First Aid Update Clinic 2010 CPR Guidelines

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?

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.

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

Changes at glance Summary of CPR steps YouTube CPR Update

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

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

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

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

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.

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)

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

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.

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

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.

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

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

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

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

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.

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

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?

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)

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

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.

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

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

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

Wrap up Final questions, comments?

First Aid Update Clinic 2010 CPR Guidelines Thank you & goodbye