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Advanced Resuscitation
Techniques [AID]
Season 2015/16
Learner Guide
This document doesn’t require submission
Candidate Name: ____________________________________________________
Acknowledgments________________________________________
This resource has been developed by Surf Life Saving Australia (SLSA).
SLSA wishes to thank the editorial team who developed the resources for this course:
Judy Spicer,
Steve Allan,
Marcia Fife,
Anne-Marie Widermanski,
Shane Daw,
Gareth Morgan,
Ashlee Biddle,
Carly Hogg,
Dr Natalie Hood, SLSA National Medical Advisor
© 2014 Surf Life Saving Australia Ltd.
This work is copyright, but permission is given to SLSA trainers and assessors to make copies for use within their
own training environment. This permission does not extend to making copies for use outside the immediate training
environment for which they are made, or the making of copies for hire or resale to third parties.
For permission outside these guidelines, apply in
writing to: Surf Life Saving Australia
Locked Bag 1010, Roseberry NSW 2018
Ph: (02) 9215 8000
Fax: (02) 9215 8180
Web: www.sls.com.au
All resources developed by Surf Life Saving Australia are reviewed at least annually and updated as required.
Feedback can be supplied through writing to the address above.
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Contents__________________________________________________
Acknowledgments
Course Summary
Course outcomes
Prerequisites
What you need to complete this course
Currency of the Advanced Resuscitation Techniques Certificate (AID) award
Topic 1: First aid and resuscitation
First aid
Legalities of first aid
First aid safety
Chain of Survival
Emergency action plan
Primary assessment
Secondary assessment
Management of injuries
Ongoing management
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Topic 2: Advanced Resuscitation & Oxygen Administration
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Why use oxygen?
Respiratory noises/Abnormal breathing
First aid conditions which require additional oxygen
Oxygen resuscitation equipment
Administering oxygen therapy – for casualties that are breathing
Resuscitation with oxygen – for causalities that are NOT breathing
Using oxygen and bag-valve-mask device during resuscitation
Equipment maintenance
Oropharyngeal airways
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Topic 3: Suction
Suction device components
Length of time to apply suction
Suction checks
Administering suction
Post-use maintenance of suction unit
Trouble shooting suctioning
Topic 4: Defibrillation
Circulatory/Cardiovascular systems
The heart
Heart rhythms and arrhythmias
Automated external defibrillators (AED)
Public access defibrillation
Use of defibrillators on children
AED operator responsibilities
Defibrillator components
Preoperational checks
Major faults
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Defibrillation pads
Operating the AED
Post-defibrillation causality care
Post-defibrillation equipment maintenance
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Course Summary____________________________________________
The aim of the Advanced Resuscitation Techniques Certificate course is to develop your skills and knowledge to
use oxygen, airway management devices, and automated external defibrillators during resuscitation, and to
administer oxygen to conscious or unconscious breathing casualties.
Course outcomes
By the end of this course, you should be able to:
• Respond to an emergency situation
• Perform primary (DRSABCD) and secondary (vital signs) assessment of the patient
• Perform advanced resuscitation, including use of oxygen equipment, oropharyngeal airways and suction
• Communicate details of the incident
• Complete documentation
• Evaluate the incident and own performance
• Restore equipment ready for us
You will also develop knowledge and skills to enable you to demonstrate competency in the nationally
recognised unit of competency:
•
HLTAID007 Provide advanced resuscitation
Prerequisites
To commence training for the Advanced Resuscitation Techniques Certificate you must meet the
following course prerequisites:
•
be at least 15 years of age on the date of final assessment
What you need to complete this course
•
•
•
•
•
•
•
•
•
a trainer/facilitator
a copy of this Learner Guide
access to a CPR resuscitation manikin (Adult or Child AND Infant)
access to oxygen equipment
access to a suction device for training
access to an airway training manikin and oropharyngeal airways
access to a training defibrillator (AED)
selection of oxygen masks with tubing, nasal cannula, therapy mask, resuscitation mask with oxygen port,
thermometer
to be part of a training squad of at least four people or have additional personnel to participate in training
scenarios with you
Currency of the Advanced Resuscitation Techniques Certificate (AID) award
For the SLSA Advanced Resuscitation Techniques (AID) award to remain current, you must maintain your skills in the
ARTC award annually.
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Topic 1: First Aid and Resuscitation____________________________
The prerequisites of this course are that participants already have an understanding of resuscitation and basic first
aid. This topic is a review of relevant first aid and resuscitation principles to assist participants with understanding
where the use of advanced resuscitation techniques, such as defibrillation, oxygen and advanced airway
management techniques, will support and improve the care they can provide to a casualty.
First aid
What is first aid?
First aid is the initial care of the suddenly sick or injured until medical aid arrives or the casualty recovers. Medical
aid,on the other hand, is professional medical treatment by a doctor, registered nurse, or ambulance paramedic.
Aims of first aid
The aims of first aid are to:
• preserve life
• protect the unconscious
• prevent the condition from worsening and to relieve pain
• promote recovery
As a first aider you also aim to prevent:
•
•
•
•
further damage to yourself, others and the casualty
the casualty’s condition from becoming worse
delay in the casualty’s recovery
any harmful intervention
Legalities of first aid
Duty of care
Australian law does not impose a duty of care on any person to give assistance unless that person already owes a
duty of care to the sick or injured person. A first aider at a work site has an implied duty of care, as does someone
caring for children. There is no such clear duty for a volunteer, but once a person starts to act, that person becomes
the caregiver and should stay with the sick or injured person until professional help arrives.
Negligence
The legal concept of duty of care arises from the laws relating to negligence. Negligence is when someone who
owes a duty of care has failed to provide a reasonable standard of care, which results in further injury.
For someone to be considered negligent under the law, four (4) conditions need to exist or to have been
breached (not adhered to). These are:
1. That a duty of care actually exists between one person and another
a. in the eyes of the law, a duty of care exists in a situation where it is reasonable for one person to be relying
on another to look out for their best interests
b. in a first aid situation it is reasonable for the person receiving first aid to be relying on the person
providing the first aid. When a decision to provide first aid has been made, a duty of care exists
2. That a person owing another a duty of care only acts towards that person in the same way that any other
reasonable person (in the same situation) would do, and in such a way that they are competent to do so
(‘standard of care’)
a. the legal concept of a ‘reasonable’ person behaving ‘reasonably’ is based on the values and expectations
held by the general public (the average man/ woman on the street) and society in general at that point in
time
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b. to determine what is ‘reasonable’ action, a court would make a decision based on what they thought an
average person (of similar knowledge and skill) would currently do in exactly the same type of situation
c. for someone to be competent in doing a certain thing, they must be properly or sufficiently qualified, or
else capable of carrying out that task or role safely and efficiently
d. a person administering first aid SHOULD NOT do anything that they are not sure about. The
person should act responsibly, within their level of competence and follow established policies and
guidelines
e. if a first aider is not sure of something, advice should be sought (emergency services or medical
personnel). The first aider should never be afraid to refer to or hand the casualty over to someone who
has more knowledge
3. That an actual duty of care and standard of care has not been met
a. a court of law actually decides this based on evidence presented in court
4. E ven if it can be shown that duty of care has not been met, for someone to be found negligent it must be
proven that someone actually suffered some type of harm as a direct result
A court will look at all of the circumstances to determine what is reasonable in any given situation. Upon
rendering assistance, a person is under the duty of care to do everything reasonable in the circumstances. A
duty of care cannot be evaded by abandoning assistance halfway through.
In the general community, the law does not impose a requirement on people to go to the assistance of anyone if
they do not want to. The exception is the Northern Territory, where under Statute Law people are required to offer
assistance to anyone in need.
Always work within yur training, following organizational procedures and manufacturers’ instructions for equipment
where required
Assisting with medication
A first aider is permitted to help a casualty requiring assistance to take their own medication. Examples of this
Include:
• someone suffering an episode of asthma. The asthmatic person should have their own reliever
medication, which the first aider can then assist to retrieve and/or assist to administer
• the same situation exists for someone who has angina. The person should have their own sublingual
(taken under the tongue) medication, which the first aider can assist the person to retrieve and selfadminister
• someone suffering from anaphylactic shock. The first aider can assist the affected person to retrieve and
administer their auto-injector
If someone requires medication for something such as pain due to a non-acute reason, they should see a
medical professional to determine the actual cause of the pain and subsequent appropriate
treatment/response. Food is not medication; giving something sweet to someone thought to be diabetic
and hypoglycaemic is acceptable
There may be additional regulations in your state or territory governing storage and supply of medications in
the work environment. Ask your Trainer for more information.
Documentation (record keeping)
Documentation serves the following purposes:
• to assist the first aider in managing their casualty’s injuries or illnesses and being able to perform an accurate
handover t o ambulance personnel
• to be a legal record and statistical information
Organisations providing a first aid service will have first aid forms to assist in information gathering and reporting.
(SLSA members should fill out an Incident Report form for all major first aid and resuscitation cases).
