First Aid and

Basic Life
Support
Disaster Nursing RLE Module 2M
Course Learning Outcomes

FIRST AID
1. Discuss the purpose of First Aid
2. Identify and elaborate on the roles and responsibilities of a First Aider
3. Enumerate and describe the common materials for First Aid
4. Provide First Aid for common emergencies:
a. Burn Injury
b. Seizure
c. Hypoglycemia
d. Fracture
e. Fainting/syncope
f. Choking
g. Fall injury
h. Motor Vehicular Accident
i. Animal bites (Dog and Snake bites)
j. Open Wounds (Abrasion, Puncture, Laceration, Avulsion)
Course Learning Outcomes

Basic Life Support

1. Describe the importance of High-Quality Cardiopulmonary Resuscitation
(CPR) and its impact on survival
2. Describe the importance of all the steps of the Chain of Survival
a. Adult Chain of Survival
i. In-Hospital Cardiac Arrest (IHCA)
ii. Out-of-Hospital Cardiac Arrest(OHCA)
b. Pediatric Chain of Survival
3. Recognize the signs of someone needing a CPR
4. Describe the importance of early use of an Automated External Defibrillator
(AED) and demonstrate its appropriate use
5. Discuss High-Quality CPR for an adult, child, and infant
6. Describe the technique for relief of foreign-body airway obstruction for an
adult, child, andinfant
FIRST AID
Purpose/Aims of FirstAid
● Preserve Life
○ Not only the casualty’s life, but your own life as well. Far too often only
one person’s life is in danger when the emergency services are
called, but by the time they arrive there are more. If you put your life in
danger, you can end up fighting for your own life instead of the
casualty’s.
● Prevent the situation from worsening
○ The skilled first aider must take action to prevent the whole situation
from becoming worse, as well as acting to prevent the casualty’s
condition from deteriorating.
● Promote recovery
○ The actions of a first aider should, after preventing things from getting
worse, help the casualty to recover from their illness or injury.
 Roles and Responsibilities of a First Aider

1. Call for 911(local emergency number) or shout for help until you know someone has heard or called for
help.
2. Assess the situation, make sure it’s safe before you proceed, and stay calm.
3. Check ABCs, and don’t move a person unless there is a life-or-death reason to do so. Ask the
injured person what happened.
4. If a person is choking or can’t breathe and you are a trained in CPR, do the heimlich maneuver and
begin rescue breathing. If the person doesn’t have a pulse, start CPR.
5. For any bleeding, apply direct, even pressure.
6. Manage for shock if the person is chilled, short of breath, nauseous, clammy, and pale.
7. Look for a medic alert bracelet, necklace, or identification tag for any medical history or special needs
8. After you have stabilized the injured person, go get professional medical help.
9. Don’t give the ill or injured person anything to eat or drink, including medication, unless necessary.
10. Wait for the ambulance to arrive while comforting the ill or injured person.
Common Materials for FirstAid
● The Right Container
○ Container with a strong handle and can be closed securely
○ Clearly mark it with “First-Aid Kit”
○ Ideally, you want your kit to be light enough to carry but large enough to hold
all the necessary items in an organized and easily accessible format.
○ Dust proof, waterproof, and study enough to resist damage from falling or
crushing.
Common Materials for FirstAid
● The Right Location
○ Store your kit safely in a cool, dry location.
○ Avoid storing it in the garage or laundry room because of the potential harm
to its contents from moisture and temperature extremes.
○ Pick a location in your home that is central and accessible to everyone
who will be using the kit.
 Common Materials for FirstAid
● The Right Contents
○ Bandages and dressings:
○ Diphenhydramine (Benadryl) ■ Commercial Band-
○ Antibiotic ointment orcream Aid bandages
○ Activated charcoal
■ Sterile cotton balls
○ Antacids
■ Cotton-tipped swabs
○ Antihistamine cream
■ Sterile gauze (pads and
○ Hydrocortisone cream rolls)
○ Povidone-iodine solution ■ Elastic bandagerolls
○ Aspirin, acetaminophen, ■ Extra bandageclips
and ibuprofen ■ Butterfly bandages
○ Sterile eye-wash solution ■ Sterile eye patches
○ Epinephrine auto-injector kit (if
■ Regular adhesive bandages
prescribed by physician)
■ Adhesive tape
○ Extra prescribed
■ Triangular bandages
medication (such as
■ Large foil-lined bandage
Common Materials for FirstAid ● Scissors
Additional tools and other items ● Tweezers
such as: ● Tooth-preservation kit
● Space blanket
● Bulb syringe ● Penlight
● Medicine spoon ● Small pad of paper and
● Small paper cups pencil
● Clean cloths and tissues ● Emergency candle
● Hand sanitizer and waterproof
● Digital thermometer matches
● Petroleum jelly ● Disposable self-
● Gloves (sterileand clean) activating cold and hot
● Safety pins packs
● Disposable CPR face ● Magnifying glass
mask ● Whistle
First Aid for Common
Emergencies
Burn Injury
● Estimate the severity of a burn (SCALD):
○ Size
■ The larger the area of the burn, the more severe
■ Percentage of the body’s surface area
○ Cause
■ Cause will influence the overall severity (electrical and
chemical burns) of injury
○ Age
■ Age of the patient will affect the recovery rate and severity
○ Location
■ Location of the burn can affect the severity of injury
○ Depth
■ The deeper the burn, the more severe
 Burn Injury

