2010 guidelines instructor update

7/30/2019 2010 guidelines instructor update

1/148

2010 Guidelines

Instructor Update


2/148

Welcome !

This class will provide you with information

about the recently released changes in

emergency medical care and how those

changes affect your authorization as an ASHI orMEDIC First Aid Instructor.


3/148

Purpose of Class

Highlight the major changes in science,

treatment recommendations, and guidelines.

Provide helpful guidance to you for the transition

to new materials.


4/148

Learning Objectives

Identify the four central publications for changes

in the 2010 science, treatment

recommendations, and guidelines.

Identify the scheduled release dates for updatedtraining programs.

Describe the significant changes affecting ASHI

and MEDIC First Aid training programs.

Describe the rationale for the changes being

made.


5/148

Who is HSI?


6/148

About HSI

The Health & Safety Institute (HSI) unites therecognition and expertise of:

American Safety & Health Institute

MEDIC FIRST AID International 24-7 EMS

24-7 Fire

First Safety Institute

HSI is the largest privately held emergency caretraining organization in the world.


7/148

Proven Track Record

In business for more than 30 years.

In more than 100 countries.

Over 16,000 training centers approved.

Over 200,000 Instructors authorized.

More than 19 million providers certified.


8/148

Training Structure

HSI develops and markets proprietary training

programs, products, and services to approved

Training Centers.

Instructors are authorized by Training Centers tocertify course participants who successfully

complete a training program.


9/148

Approved for Use

HSIs basic and professional level programs are

endorsed, accepted, approved, or meet the

requirements of more than 1800 Federal and

state regulatory agencies and occupationallicensing boards.


10/148

2010 ILCOR Conference

HSI participated in the 2010 International

Committee on Resuscitation (ILCOR)

International Conference on CPR and ECC

Science with Treatment Recommendations.


11/148

International First Aid Advisory Board

HSI representatives were members of the 2005

National and 2010 International First Aid Advisory

Board founded by the AHA and ARC.

HSI representatives contributed to both the 2005and 2010 Consensus on First Aid Science and

Treatment Recommendations.


12/148

Integrating 2010 Science,

Treatment Recommendations,and Guidelines


13/148

Where do guidelines come from?

Multi-year process involving resuscitation

experts from around the world

Results in the following publications:

2010 Science and Treatment Recommendations ILCOR International Consensus on CPR and ECC

AHA and ARC International Consensus on First Aid

2010 Training Guidelines

2010 AHA Guidelines for CPR and ECC 2010 AHA and ARC Guidelines for First Aid


14/148

2010 Guidelines

The science and guidelines were published in

the journal Circulationon October 18th, 2010

They are both freely available at

www.hsi.com/2010guidelines
http://www.hsi.com/2010guidelineshttp://www.hsi.com/2010guidelines


15/148

New Program Development

In order to integrate the 2010 guidelines, time is

required to make systematic and organized

changes to our products.

We are currently revising all of our emergencycare training materials.

New training materials will be released

throughout 2011.


16/148

Source References

2010 International Consensus on CardiopulmonaryResuscitation and Emergency Cardiovascular CareScience With Treatment Recommendations

2010 American Heart Association and American Red

Cross International Consensus on First Aid Science WithTreatment Recommendations

2010 American Heart Association Guidelines forCardiopulmonary Resuscitation and Emergency

Cardiovascular Care 2010 American Heart Association and American Red

Cross Guidelines for First Aid


17/148

Interim Training Materials

We have created interim training materials thatallow Instructors to immediately start incorporating

some of the most significant changes into current

(2005) training materials.

The interim materials are only intended to be used

until the new training programs are made

available.

Use of the interim materials is an option and not arequirement. Instructors can continue to use the

current (2005) materials as designed.


18/148

Using (2005) Materials

The release of new science and treatment

recommendations do not imply that emergency

care or instruction involving the use of previous

recommendations science and treatmentrecommendations is unsafe.


19/148

Support for Current Materials

You may continue to purchase and teach using

current (2005) training materials until the new

programs are available.

Support for the current materials will continueuntil December 31, 2011, or until the inventory of

the materials is depleted.


