Cardiopulmonary Resuscitation

Australian Swimming Coaches and Teachers Association

Course for Cardiopulmonary Resuscitation

1 Introduction

1.1 Introduction to CPR

Introduction to CPR

Each day in Australia approximately 42 people suffer from some form of a combination of unresponsiveness, absent breathing or abnormal breathing resulting in Cardiac Arrest. 

The survival rate remains under 15%, a rate that is largely unchanged in the past 30 years. However, with early CPR, early Defibrillation and access to medical care many thousands of lives around Australia are saved each year. 

In this course you will learn about the correct way to recognise the emergency, respond appropriately, manage the patient, perform care until emergency services take over, record the information if required and debrief the situation. 

2 What is Cardiopumonary Resusitation

2.1 What is CPR?

What is CPR?

CPR is the acronym for Cardiopulmonary Resuscitation. 

CPR is a technique of compression on the chest to simulate circulation of oxygenated blood. Along with Rescue breaths it is sufficient to preserve brain function and circulation of oxygen around the body.



2.2 Should anyone commence CPR on an unconscious person?

Should I do CPR?

Yes, Early Intervention on an unconscious patient saves lives. CPR should be commenced and emergency services called as soon as possible. Early high quality CPR saves lives.

It is estimated that with every minute the chances of survival diminishes by 10%. The greatest chance of a positive outcome for the patient is for the closest person to commence CPR. Chest compressions alone have been proven to be effective. 

3 Manage an Emergency Situation

3.1 Priorities in an Emergency

First check for Danger to yourself


In any emergency situation the first aid provider should always, quickly asses the situation.

Ensure the situation is safe for firstly the themselves. 

Then to the patient, then other bystanders. The patient may need to be moved to provide a safe environment.  

The provider should always, where possible, send for help.

If the person is unresponsive and not breathing, they will take precedence over other patients in a multiple patient scenario.

3.2 Safety Equipment for CPR


Safety Equipment for Cardiopulmonary Resuscitation

Safety is of paramount importance when performing CPR. The risk of cross infection is minimal. It is important to protect yourself (and the casualty) from infection as well as further injury. 

Take steps to avoid cross infection - transmitting germs or infection to a casualty or contracting infection yourself from a casualty. Remember, infection is a risk even with relatively minor injuries. It is a particular concern if you are treating a wound, because blood-borne viruses, such as hepatitis B or C and Human Immunodeficiency Virus (HIV), may be transmitted by contact with yours through a cut or graze. Usually, taking measures such as washing your hands and wearing disposable gloves will provide sufficient protection for you and the casualty. If a face shield or pocket mask is available, it should be used when you give rescue breaths. 

Minimal Protective equipment to be used-

  • Pocket mask or face shield.
  • Latex-free disposable gloves.
  • Alcohol gel to clean your hands.


3.3 Minimising the Risk of Cross Infection

Do the following to minimise the risk of Cross Infection-

  • Ensure you use a face mask for the rescue breathing.
  • Wash your hands and wear latex-free disposable gloves. If gloves are not available enclose your hands in clean plastic bags.
  • Cover cuts and grazes on your hands with waterproof dressings.
  • Wear a plastic apron if dealing with large quantities of body fluids and wear plastic glasses to protect your eyes.
  • Dispose of all waste safely.

4 DRSABCD and Chain of Survival

4.1 What is DRSABCD?

DRSABCD is the acronym given to assist first aid providers with an action list to priorities the injured. 

  • D = Danger: Prevent any further harm to the provider,  injured and bystanders
  • R = Response: Check for a response from the injured
  • S = Send: Send for help 
  • A = Airway: Check the Airway is open so the injured can breath
  • B = Breathing: Check the injured is breathing
  • C= Commpressions: Start CPR by giving 30 compressions followed by 2 breaths
  • D = Defibrillation: Early attachment of an AED for defibrillation if required 

Danger

Danger to who? What are the Dangers? 

 Danger – always check the danger to you, any bystanders and then the casualty. 

As the first aider you may need to move the casualty from the area because of the risk of danger is a too high. 

Check for items such as traffic, fallen powerlines, chemical poisoning, fire and natural predators. Also use personal protective equipment to protect against cross infection. 

Response

Response 

Can the casualty respond to a spoken direction?  Can they hear you? Can they squeeze your hand? Can you hear them breathing?  If the casualty does not respond, they are unconscious. 

