BEST PRACTICES TEACHING CPR

Paris Hotel and Casino Las Vegas, Nevada

Presented by: JOHN CARECCIA EMT-IT

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BEST PRACTICES TEACHING CPR

• PRESENTED BY: JOHN CARECCIA• EMT B AND BLS INSTRUCTOR TRAINER• CHIEF / TRAINING FOR WOODBRIDGE

TOWNSHIP AMBULANCE & RESCUE SQUAD• CPR INSTRUCTOR SINCE 1994

DO YOUR BEST TEACHING CPR

USE EFFECTIVE AND EASY TO UNDERSTAND TRAINING MATERIALS THAT COMPLEMENT THE

LEARNING PROCESS

HOW TO DELIVER THE BEST TRAINING

• CONSULT WITH EMS PROFESSIONALS• GET IT RIGHT THE FIRST TIME• LISTEN TO INSTRUCTORS• DO IT CORRECTLY – USE RESOURCES• CRITICAL EVALUATION IS A MUST• CORRECT IF NECESSARY

CONSULT WITH EMS PROFESSIONALS

• Book learning is good, but it is no substitute for experience. Consult with EMS experts in the field to make sure the training materials encourage the student to deliver effective CPR on a consistent basis.

• Utilizing different expert points of view will enable you to thoroughly develop effective training materials and aids.

GET IT RIGHT THE FIRST TIME

• To make sure the Training Materials are the best they can be everyone should agree they have done their best to make them so.

• When the contract for the Video is awarded there should be EMS professional (s) on the set to review the script and make sure the actors accurately depict the procedures as described in the course material.

LISTEN TO INSTRUCTORS

• During my years, many CPR instructors I know have cited glaring mistakes in the video portion of the HCP course as it relates to the written lesson material.

• If the mistakes are so egregious they should be addressed. Better yet, if we have EMS professionals on the set, the actors can be coached on how to perform required actions correctly before the video is released.

DO IT CORRECTLY

• Students need to see an action done correctly.

• Actors should not make glaring mistakes. • Safety is First. • Our Motto is: Do No Harm. • Make sure the actor follows the script. • Check to see the action is exactly as

described in the book.

CRITICAL EVALUATION IS A MUST

• The evaluations should find out what the student really thinks about the training materials. Questions should be directed to specific elements of the subject matter.

• Using terms like good, bad, appropriate are asking the student to be subjective. Ask the student if the section or chapter met the objective. Encourage Comments.

CORRECT IF NECESSARY

• The good name of your company or organization is attached to the lessons presented to the students. Respect and Trust must be maintained.

• If there are legitimate critiques of the material that show there are areas that should be improved or corrected, correct them either by using handouts or re-shooting portions of the video and incorporating it into a new interim video.

JOB WELL DONE

• If you take pains to produce accurate and easy to understand training materials, it will do everything possible to train confident EMS professionals and people from all walks of life.

• Each discipline needs to be scrutinized and supervised during production to turn out the best product possible. Thank You.

05/01/2023

WHO IS JOHN CARECCIA

• John is an EMT with more than 20 years experience.

• John is Chief and Training Director of Woodbridge Twp. Ambulance & Rescue Squad in New Jersey.

• John is a BLS instructor Trainer since 1994• John teaches CPR and First Aid to members

of his community .• John teaches CPR in New York and New

Jersey as part of his business.

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BEST PRACTICES TEACHING CPR

• PRESENTED BY: • JOHN CARECCIA• EMT B AND BLS INSTRUCTOR

TRAINER• DEPUTY CHIEF / TRAINING

DIRECTOR FOR THE WOODBRIDGE TOWNSHIP AMBULANCE & RESCUE SQUAD

• CPR INSTRUCTOR SINCE 1994

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DO YOUR BEST TEACHING CPRUse Effective and Easy to

Understand Training Materials That Complement

the Learning Process

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HOW TO DO THE BEST WE CAN

• CONSULT WITH EMS PROFESSIONALS• GET IT RIGHT THE FIRST TIME• LISTEN TO INSTRUCTORS• DO IT CORRECTLY – USE RESOURCES• CRITICAL EVALUATION IS A MUST• CORRECT IF NECESSARY• A CONFIDENT TEAM IS A GOOD TEAM

05/01/2023

CONSULT WITH EMS PROFESSIONALS• Book learning is good, but it is no

substitute for experience. Consult with EMS experts in the field to make sure the training materials encourage the student to deliver effective CPR on a consistent basis.

• Utilizing different expert points of view will enable the AHA to thoroughly develop effective training materials and aids.

05/01/2023

GET IT RIGHT THE FIRST TIME• To make sure the Training Materials are

the best they can be everyone should agree they have done their best to make them so.

• When the contract for the Video is awarded there should be EMS professional (s) on the set to review the script and make sure the actors accurately depict the procedures as described in the course material.