● Depth of Burns:
○ Superficial (1st degree)
■ Most commonlyoccurs
from scalds
■ Burn looks red,
sore, and swollen
○ Intermediate (2nd degree)
■ Burn looks raw and
blisters will form
○ Full thickness (3rd degree)
■ Burn may look
pale, charred or
waxy.
 Burn Injury
● Electrical Burns
○ There may be deep internal burns which are not visible along the path
of the current flow.
○ Extent of internal burns can be estimated by the severity of the entry
and exit wounds.
○ May cause cardiac arrest, Airway and Breathing become the priority.
○ Management:
■ Ensure your own safety -- make sure contact with the electricity is
broken
■ Maintain airway and breathing
■ Irrigate the area of burn injury for at least 10 minutes
■ Call for an ambulance
■ Continue treatment as you would for a dry heat burn
 Burn Injury

● Dry Heat Burns

○ Any direct contact with a dry heat source or friction
○ Management:
■ Maintain airway and breathing
■ Cool the burn immediate with cold (preferably running) water for at
least 10 minutes.
● Take care not to cool large areas of burns so much that you induce
hypothermia
■ Remove watches, rings, etc. during cooling, as burned areas will swell.
■ Dress the burn with a sterile dressing that won’t stick.
■ Call for an ambulance if the burn appears severe, or the casualty has
breathed in smoke or fumes
 Burn Injury
● Wet heat (Scalds)
○ Treat as a dry heat burn.
● Chemical burns
○ Caused by chemicals which either corrode the skin or create heat (or both)
○ Management:
■ Make the area safe -- contain chemical if possible and protect yourself
from coming into contact with it.
■ Dry powder chemicals -- brush of the skin before irrigating
■ Irrigate the burn with lots of running water to wash the chemical away, at
least for20 minutes.
● Take care not to wash the chemical onto unaffected areas of the body
■ Call for an ambulance -- make a note of the chemical and give this
information to the responders
■ Remove contaminated clothing
Burn Injury

● Radiation burns (sun burn)

○ Remove the casualty from exposure to the sun
○ Give frequent sips of water to ensure that heat
exhaustion does not take effect
○ Cool the burn with cold water for at least 10
minutes
○ For extensive blistering -- seek medical advice
○ If the sunburn is mild, after-sun cream or calamine
lotion may soothe the area
Seizures
● Minor seizures (absence
seizures or petit mal
seizures)
○ Remove any source of
danger
○ Help the patient sit down
in a quiet place and
reassure them
○ Stay with the patient until
they are fully alert
○ If the patient is unaware
of their condition, advise
them to see a doctor
Seizures

● Major Seizures
○ During the seizure
■ Help the patient to the floor to avoid injury if possible
■ Gently cushion the patient’s head to help avoid injury
■ Loosen any tight clothing around the neck to help the patient
breath
■ Move any objects from around the patient that may harm
them and ask bystanders to moveaway
■ If you are concerned about the airway, roll the casualty onto
their side
■ Take note of the exact time the seizure started and its
duration
■ Look for identification if you don’t know the patient
Seizures

● Major Seizures
○ Dial 911 (local emergency number) if:
■ The seizure lasts more than 3 minutes
■ The patient’s level of response don’t improve after the seizure within
10 minutes
■ The patient has a second seizure
■ The patient is not diagnosed as epileptic or this is their first seizure
■ You are unsure.

