cprrr

EMS Safety CPR/AED
Training
Emergency Response for the Home,
Community and Workplace
© 2012 EMS Safety Version B

INTRODUCTION
2
CPR/AED for Community Rescuers

What we will learn today
• Quickly recognize an emergency
• CPR on an adult victim
• CPR on a child and infant victim*
• AED use*
• Emergency response
– Heart Attack
– Stroke
– Choking
*Optional Topic
3
CPR/AED for Community Rescuers Intro

Certification Requirements
• Sign in on roster
• Participate in all course activities
• Pass written exam with 80% or more
• Pass skills exams
• Just FYI…
– Cards are valid for 2 years
– Let me know privately if concerns about physical
requirements or any latex allergies
– Participation certificates are available
4

State & Local Requirements
• Guidelines are consistent with other
nationally-recognized training organizations
• Follow state, local or workplace guidelines if they
differ from this course
• Ask state or local Emergency Medical Services
(EMS) Authority about
– AED use on infants
– Asthma inhalers
– Epinephrine auto-injectors
– Use of aspirin for heart attack signs and symptoms
5

CHAIN OF SURVIVAL
6

Key Concepts
• Leading cause of death in U.S. is Heart
Disease
• Heart disease leads to Sudden Cardiac Arrest
(SCA)
– Heart suddenly stops beating
– Person is unresponsive
– Breathing stops
– Brain damage in 4 – 6 min w/o CPR
• The Chain of Survival is a series of actions that
gives SCA victims the best chance of survival
7
CPR/AED for Community Rescuers Chain of Survival

5 Steps to SCA Survival
What are the best actions to take immediately
after Sudden Cardiac Arrest?
5 Steps to Survival
1. Activate EMS (Call 9-1-1)
2. Early CPR
3. Early Defibrillation
4. Early Advanced Care
5. Post-Arrest Care
8

Activate EMS (Call 9-1-1)
Use cell phone or land line Activate EMS (Call 9-1-1)
• Recognize cardiac arrest
– Not responding
– Chest not moving, no
breathing
• Don’t delay: early 9-1-1
linked to increased SCA
survival
• Send bystander if
possible
• If unsure, go call!
9

Early CPR
Start compressions! Early CPR
• Start with Chest
Compressions
• Compressions restore
flow of oxygen to brain
• Good chest
compressions linked to
increased survival
• Push hard and fast!
10

Early Defibrillation
Early Defibrillation
• Defibrillators can restart
the heart of an SCA
victim
• Calling 9-1-1 gets a
defibrillator to the scene
• An Automated External
Defibrillator (AED) is used
by citizen rescuers
• Some public places like
airports have AEDs
accessible to all rescuers
11
Use AED when it arrives

Advanced & Post-Arrest Care
Advanced Care
• AKA: Advanced Life
Support
• Provided by paramedics,
continued at hospital
• Adds advanced airway
management, drug
therapy, cardiac
monitoring to CPR
• Goal: restart heart and
stabilize for post-arrest
care
Post-Arrest Care
• Comprehensive care
once person is stabilized
• Begins at hospital and
continues through
discharge
• Provided by doctors,
nurses, therapists and
many others
• Goal: Improve chances of
continued survival with
least disability
12

Discussion
1. Why is activating EMS the first link in the chain
of survival?
2. Are AEDs located in your community or
workplace? Where?
3. Why does the bystander have the biggest
impact on survival of SCA?
13

CPR OVERVIEW
14

Key Concepts
CPR/AED for Community Rescuers CPR Overview 15
• Cardiac Arrest =
– No heartbeat
– No oxygen to brain or vital organs
• CPR can:
– Keep brain alive
– Oxygenate vital organs
– Extend the time for successful defibrillation

Cardiopulmonary Resuscitation
Heart is squeezed between
sternum and backbone
CPR
• Combines external chest
compressions and rescue
breathing
• Breaths fill lungs
• Compressions move
oxygen by pumping blood
• Keeps brain alive
• Chest compressions
are most important part

What is an AED
Automated External
Defibrillator (AED) What it does…
• Uses voice and visual
prompts
• Easily guides rescuers
• Analyzes heart rhythm
• Determines if shock is
needed
• Restores normal rhythm
• Provides CPR reminders

Ventricular Fibrillation (V-fib)
V-fib to Shock to Normal V-fib is common in SCA
• Heart overwhelmed by
electrical activity
• Can be related to lack of
oxygen
• Quickly lethal
• Victim unresponsive
• CPR won’t stop V-fib
• “Defib” is only treatment
for “V-fib”
V-fib present in 90% of SCA cases