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Confidentiality
All information relating to a casualty’s injury or condition must be kept confidential. However, you must give all
relevant information to medical personnel when they arrive.
Currency of knowledge
The Australian Resuscitation Council (ARC) recommends that CPR skills be updated at least annually. This is
covered by the SLSA requirement to underake an annual skills maintenance (proficiency) test.
First aid safety
Your own skills and limitations
You should take care to only undertake first aid or resuscitation activities that are within your limits and the limits
of what you have been trained for.
Infection control
First aiders should always follow standard precautions when performing first aid. These include using the
following barrier devices during first aid and resuscitation:
•
•
•
gloves
resuscitation mask
safety glasses
Airway obstructions
An airway obstruction (blockage) can be either partial or total. The more the airway is blocked, the more the
casualty is in danger of losing consciousness. Causes of airway obstructions include swelling of the throat
tissues, choking and body position (e.g. if the head is slumped)
Manual handling
You should always be mindful of handling casualties with care and in accordance with any safe work procedures. At
minimum this includes:
•
•
•
Not carrying things beyond you capacity
Using your knees and keeping your back straight when you lift
Not twisting to the side when you lift.
Contaminated waste disposal
First aid supplies and tools or other items that have come in contact with bodily fluids such as vomit or blood
should be disposed of in clinical waste bags.
Debriefing
It is important to consider having a debrief after any first aid incident. Debriefing gives you a chance to look at what
you did at the incident. It is not a blaming exercise, it is to identify what worked well, to improve future performance
and to reduce post incident stress. Rescue teams and many workplaces have standard debriefing procedures. A
member of the public can have their own debriefing simply by talking to someone about what happened – this could
include family and friends, or their general practitioner.
Post-traumatic stress
An unsuccessful resuscitation, not knowing the ultimate outcome, or even a successful resuscitation or emergency
response can all take an emotional toll on the first aider. This is known as post traumatic stress. If you, or a
colleague, are experiencing stress after an incident, it is important to seek out support. Surf Life Saving provides
support to its members. Further information regarding stress management after a critical incident can be found in Volume
One of the Guidelines for Safer Surf Clubs.
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Chain of survival
In 1990, the American Heart Association introduced a treatment model for casualties of sudden cardiac arrest called
the chain of survival. It outlines the specific sequence of events that needs to happen for a casualty to survive and
recover from sudden cardiac arrest.
Figure 1.1 Chain of survival
Early access
This first step occurs when someone suspects or determines that the casualty is in sudden cardiac arrest and calls
for help.
Early CPR
This second step is about buying time for the casualty. Cardiopulmonary resuscitation (CPR) keeps the casualty’s
blood flowing until defibrillation can begin. At this stage any attempt at CPR is better than no attempt. While a
person with current training in CPR is ideal, any attempt by a bystander whether trained or not will contribute to this
stage in the chain.
Early defibrillation
This third step is about resetting the heart’s rhythm by shocking the casualty as quickly as possible with a defibrillator.
Studies show that this is the most critical link in the chain of survival.
Early advanced life support
This fourth step occurs when medical personnel provide advanced care that can include airway support,
medications and hospital.
Emergency action plan
Many variables exist when dealing with emergencies. Knowing when to do what in a first aid situation, despite the
number of possible variables, is the key to giving the casualty or casualties the best chance of a full recovery.
In any first aid situation the first aider must have an action plan. The plan of action for first aiders is known as the
emergency action plan (EAP). The steps in the EAP are listed below:
•
•
•
pause and plan
call for emergency assistance
primary assessment
Before conducting a primary assessment, if possible:
•
•
•
•
introduce yourself to the casualty and ask their name
explain your intentions to the casualty
seek consent to treat the casualty
consider and respect the casualty’s privacy
Secondary assessment:
o management of injuries
o vital signs survey
o history
o body check
o treatment
o Ongoing management
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Pause and plan
The aim of pause and plan is to remind the first aider to remain calm, and to stop and think.
Any time you are called to an incident, consider the following questions:
• is the area safe?
• do you have the appropriate first aid kit and equipment to manage the incident?
- As a first aider trained in advanced resuscitation techniques, you should also consider bringing
oxygen equipment and a defibrillator with you when responding to an incident.
• how long could you be out in the elements?
• do you have a radio or mobile phone?
• are you likely to need assistance?
• do you need to call 000 before you attend the incident?
Through an understanding of your environment and the injuries you are likely to encounter you should already
have answered most of these questions. The couple of seconds it takes to pause and plan will save you minutes
down the track.
Hazard and incident management
The safety of rescuers is the first priority in any emergency situation – so care in approaching the scene is critical.
Be alert to the hazards which are obvious, e.g. fire, smoke, fallen power line; hazards which are hidden, e.g. a
needle under a casualty; hazards which may develop, e.g. a change in the weather, movement of a vehicle or a
structure, a fire which is out of control.It is important to confirm that emergency services have been notified. First
responders may not be able to approach casualties if the hazards present a risk to their safety.
You will need to assess the emergency site and implement the following steps:
1.
2.
3.
4.
5.
identify hazards (always be on the alert for any potential danger)
assess risks
identify potential causes of injuries
identify likely type and severity of injuries
choose the most appropriate responses and resources
Safety concerns:
• remain well clear of any hazards until it is safe to enter/approach
• check for any indication of dangerous substances, either liquid or gas; approach from upwind
• allow no one to smoke near any emergency/incident site
• ask bystanders to help maintain a perimeter around the incident/ emergency site and to stay back
themselves
Hazards/dangers that may be present include:
• biohazards, chemicals, corrosive agents
• fire, flammable liquids or gases, smoke or dangerous fumes
• electricity, power lines
• rising or fast flowing water, submersion in water
• vehicle traffic
• falling objects, unstable structures
• slippery surfaces
• sharp edges
• explosion, bombs, bullets
• confined spaces
• heights
• glass/sharps
• people – aggressive, armed with a weapon, uncontrollable, extreme anxiety/stress
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Call for emergency assistance
It is essential that emergency services are contacted as soon as possible. This should not be delayed until
the primary assessment has been completed, but can happen at any stage during the primary assessment.
The four Ps, Position, Problem, People and Progress can be used to remember the information that will need to be
supplied to an emergency services operator or, when working as part of a first responder organisation such as surf
lifesaving, via radio to your communications centre.
Primary assessment
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Danger
Make sure that there is no danger to yourself and no
further danger to bystanders or the casualty.
Response
Assess the consciousness of the casualty.
Send for Help
resuscitation will provide the casualty with
approximately 16% oxygen in each breath. Using
an oxygen resuscitation device such as an airbag
resuscitator with a reservoir attached will provide
up to 95% oxygen with each compression of the
airbag. The benefit of this additional oxygen during
CPR is invaluable and should be used during CPR
whenever equipment and a trained operator are
available.
Call for emergency assistance.
Compressions
Airway
Ensuring a clear airway is a key aspect of
successfully resuscitating a casualty. The use of
suction devices to clear foreign matter from the
mouth and the use of oropharyngeal airways to
assist in ensuring that the tongue does not block the
airway, can assist in maintaining the casualty’s
airway. These devices are an addition to good
airway management, first aiders should continue to
manage the airway ensuring head tilt and chin lift.
When using an airbag during resuscitation, the jaw
thrust method should be used to apply head tilt and
chin lift and ensure a good seal between the
resuscitation mask and the casualty’s face.
CPR should be commenced if the unconscious
casualty is unresponsive and not breathing normally.
Basic CPR skills are essential to ensure the best
outcome for a casualty; these skills should not be
neglected in favour of using other resuscitation
devices. As an experienced first aider, other first
aiders in your team may look to you for guidance.
You will need to be confident in your resuscitation
skills to be able to provide direction to your team.
You may also be required to instruct bystanders in
assisting with CPR to allow you to access and use
the additional equipment in which you have been
trained
Defibrillation
If you have not previously learned jaw thrust, ask
your trainer to explain how this is done now. A full
explanation of how t o perform jaw thrust can be
found in chapter four of the SLSA, Public Safety
th
and Aquatic Rescue 34 Edition manual.
Breathing
Defibrillation should be administered as soon as
possible. When working in a team, a first aider who
is trained in the use of a defibrillator should be the
operator. The operator of the defibrillator must take
control of the team performing resuscitation as they
will be responsible for the delivery of the shock and
ensuring the safety of the team.
Performing rescue breaths using expired air during
Group Activity 1.1: Jaw Thrust
You should have learned how to perform jaw thrust in your previous first aid training. This technique is essential
when using an airbag during CPR. Refresh your skills in jaw thrust by practising on a partner or a resuscitation
manikin
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Secondary assessment
The secondary assessment is a systematic means of finding other conditions that were not apparent during
the primary assessment. The secondary assessment should not be undertaken if life-threatening conditions
are still present.
