2010 Guidelines

Instructor Update

Welcome !
This class will provide you with information about the recently released changes in emergency medical care and how those changes affect your authorization as an ASHI or MEDIC First Aid Instructor.

Purpose of Class
Highlight the major changes in science, treatment recommendations, and guidelines. Provide helpful guidance to you for the transition to new materials.

Learning Objectives
Identify the four central publications for changes in the 2010 science, treatment recommendations, and guidelines. Identify the scheduled release dates for updated training programs. Describe the significant changes affecting ASHI and MEDIC First Aid training programs. Describe the rationale for the changes being made.

Who is HSI?

About HSI
The Health & Safety Institute (HSI) unites the recognition and expertise of:
American Safety & Health Institute MEDIC FIRST AID International 24-7 EMS 24-7 Fire

First Safety Institute

HSI is the largest privately held emergency care training organization in the world.

Proven Track Record

In business for more than 30 years. In more than 100 countries. Over 16,000 training centers approved. Over 200,000 Instructors authorized.

More than 19 million providers certified.

Training Structure
HSI develops and markets proprietary training programs, products, and services to approved Training Centers. Instructors are authorized by Training Centers to certify course participants who successfully complete a training program.

Approved for Use

HSIs basic and professional level programs are endorsed, accepted, approved, or meet the requirements of more than 1800 Federal and state regulatory agencies and occupational licensing boards.

2010 ILCOR Conference

HSI participated in the 2010 International Committee on Resuscitation (ILCOR) International Conference on CPR and ECC Science with Treatment Recommendations.

International First Aid Advisory Board

HSI representatives were members of the 2005 National and 2010 International First Aid Advisory Board founded by the AHA and ARC. HSI representatives contributed to both the 2005 and 2010 Consensus on First Aid Science and Treatment Recommendations.

Integrating 2010 Science, Treatment Recommendations, and Guidelines

Where do guidelines come from?

Multi-year process involving resuscitation experts from around the world Results in the following publications:
2010 Science and Treatment Recommendations
ILCOR International Consensus on CPR and ECC AHA and ARC International Consensus on First Aid

2010 Training Guidelines

2010 AHA Guidelines for CPR and ECC 2010 AHA and ARC Guidelines for First Aid

2010 Guidelines
The science and guidelines were published in the journal Circulation on October 18th, 2010 They are both freely available at www.hsi.com/2010guidelines

New Program Development

In order to integrate the 2010 guidelines, time is required to make systematic and organized changes to our products. We are currently revising all of our emergency care training materials. New training materials will be released throughout 2011.

Source References
2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations 2010 American Heart Association and American Red Cross International Consensus on First Aid Science With Treatment Recommendations 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care 2010 American Heart Association and American Red Cross Guidelines for First Aid

Interim Training Materials

We have created interim training materials that allow Instructors to immediately start incorporating some of the most significant changes into current (2005) training materials. The interim materials are only intended to be used until the new training programs are made available. Use of the interim materials is an option and not a requirement. Instructors can continue to use the current (2005) materials as designed.

Using (2005) Materials

The release of new science and treatment recommendations do not imply that emergency care or instruction involving the use of previous recommendations science and treatment recommendations is unsafe.

Support for Current Materials

You may continue to purchase and teach using current (2005) training materials until the new programs are available. Support for the current materials will continue until December 31, 2011, or until the inventory of the materials is depleted.

Planned 2nd Quarter 2011 Release

ASHI
CPR and AED Basic First Aid CPR, AED, and Basic First Aid Combination CPR Pro

MEDIC First Aid

CarePlus CPR and AED BasicPlus CPR, AED, and First Aid

Planned 3rd Quarter 2011 Release

ASHI
Advanced Cardiac Life Support (ACLS) * Bloodborne and Airborne Pathogens

MEDIC First Aid

PediatricPlus CPR, AED, and First Aid for Children, Adults, and Infants CPR and AED Child/Infant Supplement Bloodborne and Airborne Pathogens
*Release date is dependent on third party production.

Planned 4th Quarter 2011 Release

ASHI
Pediatric Advanced Life Support (PALS)* Child and Babysitting Safety Course (CABS)
*Release date is dependent on third party production.

