AEDexpert.co.uk

AED Information

  • Poor maintenance makes AED defibrillators unreliable

    maintenance-01Heart-defibrillator maintenance leaves much to be desired. The largest suppliers of resuscitation-devices have issued a warning. Last Tuesday a woman in Bergen op Zoom in the Netherlands narrowly escaped death when an AED failed.

    High costs and ignorance are the cause of many Automated External Defibrillators being poorly maintained. Owners install a lifesaving shock device in their home, but they forget about it, observes one of the country’s largest suppliers, Medisol.

    The reasoning usually behind this is that customers, having just spent on average £ 1,000,=, feel secure. “This however will not be of much help in the event of a life-threatening heart event.”, notes Anne-Marieke Wieman of Medisol.

    Free inspection

    Medisol held a campaign a year ago to inspect their customers’ totally free of charge. About half of the devices inspected displayed some defect. Often the defibrillation pads had ceased to operate (lifetime: 2 years) or the batteries were depleted (lifetime: four years). The cause is often lack of awareness, but high maintenance costs also contribute to customers’ unwillingness to pay. "The annual fee for a maintenance service contract varies from £ 59 to 99 per annum. Only 50 procent of Medisol’s customers conclude such a contract, generally the least expensive”. 

    Excessive exposure to moisture

    maintenance-02With the risk that victims cannot be helped quickly enough. This happened last Tuesday while a woman was in cardiac arrest in a shopping centre in the Dutch city Bergen op Zoom. A nurse who was at the scene proceeded with CPR and shop employees rushed to a community centre to collect an AED defibrillator. In the meantime the police had arrived and had taken over the resuscitation, but couldn’t get the AED to operate. It transpired later that the AED had been installed at a location where it was exposed to excess moisture.
    Despite this the woman survived and is still in hospital. Her son Michel Wiegeraad finds  it "ridiculous" that the AED defibrillator couldn’t do its job. “Such a thing should just work. AED's should really have a label like fire extinguishers do. They should also be subject to mandatory annual inspection. This ended on a happy note, but if my mother had died, I'd have lived on with the question: What would have happened if that AED defibrillator had simply worked "?

    The Inspection of the Healthcare Council had already in 2013 raised the alarm after receiving several reports from suppliers on failing AED's. In all instances the electrical stimulus needed had failed to materialize "with in some cases fatal consequences for the patient." On that occasion the Council asked manufacturers to send a letter to the users drawing their attention to the need for preventive maintenance.

    Responsible

    The owner - many individuals like shopkeepers and sports club owners - is responsible for maintenance and replacement of parts. If the battery needs to be replaced, most devices will beep or a led-light will blink. But you will hardly notice that if you store the AED defibrillator in a carrier case in a place where only a few people come.'

    This translation is based on an article that appeared in the Dutch National Newspaper AD, written by Heleen Boex / Hanneke van Houweling on 01/09/16 - 04:20.

  • AED defibrillator or CPR manikin with resuscitation guidelines 2010 or even 2005, should I update?

    Many AEDs claim that they meet the resuscitation guidelines from 2010 or 2005. That does not always mean that you need to update your AED. After all the changes do not always relate to the functionality of the equipment and therefore the manufacturer does not use the latest guidelines. However what if this is important? Medisol explains what you have to do:

    For the AEDs:

    • In 2005, there have been many changes. For example, you should immediately start chest compressions instead of first giving two rescue breaths in CPR. Please be certain that your AED has at least these guidelines.
    • In 2010 there was a change in the protocol, meaning that AEDs with CPR feedback had to be adjusted. More compression was required on the victim’s chest. The AEDs for which this was the case were the Zoll AED Plus, Zoll AED Pro and HeartSine Samaritan 500P. Other devices with CPR feedback came on the market later and therefore alreadymet the 2010 guidelines.
    • The guidelines of 2015 brought no changes to the AED protocol. Therefore you don’t have to update the AED. However you will notice that that there will be more emphasis during CPR training on noticing abnormal breathing and asking for help immediately. Please keep repeating your training in order to provide the best help.

    For CPR manikins

    • Only the change to the 2010 guidelines had consequences for the resuscitation manikins. Not all manikins were suitable for the provision of deeper compressions than before. The Ambu Man I and Ambu Man W can be updated to the new guidelines with an update kit. For how to proceed with other manikins please contact customer service.guideluines 2015 ready

     

  • DIFFERENCES BETWEEN AED'S: SPEED OR VOICE PROMPTS

    A lot of attention is paid to the differences between AEDs: which AED has the best life-saving qualities? This is almost impossible to prove because each resuscitation is unique. Each patient is different and so is the time taken for the AED to reach its destination.

    All AED's operate in principle in the same way. They analyze the heart rhythm and administer a life-saving shock only when a shockable rhythm is detected. There are however differences between AEDs. For example:

    • How convenient is the AED to operate? Ease of operation varies from AED and target group.
    • Some AED's follow a comprehensive self-test, others keep it short and simple. This may influence reliability.
    • Extra features: for example a screen display, multilingual function, child electrode pads etc.
    • Quality differences in material and approval labels.
    • How the manufacturer interprets the protocol of the ERC (European Resuscitation Council).

    With regard to the final point, the interpretation of the Protocol has at last been the subject of qualitative research. There is now evidence that the time taken by the AED for its spoken prompts may result in delay to vital lifesaving chest compressions and recovery of respiration.

