Use this resource to bridge the gap between EMS Safety G2010 and the newly released G2015 CPR and First Aid treatment recommendations until new course materials are available. There are no changes to the course format or requirements for successful course completion based on the G2015 update. The information below will only cover what is changed or updated for 2015. Interim exams and skill sheets are available on the EMS Safety Instructor Corner. Contents Program Titles Affected by the Guidelines (G2015) Update... 1 Basic First Aid... 2 CPR, AED (Community and Professional Rescuer)... 7 CPR & AED for Professional Rescuers... 13 Program Titles Affected by the Guidelines (G2015) Update Basic First Aid (BFA) CPR, AED and First Aid for Community Responders (ACF) CPR, AED and First Aid for Childcare Providers (CHILD) CPR, AED and First Aid for Caregivers (CAREGIVER) CPR, AED and First Aid for the Senior Community (SNR) CPR, AED for Professional Rescuers (PRO) 2015, EMS Safety Services, Inc. G2015 Interim Program Changes 1
Basic First Aid Heart Attack: Aspirin Administration Workbook: BFA, Page 8; ACF, Page 26; CHILD, Page 26; CAREGIVER, Page 35; SNR Page 35; Pro Page 32 Chew either 1 adult or 2 low-dose aspirin to improve the chance of survival while waiting for EMS responders. Aspirin Administration: Do not give aspirin if the person has an allergy to aspirin, signs of a stroke, recent bleeding problems, or is not alert. responders. If the responder is unsure of the cause of chest pain or uncomfortable giving aspirin, defer to EMS dispatcher or responders. Chew either 1 adult or 2 low-dose uncoated aspirin to improve the chance of survival while waiting for EMS Do not give aspirin if the victim has an allergy, signs of a stroke, recent bleeding problems, or is not alert. Positioning a Victim, Unresponsive Victim Workbook: BFA, Page 16; ACF, Page 34; CHILD, Page 35; CAREGIVER, Page 47; SNR Page 47; PRO Page 32 Unresponsive and breathing normally: Sidelying is the preferred recovery position. o Extend one arm above the head o Grasp the shoulder and hip and log roll the person to the side o Head should rest on the extended arm back injury is suspected. o Bend both knees for support Do not move the person if suspect spine, pelvis or hip injury. side. o Move only as needed to open the airway or to reach a safe location. Unresponsive and breathing normally: Use the modified H.A.IN.E.S. recovery position (High Arm IN Endangered Spine) when an unresponsive person is breathing normally and you must leave to get help, or when fluids or vomit may block the airway. This is the best recovery position if a neck or Grasp the arm furthest from you and gently lift it above the person s head. Place the arm nearest you by the person s Bend the knee furthest from you. With 1 hand stabilize the base of the skull and place your forearm under the shoulder. Place your other hand under the hip and arm nearest you. 2015, EMS Safety Services, Inc. G2015 Interim Program Changes 2 Carefully roll the person away from you. Do not push the head or neck. Bend the top knee so both knees are flexed to stabilize the victim. If you must leave to get help, place the person s hand, palm down, under the head near the armpit.
