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How Speed Saves Lives!

Posted on November 1, 2016

First Aid training providers are updating their syllabuses, following new official guidelines on resuscitation after a medical emergency. Patrick Gollop explains what employers need to know.

In October 2016, the European Resuscitation Council issued new guidelines on resuscitation in different scenarios. Including hospital settings and emergency first aid situations.  The new guidelines, which update the previous 2010 edition, place more emphasis on early intervention in an emergency. Ensuring that first aid steps are easy to remember to encourage people to take action, and the timely deployment of automated external defibrillators (AEDs).

Greater Expectations

The Resuscitation Council UK has updated its guidance on Adult basic life support and automated external defibrillation. This now includes sending someone to get an AED if there is one available.  The HSE has also revised its expectations for the syllabuses for the First Aid at Work (FAW) and Emergency First Aid at Work (EFAW) courses to reflect this new approach.  According to the HSE, all FAW and EFAW courses should follow the most up to date Resuscitation Council guidelines.

All training providers offering these courses will be required to include training on AEDs by 31/12/16, due to this revision.

In a June 2016 bulletin announcing the change. The HSE said: “It is sensible to ensure that EFAW and FAW First Aiders are trained in AED use, as these are now available within many workplaces and public spaces.  There is good evidence that the early use of an AED has a far more beneficial outcome for the casualty than if that intervention is delayed.”

Research papers cited by the Resuscitation Council UK suggest that the use of an AED at least doubles the chances of survival, and could save thousands of lives each year.

Since the October 2013 update to the First Aid Regulations, the HSE no longer “approves” training providers. Instead, providers themselves must ensure that their topics and methods reflect up to date thinking.  It’s now the responsibility of employers to ensure that they select a first aid training provider with appropriate course content, uses suitably qualified trainers and has robust quality assurance systems in place.

As a result of the changes on resuscitation practice. Health and safety managers may wish to refresh the skills of existing first aiders within the company. This is so they are familiar with the new guidance and know how best to act should they be faced with a casualty in need of resuscitation.

Over the last 18 months the Red Cross has included AED awareness sessions on its two and three day first aid at work courses. Following the recent HSE announcement, the Red Cross introduced competency based AED training as part of its first aid at work courses from 01/10/16.

Simultaneous Steps

The main points of difference introduced by the new guidelines are that first aiders are no longer taught to take a “step by step” approach to assessing a casualty.  Although these steps are still valid, the new guidelines stress the importance of following the steps simultaneously, quickly and with minimal interruptions.  The early steps of ensuring that the scene is safe, checking for a response, checking for breathing and calling for an ambulance may now be accomplished simultaneously.

The new guidelines highlight the role of the emergency medical dispatcher (who callers are connected to when they dial 999) in supporting a first aider in an emergency situation.  They also stress that the first aider stays with the casualty while calling for help and, if possible, put the phone on speaker so they can communicate with the emergency medical dispatcher as they carry out first aid interventions.

A casualty who is unresponsive and not breathing stands a greater chance of survival if first aid is administered quickly.  The new guidelines place more emphasis on early intervention in an emergency and the importance of speed when completing the vital steps in the “chain of survival”.

This is a series of events made up of four elements:

  • Early recognition and call for help;
  • Early cardio pulmonary resuscitation (CPR);
  • Early defibrillation using an AED;
  • Early advanced care when the emergency services arrive and take over.

If any of the elements are missing or delayed, the casualty’s chance of survival reduces.  Another noticeable change is that the term “unconscious” has been changed to “unresponsive”.  The rationale behind the change is that unresponsive is more descriptive and easier to interpret and understand.  First aiders don’t have to worry about what being conscious means or about assessing levels of consciousness. They just need to know whether the casualty is responding normally or not.

Defibrillation

There is now more emphasis on the role of an AED, and it’s importance within the treatment for a casualty who is unresponsive and not breathing normally.  This can be achieved through “public access defibrillation”. When a bystander uses a nearby AED to deliver the first shock.

Defibrillation within three to five minutes of collapse can produce survival rates as high as 50 % – 70 %.  Each minute of delay to defibrillation reduces the probability of the casualty surviving to hospital is discharged by 10%.

In the UK, fewer than 2% of victims have an AED deployed before the ambulance arrives, according to the Resuscitation Council UK.  From January 2017, all EFAW and FAW first aiders will be trained in the use of an AED.  However, according to the HSE, this does not mean that employers must purchase an AED for the workplace, as the requirement is still dependant on a needs assessment.  Nor will employers have to retrain all of their first aiders, as they will automatically be updated in this skill when they re-qualify.

What these changes do mean is that all new first aiders within the company must be trained in how to use an AED.  However, the Red Cross also believes that employers should go the extra mile in ensuring that all their first aiders are trained in the use of an AED.

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