Professional Documents
Culture Documents
Table of Contents
Introduction ...................................................................................................................................................2
About
The
Health
&
Safety
Institute
(HSI) ....................................................................................................2
Integrating
2010
Science,
Treatment
Recommendations,
and
Guidelines ..................................................3
Planned
Release
Dates
for
Updated
Training
Programs...............................................................................3
Update
Subjects
by
Brand .............................................................................................................................4
American
Safety
&
Health
Institute
(ASHI) ........................................................................................4
MEDIC
First
Aid ..................................................................................................................................4
Update
Subjects
by
Area
and
Training
Level
TABLE
1:
Basic
Life
Support
(BLS):
Education
and
Implementation ..................................................5
TABLE
2:
Layperson
Adult
CPR
and
AED ............................................................................................7
TABLE
3:
Layperson
Pediatric
CPR
and
AED ......................................................................................10
TABLE
4:
Emergency
Care/First
Aid ...................................................................................................12
TABLE
5:
Healthcare
Provider
Adult
BLS............................................................................................17
TABLE
6:
Healthcare
Provider
Pediatric
BLS ......................................................................................22
HSI
Advisory
Group ........................................................................................................................................24
1|
P a g e
Updated
Training
Guidelines
©2010
Health
and
Safety
Institute
Introduction
This
document
has
been
developed
to
provide
you
with
information
about
the
recently
released
changes
in
emergency
medical
care
and
how
those
changes
affect
your
authorization
as
an
American
Safety
&
Health
Institute
(ASHI)
or
MEDIC
First
Aid
Instructor.
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
18th,
2010,
the
International
Liaison
Committee
on
Resuscitation,
or
ILCOR,
released
the
2010 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
International
First
Aid
Science
Advisory
Board
released
the
2010 American Heart Association and American Red Cross International Consensus on First Aid Science With Treatment
Recommendations. The
Consensus
on
Science
process
occurs
every
five
years
with
the
purpose
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 The Health & Safety Institute (HSI)
HSI
unites
the
recognition
and
expertise
of
the
American
Safety
&
Health
Institute
and
MEDIC
FIRST
AID
International
to
create
the
largest
privately
held
training
organization
in
the
industry.
For
more
than
30
years,
and
in
partnership
with
16,000
approved
training
centers
and
200,000
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
19
million
emergency
care
providers.
Though
organizational
structures
differ,
the
AHA,
the
American
Red
Cross
(ARC),
and
HSI
share
a
similar
business
configuration.
Each
organization
develops
and
markets
commercially‐available,
proprietary
training
programs,
products,
and
services
to
their
Training
Centers,
Authorized
Providers,
and
qualified
Instructors.
Instructors
are
then
authorized
to
certify
course
participants
who
successfully
complete
a
training
program.
In
collaboration
with
these
and
other
emergency
care
training
organizations,
an
HSI
representative
participated
in
the
2010
ILCOR
Conference,
hosted
by
the
AHA.
HSI
representatives
for
ASHI
and
MEDIC
First
Aid
were
volunteer
members
of
the
2005
National
and
2010
International
First
Aid
Advisory
Board
founded
by
the
AHA
and
ARC,
and
contributed
to
the
2005
and
2010
Consensus
on
First
Aid
Science
and
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.
HSI’s
professional
level
resuscitation
programs
and
Instructor
Development
Course
are
CECBEMS‐approved
and
meet
the
requirements
of
the
Joint
Commission
and
the
Commission
on
Accreditation
of
Medical
Transport
Systems.
HSI’s
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
1800
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.
2|
P a g e
Updated
Training
Guidelines
©2010
Health
and
Safety
Institute
Integrating the 2010 Science, Treatment Recommendations, and Guidelines
In
order
to
integrate
the
2010
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
2011.
Updated
ASHI
and
MEDIC
First
Aid
training
program
materials
will
be
based
upon
these
publications:
2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science
With Treatment Recommendationsi
2010 American Heart Association and American Red Cross International Consensus on First Aid Science With
Treatment Recommendationsii
2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular
Careiii
2010 American Heart Association and American Red Cross Guidelines for First Aidiv
We
have
created
interim
training
materials
that
allow
Instructors
to
immediately
incorporate
some
of
the
most
significant
changes
in
science
and
treatment
recommendations
into
current
(2005)
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
(2005)
materials
as
designed.
The
release
of
new
science
and
treatment
recommendations
does
not
imply
that
emergency
care
or
instruction
involving
the
use
of
previous
recommendations
is
unsafe.
There
is
no
need
to
raise
undue
concern
among
your
Training
Center
staff,
customers,
or
students.
NOTE:
THE
NEW
SCIENCE
AND
TREATMENT
RECOMMENDATIONS
DO
NOT
IMPLY
THAT
CARE
INVOLVING
THE
USE
OF
EARLIER
SCIENCE
AND
TREATMENT
RECOMMENDATIONS
IS
UNSAFE.
YOU
MAY
CONTINUE
TO
PURCHASE
AND
TEACH
USING
THE
CURRENT
(2005)
TRAINING
MATERIALS
UNTIL
DECEMBER
31,
2011,
OR
UNTIL
THE
CURRENT
MATERIALS
ARE
DEPLETED.
Planned Release Dates for Updated Training Programs
2nd
Quarter
2011
Release:
ASHI
CPR
and
AED
ASHI
Basic
First
Aid
ASHI
CPR,
AED,
and
Basic
First
Aid
Combination
ASHI
CPR
Pro
MEDIC
First
Aid
BasicPlus
CPR,
AED,
and
First
Aid
MEDIC
First
Aid
CarePlus
CPR
and
AED
3rd
Quarter
2011
Release:
ASHI
Advanced
Cardiac
Life
Support
(ACLS)*
ASHI
Bloodborne
and
Airborne
Pathogens
MEDIC
First
Aid
PediatricPlus
CPR,
AED,
and
First
Aid
for
Children,
Adults,
and
Infants
MEDIC
First
Aid
CPR
and
AED
Child/Infant
Supplement
MEDIC
Bloodborne
and
Airborne
Pathogens
4th
Quarter
2011
Release:
ASHI
Pediatric
Advanced
Life
Support
(PALS)*
ASHI
Child
and
Babysitting
Safety
Course
(CABS)
*Release dates are dependent on third party production.
3|
P a g e
Updated
Training
Guidelines
©2010
Health
and
Safety
Institute
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
2005
guideline
for
reference,
the
updated
2010
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
the
separate
2010 HSI Updated Training Guidelines Supplement.
American Safety & Health Institute Training Programs
If
you
teach:
Related
changes
are
in:
Basic
First
Aid
Tables
1,
2,
3,
4
Basic
Wilderness
&
Wilderness
First
Aid
Tables
1,
2,
3,
4
Child
and
Babysitting
Safety
Tables
1,
2,
3,
4
CPR/AED
Tables
1,
2,
3
Emergency
Oxygen
Administration
Tables
1,
2,
3,
4
EMR
for
Adults
Tables
1,
2,
3,
4
First
Responder
Tables
1,
5,
6
Wilderness
First
Responder
Tables
1,
5,
6
Wilderness
EMT
Upgrade
Tables
1,
5,
6
CPR
Pro
Tables
1,
5,
6
ACLS
Tables
1,
5,
6,
and
Updated
Training
Guidelines
Supplement
PALS
Tables
1,
5,
6,
and
Updated
Training
Guidelines
Supplement
MEDIC First Aid Training Programs
If
you
teach:
Related
changes
are
in:
Basic
Training
Programs
Tables
1,
2,
3,
4
Emergency
Care
First
Aid
Tables
1,
2,
3,
4
CarePlus
CPR
and
AED
Tables
1,
2,
3
Child/Infant
CPR
and
AED
Supplement
Tables
1,
2,
3
Oxygen
First
Aid
for
Emergencies
Tables
1,
2,
3,
4
Pediatric
Training
Programs
Tables
1,
2,
3,
4
4|
P a g e
Updated
Training
Guidelines
©2010
Health
and
Safety
Institute
TABLE 1: Basic Life Support (BLS): Education and Implementation
Topic
2005
2010
Reason
for
Change
Skills
Not
addressed.
