What AHA Guidelines Changes Mean for Lay CPR Training

Updates to the American Heart Association’s CPR and emergency cardiovascular care guidelines have a long tail, as changes are incorporated into practice and educators and institutions modify training. So it is with the most recent tweaks, and a presentation at the Citizen CPR Foundation’s 2020 virtual summit explored what they mean for training lay responders in CPR.

Speaker Robert Chambers, RN, from the Texas-based AHA training partner RC Health Services, focused on the priorities of preparing for lay responder training, sharing best practices, and the implications of the guidelines on such efforts.

Interim training materials reflecting the changes represent the first step. Those are already available from the AHA Instructor Network for immediate use. Chambers outlined some relevant key areas of change:

1. A sixth link, recovery, had been added to the Chain of Survival. It’s not immediately clear what implications that might have for training, Chambers said, but survivors, families, and even rescuers require support after their hospital courses are completed.
2. When compressions are needed, bulky clothes should be quickly moved from the way, but if that’s not feasible, compressions can be performed over clothing. For defibrillation, though, the guidelines recommend removing all clothing that covers the chest. Remember, though, that you’re doing CPR on a person, Chambers warned—a person who can experience things like shame, fear, and guilt. Clear onlookers and protect patients’ privacy to the maximum extent possible.
3. Single rescuers compressing infants can now use two fingers, two thumbs, or the heel of one hand.
4. For children with suspected hypoglycemia who are awake but won’t swallow oral glucose, you can use a slurry of granulated sugar and water under the tongue. Call for help after 10 minutes if there’s no improvement.
5. The new guidelines contain quite a bit on bleeding control; the main point is to use a manufactured tourniquet where possible, with direct pressure and wound-packing as backup interventions.

RC Training Services had all its lead regional faculty go through the updates and develop printed materials for dissemination before classes, Chambers said. New Heartsaver materials are expected in the spring.

Best practices for teaching those courses reflect some basic tenets of professionalism in education: Be punctual and groomed. Check your AV equipment in advance; have backups for backups. Review materials in advance and be familiar. Make appropriate use of multimedia materials. War stories are OK and can alleviate stress but save them for after class.

With COVID forcing much training to become virtual, training personnel have long since received guidance and resources to help bring efforts online. If you’re not there yet, Chambers warned, get there yesterday: “The world’s not going back, it’s going forward,” and education will soon be immersed in advances like augmented reality.

Make full use of any local resources. When conducting a training at a business, for example, know the on-site variables and unique processes. Where are the AEDs? How do you call an outside line? Can you train employees on the same model of defibrillator they have and will use?

Other updates to the guidelines concern areas like opioids (don’t delay calling for help and giving naloxone) and health disparities (tailor training to racial, ethnic, and socioeconomic populations with lower rates of bystander CPR).

American bystander CPR rates remain low: Fewer than 40% of OHCA victims get it, and fewer than 12% are defibrillated before EMS arrival. Part of our educational challenge is to induce in those bystanders a willingness to act, Chambers said: “I want us to be inspirational for people when they take our courses.” Promote hands-only CPR, share videos, and remain knowledgeable, confident, and positive.

The market determines where CPR courses are delivered, Chambers added, but beyond that lie entire populations of people without the opportunity to learn lifesaving skills. Volunteer your time to go out and teach, he urged: “It’s all about spreading this mission to be a force in health and long lives.”

John Erich is the senior editor of EMS World.