Evidence Based First Aid Guidelines-Report of the US National First Aid Science Advisory Board


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Evidence Based First Aid Guidelines-Report of the US National First Aid Science Advisory Board

  1. 1. American Red Cross New ECC and First Aid Guidelines Jonathan L. Epstein, MEMS, NREMT-P Vice Chair - Advisory Council on First Aid, Aquatics, Safety and Preparedness (ACFASP)
  2. 2. Key Questions <ul><li>What was the process? </li></ul><ul><li>What were the key areas of controversy? </li></ul><ul><li>What is new? </li></ul><ul><li>What are the ARC guidelines? </li></ul>
  3. 3. History <ul><li>ECC (Emergency Cardiac Care) </li></ul><ul><ul><li>Collaboration of organizations involved in cardiac resuscitation </li></ul></ul><ul><ul><li>Promulgated guidelines for cardiac resuscitation </li></ul></ul><ul><ul><li>Currently organizationally located at AHA </li></ul></ul>
  4. 4. History <ul><li>ECC Guidelines </li></ul><ul><ul><li>Every 5 years evidence reviewed </li></ul></ul><ul><ul><li>Guidelines published </li></ul></ul><ul><ul><li>Commonly known </li></ul></ul><ul><ul><ul><li>CPR </li></ul></ul></ul><ul><ul><ul><li>PALS </li></ul></ul></ul><ul><ul><ul><li>ACLS </li></ul></ul></ul><ul><ul><ul><li>NRP </li></ul></ul></ul>
  5. 5. History <ul><li>ECC Guidelines </li></ul><ul><ul><li>First Aid Section </li></ul></ul><ul><ul><ul><li>First published in 2000 </li></ul></ul></ul><ul><ul><ul><li>Mostly consensus </li></ul></ul></ul><ul><ul><ul><li>Conducted by AHA </li></ul></ul></ul>
  6. 6. ILCOR and ECC 2005 <ul><li>In 2005, the International CoSTR Conference produced a publication that represented an international consensus on science.  These were published concurrently in Circulation and Resuscitation in Nov. 2005. </li></ul><ul><li>A separate publication covering guideline recommendations was published by each resuscitation council.  </li></ul>
  7. 11. Class Recommendations Indeterminate • Research just getting started or continuing area of research • No recommendations until further research ∙ Insufficient evidence to recommend for or against this therapy ∙ Recommendation made on basis of clinical consensus but data inadequate to justify Class at this time … is not recommended… … is not indicated… … should not… … is not useful/effective/ beneficial… … may be harmful… … may/might be considered useful… … may/might be reasonable… … usefulness/effectiveness is not well established… … is reasonable… … can be useful/effective/ beneficial… … is probably indicated… … should… … is recommended… … is indicated… … is useful/effective/ beneficial… Class III Risk > Benefit Procedure/treatment should NOT be performed/administered since it is not helpful and may be harmful. Class IIb Benefit > Risk Procedure/Treatment May Be Considered . Class IIa Benefit >>Risk It Is Reasonable to perform procedure or administer treatment. Class I Benefit >>>Risk Procedure/Treatment should be performed/administered.
