Special Circumstances of Resuscitation

cprstockBob Elling, MPA, EMT-P

(Part 4 of a 6-part series: CPR, ECC, and First Aid Guidelines: Version 2015)

Special Circumstances of Resuscitation 

A number of topics were addressed in the 2015 Guidelines on special circumstances of resuscitation (i.e., pregnant patient, pulmonary embolism, and opioid overdose) that will be incorporated into updated protocols and procedures. Let’s take a closer look at the specifics here.

Cardiac Arrest Associated With Pregnancy

  • Priorities for the pregnant woman in cardiac arrest are provision of high-quality CPR and relief of aortocaval compression (Class I).
  • If the fundus height is at or above the level of the umbilicus, manual LUD can be beneficial in relieving aortocaval compression during chest compressions (Class IIa).
  • Because immediate ROSC cannot always be achieved, local resources for a PMCD should be summoned as soon as cardiac arrest is recognized in a woman in the second half of pregnancy (Class I).
  • Systematic preparation and training are the keys to a successful response to such rare and complex events. Care teams that may be called upon to manage these situations should develop and practice standard institutional responses to allow for smooth delivery of resuscitative care (Class I).
  • During cardiac arrest, if the pregnant woman with a fundus height at or above the umbilicus has not achieved ROSC with usual resuscitation measures plus manual LUD, it is advisable to prepare to evacuate the uterus while resuscitation continues (Class I).
  • In situations such as nonsurvivable maternal trauma or prolonged pulselessness, in which maternal resuscitative efforts are obviously futile, there is no reason to delay performing PMCD (Class I).
  • PMCD should be considered at 4 minutes after onset of maternal cardiac arrest or resuscitative efforts (for the unwitnessed arrest) if there is no ROSC (Class IIa).

Cardiac Arrest Associated With Pulmonary Embolism

  • In patients with confirmed PE as the precipitant of cardiac arrest, thrombolysis, surgical embolectomy, and mechanical embolectomy are reasonable emergency treatment options (Class IIa).
  • Thrombolysis may be considered when cardiac arrest is suspected to be caused by PE (Class IIb).
  • Thrombolysis can be beneficial even when chest compressions have been provided (Class IIa).

Cardiac or Respiratory Arrest Associated With Opioid Overdose

  • It is reasonable to provide opioid overdose response education, either alone or coupled with naloxone distribution and training, to persons at risk for opioid overdose (Class IIa).
  • It is reasonable to base this training on first aid and non-health care provider BLS recommendations rather than on more advanced practices intended for health care providers (Class IIa).
  • Empiric administration of IM or IN naloxone to all unresponsive patients with opioid-associated life-threatening emergency may be reasonable as an adjunct to standard first aid and non-health care provider BLS protocols (Class IIb).
  • Victims who respond to naloxone administration should receive advanced health care services (Class I).
  • For patients with known or suspected opioid addiction who have a definite pulse but no normal breathing or only gasping (ie, a respiratory arrest), in addition to providing standard BLS care, it is reasonable for appropriately trained BLS health care providers to administer IM or IN naloxone (Class IIa).
  • Standard resuscitative measures should take priority over naloxone administration (Class I), with a focus on high-quality CPR (compressions plus ventilation).
  • It may be reasonable to administer IM or IN naloxone based on the possibility that the patient is not in cardiac arrest (Class IIb).
  • Responders should not delay access to more-advanced medical services while awaiting the patient’s response to naloxone or other interventions (Class I).
  • Unless the patient refuses further care, victims who respond to naloxone administration should receive advanced health care services (Class I).
  • Bag-mask ventilation should be maintained until spontaneous breathing returns, and standard ACLS measures should continue if ROSC does not occur (Class I).
  • After ROSC or return of spontaneous breathing, patients should be observed in a health care setting until the risk of recurrent opioid toxicity is low and the patient’s level of consciousness and vital signs have normalized (Class I).
  • If recurrent opioid toxicity develops, repeated small doses or an infusion of naloxone can be beneficial in health care settings (Class IIa).
  • Naloxone administration in post-cardiac arrest care may be considered to achieve the specific therapeutic goals of reversing the effects of long-acting opioids (Class IIb).

The next section of this blog will go into the specifics on pediatric basic and advanced life support and cardiopulmonary resuscitation quality. If you want to read all the details and background, take a look at the Supplement to Circulation, volume 132, number 18, supplement 2, November 3, 2015.

See you in the streets!

