Emergency Care and Safety Institute 2011 Instructor Update Narration: Welcome to the Emergency Care and Safety Institute 2011 Instructor Update. This program examines the changes to CPR, AED, and first aid as a result of the 2010 International Liaison Committee on Resuscitation (ILCOR) Guidelines. Based on advances in science, the 2010 ILCOR Guidelines affect how CPR, AED, and first aid programs are taught, both in the content covered and the philosophy behind the content. This presentation focuses on the key changes to CPR, AED, and first aid instruction as a result of the 2010 ILCOR Guidelines. By completing this online program, your Emergency Care and Safety Institute (ECSI) instructor authorization will be renewed for two years. All ECSI instructors must complete this program before March 30, 2011. Once you begin this program, you must complete it in one sitting. If you exit and return to the program, you will have to start over at the beginning. This program takes less than 60 minutes to complete.

Objectives Upon completion of this presentation, you will be able to: Describe the science behind the CPR, AED, and first aid education changes per the 2010 ILCOR Guidelines. Identify the modifications being made to ECSI programs and products. Describe the administrative changes to ECSI programs. Become reauthorized as an ECSI instructor. Narration: Upon completion of this presentation, you will be able to: Describe the science behind the CPR, AED, and first aid education changes per the 2010 ILCOR Guidelines. Identify the modifications being made to ECSI programs and products as a result of the 2010 ILCOR Guidelines. Describe the administrative changes to ECSI programs. Become reauthorized as an ECSI instructor for a period of two years.

Changes to CPR and AED for Trained Laypersons Narration: This section covers the changes in the 2010 ILCOR Guidelines regarding how laypersons are trained to perform CPR and use an AED in CPR courses.

Checking the Victim Removed Steps New Step Open the airway. Look, listen, and feel for breathing. New Step Check for responsiveness AND breathing at same time. Narration: In an effort to minimize the time it takes to begin chest compressions on a victim, the steps of opening the airway and then looking, listening, and feeling for breathing have been removed. Now the layperson will check for responsiveness and breathing at the same time. The layperson will look briefly at the chest to see if there is any movement. If there is no movement, the victim is likely not breathing. If the victim is pale, gray, or blue around the face and lips or if the victim is only gasping for air, then the victim is not breathing correctly. These are all signs that EMS personnel should be contacted and that the layperson should begin CPR. In summary, if the victim is unresponsive and not breathing or is breathing abnormally, then the victim needs CPR.

ABC Is Now CAB Old Order New Order ABC CAB Compressions Airway Breathing Narration: Chest compressions are now considered to be the most important part of CPR. In the past, chest compressions have been delayed by first opening the victim’s airway and checking for breathing. To rectify this problem, the old order of ABC (Airway, Breathing, and Compressions) has been replaced by a new order: CAB (Compressions, Airway, and Breathing). Rapid, deep chest compressions with few interruptions are critical to the victim’s survival. The layperson needs to begin performing chest compressions as soon as possible following the victim’s collapse. The layperson should begin chest compressions immediately after determining that the victim is unresponsive and not breathing. After performing 30 chest compressions, the layperson will open the victim’s airway. With the victim’s airway open, the layperson will provide two rescue breaths. Each breath should be gentle and take about one second, just enough to make the chest visibly rise.

Chest Compressions New Guidelines Adult At least 2″ deep Child About 2″ deep Infant About 1.5″ deep 100 compressions per minute Narration: Now chest compressions are to be performed both faster and deeper. For adults, chest compressions should be at least 2 inches deep. For children and infants, the proper depth for chest compressions is one-third to one-half the depth of the chest. For children this is about 2 inches deep. For infants, the proper depth is about 1½ inches deep. Chest compressions should be performed at a rate of at least 100 compressions per minute for adults, children, and infants—about 30 compressions every 18 seconds. Once chest compressions begin, interruptions should be minimized.

Layperson CPR Review Check for responsiveness and breathing. Make sure 9-1-1 has been called. Provide 30 chest compressions deep and fast. Provide two rescue breaths. Repeat the cycle of compressions and breaths until an AED is available or EMS personnel arrive. Narration: To review, the steps to perform layperson CPR are: The layperson will check for responsiveness and breathing simultaneously. The layperson will make sure that 9-1-1 has been called, either by a bystander or personally. The layperson will provide 30 chest compressions deep and fast. The layperson will move quickly to the head to provide two rescue breaths and then resume the chest compressions. The layperson will continue the cycle of chest compressions and breaths until an AED is available, EMS personnel arrive, the victim shows signs of life such as movement, or the layperson is too physically exhausted to continue.

