Canadian Red Cross Summary First Aid Technical Changes for 2011 Implementation Wound Care Second part of a SFA course On the first day and included in EFA To meet legislative requirements Assessment and Care for unconscious nonbreathing person H.A.IN.E.S Recovery position Conscious Adult/Child Airway Conscious Adult/Child Airway for larger or pregnant person Check the scene Check the person for responsiveness Call EMS/9-1-1 Care Open the Airway, give 2 breaths A demonstrated skill by instructors, participants didn t try the skill Abdominal thrusts Chest thrusts Check the scene Check the person for responsiveness Check ABCs rapid assessment max 5-10 sec A open airway B check breathing C check circulation Call EMS/9-1-1 Care 30 compressions An evaluated skill to replace the lateral recumbent recovery position Alternating 5 firm back blows, 5 abdominal thrusts Alternating 5 firm back blows, 5 chest thrusts Chest compressions will be initiated sooner and the delay of ventilation should be minimal. Chest compressions provide vital blood flow to the heart and brain, and should be started almost immediately. Scientific evidence indicates that the HAINES style of recovery position is less likely to cause further damage to a suspected spine injury and there was no evidence either for or against the lateral recumbent position therefore easier for participants to learn only 1 method 2005 ILCOR guidelines recommended this treatment and CRC chose not to implement it at that time. The combination of more than one technique was shown to offer the greatest success for survival. 2005 ILCOR guidelines recommended this treatment and CRC chose not to implement it at that time. The combination of more than one technique was shown to offer the greatest success for survival. June 12, 2011 Page 1 of 6
Conscious Adult/Child Airway for Someone in a wheelchair Unconscious Airway Assisting with medications Abdominal thrusts Repositioning between breaths FA person could give medications such as epi, inhalers, nitro, ASA Alternating chest thrusts and abdominal thrusts After the first reposition, you don t need to reposition in between the 2 breaths for subsequent cycles New guidelines for first aiders assisting with medications: The ill or injured person is capable of self-administering his or her own medication The ill or injured person must be conscious and be able to clearly express any risks involved with taking the medication under the present conditions Assistance should be limited to preparing medications that can be given orally or with auto-injectors that first aiders know and understand The ill or injured person should take oral medication only if he or she can swallow. The person should also be certain that nothing will interfere or react negatively with the medication. The person should read and follow all label or medical instructions All five rights of medication must be met 2005 ILCOR guidelines recommended this treatment and CRC chose not to implement it at that time. The combination of approaches was shown to offer the greatest success for survival. After it is determined that there is an obstruction, it is wasting time repositioning the airway between ventilations. To provide more clear directions for first aid personnel when helping with medications Changing the focus to assisting an ill person with the self-administration of their medication June 12, 2011 Page 2 of 6
Epinephrine AED Compression Rate Help them use their medication (single or double dose) AEDs were not used on babies About 100/min (rate with no breaths) Assist with the first dose following the guidelines for medications and call EMS/9-1-1 AEDs are now used on all people who are not breathing (adult, child, baby) At least 100/min (rate with no breaths) Epinephrine can be lifesaving for a person with anaphylaxis, but some who have the signs and symptoms of anaphylaxis may require a second dose of epinephrine. The diagnosis of anaphylaxis can be a challenge, even for professionals, and excessive epinephrine administration may produce complications if given to people who do not have anaphylaxis. Therefore a first aider is encouraged to activate EMS/9-1-1 prior to a second dose. Newer case reports suggest that AEDs may be safe and effective in infants. Because survival requires defibrillation when a shockable rhythm is present during cardiac arrest, delivery of a high-dose shock is preferable to no shock at all. The lowest energy dose for effective defibrillation in infants and children is not known. The upper limit for safe defibrillation is also not known. AEDs with relatively high-energy doses have been used successfully in infants in cardiac arrest with no clear adverse effects. More compressions are associated with higher survival rates, and fewer compressions are associated with lower survival rates. June 12, 2011 Page 3 of 6
