First AidFirst AidUpdate ClinicUpdate Clinic

2010 CPR Guidelines2010 CPR Guidelines

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AgendaAgenda

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1.1. Why change? AHA/ILCOR backgroundWhy change? AHA/ILCOR background

2.2. What has changed? (video demo/Push Hard Push Fast flyer)What has changed? (video demo/Push Hard Push Fast flyer)

3.3. Stations:Stations: CPR & AED, practice new standards & “Must Sees” CPR & AED, practice new standards & “Must Sees”

4.4. Changes to first aid & awardsChanges to first aid & awards

5.5. Teaching first aid awardsTeaching first aid awards

6.6. Stations: Stations: First Aid, practice and review first aid test itemsFirst Aid, practice and review first aid test items

7.7. Workplace Safety & Insurance Board (WSIB)Workplace Safety & Insurance Board (WSIB)

8.8. Wrap up – administration, what's next?Wrap up – administration, what's next?

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Clinic objective:Clinic objective:

To ensure all Instructors and Examiners understand To ensure all Instructors and Examiners understand

(and can demonstrate) the new resuscitation (and can demonstrate) the new resuscitation

protocols and the implications for planning, teaching protocols and the implications for planning, teaching

and evaluating the Society’s training programs.and evaluating the Society’s training programs.

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Background to changesBackground to changes

CPR & first aid science reviewed every 5 years by the CPR & first aid science reviewed every 5 years by the American Heart Association (AHA) and the International American Heart Association (AHA) and the International Liaison Committee on Resuscitation (ILCOR)Liaison Committee on Resuscitation (ILCOR)

International panel of medical experts reviews new science International panel of medical experts reviews new science and makes treatment recommendationsand makes treatment recommendations

National first aid training agencies meet to interpret National first aid training agencies meet to interpret guidelines and recommendations for course deliveryguidelines and recommendations for course delivery

Provincial regulators review submitted course content from Provincial regulators review submitted course content from first aid training agencies to meet required legislationfirst aid training agencies to meet required legislation

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Changes at glanceChanges at glance

Summary of CPR stepsSummary of CPR steps

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YouTube CPR UpdateYouTube CPR Update

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What changed?What changed?

1.1. New CPR sequence for cardiac arrest victimsNew CPR sequence for cardiac arrest victims

2.2. No change in CPR sequence for drowning victimsNo change in CPR sequence for drowning victims

3.3. Compression only CPR: unwilling or untrainedCompression only CPR: unwilling or untrained

4.4. Depth of compression: minimum depthsDepth of compression: minimum depths

5.5. Choking procedures: back blows & abdominal thrustsChoking procedures: back blows & abdominal thrusts

6.6. Jaw thrust: NLS lifeguards attempt jaw thrusts for spinalsJaw thrust: NLS lifeguards attempt jaw thrusts for spinals

7.7. AED: children and infantsAED: children and infants6

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New CPR sequenceNew CPR sequence

CPR sequence:CPR sequence: Check the scene, if unresponsive, activate EMS and get AEDCheck the scene, if unresponsive, activate EMS and get AED

Airway check – open airway (head-tilt/chin-lift)Airway check – open airway (head-tilt/chin-lift) Breathing check – use visual cues like chest rise (5 sec.)Breathing check – use visual cues like chest rise (5 sec.) Circulation – perform 30 compressions if not breathing or gaspingCirculation – perform 30 compressions if not breathing or gasping

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Depth of compressionsDepth of compressions

Minimum depths of compressions Minimum depths of compressions have changedhave changed Adult minimum of 5 cmAdult minimum of 5 cm Child minimum of 5 cm orChild minimum of 5 cm or

(1/3 chest diameter)(1/3 chest diameter) Infant minimum of 4 cm orInfant minimum of 4 cm or

(1/3 chest diameter)(1/3 chest diameter)

