CARDIAC ARREST

MANAGEMENT

Learner Package

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Welcome

Thank you for choosing Iridia Medical for your Cardiac Arrest Management (CAM) training. We

are excited to offer you the most up to date version of a course which has trained thousands

of British Columbians in CPR and AED use.

One of the Iridia cores values is innovation; we are always looking to innovate and evolve

along with the needs of our clients. We have taken the input from our clients and instructors

as well as incorporated best practices in adult education and the emerging field of medical

simulation to offer you a completely re-designed course we believe is industry leading.

The course mission remains the same, to empower people to save lives. Our goal is to teach

the skills necessary to effectively assist anyone regardless of age, suffering from two life

threatening emergencies: Sudden Cardiac Arrest (SCA) and Choking. We strive to provide the

best training in high-quality chest compressions, the use of an Automated External

Defibrillator (AED) and the most effective techniques to assist someone who is choking.

Although these situations in real life can be stressful we have created a fun, dynamic and low

stress environment for our learners so they can focus on the knowledge and skills needed to

help save a life.

During the course you will be practicing skills that require working on your hands and knees,

bending, standing, and lifting so please wear loose, comfortable clothing. If you have physical

conditions that might prevent you from participating in components of the course, please

advise the instructor when you arrive. The instructor will work to accommodate your needs.

Please feel free to contact us with any questions:

Phone: (604)-685-4747

Toll free: 1-888-404-6444

Email: education@iridiamedical.com

Thank you for choosing Iridia Medical. We hope you enjoy the course!

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Contents

Our Story ................................................................................................................................................................. 4

Our Services ........................................................................................................................................................... 5

CAM Agenda ......................................................................................................................................................... 6

CAM Overview ...................................................................................................................................................... 7

The Human Heart ................................................................................................................................................ 8

Sudden Cardiac Arrest (SCA) ...................................................................................................................... 9

The Chain of Survival ...................................................................................................................................... 10

Cardiac Arrest Management Flowchart .................................................................................................. 11

Using the AED ..................................................................................................................................................... 12

Special Considerations for using the AED ............................................................................................ 13

Troubleshooting ................................................................................................................................................. 13

EMS arrival ............................................................................................................................................................ 13

Notes ........................................................................................................................................................................15

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Our Story

In 1998, a British Columbia company suffered the tragic loss of two employees on its worksite

due to SCA. Post incident, the company learned that the only treatment for SCA was the

timely delivery of a shock from a defibrillator. Although local ambulances carried Automated

External Defibrillators (AEDs) as standard issue, the worksite’s distance from the nearby town

meant they would arrive too late to be effective. The only option was to position an AED on

site. Sadly, efforts to secure such a device were thwarted by regulations that didn’t permit the

use of AEDs by non-medical personnel.

That same year, an emergency room physician heard about the company’s plight and was

moved to act. He saw the life-saving potential of having AEDs broadly available in workplaces,

airports, community facilities, etc. In response, he founded a company and became a

distributor for AEDs outside of the medical community. That doctor was Dr. Allan Holmes, and

the company was Global Medical Services.

In 2013, Global Medical Services became Iridia Medical, and identifying emerging needs and

responding to them has defined Iridia’s way of doing business. Embracing this philosophy,

Iridia Medical has grown to offer a broad cross-section of products and services to clients

around the world. Iridia is:

• The second largest non-hospital AED distributor in Canada

• The leading provider of cardiac care education in British Columbia

• The biggest supplier of paramedics to oil and gas operators in BC

• A recognized name in both health and emergency preparedness consulting

Our values reflect our desire to remain on the cutting edge of finding needs and meeting them

in innovative ways, providing exceptional client-focused service, and being a responsible

employer and business. We fully anticipate that as our company grows, we’ll continue to see

needs and fill them to fulfill our vision.

On this journey, Iridia has gone from having one employee to well over 100 full-time and part-

time employees. In the process, Iridia has been identified as one of BC’s Fastest Growing

Companies and awarded the Profit 500 three years running.

To learn more about Iridia Medical and our rebrand journey visit,

www.iridiamedical.com/iridia-is-born.htm

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Our Services Iridia Medical specializes in providing innovative, practical solutions to enhance the

delivery and quality of healthcare for populations across Canada. Our services are

separated into four primary areas:

Medical Education & Training We have overseen the training and certification of over four thousand lay rescuers in the use of AEDs, and over three thousand medical professionals via our advanced training programs, such as Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS).