05/01/2023

LISTEN TO INSTRUCTORS• Many CPR instructors I know have cited

glaring mistakes in the video portion of the HCP course as it relates to the written lesson material.

• If the mistakes are so egregious they should be addressed. Better yet, if we have EMS professionals on the set, the actors can be coached on how to perform required actions correctly before the video is released.

• .

05/01/2023

DO IT CORRECTLY• Students need to see an action done

correctly. • Actors should not make glaring

mistakes. • Safety is First. • Our Motto is: Do No Harm. • Make sure the actor follows the script. • Check to see the action is exactly as

described in the book.

05/01/2023

CRITICAL EVALUATION IS A MUST• The evaluations should find out what the

student really thinks about the training materials. Questions should be directed to specific elements of the subject matter.

• Using terms like good, bad, appropriate are asking the student to be subjective. Ask the student if the section or chapter met the objective. Encourage Comments.

05/01/2023

CORRECT IF NECESSARY

• The good name of the American Heart Association is attached to the lessons presented to the students. Respect and Trust must be maintained.

• If there are legitimate critiques of the material that show there are areas that should be improved or corrected, correct them either by using handouts or re-shooting portions of the video and incorporating it into a new video.

05/01/2023

A CONFIDENT TEAM IS A GOOD ONE

• When everyone is confident that they have mastered the techniques of CPR and are comfortable using them, they will be able to function more effectively as individuals, or with the help of other team members be even more effective and productive.

05/01/2023

JOB WELL DONE• If the AHA takes pains to produce

accurate and easy to understand training materials, they will do everything possible to train confident EMS professionals and people from all walks of life.

• Each discipline needs to be scrutinized and supervised during production to turn out the best product possible. Thank You.

05/01/2023

WHO IS JOHN CARECCIA

• John is an EMT with more than 20 years experience.

• John is Chief and Training Director of Woodbridge Twp. Ambulance & Rescue Squad in New Jersey.

• John is a BLS instructor Trainer since 1994• John teaches CPR and First Aid to members

of his community .• John teaches CPR in New York and New

Jersey as part of his business.

05/01/2023

JOHN’S OTHER PURSUITS• John interacts with other instructors in

Discussion groups on Linked In. Some of the ideas presented here came from those discussions.

• John has a website devoted to health issues and finding solutions, especially for seniors at www.healthinformationandmore.com

• John is an avid Golfer who loves the game and started a website geared to helping seniors and the challenged play golf. www.golfsolutions4you.com

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HCP COURSE IS A CHALLENGE

• There are several additional actions and procedures that are included in the Healthcare Provider Course (HCP). It is extremely important to explain and show them as best you can. Having an EMS professional on the set is critically important to making sure the EMS student is getting the most accurate information possible.

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KEEP LIKE THINGS TOGETHER

• The Video Host and materials should end one segment with a lead in to the next (segue)

• Explain ending one segment before beginning the next one.

• Immediately following infant CPR with the Advanced Airway section without any explanation is confusing to students.

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WHY CAB?• Compressions keep the brain alive.• Effective compressions pump the

necessary amount of oxygenated blood to the brain to help keep it alive.

• If the brain is kept alive there is a good chance you will be able to revive the victim and have a good outcome.

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WHY THE ADULT RATIO IS 30 TO 2

• Studies have shown that delivering 30 compressions and 2 breaths is best for keeping a fatigued or diseased heart alive and the brain fed with a sufficient supply of oxygenated blood.

• The heart has arteries feeding it blood and you must keep up the pressure in those arteries to keep the heart alive.

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YOU CAN MAKE A DIFFERENCE

• Everyone is capable of delivering effective compressions.

• Effective compressions pump oxygenated blood to the brain, keeping it alive.

• If you don’t help the victim, who will?• If the victim could speak, they would say

please help me. • A human life should not go to waste

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ADULT CPR – SCENE SAFE• Check for Scene Safety: electricity, hazards• Shake and shout: is the person sleeping?• Check for breathing: lay your hand on the

chest and look at the chest.• No breathing: >YOU - call 911 and get AED• Start compressions by placing heel of one

hand in center of chest on the sternum between the nipples.

• Bring your shoulder over your wrist and keep your arms straight. Push straight down on the chest.

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PUSH FAST AND HARD

• To push blood from the heart to the brain effectively push down at least 2 inches and as fast as 100 pushes per minute, about 1½ per second.

• Deliver 30 compressions. Concentrate on keeping your shoulder over your wrist and keep the pace up to at least 100 per minute. Faster is better.

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LET THE CHEST COME BACK UP

• Push straight down at least 2”, more is better.

• Let the chest come completely back up before starting the next compression.

• Perform 2 minutes or 5 cycles if you can do so. Switch when you feel tired or when you see yourself leaning on the chest.

