1. WHEN TO HELP BLS UPDATE for EMDs
2011
SILVER CROSS EMS
EMD MARCH CE
EMERGENCY MEDICAL DISPATCHER

2. 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

3. NO MATTER WHAT THE CAUSE………
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.

4. 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………….

5. The Chain of Survival
Source: American Heart Association

6. The Chain of Survival The links in the Chain of Survival include:
Early recognition of cardiac arrest and activation of the system
Early bystander (or EMD assisted) CPR
Early defibrillation by EMRs or other EMS personnel
Early advanced care by paramedics and hospital personnel

7. 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.

8. When in Doubt, Resuscitate!
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!

9. 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.

10. 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.

11. It all starts with A-B-C
A – Airway
B – Breathing NO?
C – Circulation
START COMPRESSIONS!

12. New Sequence

13. FOLLOW THIS LINK TO WATCH THE NEW GUIDELINES VIDEO

14. 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

15. 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 tilt-chin 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

16. 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 tilt-chin 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

17. 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)

18. If the victim is unconscious but breathing:
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.

19. 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

20. 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

21. 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.

22. Are you choking? Mild Obstruction Severe 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

23. 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.

24. 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.

25. 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.

26. 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

27. 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