2010 Guidelines
Instructor Update
Welcome !
•
This class will provide you with information
about the recently released changes in
emergency medical care and how those
changes affect your authorization as an ASHI or
MEDIC First Aid Instructor.
Purpose of Class
• Highlight the major changes in science,
treatment recommendations, and guidelines.
• Provide helpful guidance to you for the transition
to new materials.
Learning Objectives
• Identify the four central publications for changes
in the 2010 science, treatment
recommendations, and guidelines.
• Identify the scheduled release dates for updated
training programs.
• Describe the significant changes affecting ASHI
and MEDIC First Aid training programs.
• Describe the rationale for the changes being
made.
Who is HSI?
About HSI
• The Health & Safety Institute (HSI) unites the
recognition and expertise of:
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American Safety & Health Institute
MEDIC FIRST AID International
24-7 EMS
24-7 Fire
– First Safety Institute
• HSI is the largest privately held emergency care
training organization in the world.
Proven Track Record
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In business for more than 30 years.
In more than 100 countries.
Over 16,000 training centers approved.
Over 200,000 Instructors authorized.
• More than 19 million providers certified.
Training Structure
• HSI develops and markets proprietary training
programs, products, and services to approved
Training Centers.
• Instructors are authorized by Training Centers to
certify course participants who successfully
complete a training program.
Approved for Use
• HSI’s basic and professional level programs are
endorsed, accepted, approved, or meet the
requirements of more than 1800 Federal and
state regulatory agencies and occupational
licensing boards.
2010 ILCOR Conference
• HSI participated in the 2010 International
Committee on Resuscitation (ILCOR)
International Conference on CPR and ECC
Science with Treatment Recommendations.
International First Aid Advisory Board
• HSI representatives were members of the 2005
National and 2010 International First Aid Advisory
Board founded by the AHA and ARC.
• HSI representatives contributed to both the 2005
and 2010 Consensus on First Aid Science and
Treatment Recommendations.
Integrating 2010 Science,
Treatment Recommendations,
and Guidelines
Where do guidelines come from?
• Multi-year process involving resuscitation
experts from around the world
• Results in the following publications:
– 2010 Science and Treatment Recommendations
• ILCOR International Consensus on CPR and ECC
• AHA and ARC International Consensus on First Aid
– 2010 Training Guidelines
• 2010 AHA Guidelines for CPR and ECC
• 2010 AHA and ARC Guidelines for First Aid
2010 Guidelines
• The science and guidelines were published in
the journal Circulation on October 18th, 2010
• They are both freely available at
www.hsi.com/2010guidelines
New Program Development
• In order to integrate the 2010 guidelines, time is
required to make systematic and organized
changes to our products.
• We are currently revising all of our emergency
care training materials.
• New training materials will be released
throughout 2011.
Source References
• 2010 International Consensus on Cardiopulmonary
Resuscitation and Emergency Cardiovascular Care
Science With Treatment Recommendations
• 2010 American Heart Association and American Red
Cross International Consensus on First Aid Science With
Treatment Recommendations
• 2010 American Heart Association Guidelines for
Cardiopulmonary Resuscitation and Emergency
Cardiovascular Care
• 2010 American Heart Association and American Red
Cross Guidelines for First Aid
Interim Training Materials
• We have created interim training materials that
allow Instructors to immediately start incorporating
some of the most significant changes into current
(2005) training materials.
• The interim materials are only intended to be used
until the new training programs are made
available.
• Use of the interim materials is an option and not a
requirement. Instructors can continue to use the
current (2005) materials as designed.
Using (2005) Materials
• The release of new science and treatment
recommendations do not imply that emergency
care or instruction involving the use of previous
recommendations science and treatment
recommendations is unsafe.
Support for Current Materials
• You may continue to purchase and teach using
current (2005) training materials until the new
programs are available.
• Support for the current materials will continue
until December 31, 2011, or until the inventory of
the materials is depleted.