 

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Advanced Cardiovascular Life Support and ACS

cprstockBob Elling, MPA, EMT-P

(Part 3 of a 6-part series: CPR, ECC, and First Aid Guidelines: Version 2015)

Advanced Cardiovascular Life Support and ACS

A number of topics were addressed in the 2015 Guidelines on adult advanced cardiovascular life support (ACLS) and acute coronary syndromes (ACS) that will be incorporated into updated protocols and procedures. Let’s take a closer look at the specifics here.

Advanced Cardiovascular Life Support

Adjuncts to CPR

  • When supplementary oxygen is available, it may be reasonable to use the maximal feasible inspired oxygen concentration during CPR (Class IIb).
  • Although no clinical study has examined whether titrating resuscitative efforts to physiologic parameters during CPR improves outcome, it may be reasonable to use physiologic parameters (quantitative waveform capnography, arterial relaxation diastolic pressure, arterial pressure monitoring, and central venous oxygen saturation) when feasible to monitor and optimize CPR quality, guide vasopressor therapy, and detect ROSC (Class IIb).

Adjuncts for Airway Control and Ventilation

  • Either a bag-mask device or an advanced airway may be used for oxygenation and ventilation during CPR in both in-hospital and out-of-hospital settings (Class IIb).
  • For health care providers trained in their use, either a supraglottic airway (SGA) device or an endotracheal tube (ETT) may be used as the initial advanced airway during CPR (Class IIb).
  • Continuous waveform capnography is recommended in addition to clinical assessment as the most reliable method of confirming and monitoring correct placement of an ETT (Class I).
  • If continuous waveform capnography is not available, a nonwaveform CO2 detector, esophageal detector device, or ultrasound used by an experienced operator is a reasonable alternative (Class IIa).
  • After placement of an advanced airway, it may be reasonable for the provider to deliver 1 breath every 6 seconds (10 breaths/min) while continuous chest compressions are being performed (Class IIb).

Management of Cardiac Arrest

  • Defibrillators (using BTE, RLB, or monophasic waveforms) are recommended to treat atrial and ventricular arrhythmias (Class I).
  • Based on their greater success in arrhythmia termination, defibrillators using biphasic waveforms (BTE or RLB) are preferred to monophasic defibrillators for treatment of both atrial and ventricular arrhythmias (Class IIa).
  • In the absence of conclusive evidence that one biphasic waveform is superior to another in termination of VF, it is reasonable to use the device manufacturer’s recommended energy dose for the first shock. If this dose is not known, defibrillation at the maximal dose may be considered (Class IIb).
  • It is reasonable that selection of fixed versus escalating energy for subsequent shocks be based on the specific device manufacturer’s instructions (Class IIa).
  • If using a manual defibrillator capable of escalating energies, higher energy for the second and subsequent shocks may be considered (Class IIb).
  • A single-shock strategy (as opposed to stacked shocks) is reasonable for defibrillation (Class IIa).
  • Amiodarone may be considered for VF/pVT that is unresponsive to CPR, defibrillation, and vasopressor therapy (Class IIb).
  • Lidocaine may be considered as an alternative to amiodarone for VF/pVT that is unresponsive to CPR, defibrillation, and vasopressor therapy (Class IIb,).
  • The routine use of magnesium for VF/pVT is not recommended in adult patients (Class III).
  • There is inadequate evidence to support the routine use of lidocaine after cardiac arrest. However, initiation or continuation of lidocaine may be considered immediately after ROSC from cardiac arrest due to VF/pVT (Class IIb).
  • There is inadequate evidence to support the routine use of a beta-blocker after cardiac arrest. However, the initiation or continuation of an oral or intravenous beta-blocker may be considered early after hospitalization from cardiac arrest due to VF/pVT (Class IIb).
  • Standard-dose epinephrine (1 mg every 3 to 5 minutes) may be reasonable for patients in cardiac arrest (Class IIb).
  • High-dose epinephrine is not recommended for routine use in cardiac arrest (Class III).
  • Vasopressin offers no advantage as a substitute for epinephrine in cardiac arrest (Class IIb).
  • Vasopressin in combination with epinephrine offers no advantage as a substitute for standard-dose epinephrine in cardiac arrest (Class IIb).
  • It may be reasonable to administer epinephrine as soon as feasible after the onset of cardiac arrest due to an initial nonshockable rhythm (Class IIb).
  • For patients with OHCA, use of steroids during CPR is of uncertain benefit (Class IIb).
  • In intubated patients, failure to achieve an etco2 of greater than 10 mm Hg by waveform capnography after 20 minutes of CPR may be considered as one component of a multimodal approach to decide when to end resuscitative efforts, but should not be used in isolation (Class IIb).
  • In non-intubated patients, a specific etco2 cutoff value at any time during CPR should not be used as an indicator to end resuscitative efforts (Class III).

