| Resuscitation Council (UK) Talk night
16/7/04 Transcript - nearly 250 messages! |
Special Guest Dr Tony Handley aka AJH
from the Resuscitation Council (UK)
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. |
| Admin | Well, let's kick off... |
| Admin |
Let me start by offering a warm welcome to Dr Tony
Handley. Tony holds some impressive positions: 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 |
| White-Mini_Man | Before we start, can I just say a big thank you (on behalf of everyone) to Tony for taking the time to come and speak/type to us. |
| AnnieB | Hear hear |
| AJH | Thank you for asking me. I just hope my typing skills stand up to this! |
| Michael D | Most appreciative! |
| Einstein | Hi Tony. Einstein, on this forum + Richard from HSE (go on, laugh). This is your show. I'll watch from the sidelines and pick up any HSE-related points later. |
| AnnieB | Tony - What's the position on stopping rescue breathing? |
| AnnieB | and just doing chest compressions? |
| AJH | I thought you’d ask that ! As they say, I prepared this one beforehand … |
| AnnieB | excellent |
| AJH | There has been a lot of discussion (and a fair amount of rumour ) about removing ventilation from the sequence of basic life support for laypersons. Let me say straight away that no decision on this has been taken, and no change will occur (if at all) until the new guidelines are published in December 2005 |
| AnnieB | How do you feel about it? |
| AJH | I've been the author of an editorial basically in support of compression-only CPR in the right situation ... |
| AnnieB | Which is...? |
| AJH | ... and I think the evidence is very strong in favor. BUT (a big BUT) it is not proven yet |
| AJH | The situation is a layperson attending a primary cardiac arrest, and a rapid EMS response |
| AnnieB | But aren't you relying on getting enough depth on the compression |
| Michael D | Would you define a "rapid EMS response" |
| 11w | Tony does this apply to both resuscitation scenarios |
| AJH | Although cheat compressions help with ventilation, it is the fact that there is plenty of oxygen 'on board' that allows a period of compression only without ventilation |
| AJH | Rapid EMS? The sort of time talked about is 5-8 minutes |
| Admin | I seen that effectiveness of chest compressions soon diminishes due to fatigue. Does this make any difference? |
| AJH | I like 'cheat' compressions!! |
| scouter | and we know the EMS will arrive how? |
| AnnieB | absorption time is limited though |
| White-Mini_Man | for what length of time is there sufficient oxygen in the bloodstream? |
| AJH | The evidence is that after one minute of compressions, a rescuer's performance diminishes .. |
| AJH | .. it always matters if compressions are poor! |
| Admin | and at 5-8 mins is it still worth while? |
| AJH | Oxygen in the bloodstream? Can't give exact figures, but 5 minutes is(again) the sort of time spoken about |
| AJH | Is what worthwhile? continuing CPR? |
| AnnieB | Surely not to start EMS after 5 mins - not going to be effective is it? |
| AJH | It could well be (and I am thinking aloud) that after, say, 5 minutes ventilations need to be started |
| Michael D | Without large volume ventilation, is there a build-up of increased toxic waste products, i.e. acidosis in that 5-8 minutes., that would be more of a problem than might be seen if the victim is permitted to exhale? |
| AJH | Sorry, Annie, don't quite follow that. |
| scouter | This relies on two things: 1) effective diagnosis and 2) Knowing EMS is on it's way. |
| Admin | As effectiveness of chest compressions reduces after 1 min does the evidence on no chest comp take this into account? |
| White-Mini_Man | just thinking at this from another angle - it'll take ages to run an assessment! :-) |
| AJH | Michael: We really don't know how long (if at all - this is NOT proven) that compressions alone are as good as or better than full CPR |
| Admin | sorry no rescue breathing |
| AnnieB | Are you saying that there is enough circulating O2 so that ventilation can be started after 5 minutes of a casualty not breathing? |
| AJH | Admin: Nothing nearly so clever as this! Like so much in CPR, we have some evidence but nothing like enough |