  8. 12. CoSTR <ul><li>Sample Template for Consensus on Science Summary Statement </li></ul><ul><ul><li>Evidence from [insert number of studies, study design and highest level] and additional studies [insert range of LOE] document [insert result such as clinical outcome] when [insert intervention, assessment or diagnostic tool] is administered/provided/performed for [define population] in [insert setting]. Note specific descriptors or study qualifiers, include 95% confidence interval and number needed to treat or harm, if possible. </li></ul></ul><ul><li>Sample Template for Treatment Recommendation (when possible): </li></ul><ul><ul><li>Therefore, [intervention] for [population, including disease or condition] is recommended/should be considered (For Council-specific Guidelines, include Class of Recommendation). </li></ul></ul>
  9. 13. National First Aid Science Advisory Board <ul><li>Co-Founded and Co-Chaired by </li></ul><ul><ul><li>American Red Cross </li></ul></ul><ul><ul><li>American Heart Association </li></ul></ul><ul><li>Full Partnership of both organizations </li></ul><ul><ul><ul><li>Advisory Board </li></ul></ul></ul><ul><ul><ul><li>Equal representation in writing team </li></ul></ul></ul><ul><ul><ul><li>Equal role in final approval of all documents </li></ul></ul></ul>
  10. 14. National First Aid Science Advisory Board The American Pediatric Surgical Association Australian Resuscitation Council Save a Life Foundation Army Medical Command Occupational Safety and Health Administration American Association of Poison Control Centers National Safety Council American Safety and Health Institute National Association of EMTs American Red Cross National Association of EMS Physicians American Heart Association National Association of EMS Educators American College of Surgeons Military Training Network American College of Occupational and Environmental Medicine Medic First Aid International American College of Emergency Physicians International Association of Fire Fighters American Burn Association International Association of Fire Chiefs American Academy of Pediatrics Canadian Red Cross American Academy of Orthopaedic Surgeons
  11. 15. What does this mean for First Aid? <ul><li>Consensus on Science and Treatment for First Aid </li></ul><ul><ul><li>ARC and AHA </li></ul></ul><ul><ul><ul><li>Approved by both </li></ul></ul></ul><ul><ul><ul><li>Logo from both </li></ul></ul></ul><ul><ul><ul><li>Copyright help by both </li></ul></ul></ul><ul><li>Guidelines for First Aid </li></ul><ul><ul><li>ARC and AHA </li></ul></ul><ul><ul><ul><li>Approved by both </li></ul></ul></ul><ul><ul><ul><li>Logo from both </li></ul></ul></ul><ul><ul><ul><li>Copyright help by both </li></ul></ul></ul>
  12. 16. General Recommendations <ul><li>The Board agreed that </li></ul><ul><ul><li>Recommended assessments and interventions should be medically sound and based on scientific evidence and, in its absence, on scientific consensus. </li></ul></ul><ul><ul><li>Administration of First Aid must not delay activation of the EMS system or other medical assistance when such assistance is required. </li></ul></ul>
  13. 17. General Recommendations <ul><li>The Board agreed that </li></ul><ul><ul><li>It is recognized that certain conditions addressed by First Aid may not require EMS involvement or assistance by other medical professionals. </li></ul></ul><ul><ul><li>The National First Aid Science Advisory Board strongly believes that education in First Aid should be universal. Everyone can and should learn First Aid. </li></ul></ul>
  14. 18. Scope of First Aid <ul><li>The National First Aid Science Advisory Board recognized that </li></ul><ul><ul><li>The scope of First Aid is not a purely scientific one and is related to both training and/or regulatory issues. </li></ul></ul><ul><ul><li>The definition of scope is therefore variable and should be defined according to circumstances, need, and regulatory requirements. </li></ul></ul>
  15. 19. What were the key areas of controversy?
  16. 20. Controversies First Aid <ul><li>External Bleeding </li></ul><ul><li>Burn Care </li></ul><ul><li>Ingested Poisonings </li></ul><ul><li>Wound Care </li></ul>
  17. 21. External Bleeding <ul><li>Direct Pressure </li></ul><ul><ul><li>Only proven technique </li></ul></ul><ul><li>Pressure Points </li></ul><ul><ul><li>No evidence to support technique when done by rescuers </li></ul></ul><ul><ul><li>Effective in OR studies with pressures of over 300 mmhg </li></ul></ul><ul><ul><li>May detract from direct pressure </li></ul></ul>
  18. 22. External Bleeding <ul><li>Elevation </li></ul><ul><ul><li>No evidence to support </li></ul></ul><ul><ul><li>May detract from direct pressure </li></ul></ul><ul><li>Tourniquets </li></ul><ul><ul><li>Some promising studies in military but only with </li></ul></ul><ul><ul><ul><li>Precise technique </li></ul></ul></ul><ul><ul><ul><li>Well-trained providers </li></ul></ul></ul>