Update Requirements

Need to Know
Every Instructor needs to understand the guideline changes that affect the program(s) he or she is authorized to teach. In the following pages we have organized the most significant guideline changes by area and training level. For each identified change, the lesson provides the 2005 guideline for reference, the updated 2010 guideline, and the reason for the change.

Lay and Healthcare Providers

Some of the lessons cover lay providers and some cover healthcare providers. Even though an Instructor may only teach a single provider level, the comparison information from the other level may be valuable for understanding and ability to answer student questions.

ACLS and PALS

Specific information regarding the changes in our advanced training programs, ASHI ACLS and ASHI PALS is not included in this presentation. The information is provided in the HSI 2010 Updated Training Guidelines Supplement found in the document section of the online Instructor Portal.

CPR and AED

Emphasis on High-Quality CPR

2005 Guidelines
blood flow is optimized by using the recommended chest compression force and duration and maintaining a chest compression rate of approximately 100 compressions per minute. These guidelines recommend that all rescuers minimize interruption of chest compressions CPR instruction should emphasize the importance of allowing complete chest recoil between compressions. (Circulation. 2005; 112: IV19-IV34)

Emphasis on High-Quality CPR

2010 Guidelines
To provide effective chest compressions, push hard and push fast. compress the adult chest at a rate of at least 100 compressions per minute with a compression depth of at least 2 inches/5 cm. allow complete recoil of the chest after each compression, to allow the heart to fill completely before the next compression. minimize the frequency and duration of interruptions in compressions to maximize the number of compressions delivered per minute. (Berg, et al. Circulation. 2010;122;S685-S705)

Highlights
This is a re-emphasis from 2005. For effective compressions:
Push fast Push hard Allow chest to fully recoil Minimize any interruptions

Applies to both lay and healthcare providers.

Rationale For Change

High-quality chest compressions within CPR continues to be a critical focal point. Well-performed compressions increase the likelihood of survival.

Compression Hand Position

2005 Guidelines
The rescuer should compress the lower half of the victims sternum in the center (middle) of the chest, between the nipples. The rescuer should place the heel of the hand on the sternum in the center (middle) of the chest between the nipples and then place the heel of the second hand on top of the first so that the hands are overlapped and parallel. (Circulation. 2005; 112: IV19-IV34)

Compression Hand Position

2010 Guidelines
The rescuer should place the heel of one hand on the center (middle) of the victims chest (which is the lower half of the sternum) and the heel of the other hand on top of the first so that the hands are overlapped and parallel. (Berg, et al. Circulation. 2010;122;S685-S705)

Highlights
Hands in center of the chest. Lower half of breastbone Second hand on top of the first. Not on lowest part of breastbone. Applies to both lay and healthcare providers.

Rationale For Change

Use of the nipple line as a landmark for hand placement was found to be unreliable.

Compression Rate
2005 Guidelines
There is insufficient evidence from human studies to identify a single optimal chest compression rate. Animal and human studies support a chest compression rate of >80 compressions per minute to achieve optimal forward blood flow during CPR. We recommend a compression rate of about 100 compressions per minute. (Circulation. 2005; 112: IV19-IV34)

Compression Rate
2010 Guidelines
It is reasonable for laypersons and healthcare providers to compress the adult chest at a rate of at least 100 compressions per minute with a compression depth of at least 2 inches (5 cm.) (Berg, et al. Circulation. 2010;122;S685-S705)

Highlights
At least 100 times per minute. It is okay to be a little faster. Applies to both lay and healthcare providers.

Rationale For Change

It has been found that higher survival rates are associated with an increase in the number of compressions provided per minute.

Child/Infant Compression Rate

2005 Guidelines
Push fast; push at a rate of approximately 100 compressions per minute. (Circulation. 2005; 112: IV156-IV166)

Child/Infant Compression Rate

2010 Guidelines
Push fast; push at a rate of at least 100 compressions per minute. (Berg, et al. Circulation. 2010;122;S862-S875)

Highlights
Rescuers tend to compress slower. At least 100 compressions per minute. It is okay to be a little faster. Applies to both lay and healthcare providers.

