Introduction to Basic Life Support for Climbing Rescue
Basic Life Support for Climbing Rescue
Basic Life Support: Basic Life Support (BLS) is the term commonly used to label any actions performed by any person prior to the ability to provide Advanced Life Support (ALS). A Paramedic or a Doctor for example would provide high quality BLS prior to beginning ALS if inadequate numbers of rescuers are at the scene. BLS is the foundation for all ALS skills.
Basic Life Support is also the name of several types of certification courses. The American Heart Associations' highest level of CPR class is named BLS for the Healthcare Professional.
Climbing: For the purpose of this course the term climbing refers to the full range of climbing-related activities such as hiking in mountainous terrain, cragging, mountaineering and artificial climbing towers and walls.
Rescue: For the purpose of this course the term "rescue" refers to the skills necessary to
Within Basic Life Support are five main areas of study and skill performance.
Cardiopulmonary Resuscitation (CPR)
Rescue Breathing
Use of an Automated External Defibrillator (AED)
Treating Foreign Body Airway Obstruction (FBAO). Commonly called choking.
Team dynamics
Cardiopulmonary Resuscitation (CPR)
CPR is the act of providing chest compressions and ventilations (Breaths). This is normally done for victims who are in cardiac arrest.
CPR should be started immediately upon finding a victim without response, breathing and pulse and the CPR should begin with compressions first. The pneumonic CAB can be used to remember the importance of early effective compressions followed by airway and breathing.
If you find yourself alone ensure to call for assistance and request an Automated External Defibrillator (AED)
If you find yourself with a victim in cardiac arrest and you have an AED use it immediately.
Chest compressions provide blood flow to the brain and the heart itself when the heart is not pumping blood adequately or at all. The key points to remember when giving chest compressions are:
Give compressions fast, deep, allowing full recoil after each downward compression and minimizing all delays to less than 10 seconds.
More specifically these key points are grouped differently for adults, children and infants.
An adult for BLS purposes is any human who shows any signs of puberty.
A child is over the age of one year showing no signs of puberty.
An infant is less than one year of age.
If there is doubt about age or puberty status provide care based on the more developed stage.
Adult compressions- At least two inches deep but not more than 2.4inches. Adult Depth is 2-2.4 inches. Maintain a rate of at least 100 compressions per minute but not more than120 compressions per minute. Adult Rate 100-120 compressions per minute. Allowing for full recoil after each downward compression and with all delays less than ten seconds.
Child Compressions- About 2 inches deep.
Infant Compressions- About 1.5 inches deep.
Ventilations (breaths) provide oxygen to the lungs. Oxygen is an important nutrient for the cells of the body. It would be reasonable to begin CPR with breathing first for victims who clearly suffered cardiac arrest do to an a oxygen absence such as drowning or respiratory disease. For the purposes of simplicity however and the fact that the delay of breaths would be minimal following the CAB sequence of Compressions first is recommended.
A ventilation is the pushing of air into the mouth of a victim into the lungs. Effective ventilations should result in chest rise and fall upon every ventilation. In order to achieve this it is necessary to ensure that the victim has and open and clear (patent) airway. The initial technique for opening an airway is the Head-Tilt Chin- Lift method.
Providing ventilations does provide a small risk of disease transfer and a moderate risk of vomit transfer. To minimize this risk barrier devices should be considered a part of every first aid kit. Mouth to Mouth breaths are an effective way to oxygenate the lungs but barrier devices are preferred when available.
Compressions and Ventilations should be done using the appropriate ratio. The most common ratio is 30:2. 30 compressions followed by 2 ventilations. 30:2 is always the ratio when a single rescuer is present. When two rescuers are present with a non-adult victim the ratio becomes 15:2. 15:2 is the ratio for children and infants when two rescuers are present.
Child and Infant CPR should be started if the pulse is found to be less than 60. Whereas an adult heart can provide sufficient blood flow with a slow pulse children and infants need compressions to prevent cardiac arrest when their heart is pumping less than 60 times per minute.
Should advanced help arrive and secure the patients airway with a tube that passes directly into the trachea CPR is no longer conducted using a ratio of compressions and ventilations. In the case of this Advanced Airway being placed a bag ventilation device will be attached directly to the airway tube. The compressions and ventilations will now occur without coordination. The compressions will happen at the same rate of 100-120 per