First Aid Update Clinic

1. First AidUpdate Clinic 2010 CPR Guidelines

2. Agenda Why change? AHA/ILCOR background What has changed? (video demo/Push Hard Push Fast flyer) Stations: CPR & AED, practice new standards & “Must Sees” Changes to first aid & awards Teaching first aid awards Stations: First Aid, practice and review first aid test items Workplace Safety & Insurance Board (WSIB) Wrap up – administration, what's next?

3. Clinic objective: • To ensure all Instructors and Examiners understand (and can demonstrate) the new resuscitation protocols and the implications for planning, teaching and evaluating the Society’s training programs.

4. Background to changes • CPR & first aid science reviewed every 5 years by the American Heart Association (AHA) and the International Liaison Committee on Resuscitation (ILCOR) • International panel of medical experts reviews new science and makes treatment recommendations • National first aid training agencies meet to interpret guidelines and recommendations for course delivery • Provincial regulators review submitted course content from first aid training agencies to meet required legislation

5. Changes at glance • YouTube CPR Update • Summary of CPR steps

6. What changed? New CPR sequence for cardiac arrest victims No change in CPR sequence for drowning victims Compression only CPR: unwilling or untrained Depth of compression: minimum depths Choking procedures: back blows & abdominal thrusts Jaw thrust: NLS lifeguards attempt jaw thrusts for spinals AED: children and infants

7. New CPR sequence CPR sequence: • Check the scene, if unresponsive, activate EMS and get AED • Airway check – open airway (head-tilt/chin-lift) • Breathing check – use visual cues like chest rise (5 sec.) • Circulation – perform 30 compressions if not breathing or gasping

8. Depth of compressions • Minimum depths of compressions have changed • Adult minimum of 5 cm • Child minimum of 5 cm or(1/3 chest diameter) • Infant minimum of 4 cm or(1/3 chest diameter) • Effective chest compressions • Minimum depths help to ensure essential blood flow during CPR • Landmarking • Emphasis is on “centre” of chest between the nipples

9. Drowning victims • NO change in rescue steps: • Deliver 2 rescue breaths before starting chest compressions • If not successful, start CPR and use AED • Evidence shows drowning victims are in need of urgent replenishment of oxygen compared to a cardiac arrest victim and may respond to a few initial rescue breaths

10. Compression only CPR • All trained rescuers should perform CPR with breaths and compressions. Gloves and a mask should be used • If an untrained rescuer is unwilling or unable, compression only CPR may be performed • Studies have shown a combination of breaths and compressions is best for children or victims who have an underlying cause of cardiac arrest such as: • Drowning, trauma, drug overdose, etc.

11. Choking procedures • Alternating techniques • More than one technique may be needed in removing a severe obstruction. Use back blows, abdominal thrusts, chest thrusts • Conscious choking (adult, child) • Perform alternating back blows and abdominal thrusts • 5 back blows - Bend victim over, near parallel to the ground - Support victim with one arm across their chest - With other arm apply 5 back blows, between the shoulder blades • 5 abdominal thrusts (chest thrusts for pregnant or obese)

12. Jaw thrust • A technique used to open the airway: • Used on spinal victims to help minimize head/neck movement • Grasp jaw on both sides of the face where it forms an angle close to the ears. Using both hands, move the jaw forward (upward) without tilting the head back. • Used by NLS lifeguards (NLS curriculum) • Instructed in NLS courses in management of spinal victims • Jaw thrust is “attempted” and if unsuccessful use the head-tilt/chin-lift

13. AED units • Automated External Defibrillator (AED) • Device that measures electrical activity of the heart. The use of an AED along with CPR can dramatically increase survival rates for sudden cardiac arrest • Used to provide a lifesaving shock when needed • A heart that is “fibrillating” or “twitching” cannot beat effectively. When a shock is provided the heart is “defibrillated” • Apply an AED as soon as possible to an unresponsive, non-breathing victim. Turn on unit and follow voice prompts.

14. AED pad placement • Adult: • Follow directions for pad placement. One pad on upper right side of chest. Other pad to the lower left side of chest • Children: • Look for a child key or switch or child pads • Adult pads may be used if no child pads • If child is small, place one pad on centre of chest, the other on back, so not touching

15. AED shock/no shock • Turn on AED. Unit will either advise a shock or no-shock • If shock is advised: say aloud “Stand Clear,” push the shock button, continue CPR (2 min.) • If no shock is advised: continue CPR (2 min.) • After 2 min. the AED unit re-analyzes for shock or no shock • Continue sequence of shock/no shock until victim recovers or EMS arrives.

