Dear Emergency First Response Instructor,

Emergency First Response is pleased to bring you the fourth quarter 2010 edition of The Responder. By scrolling down and clicking on the links below, you'll find the latest information on Emergency First Response programs.

Remember to monitor the EFR Blog regularly for information regarding training tips, industry news, real life accounts of Emergency First Response students in action and recent approvals.

Thanks for reading and please remember that answers to your questions are only a click away via email at Emergency First Response.

• Consensus 2010 - New Emergency Care Guidelines
• Implementing the New Guidelines into Emergency First Response Programs
• Marketing Savvy: Use the New Guidelines to Enhance your Marketing Efforts
• Frequently Asked Questions about the New Guidelines
• EFR Courses Recognized by Utah State Parks and Recreation Boating Section

Consensus 2010 - New Emergency Care Guidelines

In October of 2010, the American Heart Association (AHA) and the European Resuscitation Council (ERC), two members of the International Liaison Committee on Resuscitation (ILCOR), released new CPR and Emergency Cardiac Care (ECC) guidelines. Other large ILCOR resuscitation councils, such as the Australian Resuscitation Council, will release their guidelines after this bulletin is published. Emergency First Response and PADI programs follow guidelines established by these ILCOR member associations and implement changes whenever protocols are revised.

The 2010 guidelines represent the most extensive research into emergency cardiac care to date. These are based on extensive review of various studies, literature, debates and discussions by international resuscitation experts.

The new guidelines do not show a great change from Guidelines 2005 and further reinforce emphasis on providing effective chest compressions with minimal interruptions. Studies have shown the importance of providing fast, effective chest compressions as a critical aspect in treating a patient who has suffered cardiac arrest.

Most practices, such as the compression to ventilation ratio of 30:2, have not changed. Compression only CPR continues as a recommendation for untrained individuals. However, the recommendation remains for the trained lay rescuer to perform compressions and ventilations. A summary of the changes in administering CPR and AEDs for both ERC and AHA follows.

ERC CPR Changes

ERC First Aid Changes

These have not yet been published. Any published changes will be announced in a future edition of The Responder.

AHA CPR changes

AHA First Aid Changes

Allergic Reactions:

For patients carrying an epinephrine kit, help the patient use it following directions. If symptoms of anaphylaxis persist despite epinephrine administration, first aid providers should seek medical assistance before administering a second dose of epinephrine. In unusual circumstances when advanced medical assistance is not available, a second dose of epinephrine may be given if symptoms of anaphylaxis persist.

Heart Attack:

Advise the patient to chew one adult (non-enteric-coated) or two low dose "baby" aspirins if the patient is complaining of chest pains and does not have a history of allergy to aspirin and no recent gastrointestinal bleeding. This may be performed after activating the EMS system.

Venomous Bites and Stings:

• When treating for snake bites, apply a pressure immobilization bandage around the entire length of the bitten extremity. This is an effective and safe way to slow the dissemination of venom. Care must be taken to ensure the pressure bandage is not too tight. You should be able to slide a finger under the bandage.
• Treat jellyfish stings by liberally washing the affected area with vinegar (4-6 percent acetic acid solution) for at least 30 seconds to deactivate venom and prevent further envenomation. After the nematocysts are removed or deactivated, the pain from jellyfish stings should be treated with hot water immersion when possible.

You should implement these changes into your courses immediately but implementation is required no later than 31 March 2011. To keep EFR and PADI courses current and internationally applicable, course materials are being revised to reflect these recent guidelines.

For detailed references, see the full 2010 AHA Guidelines for CPR and ECC and the ILCOR CoSTR document in the journal Circulation at www.circ.ahajournals.org and view the ERC Guidelines 2010 at www.cprguidelines.eu.

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Implementing the New Guidelines into Emergency First Response Programs

After a thorough review of the changes, list them out and add them into your teaching outline at the appropriate points. This step makes it easy to be sure - and lets you tell your participants with confidence - that you're teaching the program according to the latest guidelines.

Next, review the background for the changes at www.circ.ahajournals.org and at www.cprguidelines.eu. This will provide you with the background behind the guidelines and emphasize the reason for the changes in your classes. Namely, guideline adjustments result from the latest findings in many out-of-hospital studies conducted around the world. This is why all emergency responders should seek retraining.

When you come to areas of the course affected by the new guidelines, have participants write the guideline in their manuals. You can help by listing the new guideline - either on a board in front of the class or by preparing a handout.

Often these participants will go back to their coworkers, friends and family to share this new information. (You might also want to consider offering a simple referral system that you can track and that credits participants for those they refer.)

Many people learn visually, so when teaching your next course, draw a flow chart on the board that highlights the new guidelines - especially C-A-B. Be sure to reinforce that initiating compressions first is a major change from past guidelines. Referring to this visual reference of the new steps throughout the course makes learning easier.

