Cambios en Las Guías 2015 ASHI

Summary Document
Protecting and Saving Lives Made Easy
G2015 Guidelines Summary 2015 Health & Safety Institute

Table of Contents

Introduction ................................................................................................................................................... 2
About Health & Safety Institute (HSI) ........................................................................................................... 2
Integrating 2015 Science, Treatment Recommendations, and Guidelines .................................................. 2
Update Subjects by Brand ............................................................................................................................. 3
American Safety & Health Institute (ASHI) ........................................................................................ 4
MEDIC First Aid .................................................................................................................................. 4
Update Subjects by Area and Training Level
TABLE 1: Education ........................................................................................................................... 5
TABLE 2: Layperson Adult CPR and AED ............................................................................................ 8
TABLE 3: Layperson Pediatric CPR and AED ...................................................................................... 15
TABLE 4: First Aid .............................................................................................................................. 17
TABLE 5: Healthcare Provider Adult BLS ........................................................................................... 33
TABLE 6: Healthcare Provider Pediatric BLS ...................................................................................... 43
HSI Advisory Group ........................................................................................................................................ 45
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Introduction
The purpose of the document is to highlight the major changes in science, treatment recommendations, and guidelines.
We are hopeful that it and other resources related to the process will provide helpful guidance to both instructors and
students during the transition.

On October 15, 2015, the International Liaison Committee on Resuscitation, or ILCOR, released the 2015 International
Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment
Recommendations. On the same day the American Heart Association, Inc. (AHA) released updated treatment guidelines
based on the ILCOR Consensus on Science. In addition, the ILCOR First Aid Task Force also released the 2015
International Consensus on First Aid Science With Treatment Recommendations which coincided with the release of the
2015 American Heart Association and American Red Cross Guidelines Update for First Aid. The Consensus on Science
process, which spanned a five year period, was designed to identify and review international science and knowledge
relevant to cardiopulmonary resuscitation, emergency cardiac care, and first aid treatment. These publications provide
updated treatment recommendations for emergency medical care based on the most current scientific evidence and are
now being integrated into updated ASHI and MEDIC First Aid training materials.

About Health & Safety Institute (HSI)
HSI unites the recognition and expertise of the American Safety & Health Institute and MEDIC First Aid to create the
largest privately held training organization in the industry. For more than 35 years, and in partnership with thousands of
approved training centers and hundreds of thousands of professional emergency care, safety, and health educators, HSI
authorized instructors in the U.S. and more than 100 countries throughout the world have certified more than 28 million
emergency care providers.

HSI representatives for ASHI and MEDIC First Aid were volunteer members of the 2010 and 2015 International First Aid
Advisory Board founded by the AHA and ARC, and contributed to the 2010 and 2015 Consensus on First Aid Science With
Treatment Recommendations.

HSI is an accredited organization of the Continuing Education Board for Emergency Medical Services (CECBEMS), the
national accreditation body for Emergency Medical Service Continuing Education programs. CECBEMS is an organization
established to standardize the review and approval of EMS continuing education activities. To ensure accepted
standards, CECBEMS accreditation requires an evidence-based peer-review process for continuing education programs
comparable to all healthcare accreditors. HSIs professional-level resuscitation programs are CECBEMS-approved and
meet the requirements of the Joint Commission and the Commission on Accreditation of Medical Transport Systems.

HSIs basic- and professional-level programs are nationally approved by the Department of Homeland Security, United
States Coast Guard, and are endorsed, accepted, approved, or meet the requirements of more than nearly 4000 state
regulatory agencies and occupational licensing boards. HSI is a member of the American National Standards Institute
and ASTM International, two of the largest voluntary standards-development and conformity-assessment organizations
in the world.

Integrating the 2015 Science, Treatment Recommendations, and Guidelines
In order to integrate the 2015 science, treatment recommendations, and guidelines, time is required to make systematic
and organized changes to our training products. We are currently revising all of our emergency care training materials
and will incorporate the updated information into our basic and advanced training program materials throughout 2016.

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Updated ASHI and MEDIC First Aid training program materials will be based upon these publications:
2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science
With Treatment Recommendationsi
2015 International Consensus on First Aid Science With Treatment Recommendationsii
2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency
Cardiovascular Careiii
2015 American Heart Association and American Red Cross Guidelines Update for First Aidiv

We will be creating interim training materials that allow instructors to immediately incorporate some of the most
significant changes in science and treatment recommendations into current (2010) training materials. The interim
materials are only intended to be used until the new training programs are made available. The use of these interim
materials is an option and not a requirement. Instructors can also continue to use the current (2010) materials as
designed.

IMPORTANT: THE NEW SCIENCE AND TREATMENT RECOMMENDATIONS DO NOT IMPLY THAT EMERGENCY CARE OR INSTRUCTION INVOLVING
THE USE OF EARLIER SCIENCE AND TREATMENT RECOMMENDATIONS IS UNSAFE. YOU MAY CONTINUE TO PURCHASE AND TEACH USING THE
CURRENT (2010) TRAINING MATERIALS UNTIL DECEMBER 31, 2016, OR UNTIL THE CURRENT MATERIALS ARE DEPLETED.

Update Subjects by Brand
Every instructor needs to understand the guideline changes that affect the program(s) he or she is authorized to teach.
On the following pages the most significant guideline changes are organized into tables by area and training level. For
each identified change, the guideline tables provide the 2010 guideline for reference, the updated 2015 guideline, and
the reason for the change.

To assist instructors, the program tables immediately below reference the guideline tables an instructor must review in
relation to the current programs he or she is authorized to teach. Instructors for the ASHI Advanced Cardiac Life Support
(ACLS) and the Pediatric Advanced Life Support (PALS) training programs can find specific guideline tables for those
programs in a separate 2015 HSI Updated Training Guidelines Supplement that will be released in the coming weeks.
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American Safety & Health Institute Training Programs
If you teach:

Related changes are in:

CPR/AED
Basic First Aid
Basic Wilderness & Wilderness First Aid
Child and Babysitting Safety
Emergency Oxygen Administration
CPR Pro
Emergency Medical Responder
Wilderness First Responder
Wilderness EMT Upgrade
Tables 1, 2, 3
Tables 1, 2, 3, 4
Tables 1, 2, 3, 4
Tables 1, 2, 3, 4
Tables 1, 2, 3, 4
Tables 1, 5, 6
Tables 1, 5, 6
Tables 1, 5, 6
Tables 1, 5, 6

MEDIC First Aid Training Programs
If you teach:
Related changes are in:
BasicPlus CPR, AED, and First Aid for Adults

Child/Infant CPR and AED Supplement
CarePlus CPR and AED
PediatricPlus CPR, AED and First Aid for Children, Infants, and Adults

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Tables 1, 2, 3, 4
Tables 1, 2, 3
Tables 1, 2, 3
Tables 1, 2, 3, 4

Topic
Basic Life Support
Training

Type
2010*
Updated Because even minimal training

in AED use has been shown to
improve performance in
simulated cardiac arrests,
training opportunities should
be made available and
promoted for lay rescuers.
S922

Basic Life Support

Training

Updated Short video instruction

combined with synchronous
hands-on practice is an
effective alternative to
instructor-led BLS courses.
S922

Updated The use of a CPR feedback

device can be effective for
training. S923

Basic Life Support

Training

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TABLE 1: Education
2015**
A combination of self-instruction and
instructor-led teaching with hands-on
training can be considered as an
alternative to traditional instructor-led
courses for lay providers. If instructor-
led training is not available, self-directed
training may be considered for lay
providers learning AED skills (Class IIb,
LOE C-EO). S564

CPR self-instruction through video-
and/or computer-based modules paired
with hands-on practice may be a
reasonable alternative to instructor-led
courses (Class IIb, LOE C-LD). S564

Use of feedback devices can be effective

in improving CPR performance during
training (Class IIa, LOE A). S564

Reason for Change

Although AEDs are located in public areas
and untrained providers are encouraged to
use them, even minimal training can
improve actual performance. Self-directed
training can provide more training
opportunities for lay rescuers who typically
would not attend a traditional training
course.

Video-based, self-directed instruction in
CPR with hands-on practice has been found
to be as effective as traditional instructor-
led courses. Self-directed instruction could
help to train more people at a lower cost.

Today's technology allows us to effectively

measure high performance CPR
recommendations such as compression
rate, depth, and recoil using standalone or
manikin-integrated feedback devices. The
ability to provide that feedback in training
allows learners to get a realistic sense of
proper skills and the effort it takes to
perform them.