| Michael D | Would this CPR-only have any effect on the use of a public access defibrillator? |
| Eric@54 | Why change then? |
| Admin | not enough volunteers I guess :-} |
| AJH | Annie: If you mean can we wait 5 minutes safely before starting ventilation on a victim of respiratory arrest but not cardiac arrest - definitely no! |
| AJH | Sorry - it's difficult keeping up with the questions! |
| Michael D | This intrigues me because students are always wary of blood borne pathogens from mouth-to-mouth, but they will do compressions |
| AnnieB | I thought not |
| AnnieB | I always advise using a face shield |
| echo | I for one was in the ambulance service for 16 years and in all my time I have found that a combination of chest compressions and ventilation was the only effective way of "pinking up the Casualty" |
| AnnieB | Improvise if they don't have one |
| AJH | Michael: Yes, if this change occurs, it would have a significant effect on how the public are taught, but probably not the healthcare/advanced first aid community |
| Michael D | Availability is an issue for those not in a formal response situation. |
| scouter | so we then have levels of care? |
| AnnieB | I was an A & E sister for a long time and we tried compressions only when severe facial injuries came in before we could intubate and it wasn't very successful. |
| AJH | Please be sure to understand that I am NOT advocating compression-only CPR for professionals! |
| scouter | define professionals |
| debs | I advixe using items of own clothing as a barrier and ensuring you fold it to at least 4 layers? |
| Michael D | I understand. It's just that most professionals find themselves in a situation where they are teaching the lay public. |
| AJH | Also, remember that we are ONLY talking about primary cardiac arrest - that is, a heart attack etc - and NOT, very definitely OT, cases of primary respiratory arrest, such as drowning, trauma, overdose etc |
| Michael D | Thanks, Deb. I'll use that in classes. |
| Michael D | So this would be what used to be called a "Witnessed" Arrest? |
| AJH | Probably |
| Admin | I attended a conference and it showed that oxygen was not the main concern. But by stopping compressions 2 carry out breathing reduced the pressure in the chest cavity. |
| WINDSURFER | Does anybody know of a rescuer actually contracting anything by doing MTM without protection? |
| Admin | Allowing one chamber of the heart to over fill. To empty the chamber several compressions were needed b4 chest compressions became effective again. |
| Michael D | I probably need to apologize. I'm from out of town, separated from most of the participants by a common language! |
| echo | I am now speaking as a lay person now and I for one would hope if I had a cardiac arrest someone would do ventilations on me ASAPI find it frustrating to |
| AJH | Admin: Absolutely! There is very impressive animal data that supports this |
| Eric@54 | Was that pigs? |
| Michael D | I think that the concepts presented here might reinforce the rescuer's confidence in dealing with an obstructed airway. |
| scouter | Do they fly? |
| Eric@54 | No seriously |
| AJH | Echo: That is assuming that they can do it without long pauses to give the ventilations. During these periods the heart suffers badly |
| Einstein | Windsurfer, HSE has done some work on this. There is no convincing evidence that anybody has ever contracted an infection through MTM |
| Admin | I feel impressed - cuz I thought I knew nothing about 1st Aid :-) |
| AnnieB | Windsurfer - I personally haven't known anyone contract anything but I have had stomach and lung contents come out at me. Most unpleasant. |
| Michael D | Please define "HSE" |
| WINDSURFER | So why do we give so much energy to making sure ff/aiders use a faceshield? Where is the proven danger? |
| debs | Hep B |
| Adventure First Aid | face shields make nasty facial injuries that are not breathing slightly easier for the lay person to deal with |
| debs | Smells and dirt put people off as well |
| Eric@54 | And C |
| Einstein | And allergy/irritation problems. I'll pick this one up in the forum if you like |
| debs | Herpes |
| Admin | I guess that face shields give a certain amount of mental comfort |
