In 2015 ILCOR announced that updates would no longer be released in five year cycles, but as and when needed. In late 2017 their latest updates were released. The good news is that there were no changes that affect EFR courses – although they did publish further research that reinforces that current guidelines are indeed best practice.
So this seems a good time to review the changes we communicated in the 2016 Responder. If you’d like a reminder in webinar format, you can watch a webinar covering some of these points.
Late 2015 member organizations of the International Liaison Committee on Resuscitation (ILCOR) have begun to release new cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) guidelines. Emergency First Response (EFR) and PADI courses follow these guidelines and implement changes whenever protocols are revised.
The 2015 updates from ILCOR indicate relatively small changes to the way CPR and first aid is conducted by lay-people; this is a reflection of the success of CPR in modern times.
Please update your Emergency First Response courses to include the following information (and please take due note of the implementation date near end of this article):
- Perform chest compressions at a rate of 100 – 120 per minute for adult, child, and infant.
- Perform compressions to a depth of 5 centimetres/2 inches for an average adult while avoiding excessive chest compression depths (greater than 6 centimetres/2.4 inches).
- Do not interrupt chest compressions for more than 10 seconds.
- Always call EMS immediately for anyone with chest pain or other signs of a heart attack, rather than trying to personally transport the person to healthcare facility.
- The use of mannequins that provide feedback on depth and rate of compressions are now encouraged. However, other mannequin types are still acceptable. Also, consider using auditory guidance (metronome or music) to improve compression rate.
Diabetic Problems (low blood sugar, hypoglycemia)
- If a person with diabetes reports low blood sugar or exhibits signs or symptoms of mild hypoglycemia and is able to follow simple commands and swallow, oral glucose should be given to attempt to resolve the hypoglycemia. If these tablets are not available, you may provide the patient with fruit juice, soda or candy if available.
- Symptoms may not resolve until 10 to 15 minutes after ingesting glucose tablets or dietary sugars. Emergency responders should wait at least 10 to 15 minutes before calling EMS and retreating a diabetic with additional oral sugars. If the diabetic’s status deteriorates during that time or does not improve, call EMS.
- A tourniquet may now be considered for initial care when an emergency provider is unable to use direct pressure to control bleeding, such as during a mass casualty incident, with a person who has multisystem trauma, in an unsafe environment, or with a wound that can’t be accessed. Tourniquets can be effective for severe external limb bleeding.
- Note the time that a tourniquet is first applied and communicate this information to EMS providers.
- Tourniquets used in the prehospital setting have been found to control bleeding effectively in most cases and have a low rate of complications.
If cool or cold water is not available, a clean cool or cold but not freezing, compress can be useful as a substitute for cooling burns. Care should be taken to monitor for hypothermia when cooling large burns.
Guidelines from Other Associations
AHA and ERC
For detailed references, see the full 2015 American Heart Association Guidelines for CPR and ECC and the ILCOR document in the journal Circulation and view the ERC Guidelines 2015.
Following the 2015 ILCOR Guidelines release, the Australian and New Zealand Committee on Resuscitation (ANZCOR) released its new guidelines mid-January 2016; these now replace all previously existing Australian and New Zealand Resuscitation Council guidelines and are endorsed by both Councils.
The only change to ANZCOR basic life support guidelines is related to the rate of chest compressions, which changed from “approximately 100” to a range of “100 to 120 compressions per minute”.
The other fundamentals remain the same: to manage emergencies, use the DRS ABCD S approach; early defibrillation is still emphasized; the ratio is still 30 compressions to two rescue breaths; and the depth of compressions remains at approximately one third of the chest depth, i.e. more than 5cm in adults, approximately 5cm in children and 4cm in infants (ANZCOR has elected not to put an upper limit on compression depth as the risk of too shallow compressions outweighs the risk of compressions that are too deep).
If you’re teaching in Australia or New Zealand, you can implement these ANZCOR changes into your courses immediately – this also applies to Nationally Recognised Training (workplace approved) first aid courses offered through PADI RTO. For detailed references, please refer the new ANZCOR guidelines when teaching in Australia and when teaching in New Zealand.
The required implementation date for this was 31 March 2016. To keep EFR and PADI courses current and internationally applicable, course materials are being revised to reflect these recent guidelines.
Instructor Manual Errata
EFR CPR & AED Instructor Guide Errata 13 Dec 2016
2016 EFR Primary and Secondary Care Instructor Guide Errata
EFR Care for Children Instructor Guide Errata 13 Dec 2016
Alternatively, contact your Regional Training Consultant to be emailed any of the above errata’s.