Bulletin #041 - CPR Update from ARC     


CPR Update
from
Professor John Pearn
RLSSA National Medical Advisor

Recently the American Heart Association (AHA) has publicly promoted a further and potential modification of the CPR guidelines for the training of lay members of the general public. The thrust of this new advocacy has been to further simplify CPR skills specifically by removing Rescue Breathing from the DRABC paradigm. This has been given many labels including ‘hands only CPR’ or ‘compression only CPR’.

Background
Prior to 1976, in Australia as elsewhere, individual organizations teaching CPR, ‘did their own thing’ with respect to teaching doctrine. Most organizations tended to follow the CPR doctrine of the Royal Life Saving Society and the St John Ambulance Association, who taught the same procedures. Nevertheless by the 1970’s individuals and individual organizations were drifting from this basic doctrine. Such was occurring without any evidence base.

2.       In 1976 to prevent confusion, 15 Australian bodies came together to form the Australian Resuscitation Council. The primary terms of reference of the ARC was to develop standardization of public teaching of basic CPR courses to the general public. Since that time, the most desirable situation has remained in Australia, in that all member bodies of the ARC have ‘taught the same thing’. Any return to the ‘bad old days’ would be disastrous both for individual bodies teaching CPR and the potential victims needing resuscitation whom bystanders or trained first aiders serve.

3.       In 2002, all bodies involved in teaching CPR appreciated the desirability of commonality of teaching, not only at a national but at an international level. To this end a number of national and supranational bodies came together to form the International Liaison Committee on Resuscitation (ILCOR). The Australian Resuscitation Council was one of these, indeed a leader in some aspects of this international and successful attempt to (a) achieve commonality worldwide and (b) to ensure that the drills and skills of CPR conformed to current best practice in both the scientific and sociological sense.

4.       In February 2006, ILCOR published new CPR doctrine for the teaching of the lay public. One major change here was the ‘30:2’ compression : rescue breathing ratio. The ARC adopted these recommendations on the joint grounds of (a) scientific evidence and (b) the maintenance of commonality of teaching

5.       All member bodies of the ARC agreed to this new CPR doctrine for training of the general lay public.

6.       The new suggestions (March 2008) promoted publicly in the press and via the AHA website have not been accepted by the Australian Resuscitation Council. The reason for this been the absence of any evidence that the new proposed AHA changes (specifically, omitting Rescue Breathing) is a better doctrine for the teaching of the lay public. Specifically, all bodies (including RLSSA) in Australia teaching CPR are training members of the general public and a set of all inclusive skills which will cover all scenarios of management of a collapsed or unconscious person, irrespective of cause.

7.       RLSSA has always, to date, followed ARC guidelines – which of course RLSSA helps formulate. For this reason our general first aid and lifesaving courses will continue with the current best-practice CPR doctrine which has been in place since February 2006.

8.       Colleagues will be aware, that specifically in RLSSA, we continue to teach ‘in water EAR’ as an extra specific skill because of the patho-physiology of drowning victims. A significant proportion of those rescued from the water, all be it unconscious have a beating heart and desperately need oxygen delivered via EAR and in the event that such victim is unable to be safely retrieved from the water then this skill (in water EAR) can be lifesaving. Such teaching is part of our doctrine for all involved in lifesaving courses, as opposed to ‘one off’ classes in general first aid taught to the lay public.

In April 2008 the ARC felt compelled to publish an advisory statement clarifying its position on the issue of compression only CPR, which it does not support. I have attached a copy of this advisory statement for distribution to your instructor network.

/uploaddocs/ARC compression only CPR advisory statement.pdf

            
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