First Responder EMS Curriculum for Training Centers in Eurasia

ed. The use of a wide board is particularly important when providing chest compressions tolarger children. If the board is too small, it will be pushed deep into the mattress duringcompressions, dispersing the force of each compression. Spine boards, preferably with headwells, can be used in ambulances and mobile life support units. They provide a firm surface forCPR in the emergency vehicle or on a wheeled stretcher and may also be useful for extricatingand immobilizing victims.Infants with no signs of head or neck trauma may be successfully carried during resuscitation onthe rescuer's forearm. The palm of one hand can support the infant's back while the fingers of theother hand compress the sternum. This maneuver effectively lowers the infant's head, allowingthe head to tilt back slightly into a neutral position that maintains airway patency. If the infant iscarried during CPR, the hard surface is created by the rescuer's forearm, which supports thelength of the infant's torso, while the infant's head and neck are supported by the rescuer's hand.Take care to keep the infant's head no higher than the rest of the body. Use the other hand toperform chest compressions. You can lift the infant to provide ventilation.Figure 33. One-rescuer infant CPR whilecarrying victim, with infant supported onrescuer's forearm.Indications for Chest CompressionsLay rescuers should provide chest compressions if the infant or child shows no signs ofcirculation (normal breathing, coughing, or movement) after delivery of rescue breaths.Healthcare providers should provide chest compressions if the infant or child shows no signs ofcirculation (breathing, coughing, movement, or pulse) or if the heart rate/pulse is < 60 bpm withsigns of poor perfusion after delivery of rescue breaths. Profound bradycardia in the presence ofpoor perfusion is an indication for chest compressions because cardiac output in infancy andchildhood is largely dependent on heart rate, and an inadequate heart rate with poor perfusionindicates that cardiac arrest is imminent. No scientific data has identified an absolute heart rate atwhich chest compressions should be initiated; the recommendation to provide cardiaccompression for a heart rate < 60 bpm with signs of poor perfusion is based on ease of teachingand skills retention.First Responder EMS Curriculum/AIHA, July 2002 363