East of England Ambulance Service
NHS Trust
Basic Life Support and
Automated External
Defibrillation
12/02/201
5
Objectives
BLS & AED
At the end of this course participants
should be able to demonstrate:
How to assess the collapsed casualty.
How to perform Basic Life Support (BLS).
How to place an unconscious breathing
victim in the recovery position.
Introduction to operating an automated
external defibrillator (AED) safely.
East of England Ambulance Service
NHS Trust
Date12/02/2015
BLS & AED
Background
In the UK approximately 30,000 people
sustain cardiac arrest outside hospital and are
treated by emergency services each year.
Bystander CPR and early Defibrillation are
vital interventions before the arrival of
emergency services.
If defibrillation is delivered promptly, survival
rates as high as 75% have been reported.
The chances of successful defibrillation
decline at a rate of about 10% with each
minute of delay.
East of England Ambulance Service
NHS Trust
Date12/02/2015
BLS & AED
Anyone can do it?
East of England Ambulance Service
NHS Trust
Date12/02/2015
BLS & AED
2%
4%
30%
East of England Ambulance Service
NHS Trust
Date12/02/2015
BLS & AED
Angina
Suspected Heart Attack
CARDIAC
CONDITIONS
East of England Ambulance Service
NHS Trust
Date12/02/2015
BLS & AED
Cardiac Conditions
Coronary heart disease is the UK's biggest
killer, with 1 in every 4 men and 1 in
every 6 women dying from the disease.
In the UK, approximately 300,000 people
have a heart attack each year.
Angina affects about1 in 50 people, and
in the UK there are an estimated 1.2 million
people with the condition. It affects men
more than women, and your chances of
being affected increase with age.
East of England Ambulance Service
NHS Trust
Date12/02/2015
Blood returning
from upper
body
BLS & AED
Oxygenated blood to
upper body
Blood to
lungs
Blood to
lungs
Oxygenated
blood from
lungs
Oxygenated blood
from lungs
Blood returning from
lower body
Oxygenated blood to
lower body
East of England Ambulance Service
NHS Trust
Date12/02/2015
BLS & AED
How many times does
the human Heart beat
in a day ?
100,800 beats per
day
(70 beats x 60 minutes x 24
hours = 100,800 beats)
East of England Ambulance Service
NHS Trust
Date12/02/2015
BLS & AED
Suspected Heart
Attack
East of England Ambulance Service
NHS Trust
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BLS & AED
Heart Attack
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NHS Trust
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BLS & AED
Suspected Heart Attack
-Pale, cold & clammy skin
-Rapid weak pulse
-Rapid shallow breathing
-Nausea
-Vomiting
-Pain in chest possibly radiating into arm, back
and/or jaw
-Sweating
-Impending sense of doom
Some or all of these symptoms may be
present,
noService
two Heart attacks are the
East
of England Ambulance
same......
Date12/02/2015
NHS Trust
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BLS & AED
Cardiac Conditions
Angina is a pain or discomfort felt in the
chest caused by coronary heart disease.
Typically presents as heaviness or
tightness in the chest
Often brought on by physical activity.
Symptoms usually subside after a few
mins.
Angina Suffers usually carry GTN
medication in the form of a spray or tablet
East of England Ambulance Service
NHS Trust
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BLS & AED
Suspected Heart attack
Dial 999 or 112 for Ambulance
-Rest in a comfortable position
-Reassure
-Help casualty to take their own GTN
-Be prepared to resuscitate
-Have AED available
If in any Doubt dial 999 or 112
East of England Ambulance Service
NHS Trust
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BLS & AED
Primary Survey
Performing CPR
Recovery Position
BASIC LIFE
SUPPORT
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NHS Trust
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BLS & AED
Primary Survey
Initial assessment using the primary survey
-
D anger
(Global overview)
- R esponse
- S hout for help
- A irway
- B reathing
- C all 999/112 - commence CPR
East of England Ambulance Service
NHS Trust
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BLS & AED
Airway Management
Airway Open
Airway Closed
Airway Obstructed
An unconscious casualty has no control over their muscles, including the
muscles that control the tongue.
East of England Ambulance Service
NHS Trust
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BLS & AED
Approach safely
Check response
Shout for help
Open airway
Check breathing
Recovery Position?