○ As soon as the seizure stops:

■ Check airway and breathing. Resuscitate if necessary
■ Place the patient in the recovery position
■ Keep the patient warm and reassure them
■ Monitor airwayand breathing
■ Move bystanders away before the casualty awakes and protect
modesty
■ Check the levels of response regularly. Call for help if they don’t
improve within 10minutes
 Seizures

● Febrile convulsions
○ Remove clothing and bedclothes. Provide fresh, cool air to
cool the child down. Take care not to cool the child too
much.
○ Place the child on their side if possible to protect the airway.
○ Remove nearby objects and use padding to protect the child
from injury whilst fitting
○ Call for help (local emergency number)
○ If the child is still fitting -- sponge them with tepid water to help
the cooling process, but take care not to cool them too much.
○ Constantly monitor airway and breathing until help or
ambulance arrives
Hypoglycemia (low blood sugar)
● Low blood sugar occurs mainly with diabetic
patients who are insulin dependent.
● The blood sugar levels will fall low if:
○ The patient does not eat enough food
○ The patient over exercises
○ The patient injects too much insulin
● Why is low blood sugar dangerous?
○ Unlike any cells in the body, the brain can only use
glucose (sugar) as its source of energy.
■ If the sugar in the blood becomes low, the brain cells
are literally starved.
 Hypoglycemia
● For a conscious casualty:
○ Sit the casualty down.
○ Give the casualty a sugary drink, sugar lumps, glucose tablets, chocolate, or
other sweet foods
○ If the casualty responds to treatment quickly, give them more food or drink
○ Stay with the casualty and let them rest until the level of response is “fully alert”
○ Tell the patient to see their doctor -- even though they have fully recovered
○ If the patient does not respond to the treatment within 10 minutes, or they are
unmanageable, dial local emergency number for an ambulance
○ Consider if there is another cause for the patient’s symptoms
● For an unconscious casualty:
○ Open the airway and check for breathing. Resuscitate as necessary.
○ Place the casualty in the recovery position if they are breathing effectively.
○ Call for ambulance.
 Fractures
● Treatment of a basic fracture:
○ Reassure the casualty, tell them to keep
still.
○ Keep injury still with your hands until it is
properly immobilized. The casualty might
be able to do this on their own.
○ Don’t move the casualty until the injury is
immobilized, unless they are in danger.
○ Don’t try to bandage an injury if you have
called an ambulance, just keep it still
(cover open wounds with a sterile
bandage)
○ Don’t let the casualty eat or drink
-- they may need an operation
 Fractures

● For an upper limb injury:

