Paediatric Module for BLS & AED

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Paediatric module for BLS & AED - Instructor Manual

Paediatric Module for BLS &

AED

Paediatric Module forBLS & AED

INSTRUCTORManual

Paediatric module for DAN Basic Life Support

and Automated External Defibrillation

© 2013 DAN Europe

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic mechanical, photocopying or other-

wise, without prior written permission of DAN Europe, P.O. Box DAN, 64026 Roseto, Italy.

Instructor Manual

DAN Southern AfricaPrivate Bag X197, Halfway House, 1685

DAN Building, Rosen Office ParkCnr Invicta & Third RoadsHalway Gardens, Midrand

DAN Southern Africa Training Tel: +27 11 266 4900 Fax: +27 11 312 0054

e-mail (general): [email protected] e-mail (training): [email protected]

www.dansa.org

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Paediatric module for DAN Basic Life Support and Automated External Defibrillation

Table of contentPaediatric module for daN Basic life suPPort aNd automated exterNal defiBrillatioN

Course Standards and Procedures 1General 1Course objective 1Instructor qualifications 1Recommended minimum hours of training 1Required curriculum subject areas 2Learning objectives 3Skill performance objectives 3DAN support materials for the Paediatric care modules 4

DAN Paediatric Care Module Retraining Standards 5General 5Retraining course objective 5Qualifications upon completion 5Prerequisites for entering the DAN Paediatric BLS(-D) Provider retraining programme 5Recommended hours of training 5DAN support materials for all retraining courses 6

Key Standards Overview 7

Knowledge Development Session Outline 8How to conduct the knowledge development session for the DAN Paediatric BLS(-D) Provider module 8

Paediatric Basic Life Support Slide Script 9

Paediatric Automated External Defibrillation Slide Script 21

Skills Development Session Overview 27How to conduct the skills development session for the DAN Paediatric BLS(-D) module 27Between the knowledge development session and skills development session 28Skills development session process 28Skills development session overview 29

Skill: Resuscitation 30Skill: Child Resuscitation 32Skill: Infant Resuscitation 36

Skill: Foreign Body Airway Obstruction 39Skill: Foreign Airway Obstruction - Child 41Skill: Foreign Airway Obstruction - Infant 45

Skill: Pad Placement (required for the PBLS-D certification) 47Skill: Proper Pad Placement 49Antero-posterior position 49

Skill: Providing Care with an AED (required for the PBLS-D certification) 50Skill: Providing Care with an AED 52

APPENDIX 53

Skill Evaluation Form Guidelines 54

Evaluation Criteria - Resuscitation 55

Evaluation Criteria - FBAO 57

Student Practice Form1– rescuer child BLS 581– rescuer infant BLS 60Foreign Body airway obstruction - child 62Foreign Body airway obstruction - infant 64Providing care with an aed (required for the PBLS-D certification) 66

Paediatric BLS-D critical skills description 68Paediatric FBAO critical skills description 70

Paediatric Basic Life Support ModuleProvider Exam (EN) 71

Paediatric Basic Life Support SupplementProvider Exam (EN) ANSWERS 75

Paediatric Automated External Defibrillation ModuleProvider Exam (EN) 79

Paediatric Automated External Defibrillation ModuleProvider Exam (EN) ANSWERS 83

DAN Paediatric Care Provider Module Checklist 87

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Course Standards and Procedures

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GeneralThe Paediatric Basic Life Support (PBLS) module and Paediatric AED (PAED) mod-ule, represents entry-level training designed to educate persons in providing Basic Life Support techniques to children and infants with life threatening injuries.

It is not sufficient as a stand-alone program, as there is no review of other life threatening medical emergencies. It is designed as an add-on to the BLS or BLSD Course.

Course Options:• Paediatric BLS module as supplement to the DAN BLS Course• Paediatric BLSD module as supplement to the DAN BLSD course

Course objectiveThe DAN Paediatric Basic Life Support provider module is designed to teach the knowl-edge and skills needed to provide Basic Life Support (BLS) to children and infants.

The Paediatric AED module, explains and teaches participants how to use an AED and deliver defibrillation shocks to a child from 1 to 8 years of age using paediatric AED Pads and proper pad placement.

Instructor qualificationsIn order to issue the DAN Paediatric Basic Life Support, or the DAN Paediatric Basic Life Sup-port including the AED certificate you must be certified as DAN Paediatric BLS-D Instructor.

Recommended minimum hours of trainingKnowledge development PBLS (lecture) hours = 30 minutes

Skills development PBLS (practice) hours = 1 – 2 hour(s)

Knowledge development PAED (lecture) hours = 30 minutes

Skills development PAED (practice) hours = 1 hour

The time needed to teach the course varies and depends on many factors including the number of students and their ability to process the educational components of the pro-gram. Instructors who want to include subjects or training beyond the course requirements may do so only before or following the course. Any additional training must not be required for completion of course requirements.

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Required curriculum subject areas

Knowledge development

Paediatric Basic Life Support module

The instructor must ensure participants understand:• How to perform chest compressions and rescue breathing – CPR for children and

infants• How to provide care for foreign body airway obstructions in children and infants

Paediatric Automated External Defibrillation module

The instructor must ensure participants understand:• Causes of paediatric cardiac arrest• Frequency of the problem• Reliability of the AED• AED use in children• Paediatric AED pads• Pad placement

Skills development


The instructor must ensure each course participant can successfully perform the following:• Paediatric Resuscitation – Lay rescuer protocol• Providing care for a child and an infant with a foreign body airway obstruction (chocking)


The instructor must ensure each course participant can successfully perform the following:

1. Proper pad placement

2. Using an AED on children

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Learning objectives


At the end of the DAN Paediatric Basic Life Support module, course participants will know:• How to perform chest compressions and rescue breathing – CPR on children and

infants• How to provide care for foreign body airway obstructions in children and infants


At the end of the DAN Paediatric Automated External Defibrillation module, course par-ticipants will know the:• Causes of paediatric cardiac arrest• Frequency of the problem• Reliability of the AED• AED use in children• Paediatric AED pads• Pad placement

Course participants must complete the DAN Paediatric BLS and AED examination with a minimum passing score of 80 percent. The instructor will review the examination with each participant to ensure 100 percent understanding of the material.

Skill performance objectives


To successfully complete the DAN Paediatric BLS Provider module, participants must in addition to the skills of the Basic Life support course, demonstrate skill and confi-dence in providing BLS to infants and children:• Paediatric resuscitation• Providing care for for a child and an infan with a foreign body airway obstruction

(chocking)


To successfully complete the DAN Paediatric BLS-D Provider module, participants must in addition to the skills of the Basic Life Support and Automated External Defibril-lation courses, demonstrate skill and confidence in providing BLS with the use of an AED to children:

1. Proper pad placement

2. Using an AED on children

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DAN support materials for the Paediatric care modulesThis module is a part of the DAN BLS and BLS(-D) programme and the Paediatric student manuals are part of the student kits for these courses. Therefore, since taught together with one of these courses, only a DAN BLS or BLS-D Student Kit is required to fulfil train-ing requirements.

Each DAN BLS(-D) Provider must possess the Student Handbook. Only DAN Instructors may acquire DAN training and certification materials from DAN or its designated agent.

This audiovisual support material must be used during the knowledge development ses-sion of the DAN Paediatric Care module:

DAN Paediatric BLS slide series (36 slides)

DAN Paediatric AED slide series (18 slides)

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DAN Paediatric Care Module Retraining Standards

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GeneralThis is a retraining programme for DAN Paediatric BLS(-D) Providers who have previously attended a DAN Paediatric BLS(-D) module. This retraining programme is not designed to train new DAN Paediatric BLS(-D) Providers.

Retraining course objectiveThe objective of this module is to refresh and update previously trained DAN Paediatric BLS(-D) Providers in necessary knowledge and skills.

Qualifications upon completionSince the first aid skills associated with providing Basic Life Support deteriorate at variable rates, DAN Training recommends retraining every two years (24 months).

Prerequisites for entering the DAN Paediatric BLS(-D) Provider retraining programmeThe course participant must show proof of having successfully completed a previous DAN BLS(D) course with Paediatric BLS(-D) module.

Recommended hours of trainingThe knowledge development is very limited and it recommended to participate in the full 2-hour DAN Paediatric BLS Provider module or a full 3.5 hour DAN Paediatric BLS-D Provider module.

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DAN support materials for all retraining coursesThe DAN Instructor only need to purchase a re-certification envelope. The most recent DAN Paediatric BLS-D Student Handbook will be available to the participant in their MyDAN area. DAN Training will issue a new provider card as soon as they received the provider course registration.

Only DAN Instructors may acquire DAN Training and certification materials from DAN or its designated agent.

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Key Standards Overview

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Key Standards Overview

DAN Paediatric BLS Provider module DAN Paediatric BLS-D Provider module

Prerequisites BLS provider ( * ) BLS-D Provider ( * )

Recommended Prerequisites None None

Student-to-Instructor Ratio 12:1 during skills development sessions

12:1 during skills development sessions

Recommended course hours Two (2) hours Three and a half (3,5) hours

Required student materials DAN Paediatric BLS Student Workbook

DAN Paediatric BLS(-D) Student Workbook

Required instructor materials DAN Instructor Manual DAN Instructor Manual

Required audiovisual materials

DAN Paeditric Basic Life Support module slide series

DAN Paeditric Basic Life Support module slide series,

DAN Paediatric AED module slide series.

Retraining period 24 months 24 months

(*) A CPR / Basic Life Support course is equivalent to the DAN BLS course if this course follows the latest ERC guidelines and the certification is issued by a recognised first aid organisa-tion. Certifications which meet this definition are accepted and don’t have to be confirmed by DAN Training prior the course.

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Knowledge Development Session Outline

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Knowledge Development Session Outline

How to conduct the knowledge development session for the DAN Paediatric BLS(-D) Provider module

Before you start:1. Provide each student with a DAN Paeditric BLS(-D) Provider kit as part of the

BLS(- D) Provider kit. Each student must have a copy of the handbook.

2. Instruct students to read the handbook.

3. Review the DAN Paediatric BLS(-D) Provider module Checklist. Make sure that you have all materials and equipment required to teach the program.

Knowledge development session process:1. Conduct introductions of the course staff and of the DAN Paediatric BLS(-D) Providers.

2. Complete DAN Paediatric BLS Provider module administrative requirements (DAN Provider Registration Form, Statement of Understanding, Practical Evaluation Re-cord and other training association administrative requirements).

3. Show the DAN Paediatric BLS(-D) slides. Answer any student questions about the material.

4. Conduct the Skills Development Session emphasising key portions of the Knowl-edge Development Session.

5. Administer the DAN Paediatric BLS (and AED) module Final Examination. Stu-dents must score at least 80 percent for successful completion of the course. To ensure 100 percent comprehension of the material, review any missed questions with the student.

6. Have students complete the DAN Paediatric BLS(-D) Provider Module Evaluation and forward the evaluation to DAN Training.

