East of England Ambulance Service

NHS Trust

Basic Life Support and

Automated External
Defibrillation

12/02/201
5
 BLS & AED

At the end of this course participants

should be able to demonstrate:
How to assess the collapsed casualty.
How to perform Basic Life Support (BLS).
How to place an unconscious breathing
victim in the recovery position.
OBJECTIVES
Introduction to operating an automated
external defibrillator (AED) safely.
East of England Ambulance Service
NHS Trust

Date12/02/2015
2
 BLS & AED
BACKGROUND
In the UK approximately 30,000 people sustain
cardiac arrest outside hospital and are treated
by emergency services each year.
Bystander CPR and early Defibrillation are vital
interventions before the arrival of emergency
services.
If defibrillation is delivered promptly, survival
rates as high as 75% have been reported.
The chances of successful defibrillation decline
at a rate of about 10% with each minute of
delay.
East of England Ambulance Service
NHS Trust

Date12/02/2015
3
 BLS & AED

ANYONE CAN DO IT?

East of England Ambulance Service

NHS Trust

Date12/02/2015
4
 BLS & AED

2% 4% 30%

East of England Ambulance Service

NHS Trust

Date12/02/2015
5
 BLS & AED

Angina
Suspected Heart Attack

CARDIAC
CONDITIONS
East of England Ambulance Service
NHS Trust

Date12/02/2015
6
 BLS & AED
CARDIAC CONDITIONS

Coronary heart disease is the UK's biggest

killer, with 1 in every 4 men and 1 in
every 6 women dying from the disease.
In the UK, approximately 300,000 people
have a heart attack each year.
Angina affects about1 in 50 people, and
in the UK there are an estimated 1.2
million people with the condition. It affects
men more than women, and your
chances of being affected increase with
East of England Ambulance Service
age. NHS Trust

Date12/02/2015
7
 Blood returning
from upper
body Oxygenated blood to
BLS & AED
upper body

Blood to
Blood to lungs
lungs

Oxygenated Oxygenated blood

blood from from lungs
lungs

Blood returning from

lower body Oxygenated blood to
lower body

East of England Ambulance Service

NHS Trust

Date12/02/2015
8
 BLS & AED

HOW MANY TIMES DOES

THE HUMAN HEART BEAT
IN A DAY ?
100,800 beats per
day
(70 beats x 60 minutes x 24
hours = 100,800 beats)
East of England Ambulance Service
NHS Trust

Date12/02/2015
9
 BLS & AED
Suspected Heart
Attack

East of England Ambulance Service

NHS Trust

Date12/02/2015
10
 BLS & AED
Heart Attack

East of England Ambulance Service

NHS Trust

Date12/02/2015
11
 BLS & AED
SUSPECTED HEART ATTACK
- Pale, cold & clammy skin
- Rapid weak pulse
- Rapid shallow breathing
-Nausea
- Vomiting
- Pain in chest possibly radiating into arm, back
and/or jaw
- Sweating
- Impending sense of doom
Some or all of these symptoms may be
present,
East noService
of England Ambulance two Heart attacks are the
NHS Trust
same...... Date12/02/2015
12
 BLS & AED
CARDIAC CONDITIONS
Angina is a pain or discomfort felt in the
chest caused by coronary heart disease.
Typically presents as heaviness or
tightness in the chest
Often brought on by physical activity.
Symptoms usually subside after a few
mins.
Angina Suffers usually carry GTN
medication in the form of a spray or tablet
East of England Ambulance Service
NHS Trust

Date12/02/2015
13
 BLS & AED
SUSPECTED HEART ATTACK
Dial 999 or 112 for Ambulance
-Rest in a comfortable position
-Reassure
-Help casualty to take their own GTN
-Be prepared to resuscitate
-Have AED available

If in any Doubt dial 999 or 112

East of England Ambulance Service

NHS Trust

Date12/02/2015
14
 BLS & AED

Primary Survey
Performing CPR
Recovery Position

BASIC LIFE
SUPPORT
East of England Ambulance Service
NHS Trust

Date12/02/2015
15
 BLS & AED
PRIMARY SURVEY
Initial assessment using the primary
survey
- D anger (Global overview)
- R esponse
- S hout for help
- A irway
- B reathing
- C all 999/112 - commence CPR
East of England Ambulance Service
NHS Trust

Date12/02/2015
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 BLS & AED
Airway Management

Airway Open Airway Closed Airway Obstructed

An unconscious casualty has no control over their muscles, including the

muscles that control the tongue.