Paramedic Services Iridia Medical is one of Western Canada’s top paramedic service

providers. Our comprehensive programs have created a new industry

standard for care in remote and/or high-risk work sites and

encompass everything from the paramedic teams and equipment, a

whole medical unit to telemedicine-supported medical direction.

Automated External Defibrillator Programs As the founder of BC’s first public access automated external defibrillator (AED) program, Iridia Medical is passionate about promoting easy access to life-saving tools. We distribute top-of-the-line AEDs and provide training, support, and medical direction services to ensure that every client receives full value from their unit.

Medical Consulting

Iridia Medical has influenced healthcare delivery and provided emergency preparedness guidance for public and private sector organizations across North America. Our clients include health authorities, public healthcare facilities, EMS providers, private surgery and diagnostic imaging facilities, and police and fire departments.

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CAM Agenda

Welcome & Introductions

7 Minutes

Setting the Stage: The Impact of SCA

20 Minutes

Performing Chest Compressions

10 Minutes

Using an AED 10 Minutes

Activating an Emergency Response

8 Minutes

Putting all the skills Together

25 Minutes

Assisting a Chocking Victim

15 Minutes

Wrap Up 10 Minutes

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CAM Overview To better prepare learners for the workshop the following overview provides additional

detail on select agenda topics:

1. Welcome and Introduction

a. A chance for the instructor to introduce themselves and find out a little about

each of you

2. Setting the Stage: the impact of SCA

a. Why is SCA a problem?

b. The Chain of Survival

c. SCA fast facts

d. Why you are key to saving a life

3. Just the Basics: Performing high-quality Compressions

a. Why compression only CPR is just as good as traditional CPR which includes

providing 2 breaths

b. How to provide high quality chest compressions that are

i. The right rate (at least 100/min)

ii. The right depth (at least 5 cm in adults)

iii. The right technique (allowing full chest recoil)

iv. The right amount (minimizing interruptions)

4. How to Shock: Using an AED safely

a. How to turn on the AED

b. How to properly place AED the pads

c. Practice following all AED prompts

d. When to use an AED on children and infants

5. You are not Alone: Accessing a Patient and Calling for Help

a. Promptly recognizing SCA

b. Calling 911

c. Calling for the on-site AED

6. Putting it all together: Assisting an SCA patient

a. Opportunity to practice putting all the above skills together using realistic

simulation scenarios

7. Putting it all together: Assisting a Choking Victim

a. Opportunity to practice how to relieve choking in adults, children and infants

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The Human Heart

How It Works

The human heart is made up of two important components: an electrical system (the sino-

atrial node) and a pumping system (the ventricles).

Right Side of the Heart

Blood enters the heart through the superior vena cava, emptying oxygen depleted blood into

the right atrium; from here, the blood flows through the right ventricle where it is pumped via

the pulmonary artery into the lungs.

Left Side of the Heart

In the lungs, the blood exchanges oxygen for carbon dioxide and then flows back to the left

atrium by way of the pulmonary vein. The blood then travels through the left atrium to the left

ventricle where it is pumped into the aorta and then out to the rest of the body.

Your heart’s electrical system

controls the timing of your heart

by regulating your:

Heart rate, which is the

number of times your heart

beats per minute

Heart rhythm, which is the

synchronized pumping

action of your four heart

chambers

Electrical Activity – A normal sinus rhythm

Pump System

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Sudden Cardiac Arrest (SCA)

What Is It?

SCA is a condition in which the heart suddenly and unexpectedly stops beating. SCA affects

over 40,000 Canadians each year and the survival rate for SCA is almost zero if untreated but

can rise significantly if promptly addressed.

When SCA occurs, the ventricles no longer pump effectively. If the heart does not pump blood

to the body and the lungs, then no oxygen is supplied to the vital organs, and death can

quickly result.

SCA can occur due to several reasons including an electrical malfunction in the heart, a sudden

blockage of blood flow to the heart, direct trauma to the chest, external electrical shock or

even certain medication effects. Some SCA rhythms can be treated with defibrillation

(shockable rhythms) and but some cannot (non-shockable rhythms). The AED devices are

automatically able to diagnose when a shock is needed. In all cases follow the prompts from

the AED and continue to perform chest compressions until the patient begins to show signs of

life or the fire/ambulance crews arrive and take over.

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The Chain of Survival

The Chain of Survival is designed as a step by step guide to illustrate how to respond to a

Sudden Cardiac Arrest and provide optimum care to the patient; thereby increasing their

chance of survival. The Chain of Survival is outlined and described below.

