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2010 Guidelines

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Title: 2010 Guidelines


1
2010 Guidelines
  • Instructor Update

2
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.

3
Purpose of Class
  • Highlight the major changes in science, treatment
    recommendations, and guidelines.
  • Provide helpful guidance to you for the
    transition to new materials.

4
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.

5
  • Who is HSI?

6
About HSI
  • The Health Safety Institute (HSI) unites the
    recognition and expertise of
  • 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.

7
Proven Track Record
  • 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.

8
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.

9
Approved for Use
  • HSIs 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.

10
2010 ILCOR Conference
  • HSI participated in the 2010 International
    Committee on Resuscitation (ILCOR) International
    Conference on CPR and ECC Science with Treatment
    Recommendations.

11
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.

12
  • Integrating 2010 Science, Treatment
    Recommendations, and Guidelines

13
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

14
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

15
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.

16
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

17
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.

18
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.

19
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.

20
Planned 2nd Quarter 2011 Release
  • ASHI
  • 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

21
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.

22
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.

23
  • Update Requirements

24
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.

25
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.

26
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.

27
  • CPR and AED

28
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)
29
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.
2010122S685-S705)
30
Highlights
  • This is a re-emphasis from 2005.
  • For effective compressions
  • Push fast
  • Push hard
  • Allow chest to fully recoil
  • Minimize any interruptions
  • Applies to both lay and healthcare providers.

31
Rationale For Change
  • High-quality chest compressions within CPR
    continues to be a critical focal point.
  • Well-performed compressions increase the
    likelihood of survival.

32
Compression Hand Position
2005 Guidelines
The rescuer should compress the lower half of
the victims 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)
33
Compression Hand Position
2010 Guidelines
The rescuer should place the heel of one hand on
the center (middle) of the victims 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. 2010122S685-S705)
34
Highlights
  • 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.

35
Rationale For Change
  • Use of the nipple line as a landmark for hand
    placement was found to be unreliable.

36
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 gt80
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)
37
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.
2010122S685-S705)
38
Highlights
  • At least 100 times per minute.
  • It is okay to be a little faster.
  • Applies to both lay and healthcare providers.

39
Rationale For Change
  • It has been found that higher survival rates are
    associated with an increase in the number of
    compressions provided per minute.

40
Child/Infant Compression Rate
2005 Guidelines
Push fast push at a rate of approximately 100
compressions per minute. (Circulation. 2005
112 IV156-IV166)
41
Child/Infant Compression Rate
2010 Guidelines
Push fast push at a rate of at least 100
compressions per minute. (Berg, et al.
Circulation. 2010122S862-S875)
42
Highlights
  • 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.

43
Rationale For Change
  • It has been found that higher survival rates are
    associated with an increase in the number of
    compressions provided per minute.

44
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)
45
Compression Depth
2010 Guidelines
It is reasonable for laypersons and
healthcareproviders 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.
2010122S685-S705)
46
Highlights
  • 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.

47
Rationale For Change
  • Research indicates the tendency for CPR providers
    to not compress deep enough, even with the
    emphasis to "push hard."

48
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)
49
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. 2010122S862-S875)
50
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.

51
Rationale For Change
  • Research indicates the tendency for CPR providers
    to not compress deep enough, even with the
    emphasis to "push hard."

52
Breathing Assessment
2005 Guidelines
While maintaining an open airway, look, listen,
and feel for breathing. (Circulation. 2005
112 IV19-IV34)
53
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.
2010122S685-S705)
54
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.

55
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.

56
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 302
(ABC method). (Summary from Circulation. 2005
112 IV19-IV34)
57
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 302
(CAB method). (Summary from Berg, et al.
Circulation. 2010122S685-S705)
58
Highlights
  • Initial assessment steps
  • 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.

59
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.

60
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 302
(ABC method). (Summary from Circulation. 2005
112 IV19-IV34)
61
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 302
(CAB method). (Summary from Berg, et al.
Circulation. 2010122S685-S705)
62
Highlights
  • Initial assessment approach
  • Assess responsiveness and breathing
  • Activate EMS
  • Assess pulse
  • Perform CPR
  • CAB begin CPR cycles with compressions,
    followed by airway and breathing.

63
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.

64
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) 
65
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 lt 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. 2010122S706-S719)
66
Highlights
  • Success at defibrillating infants.
  • Use attenuator to reduce shock.
  • Okay to use AED set for adult.
  • Applies to both lay and healthcare providers.

67
Rationale For Change
  • AEDs designed to be used on adults have been
    successful when used on infants with
    out-of-hospital cardiac arrest.
  • Minimal heart muscle damage and good neurological
    outcomes were reported.

68
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)

69
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. 2010122S676-S684)

70
Highlights
  • Addition of fifth link in chain.
  • Integrated post-cardiac arrest care.
  • Applies to both lay and healthcare providers.

71
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
    post-cardiac arrest care, further emphasizes the
    additional dependence on longer-term care for
    long-term survival.

72
Cricoid Pressure - HCP
2005 Guidelines
Cricoid pressure should be used only if the
victim is deeply unconscious. (Circulation.
2005 112 IV19-IV34)
73
Cricoid Pressure - HCP
2010 Guidelines
The routine use of cricoid pressure in adult
cardiac arrest is not recommended. (Berg, et
al. Circulation. 2010122S685-S705)
74
Highlights
  • Cricoid may impede ventilation.
  • Difficult to teach.
  • May prevent advanced airway placement.
  • Aspiration may still occur.

