New Resuscitation and First Aid Guidelines from European Resus Council – Big Changes to First Aid particularly
Resuscitation Guidelines 2015 Guidance
As you are aware, every 5 years the European Resuscitation Council (ERC), the Resuscitation Council (UK) and the International Liaison Committee on Resuscitation (ILCOR) review the latest research and evidence in resuscitation, and then release updated guidelines. In addition to this, for the first time in history, this year the European Resuscitation Council (ERC) have also produced guidelines for first aid.
With these changes underpinning first aid practice, we would like to offer our Centres a summary of the changes and some information about the next steps.
Resuscitation Council (UK) Guidelines
Whilst the updates to resuscitation were minimal, there are three subtle changes that will impact on how first aid is taught in the future:
1. ‘Shouting for help’ is no longer a step to be taught on its own. The guidelines now state that the first aider should ‘ask someone to call 999’ after checking for normal breathing.
The guidelines now only instruct the first aider to ‘ask someone to call 999’ after checking for normal breathing. This further simplifies the guidelines, making accurate recollection of the sequence even easier. It also acknowledges the frequent availability of mobile phones as the new guidance also says to use the speaker function on mobile phones for ease of communication.
2. Increased emphasis on seizure as a possible presentation of cardiac arrest
Immediately following cardiac arrest, blood flow to the brain is reduced to virtually zero. This may cause a seizure-like episode that can be confused with epilepsy. Bystanders should be suspicious of cardiac arrest in any patient presenting with seizures. It is also extremely important to teach first aiders how to recognise agonal gasps.
3. Teach first aiders to activate the speaker function on their phone when calling 999 to help communication.
A common feature on modern mobile phones, this addition helps the first aider to communicate with the Emergency Medical Despatcher at the same time as assisting the casualty. Guidance says that it is reasonable to show the first aider how this can be done on their own mobile phone.
European Resuscitation Council (ERC) First Aid Guidelines
For the first time in history, the ERC have published guidelines on first aid. This follows an ILCOR led review of evidence in specific first aid topics. The ERC first aid guidelines are based on a worldwide expert consensus of best practice following an international evidence-based review, making them an extremely important addition to first aid practice in Europe.
Below are the key changes that will affect how first aid is taught:
4. Elevation and Indirect pressure points are no longer recommended for the treatment of bleeding.
Elevation and indirect pressure have been removed due to a lack of evidence that either is effective in stopping bleeding, particularly life-threatening bleeding.
5. Haemostatic dressings and tourniquets are to be used when direct pressure cannot control severe bleeding.
Following extensive use and research in combat, there is a wealth of evidence that tourniquets are effective, save lives and have a relatively low rate of complications following application. Similarly, haemostatic dressings have also undergone significant improvements in recent years, have low complication rates and have saved many lives.
The balance of complications versus possible outcomes if not used have led to both tourniquets and haemostatic dressings being introduced into main-stream first aid. Of course, a small office workplace is unlikely to find that catastrophic bleeding is a significant risk to their employees, so they wouldn’t necessarily have to rush out and buy this new equipment. A waste recycling plant or tree surgeon on the other hand may wish to consider having these available.
The good news is that the guidelines are very clear that “training is required to ensure application is safe and effective”.
6. Sucking chest wounds should be left open to the environment – Three sided dressings are no longer recommended.
Due to clinical experience of both improvised and purpose made dressings inadvertently becoming occlusive, the ERC guidelines recommend to ‘leave the wound in open communication with the environment’. This means that there is no longer a requirement to cover it with a dressing. The main emphasis on providing care should be to ‘do no harm’, and the risk of dressings becoming occlusive is significant.
7. For the treatment of Asthma, first aiders should be taught how to administer an inhaler and how to use a spacer device.
The exact wording is “First aiders must be trained in the various methods of administering a bronchodilator”. In the UK, that includes assisting a casualty to take their own prescribed inhaler and how to take it using a spacer device.
8. Hypoglycaemia – first aiders should aim to give 15-20g of glucose.
This has been in diabetes hospital management guidance for a while so it’s good to see more clarification on quantities in first aid guidance. The updated Paediatric First Aid Made Easy book will also include some further guidance for children, as this is the adult requirement.
9. Oral Carbohydrate-electrolyte beverages (sports energy-rehydration drinks) now recommended for exertion related dehydration.
Specific sports energy-rehydration drinks have proven to be more effective than water as they also replace lost body salts. Evidence also suggests that semi-skimmed milk and tea can also be as effective as water.
10. Burns should be cooled with water for a minimum of 10 minutes, as soon as possible.
Whilst Qualsafe our Awarding Organisation have always advocated this, it’s fantastic to see that ERC guidelines have clarified it. We hope that this change will encourage others to come into line with this guidance.