2011
SILVER CROSS EMS
EMD MARCH CE
EMERGENCY MEDICAL DISPATCHER
OBJECTIVES
 Review background information on BLS
 Provide information on DOAs
 Review updated information on CPR for the Adult,
Child and Infant victims based on the AHA 2010
Guidelines for Heartsaver
 Review procedures for assisting victims that are
choking
 Troubleshoot possible complications encountered
during BLS
When the heart has stopped and the victim is not
breathing, CPR is the answer.
Without a constant supply of blood, cells of the body
will start to die. Brain damage begins within 4 to 6
minutes after cardiac arrest. Within 8 to 10 minutes,
the damage may be irreversible. Cardiopulmonary
resuscitation will help to circulate oxygenated blood
until more advanced medical care can be performed.
CPR
CPR by itself cannot sustain life indefinitely.
It should be started as soon as possible to
give the patient the best chance for
survival.
Many patients will need defibrillation and
medication to be successfully resuscitated.
It’s all part of the process………….
The Chain of Survival
Source: American Heart Association
The Chain of Survival
 The links in the Chain of Survival include:
 Early recognition of cardiac arrest and activation of the
9-1-1 system
 Early bystander (or EMD assisted) CPR
 Early defibrillation by EMRs or other EMS personnel
 Early advanced care by paramedics and hospital
personnel
Possible DOA
 Signs of death
 Decapitation: The head is separated from the rest of
the body.
 Rigor mortis: Temporary stiffening of muscles occurs
several hours after death.
 Evidence of tissue decomposition: Actual flesh decay
occurs only after a person has been dead for more than
one day.
 Dependent lividity: Red or purple color occurs on the
parts of the patient’s body that are closest to the
ground.
When to Start CPR
 CPR should be started on all non-breathing, pulseless
patients, unless they are obviously dead or have a
DNR order. (Responders will need to see a valid copy
of the order to honor it.)
 It is better to start CPR on a person that is later
declared dead by a physician than to withhold CPR
from someone that could have been saved.
When in Doubt, Resuscitate!
When to Stop CPR (1 of 2)
 Discontinue CPR only when:
 Effective spontaneous circulation and ventilation are
restored.
 Resuscitation efforts are transferred to another trained
person who continues CPR.
 A physician orders you to stop.
 The patient is transferred to properly trained EMS
personnel.
When to Stop CPR (2 of 2)
 Discontinue CPR only when: (cont’d)
 Reliable criteria for death are recognized.
 You are too exhausted to continue resuscitation,
environmental hazards endanger your safety, or
continued resuscitation would place the lives of others
at risk.
It all starts with A-B-C
A – Airway
B – Breathing
NO?
C – Circulation
START COMPRESSIONS!
New Sequence
FOLLOW THIS LINK TO WATCH THE NEW
GUIDELINES VIDEO
http://www.youtube.com/watch?
v=O9T25SMyz3A
AHA 2010 Recommendations
 Adult (HS 1 Rescuer)
 Unresponsive?

Call for help & AED
 Not breathing or only
gasping (Agonal breaths)
 Start compressions in the
center of the chest
between the nipples, at a
rate of 100/min and a
depth of at least 2 inches,
allowing for chest recoil
• 30:2 Ratio of compressions to
breaths
• After 30 compressions,
open the airway with a
head tilt-chin lift and
deliver 2 breaths
• When rescuers are
untrained or not
proficient, compressions
only can be performed
• PUSH HARD & FAST
AHA 2010 Recommendations
 Children (HS 1 Rescuer)
 Unresponsive?
 Not breathing or only
gasping
 Start compressions in the
center of the chest between
the nipples, at a rate of at
least 100/min
and a depth of 2 inches or 1/3
chest diameter, allowing for
chest recoil
• 30:2 Ratio of compressions to
breaths
• After 30 compressions, open
the airway with a head tiltchin lift and deliver 2 breaths
• After 5 cycles or 2 minutes,
call for help, continue cycles
• When rescuers are untrained
or not proficient,
compressions only can be
performed
• PUSH HARD & FAST
AHA 2010 Recommendations
 Infant (HS 1 Rescuer)
 Unresponsive?