75
Rationale For Change
  • Regardless of expertise, rescuers cannot
    effectively apply cricoid pressure.

76
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. 2005112IV-12-IV-17
)
77
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
bag-mask for rescue breathing, and a fourth
retrieves and sets up a defibrillator). (Berg,
et al. Circulation. 2010122S685-S705)
78
Highlights
  • Tasks can be performed simultaneously.
  • Integrate additional rescuers as they arrive.
  • Designate team leader with multiple rescuers.

79
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.

80
  • Emergency Care / First Aid
  • For Lay Providers

81
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)
82
Pressure Points and Elevation
2010 Guidelines
Elevation and use of pressure points are not
recommended to control bleeding. (Markenson, et
al. Circulation. 2010122S934-S946) )
83
Highlights
  • Not recommended.
  • Direct pressure is more effective.
  • May compromise direct pressure.

84
Rationale For Change
  • Elevation and pressure points are unproven
    procedures that may compromise the proven
    intervention of direct pressure, so they could be
    harmful.

85
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)
86
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.
2010122S934-S946)
87
Highlights
  • Use only if direct pressure will not work.
  • Effective in certain conditions.
  • Commercial better than improvised.
  • Training necessary.

88
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.

89
Hemostatic Agents
2005 Guidelines
The use of hemostatic agents in first aid was not
covered in the 2005 science, treatment
recommendations, and guidelines.
90
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.
2010122S934)
91
Highlights
  • Some are effective, others are marginal.
  • Wide variety of results.
  • Potential for adverse effects.

92
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.

93
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.
94
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.
2010122S934-S946)
95
Highlights
  • Lay victim flat.
  • If no injury, elevate 6-12 inches.
  • No elevation if pain occurs.

96
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.

97
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) 
98
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. 2010122S934-S946)
99
Highlights
  • Stabilize with splint if away from medical help.
  • Splint in position found.
  • Use padding.

100
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.

101
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.
102
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. 2010122S934-S946)
103
Highlights
  • Encourage victim while waiting for EMS.
  • One adult or two baby aspirin.
  • Non-coated.
  • No allergies.
  • No contraindication.

104
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.

105
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
self-administer 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.
2005112IV-196-IV-203)
106
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. 2010122S934-S946)
107
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.

108
Rationale For Change
  • If medical assistance is available, it is less
    likely that an unnecessary second dose of
    epinephrine will be given.

109
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)
110
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. (Marken
son, et al. Circulation. 2010122S934-S946)
111
Highlights
  • Rinse with large amounts of water.
  • Use specific antidote if available.

112
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.

113
Heat Stroke
2005 Guidelines
The treatment of heat stroke in first aid was not
covered in the 2005 science, treatment
recommendations, and guidelines.
114
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. 2010122S934-S946)
115
Highlights
  • Immediate cooling emphasized.
  • Immersion up to neck in cold water preferred as
    an option.

116
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.

117
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.
118
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. 2010122S934-S946)
119
Rationale For Change
  • There is evidence oxygen may be beneficial for
    divers with a decompression injury.

120
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)
121
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. 2010122S934-S946)
122
Highlights
  • Use only if directed by poison control.

123
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.

124
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. (Circulatio
n. 2005 112 IV196-IV203) 
125
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.
2010122S934-S946)
126
Highlights
  • Pressure immobilization safe and effective.
  • Be able to slide finger underneath.

127
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.

128
Jellyfish Stings
2005 Guidelines
The treatment of jellyfish stings in first aid
was not covered in the 2005 science, treatment
recommendations, and guidelines.
129
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.
2010122S934-S946)
130
Highlights
  • Vinegar wash for 30 seconds to inactivate
    nematocysts.
  • Follow with hot-water immersion for pain control.

131
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.

132
  • Education / Implementation

133
Skills Reinforcement
2005 Guidelines
Ongoing skills reinforcement was not covered in
the 2005 science, treatment recommendations, and
guidelines.
134
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. 2010122S920-S933)
135
Highlights
  • Need for more frequent review is clear.
  • Optimum reinforcement not known.
  • Reassess and reinforce.

136
Rationale For Change
  • Retention of skills deteriorates very quickly
    after training.
  • Frequent skill refreshers should help to maintain
    reasonable skill performance.

137
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.
2005112III-100-III-108)
138
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.
2010122S920-S933)
139
Highlights
  • Video self-instruction with practice-while-watchin
    g is effective.

140
Rationale For Change
  • Studies have demonstrated that lay rescuer CPR
    skills can be acquired and retained at least as
    well through interactive computer- and
    video-based synchronous practice when compared
    with instructor-led courses.

141
Skills Competency
2005 Guidelines
Training programs should be evaluated to verify
that they enable effective skills acquisition and
retention. (Circulation. 2005112III-100-III-10
8)
142
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.
2010122S920-S933)
143
Highlights
  • Verification of competence, not a set number of
    class hours.

144
Rationale For Change
  • Reflecting emerging trends, there is support to
    move toward a more competency-based approach to
    resuscitation education for all rescuers.

145
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)
146
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.
2010122S920-S933)
147
Highlights
  • Effective in training.
  • Improves quality of actual resuscitation.

148
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.
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