20/148

Planned 2nd Quarter 2011 Release

ASHI

CPR and AED

Basic First Aid

CPR, AED, and Basic First Aid Combination CPR Pro

MEDIC First Aid

CarePlus CPR and AED

BasicPlus CPR, AED, and First Aid


21/148

Planned 3rd Quarter 2011 Release

ASHI

Advanced Cardiac Life Support (ACLS) *

Bloodborne and Airborne Pathogens

MEDIC First Aid PediatricPlus CPR, AED, and First Aid for Children,

Adults, and Infants

CPR and AED Child/Infant Supplement

Bloodborne and Airborne Pathogens

*Release date is dependent on third party production.


22/148

Planned 4th Quarter 2011 Release

ASHI

Pediatric Advanced Life Support (PALS)*

Child and Babysitting Safety Course (CABS)

*Release date is dependent on third party production.


23/148

Update Requirements


24/148

Need to Know

Every Instructor needs to understand the

guideline changes that affect the program(s) he

or she is authorized to teach.

In the following pages we have organized themost significant guideline changes by area and

training level.

For each identified change, the lesson provides

the 2005 guideline for reference, the updated

2010 guideline, and the reason for the change.


25/148

Lay and Healthcare Providers

Some of the lessons cover lay providers and

some cover healthcare providers.

Even though an Instructor may only teach a

single provider level, the comparison informationfrom the other level may be valuable for

understanding and ability to answer student

questions.


26/148

ACLS and PALS

Specific information regarding the changes in

our advanced training programs, ASHI ACLS

and ASHI PALS is not included in this

presentation. The information is provided in the HSI 2010

Updated Training Guidelines Supplement found

in the document section of the online Instructor

Portal.


27/148

CPR and AED


28/148

Emphasis on High-Quality CPR

blood flow is optimized by using the recommended chest compression

force and duration and maintaining a chest compression rate of

approximately 100 compressions per minute. These guidelines

recommend that all rescuers minimize interruption of chest compressions CPR instruction should emphasize the importance of allowing complete

chest recoil between compressions.

(Circulation. 2005; 112: IV19-IV34)

2005 Guidelines


29/148

Emphasis on High-Quality CPR

To provide effective chest compressions, push

hard and push fast. compress the adult chest

at a rate of at least 100 compressions per

minute with a compression depth of at least 2inches/5 cm. allow complete recoil of the

chest after each compression, to allow the heart

to fill completely before the next compression.

minimize the frequency and duration of

interruptions in compressions to maximize the

number of compressions delivered per minute.

(Berg, et al. Circulation. 2010;122;S685-S705)

2010 Guidelines


30/148

Highlights

This is a re-emphasis from 2005.

For effective compressions:

Push fast

Push hard Allow chest to fully recoil

Minimize any interruptions

Applies to both lay and healthcare providers.


31/148

Rationale For Change

High-quality chest compressions within CPR

continues to be a critical focal point.

Well-performed compressions increase the

likelihood of survival.


32/148

Compression Hand Position

The rescuer should compress the lower half of the victims sternum in the

center (middle) of the chest, between the nipples. The rescuer should

place the heel of the hand on the sternum in the center (middle) of the

chest between the nipples and then place the heel of the second hand ontop of the first so that the hands are overlapped and parallel.


2005 Guidelines


33/148

Compression Hand Position

The rescuer should place the heel of one hand

on the center (middle) of the victims chest

(which is the lower half of the sternum) and the

heel of the other hand on top of the first so thatthe hands are overlapped and parallel.


2010 Guidelines


34/148

Highlights

Hands in centerof the chest.

Lower halfof breastbone

Second hand on top of the first.

Not on lowest part of breastbone.



35/148


Use of the nipple line as a landmark for

hand placement was found to be unreliable.


36/148

Compression Rate

There is insufficient evidence from human studies to identify a single

optimal chest compression rate. Animal and human studies support a

chest compression rate of >80 compressions per minute to achieve

optimal forward blood flow during CPR. We recommend a compressionrate ofabout 100compressions per minute.


2005 Guidelines


37/148

Compression Rate

It is reasonable for laypersons and healthcare

providers to compress the adult chest at arate of at least 100 compressions per minute

with a compression depth of at least 2 inches(5 cm.)


2010 Guidelines


38/148

Highlights

At least 100 times per minute.

It is okay to be a little faster.



39/148


It has been found that higher survival rates are

associated with an increase in the number of

compressions provided per minute.