Planned 2nd Quarter 2011 Release
• ASHI
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CPR and AED
Basic First Aid
CPR, AED, and Basic First Aid Combination
CPR Pro
• MEDIC First Aid
– CarePlus CPR and AED
– BasicPlus CPR, AED, and First Aid
Planned 3rd Quarter 2011 Release
• ASHI
– Advanced Cardiac Life Support (ACLS) *
– Bloodborne and Airborne Pathogens
• MEDIC First Aid
– PediatricPlus CPR, AED, and First Aid for Children,
Adults, and Infants
– CPR and AED Child/Infant Supplement
– Bloodborne and Airborne Pathogens
*Release date is dependent on third party production.
Planned 4th Quarter 2011 Release
• ASHI
– Pediatric Advanced Life Support (PALS)*
– Child and Babysitting Safety Course (CABS)
*Release date is dependent on third party production.
Update Requirements
Need to Know
• Every Instructor needs to understand the
guideline changes that affect the program(s) he
or she is authorized to teach.
• In the following pages we have organized the
most significant guideline changes by area and
training level.
• For each identified change, the lesson provides
the 2005 guideline for reference, the updated
2010 guideline, and the reason for the change.
Lay and Healthcare Providers
• Some of the lessons cover lay providers and
some cover healthcare providers.
• Even though an Instructor may only teach a
single provider level, the comparison information
from the other level may be valuable for
understanding and ability to answer student
questions.
ACLS and PALS
• Specific information regarding the changes in
our advanced training programs, ASHI ACLS
and ASHI PALS is not included in this
presentation.
• The information is provided in the HSI 2010
Updated Training Guidelines Supplement found
in the document section of the online Instructor
Portal.
CPR and AED
Emphasis on High-Quality CPR
2005 Guidelines
“… blood flow is optimized by using the recommended chest compression
force and duration and maintaining a chest compression rate of
approximately 100 compressions per minute. These guidelines
recommend that all rescuers minimize interruption of chest compressions
… CPR instruction should emphasize the importance of allowing complete
chest recoil between compressions.”
(Circulation. 2005; 112: IV19-IV34)
Emphasis on High-Quality CPR
2010 Guidelines
“To provide effective chest compressions, push
hard and push fast. … compress the adult chest
at a rate of at least 100 compressions per
minute with a compression depth of at least 2
inches/5 cm. … allow complete recoil of the
chest after each compression, to allow the heart
to fill completely before the next compression.
… minimize the frequency and duration of
interruptions in compressions to maximize the
number of compressions delivered per minute.
(Berg, et al. Circulation. 2010;122;S685-S705)
Highlights
• This is a re-emphasis from 2005.
• For effective compressions:
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–
–
–
Push fast
Push hard
Allow chest to fully recoil
Minimize any interruptions
• Applies to both lay and healthcare providers.
Rationale For Change
• High-quality chest compressions within CPR
continues to be a critical focal point.
• Well-performed compressions increase the
likelihood of survival.
Compression Hand Position
2005 Guidelines
“The rescuer should compress the lower half of the victim’s sternum in the
center (middle) of the chest, between the nipples. The rescuer should
place the heel of the hand on the sternum in the center (middle) of the
chest between the nipples and then place the heel of the second hand on
top of the first so that the hands are overlapped and parallel.”
(Circulation. 2005; 112: IV19-IV34)
Compression Hand Position
2010 Guidelines
“The rescuer should place the heel of one hand
on the center (middle) of the victim’s chest
(which is the lower half of the sternum) and the
heel of the other hand on top of the first so that
the hands are overlapped and parallel.”
(Berg, et al. Circulation. 2010;122;S685-S705)
Highlights
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•
•
•
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Hands in center of the chest.
Lower half of breastbone
Second hand on top of the first.
Not on lowest part of breastbone.
Applies to both lay and healthcare providers.
Rationale For Change
• Use of the nipple line as a landmark for
hand placement was found to be unreliable.
