First Aid
Update Clinic
2010 CPR Guidelines
Agenda
1.
Why change? AHA/ILCOR background
2.
What has changed? (video demo/Push Hard Push Fast flyer)
3.
Stations: CPR & AED, practice new standards & “Must Sees”
4.
Changes to first aid & awards
5.
Teaching first aid awards
6.
Stations: First Aid, practice and review first aid test items
7.
Workplace Safety & Insurance Board (WSIB)
8.
Wrap up – administration, what's next?
Slide 2
Clinic objective:
 To ensure all Instructors and Examiners understand
(and can demonstrate) the new resuscitation
protocols and the implications for planning, teaching
and evaluating the Society’s training programs.
Slide 3
Background to changes
 CPR & first aid science reviewed every 5 years by the
American Heart Association (AHA) and the International
Liaison Committee on Resuscitation (ILCOR)
 International panel of medical experts reviews new science
and makes treatment recommendations
 National first aid training agencies meet to interpret
guidelines and recommendations for course delivery
 Provincial regulators review submitted course content from
first aid training agencies to meet required legislation
Slide 4
Changes at glance
 Summary of CPR steps
 YouTube CPR Update
Slide 5
What changed?
1. New CPR sequence for cardiac arrest victims
2. No change in CPR sequence for drowning victims
3. Compression only CPR: unwilling or untrained
4. Depth of compression: minimum depths
5. Choking procedures: back blows & abdominal thrusts
6. Jaw thrust: NLS lifeguards attempt jaw thrusts for spinals
7. AED: children and infants
Slide 6
New CPR sequence
CPR sequence:
 Check the scene, if unresponsive, activate EMS and get AED
 Airway check – open airway (head-tilt/chin-lift)
 Breathing check – use visual cues like chest rise (5 sec.)
 Circulation – perform 30 compressions if not breathing or gasping
Slide 7
Depth of compressions
 Minimum depths of compressions
have changed
 Adult minimum of 5 cm
 Child minimum of 5 cm or
(1/3 chest diameter)
 Infant minimum of 4 cm or
(1/3 chest diameter)
 Effective chest compressions
 Minimum depths help to ensure
essential blood flow during CPR
 Landmarking
 Emphasis is on “centre” of chest
between the nipples
Slide 8
Drowning victims
 NO change in rescue steps:

Deliver 2 rescue breaths before starting
chest compressions
 If not successful, start CPR and use AED

Evidence shows drowning victims are in
need of urgent replenishment of oxygen
compared to a cardiac arrest victim and
may respond to a few initial rescue
breaths
Slide 9
Compression only CPR
 All trained rescuers should perform CPR with breaths and
compressions. Gloves and a mask should be used
 If an untrained rescuer is unwilling or unable, compression
only CPR may be performed
 Studies have shown a combination of breaths and
compressions is best for children or victims who have an
underlying cause of cardiac arrest such as:
 Drowning, trauma, drug overdose, etc.
Slide 10
Choking procedures
 Alternating techniques
 More than one technique may be needed in
removing a severe obstruction. Use back
blows, abdominal thrusts, chest thrusts
 Conscious choking (adult, child)
 Perform alternating back blows and
abdominal thrusts
 5 back blows
- Bend victim over, near parallel to the ground
- Support victim with one arm across their chest
- With other arm apply 5 back blows, between the
shoulder blades
 5 abdominal thrusts
(chest thrusts for pregnant or obese)
Slide 11
Jaw thrust
 A technique used to open the airway:
 Used on spinal victims to help minimize
head/neck movement
 Grasp jaw on both sides of the face where it
forms an angle close to the ears. Using both
hands, move the jaw forward (upward)
without tilting the head back.
 Used by NLS lifeguards (NLS curriculum)
 Instructed in NLS courses in management of
spinal victims
 Jaw thrust is “attempted” and if unsuccessful
use the head-tilt/chin-lift
Slide 12
AED units
 Automated External Defibrillator (AED)
 Device that measures electrical activity of
the heart. The use of an AED along with
CPR can dramatically increase survival
rates for sudden cardiac arrest
 Used to provide a lifesaving shock when
needed
 A heart that is “fibrillating” or “twitching”
cannot beat effectively. When a shock is
provided the heart is “defibrillated”
 Apply an AED as soon as possible to an
unresponsive, non-breathing victim. Turn
on unit and follow voice prompts.
Slide 13
AED pad placement
 Adult:
 Follow directions for pad placement. One
pad on upper right side of chest. Other
pad to the lower left side of chest
 Children:
 Look for a child key or switch or child pads
 Adult pads may be used if no child pads
 If child is small, place one pad on centre of
chest, the other on back, so not touching
Slide 14
AED shock/no shock
 Turn on AED. Unit will either
advise a shock or no-shock
 If shock is advised: say aloud
“Stand Clear,” push the shock
button, continue CPR (2 min.)
 If no shock is advised: continue
CPR (2 min.)
 After 2 min. the AED unit re-
analyzes for shock or no shock
 Continue sequence of
shock/no shock until victim
recovers or EMS arrives.
Slide 15
AED use: infants
 Infants: guidelines have expanded the use of
AEDs for infants BUT
 AED use on infants is very uncommon
 A manual defibrillator, which is more advanced, is
preferred versus an AED for use on an infant
 Infants typically have healthy hearts, meaning a
breathing problem is usually the cause of heart
failure versus an underlying heart condition
 AED training will focus on adult and child use
 The use of an AED on infants is knowledge-
based and not evaluated
Slide 16
Stations: CPR & AED
 Practice stations:
NEW test items & “Must Sees”
 Station 1: One-rescuer CPR: adult, child & infant
 Station 2: Two-rescuer CPR & AED: adult & child
 Station 3: Choking, conscious to unconscious
 Questions & answers
 Group feedback, comments
Slide 17
Changes to first aid awards
 Emergency First Aid (8 hrs.)
