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INFO: First Aid/CPR

First Aid/CPR

First aid (including CPR) is the initial medical care given to an ill or injured patient, usually outside the hospital at the scene of the emergency. First aid may be all the care a patient needs to fully recover, or it may be critical care required to stabilize the patient until more advanced medical personnel arrive. First aid training should include the following key components:

Background in anatomy, physiology, pathophysiology, medical terminology, and current care guidelines as well as protocols that limit care
Information about preventing disease transmission, including body-substance isolation protocols, exposure control plan, engineering controls, work-practice controls, and blood clean-up procedures
Assessment protocols, including scene size-up, primary/ongoing assessment, and secondary assessment
Care for life-threatening conditions, including respiratory distress/arrest, sudden cardiac arrest, and severe bleeding
Care for trauma cases, including wounds, burns, musculoskeletal injuries, and spinal injuries
Care for medical emergencies, including sudden illnesses, poisoning, bites and stings, drug abuse, environmental emergencies, behavioral emergencies, and obstetric emergencies

First aid and CPR protocols continue to be reviewed and improved nationally and internationally by the scientific and medical community. The last update was published in November 2010 by the Emergency Cardiac Committee (ECC) of the American Heart Association in association with the International Liaison Committee on Resuscitation (ILCOR).

Background First Aid Information

2010 ECC/ILCOR Guidelines

Key Changes in CPR and ECC (Taken from Part 1: Executive Summary: 2010 AHA Guidelines for CPR and ECC, S643-S644)

"Look, listen, and feel" eliminated in favor of a quick check for responsiveness and normal breathing. NOTE: The ARC protocol retains the pulse check; the AHA protocol eliminates it.
Compression-Only CPR to be taught to untrained rescuers who witness a sudden collapse.
Chest compressions now proceed breaths (CAB rather than ABC) for sudden cardiac arrest victims. For hypoxic victims, the ABC protocol is retained.
High-quality CPR is emphasized, including chest compressions of appropriate depth, at a rate of at least 100 per minute, with complete chest recoil between compressions and without excessive pauses.
Appropriate compression depth is changes to 1.5 inches for infants, 2 inches for children, and at least 2 inches for adults.
Tasks in resuscitation attempts (e.g., chest compressions, airway management, rescue breathing, AED use, etc.) to be performed concurrently as much as possible by trained rescue teams.

Points of Continued Emphasis in 2010 AHA Guidelines (Taken from Part 1: Executive Summary: 2010 AHA Guidelines for CPR and ECC, S643-S644)

Early recognition of sudden cardiac arrest based on assessing responsiveness and the absence of normal breathing. Training should focus on alerting potential rescuers to unusual presentations of cardiac arrest victims, including gasps and seizure-like signs.
Interruptions in CPR to be minimized. There is no reassessment of the victim once CPR is started.
The importance of the pulse check to be minimized. Detection of a pulse is difficult, and even highly trained healthcare providers often incorrectly assess the presence or absence of a pulse when blood pressure is low or absent. Rescuers should take no more than 10 seconds to determine if a pulse is present. Chest compressions delivered to patients subsequently found not to be in cardiac arrest rarely lead to significant injury. Lay rescuers should not attempt a pulse check and should assume that cardiac arrest is present if an adult suddenly collapses, is unresponsive, and is not breathing (or not breathing normally).

Links to the 2010 ECC Guidelines

Anatomy and Physiology

Pathophysiology

Body System Failures (General)

Shock

Skin Discoloration

Airway Management/Oxygen

First Aid for Choking

Head Tilt Chin Lift

Modified Jaw Thrust

Nasal/Oral Airways

Oxygen Administration

Suctioning

Assessment of Scene/Patient

General/All Inclusive

Principles of Assessment (Brady EMT-B; 1995)

Scene Size-up

Positioning the Patient

"As a general rule a victim should not be moved, especially if you suspect, from the victim’s position or the nature of the injury, that the victim may have a spinal injury. There are times, however, when the victim should be moved:

