New First Aid and CPR Guidelines: Step In to Save a Life

The latest CPR guidelines highlight how quick action, proper training, use of technology, and coordinated efforts can increase survival from cardiac arrest.

• By Jonathan L. Epstein
• Feb 01, 2016

Just as companies constantly evaluate operations, so does the science community when it comes to first aid and resuscitation. Updates are made when the science dictates, and a formal process occurs every five years.

The results of that process were announced in October 2015 by the American Red Cross and the American Heart Association (AHA). Last updated in 2010, these recommendations form the recognized scientific basis for most first aid training around the world and will be phased into a majority of training starting this year.

The recommendations make the rescue/first aid process more streamlined and efficacious, but they are not a dramatic departure from previous practice. If anything, they reaffirm the process and highlight techniques for saving more lives from illness and injury.

"First aid can be initiated by anyone in any situation, and our responsibility as experts is to designate assessments and interventions that are medically sound and based on scientific evidence or expert consensus. Knowing the correct steps to take in those critical first moments of an emergency can mean the difference between life and death," said Dr. Eunice "Nici" Singletary, M.D., co-chair of the International Liaison Committee on Resuscitation (ILCOR) First Aid Task Force and chair of the Red Cross Scientific Advisory Council's First Aid Subcouncil.

Providing Emergency Assistance on Site
Medical emergencies arrive when and where they want, whether it's miles or minutes from the nearest hospital. For Halliburton employee Mathew Enriquez, that emergency came while he was working at a staging area some distance from a company oil drilling well site northeast of Greeley, Colo. Luckily for Mathew, who collapsed and wasn't breathing, he was surrounded by colleagues ready, willing, and very able to keep him alive by administering full CPR for the 30 minutes it took for help to reach the outpost.

Being prepared for emergencies in the workplace is always good policy—but as trained Halliburton employees Dan Malone and Don Walker proved, even more so when professional medical assistance may not be near at hand. With the proper training, good outcomes are no accident.

Noteworthy First Aid Revisions

Below is a summary of seven of the most noteworthy first aid revisions in the latest update.

• Bleeding updates: The revised guidelines stress the importance of stopping severe bleeding as a critical first aid skill. Almost all bleeding can be controlled by steady, direct, manual pressure, with or without a gauze or cloth dressing over the wound. The guidelines recommend pressing hard and holding steady pressure for at least five minutes without lifting dressings to see whether the bleeding has stopped. While direct pressure is still the first line of defense, the guidelines acknowledge the important role tourniquets and hemostatic agents play in stopping severe life-threatening bleeding when standard measures fail or are not possible. Tourniquets should be considered for severe life-threatening bleeding on a leg or arm. For open wounds not on an extremity, the guidelines suggest use of a hemostatic dressing, which is coated with a special agent to enhance clotting and help stop bleeding when correctly applied and combined with direct pressure. Hemostatic dressings are available online and at pharmacies.
• Exertional dehydration: In the absence of shock, confusion, or the inability to swallow, first aid providers should assist or encourage individuals with exertional dehydration to orally rehydrate with a 5-8 percent carbohydrate-electrolyte (CE) drink. Other beverages, such as coconut water and 2 percent milk, also have been found to promote rehydration after exercise-associated dehydration. If a CE-based sports drink or these alternatives are not available, drinkable water may be used.
• Heat stroke: Persons suffering a heat-related illness with a change in mental status such as confusion, sleepiness, vision disturbances, and seizures are likely to be suffering from heat stroke. Responders should immediately apply rapid active cooling measures and call 911.
• Hypoglycemia: Early treatment of hypoglycemia (low blood sugar) while the person is still awake and able to follow instructions can prevent progression to more serious hypoglycemia that would require advanced treatment. To avoid giving too much or too little sugar, the new guidelines recommend use of glucose tablets (15-20 gm) that can be purchased at a retail pharmacy. Glucose tablets have been shown to be more effective at resolving symptoms of hypoglycemia than dietary forms of sugar. If glucose tablets are not available, food sources such as sucrose candies, fruit leather strips, or orange juice can still be used, in that order of preference.
• Anaphylaxis: Under the revised guidelines for treating anaphylaxis (severe allergic reaction), if symptoms persist beyond the initial dose and arrival of advanced care will exceed 5-10 minutes, the first aid provider may give a second epinephrine injection from a prescribed auto-injector.
• Recognition of stroke: Approximately 800,000 Americans have a stroke each year, leaving them at risk for long-term disability. Early recognition of stroke through the use of a stroke assessment system (i.e., the Face Arms Speech and Time, or FAST, assessment tool) decreases the interval between the time that the incident occurs and when the person receives specific treatment at a hospital. This faster time to treatment may reduce the damage and disability from a stroke. This is the first time that the guidelines have examined the science behind inclusion of a stroke identification system into all first aid courses.
• Use of aspirin with heart attacks: The updated guidelines clarify that aspirin should be used only when helping someone suspected of having a heart attack, characterized by symptoms such as chest pain accompanied by nausea, sweating, and pain in the arm and back. If the first aid provider is unclear on whether this is a heart attack or simply someone experiencing non-cardiac-related chest pain or discomfort, then aspirin should not be given. Additionally, the updated guidelines emphasize that there is no need to distinguish between enteric versus non-enteric coated aspirin, as long as the aspirin is chewed before being swallowed.

CPR Updates Highlight Importance of Taking Action
The latest CPR guidelines highlight how quick action, proper training, use of technology, and coordinated efforts can increase survival from cardiac arrest. More than 326,000 people experience cardiac arrest outside of a hospital each year, and about 90 percent of them die.

The 2015 guidelines say high-quality CPR training will help responders feel more confident to act and provide better CPR to cardiac arrest victims. Additionally, research shows resuscitation skills can decline within a few months—far before the two-year current evaluation standard. Conducting regular in-service CPR training will help to ensure that employees deliver the highest quality of emergency cardiovascular care.

The AHA cites the following as key points from the 2015 Guidelines Update:

• Untrained bystanders: If they haven't done so already, trained responders should encourage bystanders to call 911.
• Trained lay responders: Trained responders should simultaneously perform steps in an effort to reduce the time to the first chest compression. While the guidelines encourage use of hands-only CPR (CPR without rescue breaths) for untrained responders, they continue to recommend that trained lay responders conduct CPR with breaths.
• Compression rate and depth: For adults, upper limits of recommended rate and compression depth have been added based on new data suggesting that excessive compression rates and depth are less effective. The key points for rescuers to remember are to perform chest compressions at a rate of 100 to 120 per minute and to a depth of at least 2 inches, avoiding excessive depths greater than 2.4 inches. Rescuers also should avoid being too shallow with compressions to achieve the best possible outcomes.

This article originally appeared in the February 2016 issue of Occupational Health & Safety.