AED Use for All Ages Adults Children and Infants Use standard electrode pads. Children and Infants Use pediatric electrode pads if available. Use standard electrode pads if no pediatric electrode pads are available. Narration: AEDs can now be used on everyone—from adults to children to infants. Laypersons should use standard electrode pads on adult victims. With children and infants, pediatric electrode pads should be used if available. If pediatric electrode pads are not available, then standard electrode pads should be used on children and infants.

Changes to CPR and AED Use for Health Care Providers Narration: Many of the changes affecting layperson CPR and AED use also apply to health care providers. However, there are a few minor differences. These differences will be covered in this section of the presentation.

Checking the Victim Removed Steps New Steps Open the airway. Look, listen, feel for breathing. New Steps Check for responsiveness AND breathing at same time. Check for a pulse. Narration: In an effort to minimize the time it takes to begin chest compressions, the sequence of CPR for health care providers has also changed. While checking for responsiveness, the health care provider will simultaneously determine if the victim is breathing. The health care provider will look briefly at the chest and see if there is any movement. If there is no movement, the victim is likely not breathing. Likewise, if the victim is pale, gray, or blue around the face and lips or if the victim is only gasping for air, then the victim is not breathing correctly. These are all signs that CPR should be started. Health care providers should check quickly for the presence of a pulse. If a pulse is not found or the health care provider is uncertain of its presence, CPR should be started. If a pulse is found, and the victim is still not breathing, then rescue breathing should be performed.

ABC Is Now CAB Old Order New Order ABC CAB Compressions Airway Breathing Narration: For health care providers, the old order of ABC (Airway, Breathing, and Compressions) has been replaced by a new order: CAB (Compressions, Airway, and Breathing). Rapid, deep chest compressions with few interruptions are critical to the victim’s survival. The health care provider will begin chest compressions immediately after determining that the victim is unresponsive, not breathing, and pulseless. After performing 30 compressions, the health care provider will open the airway. With the airway open, the health care provider will provide two rescue breaths. Each breath should be gentle and take about one second, just enough to make the chest visibly rise.

Chest Compressions New Guidelines Adult At least 2″ deep Child About 2″ deep Infant About 1.5″ deep 100 compressions per minute Narration: Just like laypersons, health care providers should compress the chest both faster and deeper. For adults, chest compressions should be at least 2 inches deep. For children and infants, the proper depth for chest compressions is one-third to one-half the depth of the chest. For children this is about 2 inches deep. For infants, the proper depth is about 1½ inches deep. Chest compressions should be performed at a rate of at least 100 compressions per minute for adults, children, and infants—about 30 compressions every 18 seconds. Once chest compressions are started, interruptions should be minimized. The health care provider will move quickly to the head to provide two rescue breaths and then resume the chest compressions.

Health Care Provider CPR Overview Check for responsiveness and breathing. Check quickly for the presence of a pulse. If unresponsive and not breathing, provide 30 chest compressions deep and fast. Provide two rescue breaths. Repeat the cycle of chest compressions and breaths until an AED is available. Narration: To review, the steps for health care providers to perform CPR are: The health care provider will check for responsiveness and breathing simultaneously. The health care provider will quickly check for the presence of a pulse. If a pulse is not found or its presence is uncertain, the health care provider will start CPR. If a pulse is found and the victim is still not breathing, the health care provider will perform rescue breathing. The health care provider will provide 30 chest compressions deep and fast. The health care provider will move quickly to the head to provide two rescue breaths and then resume the chest compressions. The health care provider will continue the cycle of chest compressions and breaths until an AED is available.

AED Use for All Ages Adults Children and Infants Use standard electrode pads. Children and Infants Use pediatric electrode pads if available. Use standard electrode pads if no pediatric electrode pads are available. Narration: AEDs can now be used on everyone—from adults to children to infants. Health care providers should use standard electrode pads on adult victims. With children and infants, pediatric electrode pads should be used if available. If pediatric electrode pads are not available, then standard electrode pads should be used on children and infants.