“While
the
optimal
mechanism
for
Retention
of
skills
deteriorates
very
quickly
Reassessment
maintenance
of
competence
is
not
known,
after
training.
Frequent
skill
refreshers
the
need
to
move
toward
more
frequent
should
help
to
maintain
reasonable
skill
assessment
and
reinforcement
of
skills
is
performance.
clear.
Skill
performance
should
be
assessed
during
the
2‐year
certification
with
reinforcement
provided
as
needed
(Class
I,
LOE
B).
The
optimal
timing
and
method
for
this
assessment
and
reinforcement
are
not
known.”
(Bhanji,
et
al.
Circulation.
2010;122;S920‐
S933)
Self
Instruction
“Instruction
methods
should
not
be
limited
“Short
video
instruction
combined
with
Studies
have
demonstrated
that
lay
rescuer
to
traditional
techniques;
newer
training
synchronous
hands‐on
practice
is
an
CPR
skills
can
be
acquired
and
retained
at
methods
(e.g.,
“watch‐while‐you
practice”
effective
alternative
to
instructor‐led
basic
least
as
well
(and
sometimes
better)
through
video
programs)
may
be
more
effective.”
life
support
courses.”
interactive
computer‐
and
video‐based
synchronous
practice
when
compared
with
(Bhanji,
et
al.
Circulation.
2010;122;S920‐ instructor‐led
courses.
(Circulation. 2005;112:III‐100‐III‐108)
S933)
Skills
Competency
“Training
programs
should
be
evaluated
to
“Successful
course
completion
should
be
Reflecting
the
emerging
trends
supporting
verify
that
they
enable
effective
skills
based
on
the
ability
of
the
learner
to
continuous
maintenance
of
competence
and
acquisition
and
retention.”
demonstrate
achievement
of
course
continuing
professional
development
in
the
objectives
rather
than
attendance
in
a
healthcare
professions,
there
is
support
to
course/program
for
a
specific
time
period.”
move
away
from
a
time‐related
certification
standard
and
toward
a
more
competency‐
based
approach
to
resuscitation
education
(Bhanji,
et
al.
Circulation.
2010;122;S920‐ for
all
rescuers.
(Circulation. 2005;112:III‐100‐III‐108)
S933)
5|
P a g e
Updated
Training
Guidelines
©2010
Health
and
Safety
Institute
TABLE 1: Basic Life Support (BLS): Education and Implementation
Topic
2005
2010
Reason
for
Change
Prompting
and
“A
CPR
prompt
device
may
be
useful
in
both
“Training
in
CPR
skills
using
a
feedback
The
evidence
has
shown
prompting
and
Feedback
Devices
out‐of‐hospital
and
in‐hospital
settings
device
improves
learning
and/or
retention.
feedback
devices
to
be
effective
in
CPR
(Class
IIb).”
The
use
of
a
CPR
feedback
device
can
be
training
and
during
actual
resuscitations.
effective
for
training
(Class
IIa,
LOE
A).
CPR
Commercially‐produced
devices
are
now
prompting
and
feedback
devices
can
be
more
readily
available
for
use.
useful
as
part
of
an
overall
strategy
to
improve
the
quality
of
CPR
during
actual
resuscitations
(Class
IIa,
LOE
B).”
(Bhanji,
et
al.
Circulation.
2010;122;S920‐
(Circulation.
2005;
112:
IV19‐IV34)
S933)
6|
P a g e
Updated
Training
Guidelines
©2010
Health
and
Safety
Institute
TABLE 2: Layperson Adult CPR and AED
Topic
2005
2010
Reason
for
Change
Emphasis
on
High‐ “The
available
evidence
suggests
that
blood
“To
provide
effective
chest
compressions,
The
importance
of
high‐quality
chest
Quality
CPR
flow
is
optimized
by
using
the
recommended
push
hard
and
push
fast.
It
is
reasonable
for
compressions
within
CPR
remains
a
critical
chest
compression
force
and
duration
and
laypersons
and
healthcare
providers
to
focal
point.
Well‐performed
compressions
maintaining
a
chest
compression
rate
of
compress
the
adult
chest
at
a
rate
of
at
least
increase
the
likelihood
of
survival.
approximately
100
compressions
per
100
compressions
per
minute
(Class
IIa,
LOE
minute.
These
guidelines
recommend
that
B)
with
a
compression
depth
of
at
least
2
all
rescuers
minimize
interruption
of
chest
inches/5
cm
(Class
IIa,
LOE
B).
Rescuers
compressions
for
checking
the
pulse,
should
allow
complete
recoil
of
the
chest
analyzing
rhythm,
or
performing
other
after
each
compression,
to
allow
the
heart
activities
(Class
IIa).
CPR
instruction
should
to
fill
completely
before
the
next
emphasize
the
importance
of
allowing
compression
(Class
IIa,
LOE
B).
Rescuers
complete
chest
recoil
between
should
attempt
to
minimize
the
frequency
compressions.”
and
duration
of
interruptions
in
compressions
to
maximize
the
number
of
compressions
delivered
per
minute
(Class
IIa,
LOE
B).”
(Berg,
et
al.
Circulation.
2010;122;S685‐
(Circulation.
2005;
112:
IV19‐IV34)
S705)
Compression
Rate
“There
is
insufficient
evidence
from
human
“It
is
reasonable
for
laypersons
and
It
has
been
found
that
higher
survival
rates
studies
to
identify
a
single
optimal
chest
healthcare
providers
to
compress
the
adult
are
associated
with
an
increase
in
the
compression
rate.
Animal
and
human
chest
at
a
rate
of
at
least
100
compressions
number
of
compressions
provided
per
studies
support
a
chest
compression
rate
of
per
minute
(Class
IIa,
LOE
B)
with
a
minute.
>80
compressions
per
minute
to
achieve
compression
depth
of
at
least
2
inches/5
cm
optimal
forward
blood
flow
during
CPR.
We
(Class
IIa,
LOE
B).”
recommend
a
compression
rate
of
about
100
compressions
per
minute
(Class
IIa).”
(Berg,
et
al.
Circulation.
2010;122;S685‐
(Circulation.
2005;
112:
IV19‐IV34)
S705)
7|
P a g e
Updated
Training
Guidelines
©2010
Health
and
Safety
Institute
TABLE 2: Layperson Adult CPR and AED
Topic
2005
2010
Reason
for
Change
Compression
“Depress
the
sternum
approximately
1
½
to
“It
is
reasonable
for
laypersons
and
Research
indicates
the
tendency
for
CPR
Depth
2
inches
(approximately
4
to
5
cm)
and
then
healthcareproviders
to
compress
the
adult
providers
to
not
compress
deep
enough,
allow
the
chest
to
return
to
its
normal
chest
at
a
rate
of
at
least
100
compressions
even
with
the
emphasis
to
"push
hard."
position.”
per
minute
(Class
IIa,
LOE
B)
with
a
There
is
not
enough
evidence
to
provide
a
compression
depth
of
at
least
2
inches/5
recommended
specific
upper
limit
for
chest
cm
(Class
IIa,
LOE
B).”
compression
depth.
Research
also
indicates
the
2‐inch
depth
for
adult
compression
is
(Berg,
et
al.
Circulation.
2010;122;S685‐ more
effective
than
a
depth
of
1
½
inches.
(Circulation.
2005;
112:
IV19‐IV34)
S705)
Compression
Hand
“The
rescuer
should
compress
the
lower
half
“The
rescuer
should
place
the
heel
of
one
Use
of
the
nipple
line
as
a
landmark
for
hand
Position
of
the
victim’s
sternum
in
the
center
hand
on
the
center
(middle)
of
the
victim’s
placement
was
found
to
be
unreliable.