7. Congratulate and encourage all course participants to continue learning about safety and first aid.

8. Remind students that BLS Skills deteriorate at variable rates and retraining is rec-ommended every two years or 24 months.

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Paediatric BLSD Slide Script

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Paediatric Basic Life Support Slide Script

Objectives• Paediatric Resuscitation – Child• Paediatric Resuscitation - Infant• Foreign Body Airway Obstruction (Child – Infant)

CHILD RESuSCITATION

Paediatric BLS – Sequence (lay rescuer)Ensure the safety of rescuer and childResponsiveness?If responsive

• Leave the child in the position you find him/her• Check his condition and get help if needed• Re-assess the child regularly

Unresponsive• Shout for help• Turn the child on to his/her back

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Paediatric BLS – Sequence (lay rescuer)Look, listen and feel for no more than 10 seconds

• Open Airway• head tilt and chin lift• quick look into the mouth for foreign body objects

If the child is breathing normally• Recovery position• Send or go for help• Check for continued normal breathing

Paediatric BLS – Sequence (lay rescuer)If the breathing is not normal or absent

• Give 5 rescue breaths• Pinch the soft part of the nose• Allow the mouth to open, maintain chin lift• Cover mouth with your mouth and make sure you have a

good seal• Blow steadily over 1-1,5 seconds, sufficient to make the

chest visibly rise• Maintain head tilt and chin lift, take your mouth away and

watch the chest to fall• Assess the child’s circulation (Look for signs of life within 10 seconds)

While performing the rescue breaths note if the child gags or coughs re-sponse to your action.

Look for signs of life including any movement, coughing or normal breathing (not abnormal gasps or infrequent, irregular breaths).

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Paediatric BLS – Sequence (lay rescuer)If there are no signs of life:Start chest compressions

• 30 chest compression• Compress the lower half of the sternum

• Depress the sternum at least 1/3 of the depth of the chest|| approximately 5 cm in children

• Release the pressure completely and repeat• At least 100 compression/min (not exceeding 120)

Combine 2 rescue breaths and chest compressions• 30:2 sequence for lay rescuer

Do not confuse sign of life with cheching the pulse. Look for signs of life takes no more than 10 seconds

Chest Compressions : 1- Hand Technique• Place heel of the hand on the lower part of the sternum• Lift fingers

• Make sure pressure is not applied over the the ribs• Position yourself above the child’s chest

• Arm straight• Maintain head tilt with the other hand

Choosing the technique of chest compression will all depend on the size of the child. You probably will use 1-hand technique on smaller children, while you choose for the 2-hand technique on bigger children with a strong build.

Paediatric BLS – Sequence (lay rescuer)Do not interrupt resuscitation until

• The child shows signs of life• Starts to wake up, to move, opens eyes and to breath

normally• Qualified help arrives and takes over• You become exhausted

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Paediatric BLS – Sequence (lay rescuer)When to call for help

• When more than one rescuer is available• One starts resuscitation, the other calls for help

• Only one rescuer• Start CPR for 1 minute• Call for help

|| To minimise interruption in CPR, it may be possible to carry a small child with you whilst summoning help

• Immediately call for help in case of a witnessed, sudden collapse|| Probably will need defibrillation

It is vital for rescuers to get help as quicly as possible when a child collapses.

In this case, cardiac arrest is likely to be caused by an arrhythmia and the child will need defibrillation.

SKILL DEvELOPMENT SESSION

Child BLS – Lay Rescuer• Ensure your safety and the safety of the child• Unresponsive?

• Shout for help• Open airway

• Breathing is not normal or absent?• 5 rescue breaths• Look for signs of life• Start CPR

|| 30 compressions / 2 rescue breaths• Continue CPR until signs of life:

• starts to wake up, to move, opens eyes and to breath normally

When alone go and call for help after 1 minute CPR

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Unresponsive?

Not breathing normally?

Shout for helpOpen Airway

5 rescue breaths

• 2 rescue breaths• 30 compressions

Call EMS after 1 minute CPR

30 chest compression

No signs of life?

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BLS – Sequence - Overview

INFANT RESuSCITATION

Paediatric BLS – Sequence (lay rescuer)Ensure the safety of rescuer and childResponsiveness?

• Gently stimulate the infant, tap or rub the sole of the infant’s foot and call his/her name to see if he/she responds. Never shake an infant

If responsive• Leave the child in the position you found him/her• Check his/her condition and get help if needed• Re-assess him/her regularly

Unresponsive• Shout for help• Turn the child on to his/her back

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Paediatric BLS – Sequence (lay rescuer)Breathing normally?

• Open Airway• Ensure neutral position of the head and chin lift• Check the mouth for foreign body objects in the mouth

Breathing normally• Recovery position

• Cradle the infant in your arms, against your body, with the infant's head tilted little downwards. This prevents the infant from chocking on his/her tongue or inhaling vomit.

• Send or go for help• Check for continued normal breathing

Paediatric BLS – Sequence (lay rescuer)If the breathing is not normal or absent

• Give 5 rescue breaths• Cover mouth and nose with your mouth and make sure you

have a good seal• Blow steadily over 1-1,5 seconds, sufficient to make the

chest visibly rise• Maintain head position and chin lift, take your mouth away

and watch the chest to fall• When using a oronasal resuscitation mask, ensure that the

small part of the mask points toward the infant’s body• Assess the infant’s circulation (Look for signs of life within 10 seconds)

Although the infant’s lung capacity is smaller, we breathe in 1 – 1,5 seconds instead of 1 second for adults. Go slowly and use the volume of air in your mouth instead of blowing into the infant.

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Paediatric BLS – Sequence (lay rescuer)If there are no signs of life:Start chest compressions

• 30 chest compression• Compress the lower half of the sternum

• Depress the sternum at least 1/3 of the depth of the chest|| approximately 4 cm in infants

• Release the pressure completely and repeat• At least 100 compression/min (not exceeding 120)

Combine 2 rescue breaths and chest compressions• 30:2 sequence for lay rescuer

Chest Compressions : 2 - Finger Technique• Place the infant on hard surface or position on lower arm and

support the head with your hand• Position 3 fingers on lower part of the sternum

• Top finger (closest to the head) on the imaginary line between the infant’s nipples

• Elevate top finger• 2 fingers on the sternum

• Compress the sternum with 2 fingers

Placing the infant on a hard surface like a table is less tiring. Positioning on the lower arm facilitates moving around for example to go and call for help without interrupting resuscitation.

Using the middle finger and ring finger is advised

Chest Compressions : Encircling Technique• At least two rescuers• Place both thumbs, side by side on the lower part of the sternum

• Fingertips pointing towards the head• Hands with fingers together on lower part of the rib cage

• Fingertips supporting the back

For both methods, depress the lower sternum by at least one third of the depth of the infant’s chest.The second rescuer is positioned at the anterior of the infant's body, holding the head, and should use a mask to administer the two rescue breaths.

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Paediatric BLS – Sequence (lay rescuer)Do not interrupt resuscitation until

• The infant shows signs of life• Starts to wake up, to move, opens eyes and to breath


Paediatric BLS – Sequence (lay rescuer)When to call for help

• When more than one rescuer is available• One starts resuscitation, one call for help

• Only one rescuer• Start CPR for 1 minute• Call for help

|| To minimise interruption in CPR, it may be possible to carry an infant with you whilst summoning help


Infant BLS – Sequence (lay rescuer)• Ensure your safety and the safety of the child• Unresponsive?






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FOREIGN BODy AIRWAy OBSTRuCTION

Paediatric TreatmentAssess severity

• Effective cough• Crying or verbal response to questions, loud cough, able to

take a breath before coughing, fully responsive• Encourage to cough• Continue to check for deterioration of an ineffective cough or

until obstruction is relieved

Paediatric TreatmentIneffective cough

• Conscious• Unable to vocalise, quiet or silent cough, unable to breath,

cyonosis, decreasing level of consciousness• 5 back blows• 5 thrusts

|| Infant: chest|| Child over 1 year: abdominal

Ineffective cough• Unconscious

• Open airway• 5 rescue breaths• Start CPR

Back Blows – Child over 1 year• Back blows are more effective if the head is positioned down

• A small child can be placed across the lap• Support the child in a forward leaning position• Deliver back blows from behind• Sharp back blow with the heel of one hand in the middle of the

back, between the shoulder blades• Try to relieve the obstruction with each blow, rather then to give

all back blows

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Abdominal Thrust for Child over 1 year• Kneel behind the child• Place your arms under the child’s arms and encircle the torso• Place your fist between the navel and the bottom of his/her

breastbone• Grasp the fist with your other hand• Pull sharply inwards and upwards

Do not apply pressure on the xiphoid process* or lower rib cage

Depending on the height of the child you will probably need to kneel down. Make sure you are positioned at the same height as the child. Gravity and the weight of the child increases the force of the abdominal thrust.

*The xiphoid process is a small cartilaginous process (extension) of the lower part of the sternum

Back Blows - Infant• Support in a head downward, prone position• A seated or kneeling rescuer can support the infant across the lap• Support the head

• Thumb at the angle of the lower jaw, two fingers on the otherside of the jaw|| Do not compress the soft tissues under the jaw

• Sharp back blow with the heel of one hand in the middle of the back, between the shoulder blades

• Try to relieve the obstruction with each blow, rather then to give all back blows

Chest Thrust for Infants• Head downward supine position

• Place an arm along the infant’s back and encircle the occiput with the hand

• Support the infant down on your arm, which is placed down on your thigh

• Identify the landmark for chest compressions (on the lower half of the sternum)

• Give chest thrust• Similar to chest compressions, but sharper and delivered at

a slower rateDo not use abdominal thrust (Heimlich manoeuvre) for infants

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Foreign Body Airway Obstruction - Child• Mild airway obstruction

• Encourage to cough• Severe airway obstruction

• Conscious|| Up to 5 back blows|| If back blows fail, give up to 5 thrusts

|| child: abdominal• Unconscious

|| 5 rescue breaths|| Start CPR

Foreign Body Airway Obstruction - Infant• Mild airway obstruction

• Encourage to cough• Severe airway obstruction

• Conscious|| Up to 5 back blows|| If back blows fail, give up to 5 thrusts

|| infant: chest• Unconscious

|| 5 rescue breaths|| Start CPR

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Ineffective cough(*)

Effective cough(**)

UnconsciousOpen Airway

5 rescue breathsStart CPR

Assess severity

Encourage cough

Continue to check for deterioration to ineffective cough

or until obstruction is relieved

Conscious

5 back blows5 thrusts

(chest for infant)

(abdominal for child > 1 year)

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Foreign Body Airway Obstruction - Overview

Summary• Paediatric Resuscitation Techniques• Paediatric BLS Sequence – Lay Rescuer• Foreign Body Airway Obstruction

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Paediatric Automated External Defibrillation Slide Script

Objectives• Causes of Paediatric Cardiac Arrest• Frequency of the problem• Reliability of the system• AED use in children• Paediatric Pads• Pad Placement• Paediatric Skills

Causes of Paediatric Cardiac Arrest• Some causes of cardiac arrest in children include:

• sudden infant death syndrome (SIDS)• trauma• motor vehicle accident• electrocution• drowning• overdose / poisoning• illness• congenital heart disease• choking or airway compromise• a hard blow to the chest has also been known to cause

cardiac arrest – as when a child is playing sports

For the purposes of this program, the term “children” includes any child un-der 8 years old or who weighs less than 25 kg. Above those ranges is con-sidered an adult for the purposes of emergency care. Children younger than 1 year old are considered infants and will not be addressed in this program.