Post-Cardiac Arrest Care

Cardiovascular Care and Hemodynamic Goals 

  • Coronary angiography should be performed emergently (rather than later in the hospital stay or not at all) for OHCA patients with suspected cardiac etiology of arrest and ST elevation on ECG (Class I).
  • Emergent coronary angiography is reasonable for selected (eg, electrically or hemodynamically unstable) adult patients who are comatose after OHCA of suspected cardiac origin but without ST elevation on ECG (Class IIa).
  • Coronary angiography is reasonable in post–cardiac arrest patients for whom coronary angiography is indicated regardless of whether the patient is comatose or awake (Class IIa).
  • Avoiding and immediately correcting hypotension (systolic BP less than 90 mm Hg, MAP less than 65 mm Hg) during post-resuscitation care may be reasonable (Class IIb).

Targeted Temperature Management (TTM) and Other Critical Care Interventions

  • We recommend that comatose (ie, lack of meaningful response to verbal commands) adult patients with ROSC after cardiac arrest have TTM (Class I), LOE B-R for VF/pVT OHCA (Class I) for non-VF/pVT (ie, “non-shockable”) and in-hospital cardiac arrest.
  • We recommend selecting and maintaining a constant temperature between 32°C and 36°C during TTM (Class I).
  • It is reasonable that TTM be maintained for at least 24 hours after achieving the target temperature (Class IIa).
  • We recommend against the routine prehospital cooling of patients after ROSC with rapid infusion of cold intravenous fluids (Class III).
  • We recommend that all patients who are resuscitated from cardiac arrest but who subsequently progress to death or brain death be evaluated for organ donation (Class I).
  • Patients who do not have ROSC after resuscitation efforts and who would otherwise have termination of efforts may be considered candidates for kidney or liver donation in settings where such program exist (Class IIb).

Acute Coronary Syndromes

Diagnostic Interventions

  • Prehospital 12-lead ECG should be acquired early for patients with possible ACS (Class I).
  • Prehospital notification of the receiving hospital (if fibrinolysis is the likely reperfusion strategy) and/or prehospital activation of the catheterization laboratory should occur for all patients with a recognized STEMI on prehospital ECG (Class I).
  • Because of high false-negative rates, we recommend that computer-assisted ECG interpretation not be used as the sole means to diagnose STEMI (Class III).
  • We recommend that computer-assisted ECG interpretation be used in conjunction with physician or trained-provider interpretation to recognize STEMI (Class IIb).
  • While transmission of the prehospital ECG to the ED physician may improve PPV and therapeutic decision making regarding adult patients with suspected STEMI, if transmission is not performed, it may be reasonable for trained-nonphysician ECG interpretation to be used as the basis for decision making, including activation of the catheterization laboratory, administration of fibrinolysis, and selection of the destination hospital (Class IIa).

Therapeutic Interventions

  • The usefulness of supplementary oxygen therapy has not been established in normoxic patients. In the prehospital, ED, and hospital settings, the withholding of supplementary oxygen therapy in normoxic patients with suspected or confirmed ACS may be considered (Class IIb).
  • Where prehospital fibrinolysis is available as part of a STEMI system of care, and in-hospital fibrinolysis is the alternative treatment strategy, it is reasonable to administer prehospital fibrinolysis when transport times are more than 30 minutes (Class IIa).
  • If fibrinolytic therapy is provided, immediate transfer to a PCI center for cardiac angiography within 3 to 24 hours may be considered (Class IIb).
  • Regardless of whether the time of symptom onset is known, the interval between first medical contact and reperfusion should not exceed 120 minutes (Class I).
  • When STEMI patients cannot be transferred to a PCI-capable hospital in a timely manner, fibrinolytic therapy with routine transfer for angiography may be an acceptable alternative to immediate transfer to PPCI (Class IIb).
  • When fibrinolytic therapy is administered to STEMI patients in a non-PCI-capable hospital, it may be reasonable to transport all post-fibrinolysis patients for early routine angiography in the first 3 to 6 hours and up to 24 hours later, rather than to transport post-fibrinolysis patients only when they require ischemia-guided angiography (Class IIb).

The next section of this blog will go into the specifics on special circumstances in resuscitation. If you want to read all the details and background, take a look at the Supplement to Circulation, volume 132, number 18, supplement 2, November 3, 2015.

See you in the streets!