Effective chest compressionsEffective chest compressions Minimum depths help to ensure Minimum depths help to ensure

essential blood flow during CPRessential blood flow during CPR

Landmarking Landmarking Emphasis is on “centre” of chest Emphasis is on “centre” of chest

between the nipplesbetween the nipples8

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Drowning victimsDrowning victims

NO change in rescue steps:NO change in rescue steps: Deliver 2 rescue breaths before starting Deliver 2 rescue breaths before starting

chest compressionschest compressions

If not successful, start CPR and use AED If not successful, start CPR and use AED Evidence shows drowning victims are in Evidence shows drowning victims are in

need of urgent replenishment of oxygen need of urgent replenishment of oxygen compared to a cardiac arrest victim and compared to a cardiac arrest victim and may respond to a few initial rescue may respond to a few initial rescue breathsbreaths

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Compression only CPRCompression only CPR

All trained rescuers should perform CPR with breaths and All trained rescuers should perform CPR with breaths and compressions. Gloves and a mask should be usedcompressions. Gloves and a mask should be used

If an untrained rescuer is unwilling or unable, compression If an untrained rescuer is unwilling or unable, compression only CPR may be performedonly CPR may be performed

Studies have shown a combination of breaths and Studies have shown a combination of breaths and compressions is best for children or victims who have an compressions is best for children or victims who have an underlying cause of cardiac arrest such as:underlying cause of cardiac arrest such as: Drowning, trauma, drug overdose, etc.Drowning, trauma, drug overdose, etc.

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Choking proceduresChoking procedures Alternating techniquesAlternating techniques

More than one technique may be needed in More than one technique may be needed in removing a severe obstruction. Use back removing a severe obstruction. Use back blows, abdominal thrusts, chest thrusts blows, abdominal thrusts, chest thrusts

Conscious choking (adult, child)Conscious choking (adult, child) Perform alternating back blows and Perform alternating back blows and

abdominal thrustsabdominal thrusts 5 back blows 5 back blows

- Bend victim over, near parallel to the ground- Bend victim over, near parallel to the ground

- Support victim with one arm across their chest- Support victim with one arm across their chest

- With other arm apply 5 back blows, between the - With other arm apply 5 back blows, between the shoulder bladesshoulder blades

5 abdominal thrusts 5 abdominal thrusts (chest thrusts for pregnant or obese)(chest thrusts for pregnant or obese)

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Jaw thrustJaw thrust

A technique used to open the airway:A technique used to open the airway: Used on spinal victims to help minimize Used on spinal victims to help minimize

head/neck movementhead/neck movement Grasp jaw on both sides of the face where it Grasp jaw on both sides of the face where it

forms an angle close to the ears. Using both forms an angle close to the ears. Using both hands, move the jaw forward (upward) hands, move the jaw forward (upward) without tilting the head back.without tilting the head back.

Used by NLS lifeguards (NLS curriculum)Used by NLS lifeguards (NLS curriculum) Instructed in NLS courses in management of Instructed in NLS courses in management of

spinal victimsspinal victims Jaw thrust is “attempted” and if unsuccessful Jaw thrust is “attempted” and if unsuccessful

use the head-tilt/chin-liftuse the head-tilt/chin-lift12

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AED unitsAED 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” A heart that is “fibrillating” or “twitching”

cannot beat effectively. When a shock is cannot beat effectively. When a shock is provided the heart is “defibrillated”provided the heart is “defibrillated”

Apply an AED as soon as possible to an Apply an AED as soon as possible to an unresponsive, non-breathing victim. Turn unresponsive, non-breathing victim. Turn on unit and follow voice prompts.on unit and follow voice prompts.