Send

Send for help and or assistance

If possible ask another person to contact emergency services for assistance. Ensure they know where you are, what has occurred and what first aid treatment may be required. 

They need to be calm and able to convey the situation that is unfolding before you. 

Airway

Airway 

 If the casualty is unconscious and is unresponsive, you need to make sure that his airway is clear of any obstructions. The breaths may be faint and shallow - look, listen and feel for any signs of breathing. If you determine that the victim is not breathing, then something may be blocking his air passage. The tongue is the most common airway obstruction in an unconscious person.

With the victim lying flat on his back, place your hand on his forehead and your other hand under the tip of the chin. Gently tilt the victim's head backward. 

If the person is still not breathing on his own after the airway has been cleared, you will have to assist them breathing. 

Breathing

Breathing 

You can check the casualty for breathing by looking for chest movements. Does the chest rise and fall with each breath? Listen by putting your ear near to their mouth and nose, can you hear any gasping or wheezing? Feel for breathing by putting your hand on the lower part of their chest, again we are trying to feel any rise and fall movement of the chest  

If the person is unconscious but breathing, place them in the recovery position and monitor their condition closely until emergency services take over. 

If there is no breathing, gasping and abnormal breathing go to the next step.

Compressions

Compressions 

 When a casualty  is unconscious and not breathing, make sure they are flat on their back and then commence compressions as in this course. 

Defibrillation

Defibrillation 

For an unconscious casualties that is not breathing, apply an automated external defibrillator (AED). 

An AED is a machine that delivers an electrical shock to cancel any irregular heart beat, in an effort get the normal heart beating to re-establish itself. 

The devices are very simple to operate. Just follow the instructions and pictures on the machine, and on the package of the pads, as well as the voice prompts.

4.2 Chain of Survival

Chain of Survival

  • Recognition of cardiac arrest and activation of the emergency response system.
  • Early cardiopulmonary resuscitation (CPR) with an emphasis on chest compressions.
  • Rapid defibrillation.
  • Basic and advanced emergency medical services.
  • Advanced life support and post-cardiac arrest care.

Step 1 Early recognition

Early recognition 

Begin Cardiopulmonary Resuscitation (CPR)as soon as possible if required.  CPR is the critical link that buys time between the first link of the chain of survival. The earlier you give CPR to a casualty in cardiac or respiratory arrest, the greater their chance of survival.

Step 2 Early CPR

Early CPR 

Early CPR saves lives. It is most important to commence within the shortest possible time. It is also important to be aware of the depth of compressions at all times. 

Step 3 Early Defibrillation

Early Defibrillation 

With the rise in access to AEDs it is easier for early defibrillation. 

It is believed that the only effective treatment for ventricular fibrillation is prompt defibrillation

Defibrillation is only effective when it is administered within the first few minutes of a Sudden Cardiac Arrest.


Step 4 Basic and Advanced emergency medical services.

Basic and Advanced emergency medical services

The speed of highly trained and equipped prehospital  paramedics is of the utmost importance. They can respond to the patient and provide for the administration of drugs, advanced airway procedures, other interventions and protocols, prior to the arrival of the patient at a hospital.

Step 5 Advanced life support and post-cardiac arrest care.

Advanced life support and post-cardiac arrest care

Hospitals have the highest trained doctors with the required equipment to promote life in an unconscious non breathing casualty. 

If all of the links in the Chain of Survival are prompt it will give the casualty the greatest chance of survival. 

5 General Management of the Injured

5.1 Ensure safety to the casualty

Protect the casualty

Ensure the safety of the casualty, provider and bystanders. Send one of the bystanders to get help from other relevant emergency services. 

Prevent any further harm or injury to the casualty.

Check the person for physical alert jewellery or electronic alert devices that may assist in the management of the casualty.

Check for and control bleeding. 

Protect the person from the weather.

You may be required to assist with other first aid issue. In this time reassure the person and handle them with due care and diligence.

Continue to monitor the casualty until your assistance is no longer required. 

You may be required to provide information about the person injured to the emergency services when they arrive. 

6 Basic Anatomy and Physiology

6.1 Basic Chest Anatomy

Basic Chest Diagram 

The diagram gives a graphic picture of the basic anatomy of the Chest. It shows the position of the Lungs and Heart protected by the bones of the Ribs and Sternum. 


