Canadian First Aid Manual Revisions (Eleventh Printing, May 2013) Prepared by Ontario and Alberta Branch March 14, 2016 PURUPOSE To update the Canadian First Aid Manual in accordance with: 2015 ILCOR & AHA Guidelines for CPR and First Aid Canadian Guidelines Consensus Task Force Lifesaving Society, St. John Ambulance, Canadian Red Cross, Canadian Heart & Stroke Foundation, Canadian Ski Patrol Editorial corrections or clarifications Typos, affiliate feedback, workplace legislation requirements, typesetting and copyright OFC IFC Replace 2010 with 2015 in upper left corner and change colour from red to something else. Editorial review and proof Comments TBD Pg i Pg ii Replace 2010 with 2015 in upper left corner and change colour from red to something else. Top header The 2010 Resuscitation Guidelines Replace: year 2010 with 2015 in header. Replace 2010 with 2015 for 1 st, 2 nd and 3 rd paragraph. Replace the year 2010 with 2015 in first paragraph in 1 st paragraph. Reword: 2 nd paragraph, 1 st bullet, 2 nd sentence to read Fast means at least 100 compressions/minute to 120 compressions/minutes to a depth of 5 cm/2 inches but not greater than 6 cm/2.4 inches for adults. Reword: 3 rd paragraph 1 st sentence The 2015 guidelines continue to emphasize starting CPR with compressions rather than rescue breaths for cardiac arrest victims.
CFAM Revisions March 2016 2 Pg ii Pg iii Pg. 8 Pg. 26 Pg. 27 Pg. 28 Acknowledgements: 1 st and 3 rd paragraph Suggestion: Add the following name to the 2 nd paragraph of the last sentence, TBD Introduction: Editorial review and proof TBD Stay on the line: add new last sentence Suggestion: Reword 2 nd bullet to read You can use the speaker mode on your mobile device to follow instructions from the EMS dispatcher e.g. following CPR instructions. Rational: AHA guidelines note the importance and increased use of mobile phones in activating EMS as well as assisting bystanders with dispatcher guided CPR. Recovery Position for Spinal-Injured Victims: Suggestion Alternate recovery position delete second sentence. Use of a recovery position may be necessary with a suspected spinal-injured victim Rational: AHA/ILCOR guidelines, have downgraded effectiveness and use (very-low-quality evidence) for a spinal recovery position. Side bar: DEPTH how far to push down the breastbone Suggestion: Rewrite adult depth to read Adult: At least 5 cm (2 in.) but no more than 6 cm (2.4 in.) Rational: AHA updated guidelines emphasize a range for minimum and maximum depth for adult compressions. Side bar: Three tips for good effective CPR. Suggestion: Add range of compressions to 1 st sentence (100/min. to 120/min.). Forceful, fast CPR provides Rational: AHA updated guidelines emphasize a range for minimum and maximum rate for adult/child/infant compressions.
CFAM Revisions March 2016 3 Pg. 28 Pg. 28 Pg. 28 Counting: 2 nd paragraph Suggestion: Reword 1 st sentence to read Aim for a minimum of 100 compressions per minute to a maximum of 120 compressions per minute, or just under two compressions per second. This means 30 compressions in 15 to 18 seconds. Rational: AHA updated guidelines emphasize a range for minimum and maximum compression rate for adults, children and infants. Counting: 2 nd paragraph Suggestion: Reword last sentence, delete reference to you can t go too fast If you get lost in all the counting, don t worry, keep performing chest compression to the best of your ability. Rational: AHA guidelines emphasize a range for minimum and maximum compression rate, but going too fast (greater than 120 compressions per minute) may negatively affect survival outcomes. Add new header: Feedback devices Suggestion: add the following text Advances in technology have lead to a wide range of new CPR feedback devices helping you keep track of the rate, depth and number of compressions delivered to a victim. This includes various apps on mobile phones or small puck sized devices placed directly on the victim s chest providing instant feedback to the rescuer when performing CPR. The science for better CPR and new devices is ongoing, however you alone are the most important device to save a life and make a difference; remember to always PUSH HARD and PUSH FAST whether a CPR feedback device is available or not. Rational: AHA guidelines emphasize the increased popularity and potential of mobile phones and feedback devices to assist rescuers in performing effective CPR.
