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This Handbook is ideal for use in support of a properly structured training course. It will also prove invaluable as ongoing reference for someone who has completed a course

Cardiac

AED

13

AED safety

16

Aspirin

6

Calling for help

3

Chest pain

4

Choking

19

First Responder

Š2014 Safety Publishing Ltd. All rights reserved. No part of this publication may be reproduced in any form or by any means without the written permission of Safety Publishing Ltd


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Cardiac first responder The role of the cardiac first responder Understand the role of the first responder ▪ Cardiac first responders would be expected to attend relevant emergency calls in the area at the direction of the ambulance service. ▪ The cardiac first responder is not expected to respond to road accidents or other trauma related incidents.

Assess the situation and circumstances in order to act safely, promptly and effectively in an emergency ▪ Be aware of the safety of yourself and others. ▪ Understand the principles of the chain of survival. ▪ Call for help as appropriate

Administer first aid to a casualty who is unconscious ▪ ▪ ▪ ▪ ▪

Assess response. Open the airway and check breathing Recognition of agonal breathing The correct use of the recovery position. Obtaining an AED

Administer Cardio Pulmonary Resuscitation ▪ The correct application of CPR

Using the AED ▪ The correct use of the AED

Acute Illness ▪ Recognise and treat Heart Attack ▪ Recognise and treat Stroke including FAST assessment ▪ Recognise and treat Seizure

Record-keeping and handover ▪ Complete the relevant sections of a cardiac first response report (CFRR) ▪ Hand over to the emergency services with relevant history, treatment given and any response


Cardiac first responder Summoning help 999 or 112 are the free 24-hour numbers to call for emergency help. Utilise the PHECC RED Card system. When you get through the operator will ask you if you need police fire or ambulance services. If you ask for an ambulance they will then take details of why you need help. The initial questions are to prioritise just how urgent the problem is. In particular they will ask you if the person you’re calling about is unconscious, has breathing difficulties or chest pain as these may be life-threatening and need the fastest response. ▪ Try to stay calm and to pass on to ambulance control as much information about the casualty’s condition as you can. ▪ Only pass on information you know to be true, guesses or assumptions may mean you are given inaccurate advice. ▪ Give as much information about your location as possible to help the ambulance crew find you. ▪ Don’t hang up until the ambulance controller tells you to. ▪ In an emergency the controller is trained to talk you through procedures or to remind you to do checks that you may not have thought of. This can be very reassuring at a very tense time. These days most people carry a mobile telephone and it is likely that the emergency call would be made from this. If this is the case then dialling 112 instead of 999 may have some advantages. ▪ Over 70 countries including all of Europe use 112 as an emergency number. ▪ If your mobile doesn’t have a signal, when you dial 112 it will automatically search for and use any other mobile service which does have a signal. ▪ If your P.A.Y.G. Mobile is out of credit it will still call 112. ▪ With most modern mobiles if you have to call from someone else’s phone which is locked, it will still call 112 even without the password. ▪ 112 will work just as well as 999 from a land line telephone.

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Cardiac first responder Chest Pain Chest pain is a symptom which must always be taken seriously. It may be caused by a minor problem such as indigestion or by a major and potentially dangerous problem such as heart attack. From a first aid perspective it is always safer to assume the worst and hope for the best. Remember, it is much better to over treat indigestion than to under treat heart attack. Heart related chest pain may result from angina or heart attack. Other causes of acute chest pain may include pulmonary embolism, pneumothorax, injury to the chest wall and some types of acute chest infection such as pneumonia or pleurisy. In the absence of other information the responder should assume a heart attack.

Heart attack How a heart attack forms

Plaque with fibrous cap

Cap ruptures

Blood clot forms around the rupture

Blocked coronary artery

Death of heart tissue due to blocked coronary artery


Cardiac first responder Heart attack Heart attack - recognition ▪ Central chest pain, often described as squeezing or crushing, or as a feeling of pressure in the chest. ▪ Pain may spread to the neck and one or both arms. ▪ Pain may start at any time with no obvious cause. ▪ Pain does not improve with rest. ▪ Casualty may look pale or grey. ▪ There may be blueness of the lips (cyanosis) ▪ Pulse may be rapid, weak and irregular. ▪ They may be sweating. ▪ They may complain of shortness of breath. ▪ They may feel dizzy or weak. ▪ Sudden collapse.