6.2 Internal Organs

Position of Major Organs 

  • Lungs
  • Heart
  • Liver
  • Stomach
  • Small Intestines
  • Large Intestines


6.3 Respiratory and CIrculation Systems

Respiratory System 

Circulation System 

7 The Unconscious Person

7.1 What are the main causes of unconscious persons?

What are the main causes for a person becoming Unconscious?

There are four broad groups that can lead to the injured becoming unconscious

  1. Low brain Oxygen Levels
  2. Heart and Circulation problems
  3. Metabolic problems
  4. Brain injury


Combinations of causes may be present in an unconscious person.

7.2 How do you recognise the unconscious person?

Before loss of consciousness the person may experience some of the following symptoms yawning, sweating, dizziness, change in skin colour, blurred vision and nausea. 

Determine a casualty's level of consciousness via a gentle touching and loud talking. Do not shake the casualty. Casualty examination for first aid follows a plan which is known by the acronym 'COWS'.

This is used to remind first aid providers of some simple steps that will help to determine a casualty's ability to respond. These steps are:

  • Can you hear me?
  • Open your eyes
  • What's your name?
  • Squeeze my hand

Where there is more than one casualty, always give priority to the unconscious casualty.

A person who fails to respond or show only minimal response should be treated as an unconscious injured person and should be managed that way.

7.3 Protect the unconscious person breathing?

Protect the patient 

If the injured person is breathing, care of the airway takes precedence over any other injury. An unconscious inured person must be handled with due care and diligence. Avoid twisting and quick movements as to protect the spine, neck and spine.

If the person is not breathing commence DRSABCD

Ensure the area is safe 

Ensure the person is placed in a safe area. Assist the person into the recovery position on the side. Ensure their airway is open and head tilt is maintained. Call assistance and or get a bystander to contact emergency services. Constantly check the injured person for bleeding and any change in their condition.

8 Airway Management

8.1 Clear the Airway and Recovery Position

Clearing the Airway 

To clear the airway the mouth should be opened and the head slightly turned in a downward position. This will allow any foreign material to drain out. If the airway is blocked with foreign material you may need to scoop the material out. 

Once the airway is clear you need to roll the injured person onto their back so you can reassess their responsiveness and condition. 

 If they are unresponsive you will commence CPR as appropriate.


Recovery Position 

If the patient is breathing but not conscious you will need to place them in the recovery position. 

  • Place one arm at an angle to one side.
  • Bring other arm across the chest 
  • Place the hand under the jaw
  • Lift the same knee as the crossed arm
  • Roll the patient onto the side 
  • Place the hand under the jaw with the airway open

8.2 Managing a foreign body airway Obstruction

Clearing the Airway

A Foreign Body Airway Obstruction is a life-threatening emergency.

The simplest way to remove a Foreign Body Airway Obstruction is to assess for effective cough.The person with an effective cough should be given reassurance and encouragement to keep coughing to expel the foreign material. If the obstruction is not relieved the rescuer should call an ambulance.

Back blows are effective for relieving Foreign Body Airway Obstruction in conscious adults and children. This is four to five sharp blows, with the palm of your hand, to the middle of the back in between the shoulder blades. Check to see if each back blow has relieved the airway obstruction. The aim is to relieve the obstruction with each blow rather than to give all five blows. An infant may be placed in a head downwards position prior to delivering back blows, i.e. across the rescuer’s lap. 

If back blows are unsuccessful the rescuer should perform up to five chest thrusts. To perform chest thrusts, identify the same compression point as for CPR and give up to five chest thrusts. These are similar to chest compressions but sharper and delivered at a slower rate. The infant should be placed in a head downwards and on their back across the rescuer’s thigh, while children and adults may be treated in the sitting or standing position

The use of abdominal thrusts in the management of Foreign Body Airway Obstruction is not recommended.  These techniques should be applied in rapid sequence until the obstruction is relieved. More than one technique may be needed.  Each situation will require the responder to assess the situation to determine which should be used first.


8.3 Vomiting or Regurgitation?

Vomiting or Regurgitation? 

Regurgitation is the passive expulsion of food,fluid, or other material from the pharynx or esophagus.