(middle)
of
the
chest,
between
the
nipples.
chest
(which
is
the
lower
half
of
the
The
rescuer
should
place
the
heel
of
the
sternum)
and
the
heel
of
the
other
hand
on
hand
on
the
sternum
in
the
center
(middle)
top
of
the
first
so
that
the
hands
are
of
the
chest
between
the
nipples
and
then
overlapped
and
parallel
(Class
IIa,
LOE
B).”
place
the
heel
of
the
second
hand
on
top
of
the
first
so
that
the
hands
are
overlapped
and
parallel
(LOE
6;
Class
IIa).”
(Berg,
et
al.
Circulation.
2010;122;S685‐
(Circulation.
2005;
112:
IV19‐IV34)
S705)
Breathing
“While
maintaining
an
open
airway,
look,
“After
activation
of
the
emergency
response
There
is
a
high
likelihood
of
agonal,
or
Assessment
listen,
and
feel
for
breathing.”
system,
all
rescuers
should
immediately
irregular
gasping,
breaths
occurring
early
in
begin
CPR
for
adult
victims
who
are
cardiac
arrest.
These
reflex
actions
make
the
unresponsive
with
no
breathing
or
no
recognition
of
cardiac
arrest
confusing
for
normal
breathing
(only
gasping).”
rescuers
who
have
never
seen
agonal
breaths
before.
Simplifying
the
breathing
assessment
to
looking
for
no
breathing
or
no
normal
breathing
is
intended
to
help
laypersons
respond
more
quickly
with
chest
(Berg,
et
al.
Circulation.
2010;122;S685‐ compressions
and
CPR.
(Circulation.
2005;
112:
IV19‐IV34)
S705)
8|
P a g e
Updated
Training
Guidelines
©2010
Health
and
Safety
Institute
TABLE 2: Layperson Adult CPR and AED
Topic
2005
2010
Reason
for
Change
CPR
Sequence
For
an
unresponsive
person
who
is
not
For
an
unresponsive
person
who
is
not
The
science
indicates
the
importance
of
not
breathing
or
not
breathing
normally,
begin
breathing
or
not
breathing
normally,
begin
delaying
chest
compressions
to
perform
CPR
by
opening
the
airway
and
giving
2
CPR
with
30
compressions
followed
by
rescue
breaths.
Early
chest
compression
can
rescue
breaths
followed
with
30
chest
opening
the
airway
and
giving
2
rescue
immediately
circulate
oxygen
that
is
still
in
compressions.
Repeat
cycles
of
30:2
(ABC
breaths.
Repeat
cycles
of
30:2
(CAB
the
bloodstream.
method).
method).
(Summary
from
Circulation.
2005;
112:
IV19‐ (Summary
from
Berg,
et
al.
Circulation.
IV34)
2010;122;S685‐S705)
Chain
of
Survival
“•
Early
recognition
of
the
emergency
and
“These
actions
are
termed
the
links
in
the
Links
in
the
“Chain
of
Survival”
indicate
the
activation
of
the
emergency
medical
services
‘Chain
of
Survival.’
For
adults
they
include:
individual
actions
that
must
be
strong
in
(EMS)
or
local
emergency
response
system
Immediate
recognition
of
cardiac
arrest
order
for
a
person
to
survive
a
sudden
•
Early
bystander
CPR
and
activation
of
the
emergency
cardiac
arrest.
The
addition
of
the
fifth
link,
•
Early
delivery
of
a
shock
with
a
defibrillator
response
system
integrated
post‐cardiac
arrest
care,
further
•
Early
advanced
life
support
followed
by
Early
CPR
that
emphasizes
chest
emphasizes
the
additional
dependence
on
post
resuscitation
care
delivered
by
compressions
longer‐term
care
for
long‐term
survival.
healthcare
providers.”
Rapid
defibrillation
if
indicated
Effective
advanced
life
support
Integrated
post–
cardiac
arrest
care.”
(Travers,
et
al.
Circulation.
2010;122;S676‐
(Circulation.
2005;
112:
IV12‐IV18)
S684)
BLS
Provider
“Responders
are
split
into
layperson
“Responders
are
split
into
untrained
With
the
introduction
of
compression‐only
Levels
providers
and
healthcare
providers.”
layperson
providers,
trained
layperson
CPR
and
improved
emergency
medical
providers,
and
healthcare
providers.”
dispatcher
training,
people
who
have
had
no
formal
training
are
more
likely
to
attempt
to
perform
CPR
for
cardiac
arrest.
This
level
of
care
needs
to
be
recognized
in
the
overall
public
approach
to
dealing
with
this
(Berg,
et
al.
Circulation.
2010;122;S665‐ common
medical
emergency.
(Circulation.
2005;
112:
IV19‐IV34)
S675)
9|
P a g e
Updated
Training
Guidelines
©2010
Health
and
Safety
Institute
TABLE 3: Layperson Pediatric CPR and AED
Topic
2005
2010
Reason
for
Change
Child
and
Infant
“Push
fast;
push
at
a
rate
of
approximately
“Push
fast;
push
at
a
rate
of
at
least
100
It
has
been
found
that
higher
survival
rates
Compression
Rate
100
compressions
per
minute.”
compressions
per
minute.”
are
associated
with
an
increase
in
the
number
of
compressions
provided
per
minute.
(Berg,
et
al.
Circulation.
2010;122;S862‐
(Circulation.
2005;
112:
IV156‐IV166)
S875)
Child
Compression
“‘Push
hard’:
push
with
sufficient
force
to
“Chest
compressions
of
appropriate
rate
and
Research
indicates
there
is
a
common
Depth
depress
the
chest
approximately
one
third
depth.
‘Push
fast’:
push
at
a
rate
of
at
least
tendency
for
CPR
providers
to
not
compress
to
one
half
the
anterior‐posterior
diameter
100
compressions
per
minute.
‘Push
hard’:
deep
enough,
even
with
the
emphasis
to
of
the
chest.”
push
with
sufficient
force
to
depress
at
least
"push
hard."
one
third
the
anterior‐posterior
(AP)
diameter
of
the
chest
or
approximately
1
½
inches
(4
cm)
in
infants
and
2
inches
(5
cm)
in
children
(Class
I,
LOE
C).”
(Berg,
et
al.
Circulation.
2010;122;S862‐
(Circulation.
2005;
112:
IV156‐IV166)
S875)
Infant
“‘Push
hard’:
push
with
sufficient
force
to
“Chest
compressions
of
appropriate
rate
and
Research
indicates
there
is
a
common
Compression
depress
the
chest
approximately
one
third
depth.
‘Push
fast’:
push
at
a
rate
of
at
least
tendency
for
CPR
providers
to
not
compress
Depth
to
one
half
the
anterior‐posterior
diameter
100
compressions
per
minute.
‘Push
hard’:
deep
enough,
even
with
the
emphasis
to
of
the
chest.”
push
with
sufficient
force
to
depress
at
least
"push
hard."
one
third
the
anterior‐posterior
(AP)
diameter
of
the
chest
or
approximately
1
½
inches
(4
cm)
in
infants
and
2
inches
(5
cm)
in
children
(Class
I,
LOE
C).”
(Berg,
et
al.
Circulation.
2010;122;S862‐
(Circulation.
2005;
112:
IV156‐IV166)
S875)
10|
P a g e
Updated
Training
Guidelines
©2010
Health
and
Safety
Institute
TABLE 3: Layperson Pediatric CPR and AED
Topic
2005
2010
Reason
for
Change
Child
and
Infant
“While
maintaining
an
open
airway,
take
no
“If
the
victim
is
unresponsive
and
breathing
There
is
a
high
likelihood
of
agonal,
or
Breathing
more
than
10
seconds
to
check
whether
the
(or
only
gasping),
begin
CPR. Sometimes
irregular
gasping,
breaths
occurring
early
in
Assessment
victim
is
breathing:
Look for
rhythmic
chest
victims
who
require
CPR
will
gasp,
which
cardiac
arrest.