    AEDs differ in this respect significantly from one another; sometimes the spoken prompts are succinct, thus gaining a time advantage. Those AEDs regarded as more helpful provide longer voice prompts that delay the AED’s application.

    Unfortunate not all AEDs have been included in this investigation. Therefore Medisol AEDexpert is unable to provide you with a quality comparison. The research has however demonstrated that some leading brands aren't as good as their promotional material would suggest.

    What can you do with this information?

    The research shows that it makes sense to think one step ahead. When you have followed a resuscitation course and know what to do, then please act. Do not wait for the voice prompts  to tell you where to place your hands for the chest compressions .

    By applying CPR immediately you will gain valuable seconds and the AED will automatically follow your lead. When you don't know what to do the voice instructions are a welcome addition that will enable you to listen before acting.

    View and compare AED's
    In our product range we have tried to make it easy to compare AEDs. This will allow you to find the AED that is most suitable for your organization. You can’t find it on the website? Please give us a call so that we can be of further assistance with your questions.

    Please click here for the entire research

  • Can I readout the data of my AED and/or update it?

    Before you can readout and/or update the data on your AED, the device has to be able to communicate with a PC. Medisol AEDexpert can advise you as to what the possibilities are and what you can do. The Medisol Service Center can, when required, readout your AED data and checkthe software version. Updates will depend on availability.

    It is surprising, the number of changes that AED’s have undergone since ERC2015 in order to meet the optimum life-saving protocol. The convenience of the current readout and update options provide an indication of those brands that represent for you the greatest convenience and the lowest costs for the future. 

    Cardiac Science:

    All of the Cardiac Science AED’s can all be linked to a computer via cable in order to readout the internal memory. Both cable and software are included with every new AED. This enables you to readout your AED data. The new Cardiac Science AED’s also provide the option of changing some of the system settings, for example the shock-protocol. It is therefore not inconceivable that updates for this AED may be provided using this option. What remains to be seen however is whether the manufacturer will be prepared to make updates available, securely and at no charge.

    Defibtech:

    The data of the Defibtech AED’s can be readout using an optional SD card. For some types there is free software available. In the past corrective software updates have been provided to all Defibtech AED owners by renewing SD cards.

    Heartsine:

    You require an optional cable to read the Heartsine AED’s data. You can download the software for this free of charge on internet. The Heartsine AED’s have also in the same way been provided with new software in the past. With earlier corrective actions all AED owners were provided with free software and cable.

    Life-Point:

    The Life-Point AED is very easy to modify. The cable required is not only included with the AED, but you can also come by it very easily as this mini-USB to USB connector is widely available. Anybody can modify this AED and software updates are expected to be very straightforward to install.

    Philips:

    The data of the Philips AED can be read by the user, but updating is harder. Through infra-red connection can be made with the AED. You will need an irDA port in order to connect. The software is a free download. In the past Philips has exchanged AED’s with an obsolete protocol for newer versions.

    Physio Control:

    With Physio Control AED’s communication is difficult. Although the data on the devices can be readout by attaching via an irDA port to the PC, the software isn’t, unlike nearly all other AED’s, available free of charge.

    Primedic:

    The Primedic AED’s operate with a removable memory card. On the software CD-rom you will find a readout program. There is no information available on the implementation of updates.

    Schiller:

    Schiller AED’s can be readout with software that is available free of charge. The data from resuscitation ars stored on the SD card. It is not possible for the user to update the software because that requires special cables that only the technicians have at their disposal.

    Zoll:

    Zoll AED’s can be readout via the infra- red port. Free software is available for this AED. Updating is also possible via the infra-red port, but not by the user. Zoll’s implementation of new guidelines in the past is a reason for confidence in its future performance.

    You may have another type of AED or queries about the availability of software or components? Please ask the specialists at Medisol AEDexpert about the possibilities.

  • AED INFORMATION

    CAN I READOUT THE DATA OF MY AED AND/OR UPDATE IT?

    Before you can readout and/or update the data on your AED, the device has to be able to communicate with a PC. Medisol AEDexpert can advise you as to what the possibilities are and what you can do. The Medisol Service Center can, when required, readout your AED data and checkthe software version. Updates will depend on availability.

    It is surprising, the number of changes that AED’s have undergone since ERC2015 in order to meet the optimum life-saving protocol. The convenience of the current readout and update options provide an indication of those brands that represent for you the greatest convenience and the lowest costs for the future. 

    Cardiac Science:

    All of the Cardiac Science AED’s can all be linked to a computer via cable in order to readout the internal memory. Both cable and software are included with every new AED. This enables you to readout your AED data. The new Cardiac Science AED’s also provide the option of changing some of the system settings, for example the shock-protocol. It is therefore not inconceivable that updates for this AED may be provided using this option. What remains to be seen however is whether the manufacturer will be prepared to make updates available, securely and at no charge.

    Defibtech:

    The data of the Defibtech AED’s can be readout using an optional SD card. For some types there is free software available. In the past corrective software updates have been provided to all Defibtech AED owners by renewing SD cards.

    Heartsine:

    You require an optional cable to read the Heartsine AED’s data. You can download the software for this free of charge on internet. The Heartsine AED’s have also in the same way been provided with new software in the past. With earlier corrective actions all AED owners were provided with free software and cable.

    Life-Point:

    The Life-Point AED is very easy to modify. The cable required is not only included with the AED, but you can also come by it very easily as this mini-USB to USB connector is widely available. Anybody can modify this AED and software updates are expected to be very straightforward to install.