While vomiting is an active expulsion of ingesta from the stomach and duodenum. Vomiting involves a centrally mediated reflex with coordinated closure of the nasopharynx and glottis to protect the airway. 

Both of these processes must be differentiated from expulsion of material associated with coughing.

9 Breathing

9.1 What causes ineffective breathing?

Ineffective Breathing

Breathing may be absent or ineffective as a result of:

• direct depression of, or damage to, the breathing control centre of the brain

• upper airway obstruction

• paralysis or impairment of the nerves and/or muscles of breathing

• problems affecting the lungs

• drowning

• suffocation.

9.2 How do you assess breathing?

Look, Listen and Feel

The rescuer should maintain an airway and assess for normal breathing:

LOOK for movement of the upper abdomen or lower chest

LISTEN for the escape of air from nose and mouth

FEEL for movement of air at the mouth and nose.

Movement of the lower chest and upper abdomen does not necessarily mean the person has a clear airway. Impairment or complete absence of breathing may develop before the person loses consciousness. 

There is a high incidence of abnormal gasping after cardiac arrest. All rescuers should use a combination of unresponsiveness and absent or abnormal breathing to identify the need for resuscitation.

9.3 What is Rescue Breathing?

What is Rescue Breathing? 

Rescue Breathing is a technique used to resuscitate a person who has stopped breathing, in which the rescuer forces air into the victim's lungs at intervals of several seconds, usually by exhaling into the victim's mouth or nose or into a mask fitted over the victim's mouth.

There are four types of rescue breathing:

  1. Mouth to Mask
  2. Mouth to Mouth
  3. Mouth to Nose
  4. Mouth to Stoma 

The next four slide talk about the four different types. 

If an injured person is not breathing commence CPR by giving the 30 compressions to the chest then 2 rescue breaths.


9.4 Mouth to Mask

Mouth to Mask 

Mouth to mask resuscitation is a method of rescue breathing which avoids mouth-to-mouth contact by using a resuscitation mask. Rescuers should take appropriate safety precautions when feasible and when resources are available to do so, especially if a person is known to have a serious infection (e.g. HIV).

Position yourself at the person's head and use both hands to maintain an open airway and to hold the mask in place to maximise the seal. Maintain head tilt and chin lift. Place the narrow end of the mask on the bridge of the nose and apply the mask firmly to the face.

Inflate the lungs by blowing through the mouthpiece of the mask with sufficient volume and force to achieve chest movement. Remove your mouth from the mask to allow exhalation.

Turn your head to listen and feel for the escape of air. If the chest does not rise, recheck head tilt, chin lift and mask seal.

Failure to maintain head tilt and chin lift is the most common cause of obstruction during resuscitation.

9.5 Mouth to Mouth

Mouth to Mouth 

Kneel beside the victim’s head. Maintain an open airway.Take a breath, open your mouth as widely as possible and place it over the person’s slightly open mouth. While maintaining an open airway, pinch the nostrils (or seal nostrils with rescuer’s cheek) and blow to inflate the person’s lungs. Because the hand supporting the head comes forward some head tilt may be lost and the airway may be obstructed. Pulling upwards with the hand on the chin helps to reduce this problem.

For mouth to mouth ventilation, it is reasonable to give each breath in a short time (one second) with a volume to achieve chest rise. Care should be taken not to over-inflate the chest. Look for rise of the chest during each inflation. If the chest does not rise, possible causes are:• obstruction in the airway (tongue or foreign material, or inadequate head tilt)• insufficient air being blown into the lungs• inadequate air seal around mouth and or nose.If the chest does not rise, ensure correct head tilt, adequate air seal and ventilation. After inflating the lungs, lift your mouth from the person's mouth, turn your head towards their chest and listen and feel for air being exhaled from the mouth and nose.

9.6 Mouth to Nose

Mouth to Nose

The mouth to nose method may be used:

  • • where the rescuer chooses to do so
  • • where the person’s jaws are tightly clenched
  • • when resuscitating infants and small children.
  • • where there is an injury to the mouth of the injured

The technique for mouth to nose is the same as for mouth to mouth except for sealing the airway. Close the mouth with the hand supporting the jaw and push the lips together with the thumb. Take a breath and place your widely opened mouth over the person's nose (or mouth and nose in infants) and blow to inflate the lungs. Lift your mouth from the person’s nose. Look for the fall of the chest, and listen and feel for the escape of air from the nose and mouth.

