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Resuscitation Council Oct 2015 Guidelines- To be implemented by early 2017

European Resuscitation Council (ERC) First Aid Guidelines-Oct 2015

For the first time in history, the ERC have published guidelines on first aid. This follows an ILCOR led review of evidence in specific first aid topics. The ERC first aid guidelines are based on a worldwide expert consensus of best practice following an international evidence-based review, making them an extremely important addition to first aid practice in Europe.

Below are the key changes that will affect how first aid is taught:

4. Elevation and Indirect pressure points are no longer recommended for the treatment of bleeding.

Elevation and indirect pressure have been removed due to a lack of evidence that either is effective in stopping bleeding, particularly life-threatening bleeding.

5. Haemostatic dressings and tourniquets are to be used when direct pressure cannot control severe bleeding.

Following extensive use and research in combat, there is a wealth of evidence that tourniquets are effective, save lives and have a relatively low rate of complications following application. Similarly, haemostatic dressings have also undergone significant improvements in recent years, have low complication rates and have saved many lives.

The balance of complications versus possible outcomes if not used have led to both tourniquets and haemostatic dressings being introduced into main-stream first aid. Of course, a small office workplace is unlikely to find that catastrophic bleeding is a significant risk to their employees, so they wouldn’t necessarily have to rush out and buy this new equipment. A waste recycling plant or tree surgeon on the other hand may wish to consider having these available.

The good news is that the guidelines are very clear that “training is required to ensure application is safe and effective”.

6. Sucking chest wounds should be left open to the environment - Three sided dressings are no longer recommended.

Due to clinical experience of both improvised and purpose made dressings inadvertently becoming occlusive, the ERC guidelines recommend to ‘leave the wound in open communication with the environment’. This means that there is no longer a requirement to cover it with a dressing. The main emphasis on providing care should be to ‘do no harm’, and the risk of dressings becoming occlusive is significant.

7. For the treatment of Asthma, first aiders should be taught how to administer an inhaler and how to use a spacer device.

The exact wording is “First aiders must be trained in the various methods of administering a bronchodilator”. In the UK, that includes assisting a casualty to take their own prescribed inhaler and how to take it using a spacer device.

8. Hypoglycaemia – first aiders should aim to give 15-20g of glucose.

This has been in diabetes hospital management guidance for a while so it’s good to see more clarification on quantities in first aid guidance. The updated Paediatric First Aid Made Easy book will also include some further guidance for children, as this is the adult requirement.

9. Oral Carbohydrate-electrolyte beverages (sports energy-rehydration drinks) now recommended for exertion related dehydration.

Specific sports energy-rehydration drinks have proven to be more effective than water as they also replace lost body salts. Evidence also suggests that semi-skimmed milk and tea can also be as effective as water.

10. Burns should be cooled with water for a minimum of 10 minutes, as soon as possible.

Whilst Qualsafe have always advocated this, it’s fantastic to see that ERC guidelines have clarified it. We hope that this change will encourage others to come into line with this guidance.

What’s next?

Whilst the Resuscitation Council (UK) have asked that the new guidelines are implemented by early 2017, we understand that our Centres will be keen to start teaching the above subjects as soon as possible. As such, we are currently in the process of reviewing our assessments to make sure they correspond to the 2015 updates, and we will be launching these in early 2016. However, rest assured that assessments related to tourniquets or haemostatic dressings will not be introduced until all Trainers have had sufficient time to update their knowledge and feel confident to deliver this change in guidance. This will likely be introduced in late 2016 and we will provide Centres with plenty of notice for any changes. In the meantime, we would like to reassure our Centres that the current guidance is not incorrect and is safe to be taught until these changes are implemented.

The guideline changes will also be discussed at The Qualsafe Future of First Aid Conference on 27th November by key members of the Resuscitation Council (UK), the European Resuscitation Council (ERC) and the ILCOR , including Dr David Zideman who authored the ERC First Aid Guidelines. There will also be a special guest who will be discussing tourniquets and haemostatic dressings, making this event ideal for those who would like some clarification on these devices!