Lesson Category: First aid

What is CPR?

CPR stands for cardiopulmonary resuscitation. It combines chest compressions and rescue breaths to give a person the best chance of survival following a cardiac arrest.

Due to the COVID-19 outbreak. Do not perform rescue breaths on adult casualties.

If an adult is unresponsive and not breathing normally, you still need to call 999 or 112 for emergency help and start CPR straight away.

For more information on CPR during the COVID-19 outbreak, visit the Resuscitation Council website.

What to do

1. If you find someone collapsed, you should first perform a primary survey. Do not place your face close to theirs. If you have established from this that they are unresponsive and not breathing, you should ask a helper to call 999 or 112 for emergency help while you start CPR. Ask a helper to find and bring a defibrillator, if available.
   • Ask your helper to put the phone on speaker and hold it out towards you, so they can maintain a 2m distance
   • If you are on your own, use the hands-free speaker on a phone so you can start CPR while speaking to ambulance control
   • Do not leave the casualty to look for a defibrillator yourself. The ambulance will bring one.
2. Before you start CPR, use a face shield if available or towel/piece of clothing and lay it over the mouth and nose of the casualty.
3. Start CPR. Kneel by the casualty and put the heel of your hand on the middle of their chest. Put your other hand on top of the first. Interlock your fingers making sure they don’t touch the ribs.Keep your arms straight and lean over the casualty. Press down hard, to a depth of about 5-6cm before releasing the pressure, allowing the chest to come back up.
   • The beat of the song “Staying Alive” can help you keep the right speed
   • Do not give rescue breaths.
4. Continue to perform CPR until:  
   • emergency help arrives and takes over  
   • the person starts showing signs of life and starts to breathe normally
   • you are too exhausted to continue (if there is a helper, you can change over every one-to-two minutes, with minimal interruptions to chest compressions)
   • a defibrillator is ready to be used.
5. If the helper returns with a defibrillator, ask them to switch it on and follow the voice prompts while you continue with CPR.
   • Wherever possible, the helper should keep a distance of 2m.
6. If the casualty shows signs of becoming responsive such as coughing, opening eyes, speaking, and starts to breathe normally, put them in the recovery position. Monitor their level of response and prepare to give CPR again if necessary.
   • If you have used a defibrillator, leave it attached.

4. What to do if you are required to come into close contact with someone as part of your first responder duties

1. Personal protective equipment (PPE)

Where it is not possible to maintain a 2 metre or more distance away from an individual, disposable gloves and a disposable plastic apron are recommended. Disposable gloves should be worn if physical contact is likely to be made with potentially contaminated areas or items.

The use of a fluid repellent surgical face mask is recommended and additional use of disposable eye protection (such as face visor or goggles) should be risk assessed when there is an anticipated risk of contamination with splashes, droplets of blood or body fluids.

When using a fluid repellent surgical face mask, you should mould the metal strap of the mask over the bridge of the nose and make sure the mask fits snugly under the chin, around or across any facial hair if present.

Clean your hands thoroughly with soap and water or alcohol sanitiser before putting on and after taking off PPE. In all circumstances where some form of PPE is used, the safe removal of the PPE is a critical consideration to avoid self-contamination. Guidance on putting on and taking off PPE is available. Use and dispose of all PPE according to the instructions and training provided by your employer or organisation.

2. Cardiopulmonary resuscitation

(CPR guidance can be found in the next section)

In adults, it is recommended that you do not perform rescue breaths or mouth-to-mouth ventilation; perform chest compressions only. Compression-only CPR may be as effective as combined ventilation and compression in the first few minutes after non-asphyxial arrest (cardiac arrest not due to lack of oxygen).

Cardiac arrest in children is more likely to be caused by a respiratory problem (asphyxial arrest), therefore chest compressions alone are unlikely to be effective.

If a decision is made to perform mouth-to-mouth ventilation in asphyxial arrest, use a resuscitation face shield where available.

Should you have given mouth-to-mouth ventilation there are no additional actions to be taken other than to monitor yourself for symptoms of possible COVID-19 over the following 14 days. Should you develop such symptoms you should follow the advice on what to do on the NHS website.

2. Providing assistance to unwell individuals

If you need to provide assistance to an individual who is symptomatic and may have COVID-19, wherever possible, place the person in a place away from others. If there is no physically separate room, ask others who are not involved in providing assistance to stay at least 2 metres away from the individual. If barriers or screens are available, these may be used.4 Cleaning the area where assistance was provided

Cleaning will depend on where assistance was provided. It should follow the advice for cleaning in non-healthcare settings. Public areas where a symptomatic individual has passed through and spent minimal time in (such as corridors) but which are not visibly contaminated with body fluids can be cleaned in the usual way. However, all surfaces that a symptomatic individual has come into contact with must be cleaned and disinfected.

3. If there has been a blood or body-fluid spill

Keep people away from the area. Use a spill-kit if available, using the PPE in the kit or PPE provided by your employer/organisation and following the instructions provided with the spill-kit. If no spill-kit is available, place paper towels/roll onto the spill, and seek further advice from emergency services when they arrive.

4. Contacts of the person you have assisted

Advise anyone who had close contact with the individual that if they go on to develop symptoms of COVID-19 (a new continuous cough, fever or a loss of, or change in, normal sense of taste or smell), they should follow the advice on what to do on the NHS website.

5. What to do if you become unwell

If you have already been given specific advice from your employer about who to call if you become unwell, follow that advice.

If you develop symptoms of COVID-19, however mild, you will need to stay at home for at least 7 days. Refer to the advice on the NHS website and the Stay at home guidance.

https://www.sja.org.uk/get-advice/first-aid-advice/unresponsive-casualty/how-to-do-cpr-on-an-adult/

As there is currently sustained community transmission of COVID-19 throughout the UK, there is an increased likelihood of any individual in the community having the infection.

This guidance is for all situations where close contact (defined as being within 2 metres of an individual) is required during first responder duties.

The best way to protect yourself and others is through rigorous cleaning, personal hygiene and regular hand hygiene. An increased frequency of cleaning and disinfection of all surfaces and equipment, using standard household cleaning and disinfection products, is recommended.

After contact with any member of the public, clean your hands thoroughly with soap and water or alcohol hand sanitiser at the earliest opportunity. This advice is applicable to all situations, regardless of whether there was close contact or the minimum 2 metre social distancing was maintained.

Avoid touching your mouth, eyes and nose.

There are no additional precautions to be taken in relation to cleaning your clothing or uniform other than what is usual practice.

Advice for First Aiders

https://www.gov.uk/government/publications/novel-coronavirus-2019-ncov-interim-guidance-for-first-responders/interim-guidance-for-first-responders-and-others-in-close-contact-with-symptomatic-people-with-potential-2019-ncov

1. How COVID-19 is spread

From what we know about other coronaviruses, spread of COVID-19 is most likely to happen when there is close contact (within 2 metres or less) with an infected person. It is likely that the risk increases the longer someone has close contact with an infected person.

Respiratory secretions (droplets) containing the virus are likely to be the most important means of transmission; these are produced when an infected person coughs or sneezes.

There are 2 common routes people could become infected:

1. Secretions can be directly transferred into the mouths or noses of people who are nearby (within 2 metres) or possibly could be inhaled into the lungs.
2. It is possible that someone may become infected by touching a person, a surface or object that has been contaminated with respiratory secretions and then touching their own mouth, nose, or eyes (such as shaking hands or touching door knobs then touching own face).