How an AED Works
• AED detects V-fib
• Sends powerful
current through heart
• Shock resets heart’s
electrical activity
• Heart may start
beating normally
• Like a ‘control-alt-
delete’ for the heart
Power on & attach pads

Sum it Up
• CPR restores flow of oxygen to the brain
• CPR can extend time for successful AED use
• The sooner an AED is used, the more likely it will
work

C-A-B
The C-A-B sequence applies to victims of all ages. Learn the adult
sequence first…
CPR/AED for Community Rescuers 21

Key Concepts
• C-A-B stands for:
– Compression
– Airway
– Breathing
• Best sequence of rescuer actions for CPR
– In first few minutes victim’s body still has oxygen-rich
blood
– Starting with chest compressions circulates oxygen,
eliminating need to start with rescue breaths
• The C-A-B sequence is used for unresponsive
victims of all ages
CPR/AED for Community Rescuers C-A-B 22

Establish Response, Check Breathing
Hey! Are you okay? Tap and shout
• If no response
– Go call 9-1-1
– Get an AED if available
– Send bystander if present
Scan the chest for
breathing, 5-10 seconds
• If no breathing or only
gasping:
START COMPRESSIONS

C: Compressions
Push Hard & Fast! Provide 30 Compressions
• Use a firm, flat surface
• Center of the chest,
between nipples
• Push hard: At least 2”
• Push fast: At least 100
compressions per minute
• Ensure full recoil: Chest
expands between each
compression
• Minimize interruptions

A: Airway
Prepare for rescue breaths Quickly Open Airway
• Position head using the
head tilt/chin lift
• Place 1 hand on forehead
• Place 2 or 3 fingers of
your other hand near the
chin
• Tilt the head back while
lifting the jaw upward

B: Breathing
Give breaths carefully… 2 Rescue Breaths
• About 1 second per breath
• Maintain head tilt/chin lift
• Pinch nose
• Seal the victim’s mouth with
yours or use barrier
• Breathe into the mouth for
about 1 second
• Watch for chest rise
• Lift mouth off
• Repeat for 2nd breath
Too much air causes
vomiting

Repeat the C-A-B Sequence
• Take < 10 seconds to give 2 breaths
• Quickly resume chest compressions after giving
rescue breaths
• Continue repeating the sequence of 30
compressions, open airway, give 2 breaths
• CPR is performed in cycles
– 1 cycle is 30 compressions and 2 breaths (30:2)
– 5 cycles of CPR can be performed in about 2 minutes

When to Use the AED
Use AED when it’s available If 2nd Rescuer Present
• Rescuer 1 continues CPR
• Rescuer 2 operates AED
• Switch roles when the AED
prompts to stop CPR
– If no AED, switch performing
CPR about every 2 minutes
• Observe CPR provider &
give feedback
• Pushing hard/fast enough?

Recovery Position
If breathing normally…
Modified H.A.IN.E.S Recovery
Position
• Use when
– Need to leave to get
help
– Victim vomits
Place victim on side

Discussion
• Could I really do it?

Sum It Up
• Starting CPR with chest compressions
circulates the oxygen still in the blood and gives
the victim the best chance of survival
• Quality compressions matter
• Push hard and fast
• Minimize interruptions to compressions
– No more than 10 seconds to give breaths
• Allow the chest to fully recoil (expand) between
each compression
– Take your weight off the victim’s chest

CPR BARRIERS

Key Concepts
• The risk of catching a disease with rescue
breaths is extremely low
• It is common to be uncomfortable with the
thought of giving mouth-to-mouth rescue breaths
• CPR barriers can help prevent exposure to
blood or body fluids
• Create a barrier between the victim and rescuer
while allowing for the passage of air
CPR/AED for Community Rescuers CPR Barriers 33

CPR Face Mask
• May require quick
assembly
• Covers mouth and nose
• Prevents back flow of
exhaled air or fluids
• Select the correct size:
– Base (wide end) does
not extend past chin
– Top (narrow end) does
not extend past bridge of
the nose
Molded plastic mask

Using a Face Mask
1. Press mask onto
face
2. Lift the chin to open
the airway
3. Breathe into the
mask
4. Watch for chest rise
with each breath

CPR Face Shield
• Fits over the mouth
• Pinch the nose over
or under the face
shield
• Stored in keychain
pouch with gloves
• Close to rescuer at all
times
Small, flexible plastic
with a filter or valve

Using a CPR Face Shield
1. Place over face with
filter or valve over
person’s mouth
2. Open airway
3. Pinch nose
4. Breathe into the filter
or valve
5. Watch for chest rise
with each breath