○ Carefully place the arm in a sling against the trunk of the body
○ If the casualty is in severe pain, circulation or nerves to the arm
are affected, the casualty has breathing difficulties, or you are
unsure, dial local emergency number for an ambulance
○ Arrange transport to hospital
● For a lower limb injury:
○ Keep the casualty warm and still. Call for ambulance.
○ If the ambulance arrival will be delayed, immobilize affected leg.
○ Check circulation beyond the injury and any bandages.
Loosen bandages if necessary.
Fainting/Syncope
● Treatment of fainting:
○ Lay the casualty down and raise their legs in the air, returning
blood to the vital organs.
○ Check airway and breathing.
○ Remove causes of stress, crowds of people and allow plenty of
fresh air.
○ Reassure the casualty as they recover. Do not allow them to sit
up suddenly.
○ If they faint again, repeat the treatment. Look for an underlying
cause.
○ If the casualty does not recover quickly or you are unsure:
check airway and breathing again, place them in the recovery
position and call for an ambulance.
Choking
● If the obstruction is not cleared:
○ Back blows
■ Shout for help, but don’t leave the patient yet.
■ Bend the casualty forward so the head is lower than the chest.
■ Give up to 5 firm blows between the shoulder blades with the palm of
your hand. Check between blows and stop if your the obstruction.
○ Abdominal thrust
■ Stand behind the casualty. Place both your arms around their waist.
■ Make a fist with one hand and place it just above the belly button with
your thumb inwards.
■ Grasp the fist with your other hand, then pull sharply inwards and
upwards. Do this up to 5 times. Check between thrust and stop if you
clear the obstruction
Fall Injury
● Treat the injury as
presented.
○ Stroke
○ Hypoglycemia
○ Fracture
○ Wounds
○ etc.
Motor Vehicular
Accident
● Treat injury as
presented.
○ Head injuries
○ Chest injuries
○ Crush injuries
○ Treatment of bleeding
○ Dislocations
○ Fractures
○ Spinal injuries
○ Cardiac arrest
Animal Bite
Dog bite
● For minor bites:
○ Wash the bite under running water for at least 5 minutes.
○ Clean the bite with soap and water, saline solution, or povidone-iodine.
○ Stop the bleeding with direct pressure and treat the bite as outlined for
cuts and lacerations.
○ For unbroken skin, apply a cold pack.
○ Raise the wounded limb above the level of the person’s heart (if possible)
to reduce any swelling.
○ Check the bite site daily for signs of infection such as increased swelling,
redness, or discharge.
● For severe bites or injured person loses consciousness:
○ Check for airway, breathing, and circulation.
○ Perform CPR, if necessary.
○ Call 911, and manage shock until help arrives.
Snake bite
● For nonpoisonous snake bite:
○ Usually produce a horseshoe-shaped ring of tooth marks,
producing mild pain and swelling:
○ First-aid treatment may include:
■ Washing the bite with soap and water
■ Covering the site with a sterile bandage or dressing
■ If unsure of the date of the last tetanus shot, consult
with physician about booster shot.
Snake bite

● For poisonous snake bite:

○ Bites begin to swell and change color are usually indicative of a
poisonous bite.
○ First-aid treatment may include:
■ Call 911 (local emergency number) and the poison control center
immediately so that antivenom can be ready when the person
arrives at the emergency room.
■ Calm the person, limit movement, and keep the affected area
below heart level to reduce circulation of venom.
■ Remove jewelry or other constricting items and apply a loose
splint to help restrict movement.
■ Monitor temperature, PR, RR, and BP if possible. Manage signs of
shock.
Snake bite

● For poisonous snake bite:

○ Don’ts:
■ Do not bring the dead snake in unless it can be done safely, and
know that snakes can bite for up to an hour after they are
dead.
■ Don’t allow the person who has been bitten to exert
himself/herself
● Carry the victim if you have to transport them
■ Don’t apply a tourniquet or any cold compresses to the bite
■ Never cut into a bite or try to suction the venom by mouth
■ Don’t allow any medications unless instructed by a physician
and don’t give the person any food or drink
WOUNDS
Abrasion
● The top layers of skin are scraped off,
usually as the result of a friction burn
or sliding fall. Often containing
particles of dirt, which could cause
infection:
● Treatment:
○ Dirt that is not embedded should be
removed using clean water and sterile
swabs.
○ Clean from the center of the wound
outwards, so as not to introduce
more dirt into the wound.
Laceration
● A rip or tear of the skin.
● Treatment:
○ Treat for bleeding and prevent infection:
■ Sit or lay the casualty down. Place them in a position that is
appropriate to the location of the wound and the extent of their
bleeding.
■ Examine the wound. Look for foreign objects and note how the
wound is bleeding. Remember what it looks like, so you can
describe it to the medical staff when it’s covered with a bandage.
■ Elevate the wound. Ensure that the wound is above the level of the
heart, using gravity to reduce the blood flow to the injury.
■ Apply direct pressure or indirect pressure to stop bleeding.
Puncture
● A stabbing wound.
● Wounds can be very deep and yet appear very small in diameter.
● Damage may be caused to underlying organs such as the heart or
lungs and severe internal bleeding may occur.
● Treatment:
○ Dial emergency local number for an ambulance if you suspect
damage to underlying organs or internal bleeding.
○ Never remove an embedded object -- it may be stopping the bleeding
and further damage may result.
○ Use sterile dressings and bandages to “build up” around the object. This
will apply pressure around the wound and support the object. Send the
casualty to hospital to have the object removed.
Avulsion
● Severing of the skin from the body,
resulting in “creasing” or a flap of
skin, leaving a bare area of tissue.
● Caused by the force of the injuring
object sliding along the length of
the skin.
● Treatment:
○ Put the skin back in place if
possible.
○ Arrange urgent transport to
hospital.
BASIC LIFE SUPPORT
Basic Life Support (BLS)
● Refers to a set of procedures that can be learnt to prolong
survival in life-threatening situations, until more profession
help is available.
○ Cardiopulmonary Resuscitation
■ Chest compressions
■ Management of Airway and Rescue breathing
○ Use of an Automated External Defibrillator
○ Management of Foreign-Body Airway Obstruction (FBAO)
○ Management of opioid-associated emergencies
● Any individual can become certified in BLS.
○ Every individual who undergoes BLS certification may need to
refresh their knowledge and skills every two years
Basic Life Support (BLS) - [UPDATES 2020]
● Lay people are encouraged to initiate early CPR
○ Early initiation plays a key role in survival
○ It is suggested that emergency medical teams use mobile
technology to alert willing bystanders to perform CPR
● ‘Chain of Survival’ has been modified
○ Adding a sixth link (RECOVERY) for both adults and children
● For children, the rate for assisted ventilation has been modified.
○ Recommends delivery of one breath every 2 to 3 seconds, with 20 to
30 breaths per minute
● Opioid-associated emergencies
○ Recommended that lay rescuers receive training in
administering naloxone
● The use of algorithms in training material and program is encouraged
○ To enable easy recollection of protocols
High-Quality CPR
What is High-Quality CPR?
● Performing CPR skills effectively to improve a victim’s chances of
survival.
○ Start compression within 10 seconds of recognition of cardiac arrest
○ Push hard, push: Compress at a rate of 100 to 120/min with a depth of
■ At least 2 inches (5cm) for adults
■ At least one third the depth of the chest, about 2 inches (5cm), for
children
■ At least one third the depth of the chest, about 1 ½ inches (4cm), for
infants
○ Allow complete chest recoil after each compression
○ Minimize interruptions in compression
■ Try to limit interruptions to less than 10 seconds
○ Give effective breaths that make the chest rise
○ Avoid excessive ventilation
● By learning high-quality CPR, you’ll have the ability to improve patient outcomes
and save more live
Personal Protective Equipment (PPE)
in performing CPR
● Worn to help protect the rescuer from health or safety
risks
● PPE will vary based on situation and protocols (always
consult with your local health authority or regulatory
body on specific PPE protocols relevant to your role)
○ Medical gloves
○ Eye protection
○ Full-body coverage
○ High-visibility clothing
○ Safety footwear
○ Safety helmets
The Chain of Survival
Why is a specific protocol necessary for
BLS?
● Clinical protocols or guidelines are a set of instructions that must be followed
when a healthcare intervention is carried out.
● Protocols and algorithms are always put together based on the best available
evidence in the literature.
○ Professional bodies review this evidence at regular intervals, and the protocols are then
adjustedand updated accordingly.
○ Following set protocols can help optimize healthcare outcomes
■ Chances of patient survival improve dramatically
● Concept of Chain of Survival
○ Basically a series of critical actions that, when followed correctly, can
decrease mortality associated with cardiac arrest.
○ Each link in the chain is equally important
○ Chain of survival differs on whether the cardiac arrest occurs in-hospital or
out-of-hospital
Adult Chain of Survival
● Cardiac arrest can happen anywhere -- on the street, at home, or in a
hospital emergency department, intensive care unit (ICU), or inpatient
bed.
○ The system of care is different depending on whether the patient has
an arrest inside or outside the hospital
 Adult Chain of Survival for an In-Hospital
Cardiac Arrest

● For adult patients who are in the hospital, cardiac arrest usually happens
as a result of serious respiratory or circulatory conditions that get worse.
○ Many of these arrest can be (1) predicted and prevented by careful observation,
prevention, and early treatment to prearrest conditions
○ Once cardiac arrest is recognized,(2) immediate activation of the
resuscitation team, (3) early high-quality CPR, and (4) rapid defibrillation
are essential.
 Adult Chain of Survival for an In-Hospital
Cardiac Arrest