These
reflex
actions
make
the
and
abdominal
movement,
listen for
exhaled
may
be
misinterpreted
as
breathing.
Treat
recognition
of
cardiac
arrest
confusing
for
breath
sounds
at
the
nose
and
mouth,
and
the
victim
with
gasps
as
though
there
is
no
rescuers
who
have
never
seen
them
before.
feel for
exhaled
air
on
your
cheek.
Periodic
breathing
and
begin
CPR.”
Simplifying
the
breathing
assessment
to
gasping,
also
called
agonal gasps, is
not
looking
for
no
breathing
or
only
gasping
is
breathing.”
intended
to
help
laypersons
respond
more
quickly
with
chest
compressions
and
CPR.
(Berg,
et
al.
Circulation.
2010;122;S862‐
(Circulation.
2005;
112:
IV156‐IV166)
S875)
Child
and
Infant
For
an
unresponsive
child
who
is
not
For
an
unresponsive
child
who
is
not
The
recommended
sequence
for
children
CPR
Sequence
breathing
or
not
breathing
normally,
begin
breathing
or
not
breathing
normally,
begin
and
infants
is
the
same
as
the
adult
to
help
CPR
by
opening
the
airway
and
giving
2
CPR
with
30
compressions
followed
by
simplify
learning.
Ventilations
are
very
rescue
breaths
followed
with
30
chest
opening
the
airway
and
giving
2
rescue
important
in
child
or
infant
CPR.
It
is
not
compressions.
Repeat
cycles
of
30:2
(ABC
breaths.
Repeat
cycles
of
30:2
(CAB
known
whether
starting
with
compressions
method).
method).
or
breaths
makes
a
difference
in
the
outcome.
Starting
CPR
with
compressions
should
only
delay
rescue
breaths
about
18
(Summary
from
Circulation.
2005;
112:
(Summary
from
Berg,
et
al.
Circulation.
seconds.
IV156‐IV166)
2010;122;S862‐S875)
Use
of
an
AED
on
“There
is
insufficient
data
to
make
a
“Many
AEDs
have
high
specificity
in
AEDs
designed
to
be
used
on
adults
have
an
Infant
recommendation
for
or
against
the
use
of
recognizing
pediatric
shockable
rhythms,
been
successful
when
used
on
infants
with
AEDs
for
infants
1
year
of
age
(Class
and
some
are
equipped
to
decrease
(or
out‐of‐hospital
cardiac
arrest
when
coupled
Indeterminate).”
attenuate)
the
delivered
energy
to
make
with
bystander
CPR.
Minimal
heart
muscle
them
suitable
for
infants
and
children
<
8
damage
and
good
neurological
outcomes
years
of
age.
For
infants
a
manual
were
reported.
defibrillator
is
preferred.
If
a
manual
defibrillator
is
not
available,
an
AED
equipped
with
a
pediatric
attenuator
is
preferred
for
infants.
If
neither
is
available,
an
AED
without
a
dose
attenuator
may
be
used
(Class
IIb,
LOE
C).”
(Circulation.
2005;
112:
IV156‐IV166)
(Link,
et
al.
Circulation.
2010;122;S706‐S719)
11|
P a g e
Updated
Training
Guidelines
©2010
Health
and
Safety
Institute
TABLE 4: Emergency Care/First Aid
Topic
2005
2010
Reason
for
Change
Control
of
“There
is
insufficient
evidence
to
“Elevation
and
use
of
pressure
points
are
Evidence
indicates
that
direct
pressure
is
the
Bleeding:
recommend
for
or
against
the
first
aid
use
of
not
recommended
to
control
bleeding
(Class
single
most
effective
method
for
controlling
Elevation
and
pressure
points
or
extremity
elevation
to
III,
LOE
C).”
bleeding.
Elevation
and
pressure
points
are
Pressure
Points
control
hemorrhage.”
unproven
procedures
that
may
compromise
the
proven
intervention
of
direct
pressure,
(Markenson,
et
al.
Circulation.
so
they
could
be
harmful.
(Circulation.
2005;
112:
IV196‐IV203)
2010;122;S934‐S946)
Control
of
“The
effectiveness,
feasibility,
and
safety
of
“Because
of
the
potential
adverse
effects
of
Tourniquets
have
been
shown
to
control
Bleeding:
tourniquets
to
control
bleeding
by
first
aid
tourniquets
and
difficulty
in
their
proper
bleeding
effectively
and
without
Tourniquets
providers
are
unknown,
but
the
use
of
application,
use
of
a
tourniquet
to
control
complications
on
the
battlefield,
during
tourniquets
is
potentially
dangerous.”
bleeding
of
the
extremities
is
indicated
only
surgery,
and
when
used
by
paramedics
in
a
if
direct
pressure
is
not
effective
or
possible
civilian
setting.
There
are
no
studies
on
(Class
IIb,
LOE
B).
Specifically
designed
controlling
bleeding
with
first
aid
provider
tourniquets
appear
to
be
better
than
ones
use
of
a
tourniquet.
that
are
improvised,
but
tourniquets
should
only
be
used
with
proper
training
(Class
IIa,
LOE
B).”
(Markenson,
et
al.
Circulation.
(Circulation.
2005;
112:
IV196‐IV203)
2010;122;S934‐S946)
Control
of
Not
addressed.
“Routine
use
of
hemostatic
agents
in
first
aid
The
use
of
commercially
available
Bleeding:
cannot
be
recommended
at
this
time
hemostatic
agents
to
control
bleeding
is
not
Hemostatic
Agents
because
of
significant
variation
in
recommended
because
the
agent
and
effectiveness
by
different
agents
and
their
conditions
for
its
application
are
not
known.
potential
for
adverse
effects,
including
tissue
destruction
with
induction
of
a
proembolic
state
and
potential
thermal
injury
(Class
IIb,
LOE
B).”
(Markenson,
et
al.
Circulation.
2010;122;S934)
12|
P a g e
Updated
Training
Guidelines
©2010
Health
and
Safety
Institute
TABLE 4: Emergency Care/First Aid
Topic
2005
2010
Reason
for
Change
Leg
Elevation
for
Not
addressed.
“If
a
victim
shows
evidence
of
shock,
have
Elevating
the
legs
can
be
beneficial
in
cases
Shock
the
victim
lie
supine.
If
there
is
no
evidence
such
as
fainting,
dehydration,
and
heat
of
trauma
or
injury,
raise
the
feet
about
6
to
exhaustion
in
which
the
mechanism
of
shock
12
inches
(about
30°
to
45°).
(Class
IIb,
LOE
is
related
to
factors
other
than
injury.
The
C).
Do
not
raise
the
feet
if
the
movement
or
risk
of
further
injury
outweighs
the
benefit
the
position
causes
the
victim
any
pain.”
of
elevation
when
a
person
is
injured.
(Markenson,
et
al.
Circulation.
2010;122;S934‐S946)
Injured
Extremity
“If
you
are
far
from
definitive
health
care,
“If
you
are
far
from
definitive
health
care,
Expert
opinion
suggests
that
splinting
for
an
you
may
stabilize
the
extremity
in
the
stabilize
the
extremity
with
a
splint
in
the
extremity
injury
may
reduce
pain
and
position
found.”
position
found
(Class
IIa,
LOE
C).
If
a
splint
is
prevent
further
injury,
especially
when
used,
it
should
be
padded
to
cushion
the
professional
care
is
delayed
or
it
is
decided
injury.”
to
move
the
injured
person.
(Markenson,
et
al.
Circulation.
(Circulation.
2005;
112:
IV196‐IV203)
2010;122;S934‐S946)
Aspirin
for
Chest
Not
addressed.
