Here at Training Qualifications UK, we aim to keep you up to date with the latest news relating to our qualifications. This post will inform you of some significant changes within First Aid that will affect the assessment and materials of our First Aid qualifications. Our updated materials will go live from January 1st 2022. 

The Resus Council have recently issued updated guidelines for 2021. To summarise:

  • There are no major changes in the 2021 Basic Life Support Guidelines. 
  • Recognition of cardiac arrest is a key priority as the first step of triggering an emergency response. 
  • Chest compressions should commence as soon as possible after cardiac arrest is confirmed.
  • Someone must fetch an AED and bring it to the scene of cardiac arrest. The British Heart Foundation database, “The Circuit”, serves as a national resource for the location of AEDs.

A complete summary of the main changes since 2015 can be found here

Babies and Children

There have been further changes concerning the resuscitation methods for babies and children. 

  • Continuous assessment for ‘signs of life’ simultaneously with breathing assessment and during the delivery of rescue breaths.
  • Chest compressions to be started immediately after rescue breaths delivered
  • Emphasis on the use of the speaker function to work with emergency services response to deliver effective CPR.
  • The recovery position is not recommended in the event of traumatic injury, or airway management is required.
  • If a child has abnormal or absent breathing:
    • Five initial rescue breaths should be given.
    • Note any gag or cough response to your action. These are part of assessing ‘signs of life.’
    • Ensure head tilt and chin lift, extending the head into a ‘sniffing’ position.

Chest Compressions

  • The rate remains the same (100-120) per minute.
  • Depth for compressions in one third or approximately 4cm for an infant, 5 cm for a child and 6cm for adults.
  • After 30 compressions, rescue breaths should be given. This should be in a 30:2 compression and rescue breaths ratio.
  • Compressions should be performed on a firm surface.
  • An infant’s head should be in a neutral position.

While the changes also introduced a two-thumb encircling technique for chest compressions in infants, there was a consensus within the First Aid Forum to continue to teach the two-finger technique. 

Resuscitation

Resuscitation for children and infants should be continued until:

  • Signs of life are shown.
  • Additional qualified help arrives.
  • Exhaustion.
  • Additionally, a child should be moved in the recovery position every 30 minutes to avoid pressure on their chest.

Other notes concerning Resus Guidelines 2021

  • While the Jaw Thrust technique is discussed in the guidelines, there is a consensus in the First Aid Forum that first aiders should not cover this. 
  • While the 15:2 ratio is mentioned for children and infants, RCUK recommends the 30:2 ratio be taught to first aiders who care for children but are unlikely to resuscitate them. This includes those being taught paediatric first aid. 
  • Following consultation with the forum regarding the adjustments to recovery position in children where trauma has occurred, it was decided that in adult casualties, if the casualty has suffered physical trauma, they should only be placed in the recovery position if necessary or if there is a need to leave the casualty to get help.
  • It was decided that both the adult and child choking algorithm will have a ‘call for help’ before back blows and after back blows and thrusts.

Changes outside of Resus Guidelines 2021

We have updated our manuals to ensure consistency with the ranges of age which the Resus Council use to classify infants, children and adults. Going forward:

  • An infant is One year or under.
  • A child is One Year to Eighteen Years.
  • An adult in Eighteen Years or over.

We have also chosen to update our Primary Survey from DRAB to DRABC. The primary survey will now consist of the following steps:

  • Danger
  • Response
  • Airways
  • Breathing
  • Circulation

The addition of ‘Circulation’ is based around consultation with our subject experts, aiming to be consistent with industry standards.

During the ‘Circulation’ step, learners will check for any signs of severe bleeding. 

Updated materials will go live from January 1st 2022

Manual Changes

  • All references within our manuals to DRAB have been updated to DRABC where applicable. 
  • The definition of a child has now been updated to one to eighteen years old. 
  • The definition of an adult has now been updated to over eighteen years old. 
We have added a paragraph stating, “There should also be consideration for signs of a cardiac arrest. A cardiac arrest may look like a short-period of seizure-like movements at the beginning. Assess the casualty after the seizure, and if they are unresponsive and not breathing normally, CPR should be started” to the assessment of a casualty. 
First Aid Manual

Section 3.1

Page 8

Paediatric First Aid Manual

Section 3.1

Page 8

CPR/AED Manual

Section 4.2

Page 22

 

Primary Survey steps updated to DRABC from DRAB. 