    Philips:

    The data of the Philips AED can be read by the user, but updating is harder. Through infra-red connection can be made with the AED. You will need an irDA port in order to connect. The software is a free download. In the past Philips has exchanged AED’s with an obsolete protocol for newer versions.

    Physio Control:

    With Physio Control AED’s communication is difficult. Although the data on the devices can be readout by attaching via an irDA port to the PC, the software isn’t, unlike nearly all other AED’s, available free of charge.

    Primedic:

    The Primedic AED’s operate with a removable memory card. On the software CD-rom you will find a readout program. There is no information available on the implementation of updates.

    Schiller:

    Schiller AED’s can be readout with software that is available free of charge. The data from resuscitation ars stored on the SD card. It is not possible for the user to update the software because that requires special cables that only the technicians have at their disposal.

    Zoll:

    Zoll AED’s can be readout via the infra- red port. Free software is available for this AED. Updating is also possible via the infra-red port, but not by the user. Zoll’s implementation of new guidelines in the past is a reason for confidence in its future performance.

    You may have another type of AED or queries about the availability of software or components? Please ask the specialists at Medisol AEDexpert about the possibilities.

     

    DIFFERENCES BETWEEN AED'S: SPEED OR VOICE PROMPTS

    A lot of attention is paid to the differences between AEDs: which AED has the best life-saving qualities? This is almost impossible to prove because each resuscitation is unique. Each patient is different and so is the time taken for the AED to reach its destination.

    All AED's operate in principle in the same way. They analyze the heart rhythm and administer a life-saving shock only when a shockable rhythm is detected. There are however differences between AEDs. For example:

    • How convenient is the AED to operate? Ease of operation varies from AED and target group.
    • Some AED's follow a comprehensive self-test, others keep it short and simple. This may influence reliability.
    • Extra features: for example a screen display, multilingual function, child electrode pads etc.
    • Quality differences in material and approval labels.
    • How the manufacturer interprets the protocol of the ERC (European Resuscitation Council).

    With regard to the final point, the interpretation of the Protocol has at last been the subject of qualitative research. There is now evidence that the time taken by the AED for its spoken prompts may result in delay to vital lifesaving chest compressions and recovery of respiration.

    AEDs differ in this respect significantly from one another; sometimes the spoken prompts are succinct, thus gaining a time advantage. Those AEDs regarded as more helpful provide longer voice prompts that delay the AED’s application.

    Unfortunate not all AEDs have been included in this investigation. Therefore Medisol AEDexpert is unable to provide you with a quality comparison. The research has however demonstrated that some leading brands aren't as good as their promotional material would suggest.

    What can you do with this information?

    The research shows that it makes sense to think one step ahead. When you have followed a resuscitation course and know what to do, then please act. Do not wait for the voice prompts  to tell you where to place your hands for the chest compressions .

    By applying CPR immediately you will gain valuable seconds and the AED will automatically follow your lead. When you don't know what to do the voice instructions are a welcome addition that will enable you to listen before acting.

    View and compare AED's
    In our product range we have tried to make it easy to compare AEDs. This will allow you to find the AED that is most suitable for your organization. You can’t find it on the website? Please give us a call so that we can be of further assistance with your questions.

    Please click here for the entire research

  • Resuscitation 2015: The pathway to new Guidelines

    New resuscitation guidelines 2015 - 2020

    Every five years the international guidelines for resuscitation change to a greater or lesser extent. This change is the result of scientific research and the development of new medication and devices. Because successful resuscitation is a critical factor for the survival of a victim, every resuscitation is the subject of constant evaluation.

    These data and results are all applied when formulating the new guidelines. Those guidelines were renewed in 2005 and 2010 and an update will be announced this year for the period 2015 – 2020. The new guidelines for Europe will be announced at the congress Resuscitation 2015, which will be held in Prague from 29 – 31 October.

    What can be expected of the new guidelines? We don’t know. There is some speculation, but it may be sensible to wait for the congress.

    Are there going to be many changes? Again we can’t provide you with an answer.

    In 2005 quite a few major changes were made. For example, until then 15 thorax compressions were applied, alternating with two respirations. Since 2005 the guidelines have been changed, now providing 30 compressions combined with 2 respirations. This was a major alteration, the more so since the software of the existing AED’s also had to be changed.

    In 2010 the alterations had less impact, because for a long time it wasn’t quite clear what the guidelines meant for existing AED’s.

    Whether any of the changes will have consequences for your AED remains at this stage a matter of conjecture. First the guidelines will have to be announced. Then the National Reanimation Councils of all the countries have to give their approval (in the Netherlands this will be on 20 January 2016). Only then will the implementation phase commence, during which AED manufacturers will be given time to where necessary modify their devices. Should there be any changes, those changes will affect your AED software only by the earliest in 2016.

    We shall of course use this page to keep you abreast of developments.

    Do you want to know if you can readout and/or update your AED. For more information please click here

    fb-erc2015-banner-uk

    Medisol will be in Prague for the ERC congress Resuscitation 2015 from the 29th until the 31ste of October. This particular ERC congress is important because the new CPR reanimation guidelines for the next 5 years will be presented here. This could also be the moment to meet up with business associates to expand collaboration. Especially now, when the eyes of the AED world are all focused on Prague.

    Will you be there? We are looking forward in meeting you. If you wish to make an appointment, please contact Customer Service, phone number + 44 (0) 1223-790124.

    On this page we'll keep you posted about the latest updates ...

