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CPR training materials best practices
- 1. Best Practices in Teaching CPR Using Effective and Easy to Understand Training Materials That Complement Learning
- 2. Why CAB? • Effective compressions are most important • Start compressions immediately • You don’t know how long the person is down • Compressions keep the brain alive • Oxygenated blood is pumped to the brain • Good chance of resuscitation • Abbreviated recovery period
- 3. You Can Make A Difference • Everyone is capable of delivering effective compressions. • Effective compressions pump oxygenated blood to the brain, keeping it alive. • If you don’t help the victim, who will? • If the victim could speak, they would say please help me. • A human mind should not go to waste
- 4. Adult CPR Sequence Continued • Push straight down at least 2” more if possible • Let the chest come completely back up before starting the next compression. • Perform 2 minutes or 5 cycles if you can comfortably do so. Switch when you feel tired. • If you can’t switch, rest for the count of 5 then start over again for as long as you can. • When the AED arrives immediately put pads on while one rescuer continues compressions.
- 5. The AED Has Arrived • Once the AED is plugged in it will analyze • Make sure you or your partner is not touching the victim. • Once the analyze sequence starts: SWITCH POSITIONS • The compressor moves to the head and the person at the head moves to compressor spot. • Once the AED says shock is necessary the person at the head makes sure no one is touching the victim. Do a final check before pushing the flashing yellow shock button. • Once the shock is delivered immediately start compressions
- 6. Adult CPR Sequence • Check for Scene Safety: electricity, hazards • Shake and shout: is the person sleeping? • Check for breathing and check pulse – 10 sec. • No pulse: Call 911 (use cell phone) • Start CPR by placing heel of your hand in center of the chest between the nipples. • Bring your shoulder over your wrist and keep your arms straight. Push straight down on chest.
- 7. A Confident Team is a Good Team • When everyone is confident that they have mastered the techniques of CPR they will be able to function effectively as individuals or with the help of other team members be even more effective.
- 8. Delivering Effective Breaths • Place your non-preferred hand over top of the mask. Tilt the head back by pressing on forehead. • Put the thumb of preferred hand over bottom of mask and grip the jaw bone with remaining fingers and lift the chin to face the sky. Chin to the sky (ceiling), they never die. • Blow the air in gently over one second to make the chest rise visibly.
- 9. How Fast Should I Push • To make sure the heart is pushing blood to the brain effectively you should push at a rate of at least 100 to 120 pushes per minute or 1 ½ per second. • When pushing, concentrate on saying to yourself: One - Two - Three etc. This will keep the pace between 100 and 120 per minute. Faster is better, so you have room to go when you get tired and start to slow down.
- 10. Why is the Adult Ratio Always 30 to 2 • Studies have shown that delivering 30 compressions and 2 breaths is best for keeping the adult fatigued or diseased heart alive and the brain fed with a sufficient supply of oxygenated blood. • The heart has arteries feeding it blood and you must keep the pressure in those arteries up or the heart muscle itself will die.
- 11. Consult With Experts • Book learning is good, but it is no substitute for experience. Consult with experts in the field to make sure the training materials accomplish the objective of the student delivering effective CPR on a consistent basis. • Utilizing different expert points of view will enable you to thoroughly develop effective training materials and aids.
- 12. Keep Like Things Together • The Video Host and student materials should specify the difference between delivering 30 compressions and 2 breaths as differentiated from providing continuous compressions when an advanced airway is in place. Then you perform continuous compressions and deliver one breath every 6 minutes regardless of adult, child, or infant.
- 13. What’s Different About Children • One: If you don’t see the child collapse and are alone you should deliver 2 minutes of CPR before calling 911. • Two: If you do see the child collapse right in front of you, you need to call 911 if possible and get the AED if there is one close by. Do not leave the child for more than 2 minutes to get help.
- 14. Using the AED with Children • Do not put the AED pads on until you have delivered 5 cycles of CPR. • To make sure the pads don’t touch put one pad on the front and one on the back. • The AED recognizes a child as ages 1 to 8 • If the child is older than 8 or if you can’t determine the age of the child as over or under 8 years, use Adult pads.
- 15. Using the AED With Infants • An infant is defined as being less than one year old and older than 28 days. • After performing 5 cycles of Infant CPR you can put the AED on if you have one. • Even if you only have Adult pads you can put them on an infant. • Place one pad over the infant’s chest and one pad over the infant’s back, both in a vertical position.
Editor's Notes
- I believe to be effective the training video should mirror the statements in the written training manual. To insure the integrity of the materials certified experts in the field should review each section to make sure they meet the learning objective. The American Heart Association has taken pains to try and produce the best materials and training aids possible. What they have not done is make sure the materials accurately depict and is easily understood by the average person taking a CPR course. If the video presentation conflicts with the written training material it makes it more difficult for the student to develop their confidence. Thankfully many of the snafus in the 2010 version are addressed by the CPR instructors in the class room. I have developed a series of guidelines which supplement the course materials.