 Not breathing or only
gasping
 Start compressions in the
center of the chest between
the nipples, at a rate of at
least 100/min
and a depth of 1 1/2 inches or
1/3 chest diameter, allowing
for chest recoil
• 30:2 Ratio of compressions to
breaths
• After 30 compressions, open
the airway with a head tiltchin lift and deliver 2 breaths
• After 5 cycles or 2 minutes,
call for help, continue cycles
• When rescuers are untrained
or not proficient,
compressions only can be
performed
• PUSH HARD & FAST
GENERAL INFO
 Make sure victim is on a firm, flat surface
 Minimize interruptions to chest compressions, 1o




seconds or less
Watch for chest rise with breaths
Attach AED as soon as it is available and follow the
prompts
Resume compressions immediately after administering
a shock
30 compressions should be given over approximately 18
seconds (think of the tune Staying Alive)
Recovery Position
If the victim is unconscious but breathing:
 Roll the patient onto one side, as you support the
patient’s head.
 Place the patient’s face on his or her side so any
secretions drain out of the mouth and the tongue won’t
block the airway.
Is It Working?
 The victim’s color should improve
 The chest should be rising with each breath
 The compressions and breaths are delivered at the
appropriate rate and depth
Possible Complications
 Broken ribs
 Check hand placement and continue
 Gastric Distension (air in the stomach)
 Can happen if the airway is not open, re-tilt head
 Make sure breaths are not given too forcefully or too fast, give over 1
second each and allow for exhalation
 Give breaths only until the chest rises
 Be alert for vomiting and keep airway clear
 Chest does not rise
 Reposition head and try breath again. If it’s still not rising go right
to compressions
 Victim breathes through a stoma (opening in the neck)
 If the chest does not rise with breaths, cover mouth and nose for
possible air leakage
Causes of Airway Obstruction
 The most common airway obstruction is the tongue.
 If the tongue is blocking the airway, the head tilt–chin
lift maneuver performed on the unconscious victim
should open the airway.
 Food is the most common foreign object that causes
an airway obstruction.
 If a foreign body is lodged in the air passage, you must
use other techniques to remove it.
Are you choking?
 Mild Obstruction
 Victim is able to cough
or is gagging
 Victim is able to speak
and breath
 Encourage victim to
cough and monitor
them in case the airway
becomes blocked
 Severe Obstruction
 Victim has ineffective
cough
 Victim is unable to
speak or breath
 Victim is displaying the
Universal Sign
for choking
 Prepare to help victim
Management of Foreign Body
Airway Obstructions
 Airway obstruction in an adult or child
 If the victim is conscious, stand behind them and perform
abdominal thrusts.
 If the victim is obese or pregnant, stand behind them and
perform chest thrusts instead of abdominal thrusts.
If the victim becomes unresponsive:
 Ensure that the EMS system has been activated.
 Perform CPR, remembering to check the mouth for foreign
objects before each breath.
Steps for Managing Airway Obstruction in a
Conscious Adult or Child
1. Look for signs of
choking.
2. Place your fist with
the thumb side against
the patient’s abdomen,
just above the navel.
3. Grasp the fist with
your other hand and
press into the abdomen
with quick inward and
upward thrusts.
Management of Foreign Body
Airway Obstructions (continued)
 Airway obstruction in an infant
 Use a combination of 5 back slaps (with the heel of
your hand between the shoulder blades) and 5 chest
thrusts (with 2 fingers between the nipples on the
center of the chest), alternating, until the object is
expelled or the victim becomes unconscious.
If the infant becomes unresponsive:
 Ensure that the EMS system has been activated.
 Begin CPR, remembering to check the mouth for the
foreign object before each breath.
FYI
 The flipcharts will be updated to reflect the new changes,
in the near future. Until then, use the protocol that you’re
currently using.
 Your current CPR cards are good until the expiration dates
printed on the card. Recommended renewal is every 2
years.
 You previously learned the same skills, the order has just
changed to C-A-B.
 Hands Only CPR will be encouraged for the lay rescuer with
no training or is not proficient in the skills
 For further information on CPR visit the American Heart
Association’s website www.heart.org/cpr
Resources
 American Heart Association’s Highlights of the 2010
Guidelines for CPR & ECC and other information
provided on their website
 AAOS Emergency Medical Responder, 5th edition