  19. 23. Burn Care <ul><li>Cooling is effective </li></ul><ul><ul><li>Exact time is debatable </li></ul></ul><ul><ul><li>Temperature is variable </li></ul></ul><ul><ul><li>Phase change may be key </li></ul></ul><ul><li>Ice may be harmful </li></ul>
  20. 24. Ingested Poisonings <ul><li>Milk and Water </li></ul><ul><ul><li>Milk no proven benefit </li></ul></ul><ul><ul><li>Water may help in alkali models </li></ul></ul><ul><ul><ul><li>Only animal studies </li></ul></ul></ul><ul><ul><li>Problems with giving anything by mouth </li></ul></ul><ul><li>Charcoal </li></ul><ul><ul><li>Most universal agent </li></ul></ul><ul><li>Ipecac </li></ul><ul><ul><li>Questionable benefit </li></ul></ul><ul><ul><li>Precludes use of charcoal </li></ul></ul>
  21. 25. Wound Care <ul><li>Irrigation </li></ul><ul><ul><li>Clear benefit </li></ul></ul><ul><ul><ul><li>Water under pressure </li></ul></ul></ul><ul><ul><ul><li>Does not have to be sterile but needs to be clean </li></ul></ul></ul><ul><li>Antibiotic Ointment </li></ul><ul><ul><li>Reduces infection </li></ul></ul><ul><ul><li>Some evidence triple is better than single agent </li></ul></ul>
  22. 26. American Red Cross Summary of 2005 First Aid Changes
  23. 27. Summary of 2005 First Aid Guidelines <ul><li>As a First Aid provider assist the victim in using their bronchodilator medication under the following conditions: </li></ul><ul><li>The victim tells you that he/she has asthma and is having an attack and has medications or an inhaler </li></ul><ul><li>The victim identifies the medication and is unable to administer it without assistance. </li></ul>Breathing Difficulties— Acute Asthma Use of emergency oxygen still recommended. Professional rescuers should take precautions to avoid defibrillation in an oxygen rich environment. Oxygen
  24. 28. Summary of 2005 First Aid Guidelines First Aid providers should be familiar with the epinephrine auto-injector to help with its self administration by the person. Rescuers should be able to administer it if the victim is unable to do so, the medication has been prescribed by a physician, and state law permits it Note: Module participants must have current ARC CPR cert. to attend. Anaphylaxis—Epinephrine Auto-injector
  25. 29. Summary of 2005 First Aid Guidelines Control external bleeding by applying pressure to the bleeding area until bleeding stops or EMS rescuers arrive. Bleeding (external)
  26. 30. Summary of 2005 First Aid Guidelines <ul><li>Irrigate wounds and abrasions with clean running tap water for at least five minutes or until there appears to be no foreign matter in the wound. </li></ul><ul><li>Wounds heal better and with less infection if an antibiotic ointment or cream is applied. </li></ul><ul><li>Apply triple antibiotic ointment or cream to a minor wound if the person has no known allergies or sensitivities to the medication. </li></ul><ul><li>Cover the wound with a sterile dressing and a bandage. </li></ul>Wounds and Abrasions
  27. 31. Summary of 2005 First Aid Guidelines Loosely cover burn blisters with a sterile dressing but leave them intact. Burn Blisters Cool thermal burns with cold water as soon as possible and continue at least until pain is relieved. Do not — Apply ice or ice water except on a small, superficial burn and then for no more than 10 minutes. Thermal Burns
  28. 32. Summary of 2005 First Aid Guidelines Brush powdered chemicals off the skin with a gloved hand or piece of cloth. Remove all contaminated clothing and make sure not to contaminate yourself in the process. In case of an acid or alkali exposure to the skin or eye, Flush the burn with large amounts of cool running water. Chemical Burns Turn off the power at its source. In case of high-voltage electrocution, immediately notify the appropriate authorities (i.e., 911, fire department, etc). Once the power is off, assess the victim, who may need CPR, defibrillation, and treatment for shock and thermal burns. All victims of electric shock require medical assessment. Electrocution and Electrical Burns
  29. 33. Summary of 2005 First Aid Guidelines <ul><li>Suspect a spinal injury if an injured victim— </li></ul><ul><li>Is involved in a motor vehicle, motorized cycle, or bicycle crash as an occupant or pedestrian </li></ul><ul><li>Is injured as a result of a fall from greater than a standing height </li></ul><ul><li>Complains of neck or back pain, tingling in the extremities, or weakness </li></ul><ul><li>Is not fully alert </li></ul><ul><li>Appears to be intoxicated </li></ul><ul><li>Appears frail or older than 65 years of age </li></ul><ul><li>Has a head or neck injury </li></ul><ul><li>In any situation where you suspect a possible spinal injury, manually stabilize the head so that the head, neck, and spine do not move and are kept in line. </li></ul>Spine Stabilization