 

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Systems of Care and Continuous Quality Improvement

Bob Elling, MPA, EMT-Pcprstock

(Part 2 of a 6-part series: CPR, ECC, and First Aid Guidelines: Version 2015)

A number of topics were addressed in the 2015 Guidelines on systems of care and continuous quality improvement (CQI) that will be incorporated into updated protocols and procedures. This section is extremely important, as those communities that take the time to focus on improving all the links in the chain of survival will see the greatest improvements in survival. Whose responsibility is this? All of us have a responsibility as first aiders, EMS providers, health care professionals, and interested members of the public to step up and help implement all sections of the Guidelines!

Let’s take a closer look at the specifics here.

Public-Access Defibrillation

  • It is recommended that PAD programs for patients with OHCA be implemented in communities at risk for cardiac arrest (Class I).

Dispatcher Recognition of Cardiac Arrest

  • It is recommended that emergency dispatchers determine if a patient is unconscious with abnormal breathing after acquiring the requisite information to determine the location of the event (Class I).
  • If the patient is unconscious with abnormal or absent breathing, it is reasonable for the emergency dispatcher to assume that the patient is in cardiac arrest (Class IIa).
  • Dispatchers should be educated to identify unconsciousness with abnormal and agonal gasps across a range of clinical presentations and descriptions (Class I).
  • We recommend that dispatchers provide chest compression-only CPR instructions to callers for adults with suspected OHCA (Class I).

Use of Social Media to Summon Rescuers

  • Given the low risk of harm and the potential benefit of such notifications, it may be reasonable for communities to incorporate, where available, social media technologies that summon rescuers who are willing and able to perform CPR and are in close proximity to a suspected victim of OHCA (Class IIb).

Transport to Specialized Cardiac Arrest Centers

  • A regionalized approach to OHCA resuscitation that includes the use of cardiac resuscitation centers may be considered (Class IIb).

Immediate Recognition and Activation of the Emergency Response System

  • It is recommended that emergency dispatchers determine if a patient is unresponsive with abnormal breathing after acquiring the requisite information to determine the location of the event (Class I).
  • If the patient is unresponsive with abnormal or absent breathing, it is reasonable for the emergency dispatcher to assume that the patient is in cardiac arrest (Class IIa).
  • Dispatchers should be educated to identify unresponsiveness with abnormal breathing and agonal gasps across a range of clinical presentations and descriptions (Class I).

Untrained Lay Rescuer

  • Untrained lay rescuers should provide compression-only CPR, with or without dispatcher assistance (Class I).
  • The rescuer should continue compression-only CPR until the arrival of an AED or rescuers with additional training (Class I).

Trained Lay Rescuer

  • All lay rescuers should, at a minimum, provide chest compressions for victims of cardiac arrest (Class I). In addition, if the trained lay rescuer is able to perform rescue breaths, he or she should add rescue breaths at a ratio of 30 compressions to 2 breaths.
  • The rescuer should continue CPR until an AED arrives and is ready for use or until EMS providers take over care of the victim (Class I).

Health Care Provider

  • It is reasonable for health care providers to provide chest compressions and ventilation for all adult patients in cardiac arrest, from either a cardiac or noncardiac cause (Class IIa).

Delayed Ventilation

  • For witnessed OHCA with a shockable rhythm, it may be reasonable for EMS systems with priority-based, multitiered response to delay positive-pressure ventilation by using a strategy of up to 3 cycles of 200 continuous compressions with passive oxygen insufflation and airway adjuncts (Class IIb).

Recognition of Arrest

  • Dispatchers should instruct rescuers to provide CPR if the victim is unresponsive with no normal breathing, even when the victim demonstrates occasional gasps (Class I).

Suspected Opioid-Related Life-Threatening Emergency

  • For a patient with known or suspected opioid overdose who has a definite pulse but no normal breathing or only gasping (ie, a respiratory arrest), in addition to providing standard BLS care, it is reasonable for appropriately trained BLS health care providers to administer intramuscular or intranasal naloxone (Class IIa).
  • For patients in cardiac arrest, medication administration is ineffective without concomitant chest compressions to ensure drug delivery to the tissues. Thus naloxone administration may be considered after initiation of CPR if there is high suspicion for opioid overdose (Class IIb).
  • It is reasonable to provide opioid overdose response education with or without naloxone distribution to persons at risk for opioid overdose in any setting (Class IIa).

Chest Compression Rate

  • In adult victims of cardiac arrest, it is reasonable for rescuers to perform chest compressions at a rate of 100 to 120 compressions per minute (Class IIa).

