Dr T Handley - Resuscitation Changes 2005

<Resus' 2005 changes talk-night>

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BLS 2005 Changes Talk night 24/4/2006 Transcript - over 250 messages!
Special Guest Dr Tony Handley aka AJH. Dr Tony Handley. Tony holds some impressive positions: Author of the BLS 2005 changes Chairman BLS/AED Subcommittee Resuscitation Council (UK) Chairman ERC International BLS Course Committee Member ERC BLS Working Group Chairman ILCOR (International Liaison Committee on Resuscitation) BLS Task Force Please note: The views expressed by Dr Tony Handley are his personal views and do not necessarily represent that of the Resuscitation Council etc. Due to time constraints, answers are inherently brief and may not cover all aspects of the question. At various times an ActiveX message kept appearing causing typing difficulties and errors at various time - Sorry about that - Admin.
Admin	Hi all. Tony Handley has the nickname AJH
Admin	his messages will be in bold
Carrie1346	How do I know I am in room 1
Admin	Tony is just having a few teething problems
MG	It says it after your message
gumpo	not doing a finger sweep is he??
Admin	You know that you are in room one when you have [1] in the top window
Eric@54	Where it says you are in room 1
Admin	Right... Tony is now with us...
Admin	So welcome Dr Tony Handley
PETA	Will it be possible to ask new questions if I didn't send it in earlier?
services ltd	keep getting activex do I need to do any thing
AJH	Yes!
andycleverdon	I have a question what research led the changes in the protocols and where can I access that research data
services ltd	Welcome Tony hear that you have been Ill hope that you are well now.
Admin	Services - no, not sure about activeX
AJH	The data that are behind the science that is behind the guidelines came from ILCOR.
gumpo	The instigation of chest compressions in the absence of signs of life appear somewhat risky to me, and from a coronary care background I was under the impression this action could actually stop a beating heart
AJH	You can find these worksheets on the AHA website.
matinjapan	Why no mention of Rescue Breathing for Asphyxiated casualty in new guidelines?
andycleverdon	ok that’s great but are there copies of questionnaires or whatever that was sent out to Drs or was it changed through consensus at committee
AJH	Chest compression is very unlikely to do any harm, particularly if done according to the guidelines, even if the heart is beating normally
AJH	Thank you SErvices ltd, I am much better now, but did have a few weeks in ITU
gumpo	what about the hand position now? Surely by not placing in the correct position, and just in the centre of the chest there is increased risk of rib fracture?
services ltd	How long will we have to wait for the RLSS to implement the new changes
AJH	A study showed that the hand position was just as accurate when the students were told to put their hands in the centre of the chest. They did have to have a demonstration also.
AJH	The RLSS Life Support Manual will be launched at the Annual Conference next month - I am doing it!
PETA	Hi Tony, my question relates to the giving of rescue breaths for those situations where it is a child or for times when the rescuer is sure of asphyxiation, due to the history of the accident. I appreciate that the guidelines relate
andycleverdon	Tony I am doing research assignment for college and have to do it in my specialist field and would appreciate any guidance as to where I CAN FIND THE RESEARCH CRITERIA AND DATA for the changes
Rick	Hi Tony, you mention the RLSS when will be able to teach the protocols on an NPLQ?
AJH	The guidelines say that the modifications for drowning should be taught to those with a special likelihood of having to deal with drowning, such as lifeguards. If your group come into that category, it would be reasonable to teach these modifications.
AJH	Research is such a wide field, that I cannot direct you to any central information. If you have something definite in mind, contact Admin and they will pass on your request to me.
para	is this rm 1?
andycleverdon	thanks I will do that
Admin	para - yes rm1
MG	Tony - any research whether groups of 30 compressions are more tiring than 15 and therefore less effective after a few cycles?
PETA	I felt that this would be the most common sense approach but needed some re-assurance. Thank you.
AJH	As far as NPLQ is concerned, this depends on IQL - I am not sure for certain, but it will be after you have received a formal update
gumpo	they are more tiring when teaching
MG	Gumpo - agreed
AJH	MG: No - I was thinking of doing this myself!
sjgarth	andycleverdon, try http://www.erc.edu/index.php/guidelines_download_2005/en/ look for costra, it may help you.
gumpo	it is also more difficult to count 30 compressions at that rate whether demonstrating or assessing
Admin	There are 160 online - hope this site hold out!
services ltd	do not understand why we do not clear the mouth any more
Admin	You cant use nellie the elephant any more for timing :-)
AJH	A check of the mouth during the process of opening the airway has been removed because (a) no longer does the rescuer then give 2 breaths, (b) this saves time before chest compressions are started, (c) if there was sufficient obstruction to cause complete blockage, it is unlikely that this would be within reach
para	Tony, the new advise for the lay person is to give full cpr if no normal resps, is this true of a heroin od where cardiac output should be normal but resps are below 10 ?