Topic
Basic Life Support
Training

Type
2010*
Updated The use of a CPR feedback

device can be effective for
training. S923

Basic Life Support

Training

Updated Skill performance should be

assessed during the 2-year

certification with
reinforcement provided as
needed. S923

Basic Life Support

Training

New

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TABLE 1: Education
2015**
If feedback devices are not available,
auditory guidance (eg, metronome,
music) may be considered to improve
adherence to recommendations for
chest compression rate only (Class IIb,
LOE B-R). S564

Given the rapidity with which BLS skills
decay after training, coupled with the
observed improvement in skill and
confidence among students who train
more frequently, it may be reasonable
for BLS retraining to be completed more
often by individuals who are likely to
encounter cardiac arrest (Class IIb, LOE
C-LD). S566

Self-directed methods can be
considered for healthcare professionals
learning AED skills (Class IIb, LOE C-EO).
S564

Reason for Change

If a comprehensive feedback device is not
available for training due to cost or
logistics, an auditory guidance device such
as a metronome can be used to provide
some guidance as to compression rate.
Many metronome apps are available for no
or low cost for mobile devices.

A renewal or recertification period of two
years has proven for most people to be
inadequate for maintaining effective CPR
performance. An optimal time for
retraining can vary from person to person
depending on factors such as the quality of
initial training and the frequency in which
the skills are used in actual resuscitations.
Evidence has shown an improvement in
those who train more frequently.

Similar to the recommendation for lay
rescuers, self-directed training can provide
more frequent training opportunities for
healthcare providers.

Topic
Special
Considerations

Type
New

Special
Considerations

New

2010*

TABLE 1: Education
2015**
Communities may consider training
bystanders in compression-only CPR for
adult out-of-hospital cardiac arrest as an
alternative to training in conventional
CPR (Class IIb, LOE C-LD). S566

Training primary caregivers and/or

family members of high-risk patients
may be reasonable (Class IIb, LOE C-LD),
although further work needs to help
define which groups to preferentially
target. S566

Reason for Change

While it is important to still cover both
breaths and compressions for trained
providers because of the chance of a
respiratory-related arrest, sudden cardiac
arrests involving adults are still a major
overall issue for the public at large.
Compression-only CPR by an untrained
bystander has shown to be effective as an
initial approach to SCA and can be quickly
understood via a public service
announcement, large group presentation,
or by an EMS dispatcher over the phone.

CPR performed by trained family members
or caregivers of individuals who have been
identified as high-risk cardiac patients, has
shown to improve outcomes compared to
situations in which there was no training.

*American Heart Association. 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation
122, suppl 3 (2010): S639-S946.
**American Heart Association. 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
Circulation 132, suppl 2 (2015): S313-S589.
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Topic
Untrained Lay
Rescuer

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TABLE 2: Layperson Adult CPR and AED

2010*
2015**
Updated Because it is easier for
Untrained lay rescuers should provide
rescuers receiving telephone
compression-only CPR, with or without
CPR instructions to perform
dispatcher assistance (Class I, LOE C-LD).
Hands-Only (compression
The rescuer should continue
only) CPR than conventional
compression-only CPR until the arrival of
CPR (compressions plus rescue an AED or rescuers with additional
breathing), dispatchers should training (Class I, LOE C-LD). S416
instruct untrained lay rescuers
to provide Hands-Only CPR for
adults with SCA (Class I, LOE
B). S686

Reason for Change

Compression-only CPR, provided by a
bystander for adult cardiac arrest outside
of a hospital, has shown to be as effective
as traditional CPR. Due to the simplicity of
compression-only CPR, untrained
bystanders may be able to provide some
early treatment for adult sudden cardiac
arrest, a major public health crisis.
Information on compression-only CPR can
be distributed in messaging to large
numbers of people, such as through public
service announcements. It can also be
easily promoted through a phone
conversation with an EMS dispatcher. It
has been shown that compression-only
CPR initiated through dispatcher
instructions has improved survival
compared to traditional CPR. It is
important to note that the use of
compression-only CPR is limited to very
specific circumstances and does not take
the place of formal training in CPR, which
includes training in delivering rescue
breaths.
Topic
Layperson
Compression- Only
CPR Versus
Conventional CPR

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2010*
2015**
Updated Because rescue breathing is an All lay rescuers should, at a minimum,
important component for
provide chest compressions for victims
successful resuscitation from
of cardiac arrest (Class I, LOE C-LD). In
pediatric arrests (other than
addition, if the trained lay rescuer is able
sudden, witnessed collapse of to perform rescue breaths, he or she
adolescents), from asphyxial
should add rescue breaths in a ratio of
cardiac arrests in both adults
30 compressions to 2 breaths.(Class I,
and children (eg, drowning,
LOE C LD).S417
drug overdose) and from

prolonged cardiac arrests,
conventional CPR with rescue
breathing is recommended for
all trained rescuers (both in
hospital and out of hospital)
for those specific situations
(Class IIa, LOE C). S 691

Reason for Change

The 2015 evidence evaluation found no
overall differences between compression-
only and conventional CPR (compressions
plus breaths). However, much of the
research has been done on persons
assumed to have suffered sudden cardiac
arrest. When considering the importance
of rescue breaths in CPR delivery, the
underlying cause matters. Compression-
only CPR can be effective early in a sudden
cardiac arrest, where the underlying initial
cause is the disruption of the heart's own
electrical pathway and resulting
ventricular fibrillation. Unfortunately,
without a quick AED or EMS response,
there is a point at which the absence of
rescue breaths may reduce survival
because of inadequate oxygen and
increased carbon dioxide in the blood.
Cardiac arrest can also be the progressive
end result of the loss of an airway and/or
breathing. In these cases, the inclusion of
rescue breaths could actually reverse the
progression and restore breathing and
circulation. While compression-only CPR
can quickly be understood without formal
training, those who choose to be trained
benefit from learning both compressions
and rescue breaths. Consequently, if a
trained lay rescuer can perform rescue
breaths, they should be provided.

Topic
Cardiac or
Respiratory Arrest
Associated With
Opioid Overdose

Cardiac or
Respiratory Arrest
Associated With
Opioid Overdose

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2010*
2015**
New
There are no data to support
Empiric administration of IM or IN
and
the use of specific antidotes in naloxone to all unresponsive opioid
Updated the setting of cardiac arrest
associated life-threatening emergency
due to opioid overdose.S840
patients may be reasonable as an

adjunct to standard first aid and non
healthcare provider BLS protocols (Class
IIb, LOE C-EO). S505

New

Unless the patient refuses further care,

victims who respond to naloxone
administration should access advanced
healthcare services (Class I, LOE C-EO)
S506. Responders should not delay
access to more-advanced medical
services while awaiting the patients
response to naloxone or other
interventions (Class I, LOE C-EO). S505

Reason for Change

In high doses, opioids such as morphine,
heroin, tramadol, oxycodone, and
methadone can cause respiratory
depression and death. Opioid overdose is
a public health crisis. Naloxone is an
antidote to opioid overdose and can
completely reverse its effects if
administered in time. Naloxone
administered by bystanders - particularly
by family members and friends of those
known to be addicted is a potentially life-
saving treatment.

While naloxone administered by
bystanders is a potentially life-saving
treatment, it should not be seen as a
replacement for more advanced medical
care. The 2015 evidence evaluation
determined that naloxone administration
improves spontaneous breathing and
consciousness in the majority of persons
treated, and complication rates are low.
However, activation of EMS and CPR
should never be delayed for naloxone
administration.

Topic
Cardiac or
Respiratory Arrest
Associated With
Opioid Overdose

New
Cardiac or
Respiratory Arrest
Associated With
Opioid Overdose

New
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2010*

2015**
Victims who respond to naloxone
administration should access advanced
healthcare services (Class I, LOE C-EO).
Responders should not delay access to
more-advanced medical services while
awaiting the patients response to
naloxone or other interventions (Class I,
LOE C-EO). S505

It is reasonable to provide opioid
overdose response education, either
alone or coupled with naloxone
distribution and training, to persons at
risk for opioid overdose (Class IIa, LOE C-
LD). It is reasonable to base this training
on first aid and nonhealthcare provider
BLS recommendations rather than on
more advanced practices intended for
healthcare providers (Class IIa, LOE C-
EO). S418, S505

Reason for Change

Providing naloxone to individuals most
likely to witness an opioid overdose
(bystanders, friends, family) and training
them on its use can substantially reduce
the deaths resulting from opioid overdose.

Educating those most at risk, along with

others who have close contact with those
at risk, can improve the speed at which
naloxone can be provided.