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AED pad placementAED pad placement

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Adult:Adult: Follow directions for pad placement. One Follow directions for pad placement. One

pad on upper right side of chest. Other pad on upper right side of chest. Other pad to the lower left side of chestpad to the lower left side of chest

Children:Children: Look for a child key or switch or child padsLook for a child key or switch or child pads Adult pads may be used if no child padsAdult pads may be used if no child pads If child is small, place one pad on centre of If child is small, place one pad on centre of

chest, the other on back, so not touchingchest, the other on back, so not touching

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AED shock/no shockAED shock/no shock

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Turn on AED. Unit will either Turn on AED. Unit will either advise a shock or no-shockadvise a shock or no-shock

If shock is advised: say aloud If shock is advised: say aloud “Stand Clear,” push the shock “Stand Clear,” push the shock button, continue CPR (2 min.)button, continue CPR (2 min.)

If no shock is advised: continue If no shock is advised: continue CPR (2 min.)CPR (2 min.)

After 2 min. the AED unit re-After 2 min. the AED unit re-analyzes for shock or no shockanalyzes for shock or no shock

Continue sequence of Continue sequence of shock/no shock until victim shock/no shock until victim recovers or EMS arrives.recovers or EMS arrives.

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AED use: infantsAED use: infants

Infants: guidelines have expanded the use of Infants: guidelines have expanded the use of AEDs for infants AEDs for infants BUTBUT AED use on infants is very AED use on infants is very uncommonuncommon A A manual defibrillatormanual defibrillator, which is more advanced, is , which is more advanced, is

preferred versus an AED for use on an infantpreferred versus an AED for use on an infant Infants typically have Infants typically have healthy heartshealthy hearts, meaning a , meaning a

breathing problem is usually the cause of heart breathing problem is usually the cause of heart failure versus an underlying heart conditionfailure versus an underlying heart condition

AED training will focus on adult and child useAED training will focus on adult and child use The use of an AED on infants is knowledge-The use of an AED on infants is knowledge-

based and not evaluatedbased and not evaluated16

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Stations: CPR & AEDStations: CPR & AED

Practice stations: Practice stations: NEW test items & “Must Sees”NEW test items & “Must Sees”

Station 1: One-rescuer CPR: adult, child & infantStation 1: One-rescuer CPR: adult, child & infant

Station 2: Two-rescuer CPR & AED: adult & childStation 2: Two-rescuer CPR & AED: adult & child

Station 3: Choking, conscious to unconsciousStation 3: Choking, conscious to unconscious

Questions & answersQuestions & answers Group feedback, commentsGroup feedback, comments

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Changes to first aid awardsChanges to first aid awards

Emergency First Aid (8 hrs.)Emergency First Aid (8 hrs.) Test item 11c external bleeding:Test item 11c external bleeding:

- Elevation removed- Elevation removed NEW Test item 12 Wounds:NEW Test item 12 Wounds:

- 12a: Abdominal injury- 12a: Abdominal injury- 12b: Burn injury- 12b: Burn injury- 12c: Facial injury- 12c: Facial injury

One-rescuer CPR: test item 6One-rescuer CPR: test item 6- - withwith AED Protocol (adult/child) AED Protocol (adult/child)

Standard First Aid (16 hrs.)Standard First Aid (16 hrs.) Two-rescuer CPR: test item 1Two-rescuer CPR: test item 1

- - withwith AED Protocol (adult/child) AED Protocol (adult/child)

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AED protocol AED protocol “Must See” items “Must See” items in:in:

CPR A-B-CCPR A-B-C

CPR-HCPCPR-HCP

EFAEFA

SFASFA

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Changes to first aidChanges to first aid

Bleeding: Bleeding: Rest and direct pressure. “Elevation” Rest and direct pressure. “Elevation”

has been removed as a “Must See.” has been removed as a “Must See.” Evidence shows direct pressure is Evidence shows direct pressure is the most effective means to initially the most effective means to initially stop bleeding stop bleeding

Auto-injectorAuto-injector New EpiPen. Pull off blue cap and New EpiPen. Pull off blue cap and

apply to outer thigh for 10 seconds. apply to outer thigh for 10 seconds. After use, the auto-injector will After use, the auto-injector will extendextend over the needle tip to further over the needle tip to further prevent injury when handled prevent injury when handled

