First Responder EMS Curriculum for Training Centers in Eurasia

APPENDIX BSequence of Pediatric BLS: The ABCs of CPR(Taken from: “Part 9: Pediatric Basic Life Support” Circulation. 102(8) (Supplement):I-253-I-290, August 22,2000.)The BLS sequence described below refers to both infants (neonate outside the delivery roomsetting to 1 year of age) and children (1 to 8 years of age) unless specified. For information onnewly born infants (resuscitation immediately after birth), see "Part 11: Neonatal Resuscitation."For BLS for children > 8 years of age, see "Part 3: Adult Basic Life Support."Figure 24. Pediatric BLS algorithm.Resuscitation SequenceTo maximize survival and neurologically intact outcome following life-threateningcardiovascular emergencies, each link in the Chain of Survival must be strong, includingprevention of arrest, early and effective bystander CPR, rapid activation of the EMS system, andearly and effective ALS (including rapid stabilization and transport to definitive care andrehabilitation). When a child develops respiratory or cardiac arrest, immediate bystander CPR iscrucial to survival. In both adult and pediatric studies, bystander CPR is linked to improvedreturn of spontaneous circulation and neurologically intact survival. The greatest impact ofbystander CPR will probably be on children with noncardiac (respiratory) causes of out-ofhospitalarrest. Two studies report on the outcome of series of children who were successfullyresuscitated before EMS arrival solely by bystander CPR. The true frequency of this type ofresuscitation is unknown, but it is likely to be underestimated, because victims successfullyresuscitated by bystanders are often excluded from studies of out-of-hospital cardiac arrest.Unfortunately, bystander CPR is provided for only approximately 30% of out-of-hospitalpediatric arrests.BLS guidelines delineate a series of skills performed sequentially to assess and support or restoreeffective ventilation and circulation to the child with respiratory or cardiorespiratory arrest.Pediatric resuscitation requires a process of observation, evaluation, interventions, andassessments that is difficult to capture in a sequential description of CPR. You should initiallyFirst Responder EMS Curriculum/AIHA, July 2002 347