- The brain starts to die in approximately 4 minutes without oxygen. Except in rare circumstances the brain will succumb if starved of oxygen for more than 12 minutes. The sooner oxygenated blood is pumped to the brain the better chance the brain has to regenerate itself. If the brain is kept alive through effective compressions, the outcome will be more beneficial and the recovery period will take less time. Many patients are able to recover completely in a very short period of time.
- Bystanders are the key to improved survival rates. If a bystander is confident in his skills and committed to helping the victim they can truly make a difference between life and death. If CPR is not started within 10 minutes of Cardiac Arrest there is little hope for the successful restoration of the individual to a full and active life. If they don’t know how long the person has been down it is counter intuitive to leave the victim and go looking for a phone and AED which might not be readily available. Taking 2 minutes to find a person to send for 911 and the AED is reasonable. Any longer than that should be handled by using your cell phone on speaker to call 911 while perfoming compression only CPR. You can’t give any breaths until a mask arrives with the AED or you have a micro shield on your person. Regardless of what you have available locating the proper landmark for your hand directly in the center of the chest between the nipples is most important for the victim’s survival.
- It is important to get your body over the victim so you are pushing straight down on the center of the chest. When you flex the heel of your hand to push down it will cause your fingers to rise up from the chest. The sternum is situated on over the heart so when you push down you are compressing the left ventricle. You need to let the chest come completely back up so the heart can fill with blood again. If you lean on the chest or don’t push down far enough you will not pump the necessary volume to keep the brain alive. It is important to do effective compressions. If you can’t deliver effective compressions due to fatigue, rest for a count of 5 to recoup your energy and start again with renewed vigor. When the AED arrives immediately place it by the victim’s head and shoulder and turn it on. As soon as the pads are placed make sure the unit is plugged in to start the analyzing sequence.
- If the training materials and aids are designed and used properly, they will help the student master the necessary skills and develop the confidence to deliver good effective CPR under challenging circumstances and/or difficult situations.
- When using a pocket mask one should place the non-preferred hand completely over the top of the mask with the thumb on one side and the remaining fingers on the other. Press the forehead back with the heel of the hand so that the nostrils are completely visible. Place the thumb of the other hand over the bottom of the mask and grasp the jaw with the remaining fingers making sure to keep them on the jaw and not on the soft skin under it. Pull the jaw up, but do not push your fingers or you will close the lips and make it difficult to deliver effective breaths.
- To be effective the compressions should be deep enough and fast enough to make up for the decrease in the heart’s performance. One should push down at least 2 inches, preferrably 2 ½ and at a rate or speed of at least 100 per minute. 110 is a good starting speed. If you can’t deliver effective compressions at a rate of at least 100 per minute you should switch or rest for 5 seconds to regain your strength. The minimal delay in compressions is worth the improved effectiveness.
- We must not forget that the heart is an organ that needs a sufficient blood supply to remain alive. Pushing on the chest will do no good in the long run if the organ itself dies because it is starved of oxygenated blood. Stopping compressions for longer than 10 seconds can seriously impact the heart’s ability to remain alive. If the pressure in the heart’s artieries drops too far you will not be able to get it back up to operating range and the heart will die.
- When you are developing training materials you should consult with experts in the field about how to apply the knowledge so the training materials can incorporate their perspectives and enable to students to effectively apply what they learned in class.
- Running one section into the other without introducing the upcoming change in focus puts the student at a disadvantage. When explaining the Advanced airway section you should specify that it applies to everyone. If they are intubated no matter who they are, you deliver one breath every 7 seconds, eliminate the range. Give them one number to remember. Do the same with Rescue breaths. Give one breath every 5 seconds to infants and children and one breath every 6 seconds to adults. Better to have one number to worry about. Reinforce that this is the one breath segment to make it easier for the student to remember.
- There are two major differences between Adult CPR and Children CPR. If you witness the arrest you should call 911 and get the AED if possible immediately. However, under no circumstances should you delay beginning CPR for longer than 4 minutes. If you move two minutes away to find help it will take you two minutes to get back. Start CPR on a child within 4 minutes of finding them. Put your cell phone on speaker and dial 911 to get the ambulance on the way to you while continuing CPR.
- When performing child CPR on one between the age of 1 and puberty, you will use one hand until the child’s chest is so resistant that you need two hands to make a proper compression. When using the AED the definition of a child is very precise. Use ped pads or dose attenuator on a child aged 1 to 8. Any child older than 8 years should be treated as an adult with the AED. To keep the pads from touching it is best to place one on the front middle chest and one on the back middle. If using adult pads place the right breast pad on the front and the under the left nipple pad on the back in a verticle position.
- When using the AED with an infant it is best if you have ped pads or a dose attenuator. However, if available you can use Adult pads on the infant. Place one pad over the front of the infant’s chest and the other one over the infant’s back keeping both in a vertical position.