40/148

Child/Infant Compression Rate

Push fast; push at a rate ofapproximately 100 compressions perminute.


2005 Guidelines


41/148

Child/Infant Compression Rate

Push fast; push at a rate ofat least 100compressions per minute.


2010 Guidelines


42/148

Highlights

Rescuers tend to compress slower.

At least 100 compressions per minute.

It is okay to be a little faster.



43/148


It has been found that higher survival rates are

associated with an increase in the number of

compressions provided per minute.


44/148

Compression Depth

Depress the sternum approximately1 to 2 inches (approximately 4 to5 cm) and then allow the chest to return to its normal position.


2005 Guidelines


45/148

Compression Depth

It is reasonable for laypersons and healthcare

providers to compress the adult chest at a rate of

at least 100 compressions per minute with a

compression depth of at least 2 inches/5 cm.


2010 Guidelines


46/148

Highlights

At least 2 inches on an adult.

It is okay to compress a little deeper.

Not enough information to define upper limit.



47/148


Research indicates the tendency for CPR

providers to not compress deep enough, even

with the emphasis to "push hard."


48/148

Child/Infant Compression Depth

Push hard: push with sufficient force to depress the chest approximatelyone third to one half the anterior-posterior diameter of the chest.


2005 Guidelines


49/148

Child/Infant Compression Depth

Chest compressions of appropriate rate and

depth. Push fast: push at a rate of at least 100

compressions per minute. Push hard: push

with sufficient force to depress at least onethird the anterior-posterior (AP) diameter ofthe chest or approximately 1 inches (4 cm)in infants and 2 inches (5 cm) in children.


2010 Guidelines


50/148

Highlights

At least 1/3 of the anterior/posterior diameter of

chest.

About 2 inches for children and about 1

inches for infants. It is okay to compress a little deeper



51/148


Research indicates the tendency for CPR

providers to not compress deep enough, even

with the emphasis to "push hard."


52/148

Breathing Assessment

While maintaining an open airway, look, listen, and feel for breathing.


2005 Guidelines


53/148

Breathing Assessment

After activation of the emergency response system, all rescuers should

immediately begin CPR for adult victims who are unresponsive with no

breathing or no normal breathing (only gasping).


2010 Guidelines


54/148

Highlights

No more look, listen, and feel.

Quick look for no breathing or no normal

breathing.

Agonal breaths remain a concern. Applies to both lay and healthcare providers.


55/148

Rationale for Change

Simplifying the breathing assessment is

intended to help laypersons respond more

quickly with chest compressions and CPR.

There is a high likelihood of agonal, or irregular,gasping breaths to occur early in cardiac arrest

and confuse rescuers.


56/148

CPR Sequence - Lay

For an unresponsive person who is not breathing or not breathing

normally, begin CPR by opening the airway and giving 2 rescue breaths

followed with 30 chest compressions. Repeat cycles of30:2 (ABC

method).

(Summary from Circulation. 2005; 112: IV19-IV34)

2005 Guidelines


57/148

CPR Sequence - Lay

For an unresponsive person, activate EMS,

then assess breathing. If the person is not

breathing or not breathing normally, begin CPR

with 30 compressions followed by opening theairway and giving 2 rescue breaths. Repeat

cycles of30:2 (CAB method).

(Summary from Berg, et al. Circulation.2010;122;S685-S705)

2010 Guidelines


58/148

Highlights

Initial assessment steps: Assess responsiveness

Activate EMS(emergency medical services)

Assess breathing

Perform CPR CAB begin CPR cycles with compressions,

followed by airway and breathing.

Guideline applies to adults, children, and infants.


59/148


The science indicates the importance of not

delaying chest compressions to perform rescue

breaths.

Early chest compression can immediatelycirculate oxygen that is still in the bloodstream.

CPR S HCP


60/148

CPR Sequence - HCP

For an unresponsive person who is not

breathing or not breathing normally, begin CPR

by opening the airway and giving 2 rescue

breaths followed with 30 chest compressions.Repeat cycles of 30:2 (ABC method).

(Summary from Circulation. 2005; 112: IV19-IV34)

2005 Guidelines

CPR S HCP


61/148

CPR Sequence - HCP

For an unresponsive person who is not

breathing or not breathing normally, and has no

obvious pulse, activate EMS and begin CPR

with 30 compressions followed by opening theairway and giving 2 rescue breaths. Repeat

cycles of 30:2 (CAB method).