“While
waiting
for
EMS
to
arrive,
the
first
aid
Evidence
from
two
large,
randomized
Discomfort
provider
may
encourage
the
victim
to
chew
studies
clearly
demonstrated
that
the
1
adult
(not
enteric
coated)
or
2
low‐dose
administration
of
aspirin
within
the
first
‘baby’
aspirin
if
the
patient
has
no
allergy
to
hours
of
onset
of
chest
discomfort
in
people
aspirin
or
other
contraindication
to
aspirin,
with
acute
coronary
syndromes
reduced
such
as
evidence
of
a
stroke
or
recent
mortality.
bleeding
(Class
IIa,
LOE
A).”
(Markenson,
et
al.
Circulation.
2010;122;S934‐S946)
13|
P a g e
Updated
Training
Guidelines
©2010
Health
and
Safety
Institute
TABLE 4: Emergency Care/First Aid
Topic
2005
2010
Reason
for
Change
Second
Dose
of
"First
aid
providers
should
be
familiar
with
“First
aid
providers
are
advised
to
seek
If
medical
assistance
is
available,
it
is
less
Epinephrine
for
the
epinephrine
auto‐injector
so
that
they
medical
assistance
if
symptoms
persist,
likely
that
an
unnecessary
second
dose
of
Anaphylaxis
can
help
someone
having
an
anaphylactic
rather
than
routinely
administering
a
second
epinephrine
will
be
given.
reaction
self‐administer
the
epinephrine.
dose
of
epinephrine.
In
unusual
First
aid
providers
should
be
able
to
circumstances,
when
advanced
medical
administer
the
auto‐injector
if
the
victim
is
assistance
is
not
available,
a
second
dose
of
unable
to
do
so,
provided
that
the
epinephrine
may
be
given
if
symptoms
of
medication
has
been
prescribed
by
a
anaphylaxis
persist
(Class
IIb,
LOE
C).”
physician
and
state
law
permits
[second
dose
not
addressed]."
(Markenson,
et
al.
Circulation.
(Circulation. 2005;112:IV‐196‐IV‐203)
2010;122;S934‐S946)
Chemical
Burns
“In
case
of
an
acid
or
alkali
exposure
to
the
“Rinse
eyes
exposed
to
toxic
substances
Immediate
irrigation
of
eyes
exposed
to
a
skin
or
eye,
immediately
irrigate
the
affected
immediately
with
a
copious
amount
of
water
toxin
with
large
amounts
of
tap
water
is
area
with
copious
amounts
of
water.”
(Class
I,
LOE
C),
unless
a
specific
antidote
is
recommended.
Specialized
therapeutic
available.”
rinsing
solutions
that
have
been
properly
tested
and
approved
may
be
available
and
should
be
used
when
available.
(Markenson,
et
al.
Circulation.
(Circulation.
2005;
112:
IV196‐IV203)
2010;122;S934‐S946)
Heat
Stroke
Not
addressed.
“The
most
important
action
by
a
first
aid
Complete
immersion
in
cold
water
has
been
provider
for
a
victim
of
heat
stroke
is
to
found
to
be
the
most
effective
method
of
begin
immediate
cooling,
preferably
by
cooling
the
body
in
heat
stroke.
immersing
the
victim
up
to
the
chin
in
cold
water.”
(Markenson,
et
al.
Circulation.
2010;122;S934‐S946)
Supplemental
Not
addressed.
“Supplementary
oxygen
administration
may
There
is
evidence
oxygen
may
be
beneficial
Oxygen
for
Diving
be
beneficial
as
part
of
first
aid
for
divers
for
divers
with
a
decompression
injury.
with
a
decompression
injury
(Class
IIb,
LOE
C22).”
(Markenson,
et
al.
Circulation.
2010;122;S934‐S946)
14|
P a g e
Updated
Training
Guidelines
©2010
Health
and
Safety
Institute
TABLE 4: Emergency Care/First Aid
Topic
2005
2010
Reason
for
Change
Poisoning:
“There
is
insufficient
evidence
to
“Do
not
administer
activated
charcoal
to
a
There
is
no
evidence
that
activated
charcoal
Activated
Charcoal
recommend
for
or
against
the
use
of
victim
who
has
ingested
a
poisonous
is
effective
as
a
component
of
first
aid.
It
activated
charcoal
as
first
aid
for
ingestions
substance
unless
you
are
advised
to
do
so
by
may
be
safe
to
administer,
but
it
has
not
(Class
Indeterminate).”
poison
control
center
or
emergency
medical
been
shown
to
be
beneficial,
and
there
are
personnel
(Class
IIb,
LOE
C).”
reports
of
it
causing
harm.
(Markenson,
et
al.
Circulation.
(Circulation.
2005;
112:
IV196‐IV203)
2010;122;S934‐S946)
Snakebite:
“In
case
of
an
elapid
(e.g.,
coral)
snakebite,
“Applying
a
pressure
immobilization
Applying
a
pressure
immobilization
bandage
Pressure
wrap
a
bandage
snugly
(comfortably
tight
bandage
with
a
pressure
between
40
and
70
has
shown
to
be
an
effective
way
to
slow
Immobilization
but
loose
enough
to
slip
or
fit
a
finger
under
mm
Hg
in
the
upper
extremity
and
between
the
dissemination
of
venom
for
all
Bandage
it)
around
the
entire
length
of
the
bitten
55
and
70
mm
Hg
in
the
lower
extremity
venomous
snake
bites,
not
just
those
from
extremity,
immobilize
the
extremity,
and
get
around
the
entire
length
of
the
bitten
elapids.
definitive
medical
help
as
rapidly
as
extremity
is
an
effective
and
safe
way
to
possible.”
slow
the
dissemination
of
venom
by
slowing
lymph
flow
(Class
IIa,
LOE
C).
For
practical
purposes
pressure
is
sufficient
if
the
bandage
is
comfortably
tight
and
snug
but
allows
a
finger
to
be
slipped
under
it.
Initially
it
was
theorized
that
slowing
lymphatic
flow
by
external
pressure
would
only
benefit
victims
bitten
by
snakes
producing
neurotoxic
venom,
but
the
effectiveness
of
pressure
immobilization
has
also
been
demonstrated
for
bites
by
non‐neurotoxic
American
snakes.”
(Markenson,
et
al.
Circulation.
(Circulation.
2005;
112:
IV196‐IV203)
2010;122;S934‐S946)
15|
P a g e
Updated
Training
Guidelines
©2010
Health
and
Safety
Institute
TABLE 4: Emergency Care/First Aid
Topic
2005
2010
Reason
for
Change
Jellyfish
Stings
Not
addressed.
“To
inactivate
venom
load
and
prevent
A
number
of
topical
treatments
have
been
further
envenomation,
jellyfish
stings
should
identified
for
jellyfish
stings,
but
a
critical
be
liberally
washed
with
vinegar
(4%
to
6%
evaluation
of
the
evidence
shows
vinegar
is
acetic
acid
solution)
as
soon
as
possible
for
most
effective
for
inactivation
of
the
at
least
30
seconds (Class
IIa,
LOE
B).
For
the
nematocysts.
In
addition,
immersion
in
treatment
of
pain,
after
the
nematocysts
are
water,
as
hot
as
tolerated
for
about
20
removed
or
deactivated,
jellyfish
stings
minutes,
has
been
found
to
be
the
most
should
be
treated
with
hot‐water
immersion
effective
treatment
for
the
pain.
when
possible
(Class
IIa,
LOE
B).”
(Markenson,
et
al.
Circulation.
2010;122;S934‐S946)
16|
P a g e
Updated
Training
Guidelines
©2010
Health
and
Safety
Institute
TABLE 5: Healthcare Provider Adult BLS
Topic
2005
2010
Reason
for
Change
Emphasis
on
High‐ “The
available
evidence
suggests
that
blood
“To
provide
effective
chest
compressions,
The
importance
of
high‐quality
chest
Quality
CPR
flow
is
optimized
by
using
the
recommended
push
hard
and
push
fast.
It
is
reasonable
for
compressions
within
CPR
remains
a
critical
chest
compression
force
and
duration
and
laypersons
and
healthcare
providers
to
focal
point.