AJH	Admin: You can try singing it more than once - the tempo is the same!
Admin	IF ANYONE CAN ASSIST ON THE ANS, PLEASE JOIN IN - I EXPECT TONY'S FINGERS ARE A BLUR!
scottydog	I am old enough to recall being taught nellie the elephant for CPR timing!
AJH	There are situations where victims have 'pure' respiratory arrests. These are relatively rare, and are going to become cardiac arrests in the end. Because heart attacks are so common, it is a case of the greater good for the greater number
sjgarth	Admin, please don’t sing!
gumpo	Tony do you or will you have influence over the First Aid at Work Regs as the consultation was so long ago now that by the time they do come in they will be out of date. Have you any more info on this?
AJH	The Resuscitation Council (UK) replied to the consultation document but has no further influence, except that we have a member of HSE on the BLS/AED Subcommittee.
gumpo	Are these new CPR changes aiming for a majority of first aiders to have access to and use AED's?
AJH	Consultabut = consultation document!
AJH	Gumpo: Don't quite understand the question
gumpo	if an AED was available a VF arrest could be treated successfully, so have the changes been brought about to make CPR more simpler until AED is used
ric-carillion	Tony, are the changes made effective straight away, as the company I work for have a large number of First Aid at Work persons and Everyone as Emergency First Aid but the company has made no effort to notify everyone yet?
Admin	Gumpo - the HSE reference the VAS manual and the Resus Council. So any changes are automatically part of the training requirements
gumpo	sorry to appear thick, but what's the VAS manual??
MG	ric - the guidelines allow for the old protocols to continue until retrained
ratty	st johns manual
AJH	Use of an AED is considered part of BLS and is, of course, vitally important. The BLS guidelines integrate with AED usage, but are designed to be complete in themselves even if the rescuer has to wait for the ambulance before a defibrillator becomes available
ratty	st johns, red cross voluntary aid societies, vas
sjgarth	The changes can be implemented as soon as you feel fit to teach it. First aiders can change unilaterally if they wish. It is not necessarily the companies responsibility to change the protocols, it is up to the first aider to keep them
keven	hi Tony why has the cpr protocol changed so often over the years and what do you think makes these changes better than the previous protocol and how long before it will change again ?
AJH	I agree with the comments over introduction of the new guidelines
tex	question was asked at Manchester conference regarding the minimal standard for cleaning manikins ,any thoughts
sjgarth	The protocols were historically locally decided, then they were combined into national programs, then regional (European) then international. Each change had some research input. This change, as far as I am aware, has had more research
AJH	The changes are driven by new science and new understanding of teaching methods. They keep changing because we are still only getting 5% o-o-h survival. Each time we hope for better, and do get it, but in limited circumstances<
AJH	Sorry, most of my typos are due to freezing of my computer when the Active X sign appears on my screen as well!
gumpo	so surely AED's are the way forward?
PETA	Hi Tony, Can you offer any clarification about 'spinal cord injury' and LBS. Is it true that 'Jaw thrust' and Log Roll etc. are now removed meaning we treat a suspected spinal cord injury in exactly the same way re: bls?
sjgarth	I have no excuse for my typo's, I can't type!
Eric@54	Tony do you think the Jaw Thrust technique will be removed from the NPLQ?
AJH	AEDs are a way forward, but cannot be the only answer - there would have to be an unlimited number, including home defibrillators. Then, what about the victim alone?
kulashaka	in my mind it updating the protocol of CPR has been far too long simply being as nowadays pretty much everybody has such easy access to communications that the likelyhood of the lone first aider having to leave their patient for an
ratty	the they can do cough cpr
kulashaka	hoorah for the new protocols!!!!!!!!
AJH	The ILCOR work showed that jaw thrust produces just as much movement of the upper spine as head tilt/chin lift.
AJH	Eric@54 : YES!
Eric@54	How do you get an airway when cas. on spineboard then?
AJH	Eric@54: But it is not my decision alone!
Eric@54	?
sjgarth	OP Airway???
AJH	Head tilt/chin lift against the pressure of the head strap
Eric@54	?
services ltd	You get an airway on spinal board by person holding head and then the strap being loosen
Eric@54	Oh Yes?
AJH	Agreed!
Eric@54	Which is it then?