(Summary from Berg, et al. Circulation.2010;122;S685-S705)

2010 Guidelines


62/148

Highlights

Initial assessment approach: Assess responsiveness and breathing

Activate EMS

Assess pulse

Perform CPR

CAB begin CPR cycles with compressions,

followed by airway and breathing.


63/148


The science indicates the importance of not

delaying chest compressions to perform rescue

breaths.

Early chest compression can immediatelycirculate oxygen that is still in the bloodstream.


64/148

Use of an AED on an Infant

There is insufficient data to make a

recommendation for or against the use of AEDs

for infants 1 year of age.


2005 Guidelines

f f


65/148

Use of an AED on an Infant

Many AEDs have high specificity in recognizing

pediatric shockable rhythms, and some are

equipped to decrease (or attenuate) the

delivered energy to make them suitable forinfants and children < 8 years of age. For

infants an AED equipped with a pediatric

attenuator is preferred for infants. If neither is

available, an AED without a dose attenuator

may be used.

(Link, et al. Circulation. 2010;122;S706-S719)

2010 Guidelines


66/148

Highlights

Success at defibrillating infants.

Use attenuator to reduce shock.

Okay to use AED set for adult.



67/148


AEDs designed to be used on adults have been

successful when used on infants with out-of-

hospital cardiac arrest.

Minimal heart muscle damage and goodneurological outcomes were reported.

Ch i f S i l


68/148

Chain of Survival

Early recognition of the emergency and

activation of the emergency medical services

(EMS) or local emergency response system

Early bystander CPREarly delivery of a shock with a defibrillator

Early advanced life support followed by post

resuscitation care delivered by healthcare

providers


2005 Guidelines

Ch i f S i l


69/148

Chain of Survival

These actions are termed the links in the Chain

of Survival. For adults they include:

Immediate recognition of cardiac arrest and

activation of the emergency response system

Early CPR that emphasizes chest

compressions

Rapid defibrillation if indicated

Effective advanced life support

Integrated postcardiac arrest care.

(Travers, et al. Circulation. 2010;122;S676-S684)

2010 Guidelines


70/148

Highlights

Addition of fifth link in chain.

Integrated post-cardiac arrest care.



71/148


Links in the Chain of Survival indicate theindividual actions that must be strong in

order for a person to survive a sudden

cardiac arrest.

The addition of the fifth link, integrated post-

cardiac arrest care, further emphasizes the

additional dependence on longer-term care

for long-term survival.

C i id P HCP


72/148

Cricoid Pressure - HCP

Cricoid pressure should be used only if the

victim is deeply unconscious.


2005 Guidelines

C i id P HCP


73/148

Cricoid Pressure - HCP

The routine use of cricoid pressure in adult

cardiac arrest is not recommended.


2010 Guidelines


74/148

Highlights

Cricoid may impede ventilation.

Difficult to teach.

May prevent advanced airway placement.

Aspiration may still occur.


75/148


Regardless of expertise, rescuers cannoteffectively apply cricoid pressure.

T A h HCP


76/148

Team Approach - HCP

When multiple rescuers are present, they should rotate the compressor

role about every 2 minutes. The switch should be accomplished as quickly

as possible (ideally in less than 5 seconds) to minimize interruptions in

chest compressions.

(Circulation. 2005;112:IV-12-IV-17)

2005 Guidelines

T A h HCP


77/148

Team Approach - HCP

The intent of the algorithm is to present the steps of BLS in a logical and

concise manner that is easy for all types of rescuers to learn, remember and

perform. These actions have traditionally been presented as a sequence of

distinct steps to help a single rescuer prioritize actions. However, manyworkplaces and most EMS and in-hospital resuscitations involve teams of

providers who should perform several actions simultaneously (e.g.: one

rescuer activates the emergency response system while another begins chest

compressions, and a third either provides ventilations or retrieves the bag-

mask for rescue breathing, and a fourth retrieves and sets up a defibrillator).


2010 Guidelines


78/148

Highlights

Tasks can be performed simultaneously.

Integrate additional rescuers as they arrive.

Designate team leader with multiple

rescuers.