USING AN AED
Optional Segment, only required for AED certification…
Optional Topic

Key Concepts
• AEDs can be used on adults, children and
infants
• An AED has a status indicator to show if it is
ready for use
• Follow local protocols for age-specific AED
guidelines if they differ from this course
• Basic AED Sequence:
– Power on the AED
– Apply pads
– Follow AED prompts
CPR/AED for Community Rescuers Using an AED 39

Power the AED
• Place AED near head
• Power on AED
• AED guides actions

Apply AED Pads
• Expose chest
– Cut clothing
– Wipe dry
• Apply pads (follow
pictures)
– Right upper chest, just
below collarbone
– Lower left side of the
chest
• If 2 rescuers
– Rescuer 1 continues
CPR
– Rescuer 2 operates
AED

Shock or No Shock?
• After pads are applied:
– AED prompts rescuer to stop CPR
– AED analyzes the heart’s electrical rhythm
– Do not touch or move the person
• AED will state ‘shock advised’ or ‘no shock
advised’
• If no shock advised, AED will prompt rescuer to
resume chest compressions
• If shock advised, rescuer must clear victim first

Clear Victim and Shock
• Clear victim first
– Loudly state, “Clear!”
– Look up and down entire
victim
– Ensure no one touching
person or clothing
• Press shock button
– Some AEDs shock
automatically (no button)
– AEDs announce when
safe to resume
compressions
Do not touch victim or
clothing during a shock

Resume CPR
• Start with chest
compressions
• AED will analyze heart
rhythm every 2 minutes
• If 2nd rescuer present
– Switch roles when AED
prompts to stop CPR
– One rescuer rests
– Other rescuer gets in
position for CPR
– Rescuer 2 will continue
to operate AED
Immediately resume CPR

AED Use on Children
• Children & infants
require less electrical
current
• Special equipment
reduces amount of
energy delivered
– Child/Infant Pads
– Energy reducer or
attenuator
– Pediatric key or switch
• If pediatric equipment is
not available, use
standard equipment
For AED use:
A child is 1-8 years old, or
less than 55 lbs.
An infant is < 1 year old

For Smaller Children or Infants
• Use front-to-back AED pad placement if needed
•Pads should not touch or overlap
•Do not cut or fold pads to fit

ADULT CPR
In CPR, a victim is considered an adult when signs of puberty are
present. Look for facial or underarm hair on a male or signs of
breast development on a female.

Key Concepts
• Always check the scene for safety first
• If the scene is safe, establish a response
• If unresponsive and not breathing or only
gasping, provide CPR using the C-A-B
sequence
CPR/AED for Community Rescuers Adult CPR 48

Starting CPR
• Survey scene, size-up
potential hazards
• Tap the shoulder and
shout, “Are you all right?”
• Call 9-1-1, get AED
– Send bystander
– Go yourself if alone
• Scan chest for breathing
(5-10 seconds)
• Start compressions if no
breathing, only gasping,
unsure if breathing

C: 30 Compressions
• Expose chest if needed
• Location: center of the
chest, between nipples
• Use 2 hands:
– Heel of one hand on chest
– Heel of other hand on top
• Push hard: At least 2”
down
per minute
• Ensure full recoil
Use a firm, flat surface

A: Open Airway
• Place 1 hand on the
forehead
– Apply firm, backward
pressure with your palm
– Tilt head back
other hand near chin
– Keep fingers on bony
part of the jaw
• Tilt the head back, lift
the chin forward

B: Give 2 Breaths
• Maintain head tilt/chin
lift
• Pinch the nose
• Breathe into mouth
for about 1 second
• Repeat for the 2nd
breath
• Do not over-ventilate

Continue CPR
• If 2 rescuers, switch roles
every 2 min (5 cycles) or
when AED is analyzing
– Rest between roles as CPR
provider
– Keep provider on pace (at
least 100 comp/min)
– Instruct compressor to push
harder (at least 2”) if too
shallow
• Only Stop CPR if
– Victim begins to move
– EMS responders take over
– AED prompts you to stop
Cycles of 30:2

Defibrillation
• Use when available
• Place near victim’s
head
• Power on AED
• Follow prompts
• Apply pads
• Press shock button
• Resume compressions
after shock

Discussion
1. What is the best way to activate EMS at
home? At work?
2. What do you do if the chest won’t rise with the
1st rescue breath?
3. What is the most important part of CPR:
compressions, airway management, or rescue
breathing?

CHILD CPR
In CPR, a victim is considered a child from age 1 until puberty.