Eric@54	Against strap or loosen?
Eric@54	Or just don't buy a board
services ltd	if you look at the 7th edition for the NPL you will
AJH	Try head tilt chin lift, but be prepared to loosen the strap if a clear airway is not achieved
services ltd	that the jaw thrust has not been in it for some time. you would have to loosen the head strap if the teq did not work
ruqayya	please excuse my ignorance what is NPLQ
services ltd	national pool lifeguard qualification
mattski	Sorry, has the jaw-thrust been completely removed from guidelines now, as I thought it had just been de-emphasised from layperson BLS?
ruqayya	thank you -
Paddy	Tony would you agree that the pre-cordial thump may still be used by those medical professionals (Drs, Nurses) already trained and who feel they are still confident to do it effectively? or should it be avoided altogether?
AJH	Jaw thrust is still a healthcare professional technique
AJH	A pre-cordial thump can work, but it must be given very soon after onset of arrest. Therefore it is still given as a possibility for witnessed/monitored arrests
sjgarth	precordial thump has a place in monitored, witnesses arrests. That is, the casualty is on a cardiac monitor and a healthcare professional sees them go into VF
gumpo	If they were on a monitor and witnessed I would have thought a defib would be available and used
Admin	How much better are the new recommendations to that of the old ones?
mattski	Thanks. Just wondering why its still in then if ILCOR research has shown its has no benefit over head tilt/chin lift?
Eric@54	So am I!
AJH	The jaw thrust has some advantages over head tilt/chin lift. For example, you can achieve it with one hand, and hold on a mask - if you are good at it!
sjgarth	Jaw thrust is effective in experiJaw thrust is still leffective in experienced, practiced hands such as anaesthetists, hospital crash teams, ICU etc.
Eric@54	That’s where I learned it
sjgarth	sorry, typing error
PETA	So is it still recommended to do a gradual neck extension for suspected spinal cord injuries or just go straight for a full clear open airway?
sjgarth	I think the key is practiced. Skills are lost if not used for real on real people.
Eric@54	Manikin?
MG	manikins are not realistic enough
AJH	Try and open the airway with chin lift alone, then add head tilt as needed
MG	..but better than nothing, of course.
ratty	they at least teach the technique
Eric@54	They allow demonstration
gumpo	as the length of rescue breaths is now over 1 second each, are these effective?? Are we really able to oxygenate a casualty with this new protocol?
Eric@54	Which ever technique you use
Admin	Question for the trainers - How do you find the new techniques? - Easy to teach?
andycleverdon	yes much easier
ratty	yes, and students seem to pick it up quicker as well
services ltd	much easier for the students to understand and much easier to explain but hard to demo
keven	have you any idea what the survival rate is on compression only cpr
AJH	The duration of each rescue breath was reduced because of evidence that hyperventilation was harmful - 1 sec has been shown to be sufficient
gumpo	Difficult to teach. Everyone has firm ideas of years of practice of the old algorithms, and now it's changed dramatically. Also harder to do 30:2
andycleverdon	nothard to demo just talk as you do the compressions the students have to be really good to count and listen to you at the same time
Curtis	agree with andy and ratty, much easier and students find it easier as well
AJH	Survival with compression-only CPR has been reported as higher than combined CPR, but only when the interval from arrest to defibrillation is under about 5 mins - rarely achieved in practice
services ltd	students also feel that they would be more likely to have a go rather than worry about going wrong
Admin	At the FAC conference - I was surprised how common inadvertent hyperventilation was
sjgarth	Really easy to teach
Admin	Tony, I was surprised that the AED manuf' were not prepared for the new changes - were they consulted?
sjgarth	Why did the councils choose such a loose term as 'Healthcare professionals with a duty to respond for the paed protocols. We have a large number of community staff who work with kids, and RO's had to decide what to teach so we now
MG	Some AED manufs seem more with it than others - Zoll at least have a patch on the way, another one doesn't even reply to queries
AJH	AED manufacturers were fully aware of the timescale of the new guidelines, but were not given advanced notice of what the changes were - many reasons for this; some political!
gumpo	Admin, will you post a summary of the Q&A from tonight?? I have to leave shortly
Admin	gumpo - yes
MG	Prob for orgs with mix of AEDs if some can't be upgraded
wal	has the chest thrust for the choking child been removed or omitted?
AJH	The paediatric BLS guidelines vary from the adult BLS in many ways. We know that simplicity is the key to learning and skill retention. It was considered that the relatively minor (mostly theoretical) benefit to the child was of less importance than the need to keep teaching simple
mikael olafsson	AED location - will the 112 have a database where AED are. So if I call he can remind my to use the AED
Eric@54	wal no
AJH	Chest thrust is still in for infants. Chest compressions for all unconscious choking victims is really the same as chest thrusts!