If the area is unsafe for the rescuer or the victim, move the victim to a safe location if it is safe to do so
If the victim is face-down and unresponsive, turn the victim face-up
If the victim has difficulty breathing due to copious secretions or vomiting, or if you are alone and have to leave an unresponsive victim to get help, place the victim in the High Arm IN Endangered Spine (HAINES) recovery position. Extend one of the victim's arms above the head so the victim's head rests on the extended arm. Bend both legs to stabilize the victim.
If the victim shows evidence of shock, have the victim lie supine. If there is no evidence of trauma or injury, raise the legs about 6 to 12 inches (30 to 45 degrees). Do not raise the legs if the movement or position causes the victim any pain." --Part 17: First Aid: 2010 American Heart Association and American Red Cross Guidelines for First Aid.

Primary (Initial) Assessment/Ongoing Assessment

EMS Activation

Secondary Assessment

Recovery Position

According to 2010 ECC Guidelines: "The recovery position is used for unresponsive adult victims who clearly have normal breathing and effective circulation. This position is designed to maintain a patent airway and reduce the risk of airway obstruction and aspiration. The victim is placed on his or her side with the lower arm in front of the body."

"There are several variations of the recovery position, each with its own advantages. No single position is perfect for all victims.... The position should be stable, near a true lateral position, with the head dependent and with no pressure on the chest to impair breathing.... Studies in normal volunteers... show that extending the lower arm above the head and rolling the head onto the arm, while bending both legs, may be feasible for victims with known or suspected spinal injury...." --Part 5: CPR Overview: 2010 American Heart Association Guidelines for CPR and ECC, S694.

HAINES Recovery Position (Elementary First Aid) - Different than ARC version
HAINES Recovery Position Explained and Illustrated (Self-Care Decisions) - More like ARC version
HAINES Recovery Position (Australian First Aid)

Automated Ext. Defibrillator (AED)

Bandaging/Wound Care/Trauma

General Bandaging/Wound Care

Bandage Type/Techniques

Adhesive Bandages

Elastic Bandage

ACE Bandage Wrapping How Tos (3M)

Roller Gauze

Triangular/Cravat Bandage

Special Bandaging/Wound Care

Gunshot/Knife Wounds

Impaled Object

Protruding Organs (Abdominal Evisceration)

Severed Body Part

Sucking Chest Wound

Tourniquet

Bleeding/Shock

External Bleeding

Internal Bleeding

Shock (Hypoperfusion)

Treatment

Muscle, Bone, and Joint Injuries

Dislocations

Shoulder Dislocations (Dr. Nabil Ebraheim)

Fractures

Arm/Shoulder

Leg Fractures

Splinting the Leg in the Field (Skinny Medic)

Sprains

Strains (Muscle Pulls/Tears)

Neck Muscle Pull (Tara Pollak for eHow)

Body Substance Isolation (BSI)

Breathing Devices

Cleanup of Spills

Diseases of Concern

Bloodborne Pathogens
Other Diseases and Infections

Tuberculosis (SafetyIsSimple)

Engineering and Work Practice Controls

Exposure Control Plan

American Safety Council

OSHA Regulations

Bloodborne Pathogens Training

CPR Standards and Skills

Adult/Child CPR

Hands-Only CPR

High-Quality CPR

Health and Safety Institute
The Quest for High-Quality CPR (JEMS)
High-Frequency Chest Compressions (Rate of >120 per Minute) - "High frequency chest compressions... has been studied as a technique for improving resuscitation from cardiac arrest. The sparse human data have demonstrated mixed results.... There is insufficient evidence to recommend the routine use of high-frequency chest compressions for cardiac arrest. However, high-frequency chest compressions may be considered by adequately trained rescue personnel as an alternative." --Part 7: CPR Techniques and Devices: 2010 American Heart Association Guidelines for CPR and ECC, S720. WSG Comment: The frequency of chest compressions should not compromise the quality of CPR in terms of compression depth and full recoil of the chest following each compression.

Infant CPR