Key Concepts
• Usually different cause of cardiac arrest for
children and infants than for adults
– Adults: Heart disease, heart attack
– Children/infants: Respiratory arrest
• Common causes of respiratory arrest in children:
– Injury
– Poisoning
– Choking
– Drowning
– Asthma
CPR/AED for Community Rescuers Child CPR 57

Starting CPR
potential hazards
• Tap the shoulder and
shout, “Are you all right?”
• Send bystander to call
9-1-1, get AED
• Stay with the child
• Scan the chest for
breathing, only gasping, if
you’re unsure
If alone, yell for help. Stay for 2 minutes
of CPR before leaving to call 9-1-1

C: 30 Compressions
• Location: Center of the
chest, between nipples
• Use 1 or 2 hands
• Push hard: About 2”
down
• Push fast: At least
100 per minute
• Minimize
interruptions

A: Open Airway
• Place 1 hand on
the forehead
pressure with your
palm
– Tilt head back
• Place 2 or 3 fingers
of other hand near
chin
– Keep fingers on bony
part of the jaw
• Tilt the head back,
lift the chin forward

B: Give 2 Breaths
lift
• Pinch the nose
for about 1 second
breath

Continue CPR
• If 2 rescuers, switch
roles every 2 minutes
(5 cycles)
– Rest between roles
as CPR provider
– Keep provider on
pace (at least
100/min)
– Instruct compressor
to push harder if too
shallow
Cycles of 30:2

Call 9-1-1
• Return quickly
• Resume CPR until
EMS takes over or
the child begins to
move
• Use an AED as
soon as it is
available
If still alone after 2
minutes, go activate EMS
and get an AED if one is
close by

INFANT CPR
In CPR, a victim is considered an infant up to1 year old.

Key Concepts
• Common causes of respiratory arrest in
infants:
– Choking
– Injury
– Sudden Infant Death Syndrome (SIDS)
– Respiratory illness
CPR/AED for Community Rescuers Infant CPR 65

Starting CPR
potential hazards
• Tap bottom of foot and
shout
9-1-1, get AED
• Scan the chest for
breathing, only gasping,
or if you’re unsure
If alone, yell for help. Stay for 2
minutes of CPR before leaving to
call 9-1-1

C: 30 Compressions
• Location: Center of chest,
just below nipple line
• Use 2 fingers
• Push hard: About 1½”
down
per minute

A: Open Airway
• Place 1 hand on the
forehead
pressure with your palm
– Tilt head back
other hand near chin
• Tilt the head back, lift the
chin forward
• Maintain a neutral or
slightly extended position
Do not tilt the head too far
back. Overextending the airway
can actually close it!

B: Give 2 Breaths
lift
and nose about 1
second
breath
Breathe into mouth and
nose at the same time

Continue CPR
• If 2 rescuers, switch
roles every 2 minutes
(5 cycles)
– Rest between roles as
CPR provider
– Keep provider on pace
(at least100/min)
– Instruct compressor to
push harder if too
shallow
Cycles of 30:2

Call 9-1-1
• Take the infant with you
if you have to leave
• Resume CPR until EMS
takes over or the infant
begins to move
• Use an AED as soon as
it is available
If still alone after 2
minutes, call 9-1-1

SPECIAL CONSIDERATIONS -
CPR

Key Concepts
• Certain situations may affect response to
cardiac arrest
• Keep CPR going as long as possible
• In cold environments
– A hypothermic victim may have more time before brain
damage occurs
– Do not assume it is too late to begin CPR
• Electrical shock may cause immediate respiratory or
cardiac arrest
– Scene safety is most important
– Shut off the power source first
• Make sure scene is safe before approaching victim
CPR/AED for Community Rescuers Special Considerations - CPR 73

Vomiting
• A person in cardiac
arrest will often vomit
from over-ventilation
• If the victim vomits, roll
person to side, sweep
out mouth, roll back,
continue CPR
• Reduce risk with rescue
breaths by providing
just enough air to
cause the chest to rise

When to Stop CPR
• Victim begins to move
or breathe
• AED directs you to stop
• Scene becomes unsafe
• Physically exhausted
and unable to continue
• Professional rescuers
arrive and are ready to
take over
• Victim is pronounced
dead by a qualified
person

Compression-only CPR
• Continuous chest
compressions without
rescue breaths
• Exchange of oxygen
occurs with the force of
compressions
• Taught by dispatchers to
untrained rescuers who
call 9-1-1
• Also used for adult victim
if rescuer is unable or
unwilling to provide
rescue breaths
Only for adult victims