R i l F Ch


79/148


Some resuscitations start with a lone rescuerand builds to more, whereas other resuscitations

begin with several willing rescuers.

Training should focus on building a team andperforming tasks simultaneously.


80/148

Emergency Care / First Aid

For Lay Providers

Pressure Points and Elevation


81/148


There is insufficient evidence to recommend for

or against the first aid use of pressure points or

extremity elevation to control hemorrhage.


2005 Guidelines



82/148


Elevation and use of pressure points are not

recommended to control bleeding.

(Markenson, et al. Circulation. 2010;122;S934-S946) )

2010 Guidelines

Hi hli ht


83/148

Highlights

Not recommended.

Direct pressure is more effective.

May compromise direct pressure.

R ti l F Ch


84/148


Elevation and pressure points are unprovenprocedures that may compromise the proven

intervention of direct pressure, so they could be

harmful.

Tourniquets


85/148

Tourniquets

The effectiveness, feasibility, and safety of

tourniquets to control bleeding by first aid

providers are unknown, but the use of

tourniquets is potentially dangerous.


2005 Guidelines

Tourniquets


86/148

Tourniquets

Because of the potential adverse effects of

tourniquets and difficulty in their proper

application, use of a tourniquet to control

bleeding of the extremities is indicated only ifdirect pressure is not effective or possible.

Specifically designed tourniquets appear to be

better than ones that are improvised, but

tourniquets should only be used with proper

training.

(Markenson, et al. Circulation. 2010;122;S934-S946)

2010 Guidelines

Hi hli ht


87/148

Highlights

Use only if direct pressure will not work.

Effective in certain conditions.

Commercial better than improvised.

Training necessary.

R ti l F Ch


88/148


Tourniquets have been shown to controlbleeding effectively and without complications

on the battlefield, during surgery, and when

used by paramedics in a civilian setting.

There are no studies on controlling bleeding

with first aid provider use of a tourniquet.

Hemostatic Agents


89/148

Hemostatic Agents

The use of hemostatic agents in first aid was

not covered in the 2005 science, treatment


2005 Guidelines

Hemostatic Agents


90/148

Hemostatic Agents

Routine use of hemostatic agents in first aid

cannot be recommended at this time because of

significant variation in effectiveness by different

agents and their potential for adverse effects,including tissue destruction with induction of a

proembolic state and potential thermal injury.

(Markenson, et al. Circulation. 2010;122;S934)

2010 Guidelines

Highlights


91/148

Highlights

Some are effective, others are marginal.

Wide variety of results.

Potential for adverse effects.



92/148


The use of commercially available hemostaticagents to control bleeding is not recommended

because the agent and conditions for its

application are not known.

Leg Elevation for Shock


93/148


The use of elevation for the treatment of shock

in first aid was not covered in the 2005 science,


2005 Guidelines



94/148


If a victim shows evidence of shock, have the

victim lie supine. If there is no evidence of trauma

or injury, raise the feet about 6 to 12 inches (about

30 to 45). Do not raise the feet if the movementor the position causes the victim any pain.


2010 Guidelines

Highlights


95/148

Highlights

Lay victim flat.

If no injury, elevate 6-12 inches.

No elevation if pain occurs.



96/148


Elevating the legs can be beneficial in cases inwhich the mechanism of shock is related to

factors other than injury.

The risk of further injury outweighs the benefit ofelevation when a person is injured.

Injured Extremity


97/148

Injured Extremity

If you are far from definitive health care, you

may stabilize the extremity in the position

found.


2005 Guidelines

Injured Extremity


98/148

Injured Extremity

If you are far from definitive health care, stabilize

the extremity with a splint in the position found. If

a splint is used, it should be padded to cushion

the injury.


2010 Guidelines

Highlights


99/148

Highlights

Stabilize with splint if away from medical help.

Splint in position found.

Use padding.



100/148


Expert opinion suggests that splinting for anextremity injury may reduce pain and prevent

further injury, especially when professional care

is delayed or it is decided to move the injured

person.

Aspirin for Chest Discomfort


101/148


The use of aspirin for chest discomfort in first

aid was not covered in the 2005 science,


2005 Guidelines



102/148


While waiting for EMS to arrive, the first aid

provider may encourage the victim to chew 1

adult (not enteric coated) or 2 low-dose baby

aspirin if the patient has no allergy to aspirin orother contraindication to aspirin, such as

evidence of a stroke or recent bleeding.