CPR for Untrained Laypersons Narration: Many people will never take a CPR course. Unfortunately, some of these people will find themselves in an emergency where they need to perform CPR. By making the steps of CPR even simpler for public service announcements, more people may be able to perform the steps to save lives. CPR for those who are untrained is called hands only CPR. As an ECSI instructor, you need to understand how hands only CPR will be taught to the general public through public service announcements. This simplified version of CPR differs from the layperson CPR that you will teach in CPR courses.

Hands-Only CPR For untrained persons Compressions only Simplified steps Reduced fears Increasing likelihood of prompt care Compressions only Fast Deep Continuous Narration: Hands only CPR focuses on the most important part of CPR—chest compressions. By minimizing and simplifying the steps of CPR, more untrained persons may have less apprehension about performing CPR and may be able to act promptly to save more lives. Hands only CPR will be used for public service announcements and 9-1-1 dispatcher instructions. Untrained persons will be instructed to press on the center of the victim’s chest fast and deep, and continuously until EMS personnel arrive.

Changes to First Aid Narration: Based on advances in science, the 2010 ILCOR Guidelines also affect first aid training. Many of the changes advocated in the 2010 ILCOR Guidelines have been present in ECSI programs for years due to the medical guidance provided by the American Academy of Orthopaedic Surgeons (AAOS) and the American College of Emergency Physicians (ACEP). This section will address the few additional changes that impact the current ECSI first aid programs. It is important to note that the evidence supporting first aid guidelines is limited and more research in this field is needed. For this reason, ECSI will continue to rely on the additional guidance of its medical organization partners, AAOS and ACEP, to ensure that ECSI presents the best practices in first aid.

Positioning the Victim On the victim’s back CPR-ready On the victim’s side To keep the airway clear Cautiously for possible spinal injuries Narration: Properly positioning the victim is an important step in providing first aid. For an unresponsive victim lying facedown, roll the victim onto his or her back so that CPR can be started if necessary. If the victim is vomiting, has heavy secretions, or the rescuer must leave an unresponsive victim to call 9-1-1, roll the victim onto his or her side to allow the vomit or secretions to drain from the mouth and to keep the airway clear. If the victim has a possible spinal injury, roll the victim cautiously while minimizing movement to the head and neck. This is best done with more than 1 rescuer. If the provider believes that the victim may have a possible neck or back injury, the provider will position the victim in the High Arm In Endangered Spine (HAINES) position. The provider will roll the person gently, with the victim’s head moving along with the rest of the body.

Bleeding Control Removed Steps New Steps Elevation Pressure points Expose and examine. Apply pressure over the dressing. Bandage the wound. Seek medical care. Narration: Elevating a bleeding extremity and applying pressure to a pressure point in the body are no longer recommended as part of the care for bleeding. There is no evidence showing that these two steps help to control bleeding. However, direct pressure is a proven intervention and is usually all that is needed to control bleeding. Now the steps for controlling bleeding from a more serious wound begin with the rescuer exposing the area to better examine the extent of the wound. Then roll up or cut away clothing to see the extent of the wound. Next place a dressing, such as gauze pad, completely over the wound and apply pressure. This will control most bleeding in a few minutes. Apply a roller gauze bandage to secure the dressing in place and maintain pressure over the wound. Seek medical care for all large wounds. Call 9-1-1 if bleeding cannot be controlled.

Caring for Shock Removed Step New Steps Elevating the legs. Maintain warmth. Place the victim on his or her back. Narration: Victims with shock should be kept warm and positioned on their backs unless injuries or medical conditions prevent this from occurring. There is no definitive evidence regarding the value of raising the legs of a victim with shock, whether due to trauma or illness. Because this step would also be contraindicated in a victim with spinal injury or pelvic injury, the step is simply being eliminated from the care sequence. The new steps in caring for a victim with shock are maintain the victim’s warmth with blankets and place the victim on his or her back unless injuries or medical conditions prevent this occurring.