Before conducting a secondary assessment, always:
• introduce yourself to the casualty and ask their name
• explain your intentions to the casualty
• seek consent to treat the casualty
• consider and respect the casualty’s privacy
Management of injuries
After completing the primary assessment and having identified that the casualty is responsive and is breathing, the
first aid er can begin managing other injuries. It is important to remember that CPR must not be interrupted to treat
other injuries.
Order of treatment
The control of major bleeding is the first priority after the completion of the primary assessment. Then manage
any major burns, treat the casualty for shock, stabilise any fractures and treat any other injuries.
Note:
A key issue in managing a casualty is treating shock. Beyond treating the cause of shock (e.g. a major
bleed), the introduction of oxygen to provide therapy at this stage is the single most effective treatment
available to a first aider.
Casualty position
The casualty should be moved or assisted into the most comfortable position for their condition. Does the
casualty require protection from the sun, wind or rain?
Call for further assistance if required
The first aider should now consider what further assistance or equipment may be needed to treat the casualty, and
call 000 if necessary and not already done.
Vital signs
Vital signs are essential for not only establishing how well or sick the casualty is, but for monitoring trends in their
cond ition and assessing the effectiveness of the treatment.
There are four vital observations that should be, if possible, written down against time and the name of the
casualty. These observations are:
•
•
•
•
Skin appearance / temperature
Conscious state
Pulse
Respiration
The first set of these, once taken and recorded, becomes the ‘baseline observation’. Changes in the casualty’s
condition are measured against this baseline.
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Skin appearance
Check:
•
Colour - Check the colour of the skin in the mouth and lips. Red, pink, pale or blue. (Checking the lining of
the mouth and lips allows a quick assessment of casualties from all ethnic backgrounds).
Temperature - is the skin warm or cool to the touch?
Condition - is the skin dry or wet?
•
•
Conscious state
Note the following:
•
•
•
Is the casualty alert and aware of time and place?
Is the casualty confused, violent, agitated?
Is the casualty roused by touch or pain?
There are 4 levels of consciousness (AVPU):
1.
2.
3.
4.
Alert - the casualty is responsive and alert
Responsive to Verbal stimulus - the casualty is not aware of time and place
The casualty responds only to Painful stimuli
Unresponsive - the casualty does not respond to stimuli
Pulse
•
•
DO NOT use a pulse to determine if resuscitation is required.
DO NOT use your own thumb to check pulse (there is a pulse in your thumb)
Carotid pulse - located in the neck, the carotid is the strongest and most easily accessible of pulse points.
The Radial pulse (wrist) is often the easiest to find.
Brachial pulse - It can be quite hard to feel a baby's pulse but the best place is the brachial artery
which is located on the inside of the arm just above the elbow
Rate: How many beats per minute? Taken over one minute
•
•
•
Adults - 60 to 100 beats per minute
Children - 90 to 130 beats per minute
Infants - 120 to 160 beats per minute
Rhythm: Is the pulse regular or irregular?
Carotid pulse
Strength/Volume: Is the pulse strong or weak?
Respiration
Rate: How many breaths per minute?
Radial pulse
Rhythm: Is the breathing regular or irregular?
Sounds: Is there gasping, gurgling, wheezing or snoring?
Brachial pulse
Note
DO NOT tell the casualty you are checking their breathing. This may unconsciously alter their breathing.
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Adult
Normal
Abnormal
Pulse - rate, rhythm, volume
60-100 beats per minute
<60 or >100 beats per minute
Breathing - normal, abnormal
12-20 breaths per minute
<8 or>20 breaths per minute
Skin (colour and
Warm and pink
Cool or hot, pale, moist, flushed/red,
Conscious state
Alert and orientated
Drowsy or unconscious
Group Activity 1.2: Vital Signs
In pairs, assess your partner’s vital signs - pulse, breathing and temperature.
History
A history is relevant information about a casualty’s current injury/illness, their present symptoms and relevant
previous illnesses. You can obtain a history by:
•
•
•
observing the scene
listening to what is said by the casualty and bystanders
asking questions.
Appropriate questions can be remembered by the acronym SAMPLE:
•
•
•
•
•
•
Signs and symptoms
Allergies
Medication
Previous medical history (look for a MedicAlert bracelet or necklace)
Last oral intake
Event
If the casualty is unconscious or has an altered level of consciousness, there may be companions or bystanders
who have witnessed the incident and who can be asked for information about what happened. You can make
the casualty feel less anxious by remaining calm, speaking clearly and simply, reassuring the casualty and
referring to them by name.
Body check
The body check is a systematic check of the casualty which may be done in the following order:
1.
2.
3.
4.
5.
neck, up over the head and down across the face
shoulders and front of the chest, abdomen and pelvis including ribs
front and back of upper limbs
front and back of lower limbs
back
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Ongoing management
After completing treatment of injuries and illnesses identified during the primary and secondary assessments, the
first aider will need to decide if referral to hospital or other medical aid is required, and call 000 for an ambulance if
necessary.
Once the decision has been made to refer the casualty to medical aid, ongoing monitoring and management of the
casualty’s condition is important. Using oxygen to provide therapy to a casualty with other illnesses and injuries is
also useful. It c an be given safely to any casualty that the first aider is concerned about.
•
•
•
•
•
Ongoing monitoring and management while waiting for medical assistance should include:
reassessing the casualty’s vital signs at regular intervals
continuing to identify actual or potential problems and plan appropriate care
notifying the ambulance service of any change to the casualty’s status as appropriate
handing over the casualty to ambulance personnel
Who should be sent to hospital?
Anyone to whom any of the following applies should be sent to hospital:
•
•
•
•
•
has lost consciousness, even for a brief period
has required either initial rescue breathing or CPR
may have a secondary condition, such as a heart attack or a neck injury
has a persistent cough or an abnormal skin colour
may have inhaled any amount of fluid or gas
If none of the previous conditions applies, but if the first aider has any doubt about the casualty’s state of health, the
casualty should be advised to seek medical advice as soon as possible.
Hand over
If an ambulance has been called, the first aider should remain with the casualty until they can hand over to the
ambulance paramedics. You should be aware of the standard ambulance response times to your club/area of
operation.
Capabilities of emergency management services
Key requirements to understand when liaising with emergency agencies include:
• the capability and capacity of the first responder agencies
• response time for arrival at site
• on-site resources to support response
• communication of worksite emergency response plan to emergency agencies
• how you can help them optimise the effectiveness of their services when responding to emergencies
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Topic 2 – Advanced Resuscitation & Oxygen Administration________
Why use oxygen?
Perfusion is the body’s ability to deliver oxygen and nutrients to the cells and remove waste products. Oxygen
administration is useful for any casualty who does not appear to be adequately perfused or is not maintaining
sufficient oxygen levels. Qualified personnel may safely administer oxygen to any casualty who is not adequately
perfused. Casualties likely to benefi t from oxygen include those with the following conditions, signs or symptoms:
•
•
•
•
•
•
•
•
•
•
unconsciousness
shock
blood loss
chest pain
shortness of breath, including asthma
severe pain
injuries
after resuscitation
circulatory distress
no response
Respiratory system
The respiratory system supplies the body with a constant supply of oxygen.
Figure 2.1 The respiratory system
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Upper respiratory tract
The upper respiratory tract includes the nostrils, nasal cavity, mouth, pharynx (throat) and larynx (voice box). The
throat i s a common passageway for both food and air. It starts from the cavity at the back of the mouth and nose
and extends down to where it divides into two separate tubes, the trachea and the oesophagus. The trachea allows
the passage of air to and from the lungs. It sits in front of the oesophagus and is closest to the skin. The
oesophagus carries food and liquid to the stoma ch from the mouth and in reverse during vomiting or regurgitation.
The upper respiratory tract is the most common location for an airway obstruction.
Lower respiratory tract
The lower respiratory tract consists of the trachea and the bronchi which divide into two, going into the left and the
right lung. The bronchi then progressively divide into smaller bronchioles and eventually end up as alveoli and
alveolar sacs.
The lungs fill most of the chest cavity, which is separated from the abdomen by a large sheet of muscle known as
the diaphragm. The lungs are spongy, elastic organs that move during inhalation and exhalation.
The breathing process
Breathing is the act of moving air in and out of the lungs.
Breathing in is known as inhalation. It is a muscle action caused when the diaphragm is pulled down (contracts) and
flattened. This sucks air into the body via the mouth or nose.
Breathing out is known as exhalation. When muscles relax they recoil back to their original location and force the air
out of the mouth or nose.
The average adult takes about 12–15 breaths per minute. The average amount of air inhaled and exhaled is about
500 ml (a normal breath). In infants the normal breathing rate can be between 25-50 breaths per minute.
Respiratory noises / Abnormal Breathing
In a healthy person there should be no audible sound as they breathe in and out. Where a casualty has some
respiratory distress, this may be accompanied by noises. Noises can include cough, inspiratory/expiratory wheeze,
stridor or wet gurgling noises. A casualty in severe respiratory distress may make no sound at all.