Well‐performed
compressions
maintaining
a
chest
compression
rate
of
compress
the
adult
chest
at
a
rate
of
at
least
increase
the
likelihood
of
overall
survival.
approximately
100
compressions
per
100
compressions
per
minute
(Class
IIa,
LOE
Recommendations
center
on
improving
the
minute.
These
guidelines
recommend
that
B)
with
a
compression
depth
of
at
least
2
parts
of
the
compression
skill
found
to
have
all
rescuers
minimize
interruption
of
chest
inches/5
cm
(Class
IIa,
LOE
B).
Rescuers
the
most
influence
on
quality.
compressions
for
checking
the
pulse,
should
allow
complete
recoil
of
the
chest
analyzing
rhythm,
or
performing
other
after
each
compression,
to
allow
the
heart
activities
(Class
IIa).
CPR
instruction
should
to
fill
completely
before
the
next
emphasize
the
importance
of
allowing
compression
(Class
IIa,
LOE
B).
Rescuers
complete
chest
recoil
between
should
attempt
to
minimize
the
frequency
compressions.”
and
duration
of
interruptions
in
compressions
to
maximize
the
number
of
compressions
delivered
per
minute
(Class
IIa,
LOE
B).”
(Berg,
et
al.
Circulation.
2010;122;S685‐
(Circulation.
2005;
112:
IV19‐IV34)
S705)
Compression
Rate
“There
is
insufficient
evidence
from
human
“It
is
reasonable
for
laypersons
and
It
has
been
found
that
higher
survival
rates
studies
to
identify
a
single
optimal
chest
healthcare
providers
to
compress
the
adult
are
associated
with
an
increase
in
the
compression
rate.
Animal
and
human
chest
at
a
rate
of
at
least
100
compressions
number
of
compressions
provided
per
studies
support
a
chest
compression
rate
of
per
minute
(Class
IIa,
LOE
B)
with
a
minute
and
lower
survival
rates
are
>80
compressions
per
minute
to
achieve
compression
depth
of
at
least
2
inches/5
cm
associated
with
a
decrease
in
that
number.
optimal
forward
blood
flow
during
CPR.
We
(Class
IIa,
LOE
B).”
Recommending
a
base‐level
compression
recommend
a
compression
rate
of
about
rate
instead
of
a
fixed
rate
allows
for
the
100
compressions
per
minute
(Class
IIa).”
benefit
of
an
increased
compression
rate.
There
is
not
enough
evidence
to
provide
a
recommended
specific
upper
limit
for
(Berg,
et
al.
Circulation.
2010;122;S685‐ compression
rate.
(Circulation.
2005;
112:
IV19‐IV34)
S705)
17|
P a g e
Updated
Training
Guidelines
©2010
Health
and
Safety
Institute
TABLE 5: Healthcare Provider Adult BLS
Topic
2005
2010
Reason
for
Change
Compression
“Depress
the
sternum
approximately
1
½
to
“It
is
reasonable
for
laypersons
and
Research
indicates
the
tendency
for
CPR
Depth
2
inches
(approximately
4
to
5
cm)
and
then
healthcare
providers
to
compress
the
adult
providers
to
not
compress
deep
enough,
allow
the
chest
to
return
to
its
normal
chest
at
a
rate
of
at
least
100
compressions
even
with
the
emphasis
to
"push
hard."
position.”
per
minute
(Class
IIa,
LOE
B)
with
a
There
is
not
enough
evidence
to
provide
a
compression
depth
of
at
least
2
inches/5
recommended
specific
upper
limit
for
chest
cm
(Class
IIa,
LOE
B).”
compression
depth.
The
research
also
indicates
the
2‐inch
depth
for
adult
compression
is
more
effective
than
a
depth
(Berg,
et
al.
Circulation.
2010;122;S685‐ of
1
½
inches.
(Circulation.
2005;
112:
IV19‐IV34)
S705)
Compression
Hand
“The
rescuer
should
compress
the
lower
half
“The
rescuer
should
place
the
heel
of
one
Use
of
the
nipple
line
as
a
landmark
for
hand
Position
of
the
victim’s
sternum
in
the
center
hand
on
the
center
(middle)
of
the
victim’s
placement
was
found
to
be
unreliable.
(middle)
of
the
chest,
between
the
nipples.
chest
(which
is
the
lower
half
of
the
The
rescuer
should
place
the
heel
of
the
sternum)
and
the
heel
of
the
other
hand
on
hand
on
the
sternum
in
the
center
(middle)
top
of
the
first
so
that
the
hands
are
of
the
chest
between
the
nipples
and
then
overlapped
and
parallel
(Class
IIa,
LOE
B).”
place
the
heel
of
the
second
hand
on
top
of
the
first
so
that
the
hands
are
overlapped
and
parallel
(LOE
6;
Class
IIa).”
(Berg,
et
al.
Circulation.
2010;122;S685‐
(Circulation.
2005;
112:
IV19‐IV34)
S705)
Breathing
“While
maintaining
an
open
airway,
look,
“After
activation
of
the
emergency
response
There
is
a
high
likelihood
of
agonal
or
Assessment
listen,
and
feel
for
breathing.”
system,
all
rescuers
should
immediately
irregular
gasping
breaths
to
occur
early
in
begin
CPR
for
adult
victims
who
are
cardiac
arrest.
These
reflex
actions
make
the
unresponsive
with
no
breathing
or
no
recognition
of
cardiac
arrest
confusing
for
normal
breathing
(only
gasping).”
rescuers
who
have
never
seen
agonal
breaths
before.
Simplifying
the
breathing
assessment
to
looking
for
no
breathing
or
no
normal
breathing
helps
rescuers
respond
more
quickly
with
chest
compressions
and
(Berg,
et
al.
Circulation.
2010;122;S685‐ CPR.
(Circulation.
2005;
112:
IV19‐IV34)
S705)
18|
P a g e
Updated
Training
Guidelines
©2010
Health
and
Safety
Institute
TABLE 5: Healthcare Provider Adult BLS
Topic
2005
2010
Reason
for
Change
CPR
Sequence
For
an
unresponsive
person
who
is
not
For
an
unresponsive
person
who
is
not
The
science
indicates
the
importance
of
not
breathing
or
not
breathing
normally,
begin
breathing
or
not
breathing
normally,
and
has
delaying
chest
compressions
to
perform
CPR
by
opening
the
airway
and
giving
2
no
obvious
pulse,
begin
CPR
with
30
rescue
breaths.
Early
chest
compression
can
rescue
breaths
followed
with
30
chest
compressions
followed
by
opening
the
immediately
circulate
oxygen
that
is
still
in
compressions.
Repeat
cycles
of
30:2
(ABC
airway
and
giving
2
rescue
breaths.
Repeat
the
bloodstream.
By
changing
the
sequence,
method).
cycles
of
30:2
(CAB
method).
chest
compressions
are
initiated
sooner
and
the
delay
in
ventilation
should
be
minimal.
(Summary
from
Circulation.
2005;
112:
IV19‐ (Summary
from
Berg,
et
al.
Circulation.
IV34)
2010;122;S685‐S705)
Cricoid
Pressure
“Cricoid
pressure
should
be
used
only
if
the
“The
routine
use
of
cricoid
pressure
in
adult
Regardless
of
expertise,
rescuers
cannot
victim
is
deeply
unconscious.”
cardiac
arrest
is
not
recommended
(Class
III,
effectively
apply
cricoid
pressure.
Teaching
LOE
B).”
the
skill
is
difficult.
Cricoid
pressure
can
complicate
or
prevent
the
placement
of
an
advanced
airway.
It
has
been
found
that
some
aspiration
can
still
occur,
even
with
the
application
of
cricoid
pressure.
(Berg,
et
al.
Circulation.
2010;122;S685‐
(Circulation.