MG	mikael - there is no such database
AJH	The BHF has been working on compiling database of the whereabouts of AEDs in the UK. But nothing fully national yet
mikael olafsson	In Iceland the owner of a AED can let the 112 have the inf, so if some one ask for assistance at the address the can remind
Admin	When the changes can out, questions were raised on its implementation in various areas - ie. schools, duty of care etc. Are there other questions that you are still looking into?
MG	mikael - good idea, but you're dealing with a much smaller country
AJH	Admin: What questions were raised?
Admin	i.e. School teachers - do the hold a duty of care. Hence if so would need to know the pead' protocols
Eric@54	Childminders too?
AJH	The RC(UK) has suggested the following: 2. Special courses teaching child resuscitation to specific target groups who work with children or are likely to have to respond to child emergencies:
sjgarth	My view is that Teachers should be taught the same as adult, but give 5 breaths. I would not confuse the issue with 15:2
Eric@54	Like the guidelines say
AJH	Each group should be assessed according to this criterion. But do remember that the more you teach, the smaller is the proportion that is remembered Too much extra, and some of the essentials may be forgotten at the crucial time
AJH	The 15:2 ratio is ONLY for healthcare professionals, with special responsibility for children, who work in teams.
andycleverdon	as they say KISS for teahing Keep It Simple Stupid
Eric@54	How about the RLSS Save A Baby's Life Course?
Admin	Question for trainers - Agonal breathing - how easy is this to get across - After all, if a cas was to suddenly give a gasp - I would think, great! he/she is alive!
First Aid	has rescue breathing been removed from all sequences
sjgarth	ANDY did you get my Costra reference earlier
andycleverdon	sjgarth no I didn’t I missed it and it all disappeared off the screen
AJH	I must emphasise that the adult sequence (with one-third chest depth compression) is considered by the paediatricians as what should be taught to the majority of laypeople
Admin	Who has seen the pig in agonal breathing?
Eric@54	How about the RLSS Save A Baby's Life Course?
AJH	RLSS Save a baby's Life teaches modifications, but not 15:2
andycleverdon	any help appreciated andy.cleverdon@virgin.net
MG	Admin - what pig?
Eric@54	5-1?
AJH	If the BLS sequence is followed, there will not be a point at which rescue breaths alone are given
Admin	There is a great video clip showing a pig in agonal breathing (from Sweden)
Eric@54	Or will it become 2-30>
sjgarth	ANDY http://www.americanheart.org/presenter.jhtml?identifier=3022512 for the Costr document, it may help your studies
MG	Do you have a URL for it?
AJH	Just to mention that I shall have to go in about 5 mins
Admin	I am trying to get the video clip. I have clips showing a heart in VF - showing need for chest comp prior to AED
First Aid	Are we still teaching the trauma sequence in Lifeguard Training
PETA	I saw the pig clip/ It was interesting to see, but hard to get across by describing alone I think.
tex	any minimal standard on cleaning manikins what’s best to use
sjgarth	admin put them in the resources section of the cafe
Admin	I am trying to get clearance for clips - they will be a real asset for AED training
sjgarth	I imagine we still have to follow manufacturers guidelines to be really safe.
AJH	Cleaning manikins - follow manufacturers recommendations!
dayna	Admin, is it possible to get a copy of the pig's heart in VF
MG	Tony - how long before the next major change?
Zac	AJH Thanks most informative Zac
PETA	AJH thank you so much for your time tonight. It's been great. Take care. x
Admin	Yes, BIG thanks to Tony Handley.
sjgarth	Glad you are better Tony, hope to see you back on the 'lecture circuit' soon.
tex	many thanks
mattski	Thanks
andycleverdon	Thanks Tony can I contact you through PERU in Cardiff
AJH	The AHA are talking about 2010. I have to go now because I have a teleconference with the ERC to discuss just this!!
MG	Many thanks. Enjoy yourself!
Curtis	many thanks, most informative, lots of points cleared up
dayna	Dayna, really worthwhile and informative. Let's have more of these!!! Many Thanks
AJH	Cheers!
loopy loo	Agonal breaths is something joe bloggs have never heard of they find it quite spooky when i describe it in my courses, but I feel it is very relevant to what we are teaching, do you?
MG	I always mention it - but they don’t know what I'm talking about.
sjgarth	They are very relevant. The research showed that most first aiders stopped CPR because of agonal breathing. Keep doing CPR until the casualty is trying to thump you!!