Cough --a sudden expulsion of air from the lungs (with a characteristic noise), may be associated with mild airway
obstructions, or inflammation of the upper and/or lower airways
Wheeze- a whistling sound when breathing in or out, most commonly encountered by first aiders treating casualties
with asthma and may also be associated with other chronic obstructive airways diseases
Stridor - a louder or harsher sound than a wheeze, may be associated with a partial airway obstruction
Gurgling - a broken irregular sound similar to moving water may be associated with fluid or mucus in the lower
airways
No sound - no vocal sound, even with a casualty showing an effort to breathe. A casualty with a complete airway
obstruction may make no sound, the effort to breathe may also take in the use of accessory muscles.
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First aid conditions which require additional oxygen
The body requires a constant supply of oxygen and when it does not receive enough, hypoxia results. It is
essential to be able to recognise breathing difficulties and to provide immediate first aid including supplementary
oxygen to treat the casualty.
Respiratory distress or hypoxia can be caused by:
•
•
•
•
•
•
airway obstruction, such as:
- foreign material or vomit
- issue swelling (allergic reaction)
- incorrect head position during unconsciousness (a casualty slumped forward in the seat of
their vehicle after a car crash)
trauma (head injury)
drugs (eg heroin, which slows down breathing to the point where a casualty may stop breathing altogether)
drowning
asthma
impairment of nerves and/or muscles of breathing
- spinal cord damage
- chest injuries
- some poisons and venom
Hypoventilation
Hypoventilation is breathing that is not adequate to meet the needs of the body (too shallow or too slow), or
reduced lung function. The blood carbon dioxide level rises leading to a decreased conscious state, and the blood
oxygen level falls leading to inadequate supply to vital organs.
Respiratory arrest can follow if a casualty’s condition deteriorates, and is a life-threatening emergency. If the
body’s other systems are not receiving oxygen they will fail to function. For example, if breathing stops, the heart
will stop beating soo n after.
Asthma
Asthma is an inflammatory disorder of the lower respiratory system in which the lungs and air passages
become sensitive and sometimes narrow, making it hard for the person to breathe.
Chronic Obstructive Airways Diseases (COAD)
Chronic Obstructive Airways Diseases (COAD) include emphysema, chronic bronchitis and other airways
diseases. COAD is an ongoing illness, the casualty will be aware of their condition and, subject to having enough
breath to speak, will be able to tell you of their condition.
In healthy people, high carbon dioxide levels are a stimulus to breathe. COAD casualties, who chronically have
high carbon dioxide levels, loose this reflex and instead their breathing control centre relies on low levels of
oxygen in their body to stimulate them to breathe.
Due to their body relying on low levels of oxygen to stimulate breathing, casualties with COAD are normally
treated with low levels of oxygen (eg: two litres per minute). If the higher concentrations of oxygen commonly
available in first responder oxygen equipment (eight litres per minute or more) are used to treat a COAD casualty
it may cause them to under breathe.
Management of COAD
•
•
•
•
•
•
•
DRSABCD
reassure the casualty
provide oxygen therapy, with the casualty sitting in an upright position to ensure maximum space for lung
action
continually monitor breathing and response and commence CPR if absent
seek medical aid - call 000 for an ambulance if required
do not leave the casualty unattended, especially if receiving oxygen
document observations in order to identify trends
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Note
Any casualty presenting with breathing difficulties should be treated with oxygen. Supplemental oxygen
administration must take precedence over the concern that a casualty may under breathe due to being
administered high oxygen concentration levels.
Hyperventilation
Hyperventilation is the result of over-breathing that can be stress-related, deliberate or from medical conditions.
The rate and depth of breathing are more than is necessary to maintain a normal level of carbon dioxide in the
blood. As hyperventilation does not cause a lack of oxygen, the casualty should not be administered oxygen
therapy in this situation.
Oxygen resuscitation equipment
Approval of equipment
All oxygen resuscitation kits must meet Australian Standards. To check that your equipment meet s Australian
Standards, look for the Australian Standards logo on your equipment or packaging.
For use within surf lifesaving refer to SLSA Lifesaving Gear and Equipment specifications and/or SLSA - SLSA
Approved Gear and Equipment Manual
Servicing equipment
Oxygen regulators and flow valves require annual servicing. The manufacturer’s recommendations for servicing
should be followed.
Figure 2.2: Examples of oxygen resuscitation kits
Figure 2.3 Components included in an oxygen resuscitation kit
It is important for those trained in the use of oxygen resuscitation units to ensure that they are familiar with the
components and operation of the unit(s) in use at their location. The basic components are labeled above.
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Equipment descriptions
Protective case
This houses all the relevant equipment. It may be a soft bag or hard plastic or metal case. In some models, it
incorporates the oxygen cylinder itself.
Medical oxygen cylinder
Medical oxygen cylinders are all white. Previously cylinders were black with a white shoulder, and this was
phased out between September 2009 and June 2011.
The cylinder has two locating pin holes next to the main outlet. This is called the”Pin Index Safety System
(or PISS)”. These holes mate with pins on the mounting yoke of the oxygen equipment. A fresh, full cylinder
will usually have a protective wrapping of blue or white plastic around the oxygen outlet to prevent dust and
dirt from entering during transportation. Before attaching the cylinder to the oxygen equipment, all wrapping
must be removed and the cylinder ‘cracked’ by quickly opening and closing the outlet valve.
Cylinder cradle
This provides support for the oxygen cylinder.
Cylinder yoke
This is the connection for the oxygen cylinder. In some instances, it is part of the case; otherwise, it may be
attached as p art of the regulator.
Sealing washer
This fits in the yoke to prevent leakage from the cylinder joint. Spare seals are kept in the oxygen equipment case.
Locating pins
These are positioned in the yoke, so that the operator can locate the oxygen cylinder correctly.
Thumb screw
This helps to secure and maintain the cylinder in position.
Cylinder key wheel
This is used to open or close the cylinder valve.
External cylinder connection
This allows larger oxygen cylinders to be attached. It is important to remember that when an external cylinder is
in use, a small cylinder or the yoke plug should be firmly in place to prevent oxygen leaking. This connection is
not found on all unit s.
Contents gauge
This indicates the amount of oxygen in the cylinder.
Regulator
This regulates the oxygen pressure and flow of oxygen.
OP airways
Oropharyngeal airways help maintain a clear airway.
Bag-valve-mask device
This silicone-based apparatus is used for inflating a casualty’s lungs by squeezing, which supplies oxygen
from an oxygen reservoir bag.
Oxygen reservoir bag
Is attached to the airbag and stores oxygen to ensure that maximum oxygen is delivered to the casualty.
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Tubing
Depending on the unit, there will be either one or two tubes, usually clear and/or green in colour.
Control valves
These are turned on when using the airbag resuscitator or oxygen therapy, giving a fixed flow rate of
oxygen. On some models, the control valve and flow rate are built into the regulator.
Resuscitation masks
Each unit should contain at least one adult and one child-sized mask.
Therapy masks
Each unit contains at least one adult and one child-sized mask. These masks may be the therapy type or the
non-rebreather type of mask. Therapy masks are single use only.
Chalk
This is used to mark the volume of oxygen in the cylinder.
Gloves
Used for personal protection.
Pens, pencils and paper
Used for taking records during oxygen usage.
Patient filter (optional)
A patient filter is inserted between the resuscitation mask and the patient valve on the airbag. This filter stops
any vomit, blood or saliva from entering and clogging the patient valve during resuscitation. The patient filter is
single use only.
Other equipment
The equipment below may also be a part of your oxygen resuscitation kit.
•
Automatic oxygen-powered resuscitator
o These devices deliver oxygen under high pressure to inflate the lungs of casualties who are not
breathing. (These devices are not approved for use by surf lifesaving members).
•
Suction
o This feature helps the operator to remove fluids from the casualty’s mouth.
Group activity 2.1: Oxygen equipment
In pairs or small groups, take turns at naming all the pieces of equipment in your kit. As some equipment may
vary slightly, you may need to check with your trainer. Once you and your partner are confident that you can
remember all the items, remove an item or two without your partner watching, and then have them review the kit
and identify the missing item(s).