2005;
112:
IV19‐IV34)
S705)
Pad
Placement
“Rescuers
should
place
AED
electrode
pads
“Four
pad
positions
(anterolateral,
New
data
demonstrates
that
four
pad
on
the
victim’s
bare
chest
in
the
anteroposterior,
anterior‐left
infrascapular,
positions
(anterior‐lateral,
anterior‐
conventional
sternal‐apical
(anterolateral)
and
anterior‐right
infrascapular)
are
equally
posterior,
anterior‐left
infrascapular,
and
position
(Class
IIa).
The
right
(sternal)
chest
effective
to
treat
atrial
or
ventricular
anterior‐right
infrascapular)
appear
to
be
pad
is
placed
on
the
victim’s
right
superior
arrhythmias.
All
four
positions
are
equally
equally
effective
to
treat
atrial
or
ventrical
anterior
(infraclavicular)
chest
and
the
apical
effective
in
shock
success
and
reasonable
for
arrhythmias.
(left)
pad
is
placed
on
the
victim’s
inferior‐ defibrillation
(Class
IIa,
LOE
B).
For
ease
of
lateral
left
chest,
lateral
to
the
left
breast
placement
and
education,
anterolateral
is
a
(Class
IIa).
Other
acceptable
pad
positions
reasonable
default
electrode
placement
are
placement
on
the
lateral
chest
wall
on
(Class
IIa,
LOE
C).
Alternative
pad
positions
the
right
and
left
sides
(biaxillary)
or
the
left
may
be
considered
based
on
individual
pad
in
the
standard
apical
position
and
the
patient
characteristics.
Lateral
pads/paddles
other
pad
on
the
right
or
left
upper
back
should
be
placed
under
breast.”
(Class
IIa).”
(Circulation.
2005;
112:
IV35‐IV46)
(Link,
et
al.
Circulation.
2010;122;S706‐S719)
19|
P a g e
Updated
Training
Guidelines
©2010
Health
and
Safety
Institute
TABLE 5: Healthcare Provider Adult BLS
Topic
2005
2010
Reason
for
Change
Chain
of
Survival
“•
Early
recognition
of
the
emergency
and
“These
actions
are
termed
the
links
in
the
Links
in
the
“Chain
of
Survival”
indicate
the
activation
of
the
emergency
medical
services
‘Chain
of
Survival.’
For
adults
they
include:
individual
actions
that
must
be
strong
in
(EMS)
or
local
emergency
response
system
Immediate
recognition
of
cardiac
arrest
order
for
a
person
to
survive
a
sudden
•
Early
bystander
CPR
and
activation
of
the
emergency
cardiac
arrest.
The
addition
of
the
fifth
link,
•
Early
delivery
of
a
shock
with
a
defibrillator
response
system
integrated
post‐cardiac
arrest
care,
further
•
Early
advanced
life
support
followed
by
Early
CPR
that
emphasizes
chest
emphasizes
the
additional
dependence
on
post
resuscitation
care
delivered
by
compressions
longer‐term
care
for
long‐term
survival.
healthcare
providers.”
Rapid
defibrillation
if
indicated
Effective
advanced
life
support
Integrated
post–
cardiac
arrest
care
(Travers,
et
al.
Circulation. 2010;122;S676‐
(Circulation.
2005;
112:
IV12‐IV18)
S684)
Team
Approach
“When
multiple
rescuers
are
present,
they
“The
intent
of
the
algorithm
is
to
present
Some
resuscitations
start
with
a
lone
rescuer
should
rotate
the
compressor
role
about
the
steps
of
BLS
in
a
logical
and
concise
who
calls
for
help,
whereas
other
every
2
minutes.
The
switch
should
be
manner
that
is
easy
for
all
types
of
rescuers
resuscitations
begin
with
several
willing
accomplished
as
quickly
as
possible
(ideally
to
learn,
remember
and
perform.
These
rescuers.
Training
should
focus
on
building
a
in
less
than
5
seconds)
to
minimize
actions
have
traditionally
been
presented
as
team
and
performing
tasks
simultaneously
interruptions
in
chest
compressions.”
a
sequence
of
distinct
steps
to
help
a
single
as
each
rescuer
arrives,
or
on
designating
a
rescuer
prioritize
actions.
However,
many
team
leader
if
multiple
rescuers
are
present.
workplaces
and
most
EMS
and
in‐hospital
resuscitations
involve
teams
of
providers
who
should
perform
several
actions
simultaneously
(e.g.:
one
rescuer
activates
the
emergency
response
system
while
another
begins
chest
compressions,
and
a
third
either
provides
ventilations
or
retrieves
the
bag‐mask
for
rescue
breathing,
and
a
fourth
retrieves
and
sets
up
a
defibrillator).”
(Berg,
et
al.
Circulation.
2010;122;S685‐
(Circulation. 2005;112:IV‐12‐IV‐17)
S705)
20|
P a g e
Updated
Training
Guidelines
©2010
Health
and
Safety
Institute
TABLE 5: Healthcare Provider Adult BLS
Topic
2005
2010
Reason
for
Change
BLS
Termination
“Rescuers
who
start
BLS
should
continue
“Rescuers
who
start
BLS
should
continue
The
BLS
termination
of
resuscitation
rule
can
until
one
of
the
following
occurs:
resuscitation
until
one
of
the
following
reduce
the
rate
of
hospital
transport
to
37%
Restoration
of
effective,
spontaneous
occurs:
of
cardiac
arrests
without
compromising
the
circulation
and
ventilation.
Restoration
of
effective,
spontaneous
care
of
potentially
viable
patients.
Care
is
transferred
to
a
more
senior‐ circulation
level
emergency
medical
professional
Care
is
transferred
to
a
team
providing
who
may
determine
that
the
patient
is
advanced
life
support
unresponsive
to
the
resuscitation
The
rescuer
is
unable
to
continue
attempt.
because
of
exhaustion,
the
presence
of
Reliable
criteria
indicating
irreversible
dangerous
environmental
hazards,
or
death
are
present.
because
continuation
of
the
The
rescuer
is
unable
to
continue
resuscitative
efforts
places
others
in
because
of
exhaustion
or
the
presence
jeopardy
of
dangerous
environmental
hazards
or
Reliable
and
valid
criteria
indicating
because
continuation
of
resuscitative
irreversible
death
are
met,
criteria
of
efforts
places
other
lives
in
jeopardy.
obvious
death
are
identified,
or
criteria
A
valid
DNAR
order
is
presented
to
for
determination
of
resuscitation
are
rescuers.”
met.
One
set
of
reliable
and
valid
criteria
for
termination
of
resuscitation
is
termed
the
‘BLS
termination
of
resuscitation’
Rule:
1. Arrest
was
not
witnessed
by
EMS
provider
or
first
responder
2. No
return
of
spontaneous
circulation
(ROSC)
after
3
full
rounds
of
CPR
and
automated
external
defibrillator
(AED)
analysis
3. No
AED
shocks
were
delivered.”
(Berg,
et
al.
Circulation.
2010;122;S665‐
(Circulation.
2005;
112:
IV19‐IV34)
S675)
21|
P a g e
Updated
Training
Guidelines
©2010
Health
and
Safety
Institute
TABLE 6 Healthcare Provider Pediatric BLS
Topic
2005
2010
Reason
for
Change
Child
and
Infant
“Push
fast;
push
at
a
rate
of
approximately
“Push
fast;
push
at
a
rate
of
at
least
100
It
has
been
found
that
higher
survival
rates
Compression
Rate
100
compressions
per
minute.”
compressions
per
minute.”
are
associated
with
an
increase
in
the
number
of
compressions
provided
per
minute.
(Berg,
et
al.
Circulation.
2010;122;S862‐
(Circulation.
2005;
112:
IV156‐IV166)
S875)
Child
Compression
“‘Push
hard’:
push
with
sufficient
force
to
“The
following
are
characteristics
of
high‐ Research
indicates
there
is
a
common
Depth
depress
the
chest
approximately
one
third
quality
CPR:
Chest
compressions
of
tendency
for
CPR
providers
to
not
compress
to
one
half
the
anterior‐posterior
diameter
appropriate
rate
and
depth.