16. AED use: infants • Infants: guidelines have expanded the use of AEDs for infants BUT • AED use on infants is very uncommon • A manual defibrillator, which is more advanced, is preferred versus an AED for use on an infant • Infants typically have healthy hearts, meaning a breathing problem is usually the cause of heart failure versus an underlying heart condition • AED training will focus on adult and child use • The use of an AED on infants is knowledge-based and not evaluated

17. Stations: CPR & AED • Practice stations: NEW test items & “Must Sees” • Station 1: One-rescuer CPR: adult, child & infant • Station 2: Two-rescuer CPR & AED: adult & child • Station 3: Choking, conscious to unconscious • Questions & answers • Group feedback, comments

18. Changes to first aid awards • AED protocol “Must See” items in: • CPR A-B-C • CPR-HCP • EFA • SFA • Emergency First Aid (8 hrs.) • Test item 11c external bleeding: - Elevation removed • NEW Test item 12 Wounds: - 12a: Abdominal injury - 12b: Burn injury - 12c: Facial injury • One-rescuer CPR: test item 6 - with AED Protocol (adult/child) • Standard First Aid (16 hrs.) • Two-rescuer CPR: test item 1 - with AED Protocol (adult/child)

19. Changes to first aid • Bleeding: • Rest and direct pressure. “Elevation” has been removed as a “Must See.” Evidence shows direct pressure is the most effective means to initially stop bleeding • Auto-injector • New EpiPen. Pull off blue cap and apply to outer thigh for 10 seconds. After use, the auto-injector will extend over the needle tip to further prevent injury when handled

20. Changes to first aid • Heat-related emergencies: • Sport drinks (electrolyte drinks) can be used for treatment of heat exhaustion • For victims with suspected heat stroke, immersion in cold water is preferable if possible • Angina/heart attack: • Continued emphasis on use of ASA. The use of ASA was referenced in previous guidelines and is found in Canadian First Aid Manual, p. 34 • If victim has no heart medication, suggest taking ASA (1 regular tablet or 2 child low-dose tablets). Ask if they have ASA allergy, or advised not to take ASA from a doctor.

21. CPR-HCP: changes • CPR-HCP: health care providers (HCP) who frequently respond to emergencies • Few changes overall: • Team response is emphasized, allowing responders to delegate roles as team members arrive on the scene • Use of AED on infants permissible, manual defibrillator preferred • Cricoid pressure removed as knowledge item. A technique that is difficult to teach and apply

22. Agenda – what’s next Why change? AHA/ILCOR background What has changed? (video demo/Push Hard Push Fast flyer) Stations: CPR & AED Changes to first aid awards Teaching first aid awards Stations: first aid practice and review Workplace Safety & Insurance Board (WSIB) Wrap up – administration, what's next?

23. Teaching first aid • Brainstorm: how do the new standards and content affect how you plan and teach your first aid courses. Consider any of the following: • Lesson planning, course length, combined courses • Lifesaving Instructor schools (assignments, evaluation, etc.) • What new resources do you need • List minimum first aid equipment for teaching EFA or SFA • Evaluation criteria, what has been added • Differences among revised first aid test sheets • Additional resources: • First Aid Instructor CD (updated) • Bronze Medals Instructor CD (new)

24. First aid stations • Practice stations: (review test items & “Must Sees”) with reference to the Canadian First Aid Manual and First Aid Award Guide • Station 1: External bleeding EFA item 11c and Facial injury item 12c • Station 2: Bone or joint injury SFA item 4 • Station 3: Assessment item 5 and Unconscious victim EFA item 12 • Questions & answers • Group feedback, comments

25. WSIB: overview • Workplace Safety & Insurance Board (WSIB) www.wsib.on.ca • WSIB (Ontario government, Ministry of Labour) tasked to reduce workplace injuries and to raise awareness of workplace safety. • Employers pay WSIB (required by law) to manage claims during a workplace accident. WSIB helps employees with their medical needs to get back to work. In return employers are not sued. • WSIB is empowered with enforcement to ensure compliance for safe work environments for employees. First aid training is a requirement for worksites. Regulation 1101. • Enforcement of EFA and SFA training criteria falls under WSIB. All course providers, approved by WSIB, must follow training criteria such as course content, minimum times, etc.

26. Summary: let’s review • New test items in EFA & SFA • Elevation removed from (RED) • New auto-injector (EpiPen) • Heat-related injury • ASA use • Teaching First Aid • First Aid Stations • WSIB overview • New CPR sequence • Drowning victims: 2 breaths • Compression-only CPR knowledge • AED use on infants knowledge • Jaw thrusts (NLS lifeguards) • Choking procedures (5&5) • Minimum depths (5cm, 4cm, 1/3) • New “Must See”: AED protocol

27. Wrap up - administration • Complete Aquatic Master Sheet • First Aid Update, tracked on “find a member” • Instructors may teach new standards after successfully completing update • Check with employer when new content is implemented at worksite • 3 credits earned for successful completion • Upon recertifying your “Lifesaving Instructor” an “Emergency First Aid Instructor” award will also be issued ($7.00) • Resources at Society’s website: www.lifesavingsociety.com • Revised first aid test items and test sheets • PowerPoint slides – First Aid Update • Notes for conductors – First Aid Update • Push Hard Push Fast – flyer • Lifesaving Society YouTube channel

28. Wrap up – clinic conductors • Conductors: First Aid Update • After successful completion, the following examiners and trainers may also deliver the First Aid Update • Provincial Trainers • First Aid Instructor Trainers • NLS Instructor Trainers • Lifesaving Instructor Trainers • First Aid Examiners • NLS Examiners

29. Wrap up • Final questions, comments?

30. First AidUpdate Clinic 2010 CPR Guidelines Thank you & goodbye