Emergency First Response Article Excerpts

from PADI Training Bulletins 1Q 2010 – 4Q 2022

If you wish to obtain the complete versions of PADI Training Bulletins (2010 –
2022), please contact your Regional Training Consultant

First Quarter 2010

EFR Instructor Prerequisites Standards change:
Revise EFR Instructor prerequisite to read:
1. EFR Primary and Secondary Care (or qualifying training) within the past 24 months.
2. 18 years old.

Fourth Quarter 2010

EFR Meets Workplace Requirements in Two Canadian
Provinces
Effective immediately, EFR instructors using the Canadian EFR materials can teach EFR
workplace programs in the Canadian provinces of Alberta and Newfoundland and Labrador

Additional Accreditations
In Switzerland EFR Training recognized as meeting first Aid and CPR requirements for drivers license.

First Quarter 2011

New CPR Guidelines for EFR and PADI courses
European Resuscitation Council Changes
New Guideline Old Guideline Rationale for Change
When obtaining help, ask When obtaining help, ask for With more AEDs in public
someone to call for an ambulance someone to call for an places, it’s common to have one
and to bring an automated ambulance accessible when administering
external defibrillator CPR
(AED), if one is available

Compress adult chest to at least Compress adult chest 4-5 cm and a Emphasis is on good quality
5 cm at a rate of at least 100 rate of 100 compressions per minute chest compressions with an
compressions per minute attempt to reduce the number
and duration of pauses during
compressions
Compress infant chest to Compress infant or child chest to Emphasis is on providing
approximately 4 cm and child approximately one third the quality compressions of an
chest to approximately 5cm at a depth of the chest at 100 adequate depth
rate of 100-120 compressions compressions per minute
per minute
To minimise interruptions in chest No reference to continuing Emphasis is on reducing the
compressions, if there is more than chest compressions while number and duration of pauses
one rescuer present, preparing the AED during chest compressions
continue CPR while the AED is
switched on and the pads are
being placed on the patient
American Heart Association Changes
New Guideline
No “Look, listen, and feel” for
breathing
Begin CPR by providing 30 chest
compressions, then open the
airway and give two breaths.
If you suspect possible drowning,
begin CPR with
rescue breaths before chest
compressions
Compress adult chest to a
depth
of at least 2 inches (5
cm)
Compression depth for
children and infants is one third
the diameter of the chest. This
corresponds to approximately 2
inches (5cm) for children and
1ó inches (4cm) for infants
Give compressions at a rate of at
least 100 per minute
To minimize interruptions in chest
compressions, if there is more than
one rescuer present, continue CPR
while the AED is switched on and
the pads are
being placed on the patient
For infants (less than 1 year of
age) use of an AED with
pediatric dose reducer is
recommended.
An AED without a
dose attenuator may be used if a
pediatric one is not available.
Reduced emphasis on barrier use
when providing CPR. Although
still recommended, treatment
should not be delayed if
barriers are not
available.
Old Guideline
“Look, listen and feel” for
breathing before administering
rescue breaths and chest
compressions
Give two rescue breaths prior to
giving 30 chest compressions
Compress adult chest to a
depth of 1ó to 2 inches
Administer chest compressions at
one third to one half of the
diameter of the chest for child
and infant CPR
Give compression at a rate of
approximately 100 per minute
No reference to continuing
chest compressions while
preparing the AED
AED use for infants (less than 1
year of age) was not
recommended
Emphasized use of barriers
Rationale for Change
Minimize the delay in
providing chest compressions
Existing oxygen in the lungs and
in the circulatory system is
sufficient to provide
immediate benefits provided by
chest compressions
Emphasis is on providing good
quality chest compressions
with sufficient depth to provide
adequate circulation
Emphasis is on providing
quality compressions of an
adequate depth
Emphasis is on good quality
chest compressions at a rate to
provide adequate circulation
Emphasis is on reducing the
number and duration of pauses
during chest compressions
Use of AED on infants has
shown to be effective
Research has shown that
disease transmission is very rare
when providing CPR
AHA First Aid Changes
Allergic Reactions
• For patients carrying an epinephrine kit, help patient use it following directions. If symptoms
of anaphylaxis persist despite epinephrine administration, seek medical assistance before
administering a second dose of epinephrine. In unusual circumstances, when advanced medical
assistance is not available, a second dose of epinephrine may be given if symptoms of
anaphylaxis persist.