Bleeding, Shock, Trauma; Control of Bleeding, Hemostatic Dressings Workbook: BFA, Page 16; ACF, Page 36; CHILD, Page 37; CAREGIVER, Page 49; SNR Page 49 Treatment: Treatment: Put on gloves Put on gloves Expose the wound Expose the wound Apply firm direct pressure with sterile gauze Apply firm direct pressure with sterile gauze. Add dressings as they become soaked Add dressings as they become soaked Consider the use of hemostatic dressings when direct Treat for shock pressure is not effective. Follow manufacturer-specific instructions. Bandage the dressing once bleeding has stopped Treat for shock Bandage the dressing once bleeding has stopped Bleeding, Shock, Trauma; Control of Bleeding, Tourniquets Workbook: BFA, Page 17; ACF, Page 37; CHILD, Page 38; CAREGIVER Page 50; SNR Page 50 Use a tourniquet to control severe arm or leg bleeding when standard treatment has not worked. If bleeding from an arm or leg cannot be controlled with direct pressure and help is delayed, consider a tourniquet A tourniquet may be considered as an initial treatment to control severe bleeding for: as a last resort. o Mass casualty incidents o A person with multiple severe injuries o Unsafe environments o When a wound cannot be accessed 2015, EMS Safety Services, Inc. G2015 Interim Program Changes 3
Head, Neck and Back Injuries; Knocked-Out Adult Tooth Workbook #: BFA, Page 26; ACF, Page 44; CHILD, Page 45; CAREGIVER, Page 59; SNR Page 59 Knocked-Out Adult Tooth: Knocked-Out Adult Tooth: Re-implantation of the tooth is best. If a permanent adult tooth is knocked out, try to see a Handle the tooth by the biting edge, not by the root. dentist within 30 minutes to replant the tooth. Re-implantation may not be possible by a first aid provider The sooner it is re-inserted the more likely it can be saved. due to lack of protective gloves, training, skill or fear of Do not reinsert the tooth yourself. causing pain. Treatment: Treatment: Bite down on rolled sterile cause to control bleeding. When immediate re-implantation is not possible, store an Handle the tooth by the biting edge, not by the root. avulsed tooth in a solution to prolong the time the tooth can be replanted. Place in a container of milk. Certain solutions can prolong dental cell viability from 30 to 120 minutes. o Hanks Balanced Salt Solution o Propolis ( bee glue ) o Egg white o Coconut water o Ricetral (medication solution; Potassium Chloride, Rice Extruded, Sodium Chloride, Sodium Citrate) o Whole milk If these solutions are not available, store the tooth in the person s saliva, but not in their mouth. 2015, EMS Safety Services, Inc. G2015 Interim Program Changes 4
Chest and Abdominal Injuries; Sucking Chest Wound (Open Chest Wound) Workbook: BFA, Page 27; ACF, Page 45; CHILD, Page 46; CAREGIVER, Page 61; SNR Page 61 Treatment: 1. Call 9-1-1 (activate EMS) 2. Calm and reassure; keep the person still. 3. Control external bleeding with direct pressure. 4. When bleeding is controlled, consider leaving the wound exposed or cover with a non-occlusive dressing. 5. Ensure the dressing does not become occlusive from saturation. 6. Monitor response, breathing and appearance. Treatment: 1. Call 9-1-1 (activate EMS) 2. Calm and reassure; keep the person still. 3. Apply an airtight dressing (foil or plastic wrap) to keep air from entering during inhalation. Tape only 3 sides so air can escape during exhalation. 4. Monitor response, breathing and appearance. Burns Workbook: BFA, Page31; ACF, Page 49; CHILD, Page 50; CAREGIVER, Page 67; SNR Page 67 Treatment for Burns: Cool thermal burns with cool potable water as soon as possible for at least 10 minutes, or until the pain is resolved. If cool water is not available, use a clean, cool (not freezing) compress. For a 2 nd degree burn, apply antibiotic ointment and cover with a dry, sterile, non-stick dressing. Get Medical Care If: Blistering or broken skin Signs of infection Call 9-1-1 If: Difficulty breathing Burns to face, neck, hands, Larger surface area, such as trunk or extremities 3 rd degree burn, especially to the elderly or very young Treatment for Minor Burns: 1. Rinse the burn with cool water for at least 20 minutes or until the pain is resolved. 2. For a 2 nd degree burn, apply antibiotic ointment and cover with a dry, sterile non-stick dressing. Get Medical Care If: 2 nd degree burn larger than 2-3 inches Large 1 st degree burn Signs of infection Call 9-1-1 if: Burn to head, neck, hands, feet genitals or over a major joint Large burn area or multiple burn sites Burn to airway or difficulty breathing. Airway burns cause swelling which may close the airway. 3 rd degree burn, especially to the elderly or very young Chemical or electrical burn 2015, EMS Safety Services, Inc. G2015 Interim Program Changes 5