Admin	People still want to do pulse check - they still want the cas to bust into life - Normal breathing I feel is a BIG problem to get over especially when FAider in red mist - your thoughts?
Zac	Admin Congratulations on organising this topic
MG	.. prob because agonal breathing is not shown on tv
sjgarth	I don't know of any film clips of a human, shame really
Admin	Thanks Zac. Its been a long time since the last one - Must do it more often, say monthly
Admin	I have pro video equipment - need setting to do Agonal breathing - any takers for hospital venue?
PETA	Good night folks. Time for a cuppa. Take care everyone. A Great session!!! Well done Admin.......
Admin	Thanks Peta
sjgarth	One or two ethical problems with consent etc.
tex	any one going to Norway
Eric@54	One or To!!!!
MG	yes -stick to pigs¬
sjgarth	Might be worth seeing if we have any good actors in the cafe
Admin	sjgarth - actor maybe?
tex	see you there cheers tex
loopy loo	Tony how are you and what's the weather like back in aussie?
andycleverdon	thanks and goodnight
ruqayya	good night and thanks for an enjoyable chat
Admin	bye andyc
Admin	thanks ruq
sjgarth	Many things, but not actor
MG	Many thanks, Admin. Goodnight, all.
Admin	It been a good evening - we had 170 people at one point - Surprised site did not crash!
loopy loo	is that it?
Admin	Thanks MG
sjgarth	This chat thing is alright, most enjoyable evening, thanks
loopy loo	ok
Admin	The room is open
loopy loo	who’s still on?
sjgarth	Big list at the top of the page
sjgarth	57 people
loopy loo	ok but I’m very knew to all this computer chat stuff !!
Eric@54	57 Varieties!
Admin	The list at the top can be about 15 mins out of date
dayna	I'm new to it too loo, so I know how you feel!
sjgarth	its going up!!
Admin	We need to think of another subject to cover
sjgarth	and down
ratty	admin, ur not on the list at the top
Admin	Any thoughts
loopy loo	thank you dayna !! now i don't feel so out of ti!!
Admin	I hate software - never did find out why people disapear from the above list
sjgarth	an't wait until 2010 when the next changes occur
johnlar	gold
dayna	Admin, can I ask what is the latest on teaching quals for teaching First Aid? I complete my Cert Ed next month. I have fAW, but do I need anything else?
sjgarth	???
Admin	First aid will be reduced to just two procedures – press on it or put water on it!
loopy loo	subject I’ve been thinking about is how do we all feel about resus on a very cruished face in a car accident for example?
Admin	You need 1 year as a FAider if I recall. Teaching qual not needed by desirable
sjgarth	You're getting the idea admin
sjgarth	pocket mask, or use op airway, or mouth to nose
Admin	if you are NOT teaching FAW then no quals or experience are necessary - Suprisinly
loopy loo	i've been a first aider and teacher for many years and my hubby is a paramedic they don't do mouth to mouth but first aiders should?
Admin	loopy loo - this is where compression only CPR is used
sjgarth	The likelihood of paramedics coming into contact with blood is much higher than the general public
loopy loo	true and i agree with the knew guidelines as it makes much more sense
sjgarth	It is sensible to provide them with protection, basically a risk assessment
sjgarth	time to go, bye
Admin	One of the reasons for Comp only is that it is hoped that once the FAider starts he/she is more likely to do breathing even if they start with comp only
loopy loo	I can't emphasis enough on my courses about self protection and we give away mouth shields on our courses!
Admin	sjgarth - thanks
Admin	I will put up a transcript of the Talk Night on the FACafe in the next few days.
dayna	Going back to the point made about the manikins not being so great for demo of opening theairway, is it better to demo on a volunteer casualty?
loopy loo	well guys it's been a good evening of chat and I’m sure I will come back again to do this as tonight is the first night i have ever done this and now i realise how easy it is well i don't know why I haven't done it before!! wow !!
Admin	The problem with a volunteer is that they are not unconscious - so muscles are not relaxed
Admin	thanks loopy
dayna	Ok Thanks. Like Loopy Loo it's my first time too. I'll be back. goodnight everyone. Thanks admin!
loopy loo	not many volunteers are willing anyway so it is much better to get them used to using a manikin at the start
Admin	Thanks to you all
Admin	I guess I should go and talk to my wife - so bye from me too
loopy loo	night night I’m off to bed myself work tomorrow thanks everyone !!!!!
mikael olafsson	Good night to all, thank you for the evening