If the chest does not move, there is an obstruction, an ineffective seal, or insufficient air being blown into the lungs. In mouth-to-nose resuscitation a leak may occur if the rescuer’s mouth is not open sufficiently, or if the person’s mouth is not sealed adequately. If this problem persists, use mouth-to-mouth resuscitation. If blockage of the nose prevents adequate inflation, the rescuer should use mouth-to-mouth resuscitation.

9.7 Mouth to Stoma

Mouth to Stoma 

A person with a laryngectomy has had the larynx removed and breathes through a hole in the front of their neck. A stoma will be more obvious when the person is on their back for Rescue Breathing and the head is put into backward tilt. If a tube is seen in the stoma, always leave it in place to keep the hole open for breathing and resuscitation.The rescuer should place their mask then mouth over the stoma and perform rescue breathing as described above. If the chest fails to rise, this may be due to a poor seal over the stoma, or the person having a tracheostomy rather than laryngectomy thus allowing air to escape from the mouth and nose or a blocked stoma or tube. If stoma or tube is blocked use back blows and chest thrusts in an attempt to dislodge the obstruction.

9.8 Breathing for Adults, Child and Infants

Breathing for Adults

  • Maximum head tilt
  • Open the mouth with the Pistol Grip, control the head position with other open hand
  • 2 normal breaths


Breathing for Child

  • No head tilt
  • Open the mouth with the pistol grip
  • 2 smaller breaths


Breathing for Infants

  • Head in a neutral position
  • Breath into the mouth and nose
  • 2 puffs from the cheeks


10 Compressions

10.1 When do I perform Chest Compressions?

All providers should perform chest compressions for all persons who are unresponsive and not breathing normally. During the process of CPR interruptions to chest compressions should be minimised. Those who are trained and willing to give rescue breaths, do so for all persons who are unresponsive and not breathing normally.

The compression rate and depth is variable among rescuers and compressions may be worse in the first 5 minutes of the arrest. One study of rescuer CPR showed that compressions became shallow within one minute, but providers became aware of fatigue only after 5 min. When performing compressions, if feasible, change rescuers at least every two minutes to prevent rescuer fatigue and deterioration in chest compression quality, particularly depth. Changing rescuers performing chest compressions should be done with a minimum of interruptions to compressions.

10.2 What position do the providers hands get positioned for Chest Compressions

Position for CPR

The injured non-breathing person is lying on their back, face up.

Chest compressions occur on the lower half of the sternum. Place the heel of their hand in the centre of the chest with the other hand on top. Avoid compression beyond the lower limit of the sternum. Compression applied too high is ineffective and if applied too low may cause regurgitation and/or damage to internal organs.

10.3 Hand, Arm and Body position for effective compressions

Hand, arm and body position for compressions.

Hands- Linked for adult compressions with the weight being pushed through the ball of the wrist.

Arms- Straight with elbows locked straight, shoulder directly over the hands and elbow.

Body position- The rescuer should be close enough to the victim to enable a rocking motion form the hips.

Compression must be 1/3 of the depth of the chest.

10.4 Adults and Older Adolescents

Adult compressions

Two hand technique can be used for performing chest compressions in adults. Interruptions to chest compressions must be minimised. A person requiring chest compressions should be placed on their back on a firm surface before chest compressions to optimize the effectiveness of compressions. Compressions should be rhythmic with equal time for compression and relaxation. The rescuer must avoid either rocking backwards and forwards, or using thumps or quick jabs. Rescuers should allow complete recoil of the chest after each compression. 

The lower half of the sternum should be depressed approximately one third of the depth of the chest with each compression.

Rescuers should perform chest compressions for all ages at a rate of 100 to 120 compressions per minute.  This does not imply that 100 compressions will be delivered each minute since the number will be reduced by interruptions for breaths given by rescue breathing. It is noted that compression rates will vary between and within providers and survival rates are optimised at compressions rates of 100-120 compressions per minute. There is some evidence that compressions rates less than 100 or greater than 140 compressions per minute are associated with lower rates of survival. 