Heart attack - treatment

Distribution of pain in heart attack

The primary aim is to reduce the load on the heart by placing the casualty at rest and then to urgently call for medical attention. ▪ Place the casualty at rest. ▪ Make them as comfortable as possible to ease the strain on the heart. ▪ A half sitting position with the head and shoulders raised and the knees bent and supported would be preferred, but be guided by the casualty. ▪ Support them with pillows or folded blankets. ▪ If the chest pain does not subside after a few minutes assume a heart attack. ▪ Reassure the casualty continuously. ▪ Anxiety and fear will increase the heart rate and increase the load on the heart and should be avoided. ▪ Dial 999/112 for an ambulance. ▪ Inform ambulance control that you suspect a heart attack. ▪ If the casualty has a previous history of chest pain and has angina medication such as tablets or spray then assist them to take their medication as prescribed. ▪ If available, give one aspirin tablet, chewed rather than swallowed. ▪ Monitor the casualty’s level of consciousness and breathing and if you have been trained to do so check their pulse frequently. ▪ Record your findings. ▪ Try to stay calm and matter of fact yourself. ▪ Be prepared to offer life support as appropriate.

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Cardiac first responder Chest Pain Aspirin in cardiac chest pain Aspirin has a useful anticoagulant effect and one tablet given at the time of chest pain can reduce the risk of the blood clot in the coronary artery enlarging and causing further damage. However, there are some side effects of aspirin and it should not be used in patients below the age of 16 or those who have known allergy to aspirin, history of gastric ulcers, particularly bleeding ulcers, or any other bleeding problem. To ensure rapid transfer into the blood the aspirin tablet should be chewed and absorbed from the mouth, rather than swallowed. Soluble aspirin may be used dissolved in water.

Heart attack in women Heart attack is a major killer of women, but the signs and symptoms may be slightly different to those seen in men and there is a danger that they may be missed or misunderstood. Women may suffer chest pain, like men, but very often it is not such an important or obvious feature. In particular, look out for: ▪ ▪ ▪ ▪ ▪ ▪

indigestion or wind pain. dizziness, nausea or vomiting. unexplained weakness or fatigue. pain between the shoulder blades. recurring chest discomfort. anxiety.


Cardiac first responder The Chain of Survival The chain of survival demonstrates the steps that are necessary to increase the casualty’s chance of surviving sudden cardiac arrest. Their chances will be greatly improved when all of the links are in place.

Early access

Early CPR

Early Defib

Early ACLS

Early access ▪ Early access to the rescue services or to someone with a defibrillator.

Early CPR ▪ To buy time until the arrival of the defibrillator. ▪ CPR alone is unlikely to reverse SCA but it will help to keep the organs oxygenated until the heart can be restarted.

Early defibrillation ▪ Chances of survival decrease by around 10% per minute. ▪ Early defibrillation has to be the target.

Early ACLS ▪ If someone has been so ill that their heart has stopped, then there is always the possibility it could happen again. ▪ Proper ongoing care or advanced cardiac life support techniques may be able to prevent this.

Cardio pulmonary resuscitation (CPR) Cardio pulmonary resuscitation means combining chest compressions with rescue breathing. If for any reason the rescuer does not feel confident in performing full CPR or if there is blood or vomit on the casualties face or around their mouth and the rescuer is not comfortable in performing rescue breaths then they should start compression only resuscitation immediately. They should maintain compressions at 100 – 120 compressions a minute until help arrives or until the casualty recovers.

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Cardiac first responder Approach with care Make sure that there is no danger to yourself, the casualty or bystanders. Deal with danger if appropriate but do not take chances with your own safety.

Check response ▪ Check initially in the position that you find them. ▪ Speak loudly to them. ▪ Use their name or ask them to open their eyes. ▪ If no response, shake them gently by the shoulder. If they respond: ▪ Leave them in the position that you found them. ▪ Check to find out what might be wrong. ▪ Observe and reassess regularly. If they do not respond: ▪ Shout loudly for help.