Case reports indicate that automated external defibrillators (AEDs) are safe and successful when used in children older than 1 year of age. Automated external defibrillators are capable of identifying arrhythmias in children ac-curately; in particular, they are extremely unlikely to advise a shock inap-propriately

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Frequency of the problem• Cardiac arrest is less common in children than adults, and its

causes are more diverse• There is very little information on what goes on in the first few

minutes of a paediatric cardiac arrest• In typical emergency care situations involving children, monitoring

equipment is not attached until late in the response

Frequency of the problem• Typical respiratory arrest treatment protocols focus on airway

management and rescue breathing• If a child moves into cardiac arrest as a result of the respiratory

arrest, the focus must turn to getting the heart started again• Airway procedures are not enough• AEDs represent the only opportunity rescuers have to establish

a normal heart rhythm prior to the arrival of advanced cardiac life support

Reliability of the System• Researchers tested HeartStart’s Patient Analysis System* on a

database of 696 human paediatric rhythms for:• Sensitivity (the AED shocks a shockable rhythm)• Specificity (the AED will not shock a non-shockable rhythm)

• The system recognized VF 96 percent of the time (sensitivity) and specificity was 100 percent – both well above the European Resuscitation Council (ERC) goals for AEDs

• The unit never chose to deliver a shock based on a rhythm that did not require one

The Patient Analysis System decides to shock or not shock based on four factors – rate, conduction, amplitude and stability. Some AEDs base their shock / no-shock decisions solely on heart rate alone. Children tend to ex-perience very fast heart rates under high stress conditions, yet a shock may be inappropriate.

*HeartStart’ s Patient Analysis System refers to the proprietary analysis system used by Philips Medical System in HeartStart AEDs that analyzes a patient's ECG and determines whether a shock should be delivered.

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AED use in childrenEnergy dose in children

• The ideal energy dose for safe and effective defibrillation is unknown

• For children 1 to 8 years of age, it is reasonable to use a pediatric dose-attenuator system if one is available. If the rescuer provides CPR to a child in cardiac arrest and does not have an AED with a pediatric attenuator system, the rescuer should use a standard AED.

Paediatric AED Pads• Many manufacturers now supply purpose-made paediatric pads

or programmes• Most of them have an attenuator that automatically reduces the

energy coming out of the defibrillator, delivering a lower energy shock

• For instance with a FR2+ Paediatric Pads from Philips the child receives a shock of 50 joules instead of the 150 joules delivered to adults

The HeartStart FR2+ Defibrillator (“FR2+”) is an automated external defibril-lator designed by Philips

Paediatric AED PadsIf Paediatric AED pads are not available, it is acceptable – although not ideal – to use adult AED pads on a child in cardiac arrest. You cannot use Paediatric AED pads on an adult

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Paediatric AED PadsOptimal pad force

• To decrease transthoracic impedance during defibrillation, the pad should be applied firmly

While AEDs can be used in an aquatic environment, you must dry off the chest before placing the pads. The AED pads should be placed on the in-jured person’s chest according to the diagrams on the pads, and then the first aid provider should follow the unit’s prompts.

Paediatric AED Pads• The pads for children come in various colours• Removes confusion about which pads to use on a child

• Alleviates (or reduces) concerns from the least experienced and most stressed responder

According to guidelines released by the European Resuscitation Council, 50 joules provides sufficient energy to ensure that children up to 8 years receive at least 3-4 J/kg.

Typically, Paediatric AED pads are designed in such a way as to make it obvious taht the pad is designed for children, whether with pictures of spe-cialised plugs. This reduces concerns for the least experienced and most stressed responder.

Paediatric Pad Placement• When performed correctly both antero-posterior (A/P) and antero

lateral pad positions work equally well• Most rescuers find it easier to use the A/P pad position when

working with small children• A/P is recommended because of the child’s small chest

If there is any concern about spinal cord injury, have another rescuer im-mobilise the head and neck while you perform a log roll on the child to gain access to the child’s back. Have your students practice the log roll skill to ensure confidence with immobilising the head and neck. You can use the an-tero-lateral position used with adults, although it is more difficult to achieve proper pad placement with adult pads. Alternatively, you can use the antero-posterior position.

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Paediatric CPR Review• Ensure your safety and the safety of the child• Unresponsive?






Proper Pad Placement• Place one pad vertically on the upper back, below the left scapula• Place the second pad on the front of the child’s chest, to the left

of the sternum • Proper pad positioning and contact are very important

• Make sure pads are positioned correctly

Providing Care with an AED• Attach the paediatric defibrillator pads to the child and the AED• Allow the AED to analyse heart rhythm• Don't touch the child

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Providing Care with an AED• If shock is required:• Follow the AED unit’s prompts.• Visually and physically clear the patient.• State “I’m clear. You’re clear. All clear.”• Administer shock.• Resume CPR for 2 minutes. The AED will automatically

reanalyse after this period• Continue CPR and follow AED prompts until normal breathing

resumes or EMS arrives

Summary• Program rationale• Causes of Paediatric Cardiac Arrest• Frequency of the problem• Reliability of the AED• Paediatric Pads• Pad Placement• Skills

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Skills Development Session Overview

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How to conduct the skills development session for the DAN Paediatric BLS(-D) module

Pre-course preparation:

1. Review the DAN Paediatric BLS(-D) module Course Checklist. Make sure that you have all materials and equipment required to teach the program

a. Baby CPR manikins

b. Junior CPR manikins

c. Barrier devices, such as resuscitation mask or face shield

2. AED training equipment (required for certifying PBLS-D)

d. Must be a training version

e. Must have additional paediatric AED training pads

3. Review Ratios:

f. Maximum student-to-Instructor ratio is 12:1. Additional students may be added with the use of certified assistant to a maximum of 21 students

g. Recommended student-to-CPR manikin ratio is 3:1

h. Recommended student-to-AED unit is 3:1 (required for the PBLS-D certification)

4. Provide medical gloves to each participant

5. Prepare two wash basins to clean masks between student use. The first basin should be a cleansing solution and a second basin with water. Have cleaning and disinfectant towel available. Disinfect materials after its use


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Between the knowledge development session and skills development session

1. Instruct the students to thoroughly wash their hands.

2. Clear an area of the classroom where students can be comfortable during the skills development session.

Skills development session process

1. Introduce the skill and explain the objective and motivation (when and why the skill might be needed). Instruct the students to turn to the appropriate page of Student Handbook as a reference during the skills development session.

2. Demonstrate the skill in "real time" without elaboration or explanation. Students are expected to reproduce the critical steps of this demonstration.

3. Demonstrate the skill slowly while explaining and elaborating the critical steps to performing the skill.

4. Answer any student questions regarding the performance of the skill.

5. Separate the class into groups of three students each (Rescuer, Injured person and Observer).

6. Provide a scenario where the Rescuer will learn and apply the appropriate skills.

7. Recognise reasonable performance of skills and remediate and counsel rescuers to improve performance as necessary.

8. Debrief the skill and offer suggestions for improvement, identify areas of weak-ness and reinforce the rescuer's ability to assist an injured person. Answer stu-dent questions.

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Skills development session overview

1 CPR – CHILD RESuSCITATION Rescuer 1 Rescuer 2 Rescuer 3

2 CPR – INFANT RESuSCITATION Rescuer 1 Rescuer 2 Rescuer 3

3 CHILD AIRWAy OBSTRuCTION Rescuer 1 Rescuer 2 Rescuer 3

4 INFANT AIRWAy OBSTRuCTION Rescuer 1 Rescuer 2 Rescuer 3

5 PAD PLACEMENT (REQuIRED FOR CERTIFyING PBLS-D)

Rescuer 1 Rescuer 2 Rescuer 3

6 PROvIDING CARE WITH AN AED (REQuIRED FOR CERTIFyING PBLS-D)

Rescuer 1 Rescuer 2 Rescuer 3

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Skill: Resuscitation

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Skill: Resuscitation – Child CPR

Introduction

Objective: The student will be able to:

1. Check if the child is responsive and open the airway2. Check if the child is breathing normally and activate EMS3. Perform Chest compressions and ventilations, using the 1-hand technique or

2-Hand Technique (In case of larger children or for smaller rescuers)

MOtivatiOn:A child who does not have an open airway or is not breathing normally has little chance for survival unless the ABCs (Airway, Breathing and Circulation) can be restored. The DAN Paediatric BLS Provider must be able to open an airway and support circulation and ventilation, while waiting for Advanced Life Support (ALS) to arrive. If the EMS is not alerted, ALS will not arrive.

Page nO. _____Ask to the Students to open the student book to page ___ and follow the skill while you perform it.

Required Equipment Recommended Equipment

1. Junior CPR manikins 1. Latex or non-latex medical gloves

2. Plastic resealable bag for barrier device disposal

3. Oronasal resuscitation mask

4. Other barrier devices as necessary


Remark: ■ It is recommended (in the beginning) to divide the skill into 4 (5) parts and

have students try each part separately, before having them to do a complete CPR skill.

The 4 (5) sub skills are:

• Check responsiveness • Open airway and assess breathing • Provide chest compressions • Provide rescue breaths• (AED Skills)

The student however must demonstrate a complete CPR sequence after having practised the sub steps.

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Instructor Role Students’ Role

1. Introduce skill

2. Demonstrate skill in "real time"

3. Explain and demonstrate skill

4. Form groups of three

5. Read skill scenario

6. Oversee student practice

7. Praise student progress

8. Debrief and remediate as necessary

1. Observe Instructor demonstration

2. Ask questions

3. Each student must practice a complete CPR sequence on manikin for at least 2 minutes

4. Support other students in learning

5. Seek Instructor assistance if difficulties are experienced

Scenario: You are at the local park on a grassy area behind the canteen where your nephew and some of his friends are playing football. While you are watching you see his 5 year old friend collapse

Student Action Scene safety assessment and use of barriers, where is the phone?

Instructor Scene is safe, your mobile phone is out of order, but you know there is a public phone in the canteen

Student Action Assess responsiveness

Instructor The child does not respond

Student I carry the child to the canteen, call or have somebody calling EMS and start with 5 rescue breaths and CPR

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Skill: Child Resuscitation

• Ensure the safety of rescuer and childMake sure that you and the child are safe, locate first aid equipment such as an AED and personal protection

• Check the child’s responsivenessGently stimulate the child and ask loudly: are you all right?

if the child resPOnds by answering Or MOving

|{ Leave the child in the position in which you find him (provided that he is not in further danger). Try to find out what happened and get help if needed. Re-assess him regularly

if the child dOes nOt resPOnd

|{ Shout for help; try to get attention from somebody around you. Turn the child care-fully on its back and open the airway by tilting the head and lifting the chin

|{ Place your hand on its forehead and gently tilt its head back. At the same time, with your finger tip(s) under the point of the child’s chin, lift the chin. Do not push on the soft tissues under the chin as it may obstruct the airway. Have a quick look in the mouth and look for any visible foreign body object, which may obstruct the airway

|{ If you have difficulty in opening the airway or if you suspect an injury to the neck, try the Jaw Thrust. Place the first two fingers of each hand behind each side of the child’s mandible and push the jaw forward

• Check if the child is breathing normally• Look for chest movement. Listen at the child’s mouth and nose for breath sounds.