Nose and Stoma Rescue Breathing
Mouth-to-Nose
• Use if victim’s mouth or
jaw is severely damaged
• Holding mouth closed
prevents air from
escaping
• Make a seal and exhale
into victim’s nose
Mask-to-Stoma
• Stoma: surgical opening
at base of throat
• Can be performed with
mask or mouth-to-stoma
• Pinch nose closed if
possible to prevent air
escape
• Make a seal around the
stoma and exhale; watch
for chest rise

SPECIAL CONSIDERATIONS -
AED
Optional segment, only required for AED certification
78
Optional Topic

Key Concepts
• There are 3 situations to consider when
applying AED pads that may alter rescuer’s
actions:
– A very hairy chest
– An implanted device (e.g. pacemaker)
– A medication patch
CPR/AED for Community Rescuers Special Considerations - AED 79

Very Hairy Chest
• A lot of chest hair limits
contact between AED
pad and victim’s skin
• AED may not be able to
read heart rhythm
• If the first set of pads is
not working
– Press pads firmly onto
skin
– Remove with a quick
motion
– Apply second set of
pads
If only 1 set of pads is available,
quickly shave the areas of pad
placement before applying pads

Implanted Devices
• Devices may include
− Pacemaker
− Automated Implantable
Cardioverter-Defibrillator
(AICD)
− Medication administration
port
• Most implanted
devices do not affect
AED pad placement.
– Do not place pad directly
over implanted device
– Adjust pad placement at
least 1” from device
Device may appear as a
small raised lump under skin

Medication Patches
• Do not place an AED
pad over a medication
patch
– Use a gloved hand to
remove the patch
– Quickly wipe chest
clean with a towel or
cloth
• Apply pads after area
is wiped clean
Medication can be embedded in
an adhesive patch applied to skin

Storage & Maintenance
• Close to trained rescuers
– Near most of people, most of
the time
– Visible signage; easy access
– Common areas easy to
describe
• With accessories
– Spare adult pads
– Pediatric pads or adaptor
– CPR barrier, gloves
– Safety razor
– Absorbent towel
• Inspection
– Status indicator shows ‘Ready’
– Pads & battery not expired
– No visible damage
– No missing accessories

Troubleshooting
• An AED performs self checks regularly and every
time it is powered on.
• The AED will notify operator if problem detected
• “Check pads”
– Press down firmly, or replace pads w/ back up set
– Check pad connection to AED
• “Low Battery”
– Replace battery
– Even in low battery state, AED may provide several shocks
– Refer to AED manufacturer for more information
• Movement
– Disrupts analysis of heart rhythm
– When AED is analyzing, do not touch or move victim

Sum It Up
• Consider shaving a very hairy chest before
pad placement
• Avoid placing pads over implanted device
• Remove medication patches
• Store AED near trained rescuers and a phone
• If a problem with AED cannot be quickly solved,
discontinue AED use and resume CPR

AED SAFETY
Optional segment, only required for AED certification
86
Optional Topic

Key Concepts
• Using an AED during an emergency is
safe
• Take precautions to maximize safety
• Consider rescuer’s actions when:
– Clearing the victim
– Water is present
– The victim is using oxygen
CPR/AED for Community Rescuers AED Safety 87

What is Wrong With This Picture?

Water
• If victim is lying in puddle of
water
– Move to a dryer area
– Ensure rescuers not standing
in water
• Water on victim’s chest can
interfere with defibrillation
– Quickly dry chest before
applying pads
– A wet chest may cause
electricity from AED to
disperse before reaching heart
• Good pad contact with dry skin
provides more effective and
directed shock to heart
How would you make this scene safe
for AED use?
Wipe chest dry before
applying pads

Oxygen
• Medical oxygen is
combustible
• If a person is wearing
oxygen
– Turn it off or remove the
mask or cannula
• If oxygen is being used
with rescue breaths
– Move it several feet from
victim before shock
– Resume rescue breaths
with supplemental
oxygen
Some people may use oxygen
at home or out in community

Discussion: How would you REACT?
• Instructor-led discussion
• Review workbook questions
• Discuss at least 1 scenario
CPR/AED for Community Rescuers REACT Discussion 91

RESPONDING TO
EMERGENCIES

Key Concepts
• Emergency scenes can be dangerous
• Rescuers can quickly become victims
• Caution and common sense can save your life
CPR/AED for Community Rescuers Responding to Emergencies 93

R.E.A.C.T to an Emergency
• R: Recognize Emergency
• E: Environment Safety and Size-Up
• A: Assess Victim
• C: Call for Help
• T: Treat Victim

Recognize Emergency
• Screams, panic; seriously
ill or injured person;
victim or bystanders
agitated or threatening
• Suspicious environment;
collision or stopped
vehicle; environmental
hazard
• Remain calm; stay aware
of your own safety
• Consider resources and
options