Shout “help” ▪ If you are alone, shout for help loudly to try to attract attention but do not leave the casualty. ▪ If someone is nearby ask them to phone an ambulance. ▪ Send for an AED if available

Open the airway ▪ Undo anything tight around the neck and remove their glasses, if worn. ▪ Place one hand on the forehead and two fingers of the other hand under the bony part of the jaw. ▪ Gently rotate the head backward and lift the jaw. ▪ This lifts the tongue and straightens the airway.

Check for normal breathing ▪ Whilst opening the airway perform a quick check for normal breathing. ▪ It is not uncommon, immediately after a cardiac arrest, for the casualty to be taking what appear to be short irregular gasps for breath. (Agonal breathing) ▪ This should not be mistaken for normal breathing and resuscitation should be started without delay.


Cardiac first responder If they are breathing normally ▪ Examine them carefully for any immediately life-threatening injury such as severe bleeding and treat if possible. ▪ Turn them carefully into the recovery position as soon as it is practical to do so.

If they are NOT breathing normally ▪ Ensure that an ambulance has been called and that an AED has been sent for. ▪ Deliver 30 chest compressions

Deliver chest compressions Chest compressions should be performed with the casualty lying flat on their back on a firm surface. It should not be necessary to undress the casualty or expose the chest, unless they are wearing very heavy outer clothing. (Clothing removed in illustrations for clarity)

Place the heel of one hand in the centre of the chest, on top of the breastbone.

Place the heel of the other hand on top of the first. Interlock your fingers to stop them pressing on the chest wall.

Position yourself with your shoulders directly above the casualty’s chest, the arms straight and the elbows locked.

▪ Push straight down on their chest to a depth of 5 to 6 cm. ▪ Release the pressure completely between strokes, keeping your hand in contact with the chest. ▪ Movements should be smooth and not jerky. ▪ Erratic or violent movements may injure them and will not pump blood efficiently. ▪ Compress the chest at a rate of 100 to 120 compressions per minute. ▪ It is important to maintain the quality, rate and depth of the compressions. Your performance is liable to deteriorate as you get tired. For this reason it is recommended that if another rescuer is available and can perform chest compressions you should change over every one or two minutes.

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Cardiac first responder Deliver rescue breaths

Use the fingers of the hand performing the head tilt to pinch the nose closed. Take a normal breath.

Seal your lips around their mouth and blow steadily until their chest rises.

Release the nose and keeping the airway open, let them breathe out.

▪ The breath should take about one second to deliver. ▪ Watch the chest as the breath is delivered to ensure that it rises. ▪ If you experience problems giving an effective breath it is probably because the airway is not clear. ▪ Recheck the mouth and remove any visible obstruction. ▪ Make sure the head is tilted and the jaw is lifted correctly and that you have a good seal around their mouth. ▪ Repeat your attempts to give effective breaths but do not attempt more than two breaths before returning to chest compressions.

Problems delivering breaths If you experience problems giving an effective breath it is probably because the airway is not clear. ▪ ▪ ▪ ▪ ▪ ▪

Recheck the mouth and remove any visible obstruction. Make sure their head is tilted and the jaw is lifted correctly. Make sure that you have a good seal around the casualty’s mouth. Repeat your attempts to give effective breaths. Do not attempt more than two breaths before returning to chest compressions. If problems persist, go to compression only resuscitation.


Cardiac first responder Cardio pulmonary resuscitation (CPR) CPR means combining chest compressions with rescue breathing ▪ Give 30 chest compressions followed by two rescue breaths. ▪ Ratio 30:2. Continue until: ▪ The casualty shows obvious signs of recovery, such as opening their eyes or coughing. ▪ Someone else takes over from you. ▪ You are alone and too exhausted to continue.

Compression only resuscitation If you are unable or unwilling to give rescue breaths, start compression only resuscitation. ▪ Give chest compressions to a depth of 5 to 6 cm and at a rate of 100 to 120 compressions a minute. ▪ Continue chest compressions without a break, stopping to check the casualty only if they show obvious signs of recovery.