Dial 999/112
Monitor Patient
East of England Ambulance Service
NHS Trust
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BLS & AED
APPROACH SAFELY!
Approach safely
Rescuer
Scene
Victim
Check response
Shout for help
Open airway
Check breathing
Recovery Position
Bystanders
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NHS Trust
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Dial 999/112
Monitor
Date12/02/2015
BLS & AED
CHECK RESPONSE
Approach safely
Check response
Shout for help
Open airway
Check breathing
Recovery Position?
Dial 999/1123
Monitor
East of England Ambulance Service
NHS Trust
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BLS & AED
CHECK RESPONSE
Shake shoulders
gently
Hello can you hear
me?
If he responds
Leave as you find him.
Find out what is wrong.
Reassess regularly.
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NHS Trust
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If no
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BLS & AED
SHOUT FOR HELP
Approach safely
Check response
Shout for help
Open airway
Check breathing
Recovery Position?
Dial 999/112
Monitor
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NHS Trust
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BLS & AED
OPEN AIRWAY
Approach safely
Check response
Shout for help
Open airway
Check breathing
Recovery Position
Dial 999/112
Monitor
East of England Ambulance Service
NHS Trust
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BLS & AED
CHECK BREATHING
East of England Ambulance Service
Look, listen and feel
for NORMAL breathing
for 10 sec
Do not confuse
Agonal breathing with
NORMAL breathing
If you have any
doubts act as if
breathing is not
normal
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BLS & AED
Not Breathing normally ?
No sign of Chest Movement
No sounds of Breathing
No feeling of breath against your ear
Agonal Breathing
Occurs shortly after the heart stops in up to
40% of cardiac arrests
Described as barely, heavy, noisy or gasping
breathing
Recognised as a sign of
cardiac arrest
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NHS Trust
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BLS & AED
Agonal Breathing
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NHS Trust
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BLS & AED
Approach safely
Check response
Shout for help
If no help arrives
and you are alone
dial 999/112 After
putting into
recovery position.
Open airway
Check breathing
Recovery Position
Dial 999/112
Monitor
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NHS Trust
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Recovery position 1
Kneel next to the person. Place the
arm closest to you straight out
from the body. Position the far arm
with the back of the hand against
the near cheek.
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NHS Trust
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Recovery position 2
Grab and bend the person's far
knee
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NHS Trust
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Recovery position 3
Protecting the head with one hand,
gently roll the person toward you
by pulling the far knee over and to
the ground
East of England Ambulance Service
NHS Trust
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BLS & AED
30 CHEST COMPRESSIONS
Approach safely
Check response
Shout for help
Open airway
Check breathing
Dial 999/112
30 chest compressions
East of England Ambulance Service
2 rescue breaths
NHS Trust
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BLS & AED
Recovery position 4
Tilt the head up slightly so that the airway
remains open. Make sure that the hand is
under the cheek, checking the airway and also
for eventual wakening. Place a blanket or coat
over the person (unless he or she has a heat
illness or fever) and stay close until help
arrives
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NHS Trust
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BLS & AED
If Not Breathing
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NHS Trust
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CHEST COMPRESSIONS
Place the heel of one
hand in the centre of the
chest
Place other hand on top
Interlock fingers
Compress the chest
Rate 100 to 120
Depth 5-6 cm
Equal compression :
relaxation
East of England Ambulance Service
NHS Trust
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When possible change
CPR operator every
2 min
Date12/02/2015
BLS & AED
RESCUE BREATHS
Approach safely
Check response
Shout for help
Open airway
Check breathing
Dial 999/112
30 chest compressions
2 rescue breaths
East of England Ambulance Service
NHS Trust
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BLS & AED
RESCUE BREATHS
Pinch the nose
Take a normal breath
Place lips over mouth
Blow until the chest rises
Deliver rescue breath for 1
second
Allow chest to fall
Repeat
This should not take longer
than 5sec , then return to
chest compressions without
delay
East of England Ambulance Service
NHS Trust
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BLS & AED
Combine Compressions and
Rescue breaths
at a ratio of 30:2
30
30
East of England Ambulance Service
NHS Trust
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Date 12/02/2015
BLS & AED
ANY
QUESTIONS ?
Time to
practice.....
