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Resuscitation
Training Update.
Courtesy of BS-AC. Feb. 2001
During
August last year, the first International Guidelines for CPR were
published after a lengthy period of consultation between the American
Heart Association and the European Resuscitation Council. These
guidelines are a very extensive, evidence based reference source
which the Resuscitation Council (UK) have distilled into a more
practical document called Guidelines 2000. This document has just
been published.
The
BSAC has reviewed this document, with the result that the following
three changes are to be made to our resuscitation training procedures
- Identification
of circulation
- the identification of a pulse using the carotid artery has
been documented to lead to an incorrect conclusion (present
or not) in up to 50% of cases. Training in detecting a circulation
in this way is no longer recommended for non-healthcare persons
- a definition which covers the vast majority of divers. The
indications for a circulation should now be to assess the
casualty for any signs of breathing, coughing or any indications
of movement. If there are no signs of a circulation, or if
the rescuers are at all unsure, they should commence chest
compressions.
- Two
person CPR
- the sequence of chest compressions / ventilations for two
person CPR has standardised on 15:2 for all healthcare personnel.
The 5:1 ratio is now only recommended for paediatric life
support and is a function of the casualty not the number of
rescuers. Both single person and two person CPR should now
use a common 15:2 ratio of chest compressions / ventilations.
- Recovery
position
- Since 1998 the recovery position recommended by the Resuscitation
Council (UK) has differed from that recommended by the BSAC.
The difference arose because it was considered that the position
recommended by the BSAC (which was in fact the Resuscitation
Council (UK)'s 1997 recommendation) offered greater stability
in the environment more likely to be encountered by divers
- ie. a rolling, pitching boat. Guidelines 2000 does in fact
acknowledge that there are a number of different recovery
positions and that each has its advocates.
For a casualty on a stable base (shore)
there is little to choose between the positions, each has its
advantages and disadvantages. For consistency with other first
aid agencies the BSAC will adopt the Guidelines 2000 position
but will also continue to teach the pre-1998 position as a variation
for situations where its added stability is a benefit.
One
further aspect that emerged is clarification regarding Mouth-to
Nose AV. In water AV is identified in Guidelines 2000 as being one of
the situations where this technique is appropriate, due to the
difficulties of adequately sealing the nose / achieving jaw lift
in these circumstances. One relevant statement is that during
mouth-to-nose AV, soft parts of the nasal passages may flop back
to obstruct the airway. While this will not affect air flowing
in to the casualty, it can obstruct air coming out. It therefore
recommends that the casualty's jaw is allowed to open during the
expiration part of the cycle - in practice this will mean relieving
any pressure holding the jaw shut. While this is not really a
change to our training, this additional advice should be incorporated.
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