  • What is the reason AED electrode pads have a limited shelf life?

    blogbanner-houdbaarheid-aed-uni

    You must have noticed when you have an AED that the electrode pads have a limited shelf life. What is the reason for this?

    The function of AED electrode pads

    The pads have two main functions.  Attached to the AED the pads measure the heart rhythm to judge if a life-saving shock is required.  If the AED recommends a shock must be given then it will give a therapeutic shock using the same electrode pads. For use of these main functions  firm adhesion to the  skin is of great importance.

    The electrode pads use an adhesive gel that conducts

    For  purpose of adhesion to the skin electrode pads are equipped with a gel that not only has adhesive properties but also conducts the electric current. After a while the gel on the pads may dry out in the packaging, causing the chemical composition of the gel to change.  This will  result in  lower conduction of the electric current.  The AED may have problems with the analysis if the quality of the conducting signal reduces.  Also the electrode pads will be less adhesive. This can be a problem when chest compressions have to be applied. They may shake loose from the skin or become displaced. The AED will then be less able of providing a therapeutic shock, hence reducing its life-saving function.

    The solution

    Because of changes in the chemical composition of the pads the manufacturer can guarantee their quality only for a specific period of time after production. This is the reason that the pads are supplied with a “best before date”. The shelf life varies, depending on the brand and type and runs from 12 to 60 months. It is important that during the periodic inspection of the AED the electrode pads are also checked and, where necessary replaced.

  • Taking the Mystery out of Maintenance

    RCUK-logo_banner4ERC_logo_2011QQ20140818-1From time to time, you will need to replace components of your AED or restock first aid items in your Safety Kit.

    How Often to Check Your AED
    AEDExpert recommends that you perform a monthly inspection of your AED device. You want to ensure that the:

    • Green light is still flashing on the front of the device.
    • No damage has been done to device.
    • None of the parts need to be replaced, etc.

    In the user guide that is included with your AED, you’ll find an inspection log, a plastic protective pouch to store the log, and a guide that will instruct you on how to perform monthly inspections.

    AED Self-Checks to Ensure Optimal Performance
    In the meantime, your AED will conduct daily self-checks to ensure that all of its components are functioning properly. If your AED detects a problem, it will make a beeping noise.

    Your AED will come with a user manual, Inspection Log / Maintenance Tips booklet. It will give you step-by-step instructions on how to address the issue that the AED has identified.

    When to Consider Replacement Parts for Your AED
    To ensure that your AED is ready to use when you need it, you should replace certain parts from time to time. Please note, it is your responsibility to keep track of replacement dates and expiration dates. To help you keep track of dates, your AED comes with a small pre-printed sticker that includes an “Installation Date” and “Expiration Date” for the battery and pads.

    AEDexpert recommends that you order an extra battery and pads, so you have them handy.

    Here is a general replacement timeline for your AED components:

    • Battery: Replace four years* (unless otherwise stated) after the installation date. Once you install your battery, it should last for four years*. We recommend that you take a Sharpie marker and write “Installation date: [your date]” on your battery. (Please note, the battery comes with an “Install By” date pre-printed on it. However, the four-year battery life actually starts once it has been installed, not with the “Install By” date.)
    • Pads: Replace on the two-year expiration date, as well as after each use. Your AED pads have a two-year life span. The pads come pre-printed with an expiration date.
    • AED heart defibrillator: Replacement depends on the self-checks. The useful life of an AED is 10 years — as long as it passes the daily self-tests. When the AED device no longer passes the daily self-tests, it’s time to replace it. Your AED device is covered by warranty.
  • Paediatric Basic Life Support

    Introduction

    The paediatric basic life support guidelines have been changed, partly in response to convincing new scientific evidence, and partly to simplify them in order to assist teaching and retention.  As in the past, there remains a paucity of good quality evidence specifically on paediatric resuscitation, and some conclusions have had to be drawn from experimental work or extrapolated from adult data.

    These guidelines have a strong focus on simplification, based on the knowledge that many children receive no resuscitation at all because rescuers fear doing harm as they have not been taught specific paediatric resuscitation.  Consequently, a major area of discussion during the development of Guidelines 2005 has been the feasibility of applying the same guidelines to children as to adults.

    Bystander resuscitation improves outcome significantly.  There is good evidence from experimental models that doing either chest compression or expired air ventilation alone may result in a better outcome than doing nothing. It follows that outcomes could be improved if bystanders who would otherwise do nothing, were encouraged to begin resuscitation, even if they do not follow an algorithm targeted specifically at children.  There are, however, distinct differences between the predominantly adult arrest of cardiac origin and the asphyxial arrest which occurs commonly in children.  Therefore, a separate paediatric algorithm is justified for healthcare professionals with a duty to respond to paediatric emergencies, who are in a position to receive enhanced training.

    Guideline changes

    Compression:ventilation ratios
    • Lay rescuers should use a ratio of 30 compressions to 2 ventilations.
    • Two or more rescuers with a duty to respond should use a ratio of 15  compressions to 2 ventilations.

    Age definitions
    • An infant is a child under 1 year.
    • A child is between 1 year and puberty.

     Automated external defibrillators (AED’s)

    • A standard AED can be used in children over 8 years.
    • Purpose-made paediatric pads, or programs which attenuate the  energy output of an AED, are recommended for children  between 1 and 8 years.
    • If no such system or manually adjustable machine is available,  an unmodified adult AED may be used for children older than 1 year.
    • There is insufficient evidence to support a recommendation for  or against the use of AEDs in children less than 1 year.