| WINDSURFER | Debs: RU saying people have actually caught Hep B thru doing resus? If so where is the evidence? |
| 11w | ok debs enough about yourself |
| echo | If they are taught "properly this should not occur! |
| AJH | If you want proven protection against infection, you need to use mouth to mask technique. But the risk of transmission is very small, especially for HIV, Hepatitis etc |
| WINDSURFER | Tony: can you comment on the possibility of con tracting Hep? |
| AnnieB | Echo, echo! |
| Einstein | Agreed |
| AJH | I anticipated you! |
| Adventure First Aid | are we not concerned at all with giving the casualty an infection though an open wound... more chance of that I would suggest |
| AJH | No proven transmission of these infections recorded |
| AnnieB | We must be very predictable Tony! |
| AJH | Different (only in theory, not in recorded cases) if blood is present. |
| Eric@54 | I wouldn't do m2m without a mask Well....? |
| scouter | If I was about to die an infection would be the least of my worries! |
| AnnieB | If someone isn't breathing, giving them an infection through an open wound is the least of their worries. |
| Adventure First Aid | so you carry a mask everywhere |
| AJH | Annie: Not so much predictable, as raising real concerns that others have |
| scouter | snap |
| Michael D | Comparable to our beloved OSHA |
| jo o | I do - on my keyring |
| Eric@54 | But I always have one. |
| Admin | What about recovery position any likely changes there |
| AnnieB | Absolutely - well done you |
| bluecrystalman | how available are the keyring ones and how much? |
| White-Mini_Man | I have a keyring one on me always, and a pocket-mask on my bag strap |
| AJH | Recovery position? No change! |
| Einstein | Michael, HSE = Health and Safety Executive, the guys who license organasiations to provide First Aid at Work training. |
| WINDSURFER | Tony: Question on child resus. 1/3 to 1/2 of depth of chest. Why so deep is a question I often get asked? |
| debs | No straight arm |
| Eric@54 | Oh well.... |
| Michael D | Thanks. |
| Admin | Ambu - see www.FirstAidShop.co.uk - sorry for advert |
| AJH | Children: We probably need more compression depth in adults, but don't have the nerve to give it! In children the chest wall is much more compliment and there is less likelihood of damage |
| Adventure First Aid | with regards the "recovery position" i suggest that any position as long as the airway is safe, and the spine is straight is fine... then you give people far more option |
| ron reynolds | Recovery position no change good FA is getting like NVQ change round every three years, not always or the best. |
| scouter | depth of compression with lay persons is the main problem |
| Eric@54 | Why no change to straight arm that seems to be a popular option? |
| AJH | Recovery position: See the 6 principles suggested by ILCOR in 1996! |
| Michael D | Under this study, would the rate of compressions change? We give (USA) compressions at the rate of 100 per minute, but that's based on short periods of no compressions during ventilation. Could we slow down the compressions a bit under the no-ventilation concept? The rate contributes to the fatigue of the rescuer. |
| Admin | There has been discussions in the forum that the 'Recovery Position' is a misleading term - maybe 'Drain Position' |
| bluecrystalman | Why straight arm, I just completed FAAW course and we were taught nearest arm bent up in How position? |
| Eric@54 | Yes that too |
| Adventure First Aid | we call it a safe airway position |
| AJH | Michael: ILCOR is reviewing as much of the scientific data as it can. I have not yet seen the compression rate worksheet, but I doubt that there will be any change advised - but I cannot say that for certain at this stage |
| Einstein | "Drain, not drown" |
| Eric@54 | Some arms don't bend that readily |
| debs | Airway position |
| Adventure First Aid | some people don't have arms or legs |
| bluecrystalman | are you saying arm straight out to side then? |
| AnnieB | Tony - have to go - thank you for answering questions - how long will you be here? |
| Eric@54 | Why not? |
| carol L | I was taught straight arm to how position depending on build of cas shoulders |
| debs | Difficult to bend if they are not there |