Compression Rate
2005 Guidelines
“There is insufficient evidence from human studies to identify a single
optimal chest compression rate. Animal and human studies support a
chest compression rate of >80 compressions per minute to achieve
optimal forward blood flow during CPR. We recommend a compression
rate of about 100 compressions per minute.”
(Circulation. 2005; 112: IV19-IV34)
Compression Rate
2010 Guidelines
“It is reasonable for laypersons and healthcare
providers to compress the adult chest at a
rate of at least 100 compressions per minute
with a compression depth of at least 2 inches
(5 cm.)”
(Berg, et al. Circulation. 2010;122;S685-S705)
Highlights
• “At least” 100 times per minute.
• It is okay to be a little faster.
• Applies to both lay and healthcare providers.
Rationale For Change
• It has been found that higher survival rates are
associated with an increase in the number of
compressions provided per minute.
Child/Infant Compression Rate
2005 Guidelines
“Push fast; push at a rate of approximately 100 compressions per
minute.”
(Circulation. 2005; 112: IV156-IV166)
Child/Infant Compression Rate
2010 Guidelines
“Push fast; push at a rate of at least 100
compressions per minute.”
(Berg, et al. Circulation. 2010;122;S862-S875)
Highlights
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•
•
•
Rescuers tend to compress slower.
“At least” 100 compressions per minute.
It is okay to be a little faster.
Applies to both lay and healthcare providers.
Rationale For Change
• It has been found that higher survival rates are
associated with an increase in the number of
compressions provided per minute.
Compression Depth
2005 Guidelines
“Depress the sternum approximately 1 ½ to 2 inches (approximately 4 to
5 cm) and then allow the chest to return to its normal position.”
(Circulation. 2005; 112: IV19-IV34)
Compression Depth
2010 Guidelines
“It is reasonable for laypersons and healthcare
providers to compress the adult chest at a rate of
at least 100 compressions per minute with a
compression depth of at least 2 inches/5 cm.”
(Berg, et al. Circulation. 2010;122;S685-S705)
Highlights
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•
•
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“At least” 2 inches on an adult.
It is okay to compress a little deeper.
Not enough information to define upper limit.
Applies to both lay and healthcare providers.
Rationale For Change
• Research indicates the tendency for CPR
providers to not compress deep enough, even
with the emphasis to "push hard."
Child/Infant Compression Depth
2005 Guidelines
“‘Push hard’: push with sufficient force to depress the chest approximately
one third to one half the anterior-posterior diameter of the chest.”
(Circulation. 2005; 112: IV156-IV166)
Child/Infant Compression Depth
2010 Guidelines
“Chest compressions of appropriate rate and
depth. ‘Push fast’: push at a rate of at least 100
compressions per minute. ‘Push hard’: push
with sufficient force to depress at least one
third the anterior-posterior (AP) diameter of
the chest or approximately 1 ½ inches (4 cm)
in infants and 2 inches (5 cm) in children.”
(Berg, et al. Circulation. 2010;122;S862-S875)
Highlights
• “At least” 1/3 of the anterior/posterior diameter of
chest.
• About 2 inches for children and about 1 ½
inches for infants.
• It is okay to compress a little deeper
• Applies to both lay and healthcare providers.
Rationale For Change
• Research indicates the tendency for CPR
providers to not compress deep enough, even
with the emphasis to "push hard."
Breathing Assessment
2005 Guidelines
“While maintaining an open airway, look, listen, and feel for breathing.”
(Circulation. 2005; 112: IV19-IV34)
Breathing Assessment
2010 Guidelines
“After activation of the emergency response system, all rescuers should
immediately begin CPR for adult victims who are unresponsive with no
breathing or no normal breathing (only gasping).”
(Berg, et al. Circulation. 2010;122;S685-S705)
Highlights
• No more look, listen, and feel.
• Quick “look” for no breathing or no normal
breathing.
• Agonal breaths remain a concern.
• Applies to both lay and healthcare providers.
Rationale for Change
• Simplifying the breathing assessment is
intended to help laypersons respond more
quickly with chest compressions and CPR.