Topic
Chest Compression
Depth

Chest Compression
Rate

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2010*
2015**
Updated The adult sternum should be
During manual CPR, rescuers should
depressed at least 2 inches (5 perform chest compressions to a depth
cm) (Class IIa, LOE B) S690
of at least 2 inches or 5 cm for an

average adult, while avoiding excessive
chest compression depths (greater
than2.4 inches or 6 cm) (Class I, LOE C-
LD). S419

Updated It is therefore reasonable for

lay rescuers and healthcare
providers to perform chest
compressions for adults at a
rate of at least 100
compressions per minute
(Class IIa, LOE B). S690

In adult victims of cardiac arrest, it is

reasonable for rescuers to perform
chest compressions at a rate of 100/min
to 120/min (Class IIa, LOE C-LD). S419

Reason for Change

Most CPR compressions are too shallow
and it is more effective to compress
deeper rather than shallower. Defining an
upper limit can help rescuers better
understand the allowance for a greater
depth. The upper limit also helps rescuers
understand that, at some point,
compressions become less effective and
that there is a small risk of injury. The use
of feedback devices during resuscitation
may also help rescuers to better achieve
the recommended depth range.

Defining an upper limit for compression
rate, or speed, can help rescuers focus on
achieving an optimum approach during
CPR. A faster compression rate of more
than 100 compressions per minute has
shown to be more effective. However,
rates above 120 have shown to diminish
overall effectiveness, especially in terms of
reduced compression depth. Again,
feedback devices can help keep
compression rates on track.

Topic
Chest Wall Recoil


2010*
2015**
Updated Allow the chest to completely It is reasonable for rescuers to avoid
recoil after each compression leaning on the chest between
compressions to allow full chest wall

recoil for adults in cardiac arrest (Class
IIa, LOE C-LD). S420

Minimizing
New
Interruptions in Chest
Compressions

Minimizing
Updated Performing chest
compressions while another
Compressions
rescuer retrieves and charges

a defibrillator improves the
probability of survival. S694

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Reason for Change

Better describing chest recoil in terms of
how a rescuer most likely causes it to
happen, may help to reduce its
occurrence. Rescuers can concentrate on
allowing full expansion of the chest if they
do not feel like they are leaning on the
chest at the top of each compression.

In adult cardiac arrest with an
Research has shown the benefit of
unprotected airway, it may be
minimizing interruptions to chest
reasonable to perform CPR with the goal compressions during CPR. A compression
of a chest compression fraction as high
fraction is the percentage of time during
as possible, with a target of at least 60% overall CPR performance that chest
(Class IIb, LOE C-LD). S420
compressions are actually being provided.

While there are necessary interruptions
such as giving rescue breaths and using an
AED, keeping those to the shortest time
possible remains a point of emphasis for
high quality CPR.
In adult cardiac arrest, total pre-shock
Because shorter pauses were associated
and post-shock pauses in chest
with greater shock success, return of
compressions should be as short as
spontaneous circulation, and higher
possible (Class I, LOE C-LD). S420
survival to hospital discharge in some

studies, minimizing interruptions in chest
compressions remains a point of emphasis
for high quality CPR.


Topic

2010*
2015**
Minimizing
Updated Deliver each rescue breath
For adults in cardiac arrest receiving CPR
over 1 second (Class IIa, LOE
without an advanced airway, it is
Compressions
C). S688
reasonable to pause compressions for

less than 10 seconds to deliver 2 breaths
(Class IIa, LOE C-LD). S420

Reason for Change

Remembering that avoiding excessive
volume on rescue breaths is a goal of high
quality CPR, being able to deliver 2
effective rescue breaths as quickly as
possible, and under 10 seconds, is
recommended.

122, suppl 3 (2010): S639-S946.
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Topic
Components of High-
Quality CPR: Chest
Compression Rate
and Depth

Type
Updated
Components of High-
Quality CPR: Chest
Compression Rate
and Depth

Updated
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TABLE 3: Layperson Pediatric CPR and AED

2010*
2015**
Chest compressions of
To maximize simplicity in CPR training, in
appropriate rate and depth.
the absence of sufficient pediatric
Push fast: push at a rate of evidence, it is reasonable to use the
at least 100 compressions
adult chest compression rate of 100/min
per minute. Push hard:
to 120/min for infants and children
push with sufficient force to (Class IIa, LOE C-EO). S521
depress at least one third the
anterior-posterior (AP)
diameter of the chest or
approximately 1 12 inches (4
cm) in infants and 2 inches (5
cm) in children (Class I, LOE
C). S864

It is reasonable that in pediatric patients
(1 month to the onset of puberty)
Push fast: push at a rate of rescuers provide chest compressions
at least 100 compressions
that depress the chest at least one third
per minute. Push hard:
the anterior-posterior diameter of the
push with sufficient force to chest. This equates to approximately 1.5
depress at least one third the inches (4 cm) in infants to 2 inches (5
cm) in children (Class IIa, LOE C-LD).
S521
cm) in children (Class I, LOE
C). S864

Reason for Change

There was very little evidence in regard to
an ideal compression depth to
recommend for a child or infant. To
simplify the overall CPR information, the
recommendation was to be consistent
with the adult recommendation.

There was very little change in the

pediatric compression depth
recommendation from the previous
recommendation in 2010.

Topic
Components of High-
Quality CPR:
Compression-Only
CPR

Type
Updated

TABLE 3: Layperson Pediatric CPR and AED

2010*
2015**
Optimal CPR in infants and
Conventional CPR (rescue breathing and
children includes both
chest compressions) should be provided
compressions and
for pediatric cardiac arrests (Class I, LOE
ventilations, but
B-NR). The asphyxial nature of the
compressions alone are
majority of pediatric cardiac arrests
preferable to no CPR (Class 1 necessitates ventilation as part of
LOE B). S867
effective CPR. However, because

compression-only CPR is effective in
patients with a primary cardiac event, if
rescuers are unwilling or unable to
deliver breaths, we recommend
rescuers perform compression-only CPR
for infants and children in cardiac arrest
(Class I, LOE B-NR). S522

Reason for Change

When considering the importance of
rescue breaths in CPR, the underlying
cause matters. In adults, most cardiac
arrests are sudden and caused by
abnormal heart rhythms. Compression-
only CPR is focused on these arrests in an
attempt to circulate oxygen still available
within the blood. Cardiac arrest in infants
and children is rarely sudden. Most occur
as a result of a severe oxygen shortage in
the body, or asphyxia, when breathing is
restricted or stops. Causes include
respiratory diseases, suffocation,
strangulation, submersion, and choking.
Giving rescue breaths to a child is
extremely important. Rescue breaths
improve oxygenation which may prevent
brain damage and restore breathing and
circulation. Studies show that the use of
compression-only CPR on pediatric
patients was associated with worse
neurologic outcomes when compared with
conventional CPR. Thus, rescue breaths
remain a critically important component
of effective CPR for infants and children in
cardiac arrest.

122, suppl 3 (2010): S639-S946.
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Topic
Burns

Burns

TABLE 4: First Aid

Type
2010*
2015**
Updated Cool thermal burns with cold
Cool thermal burns with cool or cold

(15 to 25C) tap water as soon potable water as soon as possible and for at
as possible and continue
least 10 minutes (Class I, LOE B-NR). S580
cooling at least until pain is
relieved (Class I, LOE B). S937
After cooling of a burn, it may be

reasonable to loosely cover the burn with a
sterile, dry dressing (Class IIb, LOE C-LD).
S580

Burns

Updated Loosely cover burn blisters

with a sterile dressing but
leave blisters intact because
this improves healing and
reduces pain (Class IIa, LOE B).
S937
New

Burns

New

Care should be taken to monitor for

hypothermia when cooling large burns
(Class I, LOE C-EO). S580
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If cool or cold water is not available, a clean

cool or cold, but not freezing, compress can
be useful as a substitute for cooling thermal
burns (Class IIa, LOE B-NR). S580

Reason for Change

Early cooling of a burn has been found
to minimize the risk and depth of
injury. Both cool and cold water can
be effective. The use of ice is not
recommended and the time to cool a
burn has been more clearly defined.

The use of a dry, sterile dressing on a
burn after cooling may be reasonable
to help keep the burn clean.

Early cooling of a burn has been found
to minimize the risk and depth of
injury. Clean, cool, or cold (not frozen)
dressings can be used as a substitute
when running water is not
immediately available.

For larger and deeper burns, cooling
could have a secondary effect of
cooling the body overall and causing
hypothermia. This is especially true
for children.
Burns

Topic
Type
New

Burns

New

Dental Injury

New

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2010*

TABLE 4: First Aid

2015**
In general, it may be reasonable to avoid
natural remedies, such as honey or potato
peel dressings (Class IIb, LOE C-LD).
However, in remote or wilderness settings
where commercially made topical
antibiotics are not available, it may be
reasonable to consider applying honey
topically as an antimicrobial agent (Class IIb,
LOE C-LD). S580

Reason for Change

Honey has shown in some studies to
actually decrease the risk of infection
and healing time for burns. However,
the studies were questioned in regard
to the quality of the information. At
this time, it is generally recommended
to avoid natural remedies for burn
dressings. Using honey as a topical
agent in a remote or wilderness
setting when antibiotic ointments are
not available may be a reasonable
consideration for reducing the risk of
infection.

