The goal of this update course is to inform ASHI and MEDIC First Aid instructors and

instructor-trainers about recent significant changes and additions to training guidelines

for cardiopulmonary resuscitation (CPR), emergency cardiac care (ECC), and first aid
that affect ASHI and MEDIC First Aid training programs.

Successful completion of this course will help instructors provide the most current
guidelines for emergency care, allow for the use of interim training materials, and allow
the purchase and use of updated training programs and certification cards.

It is helpful to have a basic understanding of the process used to determine changes

and additions to the existing guidelines. ILCOR, the International Liaison Committee on
Resuscitation, is an organization made up of the principal resuscitation groups of the
world, such as the American Heart Association (AHA) in the United States. ILCOR
provides an underlying foundation for the most effective approach to resuscitation by
facilitating the collection and review of all scientific research on cardiopulmonary
resuscitation, emergency cardiac care, and, more recently, first aid. Historically, ILCOR
has operated on a 5-year cycle of releasing detailed information on the science of

resuscitation and related recommendations on how to best provide emergency care.

The latest release occurred on October 15, 2015.

There are two new ILCOR documents to be aware of. The first is the 2015 International
Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
Science With Treatment Recommendations. This is a comprehensive update of the
most current evidence-based science on resuscitation. In addition, the ILCOR First Aid
Task Force also released the 2015 International Consensus on First Aid Science With
Treatment Recommendations which provides a similar update on the evidence-based
science for first aid. Access to the ILCOR information is freely available atwww.ilcor.org.

The resuscitation groups that make up ILCOR use the consensus on science and
treatment recommendations to develop treatment and training guidelines specific to the

areas of the world they represent. Here in the U.S., the 2015 American Heart
Association Guidelines Update for CPR and ECC, and the 2015 American Heart
Association and American Red Cross Guidelines Update for First Aid were released on
October 15, 2015 at the same time as the ILCOR documents. Access to the AHA
guidelines is freely available atwww.eccguidelines.heart.org.

vidence shows that the quality of CPR does influence the overall survival of the person
affected. The new 2015 Guidelines place even heavier emphasis on the quality of CPR
that is provided. The specific measures are:
1. Compressing the chest at least 2 inches and avoiding depths of greater than 2.4
inches
2. Compressing the chest at a rate of between 100 and 120 compressions per
minute
3. Allowing full recoil of the chest on each compression
4. Minimizing interruptions
5. Not giving excessive volumes of air with rescue breaths
CPR is tiring and that directly affects the ability to provide high quality CPR for more
than just a few minutes. Many of the updated guidelines directly address the delivery of
high performance CPR.

MEDIC First Aid and the American Safety and Health Institute (ASHI) use the American
Heart Association guidelines as a source reference for the development of their core
CPR and first aid training programs. As has been done in the past, Health and Safety
Institute (HSI) uses the release of new guidelines as an opportunity to create new
versions of the affected MEDIC First Aid and ASHI training programs. This process is
currently well under way.

Because there will be changes in program content and the manner in which that
content is delivered, all MEDIC First Aid and ASHI authorized instructors are required
to be updated to the new guidelines and training programs. This update course is a part
of that process. The following lessons will detail the changes and additions to the
guidelines that affect MEDIC First Aid and ASHI training programs, along with some

insight as to why the changes occurred. You must complete each lesson in order to
successfully complete the update course. You can find complete information on the
update process atwww.hsi.com/guidelines.

In 2010, it was found that any training on the use of an AED, no matter how brief,
showed improvement in performance on simulated cardiac arrests. It was felt that
additional training options could be created and promoted for lay rescuers.
In 2015, that was reinforced with the specific consideration of either a combination of
self-instruction with instructor-led hands-on teaching, or self-directed training.

Although AEDs are located in public areas and untrained providers are encouraged to
use them, even minimal training can improve actual performance. Self-directed training
can provide more training opportunities for lay rescuers who typically would not attend
a traditional training course.

In 2010, the use of short training videos with a practice-while-watching feature was
found to be an acceptable alternative to instructor-led training.
In 2015, the integration of self-instruction through video and/or computer-based
approaches, with associated hands-on practice, was also found to be an acceptable
alternative.

Video-based, self-directed instruction in CPR with hands-on practice has been found to
be as effective as traditional instructor-led courses. Self-directed instruction could help
to train more people at a lower cost.

In 2010, the use of CPR prompting or feedback devices was found to be effective in
skills training.
In 2015, this was further refined as being effective in the improvement of CPR skills in a
training class. It was also clarified that if a feedback device was not available, an audio
prompting device such as a metronome could be considered to improve skill
performance at least in regard to the rate of compressions.

Today's technology allows us to effectively measure high performance CPR

recommendations such as compression rate, depth, and recoil using standalone or
manikin integrated feedback devices. The ability to provide that feedback in training
allows learners to get a realistic sense of proper skills and the effort it takes to perform

them.
If a comprehensive feedback device is not available for training due to cost or logistics,
an auditory guidance device such as a metronome can be used to provide some
guidance as to compression rate. Many metronome apps are available for no or low
cost for mobile devices.

In 2010, it was recommended to reassess and reinforce skill performance within the
standard 2-year certification period.
In 2015, this was refined to reflect on how quickly CPR skills degrade after training.
Because it appears that people who practice more often seem to have better skills and
confidence over those who dont, it is recommended for retraining to occur more often
by those likely to be involved in a resuscitation.

A renewal or recertification period of 2 years has proven for most people to be

inadequate for maintaining effective CPR performance. An optimal time for retraining
can vary from person to person depending on factors such as the quality of initial
training and the frequency with which the skills are used in actual resuscitations.
Evidence has shown an improvement in those who train more frequently.

New for 2015, it was felt that self-directed training in AED skills could be considered for
healthcare providers.

Similar to the recommendation for lay rescuers, self-directed training can provide more
frequent training opportunities for healthcare providers.

New for 2015, community-wide promotion of compression-only CPR performed by

bystanders for out-of-hospital sudden cardiac arrest can be considered as an
alternative to widespread training in traditional (compressions and breaths) CPR.

While it is important to still cover both breaths and compressions for trained providers
because of the chance of a respiratory-related arrest, sudden cardiac arrests involving
adults are still a major overall issue for the public at large. Compression-only CPR by
an untrained bystander has shown to be effective as an initial approach to SCA and
can be quickly understood via a public service announcement, large group
presentation, or by an EMS dispatcher over the phone.

New for 2015, CPR training for those close to individuals who are at a higher risk of
cardiac arrest may be reasonable. The ability to better target those high-risk people
needs improvement.

CPR performed by trained family members or caregivers of individuals who have been
identified as high-risk cardiac patients has shown to improve outcomes compared to
situations in which there was no training.