East of England Ambulance Service

NHS Trust

Date12/02/2015
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 BLS & AED
Approach safely
Check response
Shout for help
Open airway
Check breathing
Recovery Position?
Dial 999/112
Monitor Patient
East of England Ambulance Service
NHS Trust

Date12/02/2015
18
 BLS & AED
APPROACH SAFELY!
Approach safely

Rescuer Check response

Shout for help
Scene
Open airway
Victim Check breathing
Recovery Position
Bystanders
Dial 999/112
East of England Ambulance Service
NHS Trust
Monitor
Date12/02/2015
19
 BLS & AED
CHECK RESPONSE

Approach safely
Check response
Shout for help
Open airway
Check breathing
Recovery Position?
Dial 999/1123
Monitor
East of England Ambulance Service
NHS Trust

Date12/02/2015
20
 BLS & AED
CHECK RESPONSE
Shake shoulders
gently
Hello can you hear
me?

If he responds
Leave as you find him.
Find out what is wrong.
Reassess regularly.
East of England Ambulance Service
NHS Trust If no
21 response.....
Date12/02/2015
 BLS & AED
SHOUT FOR HELP
Approach safely
Check response
Shout for help
Open airway
Check breathing
Recovery Position?
Dial 999/112
Monitor
East of England Ambulance Service
NHS Trust

Date12/02/2015
22
 BLS & AED
OPEN AIRWAY
Approach safely
Check response
Shout for help
Open airway
Check breathing
Recovery Position
Dial 999/112
Monitor
East of England Ambulance Service
NHS Trust

Date12/02/2015
23
 BLS & AED
CHECK BREATHING
Look, listen and feel
for NORMAL
breathing for 10 sec
Do not confuse
Agonal breathing
with NORMAL
breathing
If you have any
doubts act as if
East of England Ambulance Service
NHS Trust
breathing is not
24 normal Date12/02/2015
 BLS & AED
Not Breathing normally ?
No sign of Chest Movement
No sounds of Breathing
No feeling of breath against your ear

Agonal Breathing
Occurs shortly after the heart stops in up to
40% of cardiac arrests
Described as barely, heavy, noisy or gasping
breathing
Recognised as a sign of
East of England Ambulance Service
NHS Trust

25 cardiac arrest Date12/02/2015

 BLS & AED

AGONAL BREATHING

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NHS Trust

Date12/02/2015
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 BLS & AED

Approach safely
Check response
Shout for help
Open airway
If no help arrives
and you are alone Check breathing
dial 999/112 After Recovery Position
putting into
recovery position. Dial 999/112
Monitor
East of England Ambulance Service
NHS Trust

Date12/02/2015
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 BLS & AED
Recovery position 1

Kneel next to the person. Place the

arm closest to you straight out
from the body. Position the far arm
with the back of the hand against
the near cheek.

East of England Ambulance Service

NHS Trust

Date12/02/2015
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 BLS & AED
Recovery position 2

Grab and bend the person's far

knee

East of England Ambulance Service

NHS Trust

Date12/02/2015
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 BLS & AED
Recovery position 3

Protecting the head with one hand,

gently roll the person toward you
by pulling the far knee over and to
the ground

East of England Ambulance Service

NHS Trust

Date12/02/2015
30
 BLS & AED
30 CHEST COMPRESSIONS
Approach safely
Check response
Shout for help
Open airway
Check breathing
Dial 999/112
30 chest compressions