Heart Attack
• Advise the patient to chew one adult (nonenteric- coated) or two low dose aspirins, if the patient is
complaining of chest pains and does not have a history of allergy to aspirin and no recent
gastrointestinal bleeding. This may be performed after activating the EMS system.

Venomous Bites and Stings

• For snake bites, apply a pressure immobilization bandage around the entire length of the bitten
extremity. This is an effective and safe way to slow the dissemination of venom. Care must be taken to
ensure the pressure bandage is not too tight. You should be able to slide a finger under the
bandage.

• Treat jellyfish stings by liberally washing the affected area with vinegar (4-6% acetic acid solution) for
at least 30 seconds to inactivate venom and prevent further envenomation. After the nematocysts
are removed or deactivated, treat pain with hot-water immersion when possible.

Second Quarter 2011

Q. Is rescue breathing still a part of CPR in EFR courses?

A. Yes. For laypeople, the recommendations still include teaching compressions with rescue breathing.
While compression-only CPR is better than no CPR, it is a recommended procedure for untrained lay
rescuers, or trained rescuers who choose not to provide rescue breaths.

EFR First Aid at Work (Asia Pacific edition) Changes

The Australian Resuscitation Council flow chart for Basic Life Support now includes S for Send for
help – DRSABCD. Therefore, the EFR First Aid at Work (FAW) Patient’s LIFELINE now is as follows:
D = Danger?
R = Responsive?
S = Send for Help
A = Airway Open?
B = Breathing Normally?
C = Start CPR! Compressions first, then breaths (30:2)
D = Defibrillation
 ILCOR Organizations Publish Guidelines:
Australian Resuscitation Council and New Zealand
Resuscitation Council CPR Changes
New Guideline
Emergency priorities state that the
rescuer must “send for
help”
Lower half of sternum should be
depressed by 1/3 chest depth with
each compression. This is more
than 5 cm in adults,
approximately 5 cm in children and
4 cm in infants.
New focus on maintenance of
CPR quality including
recommendations
to change rescuers
every 2 minutes to decrease
rescuer fatigue and maintain
depth and rate of
compressions.
Automated External Defibrillators
(AEDs) has made defibrillation part
of basic life support.
AEDs can accurately identify
cardiac rhythm as “shockable” or
“nonshockable.”
In victims who need resuscitation,
bystander CPR dramatically
increases the chance of survival.
It rarely leads to harm in victims
who are eventually found not to
have suffered
cardiac arrest: bystander CPR
should be actively encouraged.
CPR skills should be refreshed at
least annually.
BLS Flowchart
Steps in resuscitation are: DRSABCD Steps in resuscitation are: DRABCD
D – check for Danger
R – check for Response
S – Send for help (added)
A – open the Airway
B – check Breathing but no
need to deliver two rescue
Old Guideline
Emergency priorities state that the
rescuer must “call for help”
Lower half of sternum should
be
depressed by 1/3 chest depth with
each compression. This is at least
4-5 cm in adults.
NONE
The Australian Resuscitation
Council (ARC) recommends the use
of an AED if available
NONE
ARC recommends that all those
trained in CPR undertake at
least an annual competency
assessment in CPR
BLS Flowchart
D – check for Danger
R – check for Response
A – open the Airway
B – deliver two rescue Breaths
C – perform 30 Compressions on
victims who are
Rationale for Change
Minimize the delay in
providing chest compressions
Emphasis is on providing
quality compressions of an
adequate depth.
Emphasis is on good quality
chest compressions.
Recognizes the role of AEDs as part
of BLS in both out of hospital
and in hospital environments.
Clear recommendations
that training in AED use should be
part of BLS education.
Increase emphasis on bystander
CPR as lifesaving intervention.
Recommendation to refresh
CPR skills at least annually (as
opposed to undertake annual
competency assessment).
CPR starts with compressions
rather than breaths for
unresponsive/ not breathing
normally patients. Emphasis is
on minimizing chest
compression delay.
Facilitates compression-only
CPR for those unable/unwilling to
perform rescue breaths.
 breaths unresponsive
C – perform 30 Compressions on and not breathing
victims who are unresponsive normally, followed by two
and not breathing breaths
normally, followed by two D – attach an AED if it is available
breaths
D – attach an AED as soon as it is
available

Third Quarter 2011

The traditional ABCs order of priority care has been adjusted to AB-CABS

First Quarter 2012

Primary and Secondary Care Participant Exam Answer Key
Changes
The EFR Primary and Secondary Care Participant Exam answer key (Product No. 71827 v1.0) errors have
been corrected, and a revised version of the exam key (v1.01) is available for download from the PADI
Pros’ Site and the EFR Instructor site.