2010 Guidelines

Highlights


103/148

Highlights

Encourage victim while waiting for EMS.

One adult or two baby aspirin.

Non-coated.

No allergies. No contraindication.



104/148


Evidence clearly demonstrated that theadministration of aspirin within the first

hours of onset of chest discomfort in people

with acute coronary syndromes reduced

mortality.

Epinephrine for Anaphylaxis


105/148


"First aid providers should be familiar with the

epinephrine auto-injector so that they can help

someone having an anaphylactic reaction self-

administer the epinephrine. First aid providers

should be able to administer the auto-injector if

the victim is unable to do so, provided that the

medication has been prescribed by a physician

and state law permits (second dose notaddressed).

(Circulation. 2005;112:IV-196-IV-203)

2005 Guidelines



106/148


First aid providers are advised to seek medical

assistance if symptoms persist, rather than

routinely administering a second dose of

epinephrine. In unusual circumstances, whenadvanced medical assistance is not available, a

second dose of epinephrine may be given if

symptoms of anaphylaxis persist.

(Markenson, et al. Circulation. 2010;122;S934-

S946)

2010 Guidelines

Highlights


107/148

Highlights

Some people require a second dose.

Epinephrine is potentially harmful.

No routine second dose.

If medical assistance not available, providesecond dose if symptoms persist.



108/148


If medical assistance is available, it is less likelythat an unnecessary second dose of epinephrine

will be given.

Chemical Burns to the Eye


109/148


In case of an acid or alkali exposure to the skin

or eye, immediately irrigate the affected area

with copious amounts of water.


2005 Guidelines



110/148


Rinse eyes exposed to toxic substances

immediately with a copious amount of water,

unless a specific antidote is available.


2010 Guidelines

Highlights


111/148

Highlights

Rinse with large amounts of water.

Use specific antidote if available.



112/148


Immediate irrigation of eyes exposed to a toxinwith large amounts of water is recommended.

Specialized therapeutic rinsing solutions that

have been properly tested and approved may be

available and should be used.

Heat Stroke


113/148

The treatment of heat stroke in first aid was not

covered in the 2005 science, treatment


2005 Guidelines

Heat Stroke


114/148

The most important action by a first aid provider

for a victim of heat stroke is to begin immediate

cooling, preferably by immersing the victim up to

the chin in cold water.


S946)

2010 Guidelines

Highlights


115/148

Highlights

Immediate cooling emphasized.

Immersion up to neck in cold water

preferred as an option.



116/148


Immediate cooling emphasizes the criticaldanger associated with heat stroke.

Complete immersion in cold water has been

found to be the most effective method of cooling

the body in heat stroke.

Supplemental Oxygen in Diving


117/148

pp yg g

The use of supplemental oxygen for diving

injuries in first aid was not covered in the 2005

science, treatment recommendations, and

guidelines.

2005 Guidelines

Supplemental Oxygen in Diving


118/148

pp yg g

Supplementary oxygen administration may be

beneficial as part of first aid for divers with a

decompression injury.


2010 Guidelines



119/148


There is evidence oxygen may be beneficialfor divers with a decompression injury.

Activated Charcoal


120/148

There is insufficient evidence to recommend for

or against the use of activated charcoal as first

aid for ingestions.


2005 Guidelines

Activated Charcoal


121/148

Do not administer activated charcoal to a victim

who has ingested a poisonous substance unless

you are advised to do so by poison control center

or emergency medical personnel.


2010 Guidelines

Highlights


122/148

Highlights

Use only if directed by poison control.



123/148


There is no evidence that activated charcoal iseffective as a component of first aid.

It may be difficult to administer and it has not

been shown to be beneficial.

There are reports of it causing harm.

Pressure Immobilization for Snakebite


124/148

In case of an elapid (e.g., coral) snakebite,

wrap a bandage snugly (comfortably tight but

loose enough to slip or fit a finger under it)

around the entire length of the bitten extremity,

immobilize the extremity, and get definitivemedical help as rapidly as possible.


