ANZCOR Guidelines 2016 - Update for First Aid Providers

This page offers First Aid and Emergency Care training providers an overview of the changes within the ANZCOR 2016 guidelines, and what these mean for training.

20 January 2016 

The 2016 updates to New Zealand resuscitation guidelines incorporate findings from the International Liaison Committee on Resuscitation’s October 2015 consensus statements. The revised guidelines are available at nzrc.org.nz/guidelines.

The recommended approach to basic life support in Australia and New Zealand remains the same. There is continued emphasis on managing emergencies using a DRS ABCD approach, administering CPR using a compression to rescue breath ratio of 30:2, and early defibrillation.

Compression rate is now given as a range of approximately 100-120 compressions per minute (2016), as evidence shows that a person’s chance of survival is optimised within this range. It is recognised that the rate at which any rescuer gives chest compressions will vary, but compressions that are either too fast or too slow are likely to be less effective. We still want rescuers to push hard – about one-third the depth of the chest with each compression. Rescuers should also be mindful of minimising interruptions to compressions.

The text “If unwilling/unable to provide chest compressions” has been removed from the Basic Life Support flow chart and CPR guideline (ANZCOR Guideline 8). Training providers should train rescuers to give both chest compressions and rescue breathing for any person in cardiac arrest. In some cases, rescuers will not be able to give rescue breaths but should still be encouraged to give chest compressions. Rescue breaths may provide additional benefit for children and those in cardiac arrest caused by lack of oxygen – for example, drowning – or where the emergency response time is long.

Find out more about what you need to know:

Resuscitation and DRS ABCD

Choking

First Aid


Resuscitation - Summary 

DRS ABCD

The DRS ABCD is a simple tool for approaching emergencies and provides the foundation for the Basic Life Support flowchart.

Dangers

Check for dangers. Ensure your own safety and that of others before attending to the person in need. Ensure that the person is out of further danger (consider moving them).

Responsiveness

Check responsiveness. Shout “are you alright” and tap the person on an uninjured part.

Send for Help

Shout for help. Ask a bystander to call 111 or activate the emergency response system. Ask the bystander to return immediately to confirm that the call has been made.

Airway

Open the airway using head tilt and chin lift. Remove obvious causes of airway obstruction.

Breathing

Taking no more than 10 seconds, check for the presence of normal breathing.

  • If normal breathing is present: place the person on their side if they are still not responding. Stop any bleeding with direct pressure.
  • If normal breathing is absent or you are uncertain, start CPR.

CPR

Start CPR – cycles of 30 chest compressions followed by 2 attempted ventilations.

Defibrillation

Attach an Automated External Defibrillator (AED) as soon as it is available. Follow prompts.

Notes to Basic Life Support:

  • The need for CPR is determined by a person’s unresponsiveness and their absence of normal breathing. Take no more than 10 seconds to check for normal breathing.
  • If a person is unresponsive and not breathing normally, begin CPR. Start with chest compressions.
  • Correct hand placement for adults is found by placing the heel of one hand in the centre of the person’s chest with your other hand on top. For children over 1 year, place the heel of one hand in the centre of the chest. For an infant, use two fingers just below an imaginary line across the nipples.
  • Compression depth is approximately one-third the depth of the chest. For adults this is at least 5cm, for children it is approximately 5cm, and approximately 4cm for infants.
  • The rate of chest compressions is 100-120 compressions per minute.
  • The ratio of compressions to ventilations is 30:2.
  • Each attempted rescue breath should be delivered over 1 second.

Rescuers who are alone:

If the rescuer is alone and comes across a collapsed adult they should go for help as soon as it is apparent that the person is not breathing normally.

If the rescuer is alone and comes across a collapsed infant or child they should start CPR straight away and then go for help. A ‘rule of thumb’ is to give 1 minute of CPR before going for help.

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Management of Choking 

When a person is responding and appears to be have difficulty breathing, assess the person to see if they are choking on something.

Management of partial airway obstruction in adults, children and infants

If the person can cough, encourage them cough and spit out anything in their mouth. Send for help and continue to monitor the person.

Management of complete airway obstruction in adults, children and infants

If the person is responsive but cannot cough, the rescuer can assist a cough. Send for help. Try 5 back blows first, followed by 5 chest thrusts.