Burns associated with or involving (1)
Burns most likely to have secondary
blistering or broken skin; (2) difficulty
complications such as infection,
breathing; (3) the face, neck, hands, or
restrictions on function, or poor
genitals; (4) a larger surface area, such as
healing due to surface contact or
trunk or extremities; or (5) other cause for
repeated movements, should be
concern should be evaluated by a
evaluated by a healthcare provider.
healthcare provider (Class I, LOE C-EO). S580

Following dental avulsion, it is essential to
Immediate reimplantation of an
seek rapid assistance with reimplantation
avulsed tooth is felt to provide the
(Class I, LOE C-EO). S580
best chance of survival for the tooth.

Topic
Dental Injury

Type
2010*
Updated Place the tooth in milk, or

clean water if milk is not
available. S939

First Aid Education
New

20| P a g e

TABLE 4: First Aid

2015**
In situations that do not allow for
immediate reimplantation, it can be
beneficial to temporarily store an avulsed
tooth in a variety of solutions shown to
prolong viability of dental cells (Class IIa,
LOE C-LD). If none of these solutions are
available, it may be reasonable to store an
avulsed tooth in the injured persons saliva
(not in the mouth) pending reimplantation
(Class IIb, LOE C-LD). S580

Education and training in first aid can be

useful to improve morbidity and mortality
from injury and illness (Class IIa, LOE C-LD).
S575
Reason for Change

When a situation forces a delay in
reimplantation, certain solutions have
shown to prolong the time period in
which successful reimplantation can
occur. In order of preference, the
solutions are Hanks Balanced Salt
Solution (containing calcium,
potassium chloride and phosphate,
magnesium chloride and sulfate,
sodium chloride, sodium bicarbonate,
sodium phosphate dibasic and
glucose), propolis, egg white, coconut
water, Ricetral, or whole milk. If these
solutions are not immediately
available for the storage of an avulsed
tooth, it may be reasonable to store
the tooth in the saliva of the affected
person. Due to the risk of additional
tooth damage or accidentally
swallowing the tooth, it is not
recommended to store the tooth in
the affected person's mouth.

Studies have shown that education
and training in first aid can help to
improve the recognition, resolution,
and survival of medical emergencies.
Topic
Type
2010*
Medical Emergencies: Updated In unusual circumstances,
Anaphylaxis

when advanced medical

assistance is not available, a
second dose of epinephrine
may be given if symptoms of
anaphylaxis persist. S936
TABLE 4: First Aid

2015**
When a person with anaphylaxis does not
respond to the initial dose, and arrival of
advanced care will exceed 5 to 10 minutes,
a repeat dose may be considered (Class IIb,
LOE C-LD). S577

Medical Emergencies: Updated First aid providers are not

Asthma

expected to make a diagnosis

of asthma, but they may assist
the victim in using the victims
prescribed bronchodilator
medication (Class IIa, LOE B)
under the following conditions:
The victim states that he or
she is having an asthma attack
or symptoms associated with a
previously diagnosed breathing
disorder, and the victim has
the prescribed medications or
inhaler in his or her possession.
The victim identifies the
medication and is unable to
administer it without
assistance. S936
21| P a g e

It is reasonable for first aid providers to be

familiar with the available inhaled
bronchodilator devices and to assist as
needed with the administration of
prescribed bronchodilators when a person
with asthma is having difficulty breathing
(Class IIa, LOE B-R). S576

Reason for Change

Greater clarification of the need and
timing for a second dose of
epinephrine when the symptoms of
anaphylaxis do not respond to the
first dose and advanced medical care
is still not available.

Inhaled bronchodilators have shown
to be an effective treatment for
asthma and other breathing disorders
related to the narrowing of the small
breathing passages in the lungs. The
risk of adverse reactions from using
these medications is low. Being
familiar with the use of these devices
and being able to assist someone in
using one are reasonable training
goals for a first aid provider.

Topic
Type
Medical Emergencies: New
Chemical Eye Injury

2010*

Medical Emergencies: Updated While waiting for EMS to

Chest Pain

arrive, the first aid provider

may encourage the victim to
chew and swallow 1 adult
(nonenteric-coated) or 2 low-
dose baby aspirins if the
patient has no allergy to
aspirin or other
contraindication to aspirin,
such as evidence of a stroke or
recent bleeding. S936

22| P a g e

TABLE 4: First Aid

2015**
First aid providers caring for individuals with
chemical eye injury should contact their
local poison control center or, if a poison
control center is not available, seek help
from a medical provider or 9-1-1 (Class I,
LOE C-EO). S578

Aspirin has been found to significantly
decrease mortality due to myocardial
infarction in several large studies and is
therefore recommended for persons with
chest pain due to suspected myocardial
infarction (Class I, LOE B-R). While waiting
for EMS to arrive, the first aid provider may
encourage a person with chest pain to take
aspirin if the signs and symptoms suggest
that the person is having a heart attack and
the person has no allergy or
contraindication to aspirin, such as recent
bleeding (Class IIa, LOE B-NR). If a person
has chest pain that does not suggest that
the cause is cardiac in origin, or if the first
aid provider is uncertain or uncomfortable
with administration of aspirin, then the first
aid provider should not encourage the
person to take aspirin (Class III: Harm, LOE
C-EO). S577

Reason for Change

Local poison control centers reached
through the Poison Help line (1-800-
222-1222), a medical provider, or EMS
can help to quickly identify treatment
recommendations for specific
chemicals that have injured an eye.

The early administration of aspirin in
the first aid setting for chest pain
related to myocardial infarction
(typically a blood clot blocking an
artery responsible for providing
oxygen to heart tissue), has shown to
be of greater benefit than when given
later in the healthcare setting. First
aid providers need to be confident in
their suspicion of heart-related pain
and their ability to rule out any
allergies or other reasons, such as
recent bleeding If the first aid
provider is not confident that the
chest pain is related to a cardiac
problem, then the provider should not
encourage the use of aspirin.

Topic
Type
Hypoglycemia

23| P a g e

2010*

TABLE 4: First Aid

2015**
If a person with diabetes reports low blood
sugar or exhibits signs or symptoms of mild
hypoglycemia and is able to follow simple
commands and swallow, oral glucose should
be given to attempt to resolve the
hypoglycemia. Glucose tablets, if available,
should be used to reverse hypoglycemia in a
person who is able to take these orally
(Class I, LOE B-R). It is reasonable to use
dietary sugars as an alternative to glucose
tablets (when not available) for reversal of
mild symptomatic hypoglycemia (Class IIa,
LOE B-R). For diabetics with symptoms of
hypoglycemia, symptoms may not resolve
until 10 to 15 minutes after ingesting
glucose tablets or dietary sugars. First aid
providers should therefore wait at least 10
to 15 minutes before calling EMS and re-
treating a diabetic with mild symptomatic
hypoglycemia with additional oral sugars
(Class I, LOE B-R). If the persons status
deteriorates during that time or does not
improve, the first aid provider should call
EMS (Class I, LOE C-EO). S577-S578

Reason for Change

If a diabetic person is suspected to
have low blood sugar and is able to
swallow safely, it is recommended to
use oral glucose tablets to reverse
early mild symptoms of hypoglycemia.
If glucose tablets are not available,
specific dietary sugars are
recommended for use instead.
Because symptoms will diminish
gradually, it is recommended that first
aid providers wait 10 to 15 minutes
before activating EMS and providing
additional oral glucose or dietary
sugars. If a person's condition
deteriorates at any time, it is
recommended that EMS be activated
immediately.

Topic
Type
Stroke

2010*

TABLE 4: First Aid

2015**
The use of a stroke assessment system by
first aid providers is recommended (Class I,
LOE B-NR). S577

Medical Emergencies: Updated Rinse eyes exposed to toxic

Toxic Eye Injury

substances immediately with a

copious amount of water (Class
I, LOE), unless a specific
antidote is available. S940

24| P a g e

It can be beneficial to rinse eyes exposed to

toxic chemicals immediately and with a
copious amount of tap water for at least 15
minutes or until advanced medical care
arrives (Class IIa, LOE C-LD). If tap water is
not available, normal saline or another
commercially available eye irrigation
solution may be reasonable (Class IIb, LOE
C-LD). S578

Reason for Change

Hospital-based advanced treatments
for strokes are available, but the time
to get to them is a big factor in
effectiveness and survival. Early use of
a stroke assessment by a first aid
provider has shown to significantly
decrease the time between the onset
of the stroke and definitive treatment
in a hospital.

The immediate flushing of eyes that
have been exposed to toxic
substances with copious, or large,
volumes of tap water has been found
to be the easiest and best approach.
Because some toxic substances take
longer to become diluted than others,
it is recommended to flush for at least
15 minutes or until advanced help
arrives. When tap water is not
immediately available, normal saline
or another commercially available eye
irrigating solution can be used.