Chest Compression Depth

  • During manual CPR, rescuers should perform chest compressions to a depth of at least 2 inches (5 cm) for an average adult, while avoiding excessive chest compression depths (greater than 2.4 inches [6 cm]) (Class I).

Chest Wall Recoil

  • It is reasonable for rescuers to avoid leaning on the chest between compressions to allow full chest wall recoil for adults in cardiac arrest (Class IIa).

Minimizing Interruptions in Chest Compressions

  • In adult cardiac arrest, total preshock and postshock pauses in chest compressions should be as short as possible (Class I).
  • For adults in cardiac arrest receiving CPR without an advanced airway, it is reasonable to pause compressions for less than 10 seconds to deliver 2 breaths (Class IIa).
  • In adult cardiac arrest with an unprotected airway, it may be reasonable to perform CPR with the goal of keeping the chest compression fraction as high as possible, with a target of at least 60% (Class IIb).

Layperson: Compression-Only CPR Versus Conventional CPR

  • Dispatchers should instruct untrained lay rescuers to provide compression-only CPR for adults with sudden cardiac arrest (Class I).
  • Compression-only CPR is a reasonable alternative to conventional CPR in the adult cardiac arrest patient (Class IIa).
  • For trained rescuers, ventilation may be considered in addition to chest compressions for the adult in cardiac arrest (Class IIb).

Open the Airway: Lay Rescuer

  • For victims with suspected spinal injury, rescuers should initially use manual spinal motion restriction (eg, placing a hand on either side of the patient’s head to hold it still) rather than immobilization devices, because use of immobilization devices by lay rescuers may be harmful (Class III).

Bag-Mask Ventilation

  • As long as the patient does not have an advanced airway in place, rescuers should deliver cycles of 30 compressions and 2 breaths during CPR. The rescuer delivers breaths during pauses in compressions and delivers each breath over approximately 1 second (Class IIa).

Ventilation With an Advanced Airway

  • When the victim has an advanced airway in place during CPR, rescuers no longer need to deliver cycles of 30 compressions and 2 breaths (ie, they no longer need to interrupt compressions to deliver 2 breaths). Instead, it may be reasonable for the provider to deliver 1 breath every 6 seconds (10 breaths per minute) while continuous chest compressions are being performed (Class IIb).

Passive Oxygen Versus Positive-Pressure Oxygen During CPR

  • We do not recommend the routine use of passive ventilation techniques during conventional CPR for adults, because the usefulness/effectiveness of these techniques is unknown (Class IIb).
  • In EMS systems that use bundles of care involving continuous chest compressions, the use of passive ventilation techniques may be considered as part of that bundle (Class IIb).

CPR Before Defibrillation

  • For witnessed adult cardiac arrest when an AED is immediately available, it is reasonable that the defibrillator be used as soon as possible (Class IIa).
  • For adults with unmonitored cardiac arrest or for whom an AED is not immediately available, it is reasonable that CPR be initiated while the defibrillator equipment is being retrieved and applied, and that defibrillation, if indicated, be attempted as soon as the device is ready for use (Class IIa).

Analysis of Rhythm During Compressions

  • There is insufficient evidence to recommend the use of artifact-filtering algorithms for analysis of ECG rhythm during CPR. Their use may be considered as part of a research program of if an EMS system has already incorporated ECG artifact-filtering algorithms in its resuscitation protocols (Class IIb).

Timing of Rhythm Check

  • It may be reasonable to immediately resume chest compressions after shock delivery for adults in cardiac arrest in any setting (Class IIb).

Chest Compression Feedback

  • It may be reasonable to use audiovisual feedback devices during CPR for real-time optimization of CPR performance (Class IIb).

The next section of this blog will address specifics in the area of adult advanced cardiovascular life support and ACS. If you want to read all the details and background, take a look at the Supplement to Circulation, volume 132, number 18, supplement 2, November 3, 2015.

See you in the streets!

 

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Navigate 2 Customer Satisfaction Survey [Results]

The results are in!

EMS and Fire students and instructors recently completed a comprehensive survey about their experience with Navigate 2. Check out the infographic below to see how Navigate 2 is working for them:

infographicnav2

 

Want to learn how Navigate 2 can work for you? Contact your Public Safety Specialist today.

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CPR, ECC, and First Aid Guidelines: Version 2015

cprstockBob Elling, MPA, EMT-P

(Part 1 of a 6-part series)

Introduction to the 2015 Guidelines Changes

If there is one thing we can rely on in the medical field, it is change. Because many of the treatments we provide are often being evaluated in scientific studies, it has come to be an expectation that evaluation of the evidence will help guide our practice. When I was in my initial paramedic course, the physician who taught us made this statement: “About a third of what you are learning will be considered wrong in 10 years. The problem is we do not know which third.” Most of us who have practiced for a few decades can see the truth in that statement.