Rib fractures and other injuries are common but acceptable consequences of CPR given the alternative of death. CPR should be initiated for presumed cardiac arrest without concerns of harm to patients not in cardiac arrest.There is a higher value on the survival benefit of CPR initiated by rescuers for patients in cardiac arrest against the low risk of injury in patients not in cardiac arrest. If you can hear ribs breaking during CPR, reassess the area that you are performing the compressions and re-commence. 

10.5 Infant Compressions

Infant CPR

In infants the two finger technique should be used by rescuers in order to minimise transfer time from compression to ventilation. 

Having obtained the compression point the rescuer places two fingers on this point and compresses the chest. 


10.6 Children

Child CPR

For children between ages 1 - 12 years of age the provider would use only one hand for the compressions. Interruptions to chest compressions must be minimised. A person requiring chest compressions should be placed on their back on a firm surface before chest compressions to optimize the effectiveness of compressions. Compressions should be rhythmic with equal time for compression and relaxation. A rate of between 100-120 per minute for the compressions.  The rescuer must avoid either rocking backwards and forwards, or using thumps or quick jabs. Rescuers should allow complete recoil of the chest after each compression. The compressions should be 1/3 of the chest depth. Inadequate compression depth is definitely associated with poor outcomes. The head should be in a neutral position with only minimal head tilt. 

10.7 Pregnant Women

In noticeably pregnant women, standard CPR should be commenced immediately. Once CPR is in progress, if there are sufficient resources available, rescuers should place padding such as a towel, cushion or similar object under the right hip to tilt the woman’s hips (approximately 15-30 degrees) to the left, but leave her shoulders flat to enable good quality chest compressions.

The reason for this position in pregnant women is to move the weight of the pregnant uterus off of her major blood vessels in the abdomen.

If a tilted position is not possible or tilting the hips compromises the quality of chest compressions, then chest compressions should be performed as described as above with the woman on her back.

If you are required to turn a heavily pregnant women onto their side, for example to clear the airway,  it is best to roll on the left side. This will take the pressure off the unborn baby. 

11 Defibrillation and AED

11.1 Why is Defibrillation Important?

Defibrillation 

The importance of defibrillation has been well established as part of overall resuscitation, along with effective cardiopulmonary resuscitation (CPR). An Automated External Defibrillator (AED) must only be used for persons who are unresponsive and not breathing normally.

With cardiac arrest, time to defibrillation is a key factor that influences a person’s chance of survival, there is approximately 10% reduction in survival if the victim is in cardiac arrest due to Ventricular Fibrillation. CPR alone will not save a person in VF. A defibrillator should be applied to the person who is unresponsive and not breathing normally as soon as it becomes available so that a shock can be delivered if necessary.

An Automated External Defibrillator (AED) must only be used for persons who are unresponsive and not breathing normally. CPR must be continued until the AED is turned on and pads attached. The rescuer should then follow the AED prompts.

The development of AEDs has made defibrillation part of basic life support. AEDs can accurately identify the cardiac rhythm as “shockable” or “non shockable”.

AED use should not be restricted to trained personnel. Allowing the use of AEDs by individuals without prior formal training can be beneficial and may be life saving. Since even brief training improves performance, it is recommended that training in the use of AEDs be provided.

The use of AEDs by trained lay and professional providers is recommended to increase survival rates in those who have cardiac arrest. 

Rescuers should follow the prompts: care should be taken not to touch the person, or have them in water during shock delivery. There are no reports of harm to rescuers from attempting defibrillation in wet environments. In the presence of oxygen, there are no case reports of fires caused by sparking when shocks were delivered using adhesive pads.

11.2 Pad Placements - Adults

Pad Placement 

Effective pad placement ensures that a shock is delivered on an axis through the heart.

Place pads on the exposed chest in an anterior-lateral position: one pad slightly below the collar bone on the persons right chest and one pad on the person’s left side below the arm pit. 

In large-breasted individuals it is reasonable to place the left electrode pad lateral to the left breast to avoid breast tissue. All pads have a diagram on the outer covering demonstrating the area suitable for pad placement. 

Pad to skin contact is important for successful defibrillation. Rescuers may need to remove moisture or excessive chest hair prior to the application of pads but emphasis must be on minimizing delays in shock delivery.

Avoid placing pads over implantable devices. If there is an implantable medical device the defibrillator pad should be placed at least 8cm from the device. Do not place AED electrode pads directly on top of a medication patch because the patch may block delivery of energy from the electrode pad to the heart and may cause small burns to the skin. Remove medication patches and wipe the area before attaching the electrode pad.