Regurgitation/vomiting Regurgitation is common during resuscitation attempts. If it occurs: ▪ Turn the casualty on to their side, facing away from you. ▪ Support their weight on your legs to prevent them from rolling back. ▪ Ensure that their head faces down and that their open mouth is at the lowest point, to ensure drainage. ▪ If necessary remove debris from the mouth with your fingers. ▪ Place the casualty on to their back, open the airway and check for normal breathing. ▪ Resume CPR immediately if required.

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Cardiac first responder Hygiene / personal protection Although delivering rescue breathing and chest compressions offers little threat of cross infection to the rescuer, many will find the idea of mouth-to-mouth rescue breathing distasteful and there is a perceived threat from HIV or hepatitis. If this is the case one alternative would be compression only resuscitation, or the rescuer may use one of a number of barrier methods to deliver rescue breathing. It is often suggested that a simple handkerchief or something similar placed over the casualty’s face will form a barrier but this is unlikely to be particularly effective. Similarly, there are available simple plastic sheets with some form of opening which may be placed over the casualty’s face allowing the rescuer to blow through the opening. These are to be preferred to a handkerchief but are still not particularly effective. The best form of barrier for delivering rescue breathing would be a pocket mask designed for the purpose. These have the advantage of allowing mouth to nose ventilation as well as mouth-to-mouth ventilation. They will usually also include some form of one-way valve. Some may have a fixture allowing the expired air to be enriched with oxygen. The mask should be placed over the casualty’s nose and mouth whilst the rescuer blows through the one-way valve.

Keeping the airway open with head tilt and chin lift, the facemask is placed over the casualty’s nose and mouth.

The rescuer then blows through the one-way valve. The casualty’s expired air is deflected from the rescuer by the valve.

The mask may be held in place more easily using both hands in an “over the top” position with the rescuer at the head of the casualty


Cardiac first responder Defibrillation Problems with the heart’s electrical system can result in abnormal heart rhythms or arrhythmias. There are many different types of arrhythmias. Some may cause the heart to beat too fast, some too slow and some may cause the heart to stop beating altogether. SCA occurs when the heart stops beating. The most common type of arrhythmia that causes Sudden Cardiac Arrest is ventricular fibrillation.

Ventricular Fibrillation In VF, the signal to the ventricles or pumping chambers of the heart becomes disorganised, resulting in the pumping chambers starting to quiver very rapidly and irregularly. When this happens there is very little output from the heart to the other organs of the body and death will follow within a few minutes. VF causes more sudden cardiac arrests than any other arrhythmia, and without the correct treatment 95% of sufferers will die. Sudden cardiac arrest can affect anyone at any time and although it is more common with age and in people who have heart problems, many sufferers have no known risk factors or previous history.

The only treatment proven to restore a normal heart rhythm is to administer an electric shock to the casualty’s heart. This is called defibrillation and can be life-saving in sudden cardiac arrest. The machine used to deliver the shock is a defibrillator and the type of machine most commonly used outside of a specialist hospital unit would be an automated external defibrillator or AED. Defibrillators have been around for many years but their use in the past has been restricted to individuals with specialist knowledge. The problem has never been in knowing how to shock but in knowing when to shock and the danger was in giving a shock to someone who didn’t need one. The AED has solved this problem by using a computer to recognise whether or not a casualty needs a shock and by not charging up or delivering a shock to someone who does not need one. This means that AEDs can be used safely by non-medical people to save lives in sudden cardiac arrest. The effect of defibrillation decreases as time passes so the earlier into the event that the casualty can be shocked the more likely it is that it will be successful. Chances of survival decrease at around 10% a minute so early defibrillation has to be the target..

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Cardiac first responder Using an AED An AED can be used safely by almost anyone, so its use is not restricted to trained rescuers. #However training is useful to improve performance, leading to a better outcome. When using an AED keep interruptions to chest compressions to a minimum. Do not stop to check the casualty or discontinue CPR unless they show obvious signs of recovery, such as opening their eyes, speaking or starting to breathe. The appearance of individual AEDs may vary from maker to maker but they will all have similar layouts and properties. The essence of AED design and use is simplicity and so you should be able to use any AED in exactly the same sequence. One type of AED may be used for illustration but the instructions apply equally to all.