Primary Care Exam

Question 4 – answers should be A, C and D
Question 8 – answer should be False Question 13
– answers should be A and D

Secondary Care Exam

Question 3 – answers should be A and C
Please contact an Educational Consultant at your
PADI Regional Headquarters if you have any questions.

Exam and Form Changes

Please correct question 1 of the EFR Instructor Course Exam answer key (Product No. 71852
v1.0) – mark Option A as a correct answer as well.

Making this correction updates the answer key to v1.01. EFR Instructor Trainers can order an updated
Instructor Course Exam Answer Keys (v1.01) from your PADI Regional Headquarters.

EFR Primary and Secondary Care Participant Final Exam

Please correct the typographical error on page 6, question 1, answer option a of the EFR Primary and
Secondary Care Participant Exam (Product No. 71825 v1.0):
“Heart attack or sudden cardiac arrest” Change “attach” to “attack.”

Second Quarter 2012

Care for Children
It may be conducted as a stand-alone course or may be integrated with the Primary Care (CPR) and
Secondary Care (First Aid) courses to prepare participants to assist people of all
ages.

First Quarter 2014

Shift to Annual Renewal Cycle
Historically, the EFR® professional credential renewal cycle has been every two years, while PADI
Membership is renewed annually. To make things simpler and more streamlined for you, EFR
Instructor and Instructor Trainer credential renewals are transitioning to an annual cycle, aligned with
PADI’s membership renewal cycle.

Update Your EFR Materials

Change the following EFR renewal references from “every two years” to “every year:” Emergency First

Response Instructor Trainer Guide “Course Overview and Standards”

Section heading: “Emergency First Response Instructor Renewal,” first paragraph.

Section heading: “Instructor Trainer Qualifications and Renewal,” sub heading “Renewal
Requirements,” first paragraph.

“Appendix”
EFR Instructor Course Exam: question 42, answer “C.”

Emergency First Response Primary & Secondary Care Instructor Guide

“Course Overview and Standards” Section heading: “Emergency First Response Instructor
Renewal,” first paragraph.

EFR Instructor Course Exam booklet Question 42, answer “C.”

Second Quarter 2014

EFR Materials Requirement Change
You’ve always had the option of combining the Emergency First Response (EFR) Primary and
Secondary Care Course with the Care for Children program. If you are teaching both programs,
combining them saves time, because many guidelines for adults are the same for children. Up until
now, students have been required to have both participant manuals.
Effective immediately, you have the option of offering the Care for Children course in conjunction
with your Primary Care (CPR) and/or Secondary Care (First Aid) course using only the Emergency
First Response Primary and Secondary Care Participant Manual.

When combining these two programs using the one manual, you must use the Knowledge
Development Outlines from the Care for Children Instructor Guide to elaborate on necessary
information specific to the care of children and infants. Then, incorporate the Care for Children Skills
and Scenario Practice as outlined in the recommended sequence for teaching both courses
combined found in the EFR Care for Children Instructor Guide. Upon completion of all performance
requirements, you fill out the Course Completion Authorization, marking that the student has
completed Primary Care (CPR) and Secondary Care (First Aid) and Care for Children courses.

Please note this change in Section One of the Emergency First Response Care for Children
Instructor Guide, Course Overview and Standards, first paragraph under “Integrating
Emergency First Response Courses,” second sentence. It should now read: “The Primary and
Secondary Care Participant Manual is required when teaching the combined courses,
however, both manuals are recommended.”

Fourth Quarter 2014

Emergency First Response (EFR®) Compressions-Only CPR
Program
Over the last few years, many articles have been published about the benefits of compression-only
(or “hands-only”) CPR. This technique involves providing continuous chest compressions, without
stopping to provide ventilations. Compression-only CPR can
effectively circulate unused oxygen left in the patient’s lungs and blood stream to the vital organs
of the body.