11.3 Pad Placement - Children and Infants

Child AED position

These pads also are placed as per the adult and the pads and come with a diagram of where on the chest they should be placed.If the AED does not have a paediatric mode or paediatric pads then it is reasonable to proceed with standard adult AED pads. Ensure the pads do not touch each other on the child’s chest. Apply the pad firmly to the bare chest in the anterior-lateral posterior. If the pads are too large and there is a danger of pad-to-pad arcing, use the front-back position (anterior-posterior): one pad placed on the upper back (between the shoulder blades) and the other pad on the front of the chest, if possible slightly to the left.

Standard adult AEDs and pads are suitable for use in children older than 8 years. Ideally, for those under 8 years paediatric pads and an AED with a paediatric capability should be used.

12 Duty of Care, Reporting ,Legal Issues and Debriefing

12.1 Duty of Care

What is required in a Duty of Care to the Patient? 

A person who attends a first aid incident should seek consent from the patient before giving treatment, if possible. If the patient is not capable of providing consent, the rescuer may provide urgent treatment within the scope of their training, to preserve life.  

If the patient is not able to consent to treatment and the issue is not life threatening, try to gain the consent of another responsible adult in attendance. 

Responsible adults are legally entitled to refuse any treatment to preserve life. Likewise a responsible adult or guardian can refuse treatment to a child or child that they are the legal guardian, but only if it is considered in the best interest of the child.

Each State and Territory has different laws and conditions relating to Duty of Care for the injured. You can check the relevant laws for your state at the following link: https://resus.org.au/ 

12.2 Duration of Cardiopulmonary resuscitation?

How long do I continue with CPR?

A person should maintain Cardiopulmonary Resuscitation on a patient until the following-

  • The person responds, show signs of recovery or starts breathing normally
  • It is not possible for them to physically continue
  • A health care professional arrives and takes control of the situation
  • A health care professional directs that the CPR be ceased
  • It becomes unsafe to continue
  • If a AED is attached and directs you to stop CPR 

12.3 Reporting during an Incident

Reporting during an incident 

During an emergency you may be required to provide information to emergency services. This could include position, address, danger, level of consciousness of the patient, blood loss, what first aid equipment is available etc.

Emergency services will normally stay on the phone line with you to guide you through the first aid requirements and procedures. 


12.4 Incident Reporting

Incident Reporting 

Incident reports comprise two aspects. 

First, there is the actual reporting of any particular incident  and the relevant corrective action taken. 

Secondly, information from incident reports is analysed to identify overall improvements in the workplace or service.

It is important to ensure that prompt reporting of an incident, as well as appropriate corrective action, take place. Time lines for both will also be legally imposed. You should therefore understand that the requirement of incident reporting in your workplace should result in improvements in your environment.


12.5 What is included in an Incident/ Accident report?

What is included in an Incident/ Accident report? 

  • The name of the person(s) injured and the names of any witnesses to an incident
  • Where and when the incident occurred
  • The events surrounding the incident
  • What treatment was provided to the injured
  • Whether an injury occurred as a direct result of the incident
  • The response and corrective measures that were taken
  • It should be signed and dated prior to handing it in to the appropriate person, such as a supervisor

12.6 Legal Issues

Legal Issues

In Australia there are two kinds of legal duty-

  • Laws imposed by Parliament which are known as statutory laws
  • Laws imposed by the common law – the law that has been built up over the centuries as a result of decisions made by judges in court. 

All Australian States and Territories have Statutes that provide some measure of protection for a person acting in good faith and without recklessness. However, they must act within the scope of their training, activities and instruction. 

Although there have been a few cases in Australia where a claim has been brought against a ‘rescuer’, there have been no reported cases where a victim has successfully sued someone who came to his aid in an emergency. 

A claim might,therefore, in theory, be brought against a rescuer in the law of trespass on the grounds that his intervention constituted an assault on the victim, or in the law of negligence for a breach of his duty of care towards them. Potentially, there could also be liability for assault in criminal law, but this document will concentrate purely on principles of civil liability and claims for compensation. A claim could be brought either by the victim or,should they die, by their estate, and if the actions of the rescuer led to serious personal injury or death, a very large payment of damages by way of compensation could, in theory, be ordered by the Court.