At 5-year intervals, experts in resuscitation from across the world publish a consensus on what the science of resuscitation tells us. It is that publication, and the process that leads up to its development, that rolls out in the United States as the “Guidelines.” The resulting documents were recently published in two peer-reviewed journals.

Resuscitation and Circulation

As you know, major changes were made to CPR and ECC practices in the 2005 Guidelines. The emphasis turned to improving the quality of chest compressions and strengthening the links in the chain of survival in every community. These changes were reinforced in 2010. The 2015 version of the Guidelines has just been published. So what does the first half of 2016 have in store for us as these updates roll out?

The good news is that clearly those communities that have implemented the spirit of the 2010 Guidelines are on the right track and are seeing success in terms of lives saved. I would sum up the 2015 Guidelines as a combination of defining limits, emphasizing teamwork, and focusing on high quality.

Looking at the new Guidelines from a “10,000-foot level” my initial impressions are as follows:

  • There are not a lot of major changes, so incorporating the Guidelines into practice should be relatively “painless.”
  • Because ILCOR and AHA are both working on first aid guidelines, there are a number of recommendations in this topic area (ie, naloxone for overdose, glucose for hypoglycemia, assisting with a bronchodilator, giving ASA to heart attack patients, no more pressure points or elevation for bleeding control, no more occlusive dressings for open chest trauma, assessing for stroke, spinal motion restriction and no collar for laypersons).
  • There are now maximums on both the rate of compression (100 to 120) and the depth of compression (2 to 2.4 inches).
  • There is a difference between the links in the chain of survival for out-of-hospital care versus in-hospital care. In-hospital care now stresses prevention.
  • There is no longer any reason to carry vasopressin, because it has no advantage over epinephrine and should not be used in pregnant women.
  • Although TTM (targeted temperature management) post ROSC is a Class I intervention, it should be done in the hospital and not with cold IV fluid in the field.
  • Trendelenburg position is back for nontraumatic causes of shock.
  • The Guidelines state several times that the frequency of training should be more often than once every 2 years.

The ECSI team of authors and editors is working very hard to update its instructor network, and to update any and all of our materials so that everyone who uses our valuable products can continue to train students to save lives.

Over the next five segments of this blog series, many of the specific recommendations will be listed. These specific topics will be covered:

Part 2: Systems of Care and Continuous Quality Improvement

Part 3: Adult Advanced Cardiac Life Support and ACS

Part 4: Special Circumstances of Resuscitation

Part 5: Pediatric Basic and Advanced Life Support and Cardiopulmonary Resuscitation Quality

Part 6: First Aid

Each recommendation in the Guidelines has a “class of recommendation” that corresponds to the strength of the recommendation and the quality of the scientific evidence that backs up the recommendation. The classes include:

Class I: strong

Class IIa: moderate

Class IIb: weak

Class III: moderate and provides no benefit

Class III: strong and causes harm

It is important to note only topics that changed are listed. Note also that I have not listed the levels of evidence, ethical issues, alternative techniques and ancillary devices to CPR, education, and neonatal topics. If you want to read all the details and background, take a look at the Supplement to Circulation, volume 132, number 18, supplement 2, November 3, 2015.

See you in the streets!

 

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Fire Prevention Week 2015: Working Smoke Alarms Save Lives

As many of you may know, Fire Prevention Week is being celebrated this week (October 4-10, 2015) in remembrance of the Great Chicago Fire of 1871. The tragic blaze killed more than 250 people, left 100,000 homeless, destroyed more than 17,400 structures, and burned more than 2,000 acres.

The theme of this year’s Fire Prevention Week is:

“Hear The Beep Where You Sleep. Every Bedroom Needs a Working Smoke Alarm!”

This year’s theme provides the perfect opportunity to educate the public about the importance of having working smoke alarms in every bedroom, outside each sleeping area, and on every level of the home (including the basement).

NFPA has everything you need to teach your community about the importance of working smoke alarms. Get started today:

  • Fire Prevention Week infographic in English and Spanish from the NFPA and USFA (see below or visit: http://ow.ly/T5lD2)

*Portions of this post are reproduced from NFPA’s Fire Prevention Week website, www.firepreventionweek.org. © 2015 NFPA.