Feel for air on your cheek. Decide if breathing is normal, not normal or absent

• Look, listen and feel for no more than 10 seconds to determine whether the in-jured child is breathing normal. If you have any doubt whether breathing is nor-mal, act as if not normal

if the child is breathing nOrMally

|{ Turn the child on its side into the recovery position. Send or go for help and continue to monitor its breathing

if breathing is absent Or nOt nOrMal

|{ Ensure a proper head tilt and chin lift, allow the mouth to open, but maintain the chin lift. Pinch the soft part of the nose and cover the child’s mouth with your mouth ensuring a good seal

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|{ Give five initial rescue breaths using mouth-to-mouth, mouth-to-nose or mouth-to-mouth-and-nose as you find suitable. Note any gaging or coughing in re-sponse to your action

• Assess the child’s circulation (signs of life)Take no more than 10 seconds to:

• Look for signs of life – this includes any movement, coughing or normal breathing (not abnormal gasps or infrequent, irregular breaths)

• If you are confident that you can detect signs of life within 10 seconds:

|{ Continue rescue breaths, if necessary, until the child starts breathing effec-tively on its own

• If there are no signs of life:

|{ Start chest compressions|{ Combine rescue breaths and chest compressions

• Start chest compressionsUse the appropriate technique

1-hand technique

|{ Place the heel of one hand on the lower part of the chest bone. Use the imagi-nary line between the nipples as a reference. Lift your fingers off the chest to make sure that you do not apply pressure over the child’s ribs

|{ Position yourself vertically above the child’s chest and, with your arm straight, compress the chest bone to depress

2-hand technique (in case Of larger children Or fOr sMaller rescuers)

|{ Like you do with adults • 30 chest compression

• At least 100 compression a minute (but not exceeding 120 compressions a minute)

• Combine rescue breaths and chest compressions 30:2

• After 1 min, call for help

• Continue CPR 30:2 once EMS had been activated

Do not interrupt resuscitation until• The child shows signs of life: starts to wake up, to move, opens eyes and to breathe


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Skill: Resuscitation – Infant CPR

Introduction


1. Check if the infant is responsive and open the airway2. Check if the infant is breathing normally and activate EMS3. Perform Chest compressions and ventilations, using the 2-finger technique If

there are two or more rescuers, the encircling technique is an option

MOtivatiOn:An infant who does not have an open airway or is not breathing normally has little chance for survival unless the ABCs (Airway, Breathing and Circulation) can be re-stored. The DAN Paediatric BLS Provider must be able to open an airway and support circulation and ventilation, while waiting for Advanced Life Support (ALS) to arrive. If the EMS is not alerted, ALS will not arrive.



1. Baby CPR manikins 1. Latex or non-latex medical gloves


3. Oronasal resuscitation mask



1. Introduce skill









2. Ask questions

3. Each student must practice a complete CPR sequence on manikin for at least 2 minutes



Remark: ■ It is recommended (in the beginning) to divide the skill into 4 parts and have stu-

dents try each part separately, before having them to do a complete CPR skill.

The 4 sub skills are:

1. Check responsiveness,

2. Open airway and assess breathing,

3. Provide chest compressions,

4. Provide rescue breaths.

The student however must demonstrate a complete CPR sequence after having practiced the sub steps.

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Scenario: You are babysitting for some friends and you notice that the 10 months old baby, which was a few minutes ago playing in her crib is not moving anymore. What do you do next?

Student Action Scene safety assessment and use of barriers, where is the phone?

Instructor Scene is safe, phone is in the hall

Student Action Assess responsiveness

Instructor The baby does not respond

Student Start with 5 rescue breaths and 1 minute CPR, next activate EMS

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• Ensure the safety of rescuer and infant

Make sure that you and the infant are safe, locate first aid equipment such as personal protection

• Check for a response

Gently stimulate the infant, tap or rub the sole of the infant’s foot and call its name to see if the infant responds. Never shake an infant

if it resPOnds Or MOves as reactiOn tO the stiMuli

|{ Leave the infant in the position in which you found it provided there is no further danger. Try to find out what is wrong with it and get help if needed. Reassess the infant regularly

if it dOes nOt resPOnd

|{ Shout for help. Ensure head tilt and chin lift.|{ Place your hand on its forehead. At the same time, with your finger tip(s) under

the point of the infant’s chin, lift the chin. Do not push on the soft tissues under the chin as it may obstruct the airway. Have a quick look in the mouth and look for any visible foreign body object, which may obstruct the airway

|{ If you have difficulty in opening the airway or if you suspect an injury to the neck, try the Jaw Thrust. Place the first two fingers of each hand behind each side of the child’s mandible and push the jaw forward

• Keeping the airway open; look, listen and feel for breathing• Look for the chest movement. Listen at the infant’s mouth and nose for breath sounds.

Feel for air on your cheek. Decide if the breathing is normal, not normal or absent

• Look, listen and feel for no more than 10 seconds to determine whether the infant is breathing normally. If you have any doubt whether the breathing is normal, act as if is not normal

if it is breathing nOrMally

|{ Hold the infant in the recovery position|{ Cradle the infant in your arms, against your body, with its head tilted little down-

wards. This prevents it from choking on its tongue or inhaling vomit|{ Send or go for help and continue to monitor its breathing

if the breathing is absent Or nOt nOrMal

|{ Ensure there is a neutral position of the head (as an infant’s head is usually flexed when supine, this may require some extension) and a chin lift

Skill: Infant Resuscitation

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|{ Place the infant on a hard surface, e.g. a table, this will facilitate resuscitation. If no suitable hard surface is available, or you need to go and call for help, you can take small infants in a supine position on your lower arm. Place your free arm along the infants back and encircle the back of the head with your hand

|{ Give five initial rescue breaths using mouth-to-mouth, mouth-to-nose or mouth-to-mouth-and-nose as you find suitable. Note any gagging or coughing in re-sponse to your action

|{ Take a breath and cover the mouth and the nose of the infant with your mouth and ensure there is a good seal, mouth-to-mouth-and-nose breathing. If this is not possible you can either choose to cover only the nose (make sure the lips are closed to prevent air escaping), or you can choose normal mouth-to-mouth rescue breathing

|{ Maintain the head position and chin lift, take your mouth away from the infant and watch the chest fall while you take another breath and continue rescue breathing

• Assess the infant’s circulation (signs of life)

Take no more than 10 seconds to:

• Look for signs of life – this includes any movement, coughing or normal breathing (not abnormal gasps or infrequent, irregular breaths)

• If you are confident that you can detect signs of life within 10 seconds:

|{ Continue rescue breathing, if necessary, until the child starts breathing effec-tively on its own

• If there are no signs of life:

|{ Start chest compressions|{ Combine rescue breathing and chest compressions

• Start chest compressions

Use the appropriate technique as described

2-finger technique

|{ Compress the chest with the tip of 2 fingers|{ Place three fingers in the centre of the infant’s chest, the top finger on an im-

aginary line between the infant’s nipples. Raise the top finger up and compress with the bottom 2 fingers, while the other hand remains on the head to maintain the neutral position

encircling technique

|{ If there are two or more rescuers, the encircling technique is an option. Posi-tioning of the hand/thumbs may take some time, so this is not effective when you are alone

|{ Place both thumbs flat side by side on the lower part of the chest bone (same positions as with the 2-finger technique), the tips pointing towards the head of the infant. Spread the rest of both hands with the fingers together to encircle

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the lower part of the infant’s rib cage with the tips of the fingers supporting the infant’s back

• 30 chest compressions• At least 100 compressions a minute (but not exceeding 120 compressions a minute)• Combine rescue breaths and chest compressions 30:2• After 1 min call for help• Continue CPR 30:2 once EMS had been activated

Do not interrupt resuscitation until• The infant shows signs of life: starts to wake up, to move, opens eyes and to breath


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Skill: Foreign Body Airway Obstruction

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Skill: Foreign Body Airway Obstruction - Child

Introduction:


1. Encourage a child with mild airway obstruction to cough.2. Provide back blows and chest thrusts for a chocking child (severe airway obstruction).

MOtivatiOn:A foreign body airway obstruction prevents a normal flow of air in the windpipe and might result in a respiratory arrest. The rescuer should try to dislodge the obstruction and free the airway.



1. Junior CPR manikins 1. Act Fast Trainer

2. Anti-choking manikins

3. First Aid kit

4. Barrier devices



1. Introduce skill









2. Ask questions

3. Each student must practice this skill




Remark: ■ Preferably use an Act Fast Trainer or an Anti-choking manikin to perform ab-

dominal thrusts (Heimlich manoeuvre)

■ Don’t have students performing the back blows with full force during training

■ The Instructor may decide to teach the back blows to all students first, before having them practise the abdominal thrusts

■ Ask the candidate that is simulating the airway obstruction to kneel down on its knees to make the difference in height between rescuer and child more realistic.

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Scenario: Your own 8 year old daughter is eating a sandwich and starts to cough very hard.

Student Action Ask: Are you chocking?

Instructor The child tries to answer between coughs

Student Action Encourage her to keep coughing

Scenario 2: During a dinner party your friend’s 4 year old son is sitting next to you, he his laughing very hard, next he stands up, grabs his neck and is making silent attempts to cough.

Student Action Ask: Are you chocking?

Instructor The child does not respond, but nod with his head

Student Action Take him over my lap and give maximum 5 back blows (or until the foreign materials is no longer blocking airway)

Instructor The victim is still chocking

Student Give up to 5 abdominal thrusts

Instructor After 3 Thrusts, the foreign material is relieved and the airway is free again

Student Stop giving abdominal thrusts

Instructor What if the obstruction would still be present or the persons stops breathing?