Effective immediately, EFR Instructors can now offer Compression-only CPR training using the
current CPR & AED Participant Manual and instructor guide.

First Quarter 2016

New CPR Guidelines for EFR and PADI Courses
Member organizations of the International Liaison Committee on Resuscitation (ILCOR) have begun
to release new cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC)
guidelines.
Emergency First Response® (EFR) and PADI courses follow these guidelines and implement
changes whenever protocols are revised. The latest updates from ILCOR indicate relatively small
changes to the way CPR and first aid is conducted by lay-people; this is a reflection of the success of
CPR in modern times. Please update your Emergency First Response courses to including the
following information:

CPR
✦Perform chest compressions at a rate of 100 – 120 per minute for adult, child, and
infant.
✦Perform compressions to a depth of 5 centimetres/2 inches for an average adult while
avoiding excessive chest compression depths (greater than 6 centimetres/2.4 inches).
✦Do not interrupt chest compressions for more than 10 seconds.
✦Always call EMS immediately for anyone with chest pain or other signs of a heart attack,
rather than trying to personally transport the person to a healthcare facility.

The use of mannequins that provide feedback on depth and rate of compressions is now
encouraged.
However, other mannequin types are still acceptable. Also, consider using auditory guidance
(metronome or music) to improve compression rate.

Diabetic Problems (low blood sugar, hypoglycemia)

✦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. If these tablets are not available, you may provide the patient with fruit
juice, soda or candy if available.
✦Symptoms may not resolve until 10 to 15 minutes after ingesting glucose tablets or dietary sugars.
Emergency responders should wait at least 10 to 15 minutes before calling EMS and
retreating a diabetic with additional oral sugars. If the diabetic’s status deteriorates during that time or
does not improve, call EMS.

Serious bleeding
✦A tourniquet may now be considered for initial care when an emergency provider is
unable to use direct pressure to control bleeding, such as during a mass casualty incident, with a
person who has multisystem trauma, in an unsafe environment, or with a wound that can’t be
accessed. Tourniquets can be effective for severe external limb bleeding.
✦Note the time that a tourniquet is first applied and communicate this information to EMS
providers.
Tourniquets use in the prehospital setting have been found to control bleeding effectively in most
cases and have a low rate of complications.

Burns
✦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 burns. Care should be taken to monitor for hypothermia
when cooling large burns.

You can implement these changes into your course immediately. The required implementation is no
later than 31 March 2016. To keep EFR and PADI courses current and internationally applicable, course
materials are being revised to reflect these recent guidelines.
To assist you in updating your EFR knowledge and teaching techniques, you’ll find a series of
pre-recorded webinars that are free of charge and available in a range of languages on the EFR and
PADI Pros’ Sites.
As other resuscitation council national guidelines are released, you will find more detailed
information about them and how they apply to EFR and PADI courses in The Responder.
For detailed references, see the full 2015 American Heart Association Guidelines for CPR and
ECC and the ILCOR document in the journal Circulation at
circ.ahajournals.org/content/132/16_suppl_1.toc, and view the ERC Guidelines 2015 at
www.cprguidelines.eu/.

Second Quarter 2016

EFR Guidelines 2015 Update Australia and New Zealand
Following the release of the 2015 guidelines for CPR and emergency cardiovascular care by the
International Liaison Committee on Resuscitation (ILCOR) the Australian and New Zealand
Committee on Resuscitation (ANZCOR) released its new guidelines mid-January 2016. These now
replace all earlier existing Australian and New Zealand Resuscitation Council guidelines and are
endorsed by both councils.
With this new release, the only change to ANZCOR basic life support guidelines is related to
the rate of chest compressions, which changed from approximately 100 to a range of 100 - 120
compressions per minute.
For detailed references on the new ANZCOR guidelines please refer to resus.org.au when
teaching in Australia and to nzrc.org.nz when teaching in New Zealand.
 As announced in First Quarter 2016 Training Bulletin, PADI, EFR and RTO materials are
being revised to reflect all recent changes. Remember, the required implementation date of all
new CPR and first aid guidelines was no later than 31 March 2016.

Third Quarter 2016

New Emergency First Response® Instructor Guide
Errata Available
Make sure that your Emergency First Response (EFR) Instructor Guides are up-to-date by
referencing the
2016 errata document on the EFR and PADI Pros’ Site. This document outlines changes to the
instructor
guides resulting from ILCOR Guidelines 2015. Related updates to the English version Emergency
First Response Primary and Secondary Care student manuals are available now. The EFR Quick
Reference Card, Care for Children manual and CPR/AED manuals will be updated soon.