Environment Safety
• Size-up the scene from a safe distance
– Blood and body fluids: Use personal protective equipment
– Traffic: Use car to protect scene; use bystanders to stop traffic
– Fire or smoke: Do not enter; focus on escape; stay low
– Hazardous chemicals: Leave the area immediately
– Confined space: Do not enter!
– Hostile environment: Do victim or bystanders appear agitated or
threatening?
• Size-up the victim
– How many?
– What is their general condition?
– Identify cause of illness or injury
– If more than 1 victim, decide who needs help most. If unsure,
help person closest to you.
• Activate EMS now if the scene is dangerous or if there is
an obvious life-threatening injury or illness.

Assess Victim & Call for Help
• Assess the victim
– Go to the victim’s side
– Assess response and
breathing
– Life-threatening illness or
injury
• Call for help
– Shout for help
– Call 9-1-1 or your emergency
response #
• If not sure it’s an
emergency?
– Activate EMS
– Dispatcher will ask questions
to determine if an emergency

Treat Victim
• Treat life-threatening
conditions first
– If no breathing or only
gasping, begin CPR
– If severe bleeding,
control with direct
pressure
• Treat victim in position
found
• Only move victim if
– Danger
– Need to position for
essential care

Calling 9-1-1
• When you call 9-1-1, dispatcher will ask
– Name, location, call back phone #
– What happened
– Number of victims and general condition
– What aid is being given
• Follow instructions, and always hang up last
• When EMS responders arrive
– Continue care until told to stop
– Tell EMS what time event occurred, what time you
arrived, and what care has been given

Rescuer Stress
• Normal to feel stress after
incident
• Each rescuer responds
differently to stress
• Don’t ignore post-traumatic
stress, manage it
– Talk about your feelings
– Eat properly
– Avoid alcohol, drugs,
caffeine
– Exercise
– Get enough rest
• Don’t judge yourself for
your actions
Obtain professional help if needed

LEGAL ISSUES

Key Concepts
• Some people have a duty to respond to an
emergency
• Other people respond voluntarily
• Voluntary responders are protected by the Good
Samaritan Law
• Maintain skills to stay informed on current
practices
CPR/AED for Community Rescuers Legal Issues 102

Good Samaritan Law
• Respond voluntarily
• Not getting paid to
respond
• Provide care with good
intentions
• Stay within limits of
training
• Not reckless or
careless
• Do not abandon victim
after beginning care
Protects voluntary
responders from civil liability

Gaining Consent
• State name, training, & care
plan
• Ask if you can help
• Types of Consent
– Expressed: expresses desire for
aid
– Implied: unresponsive person,
unattended minor
– Minor’s consent: A parent or
legal guardian gives consent
• Right to Refuse Care
– Can refuse care at any time
– Observe situation from a distance,
call 9-1-1 if needed
• Right to Privacy
– Do not give out information to
coworkers or bystanders
– Give information to EMS
responders and to supervisor
Get consent from victim before
beginning care

PROTECTION FROM
INFECTION

Key Concepts
• The OSHA Bloodborne Pathogens
Standard requires the employer to help protect
you from exposure to BBP
• Use precautions with every emergency
• Hand washing is an important part of infection
control
CPR/AED for Community Rescuers Protection from Infection 106

Bloodborne Pathogens
• Most serious:
– HIV
– Hepatitis B
– Hepatitis C
• May be transmitted during
an emergency when
– Giving first aid
– Handling contaminated
sharps
– Cleaning a blood spill
• Routes of transmission
– Splash to eye, mouth or
nose
– Opening in skin (cut, scab,
rash, hangnail)
Bloodborne pathogens are
disease-causing
microorganisms in blood

Universal Precautions
• Assume all blood and body
fluids are infectious, except
sweat
• Take precautions with all
victims, even children
• Use personal protective
equipment
– Disposable gloves
– Gown
– Mask, goggles or face mask
– CPR barrier
• Wash hands thoroughly
immediately after glove
removal
• If no water, use hand
sanitizer, then wash ASAP

What To Do If You’re Exposed
Follow Exposure Control Plan Hand Washing Technique
• Wash hands and any
exposed area as soon as
possible
• Use soap and warm
water
• Scrub thoroughly for at
least 20 seconds
• Rinse well
• Immediately remove gloves
• Wash thoroughly with soap
and water

Removing Soiled Gloves
1. Pinch base of glove,
peel off slowly, hold
in other hand
2. Slip 1 or 2 fingers
inside other glove,
carefully peel off so
that it is inside out
3. Dispose in proper,
leak-proof container