• There is a high likelihood of agonal, or irregular,
gasping breaths to occur early in cardiac arrest
and confuse rescuers.
CPR Sequence - Lay
2005 Guidelines
For an unresponsive person who is not breathing or not breathing
normally, begin CPR by opening the airway and giving 2 rescue breaths
followed with 30 chest compressions. Repeat cycles of 30:2 (ABC
method).
(Summary from Circulation. 2005; 112: IV19-IV34)
CPR Sequence - Lay
2010 Guidelines
For an unresponsive person, activate EMS,
then assess breathing. If the person is not
breathing or not breathing normally, begin CPR
with 30 compressions followed by opening the
airway and giving 2 rescue breaths. Repeat
cycles of 30:2 (CAB method).
(Summary from Berg, et al. Circulation.
2010;122;S685-S705)
Highlights
• Initial assessment steps:
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–
–
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Assess responsiveness
Activate EMS
Assess breathing
Perform CPR
• CAB – begin CPR cycles with compressions,
followed by airway and breathing.
• Guideline applies to adults, children, and infants.
Rationale For Change
• The science indicates the importance of not
delaying chest compressions to perform rescue
breaths.
• Early chest compression can immediately
circulate oxygen that is still in the bloodstream.
CPR Sequence - HCP
2005 Guidelines
For an unresponsive person who is not
breathing or not breathing normally, begin CPR
by opening the airway and giving 2 rescue
breaths followed with 30 chest compressions.
Repeat cycles of 30:2 (ABC method).
(Summary from Circulation. 2005; 112: IV19IV34)
CPR Sequence - HCP
2010 Guidelines
For an unresponsive person who is not
breathing or not breathing normally, and has no
obvious pulse, activate EMS and begin CPR
with 30 compressions followed by opening the
airway and giving 2 rescue breaths. Repeat
cycles of 30:2 (CAB method).
(Summary from Berg, et al. Circulation.
2010;122;S685-S705)
Highlights
• Initial assessment approach:
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Assess responsiveness and breathing
Activate EMS
Assess pulse
Perform CPR
• CAB – begin CPR cycles with compressions,
followed by airway and breathing.
Rationale For Change
• The science indicates the importance of not
delaying chest compressions to perform rescue
breaths.
• Early chest compression can immediately
circulate oxygen that is still in the bloodstream.
Use of an AED on an Infant
2005 Guidelines
“There is insufficient data to make a
recommendation for or against the use of AEDs
for infants 1 year of age.”
(Circulation. 2005; 112: IV156-IV166)
Use of an AED on an Infant
2010 Guidelines
“Many AEDs have high specificity in recognizing
pediatric shockable rhythms, and some are
equipped to decrease (or attenuate) the
delivered energy to make them suitable for
infants and children < 8 years of age. For
infants … an AED equipped with a pediatric
attenuator is preferred for infants. If neither is
available, an AED without a dose attenuator
may be used.”
(Link, et al. Circulation. 2010;122;S706-S719)
Highlights
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•
•
•
Success at defibrillating infants.
Use attenuator to reduce shock.
Okay to use AED set for adult.
Applies to both lay and healthcare providers.
Rationale For Change
• AEDs designed to be used on adults have been
successful when used on infants with out-ofhospital cardiac arrest.
• Minimal heart muscle damage and good
neurological outcomes were reported.
Chain of Survival
2005 Guidelines
•“Early recognition of the emergency and
activation of the emergency medical services
(EMS) or local emergency response system
•Early bystander CPR
•Early delivery of a shock with a defibrillator
•Early advanced life support followed by post
resuscitation care delivered by healthcare
providers”
(Circulation. 2005; 112: IV12-IV18)
Chain of Survival
2010 Guidelines
“These actions are termed the links in the ‘Chain
of Survival.’ For adults they include:
 Immediate recognition of cardiac arrest and
activation of the emergency response system
 Early CPR that emphasizes chest
compressions
 Rapid defibrillation if indicated
 Effective advanced life support
 Integrated post– cardiac arrest care.”