‘Push
fast‘:
push
deep
enough,
even
with
the
emphasis
to
of
the
chest.”
at
a
rate
of
at
least
100
compressions
per
"push
hard."
minute.
‘Push
hard’:
push
with
sufficient
force
to
depress
at
least
one
third
the
anterior‐posterior
(AP)
diameter
of
the
chest
or
approximately
1
½
inches
(4
cm)
in
infants
and
2
inches
(5
cm)
in
children
(Class
I,
LOE
C).”
(Berg,
et
al.
Circulation.
2010;122;S862‐
(Circulation.
2005;
112:
IV156‐IV166)
S875)
Infant
“‘Push
hard’:
push
with
sufficient
force
to
“The
following
are
characteristics
of
high‐ Research
indicates
there
is
a
common
Compression
depress
the
chest
approximately
one
third
quality
CPR:
Chest
compressions
of
tendency
for
CPR
providers
to
not
compress
Depth
to
one
half
the
anterior‐posterior
diameter
appropriate
rate
and
depth.
‘Push
fast’:
push
deep
enough,
even
with
the
emphasis
to
of
the
chest.”
at
a
rate
of
at
least
100
compressions
per
"push
hard."
minute.
‘Push
hard’:
push
with
sufficient
force
to
depress
at
least
one
third
the
anterior‐posterior
(AP)
diameter
of
the
chest
or
approximately
1
½
inches
(4
cm)
in
infants
and
2
inches
(5
cm)
in
children
(Class
I,
LOE
C).”
(Berg,
et
al.
Circulation.
2010;122;S862‐
(Circulation.
2005;
112:
IV156‐IV166)
S875)
22|
P a g e
Updated
Training
Guidelines
©2010
Health
and
Safety
Institute
TABLE 6 Healthcare Provider Pediatric BLS
Topic
2005
2010
Reason
for
Change
Child
and
Infant
“While
maintaining
an
open
airway,
take
no
“If
the
victim
is
unresponsive
and
breathing
There
is
a
high
likelihood
of
agonal,
or
Breathing
more
than
10
seconds
to
check
whether
the
(or
only
gasping),
begin
CPR. Sometimes
irregular
gasping,
breaths
occurring
early
in
Assessment
victim
is
breathing:
Look for
rhythmic
chest
victims
who
require
CPR
will
gasp,
which
cardiac
arrest.
These
reflex
actions
make
the
and
abdominal
movement,
listen for
exhaled
may
be
misinterpreted
as
breathing.
Treat
recognition
of
cardiac
arrest
confusing
for
breath
sounds
at
the
nose
and
mouth,
and
the
victim
with
gasps
as
though
there
is
no
rescuers
who
have
never
seen
them
before.
feel for
exhaled
air
on
your
cheek.
Periodic
breathing
and
begin
CPR.”
Simplifying
the
breathing
assessment
to
gasping,
also
called
agonal gasps, is
not
looking
for
no
breathing
or
only
gasping
is
breathing.”
intended
to
help
rescuers
respond
more
(Berg,
et
al.
Circulation.
2010;122;S862‐ quickly
with
chest
compressions
and
CPR.
(Circulation.
2005;
112:
IV156‐IV166)
S875)
Child
and
Infant
For
an
unresponsive
child
who
is
not
For
an
unresponsive
child
who
is
not
The
recommended
sequence
for
children
CPR
Sequence
breathing
or
not
breathing
normally,
begin
breathing
or
not
breathing
normally,
begin
and
infants
is
the
same
as
the
adult
to
help
CPR
by
opening
the
airway
and
giving
2
CPR
with
30
compressions
followed
by
simplify
learning.
Ventilations
are
very
rescue
breaths
followed
with
30
chest
opening
the
airway
and
giving
2
rescue
important
in
child
or
infant
CPR.
It
is
not
compressions.
Repeat
cycles
of
30:2
(ABC
breaths.
Repeat
cycles
of
30:2
(CAB
known
whether
starting
with
compressions
method).
method).
or
breaths
makes
a
difference
in
the
outcome.
Starting
CPR
with
compressions
should
only
delay
rescue
breaths
about
18
(Summary
from
Circulation.
2005;
112:
(Summary
from
Berg,
et
al.
Circulation.
seconds.
IV156‐IV166)
2010;122;S862‐S875)
Use
of
an
AED
on
“There
is
insufficient
data
to
make
a
“Many
AEDs
have
high
specificity
in
AEDs
designed
to
be
used
on
adults
have
an
Infant
recommendation
for
or
against
the
use
of
recognizing
pediatric
shockable
rhythms,
been
successful
when
used
on
infants
with
AEDs
for
infants
1
year
of
age
(Class
and
some
are
equipped
to
decrease
(or
out‐of‐hospital
cardiac
arrest
when
coupled
Indeterminate).”
attenuate)
the
delivered
energy
to
make
with
bystander
CPR.
Minimal
heart
muscle
them
suitable
for
infants
and
children
<
8
damage
and
good
neurological
outcomes
years
of
age.
For
infants
a
manual
were
reported.
defibrillator
is
preferred.
If
a
manual
defibrillator
is
not
available,
an
AED
equipped
with
a
pediatric
attenuator
is
preferred
for
infants.
If
neither
is
available,
an
AED
without
a
dose
attenuator
may
be
used
(Class
IIb,
LOE
C).”
(Circulation.
2005;
112:
IV35‐IV46)
(Link,
et
al.
Circulation.
2010;122;S706‐S719)
23|
P a g e
Updated
Training
Guidelines
©2010
Health
and
Safety
Institute
HSI Advisory Group
HSI’s
interpretations
of
the
most
significant
recent
changes
to
emergency
care
science
and
instruction
included
review
and
input
of
HSI’s
Medical
Director,
Chief
Learning
Officer,
Medical
Board,
Program
Advisory
Groups,
and
professional
staff.
HSI
Medical
Director
Gregory
R.
Ciottone,
M.D,
FACEP
HSI
Chief
Learning
Officer
Jeffrey
T.
Lindsey,
PhD,
PM,
CFOD,
EFO
HSI
Medical
Board
Barbara
Aehlert,
RN,
BSPA
Richard
Abraham,
M.D.
Gregory
R.
Ciottone,
M.D
Raymond
Jarris,
M.D.
Marvin
Wayne,
M.D.
ASHI
and
Medic
First
Aid
Program
Advisory
Group
Jimmy
W.
Allen
Kim
Dennison,
RN,
BSN,
COHN‐S,
ACLS
Bradford
A.
Dykens,
EMT‐P
Howard
Main,
CCEMTP
John
F.
Mateus
RN,
EMT‐B
Kira
A.
Miller,
EMT‐B
Mark
Register,
EMT‐P
W.
Daniel
Rosenthal
R.N.,
B.S.
Tana
Sawzak,
EMT‐B
Marcy
Thobaben,
LPN,
EMT‐B
HSI
Professional
Staff
William
Clendenen
Ralph
Shenefelt
William
Rowe
Corey
Abraham
Jeff
Myers
i
Hazinski
MF,
Nolan
JP,
et
al.,
Circulation.
2010;122
[suppl
2]:
Part
1‐12,
S250
–
S581.
©
2010
American
Heart
Association®,
Inc.,
European
Resuscitation
Council,
and
International
Liaison
Committee
on
Resuscitation.
ii
Markenson
D,
Ferguson
JD,
et
al.,
Circulation.
2010;122
[suppl
2]:Part
13,
S582–S605.
©
2010
American
Heart
Association®,
Inc.,
and
American
Red
Cross.
iii
Field
JM,
Hazinski
MF,
et
al.,
Circulation.
2010;122
[suppl
3]:Part
1‐16,
S640‐
S933.©
2010
American
Heart
Association®,
Inc.
iv
Markenson
D,
Ferguson
JD,
et
al.,
Circulation.
2010;122
[suppl
3]:Part
17,
S934
–S946.
©
2010
American
Heart
Association®,
Inc.,
and
American
Red
Cross.
24|
P a g e