•
protective case
•
medical oxygen cylinder
cylinder yoke
•
•
sealing washer
•
thumb screw
•
cylinder key wheel
contents gauge
•
•
regulator
•
OP airways (Oropharyngeal airways)
Airbag
•
•
oxygen reservoir bag
•
tubing
•
control valve(s)
resuscitation masks (adult and child)
•
•
masks - therapy or non-rebreather (adult and child)
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•
•
•
chalk
gloves
pen/pencil and paper
Routine check of oxygen cylinder
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•
•
•
•
before a cylinder is fitted to the oxygen equipment, check the heat warning tag (reject any cylinders
with melted or deformed tags), and remove the protective plastic wrapping
‘crack’ the cylinder by turning it on and off very briefly, keeping it as upright as possible and taking care
that the outlet is not pointed at any person or potential danger (eg sand). Cracking the cylinder removes
any foreign matter from its valve opening
check that the sealing washer is present and is not damaged or dirty. Replace missing or damaged
sealing washers, otherwise the equipment is inoperable and cannot be used
the cylinder must be inserted into the yoke ensuring that the inlet and outlet holes are aligned. This is
achieved by ensuring that the locating pins on the yoke are aligned to the locating pin holes on the
cylinder valve. Then tighten the thumb screw
check the contents of the cylinder by using the cylinder key wheel to slowly open the cylinder valve un til
the gauge reaches a steady point. This slow build-up of pressure saves damage to the regulator and
gauge, which can occur from a sudden rush of pressure. Open the cylinder valves fully, and then turn the
key wheel back half a turn to prevent locking. The gauge should register ‘full’. This may be indicated by
the word ‘full’ or a green mark on the cylinder. Where a cylinder is less than half full, reject it and fit a new
cylinder.
Safety precautions
Oxygen must be used with care and respect at all times:
•
never use oxygen near an open flame
•
never use oxygen near cigarettes
•
never use grease or oil with oxygen equipment
•
never use oxygen when delivering a shock via a defibrillator Pullout Text
Pre-use check of oxygen equipment
To ensure that oxygen equipment is ready for use:
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•
•
•
•
•
check the oxygen tubing for cracks or other damage. Ensure that the open end will fit easily to both
therapy masks, as well as the oxygen nipple of the airbag
check the flow of oxygen from the cylinder through the tubing
check that there is no odour from the oxygen being expelled from the tubing
check the airbag
close the cylinder valve, and then drain oxygen from the system by operating the delivery system (where
the unit has two ensure both are operated) and check that the needle on the contents gauge falls to zero
mark the cylinder with the contents, time and date of inspection
Ancillary equipment
To ensure that ancillary equipment is ready for use:
•
•
•
•
check both therapy masks for cleanliness and serviceability
check the condition of the resuscitation mask cuffs for fit, perishing or cracks
ensure that a minimum of two larger (adult) size oropharyngeal airways are present and sealed in their
original packaging
check in the case for:
- chalk, for marking the amount of oxygen in the cylinder
- pens, pencils and paper for keeping records
- gloves, for personal protection during emergency care
- spare sealing washers, to replace defective or missing seals, as required
Casing and additional equipment
General care of the case and optional equipment includes:
•
•
keeping the whole unit clean and free from sand, sea water, oil and grease
checking additional equipment (eg suction, automatic oxygen-powered resuscitators)
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Group activity 2.2: Routine equipment checks
In pairs or small groups, take turns checking that the oxygen equipment and ancillary items are available and
serviceable. Have your partner test you by following the process outlined previous.
Storing oxygen equipment
Oxygen equipment should be stored:
• in a cool but accessible place, as heat causes rubber and plastic components to deteriorate (spare
oxygen cylinders should be stored in a cool and accessible place, near the oxygen equipment)
• away from busy traffic areas and sand and dust contamination
• away from oil or grease – these substances can cause fire when in contact with high-pressure oxygen
• in a ventilated space – any leakage in an enclosed space could cause an increased concentration of
oxygen which could be dangerous in the event of a fire
• uncovered – any leakage of a covered unit could cause an increased concentration of oxygen in the
unit
• without any pressure in the system – turn off the cylinder then drain oxygen from the system by
operating the delivery system
• in a location designated as a no-smoking area and not near naked flames; leaking oxygen can fuel a
fire
Empty oxygen cylinders should be returned for refilling without delay. Cylinders that are half full or less can
be used for training.
Safety Data Sheets (SDS)
Your club or service should have a Safety Data Sheet for each hazardous substance stored on the premises.
These may be stored in a central folder or each sheet may be stored with the hazardous substance. Safety data
sheets contain information on how the substance should be stored and what to do if poisoning occurs.
Administering oxygen therapy - for casualties that are breathing (conscious
or unconscious)
To administer oxygen therapy:
• check oxygen equipment before each use
• place the equipment so that the operator can reach it easily and see the contents
gauge
• connect the therapy mask to the tubing and turn on the oxygen to a flow rate
of 8 litres per minute; you should be able to feel and hear the oxygen coming
through the mask. This will deliver 45% oxygen.
• reassure the casualty and tell them what you are about to do, then put the
mask on the casualty’s face and ensure that it is secure by adjusting the
elastic and pinching the metal noseband
• place unconscious casualties in the lateral position.
Note
If a conscious casualty does not want to use the mask, they can hold the mask in
front of their face, or remove the tubing from it and direct the oxygen flow around the
mouth and nose
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Figure 2.4: Correctly
fitted therapy mask
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Resuscitation with oxygen – for casualties that are NOT breathing
Mouth-to-mask resuscitation with oxygen
Research has shown that adding oxygen during mouth to mask resuscitation can increase the oxygen received by
the casualty from 16% to 50% (16% is the oxygen content of expired air). If the therapy setting of eight litres per
minute is used, the concentration of oxygen in the casualty’s lungs will be almost 45%, but if the resuscitation
setting of 14 –15 litres per minute is used and the seal is good, the concentration for the casualty will be greater (ie
>50%). It is recommended that the higher setting be used if there is enough oxygen available for the time
resuscitation is expected to lastIf not,the flow of eight litres per minute is satisfactory.
A number of different facemasks are approved for use in mouth-to-mask resuscitation. Some of these have oxygen
ports that allow the oxygen therapy tubing to be connected.
Mouth-to-mask resuscitation with oxygen can be a one-person operation; however, it is preferable that two
operators are used. One person needs to do mouth-to-mask resuscitation while a second person handles the
oxygen unit. The oxygen is turned to the appropriate setting and the tubing fitted either to the oxygen port,
through the opening of the mask, or between the cheek and the mask if an adequate seal is maintained. Masks
with ports are highly recommended for this procedure
Bag-valve-mask
Patient valve
Airbag
Oxygen nipple
Patient filter
Resuscitation mask
Air inlet valve
Oxygen reservoir
Figure 2.5 Components of an airbag resuscitation device
The bag-valve-mask with oxygen reservoir is a manually operated, soft-recoil silicone bag with a secondary bag
attached. This secondary bag acts as a reservoir for oxygen when connected to an external oxygen supply.
Components of the bag-valve-mask vary between manufacturers, and between models from the same
manufacturer. Some manufacturers supply single use only bag-valve-masks – these must be discarded
appropriately following use, and replaced with a new unit. Users must become familiar with the equipment used at
their location.
Disposable bag-valve-mask units are contained in a sealed bag which should be visually checked for damage as
part of routine inspections. The unit then needs to be checked fully when taken out of the protective bag
immediately prior to use.
The resuscitator with oxygen reservoir will provide the casualty with up to 95% oxygen when connected to an
oxygen supply, with a flow rate of 14-15 litres per minute.
Casualties who are not breathing should be treated initially using CPR, but they will always benefit from the
administration of oxygen by trained personnel.
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When the oxygen unit arrives and is being set up, the first operator should continue with the mouth -to-mask
resuscitation method (or change to it, if a mask was not previously available) while preparing to change over to
the bag. This may take some time, however, and resuscitation must continue during the change over period. It
is possible to give mouth -to-mask resuscitation with oxygen briefly using the tubing before the bag is ready.
Bag-valve-mask checks
To ensure the bag-valve-mask is ready for use:
•
•
•
•
check the bag-valve-mask for leaks and direction of airflow by:
o blocking the patient valve with the thumb or hand and compressing the bag under reasonable
pressure
o checking that air does not leak out of the rear valve, the bag or the casualty valve
o releasing the thumb or hand, when the bag should compress and refill rapidly
check the function of the yellow disc membrane on the patient valve by:
o placing the oxygen reservoir bag over the casualty valve and inflating it fully by squeezing the
ventilation bag
o squeezing the reservoir bag gently. The yellow disc membrane will lift (during resuscitation, the
casualty exhales through this disc membrane)
check the overflow valve of the oxygen reservoir by:
o inflating the reservoir bag as described above and connecting it to the reservoir valve
o compressing the reservoir bag rapidly and watching the disc in the valve lift (this membrane
ensures that the reservoir bag cannot be overfilled with oxygen)
check the air-intake membrane which is located in the rear valve of the airbag by:
o checking its function by inflating the reservoir bag as described above and connecting it to the
airbag
o repeatedly compressing the airbag. The reservoir bag will empty and the airbag will draw in air
through the air-intake membrane
Group activity 2.3: Bag-valve-mask checks
In pairs or small groups, take turns checking that the valves of the bag-valve-mask are operational and all
components are serviceable. Have your partner test you by following the processes previously outlined.
