and he doesn t seem to be breathing. How would you REACT? The main cause of cardiac arrest in infants and children is: a. Electrical shock b. Respiratory arrest c. Heart attack d. Stroke The first step in using an AED is to: a. Apply the pads b. Shock the victim c. Clear the victim d. Power on the unit For the purpose of CPR, a victim is considered to be an adult from: a. 10 years of age b. 1 day to 1 year old c. Signs of puberty d. All of the above Community You are watching a friend s 8-month-old infant. You go to the kitchen, then return to find the baby face down and twisted up in the blankets. The baby does not appear to be moving or breathing. How would you REACT? School You and another teacher are near the pool on campus and you hear someone yelling for help. You find a 13-year-old boy pointing to another young boy lying motionless at the bottom of the pool. How would you REACT? Work 5 It is acceptable to use child AED pads on an adult victim. True False You are at work when your coworker suddenly collapses. There is an AED on the wall next to the phone. Coworkers are present but no one is doing anything. How would you REACT? 24 How Would You REACT? 2011 EMS Safety Services, Inc.

25 Responding To Emergencies DVD Ch: 10 DEMONSTRATE: PRACTICE: SUPPLIES: Learning Objectives: Be able to recognize an emergency and evaluate a scene for safety. Know when and how to activate EMS and interact with EMS. Key Concepts Emergency scenes can be dangerous. Rescuers can quickly become victims. Caution and common sense can save your life. REACT to an Emergency Recognize an emergency Screams, panic; seriously ill or injured person; victim or bystanders agitated or threatening Suspicious environment; collision or stopped vehicle; environmental hazard Remain calm; stay aware of your own safety. Consider resources and options. Environment Size up the scene from a safe distance. Common hazards include: Blood and body fluids: Use personal protective equipment on every scene. Traffic: Use your vehicle, hazard lights and bystanders to control traffic around the scene. Watch for jagged metal and broken glass. Don t turn your back to oncoming traffic. Fire or smoke: Stay low to avoid smoke inhalation, and focus on escaping. If possible, drag the victim to safety. Never enter a smoke-filled environment. Wet, icy or unstable surface or structure: Slips, falls and vehicle movement can cause additional injuries to bystanders and rescuers. Avoid walking onto a frozen lake or pond if the stability of the ice is unknown. Downed electrical wires: Do not enter the scene; maintain a safe distance. If downed lines are near your car, stay inside the vehicle. Hazardous materials, chemicals and gases: Unusual smells, hissing sounds, liquids, hazardous containers; dead birds, animals, and fish could indicate a biological or chemical hazard. Leave the area and report it immediately. Open water, strong currents: Do not attempt a water rescue without professional training and equipment. It only takes a foot of swift moving water to move a car downstream. Confined space: Could be a cave, sewer, drainage culvert, or someone s garage. Look for clues such as more than 1 victim with no apparent injury. Do not enter without training and proper equipment. Hostile environment: Do the victim or bystanders appear agitated or threatening? Responding To Emergencies 25

26 Size-up the victim(s). How many? What is their general condition? Are they moving? Try to identify cause of illness or injury. If more than 1 victim, decide who needs help the most. If unsure, help the person closest to you. Activate EMS now if the scene is dangerous or if there is an obvious life-threatening injury or illness. Tip Before you enter an emergency scene, consider how you will exit. Identify two possible exits. Assess the victim Go to the victim s side and assess response and breathing. Look for serious illness or injury, such as difficulty breathing or severe bleeding. Call for help If the victim has a life-threatening condition, get help. Shout for help; call or your emergency response number. o If not sure it s an emergency, activate EMS. The dispatcher will ask questions to determine if it s an emergency. Treat the victim Treat life-threatening conditions first. o If unresponsive, call (activate EMS) and assess breathing. o If no breathing or only gasping, begin CPR (compression-only CPR if untrained). o If severe bleeding, control with direct pressure. Treat the victim in the position found. Only move the victim if danger or need to reposition for essential care or position of comfort. When you call the dispatcher will ask: Name, location, call back phone number. What happened, number of victims, general condition, what aid is being given Follow instructions, and always hang up last. When EMS responders arrive: Continue care until you are told to stop. Tell EMS what time the event occurred, what time you arrived, and what care has been given. Senior Give EMS a printed list of medications if available. If the person wears glasses or hearing aids, try to provide these before EMS transports the person. 26 Responding To Emergencies 2011 EMS Safety Services, Inc.