Cleaning After an Emergency
• Clean spill with paper towels
or an absorbent powder
• Pick up sharp objects or
broken glass with tongs or
brush and dustpan
• Disinfect with 10% bleach
and water or another
disinfectant
• Dispose of soiled personal
protective equipment
according to workplace policy
• Wash your hands
Wear personal protective
equipment

Airborne Pathogens
• Other diseases can be spread when an ill
person coughs or sneezes
• Protect yourself by:
– Getting a flu vaccine
– Washing your hands often
– Avoiding contact when possible with people who may
be contagious

Sum it Up
• Keep first aid kits stocked with personal
protective equipment
• If you don’t have personal protective equipment
with you, use whatever is available:
– e.g. To control bleeding, have the victim apply the
pressure, or use layers of clean cloth or extra gauze

HEART ATTACK

Key Concepts
• Heart disease is leading cause of death in
the U.S.
• Heart attack can lead to cardiac arrest
• More than 1.25 million Americans have a first or
recurrent heart attack every year
• About 70% of the deaths from heart attack occur
before the victim reaches the hospital
• Call 9-1-1 early for any signs of heart attack
CPR/AED for Community Rescuers Heart Attack 115

What is a Heart Attack?
• Coronary Artery Disease
– Build-up of fatty deposits in
blood vessels
– Coronary arteries narrow &
harden over years
– Vessels become blocked
– CAD is preventable
• What is a heart attack?
– Heart pumps blood
throughout the body
– Coronary arteries deliver
oxygenated blood to heart
– A blocked coronary artery
deprives the heart of
oxygen
– Results in death of heart
muscle

Heart Attack Signs & Symptoms
• Chest discomfort
– Pain, pressure, tightness, squeezing, fullness
– Discomfort may radiate to the arms, neck, back, jaw,
or abdomen
– Often mistaken for heartburn or indigestion
• Pale, cool, sweaty skin
• Shortness of breath
• Dizziness, fainting or unresponsiveness
• Nausea, vomiting
• Unexplained fatigue

Emergency Care for Heart Attack
1. Call 9-1-1, get AED if available
2. Position of comfort, usually sitting
3. Calm, reassure person
4. Offer 1 adult or 2 baby aspirin for victim to chew
a. No allergy to aspirin, signs of stroke, or recent
bleeding problems
b. Make sure victim is alert and can swallow
5. Check breathing if victim becomes
unresponsive
a. If no breathing or only gasping, begin compressions
b. Use the AED when it arrives

Don’t Delay Calling 9-1-1
• If any signs and symptoms are present
• If the symptoms fade and return
• To give aspirin
• Calling 9-1-1 can mean difference between heart
attack & cardiac arrest
• Professional Rescuers can provide treatment
before cardiac arrest occurs

Unusual Symptoms
• Be alert to other
symptoms
– Extreme fatigue
– Nausea, vomiting
– Shortness of breath
– Pain in jaw, neck, arm(s)
or abdomen
• Women are as likely to
have a heart attack as
men
• May not report
symptoms
• Often misdiagnosed
Women, diabetics, elderly may not
have classic ‘chest discomfort’

Use of Aspirin
• Chewing aspirin gets it
into the bloodstream
faster than swallowing it
• Aspirin thins blood,
reduces ability to clot
• Ensure no allergy to
aspirin, signs of stroke,
or recent bleeding
problems
• Victim must be alert and
able to swallow
Learn your state, local & workplace
guidelines for use of aspirin.
Offer 1 adult or 2 baby aspirin
for victim to chew

STROKE

Key Concepts
• Stroke is 3rd leading cause of death in U.S.
• 800,000 strokes each year in the U.S.
• Call 9-1-1 early for any signs of stroke
CPR/AED for Community Rescuers Stroke 123

What is a stroke?
• A stroke is like a heart attack occurring in
the brain
• Caused by a clot or bleed in the brain
• Symptoms may be minor or severe
• Many survivors are permanently impaired
and struggle with daily activities

Stroke Signs & Symptoms
• Sudden onset
• Weakness or numbness of arm or leg, usually on
one side of body
• Facial droop or paralysis
• Difficulty speaking
• Difficulty eating, swallowing, or managing secretions
• Loss of balance or coordination, difficulty walking
• Confusion, anxiety, unresponsiveness
• Changes in sensation
• Severe headache or dizziness
• Change in vision
• Temporary symptoms may be a baby stroke

Emergency Care for Stroke
1. Call 9-1-1 (activate EMS)
2. Protect the airway
a. Place in the recovery position to allow fluids to drain
if needed
3. Calm and reassure victim
4. Note time that symptoms began
5. If person is unresponsive
a. Check for breathing
b. Start compressions if needed