East of England Ambulance Service

2 rescue breaths
NHS Trust

Date12/02/2015
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 BLS & AED
Recovery position 4
Tilt the head up slightly so that the airway
remains open. Make sure that the hand is
under the cheek, checking the airway and also
for eventual wakening. Place a blanket or coat
over the person (unless he or she has a heat
illness or fever) and stay close until help
arrives

East of England Ambulance Service

NHS Trust

Date12/02/2015
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 BLS & AED
If Not Breathing

Dont Panic

East of England Ambulance Service

NHS Trust

Date12/02/2015
33
 BLS & AED
CHEST COMPRESSIONS
Place the heel of one
hand in the centre of the
chest
Place other hand on top
Interlock fingers
Compress the chest
Rate 100 to 120
Depth 5-6 cm
Equal compression :
relaxation
When possible change
East of England Ambulance Service CPR operator every 2 min
NHS Trust

Date12/02/2015
34
 BLS & AED
RESCUE BREATHS
Approach safely
Check response
Shout for help
Open airway
Check breathing
Dial 999/112
30 chest compressions
2 rescue breaths
East of England Ambulance Service
NHS Trust

Date12/02/2015
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 BLS & AED
ESCUE BREATHS
Pinch the nose
Take a normal breath
Place lips over mouth
Blow until the chest rises
Deliver rescue breath for
1 second
Allow chest to fall
Repeat
This should not take
longer than 5sec , then
return to chest
compressions without
East of England Ambulance Service
NHS Trust delay
Date12/02/2015
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 BLS & AED
Combine Compressions and
Rescue breaths
at a ratio of 30:2
30 2

30
East of England Ambulance Service
NHS Trust

Date 12/02/2015
37
 BLS & AED

ANY QUESTIONS
?

TIME TO
PRACTICE.....
East of England Ambulance Service
NHS Trust

Date12/02/2015
38
 BLS & AED
CHILD CPR
Many children do not receive resuscitation
because potential rescuers fear causing harm.
This fear is unfounded; it is far better to use the
adult BLS sequence for resuscitation of a child
than to do nothing.
Bystander resuscitation significantly improves
outcome in children.
Outcomes could be further improved if
bystanders who would otherwise do nothing,
were encouraged to begin resuscitation.
East of England Ambulance Service
NHS Trust

Date12/02/2015
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 BLS & AED

CHILDREN AND BABIES

East of England Ambulance Service

NHS Trust

Date12/02/2015
40
 BLS & AED
COMPRESSION only CPR
If a rescuer is unable or
unwilling to perform
rescue breaths it is
expectable to perform
compressions only CPR

However, chest
compression combined
with rescue breaths is the
method of choice for CPR
East of England Ambulance Service
NHS Trust
by trained lay rescuers
41
and professionals. Date12/02/2015
 BLS & AED
When to stop CPR
Once CPR is started the rescuer
should only stop CPR when the
casualty shows signs of regaining
conscious by :
Coughing
Opening eyes
Speaking or moving
purposefully
Starts to Breath NORMALLY
again
Or
East of England Ambulance Service
Qualified help arrives and
NHS Trust
takes over Date
42 12/02/2015
 BLS & AED

The pocket mask is an effective

barrier device. It has a one-way
valve which prevents the casualty's
exhaled air being inhaled by the
Rescuer.

POCKET MASK

East of England Ambulance Service

NHS Trust

Date12/02/2015
43
 BLS & AED

ANY QUESTIONS
?

TIME TO
PRACTICE.....
East of England Ambulance Service
NHS Trust

Date12/02/2015
44
 BLS & AED

Understanding Defibrillation
Safe use of an AED

DEFIBRILLATION
East of England Ambulance Service
NHS Trust

Date12/02/2015
45
 BLS & AED
AUTOMATED EXTERNAL
DEFIBRILLATORS

An AED is an electric shock box used to stop the electrical

activity of the heart when it is in a life threatening rhythm, this
allows the Heart to re-establish an effective rhythm.
The AED will;
analyse
East the
of England presenting
Ambulance rhythm
Service
NHS Trust
only advise a shock for a shockable rhythm
Date12/02/2015
46 advise the operator step-by-step what to do
 BLS & AED
AUTOMATED EXTERNAL
DEFIBRILLATORS

An AED can be used safely and effectively without previous

training.
Therefore, the use of an AED should not be restricted to
trained rescuers.
However, training should be encouraged to help improve the
time
East to shock
of England delivery
Ambulance Service and correct pad placement.
NHS Trust

Date12/02/2015
47
 BLS & AED

There are 2 types of AED:

Automatic- will deliver shock
automatically
Semi Automatic rescuer
intervention required to deliver
shock.