Activate the AED Some AEDs will automatically switch on when you open the lid. With others you may have to press the ON button. Attach leads to the AED if necessary

Attach the Pads ▪ Remove the pads from any outer packing. ▪ Look carefully at the instructions on the pads. ▪ Peel off any backing paper and stick the pads onto the casualty’s chest as shown. ▪ One pad should be placed below the right collar bone, next to the breastbone. ▪ The other pad should be placed below the left armpit, on the side of the chest wall, over the lower ribcage. ▪ It is not important which way round the pads are placed.

Analyse ▪ Keep clear during analysis ▪ Ensure that nobody touches the casualty whilst the AED is analysing the heart rhythm as this may lead to inaccurate results. ▪ Follow voice prompts


Cardiac first responder No Shock Indicated ▪ If the voice prompts direct you to start CPR, start chest compression and rescue breathing immediately. ▪ Maintain CPR for two minutes or until prompted to stop. ▪ Continue to follow voice prompts.

Shock Indicated ▪ Ensure that everybody is clear of the casualty. ▪ Press the shock button as directed. ▪ After the shock is delivered continue CPR for two minutes, or until directed to stop. ▪ Allow the AED to analyse. ▪ Continue to follow voice prompts.

Placement of Chest Pads The casualty’s chest should be exposed to enable correct pad placement. If the chest is wet it may prevent the pads from sticking and making a good contact. Towel dry is usually sufficient. Excessive chest hair may also prevent effective contact. The area where the pads are to be placed should be quickly shaved if possible. Do not delay defibrillation if a razor is not immediately available. It is important that the left side pad is placed well back to the side of the rib cage. If it is too close to the front, current travelling from pad to pad will travel across the front of the chest, missing the heart. With the pad placed well to the side the current will travel from pad to pad through the heart muscle.

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Cardiac first responder BLS and AED Flowchart Unresponsive? Shout “HELP� Open airway Check breathing Not breathing normally?

Call 999/112 Send or go for an AED

Start CPR at 30:2 until AED attached

AED Analyses rhythm

Shock advised

NO shock advised

Give one shock

Resume CPR for 2 minutes

Resume CPR for 2 minutes Continue until they start to breathe normally


Cardiac first responder AED Safety An AED is like any other electrical appliance in that certain safety precautions should be observed to minimise the risk of injury to the operator, assistants or even the casualty. ▪ Keep the electrodes (pads) separate: do not allow them to touch when the machine is switched on. This could complete the circuit and could be dangerous. ▪ Never connect the pads to anyone except a casualty in suspected cardiac arrest: A live AED should never be connected to anyone for demonstration or training purposes. ▪ Be aware of patches on the skin: some medications, particularly GTN may be administered via skin patches. Remove the patches if possible or avoid placing the electrodes directly over the patch. ▪ Be aware of implants: Devices such as pacemakers or cardioverters may be implanted under the skin. Their presence is often marked by a scar or bump. They are most commonly found high on the left side of the chest and so are not often a problem for pad placement. Try to keep pads 10cm away if possible. ▪ Be aware of inflammable environments: Because of the risk of sparks the casualty may have to be removed from an area containing inflammable vapours, before a shock is given. ▪ Risk of shock to others: if the pads are making good contact then there is very little risk of shock to others, even in a wet or conductive environment, as long as they are not in direct contact with the casualty. ▪ AEDs and jewellery: reposition or remove any metal jewellery that is in danger of coming into contact with the pads. Do not place pads over body piercings.

AEDs and Children Thankfully it is rare to have to use an AED on a child. Their use however can be life saving in some circumstances. Paediatric pads and leads are designed to reduce the power of the shock delivered to the child, to limit any possible damage to the heart. In most cases the pads are designed to be placed in the conventional adult position but if the child is so small that the pads are in danger of touching they woukld have to be placed on the front and back of the chest. Children over the age of 8 years can be treated with adult pads and protocol whilst children between 1 and 8 years should be treated with paediatric pads if available. If no paediatric pads are available use adult pads front and back. Although there may be some risk it is better than doing nothing. All children should receive at least one minute of effective CPR before attempts are made to defibrillate as per paediatric life support guidelines.