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DELIVER EFFECTIVE BREATHS

• Place your non-preferred hand over the top of the mask. Tilt the head back by pressing on the forehead.

• Put the thumb of the preferred hand over bottom of mask and grip the jaw bone with remaining fingers and lift the chin to take the tongue away from the airway.

• Blow air in softly over one second to make the chest rise gently.

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WHAT IF NO ONE COMES• If no one comes you should try to find a

phone and an AED, if one is available within 2 minutes of the victim’s location..

• If you don’t know where one is use your cell phone to call 911 and start compressions.

• If you can’t switch, rest for the count of 5 then start over again for as long as you can.

• If an AED arrives, immediately put pads on while one rescuer continues compressions.

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TURN THE AED ON• Once the AED arrives, TURN IT ON. Follow

the prompts.• One rescuer places the pads while the

other delivers compressions.• Once the AED pads cord is plugged in, the

AED analyzes the victim’s heart rhythm.• Make sure no one touches the victim until

the shock sequence is complete. • Once the analyze sequence starts: HANDS

OFF AND SWITCH POSITIONS.

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HOW DO YOU SWITCH?• Rescuer 1 moves to the head and Rescuer 2 by

the head moves to the opposite side of the victim. Both move in the same direction around the head of the victim.

• Once the AED says shock is necessary the rescuer by the head makes sure no one is touching the victim. Do a final check to clear and then push the flashing yellow shock button.

• Once the shock is delivered, the other rescuer immediately starts compressions.

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CHILDREN ARE DIFFERENT

• One: If you don’t see the child collapse and are alone you should deliver 2 minutes of CPR before calling 911 and getting the AED.

• Two: If you do see the child collapse right in front of you, you need to call 911 and if possible get the AED if there is one close by. Do not leave the child for more than 4 minutes to get help.

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CHILD CPR• Steps are the same as Adult CPR with

some exceptions.• If possible use one hand to deliver

compressions to a child. Use 2 if necessary.

• The ratio with One Rescuer is 30-2. With 2 Rescuers it becomes 15 to 2.

• Push the sternum down 2 inches. Deliver 2 breaths softly over 1 second each.

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USING THE AED WITH CHILDREN

• Do not put the AED pads on until you have delivered 5 cycles of CPR.

• Place the pads according to the picture on the pad.

• The AED specifies a child as ages 1 to 8

• If the child is older than 8 or if you can’t determine the age of the child as under 8 years, use Adult pads.

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INFANT CPR

• When you find an infant who is unconscious, immediately place them on a dressing table or other hard surface.

• Tap the bottom of the foot while calling out to the baby.

• Place two fingers on the Infant’s belly and look to see if they are breathing. If not, call for help.

• Do Not Leave the Baby For Any Reason.

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DELIVER INFANT COMPRESSIONS

• To be effective you should place two fingers in vertical alignment on the center of the sternum immediately below the nipples.

• Press down with the pads of your fingers to a depth of 1 and ½ inches and allow the chest to come completely back up against your fingers for full recoil.

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OPEN THE INFANT’S AIRWAY

• To open an infant’s airway gently tilt the infant’s head back very gradually until the breath goes in. Once the breath goes in stop tilting the head. If you TILT an infant’s head MORE than needed it will CLOSE THE AIRWAY.

• Tilt the head gently and stop tilting when the tip of the baby’s nose is pointing straight up. You should not be able to see the baby’s nostrils.

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USING THE AED WITH INFANTS

• An infant is defined as being less than one year old, but older than 28 days.

• After performing 5 cycles of Infant CPR you can apply the AED pads if you have them.

• Even if you only have Adult pads, you can use them on an infant. The pads can’t touch, so

• It is better to place one pad over the infant’s chest and one pad over the infant’s back, both in a vertical position.

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HCP- TAKE PULSES CORRECTLY

• If the student is required to take a pulse, show them in detail the correct way to do so. Explain the differences between taking the pulse of an Adult, Child, and Infant. If you say 60 beats per minute, you should demonstrate it. If a rescuer takes the pulse for 10 seconds, they should feel 10 beats. 60 beats per minute is one beat per second.

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TAKING INFANT PULSE CORRECTLY• Taking the pulse of an infant is a definite

challenge to the best EMS professional. • We know we have to use the brachial,

but where is it exactly? Use animation to show exactly where it is.

• Show that the thumb is not behind the infant’s arm, the host should explain the importance of keeping your thumb out of play. Make the OK sign.

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HCP - TAKE THE INFANT’S PULSE• To get an accurate reading take the baby’s

thumb and put it near their ear. By holding the arm in this position you expose the under arm between the elbow and the shoulder.

• Place two fingers (no thumb) directly on the brachial inside the arm. If you take the pulse for 10 seconds you should feel more than 10 beats (greater than 60 beats per minute).

