CPR & AED

Familiarization Programme
For NUS Community

EM Div, OSHE
UHWC & OSA
20 March 2008
CPR & AED Familiarization Programme
Introduction
“During a Cardiac Arrest, the heart stops pumping, the casualty
stops breathing and becomes unconscious.”

“The Brain, will suffer permanent & irreversible damage if blood

circulation to the brain is not restored within 4 minutes.”

• Heart Disease
- is the 2nd most common cause of death in Singapore
- cause of 24% of total mortality

• About 2400 people suffer from heart attack each year

• Nearly 1000 of them occur out-of-hospital
• Survival rate of 2.6% for out-of-hospital collapses
What can we do to reduce “Sudden Death”?

 Education & training in CPR + AED

 ‘In An Emergency’ - take action within first few

minutes / ASAP

 “YOU & I” can make the difference in helping a family

member, loved one, a friend and maybe a stranger

 Prudent Heart Living - Adopting a healthy life style

in minimizing risk of heart attack
CPR & AED Familiarization Programme
To familiarize the NUS community (both staff and
students) with the knowledge and skills in CPR &
AED so as to enable them to act in an emergency
situation to save lives

Training Objectives
 To understand the importance of CPR & AED in a
Cardiac Arrest/Heart Attack emergency

 To perform the steps of CPR competently

 To be able to operate the AED confidently & safely

Scope of Training (in 2 hours)
 Introduction 10 mins

 Techniques of CPR 15 mins

 Practice CPR 30 mins

 Use & Administration of AED 15 mins

 Practice AED administration & Evaluation

- Practical 35 mins

 Evaluation – Quiz 10 mins

 Conclusion & Certificate presentation 5 mins

CPR & AED Familiarization Programme
Definition of Cardio-Pulmonary Resuscitation (CPR)
CPR includes a series of assessments & interventions
that support cardiac & pulmonary functions

Cardiac Arrest = Heart stops beating & oxygen circulation ceases

No Circulation > 4 mins = organ death, permanent irreversible damage

>>> Important to start CPR promptly <<<

CPR done correctly & promptly:
 Heart function can be restored
 Circulation may be maintained until application of other
life support measures
CPR & AED Familiarization Programme
Concept of ‘Chain of Survival’

Early Early
Recognition Early CPR Early
Advanced
and Access Defibrillation
Care
CPR & AED Familiarization Programme

How do you know it is a Heart Attack?

 Chest discomfort or pain

 Other symptoms – any or all may appear

• Sweating
• Nausea
• Shortness of breath
• Weakness

 Symptoms may appear suddenly &

victim does not realize it is a heart attack;
may think it is indigestion
 What commonly causes “Sudden Collapse”?
Heart Attack
Foreign Body Airway Obstruction
Suffocation
Drowning
Stroke
Drug Overdose
Smoke Inhalation
Electrocution
Severe Allergic Reactions
Severe Trauma, e.g.. an accident

Heart Attack death can be prevented?

‘Only if’
Prompt help by someone applying CPR
until medical help arrives
 CPR & AED Familiarization Programme
One-Man CPR Techniques

Step 1: Assessment – Determine responsiveness

“Hello! Hello!
Are you Ok?”
 Check site for danger, e.g. chemical
spill, exposed electrical wire, falling
items, fire, leaked fuel & gas

 Check casualty responsiveness

 tap shoulders gently
 call out loud
“Hello! Hello! Are you Ok?”

 No response – you have a casualty!

 One-Man CPR Techniques

Step 2 : Activate Emergency Service

 Call loudly for ‘help’… “Call 995 for ambulance.

Get the AED here.”

 Call 995 or campus

security @ 6874 1616
for help

 Get someone to call for

help & get an AED,
if available
 One-Man CPR Techniques

Step 3 : Position the Casualty

 Casualty must be lying

flat on his/her back on a
firm ground

Place casualty in correct

position (flat on back)
 One-Man CPR Techniques

Step 4: Open Airway

 Place one hand on forehead & apply firm backward pressure
with palm to tilt head back
 Place finger on the chin bone and lift the jaw forward (jaw trust)
 Open mouth gently and remove any obvious obstructing foreign
body, e.g.. food, loose denture or secretions (finger sweep)

‘Head Tilt – Chin Lift’

 One-Man CPR Techniques

Step 5 : Check Breathing

 Do the ‘head tilt-chin lift’ to open
airway

 Place own ear & cheek over

casualty’s mouth & nose for:

 Look – for chest rise and fall

 Listen – air escaping during

exhalation

 Feel - for the flow of air from

casualty’s nose
 One-Man CPR Techniques

Step 6 : Mouth-to-Mouth Breathing

 Maintain ‘head tilt-chin lift’
to open airway

 Pinch nose with thumb &

index finger

 Cover mouth-to-mouth fully

 Give 2 short breaths (1 sec

each) & watch chest rise

 Ventilation volume between Use resuscitation mask / face mask for

400 to 600mls mouth-to-mouth resuscitation, if possible
 One-Man CPR Techniques

Step 7 : Check for Circulation / Pulse

 Maintain the head tilt-chin lift to open airway
 Use index finger centre of throat & slide into the groove to locate
the carotid pulse
 Feel for pulse for about 10 secs & look for Signs of Circulation

Look for
Signs of Circulation
(CCMB)
• Consciousness
• Coughing
• Movement
• Breathing
 One-Man CPR Techniques

Step 8 : Locate Hand position for Chest Compressions

 Run finger from rib cage to reach the sternal notch

 Place index finger next to center finger
 Place heel of the hand next to the index finger