Adult Compression Depth Compressiononly CPR 1.5 2 At least 2 Was not mentioned Compression-only CPR uses chest compressions to pump the heart and circulate the oxygen already in the person s body. Compression-only CPR is suitable when: An adult collapses suddenly A bystander is unwilling, unable, or not sure how to perform full CPR, or is waiting for trained assistance to arrive A responder does not have a breathing barrier (mask) and does not want to perform unprotected rescue breaths Compression-only CPR should not be used for: A drowning person A respiratory emergency that may have caused the cardiac arrest A child or baby This is not a stand-alone skill that is being taught in CRC FA programs, it is knowledge information Confusion may result when a range of depth is recommended so 1 compression depth is now recommended. Rescuers often do not compress the chest enough despite recommendations to push hard. In addition, the available science suggests that compressions of at least 2 are more effective than compressions of 1.5. For this reason in 2010 ILCOR recommend a single minimum depth for compression of the adult chest. (Compression-only) CPR is easier for an untrained rescuer to perform and can be more readily guided by dispatchers over the telephone. In addition, survival rates from cardiac arrests of cardiac etiology are similar with either hands-only or CPR with both compressions and rescue breaths. However, for the trained lay rescuer who is able, the recommendation remains for the rescuer to perform both compressions and ventilations at a ratio of 30:2. June 12, 2011 Page 4 of 6
Heat Stroke Care: 1. Make sure the ABCs are present. 2. Have the person rest in a cool place. 3. Cool the body any way you can. Sponge the entire body with tepid or cool water, fan the person or put covered ice packs in the groin, in each armpit, and on the back of the neck to cool large blood vessels. Secondary Survey: Perform a secondary survey and treat any non-life-threatening injuries. Continual Care: Provide continual care until EMS personnel arrive. Care: 1. Ensure the person s ABCs are present. 2. Have the person rest in a cool place. 3. Cool the body any way you can. Full immersion of the body in cool water from the neck down. Sponge the entire body with cool water, fan the person, or put covered ice packs in the groin, in each armpit, and on the back of the neck to cool large blood vessels. 4. If the person is conscious, have him or her take small sips of cool water. 5. Perform a secondary survey and treat any non-life-threatening conditions. 6. Provide continual care until EMS personnel arrive. The most important action by a first aid provider for a person with heat stroke is to begin immediate cooling, preferably by immersing the victim up to the chin in cold water. June 12, 2011 Page 5 of 6
Marine Life HCP unwitnessed arrest HCP Cricoid Pressure Bathe the area with lots of seawater or cool, salty water. Do not rub the area. While wearing gloves, remove any tentacles or pieces of the animal Scrape or shave the area with a razor or the edge of a knife Do 5 cycles (2 minutes) of CPR then apply the AED If the HCP was trained in this they could perform the cricoid pressure while ventilations were being done Wash the area for at least 30 seconds with vinegar. If vinegar isn t available, use a mixture of baking soda and water (to make a consistency like toothpaste) and leave it on the area to 20 minutes. Then immerse the affected area in hot water (as tolerated) for 30 minutes or as long as the pain persists. Do not rub the area. While wearing gloves, remove any tentacles or pieces of the animal. Scrape or shave the area with a razor or the edge of a knife. Put a cold pack on the area for the first hour to reduce the pain. Apply the AED as soon as it is available. No longer done There are 2 actions necessary for treatment of jellyfish stings: preventing further nematocyst discharge and pain relief. A number of topical treatments have been used, but critical evaluation of the literature shows that vinegar is most effective for inactivation of the nematocysts. Immersion with water, as hot as tolerated for about 20 minutes, is most effective for treating the pain. CPR before attempting defibrillation by HCPs was not associated with a significant difference in survival. Use of cricoid pressure during ventilations is generally not recommended as it can delay or prevent the placement of an advanced airway and some aspiration can still occur despite application of cricoid pressure. June 12, 2011 Page 6 of 6