Rationale For Change

It has been found that higher survival rates are associated with an increase in the number of compressions provided per minute.

Compression Depth
2005 Guidelines
Depress the sternum approximately 1 to 2 inches (approximately 4 to 5 cm) and then allow the chest to return to its normal position. (Circulation. 2005; 112: IV19-IV34)

Compression Depth
2010 Guidelines
It is reasonable for laypersons and healthcare providers to compress the adult chest at a rate of at least 100 compressions per minute with a compression depth of at least 2 inches/5 cm. (Berg, et al. Circulation. 2010;122;S685-S705)

Highlights
At least 2 inches on an adult. It is okay to compress a little deeper. Not enough information to define upper limit. Applies to both lay and healthcare providers.

Rationale For Change

Research indicates the tendency for CPR providers to not compress deep enough, even with the emphasis to "push hard."

Child/Infant Compression Depth

2005 Guidelines
Push hard: push with sufficient force to depress the chest approximately one third to one half the anterior-posterior diameter of the chest. (Circulation. 2005; 112: IV156-IV166)

Child/Infant Compression Depth

2010 Guidelines
Chest compressions of appropriate rate and depth. Push fast: push at a rate of at least 100 compressions per minute. Push hard: push with sufficient force to depress at least one third the anterior-posterior (AP) diameter of the chest or approximately 1 inches (4 cm) in infants and 2 inches (5 cm) in children. (Berg, et al. Circulation. 2010;122;S862-S875)

Highlights
At least 1/3 of the anterior/posterior diameter of chest. About 2 inches for children and about 1 inches for infants. It is okay to compress a little deeper Applies to both lay and healthcare providers.

Rationale For Change

Research indicates the tendency for CPR providers to not compress deep enough, even with the emphasis to "push hard."

Breathing Assessment
2005 Guidelines
While maintaining an open airway, look, listen, and feel for breathing. (Circulation. 2005; 112: IV19-IV34)

Breathing Assessment
2010 Guidelines
After activation of the emergency response system, all rescuers should immediately begin CPR for adult victims who are unresponsive with no breathing or no normal breathing (only gasping).

(Berg, et al. Circulation. 2010;122;S685-S705)

Highlights
No more look, listen, and feel. Quick look for no breathing or no normal breathing. Agonal breaths remain a concern. Applies to both lay and healthcare providers.

Rationale for Change

Simplifying the breathing assessment is intended to help laypersons respond more quickly with chest compressions and CPR. There is a high likelihood of agonal, or irregular, gasping breaths to occur early in cardiac arrest and confuse rescuers.

CPR Sequence - Lay

2005 Guidelines
For an unresponsive person who is not breathing or not breathing normally, begin CPR by opening the airway and giving 2 rescue breaths followed with 30 chest compressions. Repeat cycles of 30:2 (ABC method). (Summary from Circulation. 2005; 112: IV19-IV34)

CPR Sequence - Lay

2010 Guidelines
For an unresponsive person, activate EMS, then assess breathing. If the person is not breathing or not breathing normally, begin CPR with 30 compressions followed by opening the airway and giving 2 rescue breaths. Repeat cycles of 30:2 (CAB method). (Summary from Berg, et al. Circulation. 2010;122;S685-S705)

Highlights
Initial assessment steps:
Assess responsiveness Activate EMS Assess breathing Perform CPR

CAB begin CPR cycles with compressions, followed by airway and breathing. Guideline applies to adults, children, and infants.

Rationale For Change

The science indicates the importance of not delaying chest compressions to perform rescue breaths. Early chest compression can immediately circulate oxygen that is still in the bloodstream.

CPR Sequence - HCP

2005 Guidelines
For an unresponsive person who is not breathing or not breathing normally, begin CPR by opening the airway and giving 2 rescue breaths followed with 30 chest compressions. Repeat cycles of 30:2 (ABC method). (Summary from Circulation. 2005; 112: IV19IV34)

CPR Sequence - HCP

2010 Guidelines
For an unresponsive person who is not breathing or not breathing normally, and has no obvious pulse, activate EMS and begin CPR with 30 compressions followed by opening the airway and giving 2 rescue breaths. Repeat cycles of 30:2 (CAB method). (Summary from Berg, et al. Circulation. 2010;122;S685-S705)

Highlights
Initial assessment approach:
Assess responsiveness and breathing Activate EMS Assess pulse Perform CPR

CAB begin CPR cycles with compressions, followed by airway and breathing.