Using oxygen and bag-valve-mask device during resuscitation
Setting up the bag-valve-mask
•
the operator needs to inform other first aiders about who they are and their qualifications to operate the
equipment
•
the operator sets up the equipment clear of the casualty and first aiders, but in a position where the
gauge is clearly visible
•
immediately on opening the case, a suitably sized resuscitation mask is passed to the rescue breathing
operator to change to the mouth-to-mask resuscitation method. If mouth-to-mask resuscitation is in progress,
however, the bag-valve-mask can be fitted directly to the mask (after an operational check)
•
the operator should quickly check:
o the correct operation of the patient valve
o the valve to the oxygen reservoir bag
o the connection to the oxygen supply
•
the oxygen is then turned on to 14-15 litres per minute to allow inflation of the airbag reservoir
•
when the reservoir bag is inflated, compress the airbag to expel any air from the unit. This should then
leave the airbag with 100% oxygen
Operating the bag-valve-mask (BVM) device
To apply the bag-valve-mask device during resuscitation:
• tell the other operator that the BVM device is ready for use, when the oxygen reservoir is inflated again
• position the casualty valve in the resuscitation mask and compress the airbag so that there is no
change at all in the timing of resuscitation, which is important if CPR is being performed
• compress the airbag with two hands (for an adult) using a gentle squeezing motion, taking at least 1.5-2
seconds for the
• chest to rise. The amount of oxygen to be forced into the casualty’s chest is the amount required to make
the chest rise
• release the airbag and allow it to refill ready for the next ventilation.
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•
the rescue breathing operator controls the backward head tilt and ensures a proper seal between the mask
and the
casualty’s face
ensure that the casualty’s chest rises with each inflation and falls as air exits the lungs:
- both the airbag rescue breathing operators are responsible for this
- if at any time, either operator is not happy with the functioning of the oxygen equipment, the
equipment must be removed immediately and rescue breathing must continue by the
mouth-to-mask, mouth-to-mouth or mouth-to-nose method.
•
•
If the bag-valve-mask is being used during CPR, at least two first aiders must be present, although it is highly
recommended that there are three. One controls the casualty’s airway and ensures the seal of the resuscitation
mask; the second activate s the oxygen equipment; and the third performs chest compressions. If only two
operators are present, one should control the airway, ensure the mask seal and activate the oxygen equipment
while the second operator performs chest compressions.
If oxygen equipment is being used on a child, the paediatric bag-valve-mask device (if available) should be used
and compressed with one hand. When the child’s chest is seen to rise, stop compression of the bag. Bag-valvemask devices not specifically manufactured for the exclusive use on infants should not be used on infants.
If the oxygen bottle is depleted during resuscitation, continue to use the bag-valve-mask and remove the reservoir
bag.
Complications with the use of a bag-valve-mask device and suitable strategies to
minimize
Manual resuscitators have no built in tidal volume control - the amount of air used to force-inflate the lungs during
each breath depends entirely on how much the operator squeezes the bag. This may lead to the risk of various
complications, many of which depend entirely on whether the manual resuscitator is being used with a face mask
or ET (Endotracheal) tube. Complications are related to over-inflating or over-pressurising the casualty, which can
cause:
1. air to inflate the stomach (called gastric insufflation);
2. lung injury from over stretching (called volutrauma); and/or
3. lung injury from over-pressurisation (called barotrauma).
Always strictly follow instructions and guidelines, concentrate and control what you are doing.
Group activity 2.4: CPR with oxygen
In teams of three, practice performing CPR using the bag-valve-mask device.
Operational time
A full ‘C’ cylinder (440–490 litres) will have the following approximate operational times:
•
•
50 minutes, with continuous use of oxygen therapy at 8 litres per minute
30 minutes, with continuous use of airbag (and oxygen) at 14-15 litres per minute
Equipment maintenance
General care
•
•
•
•
the machine should be kept clean and free of sand and foreign materials
to ensure its correct operation, equipment must be checked before starting operational duties (eg patrol)
each day and after any use (including training sessions)
whenever the oxygen equipment shows defects that may cause it to operate incorrectly, the machine
must be taken out of service immediately and repaired by the manufacturer
the oxygen equipment should be serviced at least every 12 months, or according to the manufacturer’s
recommendations.
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Care after use
After use, disposable items should be discarded of appropriately. Any equipment that is to be reused
should be cleaned as per the manufacturer’s guidelines . Equipment used in training should be cleaned as
per SLSA Guideline 3.1: Disinfection of equipment
Major faults
A major fault is any fault that cannot be repaired through basic maintenance (eg cleaning and replacement
of spare or missing parts that are routinely stocked in the first aid room) and that affects the safety or ability
to use the equipment properly. All major faults should be logged in the appropriate organisational logs (eg
SLSA Patrol log for SLSA members) and reported to the Club/Service First Aid Officer.
Oropharyngeal airways
Oropharyngeal (OP) airways are curved plastic devices that help keep the airway clear
in the unconscious casualty by depressing the tongue and keeping the teeth and lips
apart. The OP airway by itself does not replace correct airway management practices
and should be considered only as a tool to assist in the
management of a casualty’s airway. A correctly inserted OP airway will greatly facilitate
the maintenance of a clear airway. An OP airway is a plastic device consisting of a rigid
flange and a hollow curved tube. The flange, when properly fitted, rests against the
casualty’s lips. This flange does not prevent an adequate seal from a facemask being
achieved.
OP airways come in various sizes for different-sized casualties. The smallest OP
airways are approximately 5 cm long and the largest are more than 10cm. OP airways
are inserted using the ‘rotation’ method which is explained in the following pages. This
method is not recommended for infants or children under the age of eight because the
roof of their mouth is still soft and easily damaged. SLSA does not teach members the
methods for OP airway insertion into infants and children, therefore members should not
attempt to insert an OP airway into children under the age of eight years.
Personal protection:
For first aiders’ own safety, it is strongly recommended that they wear protective gloves
and use a resuscitation mask for every first aid or resuscitation case
Figure 2.8 An airway
blocked by the tongue
(top) and using an OP
airway to assist with a
clear airway (bottom)
Care of OP airways
OP airways must be kept in their original packaging. They should be easily accessible in the first aid kit,
oxygen unit and first aid rooms. OP airways packaging should be checked to ensure that it has not been
opened and is still intact.
After use on a casualty, the contaminated OP airway should be disposed of in a safe manner, preferably
in a clinical-waste bag provided by attending ambulance or medical personnel. If this is not possible, the
contaminated OP airway should be placed in a clinical-waste bag and stored in a safe place until proper
disposal can be organised
Note:
OP airways must only be inserted into the mouth of a deeply unconscious casualty
To choose an OP airway of the correct size, place the airway against the side of the
casualty’s face. The flange (top flattened end) of the airway will extend just past the
centre of the casualty’s lips. The curve of the airway is then run sideways along the
casualty’s jaw. The correct sized airway is the one that reaches the angle of the
casualty’s jaw.
Figure 2.9 Measuring an airway from the centre of the
lips to the corner of the jaw
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When to insert an OP airway
The use of an OP airway is optional. First aiders should take less than 15 seconds to correctly size and insert an
OP airway into a casualty’s mouth. Whether an OP airway is used or not, the management principles of DRSABCD
do not change
The OP airway can be inserted while the casualty is on their back, or when on their side if
they have been rolled over to drain fluids. If insertion is occurring. during CPR there is no
need to stop compressions for the airway to be inserted
Important:
OP airways should not be used:
•
if the casualty is conscious or semi-conscious - insertion of an OP airway into a conscious
casualty may induce vomiting or gagging
•
if an airway adjunct of the correct size is not available
•
if there is a large amount of vomit or fluid in the casualty’s mouth
Inserting an OP airway
Once you have selected the correct size airway:
• tilt the casualty’s head backwards; open the casualty’s mouth with
one hand using jaw support or jaw thrust, if necessary
• visually check the casualty’s airway, and manually clear it, if
necessary
• measure and choose an OP airway of the correct size
• remove the OP airway from the packet and lubricate it, using
moisture from the lips of the casualty, or water
• hold the OP airway by the flange. With the tip pointing towards the
roof of the casualty’s mouth, insert the airway to approximately onethird of its length
• when one-third of the airway is inside the mouth, rotate it 180° until
the tip points downwards, at the same time sliding it over the
casualty’s tongue in one smooth movement into the back of the
pharynx until the flange is touching the lips
• it should slip easily into place. If it is difficult, stop and reposition the
casualty’s lower jaw and tongue before trying again.
• Never force it into position. Care is needed to avoid damage to the
mouth and throat.
Figure 2.10 Inserting an OP Airway
Group activity 2.5: Inserting OP airways
In pairs, practise choosing the correct size OP airway for your partner. Practise inserting the OP airway into
the airway training manikin.
Precautions when inserting an OP airway:
•
ensure that the lower lip is not pinched between the casualty’s teeth and the OP airway
•
ensure that the OP airway does not push the tongue backwards and block the casualty’s airway
•
ensure that you have adequate head tilt before inserting the OP airway
•
don’t force the OP airway into the mouth - it should slide in easily.