The Chain of Survival

As with any emergency situation, always ensure the scene is safe and if available, it is optimal

to wear gloves. If you do not have gloves it is still safe to perform chest compressions on a

patient.

Tap and shout at the patient. If you do not get a normal response back, have someone call 911.

Call 911 the moment you feel someone may be suffering from a medical emergency. Also ask

someone to retrieve the onsite AED (if available). Have someone stay on the line and the

dispatcher can help guide you through the rescue.

If there are no signs of life (i.e., the patient is unresponsive and there are no normal

respirations) begin chest compressions. The compression rate should be at least 100/min with

a depth of at least 5 cm (2 inches) for adults. Ensure your hands come off the chest to permit

full recoil. Minimize any interruption in the compressions and perform compressions until the

AED arrives. You do not need to stop compressions to provide breaths.

If additional bystanders are able and willing, have them take over the compressions after every

2 minutes, or sooner, if you are getting tired

When an AED becomes available, power up the device and follow the voice/visual commands.

Provide a shock if the device directs you to. Continue compressions as directed by the AED

until Emergency Medical Services arrive or if the patient has any signs of life. If you are unsure

of what to do at any step, remember that the 911 dispatch operator is there to help guide you.

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Cardiac Arrest Management Flowchart

This flowchart provides a visual illustration of the key steps in the management of someone

suffering from a suspected SCA.

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Using the AED

When the AED arrives it should be turned on with the electrodes attached to the

patient’s bare chest

One pad is placed at the right anterior aspect just below the collar bone and the other

pad at the left lateral aspect on the axillary line

Once the pads are placed, the AED will analyze the heart rhythm and will advise a

shock if necessary (the AED will perform this analysis automatically)

Be sure to verbally and visually clear the area so no one is touching the patient before a

shock is delivered

Fig. 1 - Proper Anterior-Lateral placement of AED Pads

If the patient is an infant or a child, use child pads. If child pads are not available, it is safe to

use adult AED pads with appropriate pad placement (front/back). Do not use child pads on an

adult patient (over the age of 8).

The AED is programmed to determine the need of a shock in 2 minute intervals. In between,

chest compressions should continue until EMS arrives or the patient begins to show signs of

life (e.g. breathing, movement)

Should signs of life return, inform the 911 dispatcher and they can work with you to assess the

patient and provide any other treatments. Continue to look for signs of life until EMS arrives

and leave the AED attached. If patient conditions change, inform the dispatcher.

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Special Considerations for using the AED

Hairy Chest

If the patient is exceptionally hairy, the chest may need to be shaved before applying the

electrodes, or, apply and rapidly remove electrodes to remove the hair. If the latter is done, use

a new set of electrodes for defibrillation.

Pregnant Women

The AED can be used on a pregnant woman in cardiac arrest.

Metal Surface

The AED can be used on a metal surface such as a stretcher or bleacher. Care should be taken

to ensure the electrodes are not in contact with the metal.

Wet Surface

The AED can be used on a wet surface such as the side of a swimming pool or wet pavement.

Care should be taken to ensure the patient is not in standing water and the chest may need to

be dried off prior to attaching the electrodes.

Pacemaker

The AED can be used on patients with an implanted pacemaker or internal defibrillator. Care

should be taken to ensure the electrodes are not placed directly on top of the pacemaker.

Pacemakers can be seen as a small rectangular bulge (about the size of a cigarette lighter) just

under the skin.

Traumatic Arrest

The AED can be used on patients who are in cardiac arrest as a result of trauma such as a fall

from a height or a motor vehicle incident.

Troubleshooting As with all machines, there is the possibility of a malfunction. The AED has warning lights,

and/or audible warnings, that should indicate, “service required” or “low battery”. A low

battery will still initially deliver several shocks. Should the warning lights, and/or audible

warnings, come on; continue to follow the commands on the machine as it may still work.

Should it fail to work, power it off and power it back on again while continuing to do CPR. If it

still does not work, continue with CPR alone.

EMS Arrival Once EMS arrives they will take over. The responders may ask several questions regarding the

patient. They may ask you the length of time since the patient collapsed (without a pulse),

length of time you have been performing chest compressions, the number of shocks delivered

and whether or not there was a return of any signs of life. Any known medical history is also

important information to pass along.

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Notes

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1644 West 3rd Avenue, Vancouver

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