Rationale For Change

The science indicates the importance of not delaying chest compressions to perform rescue breaths. Early chest compression can immediately circulate oxygen that is still in the bloodstream.

Use of an AED on an Infant

2005 Guidelines
There is insufficient data to make a recommendation for or against the use of AEDs for infants 1 year of age. (Circulation. 2005; 112: IV156-IV166)

Use of an AED on an Infant

2010 Guidelines
Many AEDs have high specificity in recognizing pediatric shockable rhythms, and some are equipped to decrease (or attenuate) the delivered energy to make them suitable for infants and children < 8 years of age. For infants an AED equipped with a pediatric attenuator is preferred for infants. If neither is available, an AED without a dose attenuator may be used.

(Link, et al. Circulation. 2010;122;S706-S719)

Highlights
Success at defibrillating infants. Use attenuator to reduce shock. Okay to use AED set for adult. Applies to both lay and healthcare providers.

Rationale For Change

AEDs designed to be used on adults have been successful when used on infants with out-ofhospital cardiac arrest. Minimal heart muscle damage and good neurological outcomes were reported.

Chain of Survival
2005 Guidelines
Early recognition of the emergency and activation of the emergency medical services (EMS) or local emergency response system Early bystander CPR Early delivery of a shock with a defibrillator Early advanced life support followed by post resuscitation care delivered by healthcare providers (Circulation. 2005; 112: IV12-IV18)

Chain of Survival
2010 Guidelines
These actions are termed the links in the Chain of Survival. For adults they include: Immediate recognition of cardiac arrest and activation of the emergency response system Early CPR that emphasizes chest compressions Rapid defibrillation if indicated Effective advanced life support Integrated post cardiac arrest care. (Travers, et al. Circulation. 2010;122;S676-S684)

Highlights
Addition of fifth link in chain.
Integrated post-cardiac arrest care.

Applies to both lay and healthcare providers.

Rationale For Change

Links in the Chain of Survival indicate the individual actions that must be strong in order for a person to survive a sudden cardiac arrest. The addition of the fifth link, integrated postcardiac arrest care, further emphasizes the additional dependence on longer-term care for long-term survival.

Cricoid Pressure - HCP

2005 Guidelines
Cricoid pressure should be used only if the victim is deeply unconscious. (Circulation. 2005; 112: IV19-IV34)

Cricoid Pressure - HCP

2010 Guidelines
The routine use of cricoid pressure in adult cardiac arrest is not recommended. (Berg, et al. Circulation. 2010;122;S685-S705)

Highlights
Cricoid may impede ventilation. Difficult to teach. May prevent advanced airway placement. Aspiration may still occur.

Rationale For Change

Regardless of expertise, rescuers cannot effectively apply cricoid pressure.

Team Approach - HCP

2005 Guidelines
When multiple rescuers are present, they should rotate the compressor role about every 2 minutes. The switch should be accomplished as quickly as possible (ideally in less than 5 seconds) to minimize interruptions in chest compressions. (Circulation. 2005;112:IV-12-IV-17)

Team Approach - HCP

2010 Guidelines
The intent of the algorithm is to present the steps of BLS in a logical and concise manner that is easy for all types of rescuers to learn, remember and perform. These actions have traditionally been presented as a sequence of distinct steps to help a single rescuer prioritize actions. However, many 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 bagmask for rescue breathing, and a fourth retrieves and sets up a defibrillator).

(Berg, et al. Circulation. 2010;122;S685-S705)

Highlights
Tasks can be performed simultaneously. Integrate additional rescuers as they arrive. Designate team leader with multiple rescuers.

Rationale For Change

Some resuscitations start with a lone rescuer and builds to more, whereas other resuscitations begin with several willing rescuers. Training should focus on building a team and performing tasks simultaneously.