(Travers, et al. Circulation. 2010;122;S676-S684)
Highlights
• Addition of fifth link in chain.
– Integrated post-cardiac arrest care.
• Applies to both lay and healthcare providers.
Rationale For Change
• Links in the “Chain of Survival” indicate the
individual actions that must be strong in
order for a person to survive a sudden
cardiac arrest.
• The addition of the fifth link, integrated postcardiac arrest care, further emphasizes the
additional dependence on longer-term care
for long-term survival.
Cricoid Pressure - HCP
2005 Guidelines
“Cricoid pressure should be used only if the
victim is deeply unconscious.”
(Circulation. 2005; 112: IV19-IV34)
Cricoid Pressure - HCP
2010 Guidelines
“The routine use of cricoid pressure in adult
cardiac arrest is not recommended.”
(Berg, et al. Circulation. 2010;122;S685-S705)
Highlights
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•
•
•
Cricoid may impede ventilation.
Difficult to teach.
May prevent advanced airway placement.
Aspiration may still occur.
Rationale For Change
• Regardless of expertise, rescuers cannot
effectively apply cricoid pressure.
Team Approach - HCP
2005 Guidelines
“When multiple rescuers are present, they should rotate the compressor
role about every 2 minutes. The switch should be accomplished as quickly
as possible (ideally in less than 5 seconds) to minimize interruptions in
chest compressions.”
(Circulation. 2005;112:IV-12-IV-17)
Team Approach - HCP
2010 Guidelines
“The intent of the algorithm is to present the steps of BLS in a logical and
concise manner that is easy for all types of rescuers to learn, remember and
perform. These actions have traditionally been presented as a sequence of
distinct steps to help a single rescuer prioritize actions. However, many
workplaces and most EMS and in-hospital resuscitations involve teams of
providers who should perform several actions simultaneously (e.g.: one
rescuer activates the emergency response system while another begins chest
compressions, and a third either provides ventilations or retrieves the bagmask for rescue breathing, and a fourth retrieves and sets up a defibrillator).”
(Berg, et al. Circulation. 2010;122;S685-S705)
Highlights
• Tasks can be performed simultaneously.
• Integrate additional rescuers as they arrive.
• Designate team leader with multiple
rescuers.
Rationale For Change
• Some resuscitations start with a lone rescuer
and builds to more, whereas other resuscitations
begin with several willing rescuers.
• Training should focus on building a team and
performing tasks simultaneously.
Emergency Care / First Aid
For Lay Providers
Pressure Points and Elevation
2005 Guidelines
“There is insufficient evidence to recommend for
or against the first aid use of pressure points or
extremity elevation to control hemorrhage.”
(Circulation. 2005; 112: IV196-IV203)
Pressure Points and Elevation
2010 Guidelines
“Elevation and use of pressure points are not
recommended to control bleeding.”
(Markenson, et al. Circulation. 2010;122;S934S946) )
Highlights
• Not recommended.
• Direct pressure is more effective.
• May compromise direct pressure.
Rationale For Change
• Elevation and pressure points are unproven
procedures that may compromise the proven
intervention of direct pressure, so they could be
harmful.
Tourniquets
2005 Guidelines
“The effectiveness, feasibility, and safety of
tourniquets to control bleeding by first aid
providers are unknown, but the use of
tourniquets is potentially dangerous.”
(Circulation. 2005; 112: IV196-IV203)
Tourniquets
2010 Guidelines
“Because of the potential adverse effects of
tourniquets and difficulty in their proper
application, use of a tourniquet to control
bleeding of the extremities is indicated only if
direct pressure is not effective or possible.
Specifically designed tourniquets appear to be
better than ones that are improvised, but
tourniquets should only be used with proper
training.”
(Markenson, et al. Circulation. 2010;122;S934S946)
Highlights
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•
•
•
Use only if direct pressure will not work.
Effective in certain conditions.
Commercial better than improvised.
Training necessary.