Step 1 Step 2 Step 3

 One-Man CPR Techniques

Step 9 : Perform Chest Compression

 Place the other hand on top of the hand on the sternum &
interlock the fingers
 Straighten both elbows and lock in position
 Position shoulder directly over the casualty’s chest
 Use body weight to compress chest about 4-5cm

• Ratio of CPR is 30 compression

plus 2 ventilation
Step 1 Step 2 • Compression rate @ 100/min
• Perform 3 cycles of CPR
 One-Man CPR Techniques

Step 10 : Reassessment
 Check for Pulse or Signs of Circulation (CCMB)

 If No - Continue CPR 30 : 2

 If Yes - Check for external injuries;

- Place casualty in recovery position
and maintain open airway

 Monitor casualty every few minutes until help

arrives
 One-Man CPR Techniques

Recovery Position
Step 1 : Position the Casualty

(a) Tuck hand nearer to you,

arm straight & palm
upwards under thigh

(b) Bring arm from across &

place back of the hand
against cheek

(c) Bend the far knee to

90 degree angle
 Recovery Position

Step 2 : Roll casualty towards the

rescuer

• Place palm on palm of

casualty hand on cheek &
hold far hip and roll till lying
on the side

• Use knee to support to

prevent rolling too far
forward
 Recovery Position

Step 3 : Final Recovery Position

• Head (cheek) lie on the back

of his palm

• Other hand lying free along

side of body

• The former far leg should be

bent at 90 degree
 Automated External Defibrillation (AED)
“The most important factors that increase the chance of survival in sudden cardiac
arrest are external cardiac massage and time to the first electrical defibrillation.”

Survival rate as high as 90% has been reported when defibrillation is achieved within
the 1st minute of collapse and this declines 7 - 10% for every minute that defibrillation
is delayed, such that a cardiac arrest victim without defibrillation beyond 10 minutes
has only a 2 - 5% chance of survival.

What is an AED?
A device that delivers electrical shock to restart the pumping action of the heart

When to use an AED?

• Casualty in full Cardiac Arrest
• Signs of Cardiac Arrest:
- Unconscious
- No breathing
- No pulse / signs of circulation

“When in doubt, apply the AED”

Two-Man CPR+AED Techniques

Preparation of Casualty

• Check indicator to confirm AED is functional

• Verify Cardiac Arrest before applying defibrillation

• Check Area for Dangers - Water, Metal & Gas. (WMG) If need be,
move patient to safer place.

• Remove clothing to expose chest for AED application

• Check & Remove – Hair (thick chest hair), Jewelry, Medicated Patches.
Avoid placing pads over Pace Maker. Dry Skin if set. (HJMPS)

• Do any thing to improve the adhesion of electrodes to the skin

 Placement & Attachment of AED Pads on Patient

• Open AED & check defibrillation pad cables are firmed

attached to AED

• Follow the AED Voice Prompt Instruction from now on

• Remove Pads from packet & the protective backing

from pads

• Place one pad on the Right of Upper Half of Sternum

(breastbone), just below the casualty’s right clavicle
(collarbone)

• Place the other pad just below and to the Left of the
Left Nipple

• For female casualty, place it just below and to the left

side of the breast

• Do not place pads over the nipples, or breast (for

female)
 Two-Man CPR+AED Techniques

Safety Issues when Using an AED (for Operator & By-Standers)

• Ensure area around the casualty is clear

• Do not allow anyone touch or come into contact with casualty, when:
 During Analysis: Contact will interfere with the accuracy of AED reading
 During Defibrillation: Ensure no one is touching the casualty when shock
is delivered as electricity can be transmitted

• If casualty is on wet surface, move to a dry area, if available

• If casualty is on metal surface, place blankets, if available, between casualty

and metal surface

DO NOT DEFIBRILLATE when;

• Casualty is responsive, breathing or has a pulse / signs of circulation
• Someone is touching the casualty
• There are flammable gases or in explosive environments
Two-Man CPR+AED Techniques
MEDICAL PROTOCAL
Verify
Cardiac Arrest
Check Response (No) SHOCK ADVISED
Call 995 / 6874 1616 / AED
No Yes
Check Breathing (No)
Analyze Analyze
Check Pulse / AED Deliver
2 Ventilations Shock or
Sign of Circulation
Press to shock
Check Pulse /
Signs of Circulation (No) Resume CPR
Absent Present (30:2) & follow AED
Start CPR (30:2) until voice prompt
AED is attached Resume CPR
(30:2) & follow AED Recovery Position &
voice prompt Monitor Pulse & Signs
Prepare Chest Every 05 mins
* AED should remain connected until casualty is
Operate AED handed over to medical personnel
 Two-Man CPR+AED Techniques

Medical Protocol and Documentation

Successful Defibrillation
• If pulse / signs of circulation is present
• Maintain an open airway by placing casualty in recovery position
• Do not disconnect AED but continue to monitor casualty every 05 mins

Unsuccessful Defibrillation
1. Note that defibrillation may not be successful in all situations
2. Check pulse / signs of circulation if “NO SHOCK” is advised
3. If absent, continue CPR and follow the AED voice prompt or until
ambulance arrives

When to Stop Defibrillation

• When prompted by AED
• When a doctor directs the resuscitation to stop or when ambulance arrives
• When the casualty has been successfully resuscitation
 AED DEPLOYMENT IN NUS KENT RIDGE CAMPUS
Kent Vale

CAA: 151007

Wall Mounted Sets in Campus

Kent Ridge - 53
BTC - 03
GMS - 01
NUS Care - 01

Mobile Sets (KRC)

EM Div, OSHE - 02
Campus Security, Patrol Car - 01
SRC - 01

18 - Acquired by Units 44 - Acquired & Installed by EM Div, OSHE (May – Oct 07)
AED DEPLOYMENT IN NUS BUKIT TIMAH CAMPUS
THANK YOU