Upcoming Events
EFR Updates
EFR New Emergency Care Guidelines
In October of 2010, the American Heart Association (AHA) and the European Resuscitation Council (ERC), two members of the International Liaison Committee on Resuscitation (ILCOR), released new CPR and Emergency Cardiac Care (ECC) guidelines. Other large ILCOR resuscitation councils, such as the Australian Resuscitation Council (ARC) and the New Zealand Resuscitation Council (NZRC) have now also released their guidelines. Emergency First Response and PADI programs follow guidelines established by these ILCOR member associations and implement changes whenever protocols are revised.
The 2010 guidelines represent the most extensive research into emergency cardiac care to date. These are based on extensive review of various studies, literature, debates and discussions by international resuscitation experts.
The new guidelines do not show a great change from Guidelines 2005 and further reinforce emphasis on providing effective chest compressions with minimal interruptions. Studies have shown the importance of providing fast, effective chest compressions as a critical aspect in treating a patient who has suffered cardiac arrest.
Most practices, such as the compression to ventilation ratio of 30:2, have not changed. Compression only CPR continues as a recommendation for untrained individuals. However, the recommendation remains for the trained lay rescuer to perform compressions and ventilations. A summary of the changes in administering CPR and AEDs for both ERC and AHA follows.
|
New Guideline |
Old Guideline |
Rational for Change |
|
No look, listen, and feel for breathing. |
"Look, listen and feel" for breathing before administering rescue breaths and chest compressions. |
Minimize the delay in providing chest compressions. |
|
Begin CPR by providing 30 chest compressions, then open the airway and give two breaths. If you suspect possible drowning, begin with CPR with rescue breaths before chest compressions. |
Give two rescue breaths prior to giving 30 chest compressions. |
Existing oxygen in the lungs and in the circulatory system is sufficient to provide the immediate benefits provided by chest compressions. |
|
Compress adult chest to a depth of at least five centimetres/two inches. |
Compression depth of 4-5 centimetres/1.5-2 inches for adults. |
Emphasis is on providing good quality chest compressions with sufficient depth to provide adequate circulation. |
|
Compression depth for children and infants is one third the diameter of the chest. This corresponds to approximately five centimetres/two inches for children and 4 centimetres/1.5 inches for infants. |
Administer chest compressions at one third to one half of the diameter of the chest for child and infant CPR. |
Emphasis is on providing quality compressions of an adequate depth. |
|
Give compressions at a rate of at least 100 per minute. |
Give compression at a rate of approximately 100 per minute. |
Emphasis is on good quality chest compressions at a rate to provide adequate circulation. |
|
To minimize interruptions in chest compressions, if there is more than one rescuer present, continue CPR while the AED is switched on and the pads are being placed on the patient. |
No reference to continuing chest compressions while preparing the AED. |
Emphasis is on reducing the number and duration of pauses during chest compressions. |
|
For infants (less than one year of age) use of an AED with pediatric dose attenuation (reducer) is recommended. An AED without a dose attenuator may be used if a pediatric one is not available. |
AED use for infants (less than one year of age) was not recommended. |
Use of AED on infants has shown to be effective. |
|
Reduced emphasis on barriers when providing CPR. Although still recommended, treatment should not be delayed if barriers are not available. |
Emphasized use of barriers. |
Research has shown that chance of disease transmission is very rare when providing CPR. |
American Heart Association (AHA) First Aid Changes
Allergic Reactions:
For patients carrying an epinephrine kit, help the patient use it following directions. If symptoms of anaphylaxis persist despite epinephrine administration, first aid providers should seek medical assistance before administering a second dose of epinephrine. In unusual circumstances when advanced medical assistance is not available, a second dose of epinephrine may be given if symptoms of anaphylaxis persist.
Heart Attack:
Advise the patient to chew one adult (non-enteric-coated) or two low dose "baby" aspirins if the patient is complaining of chest pains and does not have a history of allergy to aspirin and no recent gastrointestinal bleeding. This may be performed after activating the EMS system.
Venomous Bites and Stings:
-
When treating for snake bites, apply a pressure immobilization bandage around the entire length of the bitten extremity. This is an effective and safe way to slow the dissemination of venom. Care must be taken to ensure the pressure bandage is not too tight. You should be able to slide a finger under the bandage.
-
Treat jellyfish stings by liberally washing the affected area with vinegar (4-6 percent acetic acid solution) for at least 30 seconds to deactivate venom and prevent further envenomation. After the nematocysts are removed or deactivated, the pain from jellyfish stings should be treated with hot water immersion when possible.
Implementing the New Guidelines into Emergency First Response Programs
You should implement these changes into your courses immediately but implementation is required no later than 31 March 2011. To keep EFR and PADI courses current and internationally applicable, course materials are being revised to reflect these recent guidelines.
After a thorough review of the changes, list them out and add them into your teaching outline at the appropriate points. This step makes it easy to be sure - and lets you tell your participants with confidence - that you're teaching the program according to the latest guidelines.