For ‘Circulation’, Once it has been established that breathing is normal, check and look for signs of severe bleeding. If there is severe bleeding, control by applying direct pressure to the wound and call 999

Under ‘Breathing’, we have added reference to agonal gasps and defined what agonal gasps look like.

First Aid Manual

Section 3.2

Page 9

Paediatric First Aid Manual

Section 3.2

Page 9

CPR/AED Manual

Section 4.3, 6.2

Page 23, 43

 

We have added a statement stating, “If the casualty has suffered physical trauma, they should only be placed in the recovery position where necessary.”
First Aid Manual

Section 3.4

Page 12

Paediatric First Aid Manual

Section 4.2

Page 12, 14

CPR/AED Manual

Section 4.5

Page 26

 

We have added a statement to step 5 of the recovery position procedure stating, “Move a casualty in the recovery position every 30 minutes to avoid too much pressure on their chest, which may make breathing harder.”
First Aid Manual

Section 3.4

Page 12

Paediatric First Aid Manual

Section 4.2

Page 13

CPR/AED Manual

Section 4.5

Page 27

 

Step 2 of the Adult CPR chain of survival now reads, “Effective CPR, with an emphasis on chest compressions, should commence as soon as cardiac arrest is confirmed.”
First Aid Manual

Section 3.5

Page 13

Paediatric First Aid Manual

Section N/A

Page N/A

CPR/AED Manual

Section 4.6

Page 28

 

We have the first paragraph discussing an unresponsive child. The first sentence now states “If we discover a child who is unresponsive and NOT breathing normally, we have to perform CPR, cardiopulmonary resuscitation immediately. The presence or absence of ‘signs of life’, such as response to stimuli, normal breathing (rather than abnormal gasps) or spontaneous movement must be looked for during the breathing assessment and during rescue breathing to determine the need for chest compressions. If there is still doubt at the end of the rescue breaths, start CPR.”

Additionally, for an unresponsive child, chest compressions have been overhauled to focus on the usage of one hand when giving chest compressions to a child. We also now state compression depth for a child to be approximately 5cm. 

First Aid Manual

Section 3.6

Page 16

Paediatric First Aid Manual

Section 4.3

Page 16

CPR/AED Manual

Section 4.7

Page 3.2

 

We have added additional content to step 2 of the CPR step by step for an unresponsive child, which states, “While performing rescue breaths, note any actions such as coughing or gagging. These actions are important for the on-going assessment of ‘signs of life. The casualties head should be tilted, with the chin lifted, extending the head into a ‘sniffing’ position.”
First Aid Manual

Section 3.6

Page 16

Paediatric First Aid Manual

Section 4.3

Page 17

CPR/AED Manual

Section 4.7

Page 33

 

We have the first paragraph discussing an unresponsive infant. This first sentence now states, “ If we discover an infant who is unresponsive and NOT breathing normally, we have to perform CPR, cardiopulmonary resuscitation immediately. The presence or absence of ‘signs of life’, such as response to stimuli, normal breathing (rather than abnormal gasps) or spontaneous movement must be looked for during the breathing assessment and during rescue breathing to determine the need for chest compressions. If there is still doubt at the end of the rescue breaths, start CPR.”

We also now state compression depth for an infant to be approximately 4cm.

First Aid Manual

Section 3.7

Page 18

Paediatric First Aid Manual

Section 4.4

Page 18

CPR/AED Manual

Section 4.8

Page 34

 

We have added an additional paragraph to the section that discusses AEDs, stating, “When 999/112 has been called, they will have a list of AED locations. Alternatively, when needing to locate an AED, The British Heart Foundation Database, “The Circuit”, serves as a national resource for the location of AEDs.”
First Aid Manual

Section 3.8

Page 20

Paediatric First Aid Manual

Section 4.6

Page 22

CPR/AED Manual

Section 2.1

Page 4

 

We have added “Call 999/112 on a speaker-phone if possible while giving treatment, or call for someone to dial 999/112.” to step one for the treatment of choking adults. 
First Aid Manual

Section 4.2

Page 23

Paediatric First Aid Manual

Section N/A

Page N/A

CPR/AED Manual

Section 5.2

Page 37

 

Breathing Problems – Choking Child

We have updated the term “knee” to “lap.”

