RCMS teaches combined Adult and Paediatric Basic Life Support to those who work in the pre-hospital field. We agree with the Resuscitation Council UK with regards teaching Paediatric Basic Life Support.
It is important for those who have been taught adult resuscitation should know they can use the same techniques on children. The guidelines have been deliberately simplified for ease of teaching and retention.
Please note the following minor modifications to make CPR even more suitable for use in children:
- Give 5 initial breaths before starting chest compression.
- If on your own, perform 1 minute CPR before going for help.
- Compress the chest at least one-third of its depth.
- Use two fingers for an infant under 1 year or one or two hands for a child over 1 year (as needed) to achieve an adequate depth of compression.
- The ratio of chest compression thereafter should ideally be 15:2 or 30:2.
How often will often depend on the individual or the environment they are working in. We suggest skills should be refreshed at least once a year and preferably more often.
It is important that resuscitation skills are refreshed regularly, particularly by those who have a duty to respond in an emergency. The principle is that skills should be maintained at an effective level at all times. Individual employers and organisations should make arrangements for retraining to be available.
There is no specific legal requirement for employers to provide defibrillators in the workplace.
However, there are many documents and statements which suggest certain locations to have an AED issued. For example, the Resuscitation Council and the General Dental Council issued guidelines in 2006 with regard to dental surgeries. http://www.resus.org.uk/pages/MEdental.php
The Health and Safety Executive’s syllabus of first aid training for offshore installations does include the use of defibrillators but this is not extended to onshore first aid. However, the Health and Safety (First-Aid) Regulations 1981 do not prevent an employer from providing defibrillators which could benefit both their employees and the public.
Questions on workplace legislation initially should be directed to the Health and Safety Executive.
There are many causes for cardiac arrest such as severe blood loss or other trauma, lack of oxygen caused by breathing difficulties and most commonly a heart attack causing an abnormal rhythm.
Cardiac arrest results in a complete loss of the mechanical function of the heart. The hearts stops beating, usually as a result of an abnormal heart rhythm called ventricular fibrillation.
Cardiac arrest often presents with the sudden collapse of the patient who has no pulse and is not breathing. Immediate resuscitation and chest compressions are needed until the arrival of the emergency services and possible defibrillation to restore the heart rhythm to normal.
This occurs when one of the coronary arteries becomes blocked by the formation of a blood clot depriving part of the heart muscle of the fuel (blood and oxygen) it needs. This usually presents with a crushing pain in the chest which may spread to both arms, (particularly the left), and up into the throat and jaw. If this does not go away, help should be sought immediately by phoning 999 for an ambulance.
A heart attack can sometimes lead to cardiac arrest, but it’s not the same thing.
The most common cause of sudden cardiac arrest is ventricular fibrillation – a rapid, chaotic, lethal rhythm of the heart. In this condition the heart is unable to pump life-sustaining oxygen to the brain and other vital organs. Death occurs within minutes unless the normal rhythm is restored by defibrillation. Defibrillation is the only treatment that can restart the heart and restore a normal heart rhythm in these circumstances.
People may have an abnormal heart rhythm that leaves them more at risk of ventricular fibrillation. Most commonly, however, life threatening heart rhythms such as this are the result of a severe heart attack.
Although blood flow can be maintained and the body oxygenated with cardiac massage and rescue breathing, the only effective way to restore a normal rhythm is to defibrillate by attaching two large electrodes to the patient’s chest and by delivering an electrical shock.
There are two types of defibrillator:
- Automated external defibrillators (AEDs) – these have been introduced more recently. These semi-automatic defibrillators are small, safe, simple and lightweight with two pads that can be applied to the patient. The defibrillator guides the operator step-by-step through a programme protocol. It records and analyses the rhythm and instructs the user to deliver the shock using clear voice prompts, reinforced by displayed messages. This minimises any risk of the patient being shocked inappropriately.
- Manual defibrillators – these have been used in hospitals and emergency centres for over 30 years. These usually also include an ECG monitor and facilities to cardiovert and pace. Professional expertise is needed to interpret the heart rhythm and decide whether to change the defibrillator and deliver the shock.
Since the mid-1990s, it has been recognised that lay responders may be well placed to use these defibrillators in the community. The Resuscitation Council (UK) clearly state that any person can operate an AED even without formal training. Thorough and recent training in the use of the defibrillator and appropriate updated training sessions are useful.
Defibrillation by lay people is considered safe and effective and is supported by the leading professional organisations including the Resuscitation Council (UK) who published detailed guidelines on AED use.
Speed is vital, the quicker the shock is given after the victim collapses, the greater the chance of success. Currently many people with cardiac arrest occurring in the community, die. As many as 1 in 5 people who have a cardiac arrest do so in a public place and therefore stand to benefit from early defibrillation. Once somebody has suffered a cardiac arrest, there are only a few minutes in which defibrillation is likely to succeed. The prompt institution of basic life support will buy time for the defibrillator to be brought to the patient, but the quicker defibrillation is carried out the greater the chance of saving the victim. Ambulances may take several minutes to reach the scene.
AED computer software is designed to be fail-safe. It is therefore extremely unlikely that a shock could be delivered to a conscious person. Although AEDs should not knowingly be connected to a person who is conscious, this should not prevent the use of AEDs for persons who are suspected of having a cardiac arrest.
No. Defibrillation is part of a ‘Chain of Survival’ which includes calling 999 for the emergency services, giving basic life support to provide oxygen to the brain and other vital organs, defibrillation itself, and more advanced medical and paramedical care. Each link in the ‘Chain’ is important and the Resuscitation Council (UK) will be supporting BLS training as part of the overall initiative. Defibrillation is, however, a highly effective treatment for cardiac arrest and needs to be performed at the earliest opportunity.
Every time an AED is used, this will be recorded by the ambulance service as part of their clinical audit programme. Each AED has an in-built electronic recording device which will be collated centrally and reviewed by professionals as part of the audit process. After an event each site is asked to complete an AED Event Form and fax it to the Department of Health.
At present in the UK there are no statutory requirements for the placement of defibrillators, training and retraining for potential users of automated external defibrillators (AEDs). The Department of Health is not a regulatory body in these matters.
The Resuscitation Council provides guidance on the legal status of those who attempt resuscitation and their website (see link above) provides a wealth of information and further links on this subject.