Instructor Update
Welcome !
Purpose of Class
Highlight the major changes in science,
treatment recommendations, and guidelines.
Provide helpful guidance to you for the transition
to new materials.
Learning Objectives
Identify the four central publications for changes
in the 2010 science, treatment
recommendations, and guidelines.
Identify the scheduled release dates for updated
training programs.
Describe the significant changes affecting ASHI
and MEDIC First Aid training programs.
Describe the rationale for the changes being
made.
Who is HSI?
About HSI
The Health & Safety Institute (HSI) unites the
recognition and expertise of:
Training Structure
HSI develops and markets proprietary training
programs, products, and services to approved
Training Centers.
Instructors are authorized by Training Centers to
certify course participants who successfully
complete a training program.
2010 Guidelines
The science and guidelines were published in
the journal Circulation on October 18th, 2010
They are both freely available at
www.hsi.com/2010guidelines
Source References
2010 International Consensus on Cardiopulmonary
Resuscitation and Emergency Cardiovascular Care
Science With Treatment Recommendations
2010 American Heart Association and American Red
Cross International Consensus on First Aid Science With
Treatment Recommendations
2010 American Heart Association Guidelines for
Cardiopulmonary Resuscitation and Emergency
Cardiovascular Care
2010 American Heart Association and American Red
Cross Guidelines for First Aid
Update Requirements
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 the
most 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.
Highlights
This is a re-emphasis from 2005.
For effective compressions:
Push fast
Push hard
Allow chest to fully recoil
Minimize any interruptions
Highlights
Compression Rate
2005 Guidelines
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 compression
rate of about 100 compressions per minute.
(Circulation. 2005; 112: IV19-IV34)
Compression Rate
2010 Guidelines
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.)
(Berg, et al. Circulation. 2010;122;S685-S705)
Highlights
At least 100 times per minute.
It is okay to be a little faster.
Applies to both lay and healthcare providers.
Highlights
Compression Depth
2005 Guidelines
Depress the sternum approximately 1 to 2 inches (approximately 4 to
5 cm) and then allow the chest to return to its normal position.
(Circulation. 2005; 112: IV19-IV34)
Compression Depth
2010 Guidelines
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.
(Berg, et al. Circulation. 2010;122;S685-S705)
Highlights
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
Applies to both lay and healthcare providers.
Breathing Assessment
2005 Guidelines
While maintaining an open airway, look, listen, and feel for breathing.
(Circulation. 2005; 112: IV19-IV34)
Breathing Assessment
2010 Guidelines
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).
(Berg, et al. Circulation. 2010;122;S685-S705)
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.
Highlights
Initial assessment steps:
Assess responsiveness
Activate EMS
Assess breathing
Perform CPR
Highlights
Initial assessment approach:
Highlights
Chain of Survival
2005 Guidelines
Early recognition of the emergency and
activation of the emergency medical services
(EMS) or local emergency response system
Early bystander CPR
Early delivery of a shock with a defibrillator
Early advanced life support followed by post
resuscitation care delivered by healthcare
providers
(Circulation. 2005; 112: IV12-IV18)
Chain of Survival
2010 Guidelines
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 post cardiac arrest care.
(Travers, et al. Circulation. 2010;122;S676-S684)
Highlights
Addition of fifth link in chain.
Integrated post-cardiac arrest care.
Highlights
Highlights
Tasks can be performed simultaneously.
Integrate additional rescuers as they arrive.
Designate team leader with multiple
rescuers.
Highlights
Not recommended.
Direct pressure is more effective.
May compromise direct pressure.
Tourniquets
2005 Guidelines
The effectiveness, feasibility, and safety of
tourniquets to control bleeding by first aid
providers are unknown, but the use of
tourniquets is potentially dangerous.
(Circulation. 2005; 112: IV196-IV203)
Tourniquets
2010 Guidelines
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 if
direct 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;S934S946)
Highlights
Hemostatic Agents
2005 Guidelines
The use of hemostatic agents in first aid was
not covered in the 2005 science, treatment
recommendations, and guidelines.
Hemostatic Agents
2010 Guidelines
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)
Highlights
Some are effective, others are marginal.
Wide variety of results.
Potential for adverse effects.
Highlights
Lay victim flat.
If no injury, elevate 6-12 inches.
No elevation if pain occurs.
Injured Extremity
2005 Guidelines
If you are far from definitive health care, you
may stabilize the extremity in the position
found.
(Circulation. 2005; 112: IV196-IV203)
Injured Extremity
2010 Guidelines
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.
(Markenson, et al. Circulation. 2010;122;S934S946)
Highlights
Stabilize with splint if away from medical help.
Splint in position found.
Use padding.
Highlights
Highlights
Highlights
Rinse with large amounts of water.
Use specific antidote if available.
Heat Stroke
2005 Guidelines
The treatment of heat stroke in first aid was not
covered in the 2005 science, treatment
recommendations, and guidelines.
Heat Stroke
2010 Guidelines
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.
(Markenson, et al. Circulation. 2010;122;S934S946)
Highlights
Immediate cooling emphasized.
Immersion up to neck in cold water
preferred as an option.
Activated Charcoal
2005 Guidelines
There is insufficient evidence to recommend for
or against the use of activated charcoal as first
aid for ingestions.
(Circulation. 2005; 112: IV196-IV203)
Activated Charcoal
2010 Guidelines
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.
(Markenson, et al. Circulation. 2010;122;S934S946)
Highlights
Use only if directed by poison control.
Highlights
Pressure immobilization safe and effective.
Be able to slide finger underneath.
Jellyfish Stings
2005 Guidelines
The treatment of jellyfish stings in first aid was
not covered in the 2005 science, treatment
recommendations, and guidelines.
Jellyfish Stings
2010 Guidelines
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.
(Markenson, et al. Circulation. 2010;122;S934S946)
Highlights
Vinegar wash for 30 seconds to inactivate
nematocysts.
Follow with hot-water immersion for pain control.
Education / Implementation
Skills Reinforcement
2005 Guidelines
Ongoing skills reinforcement was not covered in
the 2005 science, treatment recommendations,
and guidelines.
Skills Reinforcement
2010 Guidelines
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)
Highlights
Need for more frequent review is clear.
Optimum reinforcement not known.
Reassess and reinforce.
Self-Instruction
2005 Guidelines
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)
Self-Instruction
2010 Guidelines
Short video instruction combined with
synchronous hands-on practice is an effective
alternative to instructor-led basic life support
courses.
(Bhanji, et al. Circulation. 2010;122;S920-S933)
Highlights
Video self-instruction with practice-whilewatching is effective.
Skills Competency
2005 Guidelines
Training programs should be evaluated to
verify that they enable effective skills acquisition
and retention.
(Circulation. 2005;112:III-100-III-108)
Skills Competency
2010 Guidelines
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.
(Bhanji, et al. Circulation. 2010;122;S920-S933)
Highlights
Verification of competence, not a set number of
class hours.
Highlights
Effective in training.
Improves quality of actual resuscitation.