Fourth Quarter 2016

Q. Emergency First Response® (EFR®) courses mention that if for some reason an
emergency responder can’t or won’t provide rescue breaths in a real emergency requiring
CPR, giving compressions alone may still help. How does that relate to CPR given for
drowning victims?
A. Giving rescue breaths is emphasized for drowning victims. Because lack of breathing due to
drowning is often suspected in dive accidents, rescue breathing remains a key skill in diver rescue. The
PADI Rescue Diver course teaches divers to provide in water rescue breaths, and once on a stable
platform, to start CPR – including both rescue breaths and compressions to aid non-breathing dive
accident victim. In many countries, protocol for suspected drowning is immediate CPR if possible;
giving breaths first, followed by chest compressions.
Following base ILCOR recommendations, in other countries the local ILCOR representatives
emphasize the need for rescue breathing with suspected drowning, but do not specify starting CPR
with breaths. Experts in the medical community don’t agree on how important giving breaths first is in
drowning cases, but virtually all agree that beginning CPR (breaths and compressions) as soon as
possible is important.
Giving chest compressions with rescue breaths continues to be the standard of care (best
chance for successful outcome) for layperson CPR, which is why both skills are taught as a two-step
CPR process in EFR courses. In any emergency with a non-breathing patient, giving chest
compressions alone is not ideal, but if for some reason the rescuer can’t, or has fears about giving
rescue breaths, then giving chest compressions alone is still considered beneficial.

Second Quarter 2018

United States Coast Guard Renews EFR® Recognition
Soon after Emergency First Response released the Primary and Secondary Care program in 2002, the
United States Coast Guard (USCG) approved it to meet the first aid and CPR requirement for the
USCG merchant mariner licensure. To maintain this approval, the USCG requires a program review
every five years. The result of this re-evaluation extended USCG approval of EFR Primary and
Secondary Care courses another five years to 28 February 2023.
To meet merchant mariner licensure requirements, Primary and Secondary Care training
needs to be completed within one year of merchant mariner application. The student must be issued
a certificate of training containing the following information:
 ⮚ Name and code of the course as First Aid & CPR (Emergency First Response-Primary and
Secondary, code- EMERFR-197)
⮚ Name of the educational institution (Emergency First Response)
⮚ Date of completion and location where the training was conducted
⮚ Name of the student
⮚ Signature of an authorized representative of the school (instructor’s signature)

EFR Certificates (Product No. 40021) may be ordered through your local PADI/EFR Office to meet this
need. EFR Instructors can take advantage of this approval by actively reaching out to those seeking
CPR and first aid training to meet USCG licensure requirements.
In addition to this approval, EFR courses and programs have been rigorously evaluated
by other respected third party authorities in a number of countries and achieved significant
accreditation and approval. You can review a list of these recognitions at http://www.emergencyfi
rstresponse.com/pros/accreditations.aspx . To learn more about the United States Coast Guard go to
www.uscg.mil.

Third Quarter 2018

EFR Primary and Secondary Care Participant Manual – Korean
Please note the following error in the EFR Primary Care Knowledge Review, Question 17, page
1-37 of the EFR Primary and Secondary Care Participant Manual – Korean (70370K Rev. 07/17
Version 1.02). The question should correctly ask: “Why is defibrillation important to a patient with
cardiac arrest?” The answer choices and the answer key are correct.

Please make sure your students are aware of the correct text for this question, which, in Korean,
should read:

The manual will be corrected upon reprint. Fourth

Quarter 2018
ILCOR CONSENSUS MARCH 2018
Emergency First Response and PADI courses keep pace with current research and treatment
recommendations in emergency care. The most recent news indicates that no changes to CPR
procedures are necessary in EFR courses. After reevaluation of science and research, the International
Liaison Committee on Resuscitation’s (ILCOR) most recent Consensus on Science and Treatment
Recommendations do not include any changes to bystander CPR. ILCOR reaffirmed three areas of
bystander treatment as published in the journal, Resuscitation 121 (2017) 201-214:

● We continue to recommend that bystanders perform chest compressions for all

patients in cardiac arrest. We suggest that bystanders who are trained, able, and
willing to give rescue breaths and chest compressions do so for all adult patients in
cardiac arrest.
 ● We suggest a compression/ventilation (CV) ratio of 30:2 compared with any other CV
ratio in patients with cardiac arrest.
● We suggest that bystanders provide CPR with ventilation for infants and children less
than 18 years of age with cardiac arrest. We continue to recommend that if
bystanders cannot provide rescue breaths as part of CPR for infants and children
under 18 years of age with cardiac arrest, they should at least provide chest
compressions.