Emergency Care / First Aid For Lay Providers

Pressure Points and Elevation

2005 Guidelines
There is insufficient evidence to recommend for or against the first aid use of pressure points or extremity elevation to control hemorrhage. (Circulation. 2005; 112: IV196-IV203)

Pressure Points and Elevation

2010 Guidelines
Elevation and use of pressure points are not recommended to control bleeding. (Markenson, et al. Circulation. 2010;122;S934S946) )

Highlights
Not recommended. Direct pressure is more effective. May compromise direct pressure.

Rationale For Change

Elevation and pressure points are unproven procedures that may compromise the proven intervention of direct pressure, so they could be harmful.

Tourniquets
2005 Guidelines
The effectiveness, feasibility, and safety of tourniquets to control bleeding by first aid providers are unknown, but the use of tourniquets is potentially dangerous. (Circulation. 2005; 112: IV196-IV203)

Tourniquets
2010 Guidelines
Because of the potential adverse effects of tourniquets and difficulty in their proper application, use of a tourniquet to control bleeding of the extremities is indicated only if direct pressure is not effective or possible. Specifically designed tourniquets appear to be better than ones that are improvised, but tourniquets should only be used with proper training.

(Markenson, et al. Circulation. 2010;122;S934S946)

Highlights
Use only if direct pressure will not work. Effective in certain conditions. Commercial better than improvised. Training necessary.

Rationale For Change

Tourniquets have been shown to control bleeding effectively and without complications on the battlefield, during surgery, and when used by paramedics in a civilian setting. There are no studies on controlling bleeding with first aid provider use of a tourniquet.

Hemostatic Agents
2005 Guidelines
The use of hemostatic agents in first aid was not covered in the 2005 science, treatment recommendations, and guidelines.

Hemostatic Agents
2010 Guidelines
Routine use of hemostatic agents in first aid cannot be recommended at this time because of significant variation in effectiveness by different agents and their potential for adverse effects, including tissue destruction with induction of a proembolic state and potential thermal injury. (Markenson, et al. Circulation. 2010;122;S934)

Highlights
Some are effective, others are marginal. Wide variety of results. Potential for adverse effects.

Rationale For Change

The use of commercially available hemostatic agents to control bleeding is not recommended because the agent and conditions for its application are not known.

Leg Elevation for Shock

2005 Guidelines
The use of elevation for the treatment of shock in first aid was not covered in the 2005 science, treatment recommendations, and guidelines.

Leg Elevation for Shock

2010 Guidelines
If a victim shows evidence of shock, have the victim lie supine. If there is no evidence of trauma or injury, raise the feet about 6 to 12 inches (about 30 to 45). Do not raise the feet if the movement or the position causes the victim any pain. (Markenson, et al. Circulation. 2010;122;S934S946)

Highlights
Lay victim flat. If no injury, elevate 6-12 inches. No elevation if pain occurs.

Rationale For Change

Elevating the legs can be beneficial in cases in which the mechanism of shock is related to factors other than injury. The risk of further injury outweighs the benefit of elevation when a person is injured.

Injured Extremity
2005 Guidelines
If you are far from definitive health care, you may stabilize the extremity in the position found. (Circulation. 2005; 112: IV196-IV203)

Injured Extremity
2010 Guidelines
If you are far from definitive health care, stabilize the extremity with a splint in the position found. If a splint is used, it should be padded to cushion the injury. (Markenson, et al. Circulation. 2010;122;S934S946)

Highlights
Stabilize with splint if away from medical help. Splint in position found. Use padding.

Rationale For Change

Expert opinion suggests that splinting for an extremity injury may reduce pain and prevent further injury, especially when professional care is delayed or it is decided to move the injured person.

Aspirin for Chest Discomfort

2005 Guidelines
The use of aspirin for chest discomfort in first aid was not covered in the 2005 science, treatment recommendations, and guidelines.

Aspirin for Chest Discomfort

2010 Guidelines
While waiting for EMS to arrive, the first aid provider may encourage the victim to chew 1 adult (not enteric coated) or 2 low-dose baby aspirin if the patient has no allergy to aspirin or other contraindication to aspirin, such as evidence of a stroke or recent bleeding. (Markenson, et al. Circulation. 2010;122;S934S946)

Highlights
Encourage victim while waiting for EMS. One adult or two baby aspirin. Non-coated. No allergies. No contraindication.