CFAM Revisions March 2016 4 Pg. 34 Pg. 35 Pg. 36 Angina and heart attack: under Treatment Suggestion: 5 th bullet, reword 2 nd sentence victim chew 2 children s ASA tablets or 1 adult tablet. To victim chew 1 adult or 2 low dose ASA tablets. Rational: updated reference from Canadian Consensus Guidelines. Stroke: Under Signs and Symptom Suggestion: add new last bullet, see sidebar F.A.S.T. <Sidebar> F.A.S.T. The term F.A.S.T. is used to help assess a suspected stroke victim. Face Arms Speech Time. Is their Face drooping; ask if they can smile? Is one arm weak or numb; ask if can they raise one or both Arms, does one arm drift downward? Is their Speech slurred or impaired; ask if they can repeat a simple sentence? If you notice one or any of these signs do not delay, it is Time to act, call EMS. Rational: AHA updated guidelines emphasize the F.A.S.T. mnemonic for first aid assessment. Major bleeding: Treatment Suggestion: Add new last bullet, sidebar and photos (adjust / resize photos as needed to fit content) Tourniquet: When direct pressure fails to control lifethreatening external limb bleeding a tourniquet could be considered. <Sidebar> Applying a tourniquet: A commercial tourniquet consists of a Velcro band and one-handed crank system used to tighten the band around the entire circumference of the wound. Place the band just above the wound and turn the crank until bleeding stops. Once bleeding has stopped secure the crank into the locking position of the tourniquet. <Sidebar> Insert picture tourniquet Rational: AHA/ILCOR guidelines, first aiders should consider the use of tourniquets when direct pressure fails for massive external limb bleeding.
CFAM Revisions March 2016 5 Pg. 45 Allergies: Sidebar, top right AUTO-INJECTORS Suggestion 1: Replace side bard content under AUTO- INJECTORS with. An auto-injector is designed to administer a premeasured amount of medication. Follow the manufactures instructions for administration. (KEEP EpiPen photos.) Suggestion 2: Delete all TwinJect content and photos Suggestion 3: under Treatment add new last bullet to read A second dose may be given if signs and symptoms do not improve within 5 minutes. Suggestion 4: delete very last sentence under Treatment *If you suspect a dose of epinephrine is. proceeding. Rational: TwinJect has been discontinued in the market. AHA guidelines note a second dose may be required for some victims of anaphylaxis if the first dose is not effective and EMS arrival will exceed 5-10 minutes. Pg. 46 Diabetes: under Treatment replace 3 rd to 7 th bullet with Suggestion: If conscious, help victim self-administer prescribed medication or sugar in other types of dietary sugars preferably in order of: Glucose tablets Candy (e.g. Mentos, Skittles, Jelly beans) Orange juice or other fructose juice drinks Rational: AHA/ILCOR guidelines note glucose tables are the preferred treatment for hypoglycemia and if not available other sugary foods are recommended as listed in order of preference by name.
CFAM Revisions March 2016 6 Pg. 49 Pg. 49 Pg. 49 Wounds: under Treatment Suggestion: Reword 1 st bullet Gently clean affected area by flushing with clean water, tap water, over the wound. Rational: AHA/ILCOR guidelines, first aiders should flush a wound to help with irrigating of foreign material. Applying a soapy water solution is no longer required, also consistent with wording on page 48, 2 nd last paragraph. Wounds: under Treatment Suggestion: Add new 2 nd sentence to 2 nd bullet, to read (resize photo to fit content if needed) Apply a sterile dressing (e.g. adhesive bandage strip). For superficial wounds and abrasions apply an antibiotic ointment to promote healing. Rational: AHA/ILCOR guidelines, first aiders should consider the use triple antibiotic ointment or cream to promote faster healing of skin abrasions. Amputation: under Treatment Suggestion: Reword 2 nd bullet Apply direct pressure to control bleeding. If direct pressure fails consider using a commercial tourniquet. See how to apply a tourniquet on page 36. Rational: AHA/ILCOR guidelines, first aiders should consider the use of tourniquets when direct pressure fails for massive external limb bleeding. Pg. 52 Head Injuries: Suggestion 1: reword 2 nd paragraph, #2 to read 2. Brain injury such as bleeding within the brain or just under the skull (compression injury); or a blow transmitted to the head (concussion injury). Suggestion 2: under Signs and symptoms 4 th bullet, add blurred vision sentence to read Blurred vision, nausea and vomiting
CFAM Revisions March 2016 7 Suggestion 3: Under Treatment, add new 4 th bullet For a suspected concussion, stop the sport or recreational activity and seek medical help. Suggestion 4: add new sidebar tilted Concussion (adjust page layout to fit with sidebar Bumps on the head ) A concussion is a brain injury caused by either a direct blow to the head, face, neck or elsewhere on the body transmitted to the head. A concussion should be suspected in the presence of one or more signs or symptoms listed and can take up to a few days to appear. Rational: ILCOR / AHA Guidelines have identified the complexity in treatment for suspected head and/or concussions. Emphasis is placed on seeking medical help. Suggestion 5: Under Treatment, reword 2 nd bullet to read Immobilize spine if you suspect a neck or spinal injury (see spinal injuries). Rational: not all head injuries require immobilization Pg. 55 Pg. 59 Recovery Position for Spinal-Injured Victims: Suggestion: pg. 55 Delete header and all text Rational: AHA/ILCOR guidelines, have downgraded effectiveness and use (very-low-quality evidence) for a spinal recovery position. Add new Sidebar (bottom left): USE of Spineboard / Backboard Suggestion: SPINEBOARS: Also known as backboards, are often used as a removal device for a suspected spinal victim. EMS will use additional patient assessment protocols and may decide to remove the spineboard when preparing to transport the victim. Rational: New Brunswick and British Columbia EMS have moved away from transporting spinal victims to hospital via a backboard, other provinces to follow.