    Foreign body airway obstruction sequence.
    A simplified sequence of actions should be used for the  management of foreign body airway obstruction (FBAO) in infants and  children.

    Infant and child BLS sequence
    Rescuers who have been taught adult BLS, and have no specific knowledge of paediatric resuscitation, should use the adult sequence.
    The following modifications to the adult sequence will, however, make it more suitable for use in children:

    • Give five initial rescue breaths before starting chest compression
    • If you are on your own, perform CPR for 1 min before going for help.
    • Compress the chest by approximately one-third of its depth.  Use two  fingers for an infant under 1 year; use one or two hands for a child  over 1 year as needed to achieve an adequate depth of compression.

    The following is the sequence that should be followed by healthcare professionals with a duty to respond to paediatric emergencies:  

    1 Ensure the safety of rescuer and child. 

    2 Check the child’s responsiveness:

    • Gently stimulate the child and ask loudly, ‘Are you all right?’
    • Do not shake infants, or children with suspected cervical spine injuries.

    3 A  If the child responds by answering or moving:

    • Leave the child in the position in which you find him (provided he is  not in further danger).
    • Check his condition and get help if needed. Reassess him regularly.

    3 B If the child does not respond:

    • Shout for help.
    • Open the child’s airway by tilting the head and lifting the chin:
    • With the child initially in the position in which you find him, place your hand on his forehead and gently tilt his head back.
    • At the same time, with your fingertip(s) under the point of the child’s chin, lift the chin.  Do not push on the soft tissues under the chin as this may block the airway.
    • If you still have difficulty in opening the airway, try the jaw thrust method: place the first two fingers of each hand behind each side of the child’s mandible (jaw bone) and push the jaw forward.  Both methods may be easier if the child is turned carefully onto his back.

    If you suspect that there may have been an injury to the neck, try to open the airway using chin lift or jaw thrust alone.  If this is unsuccessful, add head tilt a small amount at a time until the airway is open.

    4 Keeping the airway open, look, listen, and feel for normal breathing by  putting your face close to the child’s face and looking along the  chest:

    • Look for chest movements.
    • Listen at the child’s nose and mouth for breath sounds.
    • Feel for air movement on your cheek.

    Look, listen, and feel for no more than 10 sec before deciding that breathing is absent.

    5 A If the child is breathing normally:

    • Turn the child onto his side into the recovery position.
    • Check for continued breathing.

    5 B If the child is not breathing or is making agonal gasps (infrequent,  irregular breaths):

    • Carefully remove any obvious airway obstruction.
    • Give 5 initial rescue breaths.
    • While performing the rescue breaths note any gag or cough response  to your action.  These responses, or their absence, will form part of  your assessment of ‘signs of a circulation’, described below.

    Rescue breaths for a child over 1 year:

    • Ensure head tilt and chin lift.
    • Pinch the soft part of his nose closed with the index finger and thumb  of your hand on his forehead.
    • Open his mouth a little, but maintain the chin upwards.
    • Take a breath and place your lips around his mouth, making sure that  you have a good seal.
    • Blow steadily into his mouth over about 1-1.5 sec watching for chest  rise.
    • Maintaining head tilt and chin lift, take your mouth away from the  victim and watch for his chest to fall as air comes out.
    • Take another breath and repeat this sequence 5 times. Identify  effectiveness by seeing that the child’s chest has risen and fallen in a  similar fashion to the movement produced by a normal breath.

    Rescue breaths for an infant:

    • Ensure a neutral position of the head and apply chin lift.
    • Take a breath and cover the mouth and nasal apertures of the infant  with your mouth, making sure you have a good seal.  If the nose and  mouth cannot both be covered in the older infant, the rescuer may  attempt to seal only the infant’s nose or mouth with his mouth (if the  nose is used, close the lips to prevent air escape).
    • Blow steadily into the infant’s mouth and nose over 1-1.5 sec sufficient  to make the chest visibly rise.
    • Maintain head tilt and chin lift, take your mouth away from the victim,  and watch for his chest to fall as air comes out.
    • Take another breath and repeat this sequence 5 times.

    If you have difficulty achieving an effective breath, the airway may be obstructed:

    • Open the child’s mouth and remove any visible obstruction.  Do not  perform a blind finger sweep.
    • Ensure that there is adequate head tilt and chin lift but also that the  neck is not over extended.
    • If head tilt and chin lift has not opened the airway, try the jaw thrust  method.
    • Make up to 5 attempts to achieve effective breaths.  If still  unsuccessful, move on to chest compression.

    6 Check for signs of a circulation (signs of life):  Take no more than 10 sec to:

    • Look for signs of a circulation.  These include any movement,  coughing, or normal breathing (not agonal gasps - these are  infrequent, irregular breaths).
    • Check the pulse (if you are trained and experienced) but ensure you take no more than 10 sec to do this:
    • In a child over 1 year — feel for the carotid pulse in the neck.
    • In an infant — feel for the brachial pulse on the inner aspect of the upper arm.

    7 A If you are confident that you can detect signs of a circulation within 10 sec:

    • Continue rescue breathing, if necessary, until the child starts  breathing effectively on his own.
    • Turn the child onto his side (into the recovery position) if he remains  unconscious.
    • Re-assess the child frequently.

    7 B If there are no signs of a circulation,   or  no pulse,   or  a slow pulse (less than 60 min-1 with poor perfusion),   or  you are not sure:

    • Start chest compression.
    • Combine rescue breathing and chest compression.