The Northern Territory has legislation that requires a duty of care to rescue any person without a duty of care. In the NT any person who fails to provide a rescue, first aid or treatment may be found guilty of a crime and imprisoned. 

It is imperative to act within the scope of training and procedures when performing CPR.

12.7 Debriefing after an Incident

Debriefing after an Incident

Debriefing  is usually carried out within three to seven days of the critical incident, when rescuers  have had enough time to take in the experience. Debriefing is not counselling. It is a structured voluntary discussion aimed at putting an abnormal event into perspective. It offers clarity about the critical incident they have experienced and assists them to establish a process for recovery. It can help the affected to explore and understand a range of issues, including:

  • The sequence of events
  • The causes and consequences
  • Each person’s experience
  • Any memories triggered by the incident
  • Normal psychological reactions to critical incidents
  • Methods to manage emotional responses resulting from a critical incident.

13 ONLINE EXAM

What is the % of patients who survive a Cardiac Arrest, that have CPR administered by the nearest person?

  • 80
  • 100
  • 30

The amount of people who have a Cariac Arrest in Australia is around 42 each day.

  • Yes, the amount is around 42 per day
  • No, the amount is over 100 per day

DRSABCD

  • DANGER
    Something to look out for- to yourself, the casualty and bystanders
  • RESPONSE
    Asking questions, look, listen for a reaction
  • SEND
    Request a bystander to do get help if possible
  • AIRWAY
    Check the this is not blocked open and not blocked so the casualty can breath
  • BREATHING
    Look, Listen and Feel to Check the injured is doing this
  • COMPRESSIONS
    Start CPR by giving 30 of these followed by 2 breaths
  • DEFRIBRILATION
    Early attachment of an AED for this action if required

First action in an emergency

If I come across a person with no breathing, I should firstly 

What is Vomit?

  • It is a flow of blood from the Kidneys
  • Is the passive flow of food, fluid, or other material from the pharynx or esophagus
  • It is an active expulsion of material, from mainly the stomach

In providing CPR on a child aged 6 years old you should include the following?

  • One hand for compressions and no head tilt
  • Two finger compressions and no head tilt
  • Two hand compressions and maximum head tilt

What of the following is NOT a cause of an airway obstruction?

  • Stomach ache
  • Suffocation
  • Drowning
  • Upper Airway obstruction

Fill in the Blanks about Rescue Breathing

Rescue Breathing is a technique used to  a person who has stopped breathing, in which the rescuer forces air into the victim's lungs.

What number do we call for emergency services?

  • 911
  • 000
  • 1234

What is the correct procedure to minimise cross infection?

  • Wash your hands prior to treating a casualty
  • Wash the patient before treatment commences
  • Use correct PPE and dispose of it safely

If a casualty is conscious, do I need to get their consent prior to treating them?

  • No, you can assume consent is given.
  • Yes, if the casualty is conscious you need to ask for their consent.

Which of the following is "not" an action to recognise a person is not breathing?

  • Use the Cows method, Can you hear me, open your eyes, what's your name and squeeze my hand.
  • Shake a person vigorously while shouting at them to wake up.
  • Look Listen and Feel the casualty for a response

What are the Bones that protect the Lungs in the chest?

  • Collar Bone
  • Ribs
  • Femur
  • Tibia

The Lungs are a part of what bodily system?

  • Nervous
  • Respiratory
  • Digestive

What is the position of AED Pads on a small child?

  • One on the left shoulder the other on the right shoulder
  • Both on the chest above the heart
  • One in the middle of the chest, the other in the middle of the back
  • On opposite sides of the chest

Select the correct answer for the following statement:

The simplest way to remove a Foreign Body Airway Obstruction is to assess for effective .

Select the correct answer for the following statement:

The reason for CPR is to  

How do you assess the breathing of an unconscious non breathing patient?

  • Look, Listen and Feel the patient
  • Shake and Shout the patient
  • Yell and scream while shaking the patient

Why is the Chain of Survival important?

  • It gives the patient greatest chance of a full recovery
  • It helps to pull the injured from the scene of the accident
  • It links First Aid and CPR

What position do you place a heavily pregnant lady in for CPR?

  • On the back with a pillow or padding under the right hip
  • On their side
  • On the back with the feet raised on a chair