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An Announcement from Jones & Bartlett Learning

fisdapAnnounceLogos

 

Jones & Bartlett Learning (JB Learning) has joined forces with Fisdap, a software company that builds educational tools for Emergency Medical Services (EMS). The alignment of JB Learning and Fisdap brings together two organizations working to achieve excellence in EMS education and the highest quality patient care.

Fisdap’s objective is to improve the training experience by providing tools to help with record keeping, accreditation, certification testing, managing internship schedules, and tracking student activities. They offer a range of products, from Scheduler and Skills Tracker to valid and reliable Entrance, Unit, and Comprehensive Exams, all designed to improve EMS training programs and students’ training experiences.

JB Learning’s Public Safety Group is committed to enriching the educational experience of today’s EMS and fire educators, students, and professionals. Their educational programs and services improve learning outcomes and enhance student achievement by combining authoritative content with proven and engaging technology that meets the diverse needs of initial and continuing education.

The combination of JB Learning and Fisdap enhances the educational process for EMS students and professionals by fully integrating gold standard teaching and learning curricula with tools to schedule and track students’ field and clinical experiences and valid, reliable, and predictive exams for EMTs, AEMTs, and Paramedics from a single source. JB Learning digital curriculum solutions powered by Fisdap will predict success on certification exams and produce a better EMS professional.

“This perfectly positions our organizations to meet the needs of the EMS community now and into the future,” said Kimberly Brophy, Vice President, Executive Publisher at JB Learning. “We look forward to collaborating with Fisdap on the development of new tools and services to support the changing EMS landscape.”

“We see tremendous opportunities to expand the scope of the Fisdap community’s mission and our focus on research by working with JB Learning,” said Michael Johnson, CEO of Fisdap. “By offering the option to integrate JB Learning’s rich library of content and learning tools with Fisdap’s experience tracking, evaluations, and exams, we will move toward a more complete learning environment for EMS and public safety.”

About Jones & Bartlett Learning

Jones & Bartlett Learning, LLC, a division of Ascend Learning, LLC, is a world-leading provider of instructional, assessment, and learning-performance management solutions for the secondary, post-secondary, and professional markets. Across a broad spectrum of fields ranging from health care and emergency services to computer information systems, our educational technology applications and instructional assessment and performance-management solutions are revolutionizing how instructors teach and how students and professionals learn. With the most up-to-date, authoritative content available from academia and industry thought-leaders, Jones & Bartlett Learning is leading the way for educators, students, and professionals to discover new educational and professional skill-development opportunities to enable personalized learning— anytime, anywhere.

For more information on Jones & Bartlett Learning, visit www.jblearning.com.

About Fisdap

Fisdap is the leader in online tools for EMS education, offering a suite of software resources to help EMS educators manage student internship schedules, document student experiential learning, administer secure exams, and maintain program accreditation. By fostering a culture of standards-based education, Fisdap brings the EMS community together to create innovative solutions for teaching and learning.

Facilitating EMS research is one of Fisdap’s most important objectives and we are proud to be a leader in EMS educational research. Over the years, the information and data that students enter into the Fisdap database has supported dozens of research projects—many of which have won awards and national recognition. We’re also building the EMS Reference, an online collection of peer-reviewed content, created by and for the EMS community.

For more information on Fisdap, visit www.fisdap.net.

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Two New EMS-Themed Reality TV Shows on ABC

This summer, two new EMS-themed reality shows based in Boston, Massachusetts, are featured on the ABC network. The first, Save My Life: Boston Trauma which aired on July 19th, will follow patients with life threatening injuries from the field to the hospital. The six part series will focus on emergencies in Brigham and Women’s Hospital, Massachusetts General Hospital, and Boston Medical Center.

Watch the Save My Life: Boston Trauma trailer:

The second series, Boston EMS, started on July 25th and allows viewers the unique opportunity to ride along with the dedicated men and women of Boston Emergency Services to witness the first step in the chain of trauma care. These are some of the same first responders who treated the Boston Marathon bombing victims two years ago. Viewers will have the opportunity to meet some of these brave EMS professionals and watch them actively save lives on the streets of Boston.

Watch the Boston EMS trailer:

Real-life scenarios are a powerful tool to utilize in public safety training. Watching emergency scenarios can help first responders analyze the best course of action before they are in a real-life situation. Watching real life scenarios such as those displayed on Save My Life: Boston Trauma and Boston EMS allows public safety personnel to look at potential problems, consider potential solutions, and test out the results of their actions in a safe environment.