● After ROSC, all cardiac arrest victims receive (5) post-cardiac arrest care.
○ This level of care is provided by a team of multidisciplinary specialist and may occur in the
cardiac catheterization suite or laboratory (“Cath Lab”) and/or ICU/CCU.
■ A group of procedure rooms in the hospital or clinic where specialized equipment is used to
evaluate the heart and the blood vessels around the heart and in the lungs
■ Procedure involves insertion of a catheter through an artery or vein into the heart to study the
heart and its surrounding structures and function
● During the procedure, specialized catheters can be used to fix some cardiac
problems (such as opening a blocked artery)
 Adult Chain of Survival for an In-
Hospital Cardiac Arrest

● (6) Recovery from cardiac arrest

○ Recovery expectations and survivorship plans that address treatment, surveillance,
and rehabilitation need to be provided to cardiac arrest survivors and their caregivers
at hospital discharge to address the sequelae of cardiac arrest and optimize
transitions of care to independent physical, social, emotional, and role function.
(RECOMMENDATIONS)
■ We recommend structured assessment for anxiety, depression, posttraumatic
stress, and fatigue for cardiac arrest survivors and their caregivers
■ We recommend that cardiac arrest survivors have multimodal rehabilitation
assessment and treatment for physical, neurological, cardiopulmonary, and
cognitive impairments before discharge from the hospital
■ We recommend that cardiac arrest survivors and their caregivers
receive comprehensive, multidisciplinary discharge planning, to
include medical and rehabilitative treatment recommendations and
return to activity/work expectations
 Adult Chain of Survival for an In-Hospital
Cardiac Arrest

● Summary
○ Link in the chain of survival for an adult who has a cardiac arrest in the hospital
care are:
■ Surveillance, prevention, and treatment of prearrest conditions
■ Immediate recognition of cardiac arrest and activation of the emergency
response system
■ Early CPR with emphasis on chest compressions
■ Rapid defibrillation
■ Multidisciplinary post-cardiac arrest care
■ Recovery from cardiac arrest
Adult Chain of Survival for an Out-of-Hospital Cardiac Arrest

● Most out-of-hospital adult cardiac arrests happen unexpectedly and result from
underlying cardiac problems.
○ Successful outcome depends on early bystander CPR and rapid
defibrillation in the first few minutes after the arrest
○ Organized community programs that prepare the lay public to respond quickly to
a cardiac arrest are critical to improving outcome from OHCA.
○ Lay rescuers are expected to recognize the victim’s distress, call for help, start
CPR, and initiate public access defibrillation until EMS arrives
■ EMS providers can take over resuscitation efforts.
Adult Chain of Survival for an Out-of-Hospital Cardiac
Arrest

● Most out-of-hospital adult cardiac arrests happen unexpectedly and

result from underlying cardiac problems.
○ Emergency Medical Service providers:
■ May perform advanced care such as administration of medications
■ Transport the cardiac arrest victim to an emergency department or
cardiac catheterization suite.
Adult Chain of Survival for an Out-of-Hospital Cardiac
Arrest

● Summary
○ Links in the chain of survival for an adult who has a cardiac arrest outside the
hospital are:
■ Immediate recognition of cardiac arrest and activation of the emergency
response system
■ Early CPR with an emphasis on chest compressions
■ Rapid defibrillation
■ Effective advanced life support (including rapid stabilization and
transport to post-cardiac arrest care)
■ Multidisciplinary post-cardiac arrest care
■ Recovery from cardiac arrest
 Key Differences between IHCA and
OHCA Chains of Survival

Element IHCA OHCA

Initial support Depends on an in-hospital system of Depends on community and EMS

appropriate surveillance, monitoring, and providers for support.
prevention with responsive primary
provider teams.

Resuscitation teams Resuscitation efforts depend on the Lay rescuers are expected to recognize
smooth interaction of the institution’s the patient’s unresponsiveness, call for
various departments (ward, ED, cathlab, help, and activate the EMS. They initiate
CCU/ICU) and on a multidisciplinary CPR and use an AED until a team of
team of professional providers (MDs, EMS providers takes over resuscitation
nurses, RT, pharmacists, counselors, and then transports the patient to an ED
and others. and/or cathlab, before the patient is
transferred to an ICU for continued care.
 Key Differences between IHCA and
OHCA Chains of Survival
Element IHCA OHCA

Available resources Depending on the facility, In out-of-hospital settings, lay rescuers may have
in-hospital multidisciplinary access to an AED, such as through their public
teams may have immediate access defibrillation system, emergency or first
access to additional personnel aid equipment, and dispatch-assisted guidance.
as well as resources of the ED, EMS providers may find themselves alone, with
cathlab, and ICU no resources except those they brought with
them. Additional backup resources and
equipment may take some time to arrive.