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Cardiac first responder Storage The AED should be stored in a secure but easily accessible location. Storage should be clean and dry. If located in a public area security may be maintained by having the unit enclosed in a cabinet with a breakable seal arrangement. Cabinets should have a clear door so that the AED is clearly visible. They should also allow easy checking of the unit’s flashing “ready” light.Many cabinets will also have an alarm that is activated when the unit is removed or the door opened. This may be audible or visual, for example a flashing strobe light.

The location of the AED should be clearly signed using the accepted international sign.

ILCOR universal sign for AED Depending on other circumstances it may be useful to store other items with the AED so that they are easily available. These may include: ▪ ▪ ▪ ▪ ▪ ▪

Spare battery Spare pads, including paediatric pads if Razor for shaving the chest TuffCuts for opening clothing Towel for wiping the chest Gloves

appropriate


Cardiac first responder Incident Reporting It is important to keep a record when an AED is used. It is especially important to record: ▪ ▪ ▪ ▪ ▪ ▪ ▪

If the collapse was witnessed; What time it occurred; When help arrived When CPR was started When defibrillation was attempted The number of attempts at defibrillation The outcome

A Cardiac First Response Report (CFRR) should be completed for each incident. This is a two-part document. The top copy should go with the patient to the hospital and the second copy should remain as a record with the responder organisation. The information will also be used for patient handover, on arrival at hospital.

After the Incident The sad fact is that some people’s condition may not allow them to survive, regardless of the treatment they receive, at the time or later. As long as the responder does the very best that they can within the scope of their training then they should not feel responsible for the outcome. Unfortunately, sometimes they may feel responsible and this can lead to ongoing psychological and physical problems. It can lead to a condition known as Critical Incident Stress (CIS) It is important to discuss your feelings and not bottle them up. It helps to speak to someone who will not be judgemental but who will be supportive. This may be as simple and straightforward as talking to family or friends. An alternative is to speak to your general practitioner who may be able to advise on any further treatment that is needed. There are also private counsellors who specialise in traumatic stress. For advice on self-help you can go to the website www.cism.ie The National Ambulance Service CISM committee has recently published a booklet called “Critical Incident Stress Management for Emergency Personnel” which can be bought by emailing: info@cism networkireland.ie

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Cardiac first responder Foreign Body Airway Obstruction

Recognition The problem often occurs whilst eating. They will often stand up and clutch their neck. They will look anxious or distressed.

Treatment Encourage them to cough. If they are coughing do not slap them on the back as this may encourage the object to drop further into the throat.

Back blows Bend them forward supporting them on the shoulder. Give up to 5 blows with the heel of the hand between the shoulder blades.

Abdominal thrusts Stand behind the casualty and reach with your arms around the upper abdomen,between the belly button and the point of the breastbone.

Abdominal thrusts Make a fist with one hand and place the fist, thumb end first, against the soft part of their abdomen, just below the point of the breastbone. Grasp your fist with your other hand.

Abdominal thrusts Pull sharply backward and upward, bending from the elbows, at an angle of about 45째 to the horizontal. Repeat up to 5 times, checking for breathing after each thrust.


Cardiac first responder If they become unconscious ▪ ▪ ▪ ▪

Lower them to the ground. Make sure an ambulance is called. Immediately start CPR with 30 chest compressions. Continue CPR until the casualty is breathing normally or you are relieved by ambulance crew.

Seek medical attention If your efforts to relieve the obstruction have been successful it is still important that the casualty receives medical attention, particularly if they have suffered a serious obstruction and have required abdominal thrusts.

Treatment – child ▪ Follow the general guidelines for obstructed airway in an adult. ▪ Moderate the force required for back blows and abdominal thrusts. ▪ If not effective dial 999/112 for an ambulance.

Treatment – infant If the infant is unable to cry or breathe: ▪ Lay them down along one arm, supporting the head with the hand. Make sure the head is lower than the body. ▪ Give five blows in the middle of the baby’s back using the heel of the other hand. ▪ If the obstruction is relieved, it is not necessary to give all five blows. ▪ Check the baby’s mouth and remove any foreign material found. ▪ If back blows are unsuccessful, give five chest thrusts. ▪ Place two fingers on the breastbone about a finger’s width above the point where the ribs meet. ▪ Give up to 5 sharp downward thrusts, similar to chest compressions but sharper and at a slower rate. ▪ The aim is to relieve the obstruction, not necessarily to give all five chest thrusts. ▪ Check the baby’s mouth for any foreign objects which should be removed. ▪ If necessary repeat the sequence of back blows and chest thrusts three times, and if still unsuccessful take the baby with you to the telephone to call for an ambulance.

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Cardiac first responder

Choking Summary Signs of Choking?

Prevent leaving

No

Effective Cough?

Yes

Severe obstruction

Unresponsive?

Mild obstruction

Give up to 5 back blows

Dial 999 /112 for an ambulance

Encourage cough

Obstruction not relieved?

Start Chest compressions

Continue to monitor for deterioration to ineffective cough or relief of obstruction

Give up to 5 abdominal thrusts

Continue CPR at 30:2 until the obstruction is relieved and casualty is breathing normally

Alternate 5 back blows and 5 abdominal thrusts


Cardiac first responder Stroke Stroke is a condition in which the blood supply to part of the brain is interrupted, leading to localised brain injury and possible death of brain cells.

Stroke - recognition ▪ May be severe headache or sudden loss of consciousness. ▪ General feeling of being unwell. ▪ Paralysis or weakness affecting one side of the body. ▪ There may be drooping of the eye or mouth on the affected side. ▪ There may be difficulty speaking or forming sentences. ▪ Stroke is a medical emergency that responds well to urgent medical treatment. To aid in early diagnosis remember the FAST test.

F A Arms S Speech T Time Face

Ask them to smile does the face look lopsided? Is the eye or mouth drooping on one side?. Ask them to raise both of their arms above their head. Can they raise them equally? Can they speak clearly and understand what you say?

Time to call 999/112 for an ambulance

If the patient fails any one of the tests call an ambulance immediately. Prompt medical care can reduce further damage to the brain and help the person to recover more completely.

Stroke - treatment ▪ ▪ ▪ ▪ ▪ ▪

Reassure Lay them down with the head slightly raised Place them in the recovery position if they are or if they become, unconscious Call urgently for medical attention Continue to monitor their condition until the arrival of medical assistance Be prepared to offer life support as appropriate

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Cardiac first responder Seizure A seizure is most often caused by an abnormal electrical disturbance in the brain. It can cause changes in body movement or function, sensation, awareness or behaviour and can last from just a few seconds to a condition which will not stop. There are many different types of seizure with many different causes. Probably the most common type of seizure that would require first aid attention is called the tonic / clonic seizure.

Seizure – Recognition ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪

Possible known history of seizures. They may appear uneasy or nervous immediately prior to the fit. They may fall to the ground with a loud cry. Breath holding or irregular breathing. Cyanosis / congestion of the face. Muscle rigidity, followed by uncontrolled movements of limbs and trunk. Sometimes teeth grinding. Sometimes the lips or tongue may be bitten and then maybe flecks of foam or blood on the lips.

Seizure – Take ACTION

A Assess C Cushion T Time I Identify O Over N Never

Assess the situation – are they in danger of injuring themselves? Remove any nearby objects that could cause injury. Cushion the head (with a pillow or clothing) to protect them from head injury. Check the time – if the seizure lasts longer than five minutes you should call an ambulance. Look for a medical bracelet or ID card – it may give you information about the person’s seizures and what to do. Once the seizure is over, put them into the recovery position. Stay with them and reassure them as they come round. Never try to restrain the person, put something in their mouth or try to give them food or drink.

Call an ambulance if: ▪ It is their first seizure. ▪ They remain unconscious for more than 10 minutes.

▪ The seizure lasts for more than five minutes. ▪ They have repeated seizures.


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