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HCP- USING INFANT BVM

• To be effective the rescuer should stand at the infant’s head and place the mask on the infant’s face with the narrow portion at the bridge of the infant’s nose and the bottom resting on the chin.

• Place your hand over the mask extending your fingers down on each side of the mask to the jaw line. The thumb is on one side and the fingers on the other side, stopping at the jaw.

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HCP -TWO PERSON INFANT CPR• If someone arrives and knows CPR they

can assist in performing Compressions while the first rescuer delivers the breaths.

• Rescuer 2 places both thumbs in the center of the infant’s chest just under the nipples.

• Deliver 15 compressions and then 2 breaths.

• Perform 10 cycles of 2 person CPR at a rate of at least 100 per minute.

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HCP – CPR - ADVANCED AIRWAY

• If the victim has an advanced airway inserted (intubated), you should perform continuous compressions at a rate of 100 per minute.

• You should deliver ONE breath every 7 seconds.

• Deliver the breath softly and look for chest rise.

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HCP - RESCUE BREATHING

• If the victim has a pulse (adult) or pulse that is greater than 60 beats / minute (Child, Infant).

• Deliver ONE breath every 6 seconds for Adult.

• Deliver ONE breath every 5 seconds for Child or Infant.

• Check the pulse every 2 minutes for each.

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ARE YOU CHOKING?

• Once you determine the Adult is choking (they can’t speak and are clutching their throat) tell them you are trained and will help them.

• Step behind them with your front leg thrust out a little and your back leg set behind you.

• Put your arms through the area by the victim’s waist and place your thumb just above the navel.

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THRUST IN AND UP• Grasp the hand with the thumb by the

navel with the other and press your fist into the victim’s abdomen with a firm thrust.

• Deliver the thrust with an in and up movement, pressing firmly into the victim’s abdomen.

• Lean the victim against your chest with your front leg between theirs, and deliver thrusts at a rate of 1 per second.

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VICTIM GOES UNCONSCIOUS

• If the victim spits out the foreign matter, tell the victim to remain calm and make them comfortable until EMS arrives.

• If the the victim goes unconscious, gently lower them to the ground and place them on their back and call for help.

• If alone Call 911 and get an AED if you can. Perform CPR.

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UNCONSCIOUS - START CPR• Perform 30 Compressions at a rate of

100 per minute, when you go to give the breath look into the mouth. If you see any foreign matter or food particles?

• Use your forefinger to hook what’s there and pull it out. If you get one breath in put in another.

• If the breath does not go in, start compressions immediately.

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CHOKING CHILD

• Stand or kneel behind as necessary and place the thumb of one hand above the navel and grasp that hand with your other and pull back into the victim’s abdomen.

• Deliver pushes until the victim spits out or goes unconscious.

• If the child goes unconscious start CPR

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CHOKING INFANT• If an infant is choking they can’t cry or make

sounds. They start to turn blue around the lips.

• Pick the infant up immediately and place them over your lowered arm with the head in the down position.

• Strike the baby 5 times with the heel of the hand on the back between the shoulder blades in the center of the upper back.

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CONTROL THE INFANT’S HEAD • Once the strikes are delivered cup the

baby’s head in your hands and arms. Turn the baby over so the chest is up and the head is resting against your lowered arm.

• Deliver 5 thrusts with 2 fingers at the same location that you performed CPR, just under the nipples in the center of the chest.

• Deliver back strikes and chest thrusts until the baby spits up, cries or goes unconscious.

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INFANT GOES UNCONSCIOUS• If the choking infant goes unconscious,

lay them on hard surface like a table and begin CPR.

• Perform 2 minutes of CPR. Deliver 30 compressions at a rate of 100 per minute.

• When you go to give a breath check inside the mouth for foreign matter. If you see something use your pinky to hook it and pull it out. Put a breath in and then another.

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INFANT’S AIRWAY STILL BLOCKED

• If the infant’s airway remains blocked and the infant does not regain consciousness after 2 minutes of CPR, take the infant in your arms and call 911 and get an AED if one is nearby.

• Do Not Leave The Infant Alone For Any Reason

• Once you or someone else calls 911 continue CPR as you did before until EMS arrives.

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CONTINUITY IS A MUST

• WE should take great pains to make sure the terms and descriptions used in the VIDEO presentation MATCH the terms and descriptions in the WRITTEN TEXT.

• When terms and procedures agree, the student learns quickly and efficiently. One enforces the other and the student is able to accomplish both effectively with confidence.

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EXAMPLES OF CONFLICTS• The HCP written training materials speak

to doing the best you can to get an accurate pulse, while the video host tells the students that they are not expected to get an accurate reading. When they show the actor taking the pulse there is no hesitation before saying no pulse. They should take the 10 seconds to accurately show the student the proper way to take the pulse.