Resuscitation Both settings may be affected by factors such as crowd control, family presence,
constraints space constraints, resources, training, transportation, and device failures.

Level of complexity Both IHCA and OHCA cases are typically complex, requiring teamworkand
coordination among responders and care providers.
Importance of Each Link in the Chain of
Survival (IHCA)

Recovery expectations and

survivorship plans that address
treatment, surveillance, and
rehabilitation need to be provided
to cardiac arrest survivors and their
caregivers at hospital discharge to
address the sequelae of cardiac
arrest and optimize transitions of
care to independent physical,
social, emotional, and role function.
Importance of Each Link in the Chain of Survival
(OHCA)

Recovery expectations and

survivorship plans that address
treatment, surveillance, and
rehabilitation need to be provided
to cardiac arrest survivors and
their caregivers at hospital
discharge to address the
sequelae of cardiac arrest and
optimize transitions of care to
independent physical, social,
emotional, and role function.
Pediatric Chain of
Survival
Pediatric Chain of
Survival
Pediatric Chain of Survival
● In children, cardiac arrest is often secondary to respiratory failure and
shock.
● Identifying children with these problems is essential to reduce the
likelihood of pediatric cardiac arrest and maximize survival and
recovery.
○ Emphasis on prevention link in the pediatric chain of survival
● Pediatric Chain of Survival:
○ Prevention of arrest
○ Early high-quality bystander CPR
○ Rapid activation of the emergency response system
○ Effective advanced life support (including rapid stabilization and transport
to post cardiac arrest care)
○ Integrated post cardiac arrest care
○ Recovery from cardiac arrest
Signs of someone needing a
CPR:
Indications:
● Unresponsive
● No pulse
● No breathing

Contraindication:
● Allow Natural Death (AND)
or Do Not Resuscitate
(DNR) order
 Automated
External
Defibrillator (AED)
Automated External Defibrillator (AED)
● A lightweight, portable, computerized device that can identify an abnormal
heart rhythm (ventricular fibrillation or pulseless ventricular tachycardia)
and allows the heart’s normal rhythm to return.
● AEDs are simple to operate, allowing laypersons and healthcare
providers to attempt defibrillation safely.
● Early defibrillation
○ The time between the collapse and defibrillation is an important factor in survival
from sudden cardiac arrest caused by VF or PVT.
○ Research has shown that if rescuers minimize the interval between the last
compression and shock delivery, the shock is much more likely to be effective
■ Minimizing this interval will require practice na excellent team
coordination, particularly between the compressor and the rescuer
operating the AED.
 Automated External Defibrillator (AED)
● Life-threatening Arrhythmias
○ An arrhythmia is an irregular or abnormal heart beat.
○ Can occur when the electrical impulses that cause the heart to beat happen too quickly,
too slowly, or erratically.
■ Pulseless Ventricular Tachycardia (PVT)
● When the lower chambers of the heart (ventricles) begin contracting at a very
fast pace, a rapid heart rate known as ventricular tachycardia develops.
● In extremely severe cases, the ventricles pump so quickly and inefficiently
that no pulse can be detected.
● Body tissues and organs, especially the heart and the brain, no longer
receive oxygen
■ Ventricular Fibrillation (VF)
● VF is an arrest rhythm.
● The heart’s electrical activity becomes disordered
● The heart muscles quiver in a fast, unsynchronized way so the heart does not
pump blood
 Automated External Defibrillator (AED)

● Public-Access Defibrillation (PAD)

