BSAC

Resuscitation Training Update No. 2

NOTE:
The Guidelines below have been superceded by BSAC Basic Life Support Guidelines 2006 regarding updated techniques and advice.
Some of the elements below (such as advice on Recovery position may still be valid but other aspects have changed and so both documents need to be refered to.

Feb. 2001
During August last year, the first International Guidelines for CPR were published after a lengthy period of consultation between the American Heart Association and the European Resuscitation Council. These guidelines are a very extensive, evidence based reference source which the Resuscitation Council (UK) have distilled into a more practical document called Guidelines 2000. This document has just been published.

The BSAC has reviewed this document, with the result that the following three changes are to be made to our resuscitation training procedures

1. Identification of circulation - the identification of a pulse using the carotid artery has been documented to lead to an incorrect conclusion (present or not) in up to 50% of cases. Training in detecting a circulation in this way is no longer recommended for non-healthcare persons - a definition which covers the vast majority of divers. The indications for a circulation should now be to assess the casualty for any signs of breathing, coughing or any indications of movement. If there are no signs of a circulation, or if the rescuers are at all unsure, they should commence chest compressions.
   
2. Two person CPR - the sequence of chest compressions / ventilations for two person CPR has standardised on 15:2 for all healthcare personnel. The 5:1 ratio is now only recommended for paediatric life support, and is a function of the casualty not the number of rescuers. Both single person and two person CPR should now use a common 15:2 ratio of chest compressions / ventilations.
   
3. Recovery position - Since 1998 the recovery position recommended by the Resuscitation Council (UK) has differed from that recommended by the BSAC. The difference arose because it was considered that the position recommended by the BSAC (which was in fact the Resuscitation Council (UK)'s 1997 recommendation) offered greater stability in the environment more likely to be encountered by divers - ie. a rolling, pitching boat. Guidelines 2000 does in fact acknowledge that there are a number of different recovery positions and that each has its advocates.

For a casualty on a stable base (shore) there is little to choose between the positions, each has its advantages and disadvantages. For consistency with other first aid agencies the BSAC will adopt the Guidelines 2000 position but will also continue to teach the pre-1998 position as a variation for situations where its added stability is a benefit.

One further aspect that emerged is clarification regarding Mouth-to Nose AV. In water AV is identified in Guidelines 2000 as being one of the situations where this technique is appropriate, due to the difficulties of adequately sealing the nose / achieving jaw lift in these circumstances. One relevant statement is that during mouth-to-nose AV, soft parts of the nasal passages may flop back to obstruct the airway. While this will not affect air flowing into the casualty, it can obstruct air coming out. It therefore recommends that the casualty's jaw is allowed to open during the expiration part of the cycle - in practice this will mean relieving any pressure holding the jaw shut. While this is not really a change to our training, this additional advice should be incorporated.

Resuscitation Training Update 1 (reviewed)

Resuscitation update 1 introduced changes to resuscitation training as a result of past Resuscitation Council (UK) recommendations. These have now been included in the current versions of most BSAC publications. For completeness those earlier recommendations which still remain valid (i.e. are not superseded by Guidelines 2000) are as summarised below:
The changes represent an amendment of the procedure on initially being presented with a non-breathing casualty which take more account of the potential causes. Previous advice was centred around the heart attack in the home, but other circumstances were then taken into account. This changed the advice to the following:

if the casualty is unconscious but breathing place in the recovery position and summon an ambulance

if the casualty is unconscious and not breathing, is the condition due to either injury or drowning?. If yes then carry out resuscitation for one minute before calling for an ambulance. If due to some other cause, call an ambulance first before commencing resuscitation. Note that the initial assessment only concerns the presence or absence of breathing not whether a circulation is present or not, this is subsequently evaluated in the resuscitation sequence defined as:

open the airway and check for breathing

if breathing, place in the recovery position; if not breathing give two full cycles of AV

check for signs of a circulation (for 10 seconds) (but, following Guidelines 2000, no longer using the pulse)

if a circulation is present continue with AV, monitoring the circulation every minute or so;

watching for the rise and fall of the casualty's chest

assessing the ease with which the casualty's chest is inflated

listening for the sound of the air exhaled by the casualty

continuously monitor the casualty and if breathing returns place in the recovery position

if circulation is absent alternate 15 chest compressions with 2 breaths of AV

the rate of chest compressions was increased to a rate of 100 compressions per minute, the depth of compression remaining unchanged. This increase in rate was based on evidence that it provides a better blood supply to the brain.

continuously monitor the casualty's appearance and only if there is a significant improvement check for a returning circulation

When applied to the diving situation it is extremely unusual for a rescuer not to have other divers or other people around to assist. Under these circumstances, AV/CC should be commenced immediately while other divers call the emergency services. In these circumstances, which cover the vast majority of diving situations, the above decision process about what to do before calling assistance is rendered unnecessary. 

See Further Details of BSAC Basic Life Support Guidelines 2006 regarding updated techniques and advice.

See Further Advice for Instructors regarding In-Water clarification of techniques.
See here for related Examination Pass Rates information from the Open Water Chief Examiner
See here for specific Practical Instructor Examination Guidance from the Open Water Chief Examiner