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Assess severity• Effective cough

• Crying or verbal response to questions, loud cough, able to take a breath before coughing, fully responsive

• Encourage coughing

• Continue to check for deterioration to ineffective cough or until obstruction is relieved

• Ineffective cough• Unable to vocalise, quiet or silent cough, unable to breathe, cyanosis, decreasing

level of consciousness

• Conscious

5 back blOws

|{ Back blows are more effective if the child is positioned head down. A small child maybe placed across the rescuer’s lap as with the infant. If this is not possible, kneel behind/beside the child, support the child in a forward leaning position and deliver up to 5 back blows from behind. Prevent the child from falling face down

|{ Deliver up to five forceful back blows with the heel of the hand in the middle of the back between the shoulder blades. The aim is to relieve the obstruction with each blow, rather than to give all five

|{ If the 5 back blows fail to dislodge the object and the child is still conscious, use abdominal thrusts (Heimlich manoeuvre)

5 abdOMinal thrusts

|{ Bend over or kneel behind the child, place your arms under the child’s arms and encircle the trunk. If you stand up straight and bend over the weight of the child and gravity will increase the force of the abdominal thrust. Administering abdominal thrusts in children is similar to adults, but is administered with less force

|{ After 5 back blows and 5 thrusts, re-assess the child. If the object is not ex-pelled and the child is still conscious, continue the sequence of back blows and chest thrusts. Call out, or send for help if it is still not available. Do not leave the child at this stage

|{ If the object is expelled successfully, assess the child’s condition. Part of the object may remain in the respiratory tract and cause complications

Skill: Foreign Airway Obstruction - Child

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|{ Abdominal thrust may cause internal injuries and all treated with thrusts should be examined by a doctor

• Unconscious|{ Open airway|{ 5 rescue breaths|{ Start CPR

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Skill: Foreign Body Airway Obstruction - Infant

Introduction

Objective: The student will be able to:Provide back blows and chest thrusts for a chocking infant (severe airway obstruction).

MOtivatiOn:A foreign body airway obstruction prevents a normal flow of air in the windpipe and might result in a respiratory arrest. The rescuer should try to dislodge the obstruction and free the airway.



1. Baby CPR manikins 1. First Aid kit

2. Barrier devices



1. Introduce skill









2. Ask questions

3. Each student must practice this skill



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Scenario: You are feeding your 8 month old baby, all of a sudden your baby gets upset and starts to act strange. It looks like she tries to breathe but that no air is going in or out

Student Action Get her in a head down, prone position and give up to 5 back blows?

Instructor The infant is still chocking.

Student Give up to 5 chest thrusts.

Instructor After 3 Thrusts, the foreign materials is relieved and the airway is free again.

Student Stop giving chest thrusts

Instructor Do you go and see a doctor afterwards?

Student Yes.

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Assess severity

• Effective cough• Crying or verbal response to questions, loud cough, able to take a breath before

coughing, fully responsive

• Encourage coughing

• Continue to check for deterioration to ineffective cough or until obstruction is relieved

• Ineffective cough• Unable to vocalise, quiet or silent cough, unable to breathe, cyanosis, decreasing

level of consciousness

• Conscious

5 back blOws

|{ Place the infant face down over hand and forearm, trunk and body straddled on your arm. Support the infants head and neck by placing the thumb at the angle of the lower jaw, and two fingers at the same point on the opposite side. Do not compress the soft tissues under the infant’s jaw, as this will exacerbate the airway obstruction

|{ Support the infant in a head down, prone position. This enables gravity to as-sist removal of the foreign body. A seated or kneeling rescuer should be able to support the infant safely across their lap

|{ Deliver up to five forceful back blows with the heel of the hand in the middle of the back between the shoulder blades. The aim is to relieve the obstruction with each blow, rather than to give all five

|{ If the 5 back blows fail to dislodge the object, use chest thrusts

5 chest thrusts

|{ Sandwich the infant between your arms and turn it on its back with its head lower than the trunk, facing up. Downward supine position and encircle the occiput with your hand. Place your arm down or across your thigh

|{ Identify the landmark for chest compressions (on the lower half of the chest bone) and give five chest thrusts. These are similar to chest compressions but sharper and delivered at a slower rate

Do not use abdominal thrust (Heimlich manoeuvre) in infants

Skill: Foreign Airway Obstruction - Infant

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Chest thrust may cause internal injuries and all treated with thrusts should be examined by a doctor

• Unconscious|{ Open airway|{ 5 rescue breaths|{ Start CPR

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Skill: Pad Placement (required for certifying PBLS-D)

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Introduction

Objective: The student will be able to:Maintain proper spinal stability on a simulated child in cardiac arrest while positioning the Paediatric AED Training Pads in the Antero-posterior position.

MOtivatiOn:If the pads are too large and proper placement in antero-lateral position is not advis-able, the most effective way to deliver a defibrillating shock to a small child is then using the Antero-posterior pad positioning. It is also critical to maintain spinal stability using the log roll manoeuvre to access the child’s back, if there is any possibility of a spinal injury.



1. Latex or non-latex medical gloves

2. Paediatric AED training pads

3. Automated External Defibrillator training unit

4. Child CPR manikins




1. Introduce skill









2. Ask questions

3. Each student must practice log rolling a simulated child into position and placing the AED pads



Skill: Pad Placement (required for the PBLS-D certification)

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Scenario: You find a child supine on the floor. You are unsure of whether he / she fell. He / she has no signs of life.

Student Action Perform a rolling technique to access the child’s back and apply the Paediatric AED Pads

Note If there is any concern about spinal cord injury, have another rescuer immobilize the head and neck while you perform a rolling technique on the child to gain ac-cess to the child’s back. Alternatively, you can use the antero-lateral used with adults, although it is more difficult to achieve proper pad placement this way.

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• Position the pads on a child in antero-lateral postion• Position the pads on a child in the antero-posterior position• Open the pad package to determine which pad goes in which position. Follow the il-

lustrations on the pads

Antero-posterior position• Proper pad positioning and contact are very important. Take a moment to make sure

you have positioned the pads correctly • Place one pad vertically, on the upper back, below the left scapula• Place the second pad on the front of the child’s chest, to the left of the sternum• Also, practice the rolling technique skill to make sure you are comfortable immobilising

the head and neck

Skill: Proper Pad Placement

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Skill: Providing Care with an AED (required for certifying PBLS-D)

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Introduction


1. Recognize the signs of sudden cardiac arrest in a child.

2. Provide defibrillation as soon as possible in the event of cardiac arrest.

MOtivatiOn:When a child is in cardiac arrest (no signs of life), CPR can continue to oxygenate the body, but it cannot reset a fibrillating heart. Only a defibrillator can do that. Early access to defibrillators greatly increases an injured person’s chances of survival. With every minute that passes until defibrillation, there is a 7-10 percent decrease in the likelihood of survival from sudden cardiac arrest.



1. Automated External Defibrillator training unit

2. Paediatric AED training pads

3. Junior CPR manikins

1. Latex or non-latex medical gloves

2. Oronasal resuscitation mask with supplemental oxygen inlet



Skill: Providing Care with an AED (required for the PBLS-D certification)

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1. Introduce skill









2. Ask questions

3. Each student must practice skills and successfully complete a scenario



Scenario: You have determined a child found on the floor is in cardiac arrest and is not breathing normally. You are alone.

Student Action Perform one minute of CPR

Instructor After one minute of CPR, the child is still not breathing normally

Student Call EMS and then begin defibrillation using Paediatric AED Pads

Note While AEDs can be used in an aquatic environment, you must dry off the chest before placing the pads. The AED pads should be placed on the injured per-son’s chest according to the di-agrams on the pads, and then the first aid provider should fol-low the unit’s prompts.

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After securing the ABCs (Airway, Breathing, Circulation) and you have verified that the child is not breathing normally, give a minute of CPR. Children often respond quickly to a CPR.If no response is received within the first minute, then open the AED and turn it on. Pro-ceed as normal.

Ensure your safety and the safety of the child

Unresponsive?• Shout for help

Not breathing normally?• Start 5 rescue breaths, CPR 30:2 for 1 minute• Send or go for AED and call EMS

Attach the defibrillator pads

Allow the AED to analyse heart rhythm• Don't touch the patient

If shock required:• Follow the AED unit's prompts• Visually and physically clear the patient • Say “Clear”• Administer shock• Resume CPR 30:2 for 2 minutes• Continue as directed by the voice/visual prompts

If no shock is required:• Continue CPR 30:2 until the injured person

starts to wake up, open eyes and to breathe normally

• Continue as directed by the voice/visual prompts

Skill: Providing Care with an AED

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Appendix

Take these pages as handouts for your practical teaching sessions and to use as a completion form.

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Appendix

54

Skill Evaluation Form Guidelines

The purpose of these guidelines are to present the necessary criteria to make an evalu-ation and correctly complete the “Student Practice form”. The guidelines are designed to provide guidance on how to get started to ensure that we are providing an effective educa-tion that meets the requirements of the DAN training.

Such criteria can help determine how to evaluate the skills of your students, and, give them appropriate feedback to strengthen their ability.

DAN Instructors should understand the process of how an adult retains new skills and information. It is the responsibility of the DAN Instructor to create an environment that encourages learning.

There are a number of skill sequences that students are encouraged to practice during the DAN BLS-D course (Adult/Paediatric care).

Students are divided into small groups of three or four. Each group has either an infant, child, or adult mannequin. Students rotate roles of the Bystander, Rescuer 1 and Rescuer 2 within the group. By experiencing all three positions, each student will see three different perspectives and better retain the educational content.

Students then change mannequins and repeat the skill. This gives all students a chance to learn the skill differences between adults, children and infants.

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Appendix

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This Evaluation criteria matches that of the Student Practice Form, but provides a more in-depth explanation on how to evaluate "bold" item skills.

The 5 sub skills are: • Check responsiveness• Open airway and assess breathing• Provide chest compressions and rescue breaths• Call for help and resume CPR• AED skills

Check responsiveness

Ensure the safety of rescuer and child – The Provider should identify most/all of the major hazards relative to the scene. As a rescuer, when approaching the scene of an injury, it‘s important to exercise caution by assessing the scene. Approach the scene with care.

Check the child’s responsiveness – The Provider gently stimulates the child and asks loudly: “are you all right?”

Shout for help – The Provider looks around and shouts for help immediately, then starts to evaluate if the child’s breathing is absent or abnormal.

Open airway and assess breathing

Look, listen and feel for no more than 10 seconds – Open the airway. Protect spine and place one hand on the forehead. Gently tilt the head. Perform chin lift. Keeping the airway open, the Provider looks, listens, and feels for normal breathing by putting his face close to the child’s face and observing the chest.

Give five initial rescue breaths using mouth-to-mouth – Give 5 slow effective rescue breaths. Every breath should make the chest rise as in normal breathing. Ensure a neutral position of the head and a chin lift.

Assess the child’s circulation (signs of life) – Look for signs of life. Look, listen and feel coughing and movement for no more than 10 seconds.

Evaluation Criteria - Resuscitation

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Appendix

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Provide chest compressions

If there are no signs of life – Start chest compressions – Position should be verti-cally above the child’s chest with arm locked straight. The other hand protects the head keeping it stable. For all children, compress the lower half of the sternum, locate the xiphisternum by finding the angle where the lowest ribs join in the middle

Combine rescue breathing and chest compressions 30:2 – The Provider blows steadily into the mouth for about 1–1.5 seconds, watching for the chest to rise. He/She provides compressions sufficient to depress the sternum by at least one third of the depth of the chest. He/She releases the pressure completely and repeats the compres-sions at a rate of at least 100/min.