    For all children, compress the lower third of the sternum: 

    • To avoid compressing the upper abdomen, locate the xiphisternum by  finding the angle where the lowest ribs join in the middle.  Compress  the sternum one finger’s breadth above this.
    • Compression should be sufficient to depress the sternum by  approximately one-third of the depth of the chest.
    • Release the pressure, then repeat at a rate of about 100 min-1.
    • After 15 compressions, tilt the head, lift the chin, and give two effective breaths.
    • Continue compressions and breaths in a ratio of 15:2.

    Lone rescuers may use a ratio of 30:2, particularly if they are having difficulty with the transition between compression and ventilation. 

    Although the rate of compressions will be 100 min-1, the actual number delivered will be less than 100 because of pauses to give breaths.  The best method for compression varies slightly between infants and children.

    Chest compression in infants:

    • The lone rescuer should compress the sternum with the tips of two  fingers.
    • If there are two or more rescuers, use the encircling technique:
    • Place both thumbs flat, side by side, on the lower third of the sternum (as above), with the tips pointing towards the infant’s head.
    • Spread the rest of both hands, with the fingers together, to encircle the lower part of the infant’s rib cage with the tips of the fingers supporting the infant’s back.
    • Press down on the lower sternum with your two thumbs to depress it approximately one-third of the depth of the infant’s chest.

    Chest compression in children over 1 year:

    • Place the heel of one hand over the lower third of the sternum (as  above).
    • Lift the fingers to ensure that pressure is not applied over the child’s ribs.
    • Position yourself vertically above the victim’s chest and, with your arm  straight, compress the sternum to depress it by approximately one- third of the depth of the chest.
    • In larger children, or for small rescuers, this may be achieved most  easily by using both hands with the fingers interlocked.

    8 Continue resuscitation until:

    • The child shows signs of life (spontaneous respiration, pulse,  movement);
    • further qualified help arrives;
    • you become exhausted.

    When to call for assistance

    It is vital for rescuers to get help as quickly as possible when a child collapses:

    • When more than one rescuer is available, one starts resuscitation  while another goes for assistance.
    • If only one rescuer is present, undertake resuscitation for about 1 min  before going for assistance.  To minimise interruptions in CPR, it may  be possible to carry an infant or small child whilst summoning help.
    • The only exception to performing 1 min of CPR before going for help  is in the case of a child with a witnessed, sudden collapse when the  rescuer is alone.  In this case cardiac arrest is likely to be an  arrhythmia and the child may need defibrillation.  Seek help  immediately if there is no one to go for you.

     

    Explanatory notes

    Definitions

    An infant is a child under 1 year. 
    A child is between 1 year and puberty.  It is neither appropriate nor necessary to establish onset of puberty formally.  If the rescuer believes the victim to be a child he should use the paediatric guidelines.

    Compression:ventilation ratios

    The publication, 2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations (CoSTR), recommends that the compression:ventilation ratio should be based on whether one or more rescuers are present.  CoSTR also recommends that lay rescuers, who usually learn only single-rescuer techniques, should be taught to use a ratio of 30 compressions to 2 ventilations.  This is the same ratio as recommended for adults and enables anyone trained in BLS techniques to resuscitate children with minimal additional information.  Two or more rescuers with a duty to respond should learn a ratio with more rescue breaths (15:2), as this has been validated by experimental and mathematical studies. This latter group, who would normally be healthcare professionals, should receive enhanced training targeted specifically at the resuscitation of children.

    Although there are no data to support the superiority of any particular ratio in children, ratios of between 5:1 and 15:2 have been studied and there is increasing evidence that the 5:1 ratio delivers an inadequate number of compressions. There is certainly no justification for having two separate ratios for children greater or less than 8 years, so a single ratio of 15:2 for multiple rescuers with a duty to respond is a logical simplification.

    Although the CoSTR recommendation is based on the number of rescuers present, it would certainly negate the main benefit of simplicity if lay rescuers were taught a different ratio for use if there were two of them.  Similarly, those with a duty to respond, who would normally be taught to use a ratio of 15:2, should not be compelled to use the 30:2 ratio if they are alone, unless they are not achieving an adequate number of compressions because of difficulty in the transition between ventilation and compression.

    Age definitions

    The adoption of a single compression:ventilation ratio for children of all ages, together with the change in advice on the lower age limit for the use of automated external defibrillators (AEDs), renders the Guidelines 2000 division between children above and below 8 years unnecessary.  The differences between adult and paediatric resuscitation are largely based on differing aetiology, with primary cardiac arrest being more common in adults whereas children usually suffer from secondary cardiac arrest.  The onset of puberty, which is the physiological end of childhood, is the most logical landmark for the upper age limit for use of paediatric guidelines.  This has the advantage of being simple to determine in contrast to an age limit, as age may be unknown at the start of resuscitation.

    Clearly, it is inappropriate and unnecessary to establish the onset of puberty formally; if the rescuer believes the victim to be a child then he should use the paediatric guidelines.  If a misjudgment is made, and the victim turns out to be a young adult, little harm will accrue as studies of aetiology have shown that the paediatric pattern of arrest continues into early adulthood.

    It is necessary to differentiate between infants and older children, as there are some important differences between these two groups.