For more real-life scenarios, Jones & Bartlett Learning offers video-based case studies in You Are the Provider: Virtual Ride-Alongs. View a brief demonstration of the cases available:

 

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Staying Safe in Extreme Heat

surfsunThe warm summer months are upon us, and with rising temperatures comes the reminder to protect yourself, friends, family, and community members from heat-related illness. During these warmer months, it is imperative to be conscious of what your body is telling you and what you are demanding of your body. On days with a higher humidity index, there is a higher percentage of moisture in the air which demands more of our bodies. Staying hydrated and cool can help you avoid the two stages of overheating: heat exhaustion and heat stroke.

The Centers for Disease Control and Prevention (CDC) provides a list of heat exhaustion and heat stroke symptoms on their website:

▶ Heat Exhaustion: heavy sweating, weakness/fatigue, cold/pale/clammy skin, pale/flushed complexion, muscle cramps, fast/weak pulse, nausea/vomiting, fainting, dizziness/confusion

▶ Heat Stroke: high body temperature, hot/red/dry/moist skin, rapid/strong pulse, possible unconsciousness, chills, throbbing headache, confusion/dizziness, slurred speech, hallucinations

When these signs and symptoms are present, the CDC provides clear instructions on how to respond and when to seek medical attention.

To avoid heat-related illness, it is recommended that the following precautions are taken when dealing with extreme heat:

  • Stay hydrated: Drink more water than usual and don’t wait until you’re thirsty to drink. Avoid alcohol or liquids containing large amounts of sugar.
  • Stay cool: Wear loose, lightweight, light-colored clothing. Take cool showers or baths. Stay in air-conditioned buildings as much as possible. Never leave anyone (infants, children, pets, etc.) in a closed, parked car.
  • Stay sun-safe: Protect your skin by applying (and reapplying!) sunscreen and wearing a brimmed hat when outdoors. Avoid outdoor activities during midday heat, if possible.
  • Stay informed: Check your local news for important health, safety, and weather updates.
  • Stay together: Check on friends, family, and neighbors and have someone do the same for you.

Children, the elderly, and those with chronic, severe illnesses are most at risk for heat-related illness, but it is important for all of us to heed the warnings above.

For first responders, it is especially important to stay vigilant about heat-related illness on the job. Whether wearing heavy clothing or equipment as part of their uniforms or being continuously active in the extreme heat, it is common for their bodies to overheat quickly. By paying close attention to their own health and safety needs first, public safety professionals will be better equipped to care for others who need their assistance in the field.

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National Pet Fire Safety Day

DogJuly 15, 2015, marks National Pet Fire Safety Day in the United States. According to the National Fire Protection Association, each year an estimated 500,000 pets are affected by home fires and approximately 1,000 of these fires are started by pets themselves. These statistics highlight the importance of pet fire safety in keeping animals and homes safe from accidental fires.

Prevent your pet from accidentally starting a fire

Implementing the following precautions can help to reduce the risk of pet-started fires in your home.

  • Remove or cover stove knobs. Be sure to remove stove knobs or protect them with covers before leaving the house. According to the National Fire Protection Association, a stove top is the number one piece of equipment involved in pet-started fires.
  • Extinguish flames. Be sure to extinguish any open flame (including fire places) before leaving your home.
  • Invest in flame-less candles. These candles contain a light bulb rather than an open flame and take the danger out of your pet knocking over a candle. Cats in particular are notorious for starting fires when their tails turn over lit candles.
  • Beware of water bowls on wooden decks. Do not leave a glass water bowl for your pet outside on a wooden deck.  The sun’s rays when filtered through the glass and water can actually heat up and ignite the wooden deck beneath it. Choose stainless steel, wooden, or ceramic bowls for your pet instead.

Ensure pet safety at all times

In the event of an actual home fire, taking the following precautions will help in the evacuation of family pets.

  • Secure young pets. Puppies and kittens are especially curious. To keep them from potential fire-starting hazards it may be safest to put them in crates or use baby gates to keep them in secure areas while you are away.
  • Keep your pets near entry/exit points when you are away from home. When you are out of the house, keep your pets in rooms with a door/window that directs outside. This will make it easier for fire fighters to rescue your pets if needed.
  • Practice escape routes with your pets. Keep leashes and collars close to exits in your home and practice fire drills periodically with your pets so they also know what to do in case of an evacuation.
  • Invest in a Pet Alert window cling. Having a Fire Emergency Window Cling on windows near the entrance to your home will help fire fighters know exactly how many animals are in your home. Be sure to keep the number of pets updated.

Pet owners can also educate and train themselves on pet first aid and emergencies by utilizing the Pet First Aid & Disaster Response Guide and Pet Emergency Pocket Guide from Jones & Bartlett Learning.

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