Removing the OP airway
If the casualty shows any signs of rejecting the OP airway, remove it immediately. In many cases, the casualty may
spit it o ut. The OP airway can be removed easily by sliding it out of the mouth following its natural curve
Note:
Do not attempt to rotate the airway on removal. It is unnecessary and may cause damage to the mouth and throat.
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Topic 3: Suction___________________________________________
Clearing of a casualty’s airway can be achieved by using manual finger
sweeps. However, if you have a unit available with suctioning capability,
you may clear additional fluids from the upper airway by using the suction
component of the unit. Suction devices help to safely remove secretions
from the person’s mouth and upper airway.
Suctioning is a skill that will require practice to become proficient. Regular
checking and cleaning of the suction device will ensure that you remain
familiar with the device(s) used by your club/service.
Suction comes in three types:
• manual
• oxygen powered (vacuum bottle)
• battery (or electric) powered.
Figure 3.1: Using suction to clear a
casualty’s airway
Suction device components
While there are many variations to suction devices based on the type and
the manufacturer, there are four components common to most suction
devices. These are:
Suction catheter- A plastic tube which is inserted into the casualty’s mouth
to suction out any foreign material. Suction catheters are single use only
and should be disposed of in clinical-waste containers.
Collection jar: Fluids and foreign material suctioned from the casualty are
collected in the jar. Collection jars are usually single-use with the jar
being disposed of along with the contents in clinical-waste containers.
Jar cap and connection port: The jar cap and connection port keeps the
contents in the collection jar and includes the fittings to connect the suction
catheter and the device which provides the suction power.
Suction device: The device which provides the suction power and is the
suction pump handle in manual devices, oxygen equipment in oxygen
powered devices or the electric pump in a battery or electric powered device.
Figure 3.2: Components of manual
suction device
Note
SLSA has currently approved the use of manual suction devices only during surf lifesaving operations.
Length of time to apply suction
Prolonged suction should be avoided as this can stimulate the vagus nerve in the back of the throat and cause
bradycardia (slow pulse). For this reason manual suction should be on for only 15 seconds at a time with a break for
at least five second s in between operations. Due to their constant suctioning action, powered suctioning devices
should only be used for five seconds before a five second break.
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Suction checks
•
•
•
•
•
ensure that the device is clean and that all components are available
including:
- suction catheter
- collection jar
- collection jar cap
- suction tubing (if required)
- suction device
operate the manual suction device (or turn suction on for powered
devices)
test for suction against thumb or finger by placing it over the vacuum
port (port should stick to the thumb or finger)
turn off (powered devices only)
return the suction device to the case in its original position.
Figure 3.3: Vaccuum port
Individual activity 3.1: Suction equipment
Look at the suction equipment that your club/service has available for use or the equipment you have been provided
to train with. Identify the following components:
• suction catheter
• collection jar
• jar cap and connection port
• suction device
• vacuum port
If you cannot identify all of the components check with your trainer. Your device may not have these exact
components but will have something that performs the same function
Test the function of your suction device by performing the checks described above.
Administering suction
1. Check the suction device for correct operation.
2. Select the catheter and remove it from the sealed packaging leaving
a contact point with the wrapper
3. Put on gloves if not already done so
4. Connect the suction catheter to the connection port (or tubing for
powered suction devices)
5. Completely remove catheter from wrapper (turn on the suction
source for powered devices)
6. Measure the maximum length of insertion by placing the tip of the
catheter at the corner of the jaw and measuring to the centre of the
lips. Mark this point with a finger (this will ensure that you insert the
catheter no further than the back teeth).
wrapper.
Figure 3.4; Measuring insertion length
7. Insert the catheter into the lower cheek of the casualty (in the lateral
position) ensuring that the catheter is inserted no further than the
point marked by the operator’s finger
8. Do not operate manual suction during insertion (or block the vent on
a powered suction device).
9. Operate suction for no longer than 15 seconds with manual suction
devices before a five second break. (If using powered devices
suction only for five seconds before a five second break.
10. Rotate the catheter within the casualty’s lower cheek, ensuring
that the action is smooth and gentle, to prevent damage.
11. Ensure that only two thirds of the container is filled.
12. Turn off suction on the completion of the procedure (if using
powered suction).
13. Dispose of the catheter in the appropriate manner.
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Figure 3.5: Inserting the catheter no further than
length marked by fingers
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Group activity 3.2: Administering suction
In pairs or groups of three, practice assembling your suction equipment and sizing the insertion distance on your
partner. If an appropriate manikin is available practise performing suction.
Note
To ensure infection free training, do no place the suction catheter in your own mouth of that of your partner(s)
Post-use maintenance of the suction unit
•
•
•
dispose of disposable jars in a suitable manner
reusable jars can be flushed with clean cold water and rinsed with antiseptic solution
ensure that all unit components are disassembled and thoroughly cleaned as per ARC guidelines.
Trouble shooting suctioning
There are a number of reasons why suction equipment can fail or not operate correctly. If experiencing problems,
check the following:
• is the suction tubing blocked
• is the contents bottle full or cracked
• is the seal missing or perished
• is the unit not turned on
• is the oxygen supply exhausted (for oxygen powered units)
• is the battery flat (if battery powered unit).
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Topic 4 – Defibrillation_____________________________________
Defibrillation is the delivery of an electrical current to the heart to correct an ineffective irregular heartbeat. The
electricity is delivered indirectly to the heart via the chest wall.
Today in Australia public access defibrillators are becoming more widely available and training in their use is
easily accessed.
The Australian Resuscitation Council supports the implementation of public access defibrillation programs and
recommends that defibrillation should preferably be undertaken by trained lay people or health professionals.
Figure 4.1 Comparison of survival rates from sudden cardiac arrest showing the difference made by defibrillation
Circulatory / Cardiovascular systems
Despite its vital importance, the heart does not work alone. It is part of the cardiovascular (circulatory) system
which also includes the kilometres of blood vessels that run through the body. Tissue cells take in nutrients and
oxygen and expel waste 24 hours per day. This can happen only with the continuous beating of the heart, a
muscular organ that pumps blood through a system of arteries and veins.
Arteries are large blood vessels which carry oxygen-rich blood from the heart to the rest of the body. The
arteries subdivide into smaller blood vessels and ultimately become capillaries. The capillaries transport blood to
all the cells of the body. After the oxygen is given to the cells, veins carry the blood low in oxygen back to the
heart.
Cardiopulmonary system
Comprise of - both the organs, the heart (cardiovascular system) and the lungs (respiratory system), and
their functions, including blood and blood vessels. Located in the thoracic cavity of the body.
Responsible for - pumping and channelling blood and oxygen to and from the body.
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Conditions which require first aid and defibrillation
The delivery of oxygen to the body can be threatened by the following cardiovascular conditions:
•
blood loss caused by severe bleeding (internal or external)
•
impaired circulation
•
failure of the heart to pump adequately, eg heart attack, or dysrhythmia (irregular heart beat).
If body tissues do not receive oxygen, they are damaged beyond repair, eg stroke. Stroke is when one of the
arteries supplying the brain is blocked or ruptures, resulting in an area of the brain receiving no blood and the
tissues becoming damaged. A similar effect occurs when one of the arteries supplying the heart with blood
becomes blocked; the heart tissues are damaged by the lack of oxygen and a heart attack is a possible outcome.
If the heart stops beating (cardiac arrest), it is inevitable that breathing will also cease. There may be some
agonal respirations (intermittent gasps from a casualty who is not breathing or responsive) but these are not
enough to sustain life.
The Heart
The relative size and weight of the heart contradicts its incredible strength and endurance. About the size of
your fist, the hollow cone shape looks nothing like the heart that is traditionally shown. The heart weighs
about 250–350 grams and is about 12–14 cm long. Approximately two-thirds of the heart is located just to the
left of the sternum (breastbone).
The heart has two actions, mechanical and electrical. Electrical stimulus causes mechanical reaction which results
in a coordinated pumping action leading to effective circulation.
Mechanical action
The mechanical action of the heart pumps blood through its structures in
the following way:
•
•
•
from the body (upper and lower)
to the right atrium
to the right ventricle
to the lungs
then from the lungs
to the left atrium
to the left ventricle
and out to the body (upper and lower).
Figure 4.2: Mechanical action of the heart
Electrical action
In a normal heart, electrical impulses travel a well-defined pathway:
•
•
•
•
sinoatrial (SA) node
atrioventricular (AV) node
right and left bundle branches
conduction pathways (Purkinje fibres)
This electrical conduction pathway synchronises the atria and
ventricles to contract and relax in a coordinated motion necessary to
pump blood efficiently.
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Figure 4.3: Electrical action of heart
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Heart rhythms and arrhythmias
The electrical impulses passing through the heart can be mapped on a graph called an electrocardiogram (ECG).
When a person’s heart becomes stressed, changes can be seen in the ECG.
An automated external defibrillator (AED) measures the electrical activity in a casualty’s heart, through
electrodes placed o n their chest, and recognises life-threatening abnormal rhythms (arrhythmias) such as
ventricular fibrillation and pulseless ventricular tachycardia.