Rationale For Change
• Tourniquets have been shown to control
bleeding effectively and without complications
on the battlefield, during surgery, and when
used by paramedics in a civilian setting.
• There are no studies on controlling bleeding
with first aid provider use of a tourniquet.
Hemostatic Agents
2005 Guidelines
The use of hemostatic agents in first aid was
not covered in the 2005 science, treatment
recommendations, and guidelines.
Hemostatic Agents
2010 Guidelines
“Routine use of hemostatic agents in first aid
cannot be recommended at this time because of
significant variation in effectiveness by different
agents and their potential for adverse effects,
including tissue destruction with induction of a
proembolic state and potential thermal injury.”
(Markenson, et al. Circulation. 2010;122;S934)
Highlights
• Some are effective, others are marginal.
• Wide variety of results.
• Potential for adverse effects.
Rationale For Change
• The use of commercially available hemostatic
agents to control bleeding is not recommended
because the agent and conditions for its
application are not known.
Leg Elevation for Shock
2005 Guidelines
The use of elevation for the treatment of shock
in first aid was not covered in the 2005 science,
treatment recommendations, and guidelines.
Leg Elevation for Shock
2010 Guidelines
“If a victim shows evidence of shock, have the
victim lie supine. If there is no evidence of trauma
or injury, raise the feet about 6 to 12 inches (about
30° to 45°). Do not raise the feet if the movement
or the position causes the victim any pain.”
(Markenson, et al. Circulation. 2010;122;S934S946)
Highlights
• Lay victim flat.
• If no injury, elevate 6-12 inches.
• No elevation if pain occurs.
Rationale For Change
• Elevating the legs can be beneficial in cases in
which the mechanism of shock is related to
factors other than injury.
• The risk of further injury outweighs the benefit of
elevation when a person is injured.
Injured Extremity
2005 Guidelines
“If you are far from definitive health care, you
may stabilize the extremity in the position
found.”
(Circulation. 2005; 112: IV196-IV203)
Injured Extremity
2010 Guidelines
“If you are far from definitive health care, stabilize
the extremity with a splint in the position found. If
a splint is used, it should be padded to cushion
the injury.”
(Markenson, et al. Circulation. 2010;122;S934S946)
Highlights
• Stabilize with splint if away from medical help.
• Splint in position found.
• Use padding.
Rationale For Change
• Expert opinion suggests that splinting for an
extremity injury may reduce pain and prevent
further injury, especially when professional care
is delayed or it is decided to move the injured
person.
Aspirin for Chest Discomfort
2005 Guidelines
The use of aspirin for chest discomfort in first
aid was not covered in the 2005 science,
treatment recommendations, and guidelines.
Aspirin for Chest Discomfort
2010 Guidelines
“While waiting for EMS to arrive, the first aid
provider may encourage the victim to chew 1
adult (not enteric coated) or 2 low-dose ‘baby’
aspirin if the patient has no allergy to aspirin or
other contraindication to aspirin, such as
evidence of a stroke or recent bleeding.”
(Markenson, et al. Circulation. 2010;122;S934S946)
Highlights
•
•
•
•
•
“Encourage” victim while waiting for EMS.
One adult or two baby aspirin.
Non-coated.
No allergies.
No contraindication.
Rationale For Change
• Evidence clearly demonstrated that the
administration of aspirin within the first
hours of onset of chest discomfort in people
with acute coronary syndromes reduced
mortality.
Epinephrine for Anaphylaxis
2005 Guidelines
"First aid providers should be familiar with the
epinephrine auto-injector so that they can help
someone having an anaphylactic reaction selfadminister the epinephrine. First aid providers
should be able to administer the auto-injector if
the victim is unable to do so, provided that the
medication has been prescribed by a physician
and state law permits (second dose not
addressed).“
(Circulation. 2005;112:IV-196-IV-203)
Epinephrine for Anaphylaxis
2010 Guidelines
“First aid providers are advised to seek medical
assistance if symptoms persist, rather than
routinely 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.”
