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 & awardsTeaching first aid awardsStations: First Aid, practice and review first aid test itemsWorkplace 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 changesCPR & 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 recommendationsNational first aid training agencies meet to interpret guidelines and recommendations for course deliveryProvincial regulators review submitted course content from first aid training agencies to meet required legislation
5 Changes at glanceSummary of CPR stepsYouTube CPR Update
6 What changed? New CPR sequence for cardiac arrest victims No change in CPR sequence for drowning victimsCompression only CPR: unwilling or untrainedDepth of compression: minimum depthsChoking procedures: back blows & abdominal thrustsJaw thrust: NLS lifeguards attempt jaw thrusts for spinalsAED: children and infants
7 New CPR sequence CPR sequence: Check the scene, if unresponsive, activate EMS and get AEDAirway 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 cmChild minimum of 5 cm or (1/3 chest diameter)Infant minimum of 4 cm or (1/3 chest diameter)Effective chest compressionsMinimum depths help to ensure essential blood flow during CPRLandmarkingEmphasis is on “centre” of chest between the nipples
9 Drowning victims NO change in rescue steps: Deliver 2 rescue breaths before starting chest compressionsIf not successful, start CPR and use AEDEvidence 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 CPRAll trained rescuers should perform CPR with breaths and compressions. Gloves and a mask should be usedIf an untrained rescuer is unwilling or unable, compression only CPR may be performedStudies 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 thrustsConscious choking (adult, child)Perform alternating back blows and abdominal thrusts5 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 blades5 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 movementGrasp 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 victimsJaw 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 arrestUsed to provide a lifesaving shock when neededA 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 chestChildren:Look for a child key or switch or child padsAdult pads may be used if no child padsIf child is small, place one pad on centre of chest, the other on back, so not touching
15 AED shock/no shockTurn on AED. Unit will either advise a shock or no-shockIf 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 shockContinue 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 BUTAED use on infants is very uncommonA manual defibrillator, which is more advanced, is preferred versus an AED for use on an infantInfants typically have healthy hearts, meaning a breathing problem is usually the cause of heart failure versus an underlying heart conditionAED training will focus on adult and child useThe 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 & infantStation 2: Two-rescuer CPR & AED: adult & childStation 3: Choking, conscious to unconsciousQuestions & answersGroup feedback, comments
18 Changes to first aid awards Emergency First Aid (8 hrs.)Test item 11c external bleeding:- Elevation removedNEW Test item 12 Wounds:- 12a: Abdominal injury- 12b: Burn injury- 12c: Facial injuryOne-rescuer CPR: test item 6- with AED Protocol (adult/child)Standard First Aid (16 hrs.)Two-rescuer CPR: test item 1AED protocol “Must See” items in:CPR A-B-CCPR-HCPEFASFA
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 bleedingAuto-injectorNew 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 exhaustionFor victims with suspected heat stroke, immersion in cold water is preferable if possibleAngina/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. 34If 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: changesCPR-HCP: health care providers (HCP) who frequently respond to emergenciesFew changes overall:Team response is emphasized, allowing responders to delegate roles as team members arrive on the sceneUse of AED on infants permissible, manual defibrillator preferredCricoid 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 & AEDChanges to first aid awardsTeaching first aid awardsStations: first aid practice and reviewWorkplace Safety & Insurance Board (WSIB)Wrap up – administration, what's next?
23 Teaching first aidBrainstorm: 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 coursesLifesaving Instructor schools (assignments, evaluation, etc.)What new resources do you needList minimum first aid equipment for teaching EFA or SFAEvaluation criteria, what has been addedDifferences among revised first aid test sheetsAdditional resources:First Aid Instructor CD (updated)Bronze Medals Instructor CD (new)
24 First aid stationsPractice stations: (review test items & “Must Sees”) with reference to the Canadian First Aid Manual and First Aid Award GuideStation 1: External bleeding EFA item 11c and Facial injury item 12cStation 2: Bone or joint injury SFA item 4Station 3: Assessment item 5 and Unconscious victim EFA item 12Questions & answersGroup feedback, comments
25 WSIB: overviewWorkplace 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 knowledgeAED use on infants knowledgeJaw thrusts (NLS lifeguards)Choking procedures (5&5)Minimum depths (5cm, 4cm, 1/3)New “Must See”: AED protocolNew test items in EFA & SFAElevation removed from (RED)New auto-injector (EpiPen)Heat-related injuryASA useTeaching First AidFirst Aid StationsWSIB overview
27 Wrap up - administration Complete Aquatic Master SheetFirst Aid Update, tracked on “find a member”Instructors may teach new standards after successfully completing updateCheck with employer when new content is implemented at worksite3 credits earned for successful completionUpon 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 sheetsPowerPoint slides – First Aid UpdateNotes for conductors – First Aid UpdatePush Hard Push Fast – flyerLifesaving Society YouTube channel
28 Wrap up – clinic conductors Conductors: First Aid UpdateAfter successful completion, the following examiners and trainers may also deliver the First Aid UpdateProvincial TrainersFirst Aid Instructor TrainersNLS Instructor TrainersLifesaving Instructor TrainersFirst Aid ExaminersNLS Examiners