For Adults and Children

Back Blows

A back blow is a blow to the back of the person that creates a cough intended to move an obstruction from the airway.

  1. Stand to the side and slightly behind the person or, in the case of a child, place the child across the thigh with the head held lower than the chest.
  2. Support the person’s chest with one hand and lean them forward so that when the obstruction is dislodged it comes out of their mouth, rather than going further down their airway.
  3. Give up to five sharp blows between the shoulder blades with the heel of your other hand. The aim should be to relieve the obstruction with each blow, rather than necessarily to deliver all five.

If back blows fail, try chest thrusts.

Chest Thrusts

The chest thrust manoeuvre is an attempt to create an artificial cough intended to move and expel an obstructing foreign body from the airway.

  1. Stand behind the person, wrap your arms around their chest and make a fist with one hand.
  2. Place one fist, thumb side, against the middle of the breastbone.
  3. Grasp the fist with the other hand.
  4. Give a quick inward thrust.
  5. Repeat as necessary until the obstruction is relieved. Each new thrust should be a separate and distinct movement delivered with the intent of relieving the obstruction, rather than necessarily delivering all five. The force should be suitably modified for children.

If the chest thrusts do not dislodge the obstruction, continue to repeat the cycle of five back blows and chest thrusts.

For Infants

The principles are the same as with adults and children: the rescuer attempts to create an artificial cough to expel the foreign body. In infants the back blows and chest thrusts are suitably modified.

  1. Deliver five back blows initially. Holding the infant in the prone position, deliver five sharp blows to the middle of the back between the shoulder blades. The head should be lower than the chest during the manoeuvre. This is best accomplished by holding the infant face down along your outstretched arm and firmly holding the infant’s jaw. The aim should be to relieve the obstruction with each blow, rather than necessarily to deliver all five.
  2. If five back blows have failed to dislodge the obstruction, turn the infant over and deliver five chest thrusts to the breastbone with the infant in their back. Although similar to chest compressions used for CPR, these should be sharper and at a slower rate (20/min).
  3. These cycles of back blows and chest thrusts are continued, either until the obstruction is relieved or the infant becomes unresponsive.

Management of Choking in unresponsive adults, children and infants

Management of choking for unresponsive people remains the same. Start CPR with a compression-to-ventilation ratio of 30:2.

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First Aid – Summary 

The following are emphasised in the ANZCOR 2016 guidelines as part of First Aid management of emergencies.

Bleeding

Direct pressure to control bleeding is the fastest, easiest and most effective way to stop bleeding. Use a cold pack and pressure where there is bruising to a limb but no external bleeding.

A tourniquet may be used in the case of life-threatening bleeding from a limb where the bleeding cannot be controlled by direct pressure. Application of a tourniquet is only recommended for rescuers who are trained to do so.

For further information see ANZCOR Guideline 9.1.1.

Spinal injury

If spinal injury is suspected, the head should be manually supported in a neutral position that limits angular movement. The New Zealand Resuscitation Council does not support the use of semi-rigid cervical collars in pre-hospital settings (2016) (ANZCOR Guideline 9.1.6).

Heart attack

Remember to give aspirin when providing first aid for the person with suspected heart attack (ANZCOR Guideline 9.2.1).

Stroke

Symptoms of stroke may not be particular to stroke, and might be associated with other problems such as abnormal blood-sugar levels. To improve the accuracy of stroke diagnosis, the measurement of blood glucose is recommended in people with suspected stroke for first aid providers trained in the use of a glucometer (ANZCOR Guideline 9.2.2).

Shock

If the person is in shock they should be laid down but it is unnecessary that a rescuer raise the person’s legs (Passive Leg Raise). While there is no harm in doing this, any long-term benefit for the person is unproven (ANZCOR Guideline 9.2.3).

Anaphylaxis

If the person has been given a dose of adrenaline by way of auto-injector pen, a second dose of adrenaline should be given after 5 minutes if they have not improved (ANZCOR Guideline 9.2.7).

Use of Oxygen in Emergencies

Pulse oximetry may help identify people who would benefit from supplementary oxygen in first aid settings. First responders who are trained to give oxygen could be trained to use pulse oximetry (ANZCOR Guideline 10.4).

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