Care in Medical Emergencies Asthma Inhaler Anaphylaxis Auto-injector Chest Discomfort Aspirin Narration: With the proper training, first aid providers may assist victims with prescribed bronchial inhalers, prescribed auto-injectors, and aspirin. It is important to become familiar with how prescribed bronchial inhalers are administered to victims with asthma. First aid providers may assist a victim if he or she has a prescribed bronchial inhaler and is having difficulty breathing. It is also important to be able to recognize the signs and symptoms of anaphylaxis, a severe allergic reaction. By properly recognizing the signs and symptoms of an anaphylactic reaction, first aid providers will know when to assist a victim with the administration of his or her prescribed auto-injector. Finally, providers should assume that chest discomfort is a cardiac-related problem until proven otherwise. Providers should instruct victims with chest pain to chew one regular or two chewable aspirin, as long as victims do not have allergies or contraindications such as recent stomach bleeding.

Product Release Dates First Aid, CPR, AED Health Care Provider CPR January–March 2011 Health Care Provider CPR April–June 2011 Bloodborne and Airborne Pathogens Narration: Throughout the first half of 2011, the new ECSI programs will be released. The CPR, AED, and first aid changes instituted by the 2010 ILCOR Guidelines will be reflected in the new ECSI programs. Please note that the new ECSI products will offer only one CPR and AED product for health care professionals, the Health Care Provider CPR program. The current Professional Rescuer CPR program will be incorporated into the Health Care Provider CPR program. The first quarter of 2011 will see the release of all the layperson programs for first aid, CPR, and AED. The ECSI advanced first aid, CPR, and AED program used by many colleges will be available in the spring of 2011. This will be followed shortly by the release of the health care provider CPR and AED program and the bloodborne and airborne pathogens program.

Student Manuals More course friendly Updated content New design More compact Narration: The ECSI student manuals have been revised to reflect the changes to CPR, AED, and first aid training due to the 2010 ILCOR Guidelines. The ECSI student manuals are even more compact and user-friendly with a format that will make it easy for students to follow along during class. In addition, the Emergency Care Wrap-Up feature at the end of the chapters summarizes how to recognize the signs and symptoms of illnesses and injuries and the appropriate steps of care.

Instructor Materials ECSI Teaching Packages New DVDs New ITK CD-ROMs Streamlined for transport One package for First Aid, CPR, and AED, Standard New DVDs Revised to meet 2010 ILCOR Guidelines New ITK CD-ROMs Revised lesson plans, course outlines, PPT Reduced course time Narration: The new ECSI Teaching Packages have also been streamlined. The cases are smaller and easier to carry to class, but still have the same high-quality DVDs and CD-ROMs. ECSI Educational Centers teaching laypersons in the ECSI First Aid, CPR, and AED, Standard program will get everything they need in one convenient package. All ECSI DVDs have been revised to reflect the 2010 ILCOR Guidelines. Our new Instructor Toolkit CD-ROMs have revised course outlines, lesson plans, and PowerPoint presentations. Please note that the approximate duration of some courses has been reduced slightly as a result of the 2010 ILCOR Guidelines.

Online Courses Interactive alternative to traditional classroom training Multiple courses First Aid, CPR, and AED CPR and AED Bloodborne and Airborne Pathogens Health Care Provider CPR Skills check Narration: All ECSI online courses will reflect the 2010 ILCOR Guidelines. ECSI offers interactive online courses as an alternative to traditional classroom-based training. The ECSI online courses include: First Aid, CPR, and AED CPR and AED Bloodborne and Airborne Pathogens Health Care Provider CPR As a reminder, access codes to the online courses are available for individuals or groups. With several course options to choose from, offering online courses to various companies is a convenient way for large groups of busy employees in various locations to complete a course. ECSI Educational Center Coordinators only need to schedule skill check sessions for course users and then issue the course completion cards. The course completion cards are free with the purchase of the access codes to the online course.

ECSI Administrative Changes Narration: This section will review the administrative changes being made to ECSI programs in 2011.

Universal Course Completion Cards Universal course completion card for all courses Plastic coated Six per page Still free with manuals for initial training New printing software Narration: ECSI is eliminating its current course-specific completion cards and will be using one universal course completion card for all courses. This will allow more than one course to be printed on each universal course completion card, such as first aid, CPR, and AED. The new universal course completion card will be plastic coated and available in sheets. There will be six universal course completion cards per sheet and the cards can be peeled from the sheet one at a time. This means that three course completion cards may be printed for a CPR and AED course, two printed for a first aid course, and one card will remain to be used at a later date. Unused cards can be re-fed through the printer at a later time. Course completion cards will continue to be provided free with the ECSI student manuals and online course codes for initial training. Also, they can be purchased in conjunction with other products for refresher training. New course completion card software will be available as a free download in the Members Area of the ECSI website once the universal course completion cards are available.