First Quarter 2019

Immediate Feedback Devices in CPR Training

Q. May I use feedback manikins or devices that let students know if their
compression rate and depth is appropriate in EFR® courses?
A. Absolutely. At least one resuscitation council, the American Heart Association, recommends the
use of quality CPR feedback devices to teach adult CPR based on research.

Though CPR skill repetition is essential, there is speculation that the use of feedback devices may
reduce mastery time as participants self-correct in response to the device’s real-time feedback. ILCOR
Guidelines in recent years have re-emphasized compression rate, depth and recoil, which make these
devices an interesting teaching aid for skill mastery evaluation.

The important aspect of using manikins that provide immediate results on compression rate, depth
and recoil in EFR courses is to do so in a reassuring way, so the competent-versus- perfect
philosophy outlined in the EFR Instructor course is not compromised. Keep in mind that CPR
students often feel intimidated by the practical skills and can feel performance anxiety, particularly
when they’re not able to achieve great feedback results right away.

Unless a level of comfort and support is achieved by the instructor in the CPR classroom, the
participant’s ability to learn and retain skills and be willing to offer them in an emergency can be
severely reduced. However, used properly, compression feedback devices are a teaching tool that
can effectively help EFR students bring their practical CPR skills in line with current compression rate,
depth and recoil guidelines. A variety of feedback devices are available, some built into the manikin,
and others can be added to and used with existing manikins.

First Quarter 2020

Global Recognition
Emergency First Response® has gained further endorsement for its Primary and Secondary Care
courses. The CPD Certifcation Service in the United Kingdom has accredited the EFR® Primary and
Secondary Care courses for the purpose of Continuing Professional Development (CPD) credit. EFR
Primary and Secondary Care course participants worldwide seeking CPD credit now have the
opportunity to gain a CPD certifcate of recognition (equivalent eight hours of credit) toward their
professional development. For more information, contact:
info.emea@emergencyfirstresponse.com

Fourth Quarter 2020

New EFR Airborne Pathogen Awareness Distinctive Specialty Course
Emergency First Response® has released the EFR Airborne Pathogen Awareness
distinctive specialty course. The EFR® Airborne Pathogen Awareness distinctive
specialty provides participants with a fundamental understanding of diseases
that are transmitted primarily through the respiratory system. Participants learn
the main mechanisms of transmission, as well as methods for reducing
transmission risk through the use of disinfection, protective equipment,
distancing and airflow.

The EFR Airborne Pathogen Awareness distinctive specialty course is an excellent

opportunity to grow your EFR business while also providing a much sought-after
service to businesses around the globe.
At present, the EFR Airborne Pathogen Awareness distinctive specialty instructor
materials are available in English and Italian only; further translations will follow as
needed. Learn how to become an EFR Airborne
Pathogen Awareness Instructor or by going to the PADI Pros’ Site.

EFR International Accreditation

Emergency First Response has gained additional endorsement for the First Aid at
Work and Emergency First Aid at Work course through the CPD Certification
Service in the United Kingdom. EFR® course participants (worldwide) seeking CPD
credit now have the opportunity to receive a CPD certificate of recognition toward
their professional development. Learn more on the PADI Pros’ Blog.

Second Quarter 2021

EFR-AUTHORED DISTINCTIVE COURSES AVAILABLE FOR PROCESSING IN OLPC
3.0
There are several distinctive specialty courses available for EFR® Instructors to add
to their suite of course offerings, including:
• EFR Manual Handling
• EFR Mental Health Awareness
• EFR Airborne Pathogen Awareness
EFR Instructors who register participants for these courses may now do so via the
PADI Online Processing Center (OLPC 3.0) and eCards will be issued.
EFR Instructor Trainers need to make it clear to non-PADI EFR Instructor candidates
that they will need to purchase Course Completion Authorizations (CCA). Upon
processing, physical completion cards will be issued.
EFR Instructors wishing to also issue a wall certificate as evidence of course
completion may complete the digital certificate found in the Instructor Materials
available on the EFR Distinctives page on the PADI Pros’ Site. The digital certificate
requires the student number to be inserted.

