Every 5 years the European Resuscitation Council (ERC), the Resuscitation Council (UK) and the International Liaison Committee on Resuscitation (ILCOR) review the latest research and evidence in resuscitation, and then release updated guidelines. In addition to this, for the first time in history, this year the European Resuscitation Council (ERC) have also produced guidelines for First Aid. With these changes underpinning First Aid practice, we think it helpful to current and future customers to show a summary of the changes.
- 1. ‘Shouting for help’ is no longer a step to be taught on its own.
The guidelines now only instruct the first aider to ‘ask someone to call 999 or 112’ after checking for normal breathing. This further simplifies the guidelines, making accurate recollection of the sequence even easier. It also acknowledges the frequent availability of mobile phones as the new guidance also says to use the speaker function on mobile phones for ease of communication.
- 2. Increased emphasis on seizure as a possible presentation of cardiac arrest.
Immediately following cardiac arrest, blood flow to the brain is reduced to virtually zero. This may cause a seizure-like episode that can be confused with epilepsy. Bystanders should be suspicious of cardiac arrest in any patient presenting with seizures. It is also extremely important to teach first aiders how to recognise agonal gasps.
- 3. Teach first aiders to activate the speaker function on their phone when calling 999 or 112 to help communication.
A common feature on modern mobile phones, this addition helps the first aider to communicate with the Emergency Medical Despatcher at the same time as assisting the casualty. Guidance says that it is reasonable to show the first aider how this can be done on their own mobile phone. .
- 4. Elevation and Indirect pressure points are no longer recommended for the treatment of bleeding.
Elevation and indirect pressure have been removed due to a lack of evidence that either is effective in stopping bleeding, particularly life-threatening bleeding.
(We report this, but do not believe it. Try this - hold one hand high in the air while keeping the other one down by your side, then compare them after 5 minutes. Why is the high hand paler compared to the one kept down? Clue: oh you don't kneed a clue do you?)
- 5. Haemostatic dressings and tourniquets are to be used when direct pressure cannot control severe bleeding.
Following extensive use and research in combat, there is a wealth of evidence that tourniquets are effective, save lives and have a relatively low rate of complications following application. Similarly, haemostatic dressings have also undergone significant improvements in recent years, have low complication rates and have saved many lives. The balance of complications versus possible outcomes if not used have led to both tourniquets and haemostatic dressings being introduced into main-stream first aid. Of course, a small office workplace is unlikely to find that catastrophic bleeding is a significant risk to their employees, so they wouldn’t necessarily have to rush out and buy this new equipment. A waste recycling plant or tree surgeon on the other hand may wish to consider having these available. The good news is that the guidelines are very clear that “training is required to ensure application is safe and effective”.
- 6. Sucking chest wounds should be left open to the environment – Three sided dressings are no longer recommended.
Not Blackbird's favourite rule change, but due to clinical experience of both improvised and purpose made dressings which have inadvertently become occlusive (leaving trash in the wound), the ERC guidelines recommend to ‘leave the wound in open and in communication with the environment’. This means that there is no longer a requirement to cover it with a dressing. The main emphasis on providing care should be to ‘do no harm’, and the risk of dressings becoming occlusive is significant.
- 7. First aiders must be trained in the various methods of administering a bronchodilator (inhalor).
In the UK, that includes assisting a casualty to take their own prescribed inhale.
- 8. Hypoglycaemia – first aiders should aim to give 15-20g of glucose.
This has been in diabetes hospital management guidance for a while so it’s good to see more clarification on quantities in first aid guidance. Future paediatric books will also include some further guidance for children, as this is the adult requirement.
- 9. Oral Carbohydrate-electrolyte beverages (sports energy-rehydration drinks) now recommended for exertion related dehydration.
Good sports energy-rehydration drinks have proven to be more effective than water as they also replace lost body salts. Evidence also suggests that semi-skimmed milk and tea can also be as effective as water.
- 10. Burns should be cooled with water for a minimum of 10 minutes, as soon as possible.
They've finally made it official.
- 11. When giving CPR, The First aider must make sure that chest compressions are effective.
- The time between stopping compressions, re-opening the airway, giving two one-second breaths, and restarting compressions - IS NO MORE THAN 10 SECONDS.
- Time for chest to recoil must be given between each compression
- Depth of compression in an adult must be 5 to 6cms (2 to 3 inches)