Another important point in the new guidelines is the recommendation that the current two-year time frame should include periodic skill and knowledge review with reinforcement or a refresher course as needed. Let participants know that they can always review the skills and information in the EFR course by watching the video (or by coming back to take a refresher course) between EFR courses. Also, make them aware that you will also contact them before the two-year time frame to remind about completing a refresher course.

By reviewing the new guidelines and emphasizing their importance, making a note in your teaching outline where you will use them and by using visual reminders, you'll be well on your way to a successful EFR course that has your participants excited to learn and use the new guidelines.

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Marketing Savvy: Use the New Guidelines to Enhance your Marketing Efforts

The publication of new guidelines is a significant opportunity for EFR® Instructors, because they come with the advisory that everyone who has ever learned CPR should be reeducated. This gives you a valid reason to contact all of your prior participants to offer a refresher course to update their skills. It also means that employers have compelling reason to update CPR skills for their employees as soon as possible.

Here are some suggestions for making the most of this opportunity:

• Start with your participants and corporate clients who are due for a refresher course – people you certified 18 months to two years ago - as they will most likely be the most receptive.
• Emphasize the importance of the new guidelines – that, because the new guidelines are derived from an evidence based review of resuscitation practices and results, your participants need this information. The new guidelines are the most current available information to ensure the best outcome possible if they step in to help a family member, friend or coworker with a cardiac emergency.
• Demonstrate that the new guidelines are simplified, but contain important changes in the way CPR should be performed.
• If you’re a PADI Member, use this opportunity to enhance continuing education. Regardless of the certification level of your student divers, this is an opportunity to certify them as EFR providers or update their CPR skills. Call or email with a personal invitation so you can customize your pitch.
• Visit the Emergency First Response Instructor site to access an updated version of the Refresher Course cover letter to contact employers and government agencies you've trained in the past.

Don’t forget that customizable marketing materials are also available from your Sales Consultant, including the Courses brochure (product no. 62320) and the Corporate Acquisition brochure (product no. 10277). If you need additional marketing information or assistance, email Jo Walters or call 800 729 7234 (US and Canada), +1 949 858 7234, ext. 2423.

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Frequently Asked Questions about the New Guidelines

Q - Is Emergency First Response going to incorporate the new guidelines?
A - Emergency First Response staff members are reviewing the guidelines and considering how the changes will be incorporated into Emergency First Response courses. Details will be available in future editions of The Responder and revised course materials should be available during the first half of 2011.

Q - The ABCs are now CAB? What’s going on?
A - The new guidelines suggest switching the sequence of steps from Airway, Breathing, Chest Compressions (ABC) to CAB - Chest Compressions, Airway, Breathing.

Q - Is rescue breathing still a part of CPR?
A - Yes. The guidelines recommend Hands-Only (compression only) CPR for untrained lay rescuers. However, for trained individuals, the recommendations state rescuers should begin with 30 compressions followed by two breaths. Compressions should now be at least five centimetres/two inches rather than the previous 4 - 5 centimetres/1.5 - 2 inches.

Q - When can I incorporate the changes into my Emergency First Response courses?
A - EFR Instructors are encouraged to immediately incorporate the new guidelines.

Q - When will incorporating the changes be mandatory?
A - 31 March 2011

Q - Do the new guidelines state that lay people shouldn't administer oxygen?
A - Not entirely. The new guidelines state, “Except in diving decompression injuries, there is no evidence of any benefit of administration of oxygen by first aid providers."

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EFR Courses Recognized by Utah State Parks and Recreation Boating Section

Emergency First Response courses now meet the first aid and CPR requirements for captain’s and guide licenses for Utah State Parks and Recreation. According to Utah State Parks and Recreation, EFR courses are accepted as equivalent to or exceeding the content of American Red Cross Emergency Response or with curriculum taught in accordance with the USDOT First Responder Guidelines or the Wilderness Medical Society Guidelines for Wilderness First Responder. You can download the listing here (37 Kb PDF).

EFR courses have been reviewed and approved by numerous federal, state, local and private organizations. You can find a list of the approvals on the EFR website. The EFR Instructor website also has downloadable copies of the letters of approval for use in your marketing information. If you are targeting a business that needs specific approval of first aid and CPR courses before they can be used to meet requirements (and they are not on the above mentioned list) EFR staff will assist with the approval process.

Please note that the approval process is not always straightforward. Some state agencies approve first aid and CPR/AED programs for specific uses, such as child care providers. Sometimes the required program components are stipulated in a formal approval process and sometimes they are not. Some states only accept programs from a specific organization and only a change in the state’s law will allow other training organizations to be recognized. Where there is an approval process, EFR will submit an application to the appropriate agency, usually a state department or board, and if approval is received, we add this new body to the growing list of accreditations. If you have any questions about a particular situation you face, please do not hesitate to contact your EFR Office.

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