Once you have completed this

AEDs can be found in many public
training
buildings e.g. Sports centres,
you will be able to use any make
Railway stations, Shopping centres
or model
and Schools
East of England Ambulance Service
NHS Trust

Date12/02/2015
48
 BLS & AED

2% 4% 30
%
East of England Ambulance Service
NHS Trust

Date12/02/2015
49
 BLS & AED
Understanding Defibrillation
The hearts pumping
action controlled by
electrical system
Electrical rhythm
Sinus Rhythm normally very
organized
Normal hearts rhythm
is called Sinus
Rhythm
Normal heart rate of
60 - 100 beats per
minute
East of England Ambulance Service
NHS Trust

Date 12/02/2015
50
 BLS & AED
Understanding Defibrillation:
Ventricular Fibrillation

(VF)
VF is the most
common rhythm in
Sudden Cardiac Arrest
(90%)
Electrical Problem in
Nature
Chaotic rhythm
results in quivering
of heart and results
in loss of pulse
VF will result in brain
damage within 5
minutes and death in
East of England Ambulance Service 10-15 minutes
NHS Trust

Date 12/02/2015
51
 BLS & AED
Understanding Defibrillation
Defibrillation may correct
VF
Uses DC current
delivered across the
heart
A successful defibrillation
depolarizes the hearts
cells
Depolarization allows the
cells to reorganize
Defibrillation is the ONLY
East of England Ambulance Service
effective cure NHS Trust
for VF!
Date 12/02/2015
52
 Single Rescuer BLS & AED

Approach safely
Check response
Shout for help
Open airway
Check breathing
Dial 999/112 get
AED
Attach AED before
CPR
Follow voice
East of England Ambulance Service prompts
NHS Trust

Date12/02/2015
53
 BLS & AED
Approach safely
Check response
Shout for help 2 or more
Open airway Rescuers
Check breathing
1st Rescuer
commence CPR
2nd Rescuer Call
999 /112
gets AED and
attaches to Patient
Follow voice
prompts
East of England Ambulance Service
NHS Trust

Date12/02/2015
54
 BLS & AED
Minimise
interruptions in CPR
If alone, attach AED before
commencing CPR

If 2 rescuers, provide good quality

CPR while the AED is brought to the
scene, is turned on, and pads
attached

Interrupt CPR only when it is

necessary to analyse the rhythm and
East of England Ambulance Service
deliver a shock
NHS Trust

Date
55 12/02/2015
 BLS & AED
DEFIBRILLATION SAFETY !
THE AED.
THE PATIENT. In good working
5 point check order
Pacemaker Do Not use in
Jewellery Heavy rain
Do Not use if they
Hair on chest
lay in a pool of
Damp/Wet skin
water
Patches (GTN) Do Not use in an
explosive
East of England Ambulance Service
NHS Trust
environment !
Date 12/02/2015
56
 BLS & AED
ATTACH PADS TO
CASUALTYS
BARE CHEST

East of England Ambulance Service

NHS Trust

Date12/02/2015
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 BLS & AED
ANALYSING RHYTHM
DO NOT TOUCH PATIENT

East of England Ambulance Service

NHS Trust

Date12/02/2015
58
 BLS & AED
SHOCK ADVISED
Stand clear
Everyone !
TOP
MIDDLE
BOTTOM
MYSELF
BEHIND YOU
DELIVER
SHOCK
East of England Ambulance Service
NHS Trust

Date 12/02/2015
59
 BLS & AED
DEFIBRILLATION SAFETY !