Call for help and resume CPR

After 1 min, call for help – The Provider calls, or sends someone to call the EMS. The Provider needs to know what information to provide. If the Provider sends someone to call the EMS, in order to minimize confusion and delays, he/she must give fast and easy info to the bystander, and tell him/her the exact details of the child’s injury. Continue with CPR until qualified help arrives and takes over.

AED skills

Attach the defibrillator pads – As soon as the AED arrives switch on the AED and attach the electrode pads on the child in antero-posterior position.

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Appendix

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This Evaluation criteria matches that of the Student Practice Form, but provides a more in-depth explanation on how to evaluate "bold" item skills.The 3 sub skills are:• Mild Foreign Airway obstruction – Child, Infant• Severe Foreign Airway obstruction – Child• Severe Foreign Airway obstruction - Infant

Mild Foreign Airway Obstruction – Child, InfantAssess severity – Foreign body airway obstruction is characterised by the sudden onset of respiratory distress associated with coughing, gaggingEncourage to cough (Effective cough) – If the child is coughing effectively, no external manoeuvre is necessary. Encourage the child to cough, and monitor continually.

Severe Foreign Airway Obstruction – ChildDeliver up to 5 forceful back blows / Deliver up to 5 abDominal thrusts (chilDren)

These manoeuvres create an artificial cough, increasing intrathoracic pressure and dis-lodging the foreign body.

Open airway (Ineffective cough - Unconscious)5 rescue breathsStart cPrCall for helpCombine rescue breathing and chest compressions 30:2 until EMS arrives

If the child with FBAO is, or becomes, unconscious, place it on a firm, flat surface. Call out, or send, for help if it is still not available. Do not leave the child at this stage.

Severe Foreign Airway Obstruction – InfantDeliver up to 5 back blows / Deliver up to 5 chest thrusts These manoeuvres create an artificial cough, increasing intrathoracic pressure and dis-lodging the foreign body.Open airway (Ineffective cough - Unconscious)5 rescue breathsStart cPrCall for helpCombine rescue breathing and chest compressions 30:2 until EMS arrivesIf the infant with FBAO is, or becomes, unconscious, place it on a firm, flat surface. Call out, or send, for help if it is still not available. Do not leave the infant at this stage.

Evaluation Criteria - FBAO

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Appendix

58

Appendix

Student Practice Form

Student name date / /

DEMONSTRATIONS & STUDENT PRACTICE PROVIDER✔ If done correctly

Skill Step

CritiCal performanCe Step Failed Acceptable Excellent

1– RescueR child Bls

1-Rescuer BLS Skills Evaluation During this phase, evaluate the rescuer’s ability to initiate BLS and deliver high quality CPR

Check responsiveness1❚❚ Ensure the safety of rescuer and child ❚❚ Check the child’s responsiveness ❚❚ Shout for help

Open airway and assess breathing2❚❚ Place your hand on his forehead and gently tilt is his head back ❚❚ Have a quick look in the mouth and look for any visible foreign body object ❚❚ Look, listen and feel for no more than 10 seconds if the child is breathing normally ❚❚ Give five initial rescue breaths using mouth-to-mouth ❚❚ Assess the child’s circulation (signs of life) - Take no more than 10 seconds

Provide chest compressions and rescue breaths3❚❚ Start chest compressions ❚❚ 1- Hand Technique - Place the heel of one hand on the lower part of the chest bone

❚❚ Compress the chest to at least 1/3 of the anterior-posterior AP chest diameter in all children (5cm)

❚❚ At least 100 compression a minute (but not exceeding 120) ❚❚ Combine rescue breathing and chest compressions 30:2

Call for help and resume CPR4❚❚ After 1 min, call for help ❚❚ Combine rescue breathing and chest compressions 30:2 until EMS arrives

COMPLETE SKILL PERFORMANCE If “Failed” make suggestions for improvement and then re-evaluate

Time:

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Appendix

59

Appendix

DEMONSTRATIONS & INSTRUCTOR PRACTICE

How to evaluate the skill: Mark with a flag in the checkboxes on the previous page; bold items are critical elements and must be performed properly by the student, otherwise the skill is failed.

Excellent – Skill is exemplary, nearly no improvement needed.

Acceptable – Skill has completed in a satisfactory manner, little improvement needed.

Failed – Skill is lacking, some important steps are missing, needs improvement

COMPLETE SKILL PERFORMANCE – Skill can be considered successfully passed if the Instructor assigned a ✔ in each box (Acceptable or Excellent) to the right of Critical Performance Step).

TEST SUMMARYRECORD ALL TEST RESULTS HERE

SIGN WHERE INDICATEDPASS Steps all checked “Acceptable/Excellent” NR Needs Remediation INDICATE: PASS or NR

Instructor’s signature affirms that skill tests were done according with the standards established by the DAN Southern Africa

Save this form with course record

Instructor name

Instructor Signature

Date

No. Step Step deScriptioN

1

INTRODUCTION Objective: The student will be able to:1. Check if the child is responsive and open the airway2. Check if the child is breathing normally and activate EMS3. Perform Chest compressions and ventilations, using the 1-hand technique or 2-Hand Technique (In case of larger children or for smaller rescuers)

Motivation: A child who does not have an open airway or is not breathing normally has little chance for survival unless the ABCs (Airway, Breathing and Circulation) can be restored. The DAN Paediatric BLS Provider must be able to open an airway and support circulation and ventilation, while waiting for Advanced Life Support (ALS) to arrive. If the EMS is not alerted, ALS will not arrive.

Page no. _____

Ask to the Students to open the student book to page ___ and follow the skill while you perform it.

2 REAL TIME DEMONSTRATION The students see how the skill should be done in a real (simulated during the course) accident situation.

3 SUB-STEP DEMONSTRATION Touch the key point of the skill. Before go ahead ask for questions

4 GROUPS Divide the class into groups and assigning the roles. Give specific roles to the students

5 SCENARIOExplain to the students the simulated accident situation. A good scenario describes signs and symptoms of the injury. By doing this you are making the links with the theoretical part where they learned about the injuries and their symptoms.

6 SUPERVISION See “STUDENT PRACTICE FORM”

7 POSITIVE REINFORCEMENT Point out what they really did well, so the student gets confidence. Pick one thing they did really well during the skill and emphasise it.

8 DEBRIEFINGA good debriefing consists of reminding them of errors which occurred during students practice, giving suggestions to avoid those mistakes in the future and remind them of the objective and value of the skill. Give them confidence and motivation.

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Appendix

60

Appendix




Skill Step


1– RescueR infant Bls

1-Rescuer BLS Skills Evaluation During this phase, evaluate the rescuer’s ability to initiate BLS and deliver high quality CPR

Check responsiveness1❚❚ Ensure the safety of rescuer and infant ❚❚ Check the child’s responsiveness ❚❚ Shout for help

Open airway and assess breathing2❚❚ Place your hand on his forehead and gently tilt is his head back ❚❚ Have a quick look in the mouth and look for any visible foreign body object ❚❚ Look, listen and feel for no more than 10 seconds if the child is breathing normally ❚❚ Give five initial rescue breaths using mouth-to-mouth ❚❚ Assess the infant’s circulation (signs of life) - Take no more than 10 seconds

Provide chest compressions and rescue breaths3❚❚ Start chest compressions ❚❚ 2-Finger Technique - Compress the chest with the tip of 2 fingers ❚❚ Compress the chest to at least 1/3 of the anterior-posterior AP chest diameter in all children (4cm in infants)

❚❚ At least 100 compression a minute (but not exceeding 120) ❚❚ Combine rescue breathing and chest compressions 30:2



Time:

61


Appendix

61

Appendix











Instructor name


Date


1

INTRODUCTION Objective: The student will be able to:1. Check if the infant is responsive and open the airway2. Check if the infant is breathing normally and activate EMS3. Perform Chest compressions and ventilations, using the 2-finger technique If there are two or more rescuers, the encircling technique is an option

Motivation: An infant who does not have an open airway or is not breathing normally has little chance for survival unless the ABCs (Airway, Breathing and Circulation) can be restored. The DAN Paediatric BLS Provider must be able to open an airway and support circulation and ventilation, while waiting for Advanced Life Support (ALS) to arrive. If the EMS is not alerted, ALS will not arrive.

Page no. _____

The students see how the skill should be done in a real (simulated during the course) accident situation.








62


Appendix

62

Appendix




Skill Step


foReign Body aiRway oBstRuction - child

❚❚ Assess severity 1❚❚ If crying or verbal response to questions ❚❚ Encourage to cough (Effective cough)

If the child cannot speak (Ineffective cough - Conscious) 2❚❚ For a small child, position the child's head down / For a larger child, stand or kneel behind the child

❚❚ Support the child in a forward leaning position ❚❚ Prevent the child from falling face down ❚❚ With the heel of the hand in the middle of the back between the shoulder blades ❚❚ Deliver up to 5 forceful back blows ❚❚ After 5 back blows, re-assess the child

If the 5 back blows fail to dislodge the object and the child is still conscious 3❚❚ Bend over or kneel behind the child ❚❚ Place your arms under the child’s arms and encircle the trunk ❚❚ Deliver up to 5 abdominal thrusts (Ineffective cough - Conscious) ❚❚ After 5 thrusts, re-assess the child ❚❚ If the child is still conscious, continue the sequence of back blows and chest thrusts

❚❚ Open airway (Ineffective cough - Unconscious) 4❚❚ 5 rescue breaths ❚❚ Start CPR

5 ❚❚ Call for help ❚❚ Combine rescue breathing and chest compressions 30:2 until EMS arrives


63


Appendix

63

Appendix











Instructor name


Date


1

INTRODUCTION Objective: The student will be able to:1. Encourage a child with mild airway obstruction to cough.2. Provide back blows and chest thrusts for a chocking child (severe airway obstruction

Motivation: A foreign body airway obstruction prevents a normal flow of air in the windpipe and might result in a respiratory arrest. The rescuer should try to dislodge the obstruction and free the airway.

Page no. _____









64


Appendix

64

Appendix




Skill Step


foReign Body aiRway oBstRuction - infant

❚❚ Assess severity 1❚❚ If crying or verbal response to questions ❚❚ Encourage to cough (Effective cough)

If the infant is unable to vocalize or breath (Ineffective cough - Conscious) 2❚❚ Place the infant face down over hand and forearm ❚❚ Trunk and body straddle on your arm ❚❚ Support the infants head and neck by placing the thumb at the angle of the lower jaw, and two fingers at the same point on the opposite side

❚❚ With the heel of the hand in the middle of the back between the shoulder blades ❚❚ Deliver up to 5 forceful back blows (Ineffective cough - Conscious) ❚❚ After 5 back blows, re-assess the child

If the 5 back blows fail to dislodge the object, use chest thrusts 3❚❚ Sandwich the infant between your arms and turn him/her on his/her back with his/her head lower than the trunk, facing up

❚❚ Downward supine position and encircle the occiput with your hand ❚❚ Place your arm down or across your thigh ❚❚ Identify the landmark for chest compressions (on the lower half of the chest bone) ❚❚ Deliver 5 chest thrusts (similar to chest compressions but sharper and delivered at a slower rate) (Ineffective cough - Conscious)

❚❚ After 5 thrusts, re-assess the infant

❚❚ Open airway (Ineffective cough - Unconscious) 4❚❚ 5 rescue breaths ❚❚ Start CPR

❚❚ Call for help 5❚❚ Combine rescue breathing and chest compressions 30:2 until EMS arrives


65


Appendix

65

Appendix











Instructor name


Date


1

INTRODUCTION Objective: The student will be able to:Provide back blows and chest thrusts for a chocking infant (severe airway obstruction).