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Changes to first aidChanges to first aid

Heat-related emergencies: Sport drinks (electrolyte drinks) can be Sport drinks (electrolyte drinks) can be

used for treatment of heat exhaustionused for treatment of heat exhaustion For victims with suspected heat stroke, For victims with suspected heat stroke,

immersion in cold water is preferable if immersion in cold water is preferable if possiblepossible

Angina/heart attack: Continued emphasis on use of ASA. The Continued emphasis on use of ASA. The

use of ASA was referenced in previous use of ASA was referenced in previous guidelines and is found in Canadian First guidelines and is found in Canadian First Aid Manual, p. 34Aid Manual, p. 34 If victim has no heart medication, suggest If victim has no heart medication, suggest

taking ASA (1 regular tablet or 2 child low-taking ASA (1 regular tablet or 2 child low-dose tablets). Ask if they have ASA allergy, dose tablets). Ask if they have ASA allergy, or advised not to take ASA from a doctor. or advised not to take ASA from a doctor. 20

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CPR-HCP: changesCPR-HCP: changes

CPR-HCP: health care providers (HCP) who CPR-HCP: health care providers (HCP) who frequently respond to emergenciesfrequently respond to emergencies Few changes overall:Few changes overall:

Team response is emphasized, allowing Team response is emphasized, allowing responders to delegate roles as team members responders to delegate roles as team members arrive on the scenearrive on the scene

Use of AED on infants permissible, manual Use of AED on infants permissible, manual defibrillator preferred defibrillator preferred

Cricoid pressure removed as knowledge item. A Cricoid pressure removed as knowledge item. A technique that is difficult to teach and applytechnique that is difficult to teach and apply

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Agenda – what’s nextAgenda – what’s next

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1. Why change? AHA/ILCOR background

2. What has changed? (video demo/Push Hard Push Fast flyer)

3. Stations: CPR & AED

4. Changes to first aid awards

5.5. Teaching first aid awardsTeaching first aid awards

6.6. Stations: first aid practice and reviewStations: first aid practice and review

7.7. Workplace Safety & Insurance Board (WSIB)Workplace Safety & Insurance Board (WSIB)

8.8. Wrap up – administration, what's next?Wrap up – administration, what's next?

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Teaching first aidTeaching 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 coursesLesson planning, course length, combined courses Lifesaving Instructor schools (assignments, evaluation, etc.)Lifesaving Instructor schools (assignments, evaluation, etc.) What new resources do you needWhat new resources do you need List minimum first aid equipment for teaching EFA or SFAList minimum first aid equipment for teaching EFA or SFA Evaluation criteria, what has been addedEvaluation criteria, what has been added Differences among revised first aid test sheetsDifferences among revised first aid test sheets

Additional resources: First Aid Instructor CD (updated)First Aid Instructor CD (updated) Bronze Medals Instructor CD (new)Bronze Medals Instructor CD (new)

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First aid stationsFirst aid stations

Practice stations: (review test items & “Must Sees”) with Practice stations: (review test items & “Must Sees”) with reference to the reference to the Canadian First Aid Manual Canadian First Aid Manual and and First Aid Award First Aid Award GuideGuide Station 1:Station 1:

External bleeding EFA item 11c andExternal bleeding EFA item 11c andFacial injury item 12cFacial injury item 12c

Station 2:Station 2:Bone or joint injury SFA item 4Bone or joint injury SFA item 4

Station 3:Station 3:Assessment item 5 andAssessment item 5 andUnconscious victim EFA item 12Unconscious victim EFA item 12

Questions & answersQuestions & answers Group feedback, commentsGroup feedback, comments

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WSIB: overviewWSIB: overview

Workplace Safety & Insurance Board (WSIB) Workplace Safety & Insurance Board (WSIB) www.wsib.on.ca WSIB (Ontario government, Ministry of Labour) tasked to reduce WSIB (Ontario government, Ministry of Labour) tasked to reduce

workplace injuries and to raise awareness of workplace safety.workplace injuries and to raise awareness of workplace safety.