  30. 34. American Red Cross Summary of 2005 First Aid Guidelines Assume that any injury to an extremity includes a bone fracture. Cover open wounds with a dressing. Do not move or straighten an injured extremity. If you are far from definitive health care, you may stabilize the extremity in the position found. If an injured extremity is blue or extremely pale activate EMS immediately. Cooling: Fill a plastic bag or wrap ice with a damp cloth and apply ice to the injured area for periods of 20 minutes. If continued icing is needed, remove the pack for 20 minutes, and replace it. Place a thin barrier between the ice and bare skin. Musculoskeletal Trauma: Sprains, Strains, Contusions, and Fractures
  31. 35. Summary of 2005 First Aid Guidelines In case of frostbite, remove wet clothing and make sure the victim does not develop hypothermia. Get the victim to a medical facility as rapidly as possible. If you are in a remote area far from a medical facility, slowly re-warm the frostbite using warm water (100-105°F), Cold Emergencies— Frostbite Move the victim to a warm environment, remove wet clothing and wrap all exposed body surfaces with anything at hand including blankets, clothing, newspapers, etc. If you are far from definitive health care, you may actively re-warm a victim of hypothermia. Active re-warming should not delay definitive care. Cold Emergencies— Hypothermia
  32. 36. Summary of 2005 First Aid Guidelines <ul><li>General Care for Poisoning </li></ul><ul><li>If you think someone has been poisoned, call the Poison Control Center (PCC) and follow their directions. </li></ul><ul><li>Follow these general care guidelines— </li></ul><ul><ul><li>Remove the person from the source of poison. </li></ul></ul><ul><ul><li>Check the person’s level of consciousness, and signs of life including a pulse. </li></ul></ul><ul><ul><li>Call 9-1-1 first if there is a life-threatening condition found (e.g., a person who is unconscious, not breathing or there is a change in consciousness), Care for any life-threatening conditions. </li></ul></ul>Ingested Poisons
  33. 37. Summary of 2005 First Aid Guidelines <ul><li>Protect the head with a pillow or other soft material. </li></ul><ul><li>Do not restrain the victim during a seizure or place any object in the victim’s mouth. </li></ul><ul><li>Maintain an open airway </li></ul><ul><li>Place the seizure victim in a recovery position after the seizure stops. </li></ul>Seizures
  34. 38. Summary of 2005 First Aid Guidelines <ul><li>F.A.S.T. Recognition of Stroke </li></ul><ul><li>For a brain attack, think FAST! </li></ul><ul><ul><li>Face—Weakness on one side of the face. </li></ul></ul><ul><ul><li>Arm—Weakness or numbness in one arm. </li></ul></ul><ul><ul><li>Speech—Slurred speech or trouble getting the words out. </li></ul></ul><ul><ul><li>Time—Time to call 9-1-1 if you see any of these signals. </li></ul></ul><ul><ul><ul><li>Note the time that the signals began and call 9-1-1 right away. </li></ul></ul></ul>Stroke
  35. 39. Summary of 2005 First Aid Guidelines <ul><li>Rescuers may be able to help a conscious person who is showing early signals of a heart attack by offering him or her an appropriate dose of aspirin when the signals first begin (and local protocols allow). </li></ul><ul><li>Never delay calling 9-1-1 to do this. Always call 9-1-1 as soon as you recognize the signals, </li></ul><ul><li>If the person is able to take medicine by mouth, ask if he or she— </li></ul><ul><ul><li>Is allergic to aspirin. </li></ul></ul><ul><ul><li>Has a stomach ulcer or stomach disease. </li></ul></ul><ul><ul><li>Has ever been advised by his or her physician not to take aspirin. </li></ul></ul><ul><ul><li>Is taking any blood thinners, such as Coumadin or Warfarin. </li></ul></ul><ul><li>If the person answers no to all of these questions— </li></ul><ul><li>Responders may offer two chewable (162mg) baby aspirins, (or up to one 5-grain (325mg) adult aspirin tablet with a small amount of water). Only use aspirin . </li></ul>Aspirin
  36. 40. Summary of 2005 First Aid Guidelines <ul><li>Unconscious Victims </li></ul><ul><li>Unconscious victims who are breathing normally should be placed in a recovery position. </li></ul><ul><li>Possible Spinal Injury </li></ul><ul><li>Spinal injured victims should not be moved. But if an open airway cannot be maintained or the rescuer must leave the victim to get help, place in a modified H.A.IN.E.S. (High Arm in Endangered Spine) position (shown but not practiced) </li></ul>Recovery position
  37. 41. What is in the future?
  38. 42. Future <ul><li>Work begins </li></ul><ul><ul><li>2010 First Aid Guidelines </li></ul></ul><ul><ul><li>2010 CoSTR </li></ul></ul><ul><ul><li>2010 ARC Guidelines for Emergency Care and Education </li></ul></ul>
  39. 43. Questions?