Resuscitation Changes 2006/07

1. Resuscitation Changes 2006/07 Prepared by Dr Natalie Hood National Lifesaving Medical Advisor and Surf Life Saving Australia

2. International Consensus International Liaison Committee on Resuscitation releasing guidelines every five years • Release of new resuscitation guidelines November 2005. Not due for any further review until 2010

3. Australian Resuscitation Council • National body of representatives from medical, first responder and major training organizations • Surf Life Saving Australia and Royal Life Saving Australia each individually represented on the ARC

4. Goals of Guideline Development • <10% victims of sudden cardiac arrest victims receive CPR • Simplify guidelines to aid teaching • Reduce confusion to improve retention of knowledge • Aim to increase the number of cardiac or respiratory arrest victims receiving bystander CPR

5. SLSA in the Picture • SLSA the peak body in aquatic rescue • SLSA in the forefront of education and training • Need to balance maintenance of niche role in the aquatic environment versus issues of Australia wide, cross organisational consistency

6. SLSA in the Picture • Adoption of new guidelines necessary to align with other national and international first responder and training organisations • Credibility of SLSA open to criticism if not seen to be adopting and promoting the ARC guidelines • Current guidelines are evidence based and form the best thinking based on research

7. Rational to New Algorithms Current practices • Evidence shows patients receive oversupply of ventilation, more so with the increase of rate of delivery of each cycle • Have differing rates and ratios for 1 and 2 person for adults and children

8. Rational to New Algorithms New guidelines for CPR • Emphasize importance of chest compressions with minimal “hands off” time. • 2 initial rescue breaths provide adequate oxygenation and allow rescuers to quickly move to chest compression • 30 compressions:2 rescue breaths ratio for 1 and 2 person CPR in adults and children at rate of 100/minute • Emphasis on hand placement “in centre of chest” • Less importance in precise measurements, walking up ribs or xiphoid finding etc

9. Two Person Assessment • Airway responder checks airway and breathing with patient on side • Roll back and give 2 rescue breaths if not breathing • ECC responder checks for “signs of life” • If “signs of life” (normal breathing, coughing, moving, conscious) put in recovery position • If no “signs of life” start CPR until “signs of life” noted or ambulance arrives.

10. Rational to New Algorithms Deletion of pulse checks and recovery checks: • Lay rescuers, first responders and even health care providers only dealing infrequently with arrested patients are unreliable in detecting presence or absence of pulse • Frequent recovery checks are associated with a worse outcome for the patient • CPR now continues until professional help arrives or patient has obvious signs of life

11. Resources

13. Defibrillation Defibrillation in combination with early CPR within an organized responder programme saves lives • Defibrillation taught in most lay community first aid courses • Proficiency in defibrillation included in the Australian definition of First Responder • Further future emphasis likely on teaching and availability of defibrillation • Club AED’s will need reprogramming in line with new guidelines. SLSA liaising with manufactures • Older AED’s may not be able to be reprogrammed and should be continue to be used as is.

14. Training Issues • Chest compressions will need to be interrupted for a short period to deliver rescue breaths • Emphasize the importance of quickly starting CPR if needed and minimizing the time with “hands off” the chest • Technique deteriorates after 1min yet awareness of fatigue delayed so rotate frequently, at least every 2 minutes (~5 cycles) • Emphasize early placement of defibrillator on patient when available

15. Change Management Issues • Change Management Circular on SLSA website • As of 1 August 2006 all Assessment must be under the new guidelines • Proficiency testing upgrades will be required • Discuss change management issues within Circular 41 – 05/06. • Discuss your role!!

16. Resources • This PowerPoint – now on SLSA website • Posters with new algorithm – May 2006 • Updated training manual “V2” released late July • Change Management Circular (41- 05/06) now on SLSA website • Q&A sheet at the back of Circular 41 • Questions? Speak to your State Medical Officer or write to the National Office at info@slsa.asn.au

17. THANK YOU