CFAM Revisions March 2016 8 Pg. 60 Pg. 61 Pg. 63 Dental and mouth injury: under Treatment 5 th bullet replace with following. Suggestion: Teeth can be salvaged, hold from the crown and do not clean the tooth, this can damage the roots. Place in a balanced salt solution (e.g. Hank s Salt Solution). Alternatives include egg white, coconut water, whole milk and saline. If none are available then store the tooth in the injured victims own saliva (not in the mouth). Do not try and reinsert the tooth because it can injure the victim or harm the tooth. Rational: ILCOR Guidelines and the Canadian Consensus Guidelines have updated the treatment for an avulsed tooth with specific solutions best suited for preservation. Nosebleeds and nose injuries: under Treatment 1 st bullet, add the following. Suggestion: head slightly tilted forward. This helps any blood drain from the nose or mouth instead of back into the throat. Rational: missing content from last reprint. The Ontario first aid written test references the treatment for a nosebleed with head tilted forward applying pressure. Sucking chest wound: delete photo and replace 1 st and 2 nd bullets under treatment with. Suggestion: Only apply a non-occlusive* dressing. The dressing must be changed immediately if it becomes blood soaked. Alternatively leave the wound exposed to prevent a tension pneumothorax (see side bar). Apply direct pressure only if there is massive external bleeding. *This is a special type of dressing, which is non-adhering and permeable, allowing liquids or gasses to pass through. Rational: AHA/ILCOR Guidelines no longer recommends tapping a plastic dressing or covering an open chest wound with an occlusive dressing.
CFAM Revisions March 2016 9 Pg. 69 Pg. 76 Electrical burns: under Treatment 2 nd bullet, delete 2 nd and 3 rd sentence and replace with new sentence. Suggestion: Only EMS or the electrical company should handle high voltage wires and power lines. Do not attempt to use a stick or plastic pole to remove a fallen wire from the victim. Stay well back. Rational: Using a wooden stick or pole is no longer recommended by electrical authorities for removing fallen power lines at an emergency scene. Frostbite: under Treatment Suggestion 1: add text to 4 th bullet The ideal water temperature is between 37 to 40 Celsius for 20-30 minutes. Rational: Scientific review showed that rapid rewarming with water baths between 37-40 degrees for 20-30 minutes improved outcomes and reduced tissue loss. Suggestion 2: add new sentence to end of 6 th bullet Do not apply chemical warmers (e.g. pocket warmers) directly on frostbitten tissue. The high temperatures produced from chemical warmers can cause more harm, potentially burning the injured tissue. Rational: Canadian Consensus Guidelines note chemical heat packs produce high temperatures (69-74 C). This is too high for treatment of frostbitten tissue. Pg. 84 Oxygen Administration: under Treatment Suggestion 1: replace 4 th paragraph You can use oxygen to supplement with new content You can use oxygen to supplement treatment for a drowning victim, decompression sickens, carbon monoxide poisoning or for victims who warrant the administration of oxygen indicated by a pulse oximeter. A victim with a pulse oximetry reading of less than 94% oxygen should receive oxygen. (See page 88, Pulse Oximetry).
CFAM Revisions March 2016 10 Suggestion 2: under Treatment add new last sentence after the sentence Continually monitor the victim s breathing and vital signs. The use of oxygen should never delay resuscitation including opening the airway, rescue breathing or chest compressions. Pg. 88 Add new header and photo: Pulse Oximetry (photo of pulse oximeter on fingertip) A pulse oximeter measures how much oxygen the blood is carrying (SpO2), shown as a percentage. It works by calculating the absorption of red and infrared light in the blood of your fingertip. Using a pulse oximeter: place on the victims finger (e.g. index or ring finger). A percentage of total oxygen saturation is detected and displayed. False readings: are possible if there is nail polish, cold hands, significant movement, bright lights directed onto the oximeter or a victim suffering from carbon monoxide poisoning. Rational: Canadian Consensus Guidelines recommend the use of supplemental oxygen should be administered if SpO2 levels are less than 94% or for victims suffering from drowning, decompression sickness or carbon monoxide poisoning. INDEX pg. 91: under T add Tourniquet pg. 91: under P add Pulse Oximetry