SWISS RESUSCITATION COUNCIL RECOGNIZES EMERGENCY FIRST

RESPONSE
Emergency First Response® has secured further international recognition. The
Swiss Resuscitation Council (SRC), a member of the European Resuscitation
Council, has recognized the Emergency First Response Primary Care course for the
purposes of CPR training within Switzerland. EFR Instructors teaching this course
 in Switzerland are required to use additional instructor materials. Please contact
training.emea@padi.com
For more information.

First Quarter 2022

Emergency First Response®
Tourniquet Use in Emergencies
Since the release of the 2020 ILCOR Guidelines,
tourniquet use may be considered as a means of
controlling life- threatening bleeding when direct
pressure and haemostatic dressings can’t control the
bleeding.

In your EFR® Primary and Secondary Care Instructor

Guide, under the heading of Primary Care Skill 6, Serious
Bleeding Management, under Critical Steps, after
Pressure Bandage, please add a new subheadings:

Commercial Tourniquet
• For life-threatening bleeding that can’t be controlled by direct pressure and dressings, and in a
location where you can use a tourniquet (i.e. arm or leg wounds, amputations), apply a commercial
(manufactured) tourniquet as soon as possible.
• Place the tourniquet around the wounded limb,
ideally 5-7 centimetres/2-2.5 inches above the
wound but not over a joint.
• Tighten the tourniquet until the bleeding slows and
stops, though some minor oozing is acceptable.
This tightening will be painful, so it may help to
warn the patient and in why you have to do it.
• Maintain the tourniquet pressure.
• Note the time that the tourniquet was applied by writing it on the tourniquet or the patient.
• Once applied, do not remove the tourniquet – the tourniquet must only be removed by a
healthcare professional.
• Monitor for shock and continue to use the Cycle of Care to monitor the patient’s medical status.
• Some cases may require two tourniquets in parallel to slow or stop the bleeding. If necessary,
apply the second tourniquet directly above the first.

Improvised Tourniquet
• If a commercial tourniquet is not immediately available or it doesn’t control bleeding alone,
reapply direct manual pressure with a gloved hand and a sterile dressing. If sterile dressing is
not available, use standard gauze, a t-shirt or other fabric as available.
• Use of an improvised tourniquet only for life-threatening bleeding that isn’t controlled by
direct pressure and in situations where a manufactured tourniquet is not available.
• To apply an improvised tourniquet, take a triangular bandage and roll to a width of 7-10
centimetres/3-4 inches. If no triangular bandage is available, a piece of clothing such as a
necktie, bandana or other similar cloth item can be tied around the limb. It must be strong
enough to be wound tightly. Note: Use of a belt is not suitable.
• Wrap the triangular bandage (or other item) around the limb, about 5 centimetres/2-2.5 inches
above the wound site and tie a square knot over the top of the limb.
• Locate a suitable and sturdy windlass – hard wood stick, a pen flashlight, carabiner, spoon, a pair of
shears, a wrench or similar – and place on top of the knot. Beware of objects like pencils and pens
because they can snap.
 • Tie another square knot on top of the windlass to secure it in place.
• Turn windlass so a large knot forms directly under it on the limb.
• Tighten until bleeding is controlled, then secure by tying the loose knot tails over windlass.
For more information on the use of tourniquets, please refer to the PADI Pros’ Blog article
Techniques for Controlling Catastrophic Bleeding.

Second Quarter 2022

Extension Discontinued for PADI Course First Aid and CPR
Requirements
The 9 April 2020 Training News announced that the requirement to have CPR/first-aid
training within 24 months for certain PADI courses was extended to 36 months in response to
the difficulties students had to complete practical training as a result of restrictions caused by
the pandemic.
Effective immediately, this extension has been discontinued as a result of precautions to
avoid the transmission of COVID-19 now being well embedded in Emergency First
Response® Training programs and as social restrictions around the world are lifting.

If you wish to obtain the complete versions of the Training Bulletins (2010 –
2023), please contact your local Training Consultant