    Chest compression technique

    The modification of age definitions enables a simplification of the advice on chest compression.  The method for determining the landmarks for infant compression is now the same as that for older children, as there is evidence that the previous recommendation could result in compression over the upper abdomen.  Infant compression techniques remain the same: two-finger compression for single rescuers and two-thumb encircling technique for two or more rescuers.  For older children there is no division between the one- or two-hand techniques; the emphasis is on achieving an adequate depth of compression with minimal interruptions, using one or two hands according to rescuer preference.

    Automated external defibrillators

    Since Guidelines 2000 there have been case reports of safe and successful use of AEDs in children less than 8 years.  Furthermore, recent studies have shown that AEDs are capable of identifying arrhythmias accurately in children and are extremely unlikely to advise a shock inappropriately.  Consequently, advice on the use of AEDs has been revised to include all children greater than 1 year. Nevertheless, if there is any possibility that an AED may need to be used in children, the purchaser should check that the performance of the particular model has been tested against paediatric arrhythmias.

    Many manufacturers now supply purpose-made paediatric pads or programs which typically attenuate the output of the machine to 50-75 J. These devices are recommended for children between 1 and 8 years.  If no such system or manually adjustable machine is available, an unmodified adult AED may be used in children older than 1 year.  There is currently insufficient evidence to support a recommendation for or against the use of AEDs in children less than 1 year.

    Recovery position

    An unconscious child whose airway is clear and who is breathing spontaneously should be turned onto his side into the recovery position.  There are several recovery positions; each has its advocates.  The important principles to be followed are:

    • The child should be placed in as near a true lateral position as  possible with his mouth dependant to enable free drainage of fluid.
    • The position should be stable.  In an infant, this may require the  support of a small pillow or a rolled-up blanket placed behind his back  to maintain the position.
    • There should be no pressure on the chest that impairs breathing.
    • It should be possible to turn the child onto his side and to return him  back easily and safely, taking into consideration the possibility of  cervical spine injury.
    • The airway should be accessible and easily observed.
    • The adult recovery position is suitable for use in children.

    Foreign body airway obstruction (FBAO)

    Recognition of FBAO

    When a foreign body enters the airway the child reacts immediately by coughing in an attempt to expel it.  A spontaneous cough is likely to be more effective and safer than any manoeuvre a rescuer might perform.  However, if coughing is absent or ineffective, and the object completely obstructs the airway, the child will rapidly become asphyxiated.  Active interventions to relieve FBAO are therefore required only when coughing becomes ineffective, but they then need to be commenced rapidly and confidently.

    The majority of choking events in children occur during play or whilst eating, when a carer is usually present.  Events are therefore frequently witnessed, and interventions are usually initiated when the child is conscious.

    FBAO is characterised by the sudden onset of respiratory distress associated with coughing, gagging, or stridor.  Similar signs and symptoms may also be associated with other causes of airway obstruction, such as laryngitis or epiglottitis, which require different management.  Suspect FBAO if:

    • The onset was very sudden
    • There are no other signs of illness
    • There are clues to alert the rescuer, for example a history of eating or  playing with small items immediately prior to the onset of symptoms.

    General signs of FBAO

    • Witnessed episode 
    • Coughing or choking
    • Sudden onset
    • Recent history of playing with or eating small objects
    Ineffective coughing Effective cough
    Unable to vocalise Crying or verbal response to  questions
    Quiet or silent cough Loud cough
    Unable to breathe Able to take a breath before  coughing
    Cyanosis Fully responsive
    Decreasing level of  consciousness   

     

    Relief of FBAO

    Safety and summoning assistance

    Safety is paramount.  Rescuers should avoid placing themselves in danger and consider the safest action to manage the choking child:

    • If the child is coughing effectively, then no external manoeuvre is  necessary.
    • Encourage the child to cough, and monitor continuously.
    • If the child’s coughing is, or is becoming, ineffective, shout for help  immediately and determine the child’s conscious level.

    Conscious child with FBAO

    • If the child is still conscious but has absent or ineffective coughing,  give back blows.
    • If back blows do not relieve the FBAO, give chest thrusts to infants or  abdominal thrusts to children.  These manoeuvres create an ‘artificial  cough’ to increase intrathoracic pressure and dislodge the foreign  body.

     

    Back blows

    In an infant:

    • Support the infant in a head-downwards, prone position, to enable  gravity to assist removal of the foreign body.
    • A seated or kneeling rescuer should be able to support the infant  safely across his lap.

    Paediatric FBAO Treatment  Unconscious 

    pediatric resc

    • Support the infant’s head by placing the thumb of one hand at the  angle of the lower jaw, and one or two fingers from the same hand at  the same point on the other side of the jaw.
    • Do not compress the soft tissues under the infant’s jaw, as this will  exacerbate the airway obstruction.
    • Deliver up to 5 sharp back blows with the heel of one hand in the  middle of the back between the shoulder blades.
    • The aim is to relieve the obstruction with each blow rather than to give  all 5.

    In a child over 1 year:

    • Back blows are more effective if the child is positioned head down.
    • A small child may be placed across the rescuer’s lap as with an infant.
    • If this is not possible, support the child in a forward-leaning position  and deliver the back blows from behind.

    If back blows fail to dislodge the object, and the child is still conscious, use chest thrusts for infants or abdominal thrusts for children.  Do not use abdominal thrusts (Heimlich manoeuvre) for infants. 

    Chest thrusts for infants:

    • Turn the infant into a head-downwards supine position.  This is  achieved safely by placing your free arm along the infant’s back and  encircling the occiput with your hand.
    • Support the infant down your arm, which is placed down (or across)  your thigh.
    • Identify the landmark for chest compression (lower sternum  approximately a finger’s breadth above the xiphisternum).
    • Deliver 5 chest thrusts.  These are similar to chest compressions,   but sharper in nature and delivered at a slower rate.