Motivation: A foreign body airway obstruction prevents a normal flow of air in the windpipe and might result in a respiratory arrest. The rescuer should try to dislodge the obstruction and free the airway.

Page no. _____









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66

Appendix




Skill Step


PRoviding caRe with an aed (RequiRed foR the PBls-d ceRtification)

1-Rescuer BLS Skills Evaluation During the first phase, evaluate the first rescuer’s ability to initiate BLS and deliver high quality CPR

Check responsiveness1❚❚ Ensure the safety of rescuer and child ❚❚ Check the child’s responsiveness ❚❚ Shout for help

Open airway and assess breathing2❚❚ Place your hand on his forehead and gently tilt is his head back ❚❚ Have a quick look in the mouth and look for any visible foreign body object ❚❚ Look, listen and feel for no more than 10 seconds if the child is breathing normally ❚❚ Give five initial rescue breaths using mouth-to-mouth ❚❚ Assess the child’s circulation (signs of life) - Take no more than 10 seconds

Provide chest compressions and rescue breaths3❚❚ Start chest compressions ❚❚ 1-Hand Technique - Place the heel of one hand on the lower part of the chest bone ❚❚ Compress the chest to at least 1/3 of the AP chest diameter in all children (5cm) ❚❚ At least 100 compression a minute (but not exceeding 120) ❚❚ Combine rescue breathing and chest compressions 30:2


Second Rescuer AED Skills Evaluation and SWITCH During this next phase, evaluate the second rescuer’s ability to use the AED and both rescuer’s abilities to switch roles

AED skills5❚❚ Attach the defibrillator pads ❚❚ Allow the AED to analyse heart rhythm ❚❚ Don’t touch the patient ❚❚ Follow the AED unit’s prompts and Administer shock if required ❚❚ Resume CPR 30:2 for 2 minutes


Time:

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Appendix

67

Appendix











Instructor name


Date


1

INTRODUCTION Objective: The student will be able to:1. Recognize the signs of sudden cardiac arrest in a child.2. Provide defibrillation as soon as possible in the event of cardiac arrest.

Motivation: When a child is in cardiac arrest (no signs of life), CPR can continue to oxygenate the body, but it cannot reset a fibrillating heart. Only a defibrillator can do that. Early access to defibrillators greatly increases an injured person’s chances of survival. With every minute that passes until defibrillation, there is a 7-10 percent decrease in the likelihood of survival from sudden cardiac arrest.

Page no. _____









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68

Paediatric BLS-D critical skills description(This informaTion is provided as a Tool of reference for giving feedback To providers)

No. critical Step commoN provider Skill error

1 ENSURE THE SAFETy OF RESCUER AND CHILD

❚❚ No SAFE, Provider does not exercise caution and check for hazards, such as traffic, unstable structures, downed electrical lines, swift-moving water, violence, explosions or toxic gas exposure

❚❚ Provider forgets gloves and/or mask breathing barriers

2 CHECk THE CHILD’S RESPONSIVENESS

❚❚ Provider does not use a combination of tapping and shouting when checking for responsiveness

❚❚ Provider kneels besides the person in the wrong position or place.

❚❚ Provider does not support the person’s head, neck and back when rolling him/her.

3 SHOUT FOR HELP ❚❚ Provider calls EMS before checking for breathing

4HAVE A qUICk LOOk IN THE MOUTH AND LOOk FOR ANy VISIBLE FOREIGN BODy OBjECT

❚❚ Provider takes too much time to search for a foreign body object

5

PLACE yOUR HAND ON THE PERSON’S FOREHEAD AND GENTLy TILT HIS/HER HEAD BACk

❚❚ Provider forgets to lift the chin when attempting to open the airway

6LOOk, LISTEN AND FEEL FOR NO MORE THAN 10 SECONDS

❚❚ Provider places fingers incorrectly when lifting the chin.❚❚ Provider does not place the ear close enough to the person’s

mouth and nose to check for breathing❚❚ Provider does not look at the chest when checking for

breathing.❚❚ Provider does not keep the airway open while checking for

breathing.❚❚ Provider checks for breathing for longer than 10 seconds.

7GIVE FIVE INITIAL RESCUE BREATHS USING MOUTH-TO-MOUTH

❚❚ Provider does not make a complete seal over mouth and nose when using a breathing barrier

❚❚ Provider does not give breaths of 1 to 1,5 second duration to make the chest clearly rise.

❚❚ Provider does not ensure a tight seal when using a breathing barrier.

❚❚ Provider does not pinch the nose shut when using certain types of breathing barriers

❚❚ Provider gives breaths too quickly or forcefully❚❚ Provider does not watch the chest rise and fall.❚❚ Provider does not use breathing barriers when giving

ventilations

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69


8ASSESS THE CHILD’S CIRCULATION (SIGNS OF LIFE) - TAkE NO MORE THAN 10 S

❚❚ Provider wastes time by checking the pulse❚❚ Provider takes more than 10 seconds

9 START CHEST COMPRESSIONS (1-HAND TECHNIqUE)

❚❚ Provider does not locate the correct hand position when giving chest compressions.

❚❚ Provider places the palm, rather than the heel of the hand, on the breastbone when giving chest compressions

10

COMPRESS THE CHEST TO AT LEAST 1/3 OF THE AP CHEST DIAMETER IN ALL CHILDREN (5CM)

❚❚ Provider does not press straight down on the chest when giving chest compressions

❚❚ Provider gives compressions that are not deep enough

11AT LEAST 100 COMPRESSION A MINUTE (BUT NOT ExCEEDING 120)

❚❚ Provider gives compressions that are not smooth enough, or fails to give compressions at the correct rate

12COMBINE RESCUE BREATHING AND CHEST COMPRESSIONS 30:2

❚❚ Provider does not give breaths of 1 to 1,5 second duration to make the chest clearly rise.

13 AFTER 1 MIN, CALL FOR HELP ❚❚ Provider forgets to call 112 or the local emergency number.

14

COMBINE RESCUE BREATHING AND CHEST COMPRESSIONS 30:2 UNTIL EMS ARRIVES AND TAkE OVER

❚❚ Provider stops when (you say) EMS arrives

15 PAD PLACEMENT

❚❚ Provider incorrectly places the pads.❚❚ Provider allows AED pads to touch each other or fails to use

the front/back (anterior/posterior) method of pad placement when necessary (child).

16 PROVIDING CARE WITH AN AED

❚❚ Provider does not turn on the automated external defibrillator (AED).

❚❚ Provider forgets to wipe off the chest.❚❚ Provider does not stay clear or tells others to stay clear when

analyzing or shocking.❚❚ Provider pushes the “SHOCk” button before being prompted

by the AED.❚❚ Provider does not begin CPR immediately after delivering a

shock.

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70

Paediatric FBAO critical skills description(This informaTion is provided as a reference Tool for giving feedback To providers)


1EMILD FOREIGN AIRWAy OBSTRUCTION – CHILD, INFANT

❚❚ Provider does not recognize the difference between a mild obstruction and a severe obstruction

❚❚ Provider does not encourage someone with a mild blockage to cough forcibly

2 SEVERE FOREIGN AIRWAy OBSTRUCTION - CHILD

❚❚ In a severe obstruction the Provider does not deliver till five back blows in the middle of the back between the shoulder blades

❚❚ In a severe obstruction the Provider does not place the child head down

❚❚ In a severe obstruction the Provider does not place his/her arms under child’s arms encircling the trunk

❚❚ In case of abdominal thrusts the Provider does not call EMS to evaluate the child

❚❚ If the child become unconscious the Provider does not call for help and perform BLS Child Sequence (5 rescue breathing and start CPR)

3 SEVERE FOREIGN AIRWAy OBSTRUCTION - INFANT

❚❚ In a severe obstruction the Provider does not place the infant face down over hand and forearm

❚❚ In a severe obstruction the Provider does not deliver till five back blows in the middle of the back between the shoulder blades

❚❚ The Provider does not support the infant head and neck by placing thumb at the angle of the lower jaw and two fingers at the same point on the opposite side

❚❚ The Provider perform abdominal thrusts to the infant❚❚ The Provider does not identify the landmark for chest

compressions❚❚ The Provider perform chest compression too fast, as for the

CPR

RETURN THESE QUESTIONS TO THE INSTRUCTOR AFTER THE EXAM

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71

Paediatric Basic Life Support Module

PRovideR exam (en)

72


Appendix

72

Paediatric Basic Life suPPort moduLe

provider exam

Pick the best possible answer. The following questions have only one correct answer.

1. When providing CPR as lay rescuer, the Compression – Ventilations ratio is:

A. 30, 1B. 15, 1C. 30, 2D. 15, 3

2. You are all alone, entered the room and found a child on the ground. After you have es-tablished that the child is not breathing normally you should:

A. Start CPRB. Give 5 rescue breaths and start CPR, and call for help after 1 minuteC. Call for help, give 5 recue breaths and start CPRD. Call for help and start chest compressions

3. Chest compressions should be given at a rate of at least ____ a minute, while a rescue breath should take about __________ in duration.

A. 100, 1 secondsB. 100, 1-1,5 secondsC. 130, 1 secondD. 130, 1-1,5 seconds

4. 1-Hand resuscitation technique is the preferred technique for children over 1 year and 2-finger technique for infants.

A. TrueB. False

5. You may only use mouth-to-mouth rescue breaths on infants and children.

A. TrueB. False

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6. If the infant shows signs of a severe foreign body airway obstruction and is conscious the rescuer should give up to ___________, followed by up to ___________ in case the obstruction was not relieved.

A. 5 abdominal thrusts, 5 back blowsB. 5 back blows, 5 chest compressionsC. 5 back blows, 5 chest thrustsD. 5 abdominal thrusts, 2 minutes of CPR

7. A child reaches for its throat and coughs. It seems that it has something obstructing its airway. You should try to calm it down, before you try to get the blockage out.