○ Means having trained rescuers and AEDs available in public places where
large numbers of people gather or where there is reasonable likelihood of
witnessed cardiac arrest
■ Airports, convention centers, sports facilities, industrial buildings,
offices, fitness facilities, shopping malls, apartments, and health care
facilities
■ Communities, businesses, or public facilities where AEDs are available
are encouraged to participate in local PAD programs by:
● Notifying or registering their AED with the local EMS agency
● Establishing medical authority (appointing a local physician) to provide
medical oversight for quality control
● Ensure that all expected rescuers are trained in high-quality CPR and
AED use
Maintaining the AED and supplies
● AEDs should be properly maintained according to the
manufacturer’s instructions.
● Maintenance may include:
○ Battery replacement
○ Calibration and testing of energy dose
○ Ordering and replacing supplies
■ AED pad replacement, including pediatric pads
■ Additional emergency equipment (kept in a separate emergency
kit or first aid kit)
● Scissors
● Razors (for shaving a hairy chest)
● Wipes
● Gloves
● Barrier device (eg, pocket mask)
Using the AED
 AED Arrival
● Once the AED arrives, place it at
the victim’s side, next to the
rescuer who will operate it.
○ This position provides access to
AED controls and easy placement
of AED pads
○ It also allows a second rescuer to
perform high-quality CPR from
the opposite side of the victim
without interfering with AED
operation
Universal Steps for Operating and
AED
Step Action

1 Open the carrying case. Power on the AED if needed:

● Some devices will “power on” automatically when you open the lid or case
● Follow the AED prompts as a guide to next steps

2 Attach AED pads to the victim’s bare chest. Choose adult pads for victims 8 years
of age and older
● Peel the backing away from the AED pads
● Attach the adhesive AED pads to the victim’s bare chest.
● Attach the AED connecting cables to the AED device (Some AED cables are
already preconnected to the device)
 Universal Steps for Operating
and AED
Step Action

3 “Clear” the victim and allow the AED to analyze the rhythm
● When the AED prompts you, clear the victim during analysis. Be sure that no one
is touching the victim, not even the rescuer in charge of giving breaths.
● Some AEDs will tell you to push a button to allow the AED to begin analyzing the
heart rhythm; others will do that automatically. The AED may take a few seconds
to analyze.

4 If the AED advises a shock, it will tell you to clear the victim and then deliver a shock.
● Clear the victim before delivering the shock; be sure that no one is touching the
victim.
● Loudly state a “clear the victim” message, such as “Everybody clear” or simply
“Clear”.
● Look to be sure that no one is in contact with the victim.
● Press shock button
● The shock will produce a sudden contraction of the victim’s muscles
 Universal Steps for Operating
and AED
Step Action

5 If no shock is needed, and after any shock delivery, immediately resume CPR, starting
with chest compressions

6 After about 5 cycles or 2 minutes of CPR, the AED will prompt you to repeat steps 3 and
4
Universal
Steps for
Operating and
AED (Adult
and Children 8
years of age
and older)
Do Not Delay High-Quality CPR after
AED use.
● Immediately resume high-quality CPR, starting with chest compression,
after:
○ A shock isdelivered
○ The AED prompts “no shock advised”
● After about 5 cycles or 2 minutes of high-quality CPR, the AED will prompt
you to repeat steps 3 and 4.
● Continue until advanced life support providers take over or the victim
begins to breathe, move, or otherwise react.
Special Circumstances:
● May require the rescuer to to take additional
actions when placing AED pads for a victim
who:
○ Has a hairy chest
○ Is immersed in water or has water
covering the chest
○ Has an implanted defibrillator or
pacemaker
○ Has a transdermal medication patch or
other object on the surface of the skin
where the AED pads are to be placed
AED for Infants and Children less than 8
years of age
● Pediatric-Capable AEDs
○ Some AED models are designed for both pediatric use and adult
use. These AEDs deliver a reduced shock dose when pediatric
pads are used.
○ AED shock dose may be reduced by pediatric cables,
an attenuator, or reprogramming in the device.
■ Reduces shock dose by about two-thirds
AED for Infants and Children less than 8
years of age
● Choosing and Placing the AED pads
○ Use child pads, if available, for infants and children less than 8
years of age
■ If not available, use adult pads.
● Make sure the pads do not touch each other or
overlap.
● Using adult pads or adult shock dose is better
than no attempt at defibrillation for an infant or
child
High-Quality CPR for
adults, children, and
infant
Adult Basic Life
Support
Algorithm for
Health Care
Providers
Pediatric Basic
Life Support
Algorithm for
Health Care
Providers
Summary of
High-Quality
CPR
Components
Relief ofForeign-Body
Airway Obstruction