Topic
Musculoskeletal
Trauma

Musculoskeletal
Trauma

25| P a g e

TABLE 4: First Aid

Type
2010*
2015**
Updated Do not move or try to
In general, first aid providers should not

straighten an injured extremity move or try to straighten an injured
(Class III, LOE C). Expert
extremity (Class III: Harm, LOE C-EO). Based
opinion suggests that splinting on training and circumstance (such as
may reduce pain and prevent
remote distance from EMS or wilderness
further injury. So, if you are far settings, presence of vascular compromise),
from definitive health care,
some first aid providers may need to move
stabilize the extremity with a
an injured limb or person. In such situations,
splint in the position found
providers should protect the injured person,
(Class IIa, LOE C). S938
including splinting in a way that limits pain,

reduces the chance for further injury, and
facilitates safe and prompt transport (Class
I, LOE C-EO). S580

New

If an injured extremity is blue or extremely

pale, activate EMS immediately (Class I, LOE
C-EO). S580

Reason for Change

As a general approach, it is best to not
move or straighten an injured
extremity that is unnaturally bent or
angulated. However, there may be
additional training necessary on
moving and splinting in specific cases,
such as in remote settings or if
neurological/vascular compromise is
suspected. Training in moving and
splinting an injured extremity should
emphasize the protection of the
affected person, limiting pain,
reducing the chance for further injury,
and facilitating quick and safe
transportation to a healthcare facility.

When the skin color of an injured
extremity indicates a lack of oxygen in
the blood (blue) or a lack of blood
flow (pale), there is a likely possibility
that the vascular system has been
compromised by the injury. Early
recognition and EMS activation by a
first aid provider can help to prevent
additional injury.

Topic
Oxygen Use in First
Aid

Position for Shock

26| P a g e

TABLE 4: First Aid

Type
2010*
2015**
Updated There is no evidence for or
The use of supplementary oxygen by first

against the routine use of
aid providers with specific training is
oxygen as a first aid measure
reasonable for cases of decompression
for victims experiencing
sickness (Class IIa, LOE C-LD). For first aid
shortness of breath or chest
providers with specific training in the use of
pain. Oxygen may be beneficial oxygen, the administration of
for first aid in divers with a
supplementary oxygen to persons with
decompression injury. S935-
known advanced cancer with dyspnea and
S936
hypoxemia may be reasonable (Class IIb,

LOE B-R). Although no evidence was
identified to support the use of oxygen, it
might be reasonable to provide oxygen to
spontaneously breathing persons who are
exposed to carbon monoxide while waiting
for advanced medical care (Class IIb, LOE C-
EO). S576

Updated 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) (Class IIb,
LOE C). Do not raise the feet if
the movement or the position
causes the victim any pain.
S935

Reason for Change

Even though supplementary oxygen is
used commonly in healthcare
environments, there was not much
evidence of its beneficial use in the
first aid setting. The use of
supplementary oxygen in first aid
situations is not a standard skill.
However, there were a few specific
circumstances in which the benefit of
supplemental oxygen was shown. In
addition, it was felt to be reasonable
to provide oxygen, while waiting for
advanced medical care, for individuals
who had been exposed to carbon
monoxide. Specialized training in the
use of oxygen delivery systems is
required when it is made available.

If there is no evidence of trauma or injury
Clarification is provided for the
(eg, simple fainting, shock from
description of non-traumatic
nontraumatic bleeding, sepsis,
situations, including nervous system
dehydration), raising the feet about 6 to 12 reactions (fainting), non-traumatic
inches (about 30 to 60) from the supine
bleeding, sepsis, and dehydration. The
position is an option that may be considered recommendation is simply an option
while awaiting arrival of EMS (Class IIb, LOE to consider based on the limited, or
C-LD). S576
lack of any, benefit shown by the

evidence.

Topic
Positioning the Ill or
Injured Person

27| P a g e

TABLE 4: First Aid

Type
2010*
2015**
Updated If the victim is facedown and is If a person is unresponsive and breathing

unresponsive, turn the victim
normally, it may be reasonable to place him
face up. If the victim has
or her in a lateral side-lying recovery
difficulty breathing because of position (Class IIb, LOE C-LD). If a person has
copious secretions or vomiting, been injured and the nature of the injury
or if you are alone and have to suggests a neck, back, hip, or pelvic injury,
leave an unresponsive victim
the person should not be rolled onto his or
to get help, place the victim in her side and instead should be left in the
a modified HAINES recovery
position in which he or she was found, to
position. S935
avoid potential further injury (Class I, LOE C-

EO). If leaving the person in the position
found is causing the persons airway to be
blocked, or if the area is unsafe, move the
person only as needed to open the airway
and to reach a safe location (Class I, LOE C-
EO). S575

Reason for Change

When an unresponsive and breathing
person is not suspected of being
injured, it is reasonable to place them
in a lateral side-lying recovery position
to improve the airway and the ability
to breath. This position uses an
extended arm to rest the head on and
positioning of the legs to stabilize the
body. To avoid additional injury, it is
best to leave an injured person, who
is unresponsive and breathing, in the
position he or she was found. If that
position is unsafe or results in a
compromised airway, it is appropriate
to move the person as needed to
create a clear airway or be removed
from danger.

Topic
Type
Trauma Emergencies: New
Concussion


Concussion

28| P a g e

2010*

TABLE 4: First Aid

2015**
Any person with a head injury that has
resulted in a change in level of
consciousness, has progressive
development of signs or symptoms as
described above, or is otherwise a cause for
concern should be evaluated by a
healthcare provider or EMS personnel as
soon as possible (Class I, LOE C-EO). S579

Reason for Change

Available two-stage assessment
processes for identifying concussions
are not appropriate for use in first aid
settings because they require an
assessment prior to injury for
comparison. An appropriate single
stage assessment for first aid is
currently not available. The first aid
recommendation is to suspect the
possibility of a concussion whenever
there is a change in the level of
consciousness or if there is a
progressive development of signs
such as feeling stunned or dazed,
experiencing headache, nausea,
dizziness or difficulty in balance, or
showing visual disturbance, confusion,
or loss of memory (from either before
or after the injury). If a concussion is
suspected, it is appropriate for the
affected person to be evaluated by
EMS or another healthcare provider
as soon as possible.

Using any mechanical machinery, driving,
Because of the progressive nature of
cycling, or continuing to participate in sports concussion, it is best not to allow an
after a head injury should be deferred by
affected person to perform actions
these individuals until they are assessed by that could pose a risk for additional
a healthcare provider and cleared to
injury, until he or she can adequately
participate in those activities (Class I, LOE C- be assessed by a healthcare provider.
EO). S579

TABLE 4: First Aid

Topic
Type
2010*
2015**
Trauma Emergencies: Updated Bleeding is best controlled by
The standard method for first aid providers
Control of Bleeding

applying pressure until
to control open bleeding is to apply direct

bleeding stops or EMS rescuers pressure to the bleeding site until it stops.
arrive (Class I, LOE A). S936
Control open bleeding by applying direct

pressure to the bleeding site (Class I, LOE B-
NR). S578


Local cold therapy, such as an instant cold
Control of Bleeding

pack, can be useful for these types of

injuries to the extremity or scalp (Class IIa,
LOE C-LD). Cold therapy should be used with
caution in children because of the risk of
hypothermia in this population (Class I, LOE
C-EO). S578

29| P a g e

Reason for Change

Further clarification of direct pressure
as the standard method of bleeding
control for open bleeding.

Although there is limited data on the

benefit, local cooling of a closed
injury, such as bruising, can be useful
when the scalp or an extremity is
injured.

TABLE 4: First Aid

Topic
Type
2010*
2015**
Trauma Emergencies: Updated Because of the potential
Because the rate of complications is low and
Control of Bleeding

adverse effects of tourniquets the rate of hemostasis is high, first aid

and difficulty in their proper
providers may consider the use of a
application, use of a tourniquet tourniquet when standard first aid
to control bleeding of the
hemorrhage control does not control severe
extremities is indicated only if external limb bleeding. (Class IIb, LOE C-LD).
direct pressure is not effective A tourniquet may be considered for initial
or possible (Class IIb, LOE B).
care when a first aid provider is unable to
S937
use standard first aid hemorrhage control,

such as during a mass casualty incident,
with a person who has multisystem trauma,
in an unsafe environment, or with a wound
that cannot be accessed (Class IIb, LOE C-
EO). S579


Control of Bleeding

30| P a g e

It is reasonable for first aid providers to be

trained in the proper application of
tourniquets, both manufactured and
improvised (Class IIa, LOE C-EO). S579

Reason for Change

Additional evidence since 2010
indicates a low rate of potential
complications and a high rate of
success when using a tourniquet for
severe bleeding control. For most
situations, the guideline remains the
same: Begin with direct pressure on a
severely bleeding limb wound and use
a tourniquet if direct pressure cannot
be applied or control the bleeding
effectively. However, in certain
circumstances, such as a large mass-
casualty event, a single person with
multiple injuries, a dangerous
environment, or a wound that cannot
be accessed, the use of a tourniquet
as the first bleeding control measure
can be considered.

