First Responder EMS Curriculum for Training Centers in Eurasia

Epidemiological data does not distinguish between FBAO fatalities in which the victims areresponsive when first encountered from those in which the victims are unresponsive wheninitially encountered. Anecdotal evidence, however, suggests that the lay rescuer is more likelyto encounter a victim of FBAO who is conscious initially.The likelihood that a cardiac arrest or unresponsiveness will be caused by an unsuspected FBAOis thought to be low. However, the impact of averting a cardiac arrest in a responsive victim withcomplete airway obstruction would be significant.The 1992 guidelines for treatment of FBAO in the unconscious/unresponsive victim were timeconsuming to teach and perform and were often confusing to students. Training programs thatattempt to teach large amounts of material to lay rescuers may fail to achieve core educationalobjectives (i.e., the psychomotor skills of CPR), resulting in poor skills retention andperformance. Focused skills training results in superior levels of student performance comparedwith traditional CPR courses. This data indicates a need to simplify CPR training for laypersons,including skills in relief of FBAO.Expert panelists at the Second AHA International Evidence Evaluation Conference held in 1999and at the International Guidelines 2000 Conference on CPR and ECC agreed that lay rescuerBLS courses should focus on teaching a small number of essential skills. These essential skillswere identified as relief of FBAO in the responsive/conscious victim and the skills of CPR.Teaching of the complex skills set of relief of FBAO in the unresponsive/ unconscious victim tolay rescuers is no longer recommended (Class IIb).If the infant or child choking victim becomes unresponsive/unconscious during attempts torelieve FBAO, provide CPR for approximately 1 minute and then activate the EMS system.Several studies indicate that chest compressions identical to those performed during CPR maygenerate sufficient pressure to remove a foreign body. If the lay rescuer appears to encounter anairway obstruction in the unresponsive victim during the sequence of CPR after attempting andreattempting ventilation, the rescuer should look for and remove the object if seen in the airwaywhen the mouth is opened for rescue breathing. Then the rescuer continues CPR, including chestcompressions and cycles of compressions and ventilation.Healthcare providers should continue to perform abdominal thrusts for responsive adults andchildren with complete FBAO and alternating back blows and chest thrusts for responsive infantswith complete FBAO. Healthcare providers should also be taught the sequences of actionappropriate for relief of FBAO in unresponsive infants, children, and adults. These sequences ofactions for healthcare providers are unchanged from the 1992 guidelines.Relief of FBAO in the Responsive Infant: Back Blows and Chest ThrustsThe following sequence is used to clear a foreign-body obstruction from the airway of an infant.Back blows are delivered while the infant is supported in the prone position, straddling therescuer's forearm, with the head lower than the trunk. After 5 back blows, if the object has notbeen expelled, give up to 5 chest thrusts. These chest thrusts consist of chest compressions overthe lower half of the sternum, 1 finger's breath below the intermammary line. This landmark isthe same location used to provide chest compressions during CPR. Chest thrusts are deliveredwhile the infant is supine, held on the rescuer's forearm, with the infant's head lower than thebody.380 First Responder EMS Curriculum/AIHA, July 2002