East of England Ambulance Service
NHS Trust
38
Date12/02/2015
Child CPR
BLS & AED
Many children do not receive resuscitation
because potential rescuers fear causing harm.
This fear is unfounded; it is far better to use
the adult BLS sequence for resuscitation of a
child than to do nothing.
Bystander resuscitation significantly improves
outcome in children.
Outcomes could be further improved if
bystanders who would otherwise do nothing,
were encouraged to begin resuscitation.
East of England Ambulance Service
NHS Trust
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BLS & AED
Children and babies
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NHS Trust
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BLS & AED
COMPRESSION only CPR
If a rescuer is unable or
unwilling to perform
rescue breaths it is
expectable to perform
compressions only CPR
East of England Ambulance Service
NHS Trust
41
However, chest
compression combined
with rescue breaths is the
method of choice for CPR
by trained lay rescuers
and professionals. Date12/02/2015
BLS & AED
When to stop CPR
Once CPR is started the rescuer
should only stop CPR when the
casualty shows signs of regaining
conscious by :
Coughing
Opening eyes
Speaking or moving
purposefully
Starts to Breath NORMALLY
again
Or
East of England Ambulance Service
NHS Trust
42
Qualified help arrives and
takes over
Date12/02/2015
You become exhausted
BLS & AED
Pocket Mask
The pocket mask is an effective barrier
device. It has a one-way valve which
prevents the casualty's exhaled air
being inhaled by the Rescuer.
East of England Ambulance Service
NHS Trust
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BLS & AED
ANY
QUESTIONS ?
Time to
practice.....
East of England Ambulance Service
NHS Trust
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BLS & AED
Understanding Defibrillation
Safe use of an AED
DEFIBRILLATION
East of England Ambulance Service
NHS Trust
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BLS & AED
Automated External
Defibrillators
An AED is an electric shock box used
to stop the electrical activity of the
heart when it is in a life threatening
rhythm, this allows the Heart to reestablish an effective rhythm.
The AED will;
analyse the presenting rhythm
only advise a shock for a shockable rhythm
East
England Ambulance
ofadvise
theService
operator step-by-step what to
do
Date12/02/2015
46
NHS Trust
BLS & AED
Automated External
Defibrillators
An AED can be used safely and
effectively without previous training.
Therefore, the use of an AED should
not be restricted to trained rescuers.
However, training should be
encouraged to help improve the time
to shock delivery and correct pad
East placement.
of England Ambulance Service
NHS Trust
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BLS & AED
There are 2 types of AED:
Automatic- will deliver shock
automatically
Semi Automatic rescuer
intervention required to deliver
shock.
Once you have completed this
AEDs can be found in many public
training
buildings e.g. Sports centres,
you will be able to use any make
Railway stations, Shopping centres
or model
and
Schools
East of England
Ambulance Service
NHS Trust
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BLS & AED
2%
4%
30
%
East of England Ambulance Service
NHS Trust
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Understanding Defibrillation
The hearts pumping
action controlled by
electrical system
Electrical rhythm
normally very organized
Normal hearts rhythm is
called Sinus Rhythm
Normal heart rate of 60 100 beats per minute
Sinus Rhythm
East of England Ambulance Service
NHS Trust
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Date 12/02/2015
BLS & AED
Understanding Defibrillation:
Ventricular Fibrillation (VF)
VF is the most common
rhythm in Sudden
Cardiac Arrest (90%)
Electrical Problem in
Nature
Chaotic rhythm results in
quivering of heart and
results in loss of pulse
VF will result in brain
damage within 5 minutes
and death in 10-15
minutes
East of England Ambulance Service
NHS Trust
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Date 12/02/2015
BLS & AED
Understanding Defibrillation
Defibrillation may correct VF
Uses DC current delivered
across the heart
A successful defibrillation
depolarizes the hearts
cells
Depolarization allows the
cells to reorganize
Defibrillation is the ONLY
effective cure for VF!
