Making rescuers of us all

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EH&S now offers first aid/CPR/AED training, certification under new standards created to improve survival

Environmental Health and Safety's Ron Clark, left, shows Brian Henderson of Collaborative Data Services how to use an automated external defibrillator. Photo by Dean Forbes

The science of resuscitation and providing emergency care is constantly improving. Every five years, the American Heart Association and other organizations involved in emergency cardiovascular care meet to review, evaluate and discuss resuscitation science through a multi-year, comprehensive review process.

Last December, after taking on the challenge of simplifying resuscitation training and improving effectiveness, the AHA published the 2005 American Heart Association's Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, based on the scientific consensus reached by physicians, nurses, scientists, researchers and emergency medical-service professionals from around the world.

This fall, the Center will begin teaching first aid/CPR/AED to the new standard. Certification under the old standard will remain valid until the individual is due for recertification, which will take place according to the new standard.

Coronary heart disease is responsible for an estimated 330,000 out-of-hospital deaths in the United States each year. Many victims of sudden-cardiac arrest (SCA) present in ventricular fibrillation (a condition in which the heart's electrical activity becomes disordered), treatment of which requires early CPR and shock delivery with a defibrillator. High-quality bystander CPR can double or triple survival rates. Unfortunately, fewer than one third of victims of sudden-cardiac arrest receive high-quality CPR. A major purpose of the 2005 guidelines is to improve survival from cardiac arrest by increasing the number of victims who receive early, high-quality CPR.

The major changes in the 2005 guidelines are as follows:

1. Emphasis on effective chest compressions. Studies have shown that half of chest compressions given by trained rescuers are too shallow and are interrupted too often during CPR.
   The new mantra is, "Push hard. Push fast." Effective chest compressions produce blood flow during CPR. Rescuers should compress the chest at a rate of about 100 compressions per minute for all victims (except newborns), at a depth of two inches.
   Allow the chest to recoil (return to normal position) completely after each compression, and use approximately equal compression and relaxation times. This allows the heart to fill before it is again compressed.
   Try to limit interruptions in chest compressions. Every time chest compressions are stopped, blood flow stops.
2. A single compression to ventilation (breath) ratio for all victims (except newborns). To re-emphasize the importance of delivering longer series of uninterrupted compressions — and to simplify CPR information so that more rescuers would learn, remember and perform better CPR — the guidelines increase the ratio to 30 compressions — two breaths (repeated until the patient is revived or medics take over) for all victims, except newborns.
3. Each rescue breath should be given over a period of one second and should produce a visible chest rise. Previously, the breath was given over a period of two seconds. This further emphasizes the need to reduce interruptions in chest compressions.
4. Defibrillators will be reprogrammed to deliver one shock followed by two minutes of CPR. The analysis conducted by current defibrillators result in delays of 37 seconds and longer before a post-shock compression is delivered. This change in shock protocol is further justified by the fact that most defibrillators eliminate ventricular fibrillation in the first shock, 85 percent of the time.
5. Defibrillators are recommended for children aged 1 year and older. Pediatric defibrillators are available. However, if not available, use an adult defibrillator on patients age 1 year and older. The evidence is insufficient to recommend for or against the use of defibrillators on children under the age of 1 year.

To sign up for CPR/AED or first-aid training, or if you have any questions, contact Ron Clark or Suzanne Giftai at (206) 667-4866.

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