REMEMBER.
Always check that NO PERSON or
ANIMALS are touching the patient
prior to shocking.
That you are not touching the patient
in any way.

East of England Ambulance Service

NHS Trust

Date12/02/2015
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 BLS & AED
DEFIBRILLATION

East of England Ambulance Service

NHS Trust

Date12/02/2015
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 BLS & AED
SHOCK DELIVERED
FOLLOW AED INSTRUCTIONS

East of England Ambulance Service

NHS Trust

Date12/02/2015
62
 BLS & AED
COMMENCE CPR (2
MINS)
30 2

30 2
East of England Ambulance Service
NHS Trust

Date12/02/2015
63
 BLS & AED
NO SHOCK ADVISED
FOLLOW AED INSTRUCTIONS

East of England Ambulance Service

NHS Trust

Date12/02/2015
64
 BLS & AED
COMMENCE CPR (2
MINS)
30 2

30 2
East of England Ambulance Service
NHS Trust

Date12/02/2015
65
 BLS & AED

ANY QUESTIONS
?

TIME TO
PRACTICE.....
East of England Ambulance Service
NHS Trust

Date12/02/2015
66
 BLS & AED
CHILDREN AND AEDS
Standard AEDs are suitable for use
on children of 8 years and above.
In children between 1 and 7 years
paediatric pads or a paediatric mode
should be used.
Do not use an AED on an Infant less
than 1 year.

East of England Ambulance Service

NHS Trust

Date12/02/2015
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 BLS & AED

IPAD

East of England Ambulance Service

NHS Trust

Date12/02/2015
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 BLS & AED

East of England Ambulance Service

NHS Trust

Date12/02/2015
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 BLS & AED
FOLLOW UP WHAT TO
If you have used an Automated External
DO AFTER?
Defibrillator, even by just attaching it to a
patient, you must:
Dispose of the pads used as clinical waste
Replace the pads on the machine
Inform named person that the Defibrillator
has been used so that any data can be
captured from the device
Complete a Defibrillator Event Report
Form
EastIfof you require
England Ambulance
NHS Trust
any equipment to be replaced,
Service

70 i.e. pads, pocket masks, razors etc. Please Date12/02/2015

 BLS &
WHEN NOT TO RESUSCITATE AED
Once CPR is started the rescuer should only
stop CPR when the casualty shows signs or
regaining conscious by
Coughing
Opening eyes
Speaking or moving purposefully
Starts to Breath NORMALLY again
Or
Qualified help arrives and takes over
You become exhausted
East
It ofisEngland
unsafeAmbulanceto continue
Service
NHS Trust

Date12/02/2015
71
 BLS & AED

OR IF YOU SEE
THIS HAS
OCCURRED !

East of England Ambulance Service

NHS Trust

Date12/02/2015
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 BLS & AED
OOPS ??

East of England Ambulance Service

NHS Trust

Date12/02/2015
73
 BLS & AED

ANY QUESTIONS
?

East of England Ambulance Service

NHS Trust

Date12/02/2015
74
 BLS & AED

BLEEDING

East of England Ambulance Service

NHS Trust

Date12/02/2015
75
 BLS & AED

Raise Limb
Cover with clean dressing or cloth
999 or 112
Reassure
Lay down
Raise legs
Monitor

BLEEDING

East of England Ambulance Service

NHS Trust

Date12/02/2015
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 BLS & AED

SHOCK

East of England Ambulance Service

NHS Trust

Date12/02/2015
77
 BLS & AED

SHOCK

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NHS Trust

Date12/02/2015
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 BLS & AED

CHOKING

East of England Ambulance Service

NHS Trust

Date12/02/2015
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 BLS & AED

Choking

East of England Ambulance Service

NHS Trust

Date12/02/2015
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 BLS & AED

CHOKING

East of England Ambulance Service

NHS Trust

Date12/02/2015
81
 BLS & AED

ANY QUESTIONS
?

TIME TO
PRACTICE.....
East of England Ambulance Service
NHS Trust

Date12/02/2015
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 BLS & AED

East of England Ambulance Service

NHS Trust

Date12/02/2015
83