1. First Aid Update Clinic
2010 CPR Guidelines

2. Agenda Why change? AHA/ILCOR background
What has changed? (video demo/Push Hard Push Fast flyer)
Stations: CPR & AED, practice new standards & “Must Sees”
Changes to first aid & awards
Teaching first aid awards
Stations: First Aid, practice and review first aid test items
Workplace Safety & Insurance Board (WSIB)
Wrap up – administration, what's next?

3. 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.

4. 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

5. Changes at glance
Summary of CPR steps
YouTube CPR Update

6. What changed? New CPR sequence for cardiac arrest victims
No change in CPR sequence for drowning victims
Compression only CPR: unwilling or untrained
Depth of compression: minimum depths
Choking procedures: back blows & abdominal thrusts
Jaw thrust: NLS lifeguards attempt jaw thrusts for spinals
AED: children and infants

7. 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

8. 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

9. 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

10. 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.

11. 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)

12. 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

13. 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.

14. AED pad placement Adult: Children:
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

15. 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.

16. AED use: infants AED training will focus on adult and child use
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

17. 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

18. 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
AED protocol “Must See” items in:
CPR A-B-C
CPR-HCP
EFA
SFA

19. Changes to first aid Bleeding: Auto-injector
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

20. Changes to first aid Heat-related emergencies: Angina/heart attack:
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 low- dose tablets). Ask if they have ASA allergy, or advised not to take ASA from a doctor.

21. 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

22. Agenda – what’s next Why change? AHA/ILCOR background
What has changed? (video demo/Push Hard Push Fast flyer)
Stations: CPR & AED
Changes to first aid awards
Teaching first aid awards
Stations: first aid practice and review
Workplace Safety & Insurance Board (WSIB)
Wrap up – administration, what's next?

23. 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)

24. 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

25. WSIB: overview
Workplace Safety & Insurance Board (WSIB)
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.

26. Summary: let’s review New CPR sequence Drowning victims: 2 breaths
Compression-only CPR knowledge
AED use on infants knowledge
Jaw thrusts (NLS lifeguards)
Choking procedures (5&5)
Minimum depths (5cm, 4cm, 1/3)
New “Must See”: AED protocol
New test items in EFA & SFA
Elevation removed from (RED)
New auto-injector (EpiPen)
Heat-related injury
ASA use
Teaching First Aid
First Aid Stations
WSIB overview

27. 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:
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

28. 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

29. Wrap up
Final questions, comments?

30. First Aid Update Clinic
2010 CPR Guidelines
Thank you & goodbye