East of England Ambulance Service
NHS Trust
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Date 12/02/2015
BLS
&
AED
Single Rescuer
Approach safely
Check response
Shout for help
Open airway
Check breathing
Dial 999/112 get
AED
Attach AED before
CPR
Follow voice
prompts
East of England Ambulance Service
NHS Trust
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Date12/02/2015
Approach safely
Check response
Shout for help
Open airway
BLS & AED
2 or more
Rescuers
Check breathing
1st Rescuer
commence CPR
2nd Rescuer Call
999 /112
gets AED and
attaches to Patient
Follow voice
prompts
East of England Ambulance Service
NHS Trust
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Date12/02/2015
BLS & AED
Minimise
interruptions in CPR
If alone, attach AED before
commencing CPR
If 2 rescuers, provide good quality
CPR while the AED is brought to the
scene, is turned on, and pads attached
Interrupt CPR only when it is
necessary to analyse the rhythm and
deliver a shock
East of England Ambulance Service
NHS Trust
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Date12/02/2015
BLS & AED
DEFIBRILLATION SAFETY !
THE PATIENT.
5 point check
Pacemaker
Jewellery
Hair on chest
Damp/Wet skin
Patches (GTN)
THE AED.
In good working order
Do Not use in Heavy
rain
Do Not use if they
lay in a pool of water
Do Not use in an
explosive
environment !
East of England Ambulance Service
NHS Trust
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BLS & AED
ATTACH PADS TO
CASUALTYS
BARE CHEST
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NHS Trust
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ANALYSING RHYTHM
DO NOT TOUCH PATIENT
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SHOCK ADVISED
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Stand clear
Everyone !
TOP
MIDDLE
BOTTOM
MYSELF
BEHIND YOU
DELIVER
SHOCK
Date 12/02/2015
BLS & AED
DEFIBRILLATION SAFETY !
REMEMBER.
Always check that NO PERSON or
ANIMALS are touching the patient
prior to shocking.
That you are not touching the patient
in any way.
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NHS Trust
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BLS & AED
DEFIBRILLATION
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BLS & AED
SHOCK DELIVERED
FOLLOW AED
INSTRUCTIONS
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COMMENCE CPR (2
Mins)
30
30
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NHS Trust
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BLS & AED
NO SHOCK ADVISED
FOLLOW AED
INSTRUCTIONS
East of England Ambulance Service
NHS Trust
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BLS & AED
COMMENCE CPR (2
Mins)
30
30
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NHS Trust
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BLS & AED
ANY QUESTIONS
?
Time to
practice.....
East of England Ambulance Service
NHS Trust
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BLS & AED
Children and AEDs
Standard AEDs are suitable for use
on children of 8 years and above.
In children between 1 and 7 years
paediatric pads or a paediatric mode
should be used.
Do not use an AED on an Infant less
than 1 year.
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NHS Trust
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BLS & AED
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NHS Trust
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BLS
& AED
Follow up what to
do
after?
If you have used an Automated External
Defibrillator, even by just attaching it to a patient,
you must:
Dispose of the pads used as clinical waste
Replace the pads on the machine
Inform named person that the Defibrillator has
been used so that any data can be captured from
the device
Complete a Defibrillator Event Report Form
If you require any equipment to be replaced, i.e.
pads, pocket masks, razors etc. Please contact
East of England Ambulance Service
your named person as soon as possible.
NHS Trust
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BLS & AED
WHEN NOT TO RESUSCITATE
Once CPR is started the rescuer should only
stop CPR when the casualty shows signs or
regaining conscious by
Coughing
Opening eyes
Speaking or moving purposefully
Starts to Breath NORMALLY again
Or
Qualified help arrives and takes over
You become exhausted
East
It ofisEngland
unsafe
toService
continue
Ambulance
NHS Trust
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BLS & AED
OR IF YOU SEE
THIS HAS
OCCURRED !
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NHS Trust
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BLS & AED
Oops ??
East of England Ambulance Service
NHS Trust
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ANY
QUESTIONS ?
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NHS Trust
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Bleeding
BLS & AED
East of England Ambulance Service
NHS Trust
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Bleeding
BLS & AED
Raise Limb
Cover with clean dressing or cloth
999 or 112
Reassure
Lay down
Raise legs
Monitor
East of England Ambulance Service
NHS Trust
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Shock
BLS & AED
East of England Ambulance Service
NHS Trust
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Shock
BLS & AED
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NHS Trust
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Choking
BLS & AED
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NHS Trust
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BLS & AED
Choking
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NHS Trust
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Choking
BLS & AED
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NHS Trust
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ANY QUESTIONS
?
Time to
practice.....
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NHS Trust
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NHS Trust
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