Commercially manufactured
tourniquets have shown to be more
effective than improvised ones. If a
manufactured tourniquet is not
immediately available, it is possible to
create an improvised tourniquet using
nearby materials.

TABLE 4: First Aid

Topic
Type
2010*
2015**
Trauma Emergencies: Updated Among the large number of
Hemostatic dressings may be considered by
Control of Bleeding

commercially available
first aid providers when standard bleeding

hemostatic agents, some have control (direct pressure with or without
been shown to be effective.
gauze or cloth dressing) is not effective for
However, their routine use in
severe or life threatening bleeding (Class IIb,
first aid cannot be
LOE C-LD). Proper application of hemostatic
recommended at this time
dressings requires training (Class I, LOE C-
because of significant variation EO). S579
in effectiveness by different

agents and their potential for
adverse effects, including
tissue destruction with
induction of a pro embolic
state and potential thermal
injury (Class IIb, LOE B). S397

31| P a g e

Reason for Change

Manufactured hemostatic dressings
that are impregnated with clot-
promoting agents have evolved
significantly since the 2010 first aid
guidelines. The latest generation of
these dressings has a much lower risk
of complications and is now
recommended for use by first aid
providers. Hemostatic dressings have
shown to be beneficial for body
locations (trunk, abdomen, groin)
where standard bleeding control
recommendations are not effective,
or when a tourniquet is not available
or cannot control bleeding on its own.

Topic
Type
Open Chest Wounds

32| P a g e

2010*

TABLE 4: First Aid

2015**
We recommend against the application of
an occlusive dressing or device by first aid
providers for individuals with an open chest
wound (Class III: Harm, LOE C-EO). In the
first aid situation, it is reasonable to leave
an open chest wound exposed to ambient
air without a dressing or seal (Class IIa, LOE
C-EO). S579

Reason for Change

The generally accepted first aid
approach to manage an open wound
on the chest wall has been to prevent
the "sucking" of air through the
wound and into the chest cavity by
using an occlusive, or air tight,
dressing. This was accompanied by
the recommendation of leaving an
unsealed corner or side of the
dressing to allow pressurized air to
escape. This addressed the possibility
of a tension pneumothorax which can
rapidly cause serious complications.
Due to a lack of evidence of the
effectiveness of an occlusive dressing
and the high risk of an unmanaged
tension pneumothorax, the new
recommendation is to not use
occlusive dressings for open injuries
of the chest.

TABLE 4: First Aid

Topic
Type
2010*
2015**
Trauma Emergencies: Updated Because of the dire
If a first aid provider suspects a spinal injury,
Spinal Motion

consequences if secondary
he or she should have the person remain as
Restriction

injury does occur, maintain
still as possible and await the arrival of EMS

spinal motion restriction by
providers (Class I, LOE C-EO). For victims
manually stabilizing the head
with suspected spinal injury, rescuers
so that the motion of head,
should initially use manual spinal motion
neck, and spine is minimized
restriction (eg, placing 1 hand on either side
(Class IIb, LOE C). S938
of the patients head to hold it still) rather

than immobilization devices, because use of

immobilization devices by lay rescuers may
be harmful (Class III: Harm, LOE C-LD). S580,
S421

Reason for Change

Further clarification was provided in
regard to the technique of spinal
motion restriction, including verbal
instructions for a victim to remain still
and manually stabilizing the head with
a hand on either side of the head.
Additionally, the use of a head
immobilization device by a lay rescuer
was not recommended because of the
potential difficulty of being able to
maintain a clear and open airway with
one in place.


With a growing body of evidence showing
The 2015 evaluation of spinal motion
Spinal Motion

more actual harm and no good evidence
restriction was limited to the
Restriction
showing clear benefit, we recommend
application of cervical collars by first

against routine application of cervical collars aid providers. No evidence was shown
by first aid providers (Class III: Harm, LOE C- that the use of the cervical collars
LD). S580
decreased the occurrence of

neurological injury, but there was
evidence of adverse effects, such as
increasing pressure within the
cranium and airway compromise, in
their use by providers with limited
training.

122, suppl 3 (2010): S639-S946.
33| P a g e


Topic
Cardiac Arrest
Associated With
Pregnancy

34| P a g e

New
and
Updated

TABLE 5: Healthcare Provider Adult BLS

2010*
2015**
To relieve aortocaval
Priorities for the pregnant woman in cardiac
compression during chest
arrest are provision of high-quality CPR and
compressions and optimize the relief of aortocaval compression (Class I,
quality of CPR, it is reasonable LOE C-LD). If the fundus height is at or above
to perform manual left uterine the level of the umbilicus, manual LUD can
displacement in the supine
be beneficial in relieving aortocaval
position first (Class IIa, LOE
compression during chest compressions
C).S834

Reason for Change

At approximately 20 weeks into a
pregnancy, a woman's enlarged
uterus can compress the inferior vena
cava that returns blood to the heart,
especially when the woman is in a
supine position. If it was necessary to
perform CPR, this restriction of blood
flow to the heart would reduce the
quality of the CPR provided. It is
recommended to relieve the
compression by manually displacing
the uterus to the woman's left side
while compressions are performed.
This BLS modification for maternal
cardiac arrest is now recommended as
a priority for all BLS providers. In 2010
it was limited to subsequent but not
first responders.

Topic
Cardiac or
Respiratory Arrest
Associated With
Opioid Overdose

Cardiac or
Respiratory Arrest
Associated With
Opioid Overdose

35| P a g e


2010*
2015**
New

For patients with known or suspected opioid

overdose who have a definite pulse but no
normal breathing or only gasping (ie, a
respiratory arrest), in addition to providing
standard BLS care, it is reasonable for
appropriately trained BLS healthcare
providers to administer IM or IN naloxone
(Class IIa, LOE C-LD). It may be reasonable to
administer IM or IN naloxone based on the
possibility that the patient is not in cardiac
arrest (Class IIb, LOE C-EO). Bag-mask
ventilation should be maintained until
spontaneous breathing returns, and
standard ACLS measures should continue if
return of spontaneous breathing does not
occur (Class I, LOE C-LD). S418

New
There are no data to support
For patients in cardiac arrest, medication
and
the use of specific antidotes in administration is ineffective without
Updated the setting of cardiac arrest
concomitant chest compressions for drug

due to opioid overdose.
delivery to the tissues, so naloxone
Resuscitation from cardiac
administration may be considered after
arrest should follow standard
initiation of CPR if there is high suspicion for
BLS and ACLS algorithms. S840 opiate overdose (Class IIb, LOE C-EO).
Naloxone has no role in the
Standard resuscitative measures should
management of cardiac arrest. take priority over naloxone administration
S841
(Class I, LOE C-EO), with a focus on high-

quality CPR (compressions plus ventilation).
S418

Reason for Change

Opioid overdose is a significant health
problem. Naloxone is a medication
that can quickly reverse the
depression of the respiratory drive
caused by an overdose of opioids.
Eliminating the effect of the opioids
can remove the underlying cause of
respiratory arrest and allow the
person to resume breathing on his or
her own.

CPR is the priority over any other

treatment for cardiac arrest. If the
heart is not moving blood forward to
distribute the medication to the body
tissues where it has its therapeutic
effect, there will be little or no
benefit.


2010*
2015**
It is reasonable to provide opioid overdose
response education with or without
naloxone distribution to persons at risk for
opioid overdose in any setting (Class IIa, LOE
C-LD). S418

Topic
Suspected Opioid-
Related Life-
Threatening
Emergency

New
Chest Compression
Depth

Updated The adult sternum should be

depressed at least 2 inches (5
cm). (Class IIa, LOE B). S690

36| P a g e

Reason for Change

Early recognition and treatment for an
opioid overdose can have a significant
effect on survival. Educating those
most at risk, along with others who
have close contact with those at risk,
can improve the speed at which
naloxone can be provided.

During manual CPR, rescuers should
Most CPR compressions are too
perform chest compressions to a depth of at shallow and it is more effective to
least 2 inches or 5 cm for an average adult, compress deeper rather than
while avoiding excessive chest compression shallower. Defining an upper limit can
depths (greater than 2.4 inches or 6 cm)
help rescuers better understand the
(Class I, LOE C-LD). S419
allowance for a greater depth. The

upper limit also helps rescuers
understand that at some point
compressions become less effective
and there is a small risk of injury. The
use of feedback devices during
resuscitation may also help rescuers
to better achieve the recommended
depth range.