| AJH | Back to RP and its name! Long discussion, but the BLS/AED Subcommittee of the Resuscitation Council (UK) was asked this, and agreed that there was no good reason to change from the existing name |
| Michael D | Again, I apologize -- please define ILCOR. |
| Adventure First Aid | it does not matter where the arm is as long as the airway is open and draining |
| AJH | International Liaison Committee on Resuscitation |
| Admin | Annie there will be a transcript of this put up on the site shortly |
| Michael D | thanks. |
| bluecrystalman | I am and advocator of arm anywhere, as long as airway is open, people get hung up on this is the only way! |
| debs | Tony what are your thoughts on 2 person CPR |
| run reynolds | what has happened to standardisation? all these varying terms no wonder the trainees get confused, we have to remember that when we finish with them they go out and tel people about the course and confusion steps in when they meet up with a first aider taught differently? |
| AJH | Annie: I'm not sure - get hungry or my typing deteriorates too much! Seriously, about 9.15 to 9.30? |
| Eric@54 | Tony what do you think of the way Jaw Thrust is described in the NPLQ manual? |
| Admin | If changes are decided, what route occurs to put them in practice |
| AJH | Eric: I shall have to look that up - but I did not write that section! |
| Admin | 1 4 HSE maybe |
| Adventure First Aid | it all depends how you teach people! |
| debs | Names not Tony but I don't think it is too difficult to understand! |
| Adventure First Aid | options are different to standardisation |
| Eric@54 | That's what I thought! |
| AJH | Debs: What thoughts do you mean? Do I think it is better than single-person CPR? |
| White-Mini_Man | Eric - I'll be seeing Peter Whitall on Sunday, he was one of the Editors - I'll ask him for you |
| debs | Do you think it will return for gen public |
| Eric@54 | Thanks WMM! |
| debs | Ron, when we teach it is important to let the delegates know there are other options and that your method suits you and follows the guidelines |
| mariana | hallo, nice to meet you |
| AJH | Debs: No - at least I hope not! To perform CPR better with two people, you need both to be trained in that technique. My experience is very much that 2-person CPR performed badly results in long hands-off periods. Very bad for the victim! |
| debs | But also that others may teach something slightly different, this is also okay. FA is not just Black n White |
| debs | But what about those who were taught it well. 11w and I have never performed cpr together but I bet we could do effective 2 person cPR |
| ron reynolds | Thanks Debs I consider myself to be a good FA Trainer but perhaps I have been in NVQ training To long. |
| AJH | Two-person CPR performed well as a team PROBABLY is better than one-person, but there is no proof of this |
| divetech | Hi, do you, or the HSE classify a Lifeguard as a Health Care Provider, a Layperson or advanced First Aider, bearing in mind that they receive monthly training (or should be) in resuscitation, and many are now trained in the use of AED's and 02? |
| White-Mini_Man | but that is because you maintain your skills to a high standard ( I assume) both being Trainers - the gen. pub. aren't necessarily |
| Eric@54 | Pool Lifeguards train in 2 person CPR Trained Teams |
| AJH | The RC(UK) does NOT classify a lifeguard as a healthcare provider |
| debs | so should trainers do 2 person CPR |
| Adventure First Aid | a lifeguards would be a layperson who is very well practiced at first aid |
| White-Mini_Man | LGs have to train in CPR on a monthly basis though - the gen. pub. don't |
| AJH | Lifeguards are taught two-person CPR because they are fully trained in this and are used to working as a team |
| scouter | AFA: like trainers then? |
| Adventure First Aid | one would hope so!! |
| carol L | Scouter well said |
| Eric@54 | Tony do you think 2 per CPR will come out of the NPLQ syllabus? |
| Admin | Resuscitation Council Scientific Congress in Budapest this September |
| AJH | Eric: No |
| Eric@54 | Good |
| Admin | What outcomes do you expect |
| debs | so should trainers do 2 person CPR |
| mariana | hallo Tony, I am from Bulgaria |
| AJH | Its the ERC, not RC(UK), Congress! What outcomes? There are so many sessions and lectures that it is hard to guess.. |
