Red Cross Health & Safety Courses To Reflect New Emergency CPR Guidelines

More than 250,000 Americans die each year of sudden cardiac arrest, but the American Heart Association (AHA) estimates that many of them could be saved by quickly calling 911, initiating cardiopulmonary resuscitation (CPR), using an automated external defibrillator (AED) when available and fast follow-up by advanced medical personnel. To make the process even easier for people who lack formal medical training — and save more lives — the AHA recently revamped their CPR guidelines with specific adaptations for lay rescuers.

Updates like these will soon be reflected in American Red Cross health and safety programs. The Red Cross has long been regarded as the premier provider of CPR, first aid and other health and safety education programs. Each year, the Red Cross trains more than five million people in adult, infant and child, and professional rescuer CPR and nearly 12 million in health-and-safety related education.

"We have always been committed to updating our courses with the latest scientific research and consensus of medical opinion," said Don Vardell, director of research and product development for Red Cross Health and Safety Services. "All of our core education programs that involve CPR — from first aid to lifeguard training — will be updated and available for chapters and their customers."

Vardell said that the Red Cross will implement the new guidelines into standard first aid (which includes adult CPR), AED and infant and child CPR courses beginning this fall. Other educational programs, such as lifeguard training and babysitter training, will be revised throughout the year. Instructors for these courses will have a chance through a variety of means to become familiar with the new AHA guidelines by the time the revised materials are available.

Streamlining the Standard of Emergency Care

The last time the AHA guidelines were revised was in 1992. The 2000 edition offers streamlining and simplification, including the recommendation that lay rescuers (people without an occupational obligation to respond to an emergency and who are normally not certified) administering CPR not rely on checking the victim's carotid pulse to determine if chest compressions are neccesary. Instead, the recommendation is to check for other signs of circulation, including coughing, movement and normal breathing. At a press conference in Washington, D.C., AHA officials said that people are wrong about whether or not the victim has a pulse about 35 percent of the time.

"We recognize that it is very difficult for the layperson to assess whether a patient has a pulse within the first few seconds," AHA president Rose Marie Robertson, M.D., told the media. To salvage precious seconds, Robertson said, it is important to begin CPR right away.

If it is determined that the victim's heart is not beating, the revamped guidelines instruct people to proceed with chest compressions and rescue breathing, but at a different rate than had previously been recommended. Whereas the standard had been a pattern of 15 compressions and two breaths at a rate of 80 to 100 compressions a minute, the new guidelines specifically call for 100 compressions a minute. The cycles of 15 compressions and two breaths are the same, just performed faster.

The new CPR guidelines are also applicable for unconscious adult choking victims. Under the older guidelines, lay rescuers were supposed to try to clear a choking victim's airway using blind finger sweeps and attempt the Heimlich Maneuver (abdominal thrusts) before proceeding with chest compressions and rescue breathing. The new guidelines advise that rescuers begin CPR immediately upon determination that the victim is unconscious. Neither finger sweeps nor abdominal thrusts are recommended by the AHA's new guidelines for lay rescuers. According to AHA officials, the pressure on the chest should dislodge whatever object is obstructing the airway.

The Impact of Technology

Other changes to the CPR guidelines reflect changes in medical technology that have taken place over the last eight years. When the guidelines were first drafted in the early 1990s, clot-busting drugs were not widely available in hospitals. Now that hospitals commonly stock these drugs, whose artery-opening capabilities have been clinically demonstrated, the AHA advises that they be given to heart attack and stroke victims once professional health care is available.

The increasing availability of automated external defibrillators (AEDs) in public settings has also influenced the new AHA guidelines. AEDs are fairly inexpensive and easy for lay rescuers to use. When a victim has suffered a heart attack, two electrodes attached to the AED are applied to the unconscious victim's chest. The device automatically senses the heart rhythm and determines whether a lifesaving electric shock is necessary. If a shock is necessary to revive the victim, the AED prompts the rescuer to press the "shock" button on the device. The AED needs no calibration or adjustment — everything is automatically detected.

AHA's Robertson said in a press statement that early defibrillation (shock) is extremely effective in saving the life of a cardiac arrest victim. "With every minute we lose in delaying defibrillation, we lose 7 to 10 percent of people we could save," she said. "If we delay 10 minutes, the chances of saving someone really drop off."

The revised guidelines call for even greater availability of AEDs in heavily trafficked public arenas like airports, sports stadiums and theaters. The AHA expects that AEDs will also become standard pieces of equipment for fire trucks and police cars to carry as well.

Since 1993, the American Red Cross has offered training in the use of AEDs to professional rescuers. In 1998, a course for lay rescuers combining adult CPR and AED education was released to chapters. As the new emergency cardiac care guidelines are incorporated into Red Cross programs, offering training in the use of AEDs will be a part of every first aid and CPR program.

"Not only will our programs have the flexibility to build in AED training, but chapters can now participate in a program to offer AED devices along with our high quality training," said Vardell. The Red Cross is collaborating with Agilent Technologies and Medtronic, two AED manufacturers, to offer AEDs for sale by chapters to providers of CPR and AED training. Said Vardell, "We want to be the health and safety solution for workplaces and communities across the U.S."