Employers pay WSIB (required by law) to manage claims during a Employers pay WSIB (required by law) to manage claims during a workplace accident. WSIB helps employees with their medical needs workplace accident. WSIB helps employees with their medical needs to get back to work. In return employers are not sued.to get back to work. In return employers are not sued.

WSIB is empowered with enforcement to ensure compliance for safe WSIB is empowered with enforcement to ensure compliance for safe work environments for employees. First aid training is a requirement work environments for employees. First aid training is a requirement for worksites. Regulation 1101.for worksites. Regulation 1101.

Enforcement of EFA and SFA training criteria falls under WSIB. All Enforcement of EFA and SFA training criteria falls under WSIB. All course providers, approved by WSIB, must follow training criteria course providers, approved by WSIB, must follow training criteria such as course content, minimum times, etc.such as course content, minimum times, etc.

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Summary: let’s reviewSummary: let’s review

New CPR sequenceNew CPR sequence

Drowning victims: 2 breaths Drowning victims: 2 breaths

Compression-only CPR knowledgeCompression-only CPR knowledge

AED use on infants knowledgeAED use on infants knowledge

Jaw thrusts (NLS lifeguards)Jaw thrusts (NLS lifeguards)

Choking procedures (5&5)Choking procedures (5&5)

Minimum depths (5cm, 4cm, 1/3)Minimum depths (5cm, 4cm, 1/3)

New “Must See”: AED protocolNew “Must See”: AED protocol

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New test items in EFA & SFANew test items in EFA & SFA

Elevation removed from (RED)Elevation removed from (RED)

New auto-injector (EpiPen)New auto-injector (EpiPen)

Heat-related injuryHeat-related injury

ASA useASA use

Teaching First AidTeaching First Aid

First Aid StationsFirst Aid Stations

WSIB overview

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Wrap up - administrationWrap up - administration

Complete Aquatic Master SheetComplete Aquatic Master Sheet First Aid Update, tracked on “find a member” First Aid Update, tracked on “find a member” Instructors may teach new standards after successfully completing updateInstructors may teach new standards after successfully completing update Check with employer when new content is implemented at worksiteCheck with employer when new content is implemented at worksite 3 credits earned for successful completion3 credits earned for successful completion Upon recertifying your “Lifesaving Instructor” an “Emergency First Aid Upon recertifying your “Lifesaving Instructor” an “Emergency First Aid

Instructor” award will also be issued ($7.00)Instructor” award will also be issued ($7.00)

Resources at Society’s website: www.lifesavingsociety.comResources at Society’s website: www.lifesavingsociety.com Revised first aid test items and test sheetsRevised first aid test items and test sheets PowerPoint slides – First Aid UpdatePowerPoint slides – First Aid Update Notes for conductors – First Aid Update Notes for conductors – First Aid Update Push Hard Push Fast – flyerPush Hard Push Fast – flyer Lifesaving Society YouTube channelLifesaving Society YouTube channel

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Wrap up – clinic conductorsWrap up – clinic conductors

Conductors: First Aid UpdateConductors: First Aid Update After successful completion, the following examiners and

trainers may also deliver the First Aid Update Provincial TrainersProvincial Trainers First Aid Instructor TrainersFirst Aid Instructor Trainers NLS Instructor TrainersNLS Instructor Trainers Lifesaving Instructor TrainersLifesaving Instructor Trainers First Aid ExaminersFirst Aid Examiners NLS ExaminersNLS Examiners

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Wrap upWrap up

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Final questions, comments?Final questions, comments?

First AidFirst AidUpdate ClinicUpdate Clinic

2010 CPR Guidelines2010 CPR Guidelines

Thank you & goodbyeThank you & goodbye