| White-Mini_Man | Tony, could I ask if the child choking sequence is likely to change, as I think most find it absurdly complicated, and there is a fair few disparities between different training manuals e.g. NPLQ & VAS |
| mariana | I am not a medical personnel |
| Admin | we have an international Flavour tonight! |
| White-Mini_Man | if so, what is it likely to change to? |
| mariana | I would like to know if it is possible to become a BLS trainer |
| AJH | ... do consider coming to the session in which we are asking for suggestions as to what you would like see changed in the guidelines! |
| mariana | I would like to take part in the pre-congress course in Budapest but I am not sure if I have a chance? |
| AJH | Child choking sequence is, as you say, incredibly complicated! I am not involved in the paediatric guidelines, but I have been going on at the paediatricians since year 2000 - maybe they will listen!! |
| Adventure First Aid | will there be a full transcript of this on the web site... I have to go |
| mariana | here in my country I am a trainer but I wish to have a certificate |
| Admin | There are a Few members of the FAC going to Budapest |
| Admin | Yes AFA |
| Adventure First Aid | thank you... interesting discussion...# |
| White-Mini_Man | I hope so! :-) |
| AJH | Marina: The ERC BLS/AED/Instructor Course is open to 'first aiders' as well as doctors/nurses/paramedics. Contact the ERC (email address coming up) and ask. There are still places available |
| debs | Hello Mike |
| AJH | Contact: inge.beuckelaers@erc.edu |
| ron reynolds | Good night all very interesting when I eventually got hold of what was happening as this was my first ever visit to a chat room. thank you all and good night eric |
| Eric@54 | Night Ron |
| Admin | Tony, you must be feeling a little fatigued by now, maybe we should ask for the last question |
| AJH | Anyone left on line? Or is it time for my dinner?! |
| AnnieB | I'm back - managed to escape duty - are you going - was it something I said? |
| Admin | There's still a lot of people listening in |
| Michael D | Eat well, Tony, and thanks for a great discussion. |
| White-Mini_Man | There's plenty of people still here - lot's of lurkers |
| jo o | I'm here |
| Admin | As a question. How long does it take for changes to be implemented? |
| AJH | You are letting me off lightly! |
| AAKD | Hi AJH. aakd JUST LOGGED ON. Am I too late? |
| AnnieB | Have you any advice on the child choking |
| Eric@54 | I am still on line Tony but enjoy your dinner! |
| AJH | The ILCOR ‘Consensus 2000’ document is due for publication in November 2005, and the ERC Guidelines are due for publication in December 2005. It is expected that the Resuscitation Council (UK) Guidelines will appear at the same time as those from the ERC. |
| Admin | Well I sure we would all agree, this has been an interesting evening.. |
| Mareezy | Hi I'm lurking too - my first visit so wanted to see what happens |
| Einstein | I think we all owe Tony a big vote of thanks for hosting a very interesting, and very busy, chat session |
| Admin | I would like to thank Dr Tony Handley for his time. |
| White-Mini_Man | definitely Einstein |
| AJH | Child choking: I must be careful as it is my paediatric colleagues who make the guidelines. I can only say 'follow the guidelines' and hope that thy will be simplified! |
| Admin | BIG thanks |
| scouter | Yes - Thanks - enjoy your dinner but don't choke :-) |
| debs | Thanks Tony, we gave you an easy run, but you handled us well!! |
| AJH | It's been a pleasure! Hop to see many of you in Budapest! |
| AnnieB | Me too, I am running courses for parents, grandparents etc and they find it very confusing |
| AAKD | Admin. Will there be a summary from this discussion on the site. |
| Admin | Your typing is excellent |
| Eric@54 | Thanks for the talk! |
| Admin | Yes - transcript will be up in a few days |
| AnnieB | Thank you Tony - hope to meet up with you |
| Mareezy | all interesting - thanks |
| AJH | As I say, see you in Budapest! |
| carol L | thank you its my first time on line and I'm glad I've not been baffled by science if feel I could join again |
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