COVID-19 Update

CPR and resuscitation in first aid and community settings

RESUSCITATION COUNCIL UK STATEMENT ON COVID-19

This statement is for anyone who is performing CPR/defibrillation in an out-of-hospital setting.

Whenever CPR is carried out, particularly on an unknown victim, there is some risk of cross infection, associated particularly with giving rescue breaths. Normally, this risk is very small and is set against the inevitability that a person in cardiac arrest will die if no assistance is given. The first things to do are shout for help and dial 999.

  • Those laypeople and first responders with a duty of care (workplace first-aiders, sports coaches etc.) that may include CPR should be guided by their employer’s advice.
  • This guidance may change based on increasing experience in the care of patients with COVID-19.

“If you are untrained or unable to do rescue breaths, give chest compression-only CPR (i.e. continuous compressions at a rate of at least 100–120 per minute”.

Resuscitation Council UK Guidelines 2015

Because of the heightened awareness of the possibility that the victim may have COVID-19, Resuscitation Council UK offers this advice:

  • Recognise cardiac arrest by looking for the absence of signs of life and the absence of normal breathing. Do not listen or feel for breathing by placing your ear and cheek close to the patient’s mouth. If you are in any doubt about confirming cardiac arrest, the default position is to start chest compressions until help arrives.
  • Make sure an ambulance is on its way. If COVID 19 is suspected, tell them when you call 999 / 112.
  • If there is a perceived risk of infection, rescuers should place a cloth/towel over the victims mouth and nose and attempt compression only CPR and early defibrillation until the ambulance (or advanced care team) arrives. Put hands together in the middle of the chest and push hard and fast.
  • Early use of a defibrillator significantly increases the person’s chances of survival and does not increase risk of infection.
  • If the rescuer has access to personal protective equipment (PPE) (e.g. FFP3 face mask, disposable gloves, eye protection), these should be worn.
  • After performing compression-only CPR, all rescuers should wash their hands thoroughly with soap and water; alcohol-based hand gel is a convenient alternative. They should also seek advice from the NHS 111 coronavirus advice service or medical adviser.

RESUSCITATION COUNCIL UK PAEDIATRIC ADVICE

We are aware that paediatric cardiac arrest is unlikely to be caused by a cardiac problem and is more likely to be a respiratory one, making ventilations crucial to the child’s chances of survival. However, for those not trained in paediatric resuscitation, the most important thing is to act quickly to ensure the child gets the treatment they need in the critical situation.

For out-of-hospital cardiac arrest, the importance of calling an ambulance and taking immediate action cannot be stressed highly enough. If a child is not breathing normally and no actions are taken, their heart will stop and full cardiac arrest will occur. Therefore, if there is any doubt about what to do, this statement should be used.

It is likely that the child/infant having an out-of-hospital cardiac arrest will be known to you. We accept that doing rescue breaths will increase the risk of transmitting the COVID-19 virus, either to the rescuer or the child/infant. However, this risk is small compared to the risk of taking no action as this will result in certain cardiac arrest and the death of the child.



EUROPEAN RESUSCITATION COUNCIL COVID-19 GUIDELINES

General recommendations for BLS in adults by lay rescuers for suspected or confirmed COVID-19. This guideline was provided on 24 April 2020 and will be subject to evolving knowledge and experience of COVID-19. As countries are at different stages of the pandemic, there may be some international variation in practice.

  • Cardiac arrest is identified if a person is unresponsive and not breathing normally.
  • Responsiveness is assessed by shaking the person and shouting. When assessing breathing, look for normal breathing. In order to minimise the risk of infection, do not open the airway and do not place your face next to the victims’ mouth / nose.
  • Call the emergency medical services if the person is unresponsive and not breathing normally.
  • During single-rescuer resuscitation, if possible, use a phone with a hands-free option to communicate with the emergency medical dispatch centre during CPR.
  • Lay rescuers should consider placing a cloth/towel over the person’s mouth and nose before performing chest compressions and public-access defibrillation. This may reduce the risk of airborne spread of the virus during chest compressions.
  • Lay rescuers should follow instructions given by the emergency medical dispatch centre.
  • After providing CPR, lay rescuers should, as soon as possible, wash their hands thoroughly with soap and water or disinfect their hands with an alcohol-based hand-gel and contact the local health authorities to enquire about screening after having been in contact with a person with suspected or confirmed COVID-19.

EUROPEAN RESUSCITATION COUNCIL RECOGNITION OF CARDIAC ARREST IN CHILDREN AND BLS ALGORITHM

Check for responsiveness - in an unresponsive child, assess breathing visually (chest rise) and optionally by placing a ‘hand on the belly’. Do not approach the victim’s mouth or nose at this stage. Cardiac arrest is defined by ‘being unresponsive and not breathing normally’.

Untrained lay rescuers will likely have called the emergency medical services [EMS] dispatcher (112/national emergency number) at the start; trained providers should do so before starting chest compressions. In cases where there are two or more rescuers, a second rescuer should call the EMS immediately.

Once cardiac arrest is identified, rescuers should provide at least compression-only CPR. In such a case, place a surgical mask over the child’s mouth and nose before commencing chest compressions. The routine use of a cloth as an alternative is not advised because of the potential risk of airway obstruction and/or restriction of passive air movement (due to compressions); there is also no evidence that a cloth prevents airborne transmission. However, when a surgical mask is not available and this cloth encourages rescuers to provide support where otherwise they would not, they should use it (lightly draped over mouth and nose).

Unless a primary cardiac origin is likely (‘sudden witnessed collapse’), those rescuers who are willing and able should also open the airway and provide rescue breaths, as per 2015 guidelines, knowing that this is likely to increase the risk of infection (if the child has COVID-19), but can signi cantly improve the outcome (see ‘Protection of bystanders and healthcare professionals’).

EUROPEAN RESUSCITATION COUNCIL COVID-19 AED GUIDELINES

When an automated external de brillator [AED] is readily available, trained providers should use it as soon as feasible. An AED should primarily be advised as part of dispatcher-assisted CPR in those cases where the likelihood of a primary shockable rhythm is suficiently high: in cases of sudden witnessed collapse; for children with a specific ‘cardiac’ history; or for children older than 1 year of age without any identifiable non-cardiac cause of arrest, always provided there are at least two bystanders and an AED nearby.



RECENTLY EXPIRED CERTIFICATES

The Health & Safety Executive in the UK states the following;

If you hold a first aid certificate that expires on or after 16 March 2020 and cannot access requalification training because of coronavirus you may qualify for a 3-month extension. This applies to:

  • Offshore Medic (OM)
  • Offshore First Aid (OFA)
  • First Aid at Work (FAW)
  • Emergency First Aid at Work (EFAW)

To qualify for the extension, you must be able to explain why you haven’t been able to requalify and demonstrate what steps you have taken to access the training, if asked to do so.

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