1. THALASSSEMIA CENTER RESUSCITATION GUIDELINES

2. All medical and nursing personnel should be trained in Basic Life support for healthcare providers All clinical personnel and staff trained in Basic Life Support who identifies unresponsiveness may activate the Crash Call Non clinical personnel and staff not trained in BLS who suspects an emergency within the clinical or patient care area of the Thalassemia Center should immediately call or summon assistance from a clinical staff and render assistance at the guidance of the clinical staff. Non-clinical personnel and staff not trained in BLS who suspects an emergency outside the clinical or patient care areas should call for help and should try to bring the victim to the Day Care unit.

3. Pediatric Advanced Life Support (PALS) shall be provided to children as per current PALS guideline recommendations from the American Heart Association and American Academy of Pediatrics. Adult emergencies will be treated utilizing Basic Life Support until a qualified advance life support provider or the Crash Call team members arrive and assume care.

4. PROCEDURE TO FOLLOW IF YOU DISCOVER A VICTUM:

5. Ensure the scene is safe for both you and the victim. Assesses the victim for response Taps the victim's shoulder and shouts "Are you OK ? If no response shout for help. If another rescuer responds, sent him/her to call the "Crash Call **33" The 2 ND rescuer dial **33 stating: " Crash Call Thalassemia Center “ (name of the ward/unit/area), room no._________, child or adult" If alone, the first rescuer dials **33 stating: "Crash Call Thalassemia Center" specifies area/room no____, child or adult" Please wear protective personnel equipment such as gloves and mask as soon as possible Go back to the victim and continues the steps of CPR ( BLS Algorithm) After activating the Crash Call, the second rescuer brings the Crash Trolley to the scene if not available yet. The steps of CPR will be followed using the two-rescuer CPR as per the American Heart Association guidelines and recommendations on resuscitation, until the crash call team arrives.

6. GUIDELINES FOR RELIEF OF FOREIGN BODY OBSTRUCTION ADULT OR CHILD VICTIM IS RESPONSIVE Ask, "Are you choking?" Give abdominal thrusts (Heimlich maneuver) Repeat thrusts until object is removed or victim becomes unresponsive. VICTIM BECOMES UNREPONSIVE FOR ADULTS –Activate the emergency response system –Begin CPR (each time you open the airway to give breaths, look for and remove object if visible) –If the object is removed and victim remains unresponsive, give CPR FOR CHILDREN –Begin CPR (each time you open the airway to give breaths, look for and remove object if visible) –If the object is removed and victim remains unresponsive, continue CPR as needed. –After 5 cycles or about 2 minutes of CPR, activate the emergency response system (if not already done) and resume CPR. Recognize Severe Choking Universal choking Signs: –Sudden onset: –Victim cannot breathe, cough, speak or make sounds –Breathing with high-pitched noises Blue lips or skin. Use chest thrust instead of abdominal thrust

7. ADULT BLS ALGORITHM

8. *Give 1 breath every 5 to 6 sec. *Recheck pulse every 2 mins Give cycles of 30 COMPRESSIONS and 2 BREATHS until crash trolley or AED/defibrillator arrives, ALS Providers take over, or victim start to move Push hard and fast (100/min) and release completely Minimize interruptions in compressions Definite Pulse No movement or response Open AIRWAY, check BREATHING If no breathing, give 2 BREATHS That make chest rise If no response, check pulse: Do you DEFINITELY feel pulse within 10 Seconds? No Pulse Crash Trolley or AED/defibrillators ARRIVES Check Rhythm Shockable rhythm? Give 1 shock Resume CPR immediately for 5 cycles Shockable Not Shockable Resume CPR immediately for 5 cycles Check rhythm every 5 cycles; Continue until ALS providers take over or victim starts to move PHONE **33 or emergency number Get AED/Crash trolley Or send second rescuer (if unavailable) to do this

9. CHILD BLS ALGORITHM

10. *Give 1 breath every 3 sec. *Recheck pulse every 2 mins Definite Pulse No movement or response Send someone to phone **33, get crash trolley Lone Rescuer: For SUDDEN COLLAPSE, PHONE **33, Get crash trolley One Rescuer: Give cycles of 30 COMPRESSIONS and 2 BREATHS Push hard and fast (100/min) and release completely Minimize interruptions in compressions ------------------------------------------------------------------------------- Two Rescuer: Give cycles of 15 COMPRESSIONS And 2 BREATHS Open AIRWAY, check BREATHING If no response, check pulse: Do you DEFINITELY feel pulse within 10 Seconds? If not already done, PHONE **33, for child get crash trolley/Defibrillator. Infant (<1 year): Continue CPR until ALS responders take over or victim starts to move Child (>1 year): Continue CPR; use AED/defibrillator After 5 cycles of CPR (Use AED as soon as it is available for sudden, witnessed collapse) Child >1 year Check Rhythm Shockable rhythm? Give 1 shock Resume CPR immediately for 5 cycles Shockable Not Shockable Resume CPR immediately for 5 cycles Check rhythm every 5 cycles; Continue until ALS providers take over or victim starts to move If no breathing, give 2 BREATHS That make chest rise