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First aid training
CPR is taught to the general public in order to increase the chance to CPR being
performed in the crucial few minutes before emergency personnel are available.
Simple training is the goal of the 2005 guidelines to maximise the prospect that
CPR will be performed successfully.
CPR is a practical skill and needs professional instruction followed up by
regular practice on a resuscitation mannequin to gain and maintain full
competency.
In most CPR classes, a simple mnemonic is used to aid memory of the clinical
approach to the unconscious patient and CPR. The most common one used worldwide
is ABC which stands for Airway, Breathing and Circulation. This may be built
upon with extra information (and letters) and can reach complicated levels such
as AcBCDEEEFG, explained further in the ABC (medical).
CPR skills are not confined to medical professionals, but are regularly taught
to members of the public. Widespread knowledge of CPR has a community benefit,
as CPR must be applied quickly after a patients heart has stopped. Early CPR in
the community is essential to the prevention of brain damage during a cardiac
arrest and increases the chance of survival. CPR maintains the blood flow and
perfusion to the brain, buying time until a defibrillator and professional
medical help arrives.
It is considered best to obtain training in CPR before a medical emergency
occurs, although some modern ambulance dispatchers will talk an untrained lay
rescuer through the process over the phone, whilst the crew is en-route. For the
most effective results, hands-on training should be given by an expert. This
will enable the person to perform CPR more safely and more effectively. Most
organisations advocate regular retraining, in order to keep practice in the
skills, and to ensure that the person is up to date with the latest guidelines,
which change periodically based on the outputs from governing bodies.
First aid training, including CPR is often provided by a community organisation
or charity (with or without a fee), with international providers including the
Red Cross and St. John Ambulance, or more local providers such as St. Andrew's
Ambulance Association in Scotland or the American Heart Association in the
United States. There are also many commercial organisations who will train
people for a fee. Training is often provided or paid for by employers who wish,
or are required by law, to have trained first aiders on site.
Guidelines
In 2005, new CPR guidelines were published by the International Resuscitation
Councils, agreed at the 2005 International Consensus Conference on
Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science. The
primary goal of these changes was to simplify CPR for lay rescuers and
healthcare providers alike, to maximise the potential for early resuscitation.
The important changes for 2005 were:
A universal compression-ventilation ratio (30:2) recommended for all single
rescuers of infant (less than one year old), child (1 year old to puberty), and
adult (puberty and above) victims (excluding newborns). The primary difference
between the age groups is that with adults the rescuer uses two hands for the
chest compressions, while with children it is only one, and with infants only
two fingers (pointer and middle fingers). Whilst this simplification has been
introduced, it has not been universally accepted, and especially amongst
healthcare professionals, protocols may still vary.
The removal of the emphasis on lay rescuers assessing for pulse or signs of
circulation for an unresponsive adult victim, instead taking the absence of
normal breathing as the key indicator for commencing CPR.
The removal of the protocol in which lay rescuers provide rescue breathing
without chest compressions for an adult victim, with all cases such as these
being subject to CPR.
Research has shown that lay personnel cannot accurately detect a pulse in about
40% of cases and cannot accurately discern the absence of pulse in about 10%,
the pulse check step has been removed from the CPR procedure completely for lay
persons and de-emphasized for healthcare professionals.
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