Topic
Chest Compression
Rate

Chest Wall Recoil

37| P a g e


2010*
2015**
Updated It is therefore reasonable for
In adult victims of cardiac arrest, it is
lay rescuers and healthcare
reasonable for rescuers to perform chest
providers to perform chest
compressions at a rate of 100/min to
compressions for adults at a
120/min (Class IIa, LOE C-LD). S419
rate of at least 100

compressions per minute


Updated Allow the chest to completely

recoil after each compression

Reason for Change

Defining an upper limit for
compression rate, or speed, can help
rescuers focus on achieving an
optimum approach during CPR. A
faster compression rate of more than
100 compressions per minute has
shown to be more effective. However,
rates above 120 have shown to
diminish overall effectiveness,
especially in terms of reduced
compression depth. Again, feedback
devices can help keep compression
rates on track.

It is reasonable for rescuers to avoid leaning Better describing chest recoil in terms
on the chest between compressions to
of how a rescuer most likely causes it
allow full chest wall recoil for adults in
to happen, may help to reduce its
cardiac arrest (Class IIa, LOE C-LD). S420
occurrence. Rescuers can concentrate

on allowing full expansion of the chest

if they do not feel like they are leaning
on the chest at the top of each
compression.

Topic
Chest Compression
Feedback

Delayed Ventilation

38| P a g e


2010*
2015**
Updated Nevertheless, real-time CPR
It may be reasonable to use audiovisual
prompting and feedback
feedback devices during CPR for real-time
technology such as visual and
optimization of CPR performance (Class IIb,
auditory prompting devices
LOE B-R). Although the effectiveness of CPR
can improve the quality of CPR feedback devices was not reviewed by this
writing group, the consensus of the group is

that the use of feedback devices likely helps
the rescuer optimize adequate chest
compression rate and depth, and we
suggest their use when available (Class IIb,
LOE C-EO). S423

New

For witnessed OHCA with a shockable

rhythm, it may be reasonable for EMS
systems with priority-based, multi-tiered
response to delay positive-pressure
ventilation by using a strategy of up to 3
cycles of 200 continuous compressions with
passive oxygen insufflation and airway
adjuncts (Class IIb, LOE C-LD). S417

Reason for Change

Real-time measurement of the high-
quality components of CPR, including
compression rate, depth, and full-
recoil allows rescuers to make
ongoing adjustments to performance
in order to achieve the most effective
CPR possible.

A number of EMS systems with a

tiered response approach (closest BLS
engine or aid car, followed by closest
ALS unit) have tested the concept of
having initial BLS responders perform
uninterrupted chest compressions,
along with passive oxygen insufflation
for suspected sudden cardiac arrest.
This is based on the underlying
concept that a limited amount of
uncirculated oxygen remains in the
circulatory system after arrest and the
benefit of uninterrupted chest
compressions can be fully utilized to
improve defibrillation success. It is
important to note that this is a system
approach and not an individual
recommendation for trained rescuers.

Topic
Devices to Support
Circulation: Load-
Distributing Band
Devices (LDB)

39| P a g e


2010*
2015**
New
The LDB may be considered for The evidence does not demonstrate a
and
use by properly trained
benefit with the use of LDB-CPR for chest
Updated personnel in specific settings
compressions versus manual chest

for the treatment of cardiac
compressions in patients with cardiac
arrest (Class IIb, LOE B).
arrest. Manual chest compressions remain
However, there is insufficient
the standard of care for the treatment of
evidence to support the
cardiac arrest, but LDB-CPR may be a
routine use of the LDB in the
reasonable alternative for use by properly
treatment of cardiac arrest.
trained personnel (Class IIb, LOE B-R). The
S723
use of LDB-CPR may be considered in

specific settings where the delivery of high-
quality manual compressions may be
challenging or dangerous for the provider
(eg, limited rescuers available, prolonged
CPR, during hypothermic cardiac arrest, in a
moving ambulance, in the angiography
suite, during preparation for extracorporeal
CPR [ECPR]), provided that rescuers strictly
limit interruptions in CPR during
deployment and removal of the devices
(Class IIb, LOE E). S438-S439

Reason for Change

The use of a load distributing band
device (LDB) to mechanically deliver
compressions has not shown to be
more beneficial than manual chest
compressions. The recommendation
defines manual compressions as the
continuing standard of care for
delivering compressions during CPR.
However, the use of an LDB can be
used in extended or resource limited
situations, provided the interruption
caused by setting up or removing an
LDB is minimized.


Topic

2010*
2015**
Devices to Support
New
There is insufficient evidence
The evidence does not demonstrate a
Circulation:
and
to support or refute the
benefit with the use of mechanical piston
Mechanical Chest
Updated routine use of mechanical
devices for chest compressions versus
Compression Devices:
piston devices in the treatment manual chest compressions in patients with
Piston Device
of cardiac arrest. Mechanical
cardiac arrest. Manual chest compressions

piston devices may be
remain the standard of care for the
considered for use by properly treatment of cardiac arrest, but mechanical
trained personnel in specific
chest compressions using a piston device
settings for the treatment of
may be a reasonable alternative for use by
adult cardiac arrest in
properly trained personnel (Class IIb, LOE B-
circumstances (e.g., during
R). The use of piston devices for CPR may be
diagnostic and interventional
considered in specific settings where the
procedures) that make manual delivery of high-quality manual
resuscitation difficult (Class IIb, compressions may be challenging or
LOE C).
dangerous for the provider (eg, limited

rescuers available, prolonged CPR, during
hypothermic cardiac arrest, in a moving
ambulance, in the angiography suite, during
preparation for extracorporeal CPR [ECPR]),
provided that rescuers strictly limit
interruptions in CPR during deployment and
removal of the device (Class IIb, LOE C-EO).
S438
40| P a g e

Reason for Change

The use of a piston device to
mechanically deliver compressions
has not shown to be more beneficial
than manual chest compressions. The
recommendation defines manual
compressions as the continuing
standard of care for delivering
compressions during CPR. However,
the use of a piston device can be used
in extended or resource limited
situations, provided the interruption
caused by setting up or removing a
piston device is minimized.


Topic

2010*
2015**
Minimizing
New
High-quality CPR is important
In adult cardiac arrest with an unprotected
Interruptions in Chest and
not only at the onset but
airway, it may be reasonable to perform
Compressions
Updated throughout the course of
CPR with the goal of a chest compression

resuscitation. Defibrillation
fraction as high as possible, with a target of
and advanced care should be
at least 60% (Class IIb, LOE C-LD). S420
interfaced in a way that

minimizes any interruption in
CPR. S686

Minimizing
Updated Shortening the interval
between the last compression
Compressions
and the shock by even a few

seconds can improve shock
success (defibrillation and
ROSC).Thus, it is reasonable for
healthcare providers to
practice efficient coordination
between CPR and defibrillation
to minimize the hands-off
interval between stopping
compression and administering
shock (Class IIa, LOE C). S707
Minimizing
Updated Deliver each rescue breath
over 1 second (Class IIa, LOE
Compressions
C). S688

41| P a g e

In adult cardiac arrest, total pre-shock and

post-shock pauses in chest compressions
should be as short as possible (Class I, LOE
C-LD). S420

For adults in cardiac arrest receiving CPR

without an advanced airway, it is reasonable
to pause compressions for less than 10
seconds to deliver 2 breaths (Class IIa, LOE
C-LD). S420

Reason for Change

Research has shown the benefit of
minimizing interruptions to chest
compressions during CPR. A
compression fraction is the
percentage of time during overall CPR
performance that chest compressions
are actually being provided. While
there are necessary interruptions such
as giving rescue breaths and using an
AED, keeping those to the shortest
time possible is beneficial for the
overall resuscitation attempt.

Because shorter pauses were
associated with greater shock success,
return of spontaneous circulation, and
higher survival to hospital discharge in
some studies, minimizing
interruptions in chest compressions
remains a point of emphasis for high-
quality CPR.
Remembering that avoiding excessive

volume on rescue breaths is a goal of
high-quality CPR, being able to deliver
2 effective rescue breaths as quickly
as possible, and under 10 seconds, is
recommended.
Topic
Passive Oxygen
Versus Positive-
Pressure Oxygen
During CPR

42| P a g e

New


2010*
2015**
We do not recommend the routine use of
passive ventilation techniques during
conventional CPR for adults, because the
usefulness/effectiveness of these
techniques is unknown (Class IIb, LOE C-EO).
However, in EMS systems that use bundles
of care involving continuous chest
compressions, the use of passive ventilation
techniques may be considered as part of
that bundle (Class IIb, LOE C-LD). S422

Reason for Change

Passive ventilation is the reliance on
the mechanics of CPR compression to
drive an exchange of air by a number
of means, including positioning the
body, inserting an oral airway, and
administration of oxygen (with or
without a nonrebreather mask). It is
not recommended because of a lack
of evidence on its benefit. However,
in cases where EMS systems are
implementing controlled initial
compression-only protocols, passive
ventilation can be considered as a
part of the overall approach.

