1. Resuscitation Changes 2006/07 5.1© Surf Life Saving Australia – Version 2 Resuscitation Changes 2006/07 Prepared by Dr Natalie Hood National Lifesaving Medical Advisor and Surf Life Saving Australia Prepared by Dr Natalie Hood National Lifesaving Medical Advisor and Surf Life Saving Australia

2. Resuscitation Changes 2006/07 5.2© Surf Life Saving Australia – Version 2 International Liaison Committee on Resuscitation releasing guidelines every five years Release of new resuscitation guidelines November 2005. Not due for any further review until 2010 International Consensus

3. Resuscitation Changes 2006/07 5.3© Surf Life Saving Australia – Version 2 National body of representatives from medical, first responder and major training organizations Surf Life Saving Australia and Royal Life Saving Australia each individually represented on the ARC Australian Resuscitation Council

4. Resuscitation Changes 2006/07 5.4© Surf Life Saving Australia – Version 2 < 10% victims of sudden cardiac arrest victims receive CPR Simplify guidelines to aid teaching Reduce confusion to improve retention of knowledge Aim to increase the number of cardiac or respiratory arrest victims receiving bystander CPR Goals of Guideline Development

5. Resuscitation Changes 2006/07 5.5© Surf Life Saving Australia – Version 2 SLSA the peak body in aquatic rescue SLSA in the forefront of education and training Need to balance maintenance of niche role in the aquatic environment versus issues of Australia wide, cross organisational consistency SLSA in the Picture

6. Resuscitation Changes 2006/07 5.6© Surf Life Saving Australia – Version 2 Adoption of new guidelines necessary to align with other national and international first responder and training organisations Credibility of SLSA open to criticism if not seen to be adopting and promoting the ARC guidelines Current guidelines are evidence based and form the best thinking based on research SLSA in the Picture

7. Resuscitation Changes 2006/07 5.7© Surf Life Saving Australia – Version 2 Current practices –Evidence shows patients receive oversupply of ventilation, more so with the increase of rate of delivery of each cycle –Have differing rates and ratios for 1 and 2 person for adults and children Rational to New Algorithms

8. Resuscitation Changes 2006/07 5.8© Surf Life Saving Australia – Version 2 New guidelines for CPR –Emphasize importance of chest compressions with minimal “hands off” time. –2 initial rescue breaths provide adequate oxygenation and allow rescuers to quickly move to chest compression –30 compressions:2 rescue breaths ratio for 1 and 2 person CPR in adults and children at rate of 100/minute –Emphasis on hand placement “in centre of chest” –Less importance in precise measurements, walking up ribs or xiphoid finding etc Rational to New Algorithms

9. Resuscitation Changes 2006/07 5.9© Surf Life Saving Australia – Version 2 Airway responder checks airway and breathing with patient on side Roll back and give 2 rescue breaths if not breathing ECC responder checks for “signs of life” If “signs of life” (normal breathing, coughing, moving, conscious) put in recovery position If no “signs of life” start CPR until “signs of life” noted or ambulance arrives. Two Person Assessment

10. Resuscitation Changes 2006/07 5.10© Surf Life Saving Australia – Version 2 Deletion of pulse checks and recovery checks: –Lay rescuers, first responders and even health care providers only dealing infrequently with arrested patients are unreliable in detecting presence or absence of pulse –Frequent recovery checks are associated with a worse outcome for the patient –CPR now continues until professional help arrives or patient has obvious signs of life Rational to New Algorithms

11. Resuscitation Changes 2006/07 5.11© Surf Life Saving Australia – Version 2 Resources

12. Resuscitation Changes 2006/07 5.12© Surf Life Saving Australia – Version 2 Current Method/PracticeNew Method/PracticeWhy the Change? Checking for Danger and responseNo Change Clearing the airwayNo change to clearing the airway for aquatic drowning For non aquatic locations clearing the airway may not be necessary and the assessment of the patient may be conducted on the back without rolling the patient on the side 5 Full Breaths2 Rescue BreathsMost research shows that during resuscitation patients are given too much oxygen – the added breaths also delays CPR Feel the PulseCheck for “signs of life”According to the most recent research pulse cheeks are ineffective with over 50% of checks being inaccurate EAR if pulse is presentNo EAR but continue with CPR if no “signs of life” For a patient with no breathing and no signs of life commence CPR CPR at a rate of 60 to 100 compressions per minute CPR at a rate of 100 compressions per minute Research has shown that an increased rate will help maintain a best possible blood flow and blood pressure. CPR at a rate of 15:2 and 1:5CPR at 30:2 for one and two person operation The faster and prolonged rate will allow for an increase in blood pressure Continue as the chest compression operator until feeling tired Change as the chest compression operator every two minutes if available personnel There is good evidence that the technique of the chest compression operator deteriorates after one minute even if the operator does not feel fatigued.

13. Resuscitation Changes 2006/07 5.13© Surf Life Saving Australia – Version 2 Defibrillation in combination with early CPR within an organized responder programme saves lives –Defibrillation taught in most lay community first aid courses –Proficiency in defibrillation included in the Australian definition of First Responder –Further future emphasis likely on teaching and availability of defibrillation –Club AED’s will need reprogramming in line with new guidelines. SLSA liaising with manufactures –Older AED’s may not be able to be reprogrammed and should be continue to be used as is. Defibrillation

14. Resuscitation Changes 2006/07 5.14© Surf Life Saving Australia – Version 2 Chest compressions will need to be interrupted for a short period to deliver rescue breaths Emphasize the importance of quickly starting CPR if needed and minimizing the time with “hands off” the chest Technique deteriorates after 1min yet awareness of fatigue delayed so rotate frequently, at least every 2 minutes (~5 cycles) Emphasize early placement of defibrillator on patient when available Training Issues

15. Resuscitation Changes 2006/07 5.15© Surf Life Saving Australia – Version 2 Change Management Circular on SLSA website As of 1 August 2006 all Assessment must be under the new guidelines Proficiency testing upgrades will be required Discuss change management issues within Circular 41 – 05/06. Discuss your role!! Change Management Issues

16. Resuscitation Changes 2006/07 5.16© Surf Life Saving Australia – Version 2 This PowerPoint – now on SLSA website Posters with new algorithm – May 2006 Updated training manual “V2” released late July Change Management Circular (41- 05/06) now on SLSA website Q&A sheet at the back of Circular 41 Questions? Speak to your State Medical Officer or write to the National Office at info@slsa.asn.auinfo@slsa.asn.au Resources

17. Resuscitation Changes 2006/07 5.17© Surf Life Saving Australia – Version 2 THANK YOU