Chemical or electrical burn Burn combined with other traumatic injuries In remote settings where topical antibiotics are not available, consider applying honey to decrease the chance of infection. Burn with other traumatic injuries. Allergic Reactions Workbook: BFA, Page 35; ACF, Page 53; CHILD, Page 55; CAREGIVER, Page 71; SNR Page 71 Treatment 1. Send a bystander to call 9-1-1 (activate EMS). 2. Help the person locate and use the epinephrine autoinjector. 3. If the allergic reaction is from a bee sting, quickly scrape off the stinger with a straight-edged object. 4. Monitor response, breathing, and signs of shock. 5. Consider a repeat dose if symptoms persist and EMS is delayed more than 5 minutes. Treatment 1. Send a bystander to call 9-1-1 (activate EMS). 2. Calm and reassure the person. 3. If requested, help the person locate and use the epinephrine auto-injector if you are trained and know how to use it and State and local regulations allow. 4. If the allergic reaction is from a bee sting, quickly scrape off the stinger with a straight-edged object. 5. Monitor response, breathing, and signs of shock. Diabetic Emergencies Workbook: BFA, Page 37; ACF, Page 55; CHILD, Page 57; CAREGIVER, Page 75; SNR Page 75 Treatment 1. Assess response, breathing and appearance. 2. If the person is alert enough to sit up and swallow, give sugar to eat or drink. 3. Glucose tablets are the preferred form of sugar. Other sugars include: juice, regular soda, sugar dissolved in water, and honey. Treatment 1. Assess responsiveness, breathing and appearance. 2. If the person is alert enough to sit up and swallow, give sugar to eat or drink (juice, regular soda, sugar dissolved in water, honey, glucose tables. 2015, EMS Safety Services, Inc. G2015 Interim Program Changes 6
Exercise-Related Dehydration Workbook: CHILD, Page 58, CAREGIVER, Page 77; SNR Page 77 Exercise-Related Dehydration 1. Encourage oral rehydration with a 5% to 8% Carbohydrate- Electrolyte (CE) Solution (e.g. Lucozade Sport or Gatorade) 2. If not available, use potable water 3. Do not give fluids if signs of shock, confusion or inability to swallow N/A CPR, AED (Community and Professional Rescuer) The changes listed below are included in both CPR, AED for Professional Rescuers and CPR, AED for Community Rescuers. The section, Professional Rescuer CPR, AED includes updates that ONLY affect the CPR, AED for Professional Rescuers program. CPR Overview, Quality CPR Compressions Workbook: CPR/ACF, Page 4; CHILD, Page 4; CAREGIVER, Page 4; SNR, Page 4; PRO Page 4 Quality Chest Compressions: Quality Chest Compressions: Push hard and fast Push hard and fast Minimize interruptions to chest compressions Minimize interruptions to chest compressions Avoid leaning on the chest between compressions Allow full chest recoil C-A-B, Use of Mobile Phones Workbook: CPR/ACF, Page 5; CHILD, Page 5; CAREGIVER, Page 6; SNR, Page 6; PRO Page 5 When you arrive at the patient s side When you arrive at the patient s side Check for response. Check for response. o Tap his shoulder and shout, Are you alright? Tap his shoulder and shout, Are you alright? o Look for any response such as eyes opening, moaning or talking. Some people may have brief generalized seizures Look for any response such as eyes opening, moaning or talking. as the first indicator of cardiac arrest. Call 9-1-1 if the victim does not respond. 2015, EMS Safety Services, Inc. G2015 Interim Program Changes 7