(Markenson, et al. Circulation. 2010;122;S934S946)
Highlights
•
•
•
•
Some people require a second dose.
Epinephrine is potentially harmful.
No routine second dose.
If medical assistance not available, provide
second dose if symptoms persist.
Rationale For Change
• If medical assistance is available, it is less likely
that an unnecessary second dose of epinephrine
will be given.
Chemical Burns to the Eye
2005 Guidelines
“In case of an acid or alkali exposure to the skin
or eye, immediately irrigate the affected area
with copious amounts of water.”
(Circulation. 2005; 112: IV196-IV203)
Chemical Burns to the Eye
2010 Guidelines
“Rinse eyes exposed to toxic substances
immediately with a copious amount of water,
unless a specific antidote is available.”
(Markenson, et al. Circulation. 2010;122;S934S946)
Highlights
• Rinse with large amounts of water.
• Use specific antidote if available.
Rationale For Change
• Immediate irrigation of eyes exposed to a toxin
with large amounts of water is recommended.
• Specialized therapeutic rinsing solutions that
have been properly tested and approved may be
available and should be used.
Heat Stroke
2005 Guidelines
The treatment of heat stroke in first aid was not
covered in the 2005 science, treatment
recommendations, and guidelines.
Heat Stroke
2010 Guidelines
“The most important action by a first aid provider
for a victim of heat stroke is to begin immediate
cooling, preferably by immersing the victim up to
the chin in cold water.”
(Markenson, et al. Circulation. 2010;122;S934S946)
Highlights
• Immediate cooling emphasized.
• Immersion up to neck in cold water
preferred as an option.
Rationale For Change
• Immediate cooling emphasizes the critical
danger associated with heat stroke.
• Complete immersion in cold water has been
found to be the most effective method of cooling
the body in heat stroke.
Supplemental Oxygen in Diving
2005 Guidelines
The use of supplemental oxygen for diving
injuries in first aid was not covered in the 2005
science, treatment recommendations, and
guidelines.
Supplemental Oxygen in Diving
2010 Guidelines
“Supplementary oxygen administration may be
beneficial as part of first aid for divers with a
decompression injury.”
(Markenson, et al. Circulation. 2010;122;S934S946)
Rationale For Change
• There is evidence oxygen may be beneficial
for divers with a decompression injury.
Activated Charcoal
2005 Guidelines
“There is insufficient evidence to recommend for
or against the use of activated charcoal as first
aid for ingestions.”
(Circulation. 2005; 112: IV196-IV203)
Activated Charcoal
2010 Guidelines
“Do not administer activated charcoal to a victim
who has ingested a poisonous substance unless
you are advised to do so by poison control center
or emergency medical personnel.”
(Markenson, et al. Circulation. 2010;122;S934S946)
Highlights
• Use only if directed by poison control.
Rationale For Change
• There is no evidence that activated charcoal is
effective as a component of first aid.
• It may be difficult to administer and it has not
been shown to be beneficial.
• There are reports of it causing harm.
Pressure Immobilization for Snakebite
2005 Guidelines
“In case of an elapid (e.g., coral) snakebite,
wrap a bandage snugly (comfortably tight but
loose enough to slip or fit a finger under it)
around the entire length of the bitten extremity,
immobilize the extremity, and get definitive
medical help as rapidly as possible.”
(Circulation. 2005; 112: IV196-IV203)
Pressure Immobilization for Snakebite
2010 Guidelines
“Applying a pressure immobilization bandage …
around the entire length of the bitten extremity is
an effective and safe way to slow the
dissemination of venom… pressure is sufficient if
the bandage … allows a finger to be slipped
under it. Initially it was theorized that … external
pressure would only benefit victims bitten by
snakes producing neurotoxic venom, but the
effectiveness … has also been demonstrated for
bites by non-neurotoxic American snakes.”
(Markenson, et al. Circulation. 2010;122;S934S946)
Highlights
• Pressure immobilization safe and effective.
• Be able to slide finger underneath.