Sinus rhythm
The normal rhythm of a healthy heart is called sinus rhythm. An AED will not recommend a shock if it detects this
rhythm in a casualty. A patient can have an electrical sinus rhythm but still not have a pulse. In these cases, even
if no shock is recommended, if the patient is not breathing and unresponsive, continue CPR. The medical term
for normal electrical rhythm but no pulse is ‘electro-mechanical dissociation’.
Figure 4.4 ECG of a sinus rhythm
Ventricular fibrillation
Ventricular fibrillation (VF) is a life-threatening heart arrhythmia which is characterised by chaotic electrical and
mechanical heart activity and which produces a quivering action rather than co-ordinated contractions. It is
most commonly associated with coronary artery disease and heart attack (myocardial infarction). Electrical
shock, poisoning and drowning can also cause ventricular fibrillation.
Figure 4.5 ECG of ventricular fibrillation
Ventricular tachycardia (VT)
Ventricular tachycardia occurs when the ventricles beat faster than the rhythm generated by the SA node. The
rate will vary, however it is always faster than 100 bpm and generally slower than 200 bpm.
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Figure 4.6 ECG of ventricular tachycardia
Ventricular tachycardia can be life-threatening as it may degenerate into pulseless ventricular tachycardia,
inhibiting effective distribution of oxygenated blood throughout the body, leading to hypoxia and organ damage,
which may lead to death.
Signs and symptoms of VT include:
•
•
•
•
•
•
•
•
•
fainting
difficulty breathing or shortness of breath
very rapid pulse or no pulse
palpitations - the casualty may feel like their heart is racing
light-headedness or dizziness
chest pain
pale/grey skin colour
sweating
nausea.
Management of VT
•
•
minor cases may spontaneously revert to normal sinus rhythm without treatment
pulseless VT will require treatment with an AED.
Asystole
Asystole refers to the absence of electrical activity in the heart.
Figure 4.7 ECG showing asystole
Note
An AED will not recommend a shock as it can only correct the heart’s electrical activity, not create it from nothing.
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Automated external defibrillators (AED)
An AED is used to reverse the effect of a cardiac arrest. Cardiac
arrest occurs when a casualty:
•
•
is not responding
is not breathing
An AED is only to be attached to casualties who are not breathing
and not responsive. However, an AED should be on standby in all
first aid situations where there is a possibility the patient may go into
cardiac arrest.
Figure 4.8: Electrical action of heart
The defibrillation process uses electricity to contract (depolarise) the entire heart at one time. Following this,
resting (repolarisation) of the whole heart muscle occurs.
Effectively the process stops the heart. Once repolarisation has occurred, it is hoped that the heart’s normal
electrical activity will resume. Defibrillation is the definitive treatment for Ventricular Fibrillation.
Public access defibrillation
Defibrillation technology and training has reached a level in society where it is making an extremely positive
impact in the chain of survival. AEDs are easy for members of the public to use and are widely available through
public access defibrillation programs in public places such as airports, train stations, stadiums and shopping
malls.
While AEDs may be used by members of the public, the best outcomes for the casualty will be achieved when
they are used by trained personnel. Accordingly, when working in a team situation, a team member with
specific training in the use of an AED (such as this Advanced Resuscitation Techniques Certificate) should
operate it.
Use of defibrillators on children
An AED can be used on children aged one and above. For children aged one to eight; if the AED has a setting
that reduces the joules delivered this should be used. If this is not available the adult setting should be used.
AED operator responsibilities
It is the responsibility of the AED operator to apply and operate the AED and ensure the safety of bystanders
and other first aiders. To do this, the AED operator must take control of the resuscitation team, directing team
members and bystanders as required to ensure the safe operation of the AED.
Defibrillator components
A portable defibrillator of the type commonly used by first aiders consists of a case containing the base unit with
single use, self-adhesive electrode pads. In addition to the AED, the following accessories should be kept with the
unit (either in the same case if possible or in a case attached to the unit):
•
•
•
•
•
•
•
•
•
•
resuscitation masks (adult)
gloves
razor
shears
gauze wipes (or similar)
spare battery (if applicable to AED)
spare electrode pads
space blanket
pen and paper
chamois or towel.
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Pre-operational checks
All modern AEDs will have a self-check mechanism to ensure that they are operational. This check usuallu includes
ensuring that there is a sufficient level of charge in the battery and that all electronic components are functioning correctly.You
should make yourself familiar with the unit used by your club/service, including what is included in the automatic
self-check and how you check that the unit has passed the self-check.
At the start of a duty shift, you should check the following:
•
•
•
AED has passed the self check
electrode pads are in date (this will be marked on the outside of the packaging) and that the
packaging has not been damaged
all additional equipment as listed above or required by your state or service is included and in an
operational condition.
Major faults
A major fault is any fault that cannot be repaired through basic maintenance (e.g. cleaning and replacement of
spare or missing parts that are routinely stocked in the first aid room) and affects the safety or ability to use the
equipment proper ly. All major faults should be recorded in the relevant document and reported to the
club/service First Aid Officer.
Defibrillation pads
Pad positioning
Correct positioning of the electrode pads is essential for
successful defibrillation to take place. The optimal position is
usually indicated on the electrode pads or on the packaging they
come in:
•
•
•
place the sternum electrode pad to the right of the
sternum
(breastbone) below the collarbone and above the right
nipple
place the apex electrode pad to the left of the sternum,
with the upper edge of the pad below and to the left of the
left nipple.
If the casualty has an implanted pacemaker or defibrillator, make
sure the pads are at least 8cm away from it.
Apply the pads with a smooth rolling action to prevent air bubbles. Once applied, pads should not be repositioned
or removed unless prompted by the AED.
For children, (or adults if the front and back of the chest are clean and dry and readily
accessible, e.g. not covered with sand), pads can be placed
one in the front centre of the chest and the other between the shoulder blades
Prepare the casualty
•
•
•
•
•
expose the casualty’s chest (including removing undergarments)
it may be necessary to trim hair if the casualty is very hairy, with scissors/razor in
the locations where pads will be placed in order to have good adhesion to the
skin
dry the casualty’s skin if necessary, due to immersion or sweat
remove any metal jewellery and medication patches
ensure that the casualty is not lying on metal grates, in pools of water or on other conductive material.
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Safety precautions
A safe working environment must be created before defibrillation occurs. There are three areas of danger
directly related to the defibrillation process:
• contact
o no person or conductive material is to be in direct or indirect contact with the casualty at the time
of defibrillation
• conduction
o there should be no conductive items near the casualty, such as:
 water/rain (ensure that you are clear of the incoming tide if in a beach environment)
 metal/grates
 moisture on the chest (eg vomit, blood or perspiration)
• explosion
o do not defibrillate if there is a chance of explosion due to the presence of gases, fumes or
flammable substances.
o oxygen masks should be moved away during defibrillation and the flow of oxygen directed away
from the chest.
Note
• do not remove electrodes after a casualty’s breathing and response have returned. Keep them in
place to allow prompt action should the casualty’s condition deteriorate
• do not place electrodes over medication patches
• avoid placing pads over an implanted pacemaker if the casualty has one.
• do not operate in an unstable environment which may prevent the AED from performing a valid
assessment of the ECG signal (eg. rapidly moving vehicle) Pullout Text
Operating the AED
There are three main steps for operating an AED:
• turn the machine on
• apply the pads
• respond to the prompts
Different AED machines have different protocols for shock delivery. Some have set joule settings, others have
variable joule settings, and some even measure impedance and calculate the joules needed.
Group activity 4.1: Applying an AED
In groups of three, practise performing two-operator CPR with the third person arriving and applying the
AED. Rotate the roles until each person in the group has performed the role of AED operator.
Make sure that you:
• take control of the situation
• assess breathing and response
• prepare the casualty’s chest
• remove clothing
• shave hair
• remove metal jewellery
• remove medication patches
• apply pads to the casualty
• in correct positions
• using a rolling motion
• follow the prompts of the AED
• ensure that all first aiders and bystanders are clear of the casualty
• deliver the shock as indicated by the AED
• direct the team to continue CPR as required.
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Post-defibrillation casualty care
If the defibrillation has not been successful and when the standard protocol is exhausted:
•
•
•
leave the pads on the casualty
continue CPR until relieved or unable to continue
care for family and friends of the casualty.
If the defibrillation has been successful:
•
•
•
•
•
•
leave the pads on the casualty
check for breathing
if they are not breathing, continue CPR
if they are breathing, check for a response
if they are not responding, place them in the lateral position
if they are responding, reassure and make them comfortable.
Post-defibrillation equipment maintenance
After every use, the defibrillator should be disassembled, cleaned of sand and debris, reassembled and tested as
per the manufacturer’s instructions. Single-use items such as electrode pads and gloves should be disposed of
and replaced from stores in the first aid room. All other equipment should be cleaned and disinfected and
replaced in the kit.
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