27 Child Sum it up Give EMS responders a copy of the child s Emergency Information Form from the school or childcare facility. Follow your school or childcare facility s Emergency Action Plan for contacting parent or legal guardian and for supervising other children. Remain calm. Assess the scene from a safe distance. Check for hazards and resources before focusing on the victim. If the scene is not safe, do not enter; call Do not become a victim. Rescuer Stress Learning Objectives Understand that there might be physical, mental, and emotional consequences to providing care in an emergency. Key Concepts It s normal to feel stress after an incident. Each rescuer will respond differently to stress depending on: o Experience o Personality o Seriousness of the incident o Outcome Rescuer stress may cause changes in emotions, ability to concentrate, appetite, sleep, and other physical symptoms. Don t ignore signs and symptoms of rescuer stress. Take care of yourself. o Eat properly. o Avoid alcohol, drugs and caffeine. o Exercise. o Get enough rest. Talk about your feelings. o Find someone who has had a similar experience. o Don t judge yourself for your actions. o Obtain professional help if needed. DISCUSS: Has anyone here responded to a serious emergency? Will you discuss what emotions you felt after the emergency was over? How did you deal with the emotions? Responding To Emergencies 27

28 Legal Issues DVD Ch: 11 DEMONSTRATE: PRACTICE: SUPPLIES: Learning Objectives: Know the common elements of the Good Samaritan Law. Understand the need for consent, right to privacy and right to refuse care. Key Concepts Some people have a duty to respond to an emergency. Other people respond voluntarily. Good Samaritan Law Purpose: encourage people to help in an emergency. Requirements: o Respond voluntarily (no duty to act ) o Not getting paid to respond o Provide care with good intentions o Stay within the limits of your training o Not reckless or careless when giving care o Not abandoning the victim after beginning care Gain Consent Before Treating Give your name, level of training, and the problem. Ask if you can help. Types of Consent Expressed consent: Victim expresses desire for aid Implied consent: Consent is assumed (unresponsive person) Minor s consent: A parent or legal guardian must give consent. If condition is life-threatening, treat under implied consent. Right to Refuse Care A mentally competent adult can refuse care at any time. Observe the situation from a distance and call if needed. Right to Privacy Do not give out the victim s information to coworkers or bystanders. Give information to EMS responders and to the person in charge of workplace safety. 28 Legal Issues 2011 EMS Safety Services, Inc.

29 Senior Do Not Attempt Resuscitation (DNAR) Sum it up Some people may have a DNAR order from their doctor. o Usually specific to out-of-hospital cardiac arrest. o Must be put in place before an emergency. If DNAR order is in place, do not begin CPR. o Call and tell the dispatcher that the person is unresponsive and not breathing, and has a DNAR order. DNAR protocols may be different in each state. Learn about your state s Advance Directives from your doctor or attorney. A designated first aid responder has a duty to act when at work. Once you begin care, do not leave the victim until help arrives. Request consent before giving care. Do not provide treatment that you are not trained to give. Protection from Infection DVD Ch: 12 DEMONSTRATE: Glove removal PRACTICE: Glove removal (Skill ) SUPPLIES: Disposable gloves Skill Sheet 3 Instructor Note: Skip this chapter if you will be certifying your students in the annual Bloodborne Pathogens awareness training. Learning Objectives: Understand how to help prevent BBP exposure and what to do if you are exposed. Demonstrate the skill of disposable glove removal. Key Concepts The OSHA Bloodborne Pathogens Standard requires the employer to help protect you from exposure to BBP. Use precautions with every emergency to protect yourself. Hand washing is an important part of infection control. Bloodborne Pathogens Bloodborne pathogens are disease-causing microorganisms in blood. Most serious: HIV, Hepatitis B, Hepatitis C May be transmitted during an emergency when giving first aid, handling contaminated sharp objects, cleaning a blood spill. Protection from Infection 29

