First Responder EMS Curriculum for Training Centers in Eurasia

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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
Figure 41. Infant back blows to relievecomplete FBAO.Perform the following steps to relieve airway obstruction (the rescuer is usually seated orkneeling with the infant on the rescuer's lap):1. Hold the infant prone with the head slightly lower than the chest, resting on your forearm.Support the infant's head by firmly supporting the jaw. Take care to avoid compressing thesoft tissues of the infant's throat. Rest your forearm on the your thigh to support the infant.2. Deliver up to 5 back blows forcefully in the middle of the back between the infant's shoulderblades, using the heel of the hand. Each blow should be delivered with sufficient force toattempt to dislodge the foreign body.3. After delivering up to 5 back blows, place your free hand on the infant's back, supporting theocciput of the infant's head with the palm of your hand. The infant will be effectively cradledbetween your 2 forearms, with the palm of one hand supporting the face and jaw, while thepalm of the other hand supports the occiput.4. Turn the infant as a unit while carefully supporting the head and neck. Hold the infant in thesupine position, with your forearm resting on your thigh. Keep the infant's head lower than thetrunk.5. Provide up to 5 quick downward chest thrusts in the same location as chest compressionslowerthird of the sternum, approximately 1 finger's breadth below the intermammary line.Chest thrusts are delivered at a rate of approximately 1 per second, each with the intention ofcreating enough of an "artificial cough" to dislodge the foreign body.6. If the airway remains obstructed, repeat the sequence of up to 5 back blows and up to 5 chestthrusts until the object is removed or the victim becomes unresponsive.Relief of FBAO in the Responsive Child: Abdominal Thrusts (Heimlich Maneuver)Note: Three maneuvers are suggested to relieve FBAO in the child: back blows, chest thrusts, and abdominalthrusts. Back blows and chest thrusts may be alternative interventions for FBAO in children, and internationaltraining programs should train providers on the basis of ease of teaching and retention in their community.Abdominal Thrusts with Victim Standing or SittingThe rescuer should perform the following steps to relieve complete airway obstruction:1. Stand or kneel behind the victim, arms directly under the victim's axillae, encircling thevictim's torso.2. Place the flat, thumb side of 1 fist against the victim's abdomen in the midline slightly abovethe navel and well below the tip of the xiphoid process.3. Grasp the fist with the other hand and exert a series of up to 5 quick inward and upwardthrusts. Do not touch the xiphoid process or the lower margins of the rib cage, because forceapplied to these structures may damage internal organs.First Responder EMS Curriculum/AIHA, July 2002 381
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PrefaceIn the region of Central and
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Practical Lab MaterialsAirway .....
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Guidelines for Conducting the First
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sheets supplied in this guide will
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should have attended a workshop tha
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Job Description: First ResponderThe
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c. Additional Skills1. Use of the t
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as possible. After students have pr
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Guidelines for Case-Based Practical
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General Lecturing GuidelinesChapter
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discussing the different methods of
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survival. First Responders include
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medical director functions to ensur
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First Responder EMS Curriculum/AIHA
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Well-Being of the First ResponderCo
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and family. Do not become defensive
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1. Eye protection. Safety glasses m
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Legal and Ethical IssuesContents1.
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a. Expressed ConsentExpressed conse
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14. DocumentationProviding written
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The Human Body: A Systems ApproachC
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that the pharynx performs the dual
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c. Kinesthetic (Doing)1. Students w
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38 First Responder EMS Curriculum/A
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Lifting and Moving PatientsContents
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If the patient is on the floor or g
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7. Application of Content Materiala
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14. Describe how to clear a foreign
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Precautions1. Finger must not press
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. Finger SweepsThis method involves
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4. Place your other fingers along t
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. Management of the Obstructed Airw
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5. Students will practice ventilati
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19. Explain what additional questio
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can be determined by questioning th
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Determine estimated time of arrival
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E - Events Leading to the Injury or
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c. Kinesthetic (Doing)1. Students w
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100 First Responder EMS Curriculum/
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CirculationContents1. Objectivesa.
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Veins are the vessels that carry bl
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Step 5:Step 6:Step 7:Step 8:Step 9:
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Steps of Infant CPRStep 1: Assess r
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a. Use of the Semiautomatic Externa
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PracticalEvaluate the actions of th
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Medical EmergenciesContents1. Objec
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5. Demonstrate the steps in providi
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additional emergency medical person
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this internal temperature, adverse
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Signs and SymptomsSigns and symptom
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3. Ask questions in a calm, reassur
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EvaluationWrittenDevelop evaluation
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2. Attend to the feelings of the pa
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transmission of disease to yourself
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Sharp, pointed objects cause penetr
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c. Chemical BurnsChemical burns fro
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6. Partial-thickness burns7. Full-t
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2. Demonstrate opening the airway i
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3. Try to pad the extremity to prev
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soft tissue injuries. Remember, the
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2. IntroductionChildbirth can occur
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a. Delivery ProceduresWhen assistin
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5. Student Activitiesa. Auditory (H
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Infants and ChildrenContents1. Obje
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Suctioning the airway also is an im
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6. Common Problems in Infants and C
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Remember that parents will be in ag
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Vigorous shaking of a baby may show
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3. DispatchDispatch is the communic
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in the absence of airway problems,
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Documentation and Quality Managemen
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Identify concrete, specific project
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Practical Lab: AirwayObjectives1. C
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6. Students will practice insertion
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Assistant Instructor:The instructor
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Practical Lab: CirculationObjective
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Practical Lab: Illness and InjuryOb
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Instructor will demonstrate the pro
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19. Students will practice manual s
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Assistant InstructorThe instructor-
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Practical Lab: Lifting and Moving P
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EvaluationPracticalEvaluate the act
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4. Insert it posteriorly. Bevel sho
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• 20 breaths per minute for child
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one per second, each with the inten
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Skill Descriptions: Patient Assessm
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Skill Descriptions: CirculationNote
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4. To determine whether the victim
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• Place the two fingers of one ha
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Skill Descriptions: Illness and Inj
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• Apply enough pressure to contro
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12. As the feet are delivered, gras
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2. The rescuer at the head places o
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Skill Algorithms: AirwayForeign Bod
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Trauma PatientSkill Algorithms: Pat
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Skill Algorithms: Patient Assessmen
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Two-Person CPRSkill Algorithms: Cir
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External BleedingSkill Algorithms:
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Skill Algorithms: Illness and Injur
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Skill Algorithms: Childbirth and Ch
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Skill Algorithms: Lifting and Movin
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Skill Algorithms: Lifting and Movin
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Sample Case Scenario - Patient Asse
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Sample Case Scenario - Illness and
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Sample Case Scenario - Childbirth a
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• Demonstrate the extremity lift.
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Figure 6. Check for unresponsivenes
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Page 409: APPENDIX DRelief of Foreign-Body Ai
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Page 439 and 440: Answer KeyFirst Responder Extra Tes
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First Responder EMS Curriculum for Training Centers in Eurasia

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