Rationale For Change
• Applying a pressure immobilization bandage
has shown to be an effective way to slow the
dissemination of venom for all venomous
snake bites, not just those from elapids.
Jellyfish Stings
2005 Guidelines
The treatment of jellyfish stings in first aid was
not covered in the 2005 science, treatment
recommendations, and guidelines.
Jellyfish Stings
2010 Guidelines
“To inactivate venom load and prevent further
envenomation, jellyfish stings should be liberally
washed with vinegar (4% to 6% acetic acid
solution) as soon as possible for at least 30
seconds. For the treatment of pain, after the
nematocysts are removed or deactivated, jellyfish
stings should be treated with hot-water immersion
when possible.”
(Markenson, et al. Circulation. 2010;122;S934S946)
Highlights
• Vinegar wash for 30 seconds to inactivate
nematocysts.
• Follow with hot-water immersion for pain control.
Rationale For Change
• Vinegar is most effective for inactivation of the
nematocysts.
• Immersion in water, as hot as tolerated for about
20 minutes, has been found to be the most
effective treatment for the pain.
Education / Implementation
Skills Reinforcement
2005 Guidelines
Ongoing skills reinforcement was not covered in
the 2005 science, treatment recommendations,
and guidelines.
Skills Reinforcement
2010 Guidelines
“While the optimal mechanism for maintenance of
competence is not known, the need to move toward
more frequent assessment and reinforcement of skills
is clear. Skill performance should be assessed during
the 2-year certification with reinforcement provided as
needed. The optimal timing and method for this
assessment and reinforcement are not known.”
(Bhanji, et al. Circulation. 2010;122;S920-S933)
Highlights
• Need for more frequent review is clear.
• Optimum reinforcement not known.
• Reassess and reinforce.
Rationale For Change
• Retention of skills deteriorates very quickly after
training.
• Frequent skill refreshers should help to maintain
reasonable skill performance.
Self-Instruction
2005 Guidelines
“Instruction methods should not be limited to
traditional techniques; newer training methods
(e.g., “watch-while-you practice”
video programs) may be more effective.”
(Circulation. 2005;112:III-100-III-108)
Self-Instruction
2010 Guidelines
“Short video instruction combined with
synchronous hands-on practice is an effective
alternative to instructor-led basic life support
courses.”
(Bhanji, et al. Circulation. 2010;122;S920-S933)
Highlights
• Video self-instruction with practice-whilewatching is effective.
Rationale For Change
• Studies have demonstrated that lay rescuer
CPR skills can be acquired and retained at least
as well through interactive computer- and videobased synchronous practice when compared
with instructor-led courses.
Skills Competency
2005 Guidelines
“Training programs should be evaluated to
verify that they enable effective skills acquisition
and retention.”
(Circulation. 2005;112:III-100-III-108)
Skills Competency
2010 Guidelines
“Successful course completion should be based
on the ability of the learner to demonstrate
achievement of course objectives rather than
attendance in a course/program for a specific
time period.”
(Bhanji, et al. Circulation. 2010;122;S920-S933)
Highlights
• Verification of competence, not a set number of
class hours.
Rationale For Change
• Reflecting emerging trends, there is support
to move toward a more competency-based
approach to resuscitation education for all
rescuers.
Prompting and Feedback Devices
2005 Guidelines
“A CPR prompt device may be useful in both
out-of-hospital and in-hospital settings.”
(Circulation. 2005; 112: IV19-IV34)
Prompting and Feedback Devices
2010 Guidelines
“Training in CPR skills using a feedback device
improves learning and/or retention. The use of a
CPR feedback device can be effective for training.
CPR prompting and feedback devices can be
useful as part of an overall strategy to improve the
quality of CPR during actual resuscitations.”
(Bhanji, et al. Circulation. 2010;122;S920-S933)
Highlights
• Effective in training.
• Improves quality of actual resuscitation.
Rationale For Change
• The evidence has shown prompting and
feedback devices to be effective in CPR training
and during actual resuscitations.
• Commercially-produced devices are now more
readily available for use.