Rationale For Change

Evidence clearly demonstrated that the administration of aspirin within the first hours of onset of chest discomfort in people with acute coronary syndromes reduced mortality.

Epinephrine for Anaphylaxis

2005 Guidelines
"First aid providers should be familiar with the epinephrine auto-injector so that they can help someone having an anaphylactic reaction selfadminister the epinephrine. First aid providers should be able to administer the auto-injector if the victim is unable to do so, provided that the medication has been prescribed by a physician and state law permits (second dose not addressed).

(Circulation. 2005;112:IV-196-IV-203)

Epinephrine for Anaphylaxis

2010 Guidelines
First aid providers are advised to seek medical assistance if symptoms persist, rather than routinely 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. (Markenson, et al. Circulation. 2010;122;S934S946)

Highlights
Some people require a second dose. Epinephrine is potentially harmful. No routine second dose. If medical assistance not available, provide second dose if symptoms persist.

Rationale For Change

If medical assistance is available, it is less likely that an unnecessary second dose of epinephrine will be given.

Chemical Burns to the Eye

2005 Guidelines
In case of an acid or alkali exposure to the skin or eye, immediately irrigate the affected area with copious amounts of water. (Circulation. 2005; 112: IV196-IV203)

Chemical Burns to the Eye

2010 Guidelines
Rinse eyes exposed to toxic substances immediately with a copious amount of water, unless a specific antidote is available.

(Markenson, et al. Circulation. 2010;122;S934S946)

Highlights
Rinse with large amounts of water. Use specific antidote if available.

Rationale For Change

Immediate irrigation of eyes exposed to a toxin with large amounts of water is recommended. Specialized therapeutic rinsing solutions that have been properly tested and approved may be available and should be used.

Heat Stroke
2005 Guidelines
The treatment of heat stroke in first aid was not covered in the 2005 science, treatment recommendations, and guidelines.

Heat Stroke
2010 Guidelines
The most important action by a first aid provider for a victim of heat stroke is to begin immediate cooling, preferably by immersing the victim up to the chin in cold water. (Markenson, et al. Circulation. 2010;122;S934S946)

Highlights
Immediate cooling emphasized. Immersion up to neck in cold water preferred as an option.

Rationale For Change

Immediate cooling emphasizes the critical danger associated with heat stroke. Complete immersion in cold water has been found to be the most effective method of cooling the body in heat stroke.

Supplemental Oxygen in Diving

2005 Guidelines
The use of supplemental oxygen for diving injuries in first aid was not covered in the 2005 science, treatment recommendations, and guidelines.

Supplemental Oxygen in Diving

2010 Guidelines
Supplementary oxygen administration may be beneficial as part of first aid for divers with a decompression injury.

(Markenson, et al. Circulation. 2010;122;S934S946)

Rationale For Change

There is evidence oxygen may be beneficial for divers with a decompression injury.

Activated Charcoal
2005 Guidelines
There is insufficient evidence to recommend for or against the use of activated charcoal as first aid for ingestions. (Circulation. 2005; 112: IV196-IV203)

Activated Charcoal
2010 Guidelines
Do not administer activated charcoal to a victim who has ingested a poisonous substance unless you are advised to do so by poison control center or emergency medical personnel. (Markenson, et al. Circulation. 2010;122;S934S946)

Highlights
Use only if directed by poison control.

Rationale For Change

There is no evidence that activated charcoal is effective as a component of first aid. It may be difficult to administer and it has not been shown to be beneficial.

There are reports of it causing harm.

Pressure Immobilization for Snakebite

2005 Guidelines
In case of an elapid (e.g., coral) snakebite, wrap a bandage snugly (comfortably tight but loose enough to slip or fit a finger under it) around the entire length of the bitten extremity, immobilize the extremity, and get definitive medical help as rapidly as possible. (Circulation. 2005; 112: IV196-IV203)

Pressure Immobilization for Snakebite

2010 Guidelines
Applying a pressure immobilization bandage around the entire length of the bitten extremity is an effective and safe way to slow the dissemination of venom pressure is sufficient if the bandage allows a finger to be slipped under it. Initially it was theorized that external pressure would only benefit victims bitten by snakes producing neurotoxic venom, but the effectiveness has also been demonstrated for bites by non-neurotoxic American snakes. (Markenson, et al. Circulation. 2010;122;S934S946)

Highlights
Pressure immobilization safe and effective. Be able to slide finger underneath.