If the victim does not respond and: o You are alone with a mobile phone, call 9-1-1 and get an AED if one is immediately available. o You are alone without a mobile phone, leave the victim to call 9-1-1 and get an AED if one is immediately available. Anytime bystanders are available, direct them to call 9-1-1 and get an AED if one is available. o If there is more than one bystander, split the tasks. Quickly check for breathing by visually scanning the victim s chest. If no breathing or only gasping, begin compressions. Anytime bystanders are available, direct them to call 9-1-1 and get an AED if one is available. If there is more than one bystander, split the tasks. Quickly check for breathing by visually scanning the victim s chest. If no breathing or only gasping, begin compressions. C-A-B, Recovery Position Workbook: CPR/ACF, Page 6; CHILD, Page 6; CAREGIVER, Page 8; SNR, Page 8; PRO Page 8 Unresponsive and Breathing Normally: Unresponsive and Breathing Normally: If the unresponsive victim is breathing normally, CPR is not required. If the unresponsive victim is breathing normally, CPR is not required. A sidelying position is the preferred recovery position. Place the victim in the recovery position if you must leave o Extend one arm above the head to get help or if fluids or vomit may block the airway. o Grasp the shoulder and hip and log roll the person to the side If breathing stops, immediately roll the victim onto his back and begin chest compressions. o Head should rest on the extended arm o Bend both knees for support If breathing stops, immediately roll the victim onto his back and begin chest compressions. Use the modified H.A.IN.E.S. recovery position (High Arm IN Endangered Spine) to keep the airway open and allow fluids to drain. Adult CPR, Check Response and Activate EMS Workbook: CPR/ACF, Page 10; CHILD, Page 10; CAREGIVER, Page 12; SNR, Page 12; PRO Page 16 Check response and activate EMS: Tap the victim on the shoulder and shout. Check response and activate EMS: Tap the victim on the shoulder and shout. 2015, EMS Safety Services, Inc. G2015 Interim Program Changes 8
If no response, yell for help. Send a bystander to call 9-1-1 and get the AED. If you are alone with a mobile phone, call 9-1-1 and get an AED if one is immediately available. If you are alone without a mobile phone, leave the victim to call 9-1-1, retrieve an AED if one is immediately available and quickly return. If no response, yell for help. Send a bystander to call 9-1-1 and get the AED. Go yourself if a bystander is not available Adult CPR, C: Compressions Workbook: CPR/ACF, Page 10; CHILD, Page 10; CAREGIVER, Page 12; SNR, Page 12; PRO Page 16 C: Compressions Perform 30 chest compressions with 2 hands. C: Compressions Perform 30 chest compressions with 2 hands. Position the victim face up on a firm, flat surface. Position the victim face up on a firm, flat surface. Quickly remove clothing from the front of the chest if it may interfere with compressions. Quickly remove clothing from the front of the chest if it may interfere with compressions. Place the heel of 1 hand in the center of the chest between the nipples, and the heel of the other hand on top. Place the heel of 1 hand in the center of the chest between the nipples, and the heel of the other hand on top. Compress the chest 30 times. Compress the chest 30 times. Rate: 100-120 compressions/minute Rate: At least 100/minute Depth: At least 2 Depth: At least 2 Make sure the compressions are good quality. Make sure the compressions are good quality. o Push hard and fast. o Push hard and fast. o Avoid leaning between each compression. o Allow full recoil between each compression. Minimize interruptions to compressions o Minimize interruptions to compressions. Adult CPR, Defibrillation (Recovery Position) Workbook: CPR/ACF, Page 11; CHILD, Page 11; CAREGIVER, Page 14; SNR, Page 14; PRO Page 17 If the victim begins to move or breathe, leave the AED pads in place. If the victim begins to move or breathe, leave the AED pads in place. Place the victim in a sidelying recovery position. 2015, EMS Safety Services, Inc. G2015 Interim Program Changes 9