 Test item 11c external bleeding:
- Elevation removed
 NEW Test item 12 Wounds:
- 12a: Abdominal injury
- 12b: Burn injury
- 12c: Facial injury
 One-rescuer CPR: test item 6
- with AED Protocol (adult/child)
 Standard First Aid (16 hrs.)
 Two-rescuer CPR: test item 1
- with AED Protocol (adult/child)
 AED protocol
“Must See” items
in:
 CPR A-B-C
 CPR-HCP
 EFA
 SFA
Slide 18
Changes to first aid
 Bleeding:
 Rest and direct pressure. “Elevation”
has been removed as a “Must See.”
Evidence shows direct pressure is
the most effective means to initially
stop bleeding
 Auto-injector
 New EpiPen. Pull off blue cap and
apply to outer thigh for 10 seconds.
After use, the auto-injector will
extend over the needle tip to further
prevent injury when handled
Slide 19
Changes to first aid
 Heat-related emergencies:
 Sport drinks (electrolyte drinks) can be
used for treatment of heat exhaustion
 For victims with suspected heat stroke,
immersion in cold water is preferable if
possible
 Angina/heart attack:
 Continued emphasis on use of ASA. The
use of ASA was referenced in previous
guidelines and is found in Canadian First
Aid Manual, p. 34
 If victim has no heart medication, suggest
taking ASA (1 regular tablet or 2 child lowdose tablets). Ask if they have ASA allergy,
or advised not to take ASA from a doctor.
Slide 20
CPR-HCP: changes
 CPR-HCP: health care providers (HCP) who
frequently respond to emergencies
 Few changes overall:
 Team response is emphasized, allowing
responders to delegate roles as team members
arrive on the scene
 Use of AED on infants permissible, manual
defibrillator preferred
 Cricoid pressure removed as knowledge item. A
technique that is difficult to teach and apply
Slide 21
Agenda – what’s next
1.
Why change? AHA/ILCOR background
2.
What has changed? (video demo/Push Hard Push Fast flyer)
3.
Stations: CPR & AED
4.
Changes to first aid awards
5.
Teaching first aid awards
6.
Stations: first aid practice and review
7.
Workplace Safety & Insurance Board (WSIB)
8.
Wrap up – administration, what's next?
Slide 22
Teaching first aid
 Brainstorm: how do the new standards and content affect how
you plan and teach your first aid courses. Consider any of the
following:
 Lesson planning, course length, combined courses
 Lifesaving Instructor schools (assignments, evaluation, etc.)
 What new resources do you need
 List minimum first aid equipment for teaching EFA or SFA
 Evaluation criteria, what has been added
 Differences among revised first aid test sheets
 Additional resources:
 First Aid Instructor CD (updated)
 Bronze Medals Instructor CD (new)
Slide 23
First aid stations
 Practice stations: (review test items & “Must Sees”) with
reference to the Canadian First Aid Manual and First Aid Award
Guide
 Station 1:
External bleeding EFA item 11c and
Facial injury item 12c
 Station 2:
Bone or joint injury SFA item 4
 Station 3:
Assessment item 5 and
Unconscious victim EFA item 12
 Questions & answers
 Group feedback, comments
Slide 24
WSIB: overview
 Workplace Safety & Insurance Board (WSIB) www.wsib.on.ca
 WSIB (Ontario government, Ministry of Labour) tasked to reduce
workplace injuries and to raise awareness of workplace safety.
 Employers pay WSIB (required by law) to manage claims during a
workplace accident. WSIB helps employees with their medical needs
to get back to work. In return employers are not sued.
 WSIB is empowered with enforcement to ensure compliance for safe
work environments for employees. First aid training is a requirement
for worksites. Regulation 1101.
 Enforcement of EFA and SFA training criteria falls under WSIB. All
course providers, approved by WSIB, must follow training criteria
such as course content, minimum times, etc.
Slide 25
Summary: let’s review
 New CPR sequence
 New test items in EFA & SFA
 Drowning victims: 2 breaths
 Elevation removed from (RED)
 Compression-only CPR knowledge
 New auto-injector (EpiPen)
 AED use on infants knowledge
 Heat-related injury
 Jaw thrusts (NLS lifeguards)
 ASA use
 Choking procedures (5&5)
 Teaching First Aid
 Minimum depths (5cm, 4cm, 1/3)
 First Aid Stations
 New “Must See”: AED protocol
 WSIB
overview
Slide 26
Wrap up - administration
 Complete Aquatic Master Sheet
 First Aid Update, tracked on “find a member”
 Instructors may teach new standards after successfully completing update
 Check with employer when new content is implemented at worksite
 3 credits earned for successful completion
 Upon recertifying your “Lifesaving Instructor” an “Emergency First Aid
Instructor” award will also be issued ($7.00)
 Resources at Society’s website: www.lifesavingsociety.com
 Revised first aid test items and test sheets
 PowerPoint slides – First Aid Update
 Notes for conductors – First Aid Update
 Push Hard Push Fast – flyer
 Lifesaving Society YouTube channel
Slide 27
Wrap up – clinic conductors
 Conductors: First Aid Update
 After successful completion, the following examiners and
trainers may also deliver the First Aid Update
 Provincial Trainers
 First Aid Instructor Trainers
 NLS Instructor Trainers
 Lifesaving Instructor Trainers
 First Aid Examiners
 NLS Examiners
Slide 28
Wrap up
 Final questions, comments?
Slide 29
First Aid
Update Clinic
2010 CPR Guidelines
Thank you & goodbye