Rationale For Change

Applying a pressure immobilization bandage has shown to be an effective way to slow the dissemination of venom for all venomous snake bites, not just those from elapids.

Jellyfish Stings
2005 Guidelines
The treatment of jellyfish stings in first aid was not covered in the 2005 science, treatment recommendations, and guidelines.

Jellyfish Stings
2010 Guidelines
To inactivate venom load and prevent further envenomation, jellyfish stings should be liberally washed with vinegar (4% to 6% acetic acid solution) as soon as possible for at least 30 seconds. For the treatment of pain, after the nematocysts are removed or deactivated, jellyfish stings should be treated with hot-water immersion when possible. (Markenson, et al. Circulation. 2010;122;S934S946)

Highlights
Vinegar wash for 30 seconds to inactivate nematocysts. Follow with hot-water immersion for pain control.

Rationale For Change

Vinegar is most effective for inactivation of the nematocysts. Immersion in water, as hot as tolerated for about 20 minutes, has been found to be the most effective treatment for the pain.

Education / Implementation

Skills Reinforcement
2005 Guidelines
Ongoing skills reinforcement was not covered in the 2005 science, treatment recommendations, and guidelines.

Skills Reinforcement
2010 Guidelines
While the optimal mechanism for maintenance of competence is not known, the need to move toward more frequent assessment and reinforcement of skills is clear. Skill performance should be assessed during the 2-year certification with reinforcement provided as needed. The optimal timing and method for this assessment and reinforcement are not known. (Bhanji, et al. Circulation. 2010;122;S920-S933)

Highlights
Need for more frequent review is clear. Optimum reinforcement not known. Reassess and reinforce.

Rationale For Change

Retention of skills deteriorates very quickly after training. Frequent skill refreshers should help to maintain reasonable skill performance.

Self-Instruction
2005 Guidelines
Instruction methods should not be limited to traditional techniques; newer training methods (e.g., watch-while-you practice video programs) may be more effective. (Circulation. 2005;112:III-100-III-108)

Self-Instruction
2010 Guidelines
Short video instruction combined with synchronous hands-on practice is an effective alternative to instructor-led basic life support courses. (Bhanji, et al. Circulation. 2010;122;S920-S933)

Highlights
Video self-instruction with practice-whilewatching is effective.

Rationale For Change

Studies have demonstrated that lay rescuer CPR skills can be acquired and retained at least as well through interactive computer- and videobased synchronous practice when compared with instructor-led courses.

Skills Competency
2005 Guidelines
Training programs should be evaluated to verify that they enable effective skills acquisition and retention. (Circulation. 2005;112:III-100-III-108)

Skills Competency
2010 Guidelines
Successful course completion should be based on the ability of the learner to demonstrate achievement of course objectives rather than attendance in a course/program for a specific time period. (Bhanji, et al. Circulation. 2010;122;S920-S933)

Highlights
Verification of competence, not a set number of class hours.

Rationale For Change

Reflecting emerging trends, there is support to move toward a more competency-based approach to resuscitation education for all rescuers.

Prompting and Feedback Devices

2005 Guidelines
A CPR prompt device may be useful in both out-of-hospital and in-hospital settings. (Circulation. 2005; 112: IV19-IV34)

Prompting and Feedback Devices

2010 Guidelines
Training in CPR skills using a feedback device improves learning and/or retention. The use of a CPR feedback device can be effective for training. CPR prompting and feedback devices can be useful as part of an overall strategy to improve the quality of CPR during actual resuscitations. (Bhanji, et al. Circulation. 2010;122;S920-S933)

Highlights
Effective in training. Improves quality of actual resuscitation.

Rationale For Change

The evidence has shown prompting and feedback devices to be effective in CPR training and during actual resuscitations. Commercially-produced devices are now more readily available for use.