30 Routes of transmission: Splash to eye, mouth or nose Opening in skin (cut, scab, rash, hangnail) Universal Precautions Universal Precautions & Body Substance Isolation provide protection. Assume all blood and body fluids are infectious, except sweat. Take precautions with all victims, even children. Use personal protective equipment. o Disposable gloves, gown, mask, goggles or face mask, CPR barrier o Choose the right equipment for each emergency. o Wash hands thoroughly immediately after glove removal. o Wash with soap and water for at least 20 seconds. o If hands not visibly soiled and running water is not available, use hand sanitizer, then wash ASAP. What to do if you re exposed: Immediately remove your gloves. Wash your hands and the exposed area thoroughly with soap and water. Follow your workplace Exposure Control Plan. Removing Soiled Gloves DEMONSTRATE: Soiled glove removal PRACTICE: Soiled glove removal Instructor Note: Use Skill Sheet 3 - Glove Removal, Choking Care Cleaning after an Emergency Wear personal protective equipment. Clean the spill with paper towels or an absorbent powder. Pick up sharp objects or broken glass with tongs or brush and dustpan. Disinfect with 10% bleach and water or another disinfectant. Dispose of soiled personal protective equipment according to workplace policy. Wash your hands. If you don t have a biohazard bag or container, place the contaminated items in a leak-proof Tip plastic bag and seal it. Dispose of it according to your workplace policy. 30 Protection from Infection 2011 EMS Safety Services, Inc.

31 Airborne Pathogens Other diseases can be spread when an ill person coughs or sneezes. Protect yourself by: Sum it up o Getting a flu vaccine. o Washing your hands often. o Avoiding contact when possible with people who may be contagious. Keep first aid kits stocked with personal protective equipment. If you don t have personal protective equipment with you, use whatever is available: o e.g. To control bleeding, have the victim apply the pressure, or use layers of clean cloth or extra gauze. Heart Attack DVD Ch: 13 DEMONSTRATE: PRACTICE: SUPPLIES: Learning Objectives: Know how to recognize a heart attack and the proper rescuer actions. Understand the importance of early activation of EMS. Key Concepts Heart disease is the leading cause of death in the U.S. Heart attack can lead to cardiac arrest. More than 1.25 million Americans have a first or recurrent heart attack every year. About 70% of the deaths from heart attack occur before the victim reaches the hospital. Call early for any signs of heart attack. Coronary Artery Disease (CAD) The build-up of fatty deposits in blood vessels. o Coronary arteries narrow and harden. o Vessels can become blocked. o Process takes years. Heart disease is preventable. What is a heart attack? The heart pumps blood throughout the body. Coronary arteries deliver oxygenated blood to the heart. Heart Attack 31

32 A blocked coronary artery deprives the heart of oxygen. o Results in death of heart muscle (heart attack). o If enough critical heart tissue is affected, causes cardiac arrest. o Can end a life in seconds. Signs and Symptoms of Heart Attack Chest discomfort: o Pain, pressure, tightness, squeezing, fullness. o Discomfort may radiate to the arms, neck, back, jaw, or abdomen. o Often mistaken for heartburn or indigestion. Pale, cool, sweaty skin Shortness of breath Dizziness, fainting or unresponsiveness Nausea, vomiting Unexplained fatigue Treatment of Heart Attack 1. Call and get an AED if available. 2. Position of comfort, usually sitting. 3. Calm and reassure the person. 4. Offer 1 adult or 2 baby aspirin for victim to chew. o Make sure no allergy to aspirin, signs of stroke, or recent bleeding problems. o Make sure the victim is alert and can swallow. 5. If victim becomes unresponsive, check breathing. o If no breathing or only gasping, begin CPR (compression-only CPR if you are untrained). o Use the AED when it arrives. Don t Delay calling If any signs and symptoms are present. If the symptoms fade and return. To give aspirin. Calling can mean the difference between heart attack & cardiac arrest. Paramedics can provide treatment before cardiac arrest occurs. Sum it up Heart attack victims often deny or ignore symptoms, or say there is another cause. Be alert to less common symptoms in women, diabetics, and older people. Fast recognition of heart attack symptoms gives the best chance of survival. Clot-busting medications can dissolve the clot. Only effective in the first few hours of a heart attack. 32 Heart Attack 2011 EMS Safety Services, Inc.