Don’t Delay Calling 9-1-1
• Call 9-1-1 immediately for signs of stroke
• Do not wait to see if symptoms go away
• Do not drive to hospital
• The time it takes to call 9-1-1 is critical
– Some strokes treated with clot-busting medication
(fibrinolytic therapy)
– Same as with a heart attack
– Only effective in the first few hours of a stroke
• Early recognition of stroke can make difference
between life and death or between complete
recovery and lifelong disability

STR: Smile, Talk, Reach Assessment
• Smile: Ask person to
smile.
– Look for uneven smile or
facial droop
• Talk: Ask person to
repeat a common
phrase.
– Listen for slurred or
incorrect words
• Reach: Ask person to
close eyes and raise
arms.
– Look for arm drift or
weakness on one side

ADULT OR CHILD CHOKING

Key Concepts
• Choking is a preventable emergency
• Most choking incidents occur in children younger than 5
years old
• Treatment is the same for an adult or child
• Act quickly! Severe choking results in death if not treated
• Differentiate between choking and other emergencies
(heart attack, asthma, seizure, drug overdose)
• Was person
– Talking or drinking alcohol while eating
– Eating too fast or not chewing food completely
– Wearing dentures while eating (hard to tell if food is chewed)
– Walking or running while eating or chewing gum
• Universal sign of choking: 1 or both hands at throat
CPR/AED for Community Rescuers Adult/Child Choking 130

Mild Obstruction
• If person can forcefully
cough or speak, do not
interfere
• Forceful coughing is the
best way to relieve an
obstruction
• Ask, “Are you choking?”
– If can cough or speak,
encourage coughing
– Watch for progression to
severe obstruction
• Send someone to call
9-1-1 if coughing is
prolonged
Airway is partially blocked

Severe Obstruction
• Use abdominal thrusts
• Ask, “Are you choking?”
• If nods or can’t speak:
1. Say you are going to help
2. Stand behind person &
reach under arms
3. Place 1 fist just above
navel, thumb side in
4. Grasp fist with other hand
5. Give quick upward thrusts
until object comes out or
the person can breathe or
cough
6. Send bystander to call
9-1-1 if cannot quickly
clear obstruction
Airway is completely blocked
and person cannot breathe

Unresponsive Choking Person
• Lower person to ground
• Send a bystander to call
9-1-1
• If alone with adult victim,
go call 9-1-1 now
• Perform CPR
• Look in mouth after each
set of compressions
– If object is seen, remove it
– Do not ‘blind sweep’ mouth
• If alone with a child or
infant, go call 9-1-1 after
2 min. of CPR

Pregnant or Larger Victim
• Stand behind person
• Reach around chest,
under arms
• Place one fist in center
of the chest
– Same location as chest
compressions
• Grasp fist with other
hand
• Perform continuous
backward thrusts
Use Chest Thrusts

Choking Prevention Tips
• Eat slowly and chew food completely
• Do not talk or laugh with food in your mouth
• Adults: Don’t drink too much alcohol while
eating; make sure dentures fit well
• Children: Cut food into small pieces; cut round
food into halves or quarters
• Protect young children from objects small
enough to fit through center of toilet paper roll
• Keep children seated and supervised at
mealtime

INFANT CHOKING

Key Concepts
• Choking is a preventable emergency
• Most choking incidents occur in children younger
than 5 years old
• Treatment for infants is different than for adults
and children
CPR/AED for Community Rescuers Infant Choking 137

Signs of Infant Choking
• Signs of Choking
– Unable to cry or cough effectively
– Difficulty or no breathing
– Wheezing or high-pitched sounds
– Bluish color skin
– Bulging or tearing eyes
– Panic or distressed facial expressions
• Mild Obstruction: Infant able to cough or cry
– Do not interfere
– Observe for progression to severe obstruction
– Do not leave the infant
– Call 9-1-1 if unsure

Severe Obstruction
9-1-1
– Stay with infant if alone
• Sit or kneel
• Hold face down &
provide 5 back slaps
• Turn face up & provide
5 chest thrusts
• Repeat sequence until
relieved or
unresponsive

Unresponsive Choking Infant
1. Use CPR to remove
object
2. Send bystander to call
9-1-1
3. Perform CPR with
added step of looking in
mouth after
compressions
4. Continue CPR until
infant begins to breathe
5. Call 9-1-1 after 2
minutes if still alone

Discussion: How would you REACT?
• Instructor-led discussion
• Review workbook questions
• Discuss at least 1 scenario
CPR/AED for Community Rescuers REACT Discussion 141

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