Student Manual Libraries Creating libraries of student manuals is restricted to: Secondary schools Government contracts National contracts Narration: ECSI student manuals are required for use in all ECSI courses. Creating libraries of student manuals is restricted to select entities and is reviewed and approved on a case-by-case basis. Those eligible to library books include: Secondary schools Government or national contracts in which the terms have been specified in a Request for Proposal (RFP) or bid process If your ECSI educational center does not fall under one of these two entities, then you are not eligible to library student manuals.

Initial and Refresher Training Initial training: Students own the student manuals. Refresher training: Students can use pocket guides. Digital product options Narration: Students completing an initial ECSI course are required to have a student manual that they take home with them. Students should be notified by the instructor that the student manuals are theirs to keep. For those students completing a refresher course, pocket guides can be provided in lieu of the student manuals. Now the pocket guides will be available in packs of 50 and you may order up to nine sheets of universal course completion cards along with each box of pocket guides. Pocket guides and universal course completion cards can also be purchased separately. ECSI also provides digital versions of its student manuals for initial and refresher training. Instructors can take advantage of this opportunity to reduce their reliance on paper, promote a green environment, provide a technology alternative for customers who desire this option, and save money all at the same time.

Website Revisions (1 of 2) More user-friendly ECSI Educational Center Coordinators Separate log-in page Updated Members Area New marketing materials Narration: ECSI is excited to announce the development of a newly designed ECSI website. The new ECSI website will be easy to navigate, more user-friendly, and accessible to more users. ECSI Educational Center Coordinators will have their own separate log-in page. ECSI Educational Center Coordinators will be able to view and update all of their instructors’ information, as well as reauthorize each instructor every two years. There will also be an updated Members Area featuring simple navigation and additional marketing materials.

Website Revisions (2 of 2) New roster tracking program Enter course rosters View past students Send reminder notifications Narration: There will also be a new roster tracking program available. This program will allow an ECSI Educational Center Coordinator or ECSI instructors to enter course rosters, including select contact information for students. Once this information is entered into the roster tracking program, the ECSI Educational Center Coordinator or ECSI instructors can view the status of any past students and track former students with pending expirations of course completion cards. The ECSI Educational Center Coordinator or ECSI instructors will have the ability to send convenient reminder notifications to these students and create repeat business opportunities.

New ECSI Instructors ECSI Educational Center Coordinators can add and update ECSI instructor records New Instructor Cards Electronic files Narration: ECSI Educational Centers will have the ability to add new ECSI instructors and update instructor records through the ECSI website. The ECSI Educational Center Coordinator will simply click the “Instructor Application” link to add an instructor. Once approved, an email notification will be sent both to the ECSI Educational Center Coordinator and the new ECSI instructor. This email will contain an assigned username and a computer-generated password to enable the instructor to enter the private Members Area of the ECSI website. Hard copies of ECSI instructor cards will no longer be mailed from ECSI headquarters. Once an instructor is approved in the ECSI database, a copy of his or her ECSI instructor card will be made available in a PDF file that can be printed.

Course Exams No written exams for laypersons. End-of-course group activity Health care professionals still take formal exams. Narration: Formal written exams will no longer be used in the layperson courses. The end-of-course group activities will be used in place of the written exams. The group activities provide students with guided review activities that test the students’ understanding of the course content. Health care professionals will still take the formal written exams in order to complete the course.

Contact Us By phone: By email: 1-800-71-ORANGE Info@ECSInstitute.org Narration: If you have any questions about this presentation or the changes to the ECSI programs, please contact us through our toll free number (1.800.71.ORANGE) or via email at info@ECSInstitute.org. Please proceed to the final slide to complete the program.

Wrap Up The 2011 ECSI Instructor Update is now complete. Please exit from the presentation. Narration: Congratulations on completing the 2011 ECSI Instructor Update! Your new ECSI instructor card is now being prepared. When you exit the program, you will be linked to a site where you can print out a form verifying your completion of this instructor Update. You will be notified shortly of your ability to download your new ECSI instructor card. Thank you for taking the time to quickly and easily update your records and for learning about the changes to CPR, AED, and first aid training required by the 2010 ILCOR Guidelines.