Extend one arm above the head and log roll the person to the side, so the person s head rests on the extended arm. Bend the knees for support. Place in the modified H.A.IN.E.S position if you need to keep the airway clear of fluids or vomit. Adult CPR, Maximum Number of Seconds to Complete 30 Compressions (Footer) Workbook: CPR/ACF, Page 10; CHILD, Page 10; CAREGIVER, Page 12; SNR, Page 12; PRO Page 16 Footer Tip Footer Tip 15-18. The minimum and maximum number of seconds to complete 30 chest compressions. 18. The maximum number of seconds in which to complete 30 chest compressions. Child CPR, Check Response and Activate EMS Workbook: CPR/ACF, Page 12; CHILD, Page 12; CAREGIVER, Page 15; SNR, Page 15; PRO Page 18 Check response and activate EMS: Check response and activate EMS: Tap the victim on the shoulder and shout. Tap the victim on the shoulder and shout. If no response, yell for help. Send a bystander to call 9-1-1 and get the AED. If no response, yell for help. Send a bystander to call 9-1-1 and get the AED. If you are alone with a mobile phone, call 9-1-1. If alone stay with the child. If you are alone without a mobile phone, stay with the child. Check Breathing Check Breathing Child CPR, C: Compressions Workbook: CPR/ACF, Page 12; CHILD, Page 12; CAREGIVER, Page 15; SNR, Page 15; PRO Page 18 C: Compressions Perform 30 chest compressions with 1 or 2 hands. C: Compressions Perform 30 chest compressions with 1 or 2 hands. Position the victim face up on a firm, flat surface. Position the victim face up on a firm, flat surface. Quickly remove clothing from the front of the chest if it may interfere with compressions. Quickly remove clothing from the front of the chest if it may interfere with compressions. 2015, EMS Safety Services, Inc. G2015 Interim Program Changes 10
Place the heel of 1 hand in the center of the chest between the nipples, and the heel of the other hand on top (optional). Compress the chest 30 times. Rate: 100-120 compressions/minute Depth: About 2 o Push hard and fast. o Avoid leaning between each compression. Minimize interruptions to compressions Place the heel of 1 hand in the center of the chest between the nipples, and the heel of the other hand on top (optional). Compress the chest 30 times. Rate: At least 100/minute Depth: About 2 o Push hard and fast. o Allow full recoil between each compression. Minimize interruptions to compressions. Child CPR, Call 9-1-1 (Recovery Position) Workbook: CPR/ACF, Page 13; CHILD, Page 13; CAREGIVER, Page 17; SNR, Page 17; PRO Page N/A Place the victim in a sidelying recovery position. Place in the modified H.A.IN.E.S position: Extend one arm above the head and log roll the person to o If you must leave to get help. the side, so the person s head rests on the extended arm. Bend the knees for support. o To allow fluids to drain from the mouth. Infant CPR, Check Response and Activate EMS Workbook: CPR/ACF, Page 14; CHILD, Page 14; CAREGIVER, Page 18; SNR, Page 18; PRO Page 20 Check response and activate EMS: Check response and activate EMS: Tap the bottom of the foot and shout. Tap the bottom of the foot and shout. If no response, yell for help. Send a bystander to call 9-1-1 and get the AED. If no response, yell for help. Send a bystander to call 9-1-1 and get the AED. If you are alone with a mobile phone, call 9-1-1. If alone stay with the infant. If you are alone without a mobile phone, stay with the infant. Check Breathing Check Breathing 2015, EMS Safety Services, Inc. G2015 Interim Program Changes 11
Infant CPR, C: Compressions Workbook: CPR/ACF, Page 14; Childcare, Page 14; CAREGIVER, Page 18; SNR, Page 18; PRO Page 20 C: Compressions Perform 30 chest compressions with 2 fingers. C: Compressions Perform 30 chest compressions with 2 fingers. Position the victim face up on a firm, flat surface. Position the victim face up on a firm, flat surface. Quickly remove clothing from the front of the chest if it may interfere with compressions. Quickly remove clothing from the front of the chest if it may interfere with compressions. Place 2 fingers in the center of the chest just below the nipple line. Place 2 fingers in the center of the chest just below the nipple line. Compress the chest 30 times. Compress the chest 30 times. Rate: 100-120 compressions/minute Rate: At least 100/minute Depth: About 1.5 Depth: About 1.5 o Push hard and fast. o Push hard and fast. o Avoid leaning between each compression. o Allow full recoil between each compression. Minimize interruptions to compressions Minimize interruptions to compressions. CPR at a Glance (Table) Workbook: CPR/ACF, Page 15; CHILD, Page 19; CAREGIVER, Page 26, SNR, Page 26; PRO Page 25 Table: CPR-at-a-Glance Table: CPR-at-a-Glance Push Fast: 100-120/minute Push Fast: At least 100/minute Avoid Leaning: Allow full chest recoil between each compression. Change CPR rescuers every 2 minutes. Allow Full Recoil: Change CPR rescuers every 2 minutes. 2015, EMS Safety Services, Inc. G2015 Interim Program Changes 12
