Just as park and recreation agencies constantly evaluate operations, so does the science community when it comes to first aid and resuscitation. Updates are made when the science dictates, and a formal process occurs every five years.
The results of the formal five-year evaluation process were announced this October by the American Red Cross and American Heart Association (AHA). Last updated in 2010, these recommendations form the recognized scientific basis for most first-aid training around the world and will be phased into a majority of training starting in 2016.
At a glance, the recommendations make the rescue/first-aid process more streamlined and efficacious, but they are not a dramatic departure from past practices.
“First aid can be initiated by anyone in any situation, and our responsibility as experts is to designate assessments and interventions that are medically sound and based on scientific evidence or expert consensus,” says Eunice “Nici” Singletary, M.D., co-chair of the International Liaison Committee on Resuscitation (ILCOR) First Aid Task Force and chair of the Red Cross Scientific Advisory Council’s First Aid Subcouncil. “Knowing the correct steps to take in those critical first moments of an emergency can mean the difference between life and death.”
Summary of the Most Noteworthy Revisions
Bleeding updates: The revised guidelines stress the importance of stopping severe bleeding as a critical first-aid skill. Almost all bleeding can be controlled by steady, direct, manual pressure, with or without a gauze or cloth dressing over the wound. The guidelines recommend pressing hard and holding steady pressure for at least five minutes without lifting the dressings to see if the bleeding has stopped.
Tourniquets should be considered for severe, life-threatening bleeding on a leg or arm. For open wounds not on an extremity, the guidelines suggest use of a hemostatic dressing, which is coated with a special agent to enhance clotting and help stop bleeding when correctly applied and combined with direct pressure. Hemostatic dressings are readily available online and at pharmacies.
Exertional dehydration: In the absence of shock, confusion or the inability to swallow, first-aid providers should assist or encourage individuals with exertional dehydration to orally rehydrate with a 5-8 percent carbohydrate-electrolyte (CE) drink. Other beverages, such as coconut water and 2-percent milk, have also been found to promote rehydration after exercise-associated dehydration. If a CE-based sports drink or these alternatives are not available, drinkable water may be used.
Heat stroke: Persons suffering a heat-related illness with a change in mental status, such as confusion, sleepiness, vision disturbances and seizures, are likely to be suffering from heat stroke. Responders should immediately apply rapid active cooling measures and call 911.
Hypoglycemia: Early treatment of hypoglycemia (low blood sugar) while the person is still awake and able to follow instructions can prevent progression to more serious hypoglycemia that would require advanced treatment. To avoid giving too much or too little sugar, the new guidelines recommend use of glucose tablets (15-20 gm) that can be purchased at a retail pharmacy. Glucose tablets have been shown to be more effective at resolving symptoms of hypoglycemia than dietary forms of sugar. If glucose tablets are not available, food sources such as sucrose candies, fruit leather strips or orange juice can still be used, in that order of preference.
Anaphylaxis: Under the revised guidelines for treating anaphylaxis (severe allergic reaction), if symptoms persist beyond the initial dose and arrival of advanced care will exceed 5-10 minutes, the first-aid provider may give a second epinephrine injection from a prescribed auto-injector.
Recognition of stroke: Approximately 800,000 Americans have a stroke each year, leaving them at risk for long-term disability. Early recognition of stroke through the use of a stroke assessment system (i.e., the Face, Arms, Speech and Time, or FAST, assessment tool) decreases the interval between the time that the incident occurs and the time it takes for that person to arrive at a hospital and receive specific treatment. This faster time to treatment may reduce the damage and disability from a stroke.
Use of aspirin with heart attacks: The updated guidelines clarify that aspirin should be used only when helping someone suspected of having a heart attack, characterized by symptoms such as chest pain accompanied by nausea, sweating and pain in the arm and back. If the first-aid provider is unclear on whether this is a heart attack or simply someone experiencing non-cardiac-related chest pain or discomfort, then aspirin should not be given. Additionally, the updated guidelines emphasize that there is no need to distinguish between enteric (coated, time-release tablets) versus non-enteric coated aspirin as long as the aspirin is chewed before being swallowed.
CPR Updates Highlight Importance of Taking Action
The latest CPR guidelines highlight how quick action, proper training, use of technology and coordinated efforts can increase survival from cardiac arrest. More than 326,000 people experience cardiac arrest outside of a hospital each year and about 90 percent of them die.
The 2015 guidelines say high-quality CPR training will help responders act confidently and provide better CPR to cardiac arrest victims. Additionally, research shows resuscitation skills can decline within a few months — far before the two-year current evaluation standard. Conducting regular in-service CPR training will help ensure that employees deliver the highest quality of emergency cardiovascular care.
The American Heart Association cites the following as key points from the 2015 guidelines update:
Untrained bystanders: If they haven’t done so already, lifeguards and other trained responders should encourage bystanders to call 911.
Trained lay responders: Trained responders should simultaneously perform steps in an effort to reduce the time to the first chest compression. While the guidelines encourage use of hands-only CPR (CPR without rescue breaths) for untrained responders, they continue to recommend that trained lay responders conduct CPR with breaths.
Compression rate and depth: For adults, upper limits of recommended rate and compression depth have been added based on new data suggesting that excessive compression rates and depth are less effective. The key points for rescuers to remember are to perform chest compressions at a rate of 100 to 120 per minute and to a depth of at least 2 inches, avoiding excessive depths greater than 2.4 inches. Rescuers should also avoid being too shallow with compressions to achieve the best possible outcomes.
Proper and robust training around these updated guidelines will give your staff the technical edge needed to ensure the safety and health of all patrons if or when a medical emergency should occur. Learn more about first-aid training.
Jonathan Epstein is a paramedic and Senior Director of Science and Content Development for the American Red Cross.