A. TrueB. False

8. When you give back blows to a small child

A. You could stand up behind the childB. You could kneel behind the childC. You could have the child over your lapD. B and C are correct

9. You should try to remove any foreign body with your fingers before trying anything else.

A. TrueB. False

10. The knowledge and skills learned in the DAN Paediatric BLS course:

A. Prepares rescuers to provide care with and AEDB. Should never been refreshedC. Are to be used only if nobody else wants to provide careD. Should be refreshed at least once every 2 years

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74


provider exam - answers sheet

Name _________________________________________ Date _________________

A B C D

1 ❏ ❏ ❏ ❏2 ❏ ❏ ❏ ❏3 ❏ ❏ ❏ ❏4 ❏ ❏5 ❏ ❏

A B C D

6 ❏ ❏ ❏ ❏7 ❏ ❏8 ❏ ❏ ❏ ❏9 ❏ ❏

10 ❏ ❏ ❏ ❏

I have revIeweD thIs exam wIth the course INstructor. I uNDerstaND the correct respoNse as INDIcateD by my sIgNature. aNy QuestIoNs regarDINg thIs exam aND the coNteNts of thIs course have beeN aNswereD to my satIsfactIoN.

score: ______ %

stuDeNt’s sIgNature: _____________________________ Date: __________________

10 correct = 100 %

9 correct = 90 %

8 correct = 80 %

7 correct = 70 %

6 correct = 60 %

5 correct = 50 %

4 correct = 40 %

3 correct = 30 %

2 correct = 20 %

1 correct = 10 %

0 correct = 0 %


75


Appendix

75

Paediatric Basic Life Support Supplement

PRovideR exam (en) answeRs

76


Appendix

76


provider exam - answers


1. When providing CPR as lay rescuer, the Compression – Ventilations ratio is:

A. 30, 1B. 15, 1C. 30, 2D. 15, 3

2. You are all alone, entered the room and found a child on the ground. After you have es-tablished that the child is not breathing normally you should:

A. Start CPRB. Give 5 rescue breaths and start CPR, and call for help after 1 minuteC. Call for help, give 5 recue breaths and start CPRD. Call for help and start chest compressions

NB: The only exception to performing 1 minute CPR before going for help is in the case of a child with a witnessed, sudden collapse when the rescuer is alone. In this case, cardiac arrest is likely to be caused by an arrhythmia and the child will need defibrillation. Seek help immedi-ately if there is no one to go for you

3. Chest compressions should be given at a rate of at least ____ a minute, while a rescue breath should take about __________ in duration.

A. 100, 1 secondsB. 100, 1-1,5 secondsC. 130, 1 secondD. 130, 1-1,5 seconds

4. 1-Hand resuscitation technique is the preferred technique for children over 1 year and 2-finger technique for infants.

A. TrueB. False

5. You may only use mouth-to-mouth rescue breaths on infants and children.

A. TrueB. False

NB: You have to choose the most suitable technique. this can be mouth-to-mouth, mouth-to-nose and mouth-to-mouth-and-nose techniques

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77

6. If the infant shows signs of a severe foreign body airway obstruction and is conscious the rescuer should give up to ___________, followed by up to ___________ in case the obstruction was not relieved.

A. 5 abdominal thrusts, 5 back blowsB. 5 back blows, 5 chest compressionsC. 5 back blows, 5 chest thrustsD. 5 abdominal thrusts, 2 minutes of CPR

NB: Chest trusts are similar to chest compressions but sharper and delivered at a slower rate.

7. A child reaches for its throat and coughs. It seems that it has something obstructing its airway. You should try to calm it down, before you try to get the blockage out

A. TrueB. False

NB: You should encourage him to cough

8. When you give back blows to a small child

A. You could stand up behind the childB. You could kneel behind the childC. You could have the child over your lapD. B and C are correct

NB: Standing behind the child will increase the force of the abdominal thrust

9. You should try to remove any foreign body with your fingers before trying anything else.

A. TrueB. False

10. The knowledge and skills learned in the DAN Paediatric BLS course:

A. Prepares rescuers to provide care with and AEDB. Should never been refreshedC. Are to be used only if nobody else wants to provide careD. Should be refreshed at least once every 2 years

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78


provider exam - answers key

A B C D

1 ❏ ❏ ✔ ❏2 ❏ ✔ ❏ ❏3 ❏ ✔ ❏ ❏4 ✔ ❏5 ❏ ✔

A B C D

6 ❏ ❏ ✔ ❏7 ❏ ✔8 ❏ ❏ ❏ ✔9 ❏ ✔

10 ❏ ❏ ❏ ✔

10 correct = 100 %

9 correct = 90 %

8 correct = 80 %

7 correct = 70 %

6 correct = 60 %

5 correct = 50 %

4 correct = 40 %

3 correct = 30 %

2 correct = 20 %

1 correct = 10 %

0 correct = 0 %


79


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79

Paediatric Automated External Defibrillation Module

PRovideR exam (en)

80


Appendix

80

Paediatric automated externaL defiBriLLation moduLe

provider exam


1. Proper pad placement on a child would be:

A. one pad placed below the right collarbone and the other in the left armpitB. one pad placed in the right armpit and the other in the left armpitC. one pad placed below the left collarbone and the other in the right armpitD. one should be place on the upper back, below the left scapula and the other on the

front of the child's chest, to the left of the sternum

2. Only paediatric defibrillation pads may be used on children from 1 to 8 years:

A. TrueB. False

3. Paediatric pads:

A. Are easily identifiable as paediatric padsB. Reduce the shock energyC. Are smaller than adult padsD. All of the above

4. After the first shock you should start CPR immediately for 2 minutes, the AED will reana-lyze automatically after this period.

A. TrueB. False

5. AEDs represent the only opportunity rescuers have to establish a normal heart rhythm prior to the arrival of advanced cardiac life support.

A. TrueB. False

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6. Some causes of cardiac arrest in children include:

A. TraumaB. Motor vehicle accidentC. ElectrocutionD. All of the above

7. When you do not have paediatric pads and you are going to use adult pads on a child.

A. One pad placed below the right collarbone and the other in the left armpitB. One should be place on the upper back, below the left shoulder blade and the other

on the front, to the left of the breastboneC. One pad placed in the right armpit and the other in the left armpitD. Depending on the child’s build you can choose between A and B

8. If the AED decided a shock is required

A. You should follow the AED unit’s promptsB. Visually and physically clear the patientC. You should state “I’m clear. You are clear. All clear”D. All the above

9. Paediatric pads remove confusion about which pads to use on a child, and alleviates (or reduces) concern from least experienced and most stressed responder.

A. TrueB. False

10. Put following steps in the correct sequence. You are alone on the scene and made sure that nor the child, nor you are any immediate danger:

A. Get the AED and follow the prompts of the AED unitB. 5 Rescue breaths, 30 compressions/2 rescue breaths, for 1 minuteC. Call for helpD. Check responsiveness, shout for help and open airway. You established that the

child is not breathing normally

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provider exam - answers sheet

Name _________________________________________ Date _________________

A B C D

1 ❏ ❏ ❏ ❏2 ❏ ❏3 ❏ ❏ ❏ ❏4 ❏ ❏5 ❏ ❏

A B C D

6 ❏ ❏ ❏ ❏7 ❏ ❏ ❏ ❏8 ❏ ❏ ❏ ❏9 ❏ ❏

10 _ _ _ _

I have revIeweD thIs exam wIth the course INstructor. I uNDerstaND the correct respoNse as INDIcateD by my sIgNature. aNy QuestIoNs regarDINg thIs exam aND the coNteNts of thIs course have beeN aNswereD to my satIsfactIoN.

score: ______ %

stuDeNt’s sIgNature: _____________________________ Date: __________________

10 correct = 100 %

9 correct = 90 %

8 correct = 80 %

7 correct = 70 %

6 correct = 60 %

5 correct = 50 %

4 correct = 40 %

3 correct = 30 %

2 correct = 20 %

1 correct = 10 %

0 correct = 0 %


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Paediatric Automated External Defibrillation Module

PRovideR exam (en) answeRs

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provider exam - answer


1. Proper pad placement on a child would be:

A. one pad placed below the right collarbone and the other in the left armpitB. one pad placed in the right armpit and the other in the left armpitC. one pad placed below the left collarbone and the other in the right armpitD. one should be place on the upper back, below the left scapula and the other on

the front of the child's chest, to the left of the sternum

2. Only paediatric defibrillation pads may be used on children from 1 to 8 years:

A. TrueB. False

3. Paediatric pads:

A. Are easily identifiable as paediatric padsB. Reduce the shock energyC. Are smaller than adult padsD. All of the above

4. After the first shock you should start CPR immediately for 2 minutes, the AED will reana-lyze automatically after this period.

A. TrueB. False

5. AEDs represent the only opportunity rescuers have to establish a normal heart rhythm prior to the arrival of advanced cardiac life support.

A. TrueB. False

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6. Some causes of cardiac arrest in children include:

A. TraumaB. Motor vehicle accidentC. ElectrocutionD. All of the above

7. When you do not have paediatric pads and you are going to use adult pads on a child.

A. one pad placed below the right collarbone and the other in the left armpitB. one should be place on the upper back, below the left shoulder blade and the other

on the front, to the left of the breastboneC. one pad placed in the right armpit and the other in the left armpitD. Depending on the child’s build you can choose between A and B

8. If the AED decided a shock is required

A. You should follow the AED unit’s promptsB. Visually and physically clear the patientC. You should state “I’m clear. You are clear. All clear”D. All the above

9. Paediatric pads remove confusion about which pads to use on a child, and alleviates (or reduces) concern from least experienced and most stressed responder.

A. TrueB. False

10. Put following steps in the correct sequence. You are alone on the scene and made sure that nor the child, nor you are any immediate danger:

D. Check responsiveness, shout for help and open airway. You established that the child is not breathing normally

B. 5 Rescue breaths, 30 compressions/2 rescue breaths, for 1 minuteC. Call for helpA. get the AED and follow the prompts of the AED unit

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provider exam - answers key

A B C D

1 ❏ ❏ ❏ ✔2 ❏ ✔3 ❏ ❏ ❏ ✔4 ✔ ❏5 ✔ ❏

A B C D

6 ❏ ❏ ❏ ✔7 ❏ ❏ ❏ ✔8 ❏ ❏ ❏ ✔9 ✔ ❏

10 4 2 3 1

10 correct = 100 %

9 correct = 90 %

8 correct = 80 %

7 correct = 70 %

6 correct = 60 %

5 correct = 50 %

4 correct = 40 %

3 correct = 30 %

2 correct = 20 %

1 correct = 10 %

0 correct = 0 %

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DAN Paediatric Care Provider Module Checklistc DAN First Aid Kit

c Resuscitation masks and/ or face shields

c Latex or non-latex medical gloves (One pair per student required)

c Baby CPR manikins

c Junior CPR manikins

c Anti-choking manikins

c Plastic resealable “contaminated waste” bags

c AED Training unit paediatric pads

c Plastic resealable “contaminated waste” bags

c DAN Paediatric BLS-D slide set

c BLS Paediatric BLS-D Instructor Manual

c DAN BLS-D Provider Student Kits, with the Paediatric module [One per student required]

c Decontamination solution or decontamination wipes for quick cleaning

c 2 washtubs labelled bleach and rinse

c Towels

Classroom/audiovisual equipment: ❑ Laptop ❑ Beamer ❑ Screen ❑ Tables and chairs ❑ Blackboard / marker board ❑ Student / staff name badges

Recommended equipment: ❑ Face shields / safety glasses

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Notes


Paediatric Module for BLS &

AED

Paediatric Module forBLS & AED

INSTRUCTORManual

Paediatric Module for BLS & AED

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