Topic
Ventilation With an
Advanced Airway


2010*
2015**
Updated When the victim has an
When the victim has an advanced airway in
advanced airway in place
place during CPR, rescuers no longer deliver
during CPR, rescuers no longer cycles of 30 compressions and 2 breaths
deliver cycles of 30
(i.e., they no longer interrupt compressions
compressions and 2 breaths
to deliver 2 breaths). Instead, it may be
(ie, they no longer interrupt
reasonable for the provider to deliver 1
compressions to deliver 2
breath every 6 seconds (10 breaths per
breaths). Instead, continuous
minute) while continuous chest
chest compressions are
compressions are being performed (Class
performed at a rate of at least IIb, LOE C-LD). S421
100 per minute without pauses
for ventilation, and

ventilations are delivered at
the rate of 1 breath about
every 6 to 8 seconds (which
will deliver approximately 8 to
10 breaths per minute). S693

Reason for Change

This change represents a
simplification from 2010 to a simple
rate (1 breath every 6 seconds) from a
range (1 breath about every 6 to 8
seconds) to make ventilation with an
advanced airway easier to learn,
remember, and perform.

122, suppl 3 (2010): S639-S946.
43| P a g e


Topic
Components of High-
Quality CPR: Chest
Compression Rate
and Depth

Type
Updated
Components of High-
Quality CPR: Chest
Compression Rate
and Depth

Updated
44| P a g e

TABLE 6: Healthcare Provider (BLS) Pediatric

2010*
2015**
To maximize simplicity in CPR training, in
the absence of sufficient pediatric
Push fast: push at a rate of
evidence, it is reasonable to use the adult
at least 100 compressions per chest compression rate of 100/min to
minute. Push hard: push
120/min for infants and children (Class IIa,
with sufficient force to
LOE C-EO). S521
depress at least one third the
cm) in children (Class I, LOE C).
S864

It is reasonable that in pediatric patients (1
month to the onset of puberty) rescuers
Push fast: push at a rate of
provide chest compressions that depress
at least 100 compressions per the chest at least one third the anterior-
minute. Push hard: push
posterior diameter of the chest. This
with sufficient force to
equates to approximately 1.5 inches (4 cm)
depress at least one third the in infants to 2 inches (5 cm) in children

cm) in children (Class I, LOE C).
S864

Reason for Change

There was very little evidence in
regard to an ideal compression depth
to recommend for a child or infant. To
simplify the overall CPR information,
the recommendation was to be
consistent with the adult
recommendation.

There was very little change in the

pediatric compression depth
recommendation from the previous
recommendation in 2010.

Topic
Components of High-
Quality CPR:
Compression-Only
CPR

Reason for Change

When considering the importance of
rescue breaths in CPR delivery, the
underlying cause matters.
Compression-only CPR is focused on
sudden cardiac arrest, where the
underlying initial cause is the
disruption of the heart's electrical
pathway and the resulting ventricular
fibrillation. Cardiac arrest is also the
progressive end result of situations in
which the loss of an airway and/or
breathing is the initiating factor. This is
the most likely situation in a child or
infant. The inclusion of rescue breaths
can potentially reverse the
progression and restore breathing and
circulation. While compression-only
CPR can quickly be understood
without formal training, those who
choose to be trained benefit from
learning both compressions and
rescue breaths.

122, suppl 3 (2010): S639-S946.
45| P a g e

Type
Updated

TABLE 6: Healthcare Provider (BLS) Pediatric

2010*
2015**
Optimal CPR in infants and
Conventional CPR (rescue breathing and
children includes both
chest compressions) should be provided for
compressions and
pediatric cardiac arrests (Class I, LOE B-NR).
ventilations, but compressions The asphyxial nature of the majority of
alone are preferable to no CPR pediatric cardiac arrests necessitates
(Class 1 LOE B). S867
ventilation as part of effective CPR.

However, because compression-only CPR is
effective in patients with a primary cardiac
event, if rescuers are unwilling or unable to
deliver breaths, we recommend rescuers
perform compression-only CPR for infants
and children in cardiac arrest (Class I, LOE
B-NR). S522


HSI Advisory Group
HSIs interpretations of the most significant recent changes to emergency care science and instruction included review
and input of HSIs Medical Director, Chief Learning Officer, Program Advisory Groups, and professional staff.

HSI Medical Director
Gregory R. Ciottone, MD, FACEP

HSI Chief Learning Officer
Jeffrey T. Lindsey, PhD, PM, CFOD, EFO

ASHI and MEDIC First Aid Program Advisory Group

Kim Dennison, RN, MPH, BSN, COHN-S, COHC
Tanya LeDonne, EMT
Bradford A. Dykens, EMT-P
Jason Royce
Howard Main, NREMTP, CCEMTP
Jill White, Founder, Starfish Aquatics Institute (SAI)
John F. Mateus, EMT(i), MSN, RN, NREMT-P
Pam Isom
W. Daniel Rosenthal RN, BS
Lake White
Tana Sawzak, EMT-B
Craig Aman, MICP
Marcy Thobaben, LPN, EMT-B
Benjamin Karp, MA, President/Owner of Georgia CPR, LLC
Brandon Condon, BA, RN, EMT-B (ret)
James Clover, MED, ATC, PTA, CES
Jeannie Hanson, EMT-B
Wade Himmerlick
Neal Shabashov
Kira A. Miller, EMT, CNA (ret)

HSI Professional Staff
William Clendenen
Steve Barnett
Donna Medina
Ralph Shenefelt
William Rowe
Corey Abraham
Jeff Myers

i
Hazinski MF, Nolan JP, et al., 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment
Recommendations. Circulation. 2015;132(suppl 1):S2S268.
ii
Singletary EM, Zideman DA, et al., Part 9: first aid: 2015 International Consensus on First Aid Science With Treatment Recommendations. Circulation.
2015;132(suppl 1):S269S311.
iii
Neumar RW, Shuster M, et al., 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
Circulation. 2015;132(suppl 2):S315S573.
iv
Singletary EM, Charlton NP, et al., Part 15: first aid: 2015 American Heart Association and American Red Cross Guidelines Update for First Aid. Circulation.
2015;132(suppl 2):S574S589.
46| P a g e

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Summary Document

Protecting and Saving Lives Made Easy

G2015 Guidelines Summary 2015 Health & Safety Institute

G2015 Guidelines Summary 2015 Health & Safety Institute

G2015 Guidelines Summary 2015 Health & Safety Institute

G2015 Guidelines Summary 2015 Health & Safety Institute

Related changes are in:

Related changes are in:

BasicPlus CPR, AED, and First Aid for Adults

G2015 Guidelines Summary 2015 Health & Safety Institute

Basic Life Support

Updated Short video instruction

Basic Life Support

Use of feedback devices can be effective

Reason for Change

Today's technology allows us to effectively

G2015 Guidelines Summary 2015 Health & Safety Institute

Basic Life Support

Updated Skill performance should be

Basic Life Support

Reason for Change

G2015 Guidelines Summary 2015 Health & Safety Institute

Training primary caregivers and/or

Reason for Change

G2015 Guidelines Summary 2015 Health & Safety Institute

TABLE 2: Layperson Adult CPR and AED

Reason for Change

G2015 Guidelines Summary 2015 Health & Safety Institute

TABLE 2: Layperson Adult CPR and AED

Reason for Change

G2015 Guidelines Summary 2015 Health & Safety Institute

TABLE 2: Layperson Adult CPR and AED

Unless the patient refuses further care,

Reason for Change

G2015 Guidelines Summary 2015 Health & Safety Institute

TABLE 2: Layperson Adult CPR and AED

Reason for Change

Educating those most at risk, along with

G2015 Guidelines Summary 2015 Health & Safety Institute

TABLE 2: Layperson Adult CPR and AED

Updated It is therefore reasonable for

In adult victims of cardiac arrest, it is

Reason for Change

G2015 Guidelines Summary 2015 Health & Safety Institute

TABLE 2: Layperson Adult CPR and AED

Reason for Change

G2015 Guidelines Summary 2015 Health & Safety Institute

TABLE 2: Layperson Adult CPR and AED

Reason for Change

G2015 Guidelines Summary 2015 Health & Safety Institute

TABLE 3: Layperson Pediatric CPR and AED

Reason for Change

There was very little change in the

G2015 Guidelines Summary 2015 Health & Safety Institute

TABLE 3: Layperson Pediatric CPR and AED

Reason for Change

G2015 Guidelines Summary 2015 Health & Safety Institute

TABLE 4: First Aid

After cooling of a burn, it may be

Updated Loosely cover burn blisters

Care should be taken to monitor for

If cool or cold water is not available, a clean

Reason for Change

G2015 Guidelines Summary 2015 Health & Safety Institute