CPR & AED for Professional Rescuers The following changes only affect the CPR & AED for Professional Rescuers program. Chain of Survival, In-Hospital Cardiac Arrest (IHCA) Workbook: PRO Page 3 Improved chain of survival for IHCA with emphasis on rapid identification of cardiac arrest: Surveillance and protection (RRT/Early warning systems) Recognition and activation of the emergency response system Immediate high-quality CPR Rapid defibrillation Advanced life support and post-arrest care N/A C-A-B, Assessment (Simultaneous Breathing and Pulse Check) Workbook: Pro Page 5 When you arrive at the victim s side, check for response. Tap shoulder and shout, Are you all right? If no response, yell for nearby help. o Send bystander to activate response team and retrieve AED o If alone with a mobile phone, activate response team Check breathing AND pulse for 5-10 seconds o Visually scan the person s chest. Check for no breathing or only gasping o o Check pulse If alone without a mobile phone, leave to activate response, retrieve an AED if one is immediately available and quickly return When you arrive at the victim s side, check for response. Tap his shoulder and shout, Are you all right? Look for any response such as eyes opening, moaning, or talking. While checking for response, check for breathing by visually scanning the victim s chest for 5-10 seconds. If no response and no breathing or only gasping, yell for help and have someone activate EMS and get the AED. Check for a pulse for 5-10 seconds. 2015, EMS Safety Services, Inc. G2015 Interim Program Changes 13
C-A-B, When to Use an AED Workbook: PRO Page 8 Use an AED as soon as possible If an AED is immediately available, use the AED. If a second rescuer is available and an AED is immediately available: o The first rescuer should continue CPR while the second rescuer powers on the AED and applies the pads. o The second rescuer will clear the victim (stop CPR, and make sure no one is touching the victim or his clothes) before shocking. Use an AED as soon as possible: If a second rescuer is available, the first rescuer should continue CPR while the second rescuer powers on the AED and applies the pads. The second rescuer will clear the victim (make sure no one is touching the victim or his clothes) before shocking. Child CPR; Checking Response, Breathing and Pulse, and Activating EMS Workbook: Pro Page 18 Check Response and yell for help: Check Response and Breathing: Tap the shoulder and shout. Tap the shoulder and shout. If no response, yell for nearby help. While checking for response, scan for breathing for o Send bystander to activate response team and 5-10 seconds. retrieve AED If no response and no breathing or only gasping, yell for o If alone with a mobile device: activate response help. Send someone to call 9-1-1 and get the AED. If alone, Check Breathing AND Pulse for 5-10 seconds stay with the child. Check Pulse for 5-10 seconds 2015, EMS Safety Services, Inc. G2015 Interim Program Changes 14
Infant CPR; Checking Response, Breathing and Pulse, and Activating EMS Workbook: Pro Page 20 Check Response and yell for help: Check Response and Breathing: Tap the bottom of the foot and shout. Tap the bottom of the foot and shout. If no response, yell for nearby help. While checking for response, scan for breathing for o Send bystander to activate response team and 5-10 seconds. retrieve AED If no response and no breathing or only gasping, yell for o If alone with a mobile device: activate response help. Send someone to call 9-1-1 and get the AED. If alone, Check Breathing AND Pulse for 5-10 seconds activate EMS and get the AED yourself. Check Pulse for 5-10 seconds Advanced Equipment, Advanced Airways (Single Rate for Rescue Breaths) Workbook: Pro Page 40 For victims of all ages provide: For victims of all ages provide: 1 breath every 6 seconds (10 breaths/minute) 1 breath every 6 8 seconds (8 10 breaths/minute) 100-120 compressions/minute without pauses for breaths At least 100 compressions/minute without pauses for breaths 2015, EMS Safety Services, Inc. G2015 Interim Program Changes 15