We have added “Call 999/112 on a speaker-phone if possible while giving treatment, or call for someone to dial 999/112.” to step 1. 

Step 5 has now been updated to read, “Check the child’s mouth for obstructions. If expelled successfully, medical followup is important where there is possibility that part of the object still remains or thrusts have been used. If the obstruction has still not cleared, call for an ambulance on 999/112. Until help arrives, repeat steps 1 to 4.

A new step (6) has been added. This states, “If a child is unresponsive, or becomes unresponsive, it is important to move immediately to the paediatric basic life support sequence.  Firstly, call for an ambulance if this is still not available. 

When delivering rescue breaths, if the obstructing object can be seen, attempt to remove it with a single finger swipe. This should not be attempted more than once. If, during rescue breaths, the chest of the infant does not rise, reposition the head before the next attempt. Begin CPR immediately until help arrives or the child’s condition improves. If the child regains consciousness and is breathing normally, place them in the recovery position and monitor until help arrives.“

First Aid Manual

Section 4.3

Page 24-25

Paediatric First Aid Manual

Section 5.2

Page 24-25

CPR/AED Manual

Section 5.3

Page 38-39

 

Breathing Problems – Choking Infant

We have added, “Ensure support for the infant’s head by placing one thumb at the angle of the lower jaw, with two fingers of the same hand on the other side of the jaw. The rescuer should not compress the soft tissue under the infant’s jaw as this will worsen the obstruction. Call 999/112 on a speaker-phone if possible while giving treatment, or call for someone to dial 999/112.” to step 1. 

We have added “If expelled successfully, medical followup is important where there is possibility that part of the object still remains or thrusts have been used” to step 5.

A new step (6) has been added. This states, “If an infant is unresponsive, or becomes unresponsive, it is important to move immediately to the paediatric basic life support sequence.  Firstly, call for an ambulance if this is still not available. 

When delivering rescue breaths, if the obstructing object can be seen, attempt to remove it with a single finger swipe. This should not be attempted more than once. If, during rescue breaths, the chest of the infant does not rise, reposition the head before the next attempt. Begin CPR immediately until help arrives or the infant’s condition improves. If the child regains consciousness and is breathing normally, place them in the recovery position and monitor until help arrives.“ 

First Aid Manual

Section 4.3

Page 26-27

Paediatric First Aid Manual

Section 5.2

Page 26-27

CPR/AED Manual

Section 5.3

Page 40-41

 

Updated materials will go live from January 1st 2022

Changes to assessment records

Content

Emergency First Aid Assessment Record

Looking for signs of cardiac arrest has been added to practical exercise 2.1

References to DRAB have been updated to DRABC in 2.2 and 3.2

Rotate the recovery position every 30 minutes added to practical exercise 3.4

First Aid Assessment Record

Unit 1

Looking for signs of cardiac arrest has been added to practical exercise 2.1

References to DRAB have been updated to DRABC in 2.2 and 3.2

Rotate the recovery position every 30 minutes added to practical exercise 3.4

Unit 2

Reference to DRAB have been updated to DRABC in 1.2

Paediatric First Aid Assessment Record

Moving a child in the recovery position every 30 minutes added to 3.3

Looking for signs of cardiac arrest has been added to practical exercise 2.1

References to DRAB have been updated to DRABC in 2.2 and 3.2

Monitor signs of life added to 3.2

Rotate the recovery position every 30 minutes added to practical exercise 3.5

Format

We would also like to take this opportunity to inform you of some changes to the format of our Free Assessment Records provided for download. Previously these have been word-based documents; however, going forward, these will now be PDF.

Updated materials will go live from January 1st 2022