First Responder EMS Curriculum for Training Centers in Eurasia

CPR. The child must be moved if he or she is in a dangerous location (i.e., a burning building) orif CPR cannot be performed where the child was found.If a second rescuer is present during the initial assessment of the child, that rescuer shouldactivate the EMS system as soon as the emergency is recognized. If trauma is suspected, thesecond rescuer should activate the EMS system and then may assist in immobilizing the child'scervical spine, preventing movement of the neck (extension, flexion, and rotation) and torso. Ifthe child must be positioned for resuscitation or moved for safety reasons, support the head andbody and turn as a unit.Activate EMS System if Second Rescuer Is AvailableBecause all of the links in the Chain of Survival are connected, it is difficult to evaluate the effectof EMS system activation or specific EMS interventions in isolation. In addition, local EMSresponse intervals, dispatcher training, and EMS protocols may dictate the most appropriatesequence of EMS activation and early life support interventions for a given situation.Current AHA guidelines instruct the rescuer to provide approximately 1 minute of CPR beforeactivating the EMS system in out-of-hospital arrest for infants and children up to the age of 8years. In the International Guidelines 2000 the "phone first" sequence of resuscitation continuesto be recommended for children > 8 years of age and adults. The "phone fast" sequence ofresuscitation continues to be recommended for children < 8 years of age on the basis of face andconstruct validity (Class Indeterminate).The AHA Subcommittees on Pediatric Resuscitation and BLS and a panel addressing thecitizen's response in the Chain of Survival debated a proposal to teach lay rescuers to tailor theCPR sequence and EMS activation to the likely cause of the victim's arrest rather than thevictim's age. This proposed approach would teach lone lay rescuers to provide 1 minute of CPRbefore activating the EMS system if a victim of any age collapses with what is thought to be aprobable breathing/respiratory problem. Lone lay rescuers would also be taught to activate theEMS system immediately if a victim of any age collapses suddenly (presumed sudden cardiacarrest). Although the proposal has appeal when considered for an individual victim, it wasrejected for several reasons. First, no data was presented that indicated that a change to anetiology-based triage method for all age groups would improve survival for victims of out-ofhospitalcardiac arrest. Second, the proposal would probably complicate the education of layrescuers. CPR instruction must remain simple for lay rescuers. Retention of CPR skills andknowledge is already suboptimal. The addition of complex instructions to existing CPRguidelines would most likely make them more difficult to teach, learn, remember, and perform.It is important to note that the "phone first" or "phone fast" sequence is applicable only to thelone rescuer. When multiple rescuers are present, 1 rescuer remains with the victim of any age tobegin CPR while another rescuer goes to activate the EMS system. It is unknown how frequently2 or more lay responders are present during initial evaluation of a pediatric cardiopulmonaryemergency.Sophisticated healthcare providers, family members, and potential rescuers of infants andchildren at high risk for cardiopulmonary emergencies should be taught a sequence of rescueactions tailored to the potential victim's specific high-risk condition. For example, parents andchild care providers of children with congenital heart disease who are known to be at risk forFirst Responder EMS Curriculum/AIHA, July 2002 349