    Abdominal thrusts for children over 1 year: 

    • Stand or kneel behind the child.  Place your arms under the child’s  arms and encircle his torso.
    • Clench your fist and place it between the umbilicus and xiphisternum.
    • Grasp this hand with your other hand and pull sharply inwards and  upwards.
    • Repeat up to 5 times.
    • Ensure that pressure is not applied to the xiphoid process or the lower rib cage as this may cause abdominal trauma.

    Following chest or abdominal thrusts, reassess the child:

    • If the object has not been expelled and the victim is still conscious,  continue the sequence of back blows and chest (for infant) or  abdominal (for children) thrusts.
    • Call out, or send, for help if it is still not available.
    • Do not leave the child at this stage.

    If the object is expelled successfully, assess the child’s clinical condition.  It is possible that part of the object may remain in the respiratory tract and cause complications.  If there is any doubt, seek medical assistance.  Abdominal thrusts may cause internal injuries and all victims so treated should be examined by a medical practitioner.

    Unconscious child with FBAO

    • If the child with FBAO is, or becomes, unconscious place him on a  firm, flat surface.
    • Call out, or send, for help if it is still not available.
    • Do not leave the child at this stage.

    Airway opening:

    • Open the mouth and look for any obvious object.
    • If one is seen, make an attempt to remove it with a single finger  sweep.

    Do not attempt blind or repeated finger sweeps - these can impact the object more deeply into the pharynx and cause injury.

    Rescue breaths:  

    • Open the airway and attempt 5 rescue breaths.
    • Assess the effectiveness of each breath: if a breath does not make  the chest rise,
    • reposition the head before making the next attempt.

    Chest compression and CPR:

    • Attempt 5 rescue breaths and if there is no response, proceed  immediately to chest compression regardless of whether the breaths  are successful.
    • Follow the sequence for single rescuer CPR (step 7B above) for  approximately 1 min before summoning EMS (if this has not already  been done by someone else).
    • When the airway is opened for attempted delivery of rescue breaths,  look to see if the foreign body can be seen in the mouth.
    • If an object is seen, attempt to remove it with a single finger sweep.
    • If it appears that the obstruction has been relieved, open and check  the airway as above.  Deliver rescue breaths if the child is not  breathing.
    • If the child regains consciousness and is breathing effectively, place  him in a safe side-lying (recovery) position and monitor breathing and  conscious level whilst awaiting the arrival of EMS.

     

  • Responsibility to provide an AED at a public place

    In the years since their introduction, the use of AEDs by lay persons has proved so
    successful that fears have been expressed that failing to provide an AED might lead to a claim for negligence should a member of the public suffer a cardiac arrest while on the premises. The problem was highlighted when two airline companies were successfully sued in the USA because an AED was not available to treat passengers who suffered cardiac arrests during a flight.

    AEDs are being widely provided in busy public places by a government led initiative, and many other organisations have acted on their own initiative to make the equipment available. The police have equipped custody suites with AEDs and many patrol cars also carry the equipment. The first aid societies have deployed AEDs at many of the functions that they attend. There is, therefore, widespread public awareness of the purpose of such equipment, but so far there have been no cases in the UK brought against those who have not equipped themselves with AEDs.

    Several US states now require AEDs to be placed in particular buildings, including schools, health clubs, day care centres, places of public assembly, and swimming pools. There is currently no such legislation in the UK.

    Under English law, there can be liability in negligence for failing to take appropriate safety precautions on your premises, for example the case of Lips v Older [2004] All ER (D) 168, where a landlord was found to be negligent for not arranging for a handrail to be put up by a staircase with a steep drop to one side. Whether precautions are appropriate will depend on balancing the cost and benefit of the precaution. When considering the benefit, one must consider the likelihood of harm, the severity of the potential harm, and the vulnerability of potential victims that the Defendant knew or should have known about. In that and similar cases, the hazard was inherent in the premises, but it can be seen by analogy that the time might come (although it has probably not yet arrived) where certain types of premises would be considered defective if they were not equipped with AEDs.

    In relation to AEDs, the likelihood of harm will depend on the type of people who use the facility, and how likely they are to have a cardiac arrest. The severity of potential harm is clearly very high. The vulnerability of potential victims will very much depend on the circumstances and the type of people attending the defendant's facility. The cost of purchasing an AED and training staff to use it may be quite high. However, when looking at the cost, lack of resources will not be a relevant factor. Failing to adopt common practice can be strong evidence that appropriate precautions were not taken. Where an AED is provided in a workplace, and used by a member of staff, it becomes work equipment to which the Provision and Use of Work Equipment Regulations 1998 apply. Failure to maintain the equipment and to train persons in its use would be a breach of the 1998 Regulations by the employer.

    It may be possible to use this basis of liability to found a claim against an organisation that did not equip itself with AEDs. For any such claim to succeed, it may well have to be shown, at the least, either that the people who generally used the organisation's premises were at a particular risk of cardiac arrest (i.e. that there was a fairly high risk of potential harm), or that it was common practice amongst such organisations to have an AED available. An example could be a gym or health club where cardiac arrests have been reported with some frequency. In addition, many such facilities (but not all) have already equipped themselves with AEDs and lives have been saved. Some states in the USA do actually require health clubs to be equipped with AEDs.

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