2005 Guidelines

Pressure Immobilization for Snakebite


125/148

Applying a pressure immobilization bandage

around the entire length of the bitten extremity is

an effective and safe way to slow the

dissemination of venom pressure is sufficient if

the bandage allows a finger to be slipped

under it. Initially it was theorized that external

pressure would only benefit victims bitten by

snakes producing neurotoxic venom, but the

effectiveness has also been demonstrated for

bites by non-neurotoxic American snakes.


2010 Guidelines

Highlights


126/148

g g

Pressure immobilization safe and effective. Be able to slide finger underneath.



127/148

g

Applying a pressure immobilization bandagehas shown to be an effective way to slow the

dissemination of venom for all venomous

snake bites, not just those from elapids.

Jellyfish Stings


128/148

The treatment of jellyfish stings in first aid was

not covered in the 2005 science, treatment


2005 Guidelines

Jellyfish Stings


129/148

To inactivate venom load and prevent further

envenomation, jellyfish stings should be liberally

washed with vinegar (4% to 6% acetic acid

solution) as soon as possible for at least 30

seconds. For the treatment of pain, after the

nematocysts are removed or deactivated, jellyfish

stings should be treated with hot-water immersion

when possible.


S946)

2010 Guidelines

Highlights


130/148

g g

Vinegar wash for 30 seconds to inactivatenematocysts.

Follow with hot-water immersion for pain control.



131/148

g

Vinegar is most effective for inactivation of thenematocysts.

Immersion in water, as hot as tolerated for about

20 minutes, has been found to be the most

effective treatment for the pain.


132/148

Education / Implementation

Skills Reinforcement


133/148

Ongoing skills reinforcement was not covered in

the 2005 science, treatment recommendations,

and guidelines.

2005 Guidelines

Skills Reinforcement


134/148

While the optimal mechanism for maintenance of

competence is not known, the need to move toward

more frequent assessment and reinforcement of skills

is clear. Skill performance should be assessed during

the 2-year certification with reinforcement provided as

needed. The optimal timing and method for this

assessment and reinforcement are not known.

(Bhanji, et al. Circulation. 2010;122;S920-S933)

2010 Guidelines

Highlights


135/148

g g

Need for more frequent review is clear. Optimum reinforcement not known.

Reassess and reinforce.



136/148

g

Retention of skills deteriorates very quickly aftertraining.

Frequent skill refreshers should help to maintain

reasonable skill performance.

Self-Instruction


137/148

Instruction methods should not be limited to

traditional techniques; newer training methods

(e.g., watch-while-you practice

video programs) may be more effective.

(Circulation. 2005;112:III-100-III-108)

2005 Guidelines

Self-Instruction


138/148

Short video instruction combined with

synchronous hands-on practice is an effective

alternative to instructor-led basic life support

courses.


2010 Guidelines

Highlights


139/148

Video self-instruction with practice-while-watching is effective.



140/148

Studies have demonstrated that lay rescuerCPR skills can be acquired and retained at least

as well through interactive computer- and video-

based synchronous practice when compared

with instructor-led courses.

Skills Competency


141/148

Training programs should be evaluated to

verify that they enable effective skills acquisition

and retention.

(Circulation. 2005;112:III-100-III-108)

2005 Guidelines

Skills Competency


142/148

Successful course completion should be based

on the ability of the learner to demonstrate

achievement of course objectives rather than

attendance in a course/program for a specific

time period.


2010 Guidelines

Highlights


143/148

Verification of competence, not a set number ofclass hours.



144/148

Reflecting emerging trends, there is supportto move toward a more competency-based

approach to resuscitation education for all

rescuers.

Prompting and Feedback Devices


145/148

A CPR prompt device may be useful in both

out-of-hospital and in-hospital settings.


2005 Guidelines

Prompting and Feedback Devices


146/148

Training in CPR skills using a feedback device

improves learning and/or retention. The use of a

CPR feedback device can be effective for training.

CPR prompting and feedback devices can be

useful as part of an overall strategy to improve the

quality of CPR during actual resuscitations.


2010 Guidelines

Highlights


147/148

Effective in training. Improves quality of actual resuscitation.



148/148

The evidence has shown prompting andfeedback devices to be effective in CPR training

and during actual resuscitations.

Commercially-produced devices are now more

readily available for use.

2010 guidelines instructor update

Documents

Transcript of 2010 guidelines instructor update