October 13th, 2011
We are well into 2011 and the NREMT is still testing over the 2005 American Heart Association CPR Guidelines. You may be wondering why, since the 2010 guidelines have been out since... you guessed it...2010. The answer is that, “Big wheels turn slowly, and the NREMT is one big wheel.”
The 2010 CPR Guidelines are being introduced into the computer-based examinations beginning on November 1st, 2011, but only for Paramedics. On January 1st, 2012 the NREMT will begin using the 2010 guidelines for EMT’s. Finally, on March 1st, 2012 AEMT and EMT-I will have the 2010 CPR guidelines introduced into their NREMT examinations.
So, depending on when you test, you will need to know different information. The changes from the 2005 guidelines to the 2010 guidelines are subtle in some areas and significant in others. Let's take a look at them.
AHA CPR Guideline Changes - 2005 to 2010 - What You Need To Know.
According to 2010 guidelines you should activate the Emergency Response System after checking the patient for response and absent or abnormal breathing. In the 2005 Guidelines you would activate the Emergency Response System immediately after finding the person unresponsive, and then return to open airway and assess breathing.
Basic Life Support sequence:
2010 guidelines use CAB- Chest Compressions, Airway, and Breathing. 2005 guidelines used ABC. This is the biggest change in the new guidelines. 2010 guidelines recommend to immediately begin compressions rather than opening the patient's airway and beginning ventilations as in the 2005 guidelines. Rescuers should recognize agonal gasps/ineffective breathing, and unresponsiveness as signs of cardiac arrest, but begin CPR with compressions. An AED should be used as soon as possible when the rescuer has witnessed the arrest.
The change was made so that rescuers would get to compressions quicker. Opening the airway, retrieving and or assembling equipment often delays the initiation of compressions. Beginning the CPR cycle with compressions only delays the first ventilations by approximately 18 seconds (During 2 person CPR). The AHA is continuing increased emphasis on quality CPR including adequate rate and depth, allowing for complete chest recoil and minimal interruption.
Detail of CPR Changes for Health Care Professionals
The Compression rate is now AT LEAST 100/min. Changed From: APPROXIMATELY 100/min. This is a subtle change, but the obvious message is, ‘More (quality) compressions is better.’
The Compression depth is now AT LEAST 2 inches in adults. Changed From: 1.5 to 2 inches. The change was to simplify the procedure by eliminating the range. The change was made to increase the depth at which rescuers were compressing.
The Compression depth is now AT LEAST 1/3 of the anterior posterior diameter of the chest for children. Changed From: 1/2 to 1/3 of the depth of the chest. As in adult CPR the range was eliminated to simplify the procedure as well as increase the depth at which rescuers were compressing.
No more, ‘Look, listen and feel for breathing.’ The rescuer should now briefly check for breathing while assessing responsiveness. If the rescuer detects signs of cardiac arrest he/she should begin CPR with 30 compressions and then open the victim's airway and deliver the 2 rescue breaths.
Cricoid pressure during ventilation is no longer recommended with the 2010 guidelines. The 2005 guidelines recommended cricoid pressure only when the patient was deeply unconscious. The change was made because studies have shown that cricoid pressure can impede ventilations at times and still allow for aspiration. It has also been shown that it is difficult to properly train rescuers in the use of cricoid pressure. For these reasons the maneuver is not being recommended as routine.
Keeping up on current AHA CPR guidelines can be confusing. That fact, coupled with the varying timeline for adaptation by the NREMT, makes it even more crucial that you understand the new changes along with ‘when and where’ they will be implemented. For a more detailed list of the changes you can download the AHA Guideline Highlights here: http://guidelines.ecc.org/guidelines-highlights.html
You can also access the NREMT essay on AHA implementation by going here: https://www.nremt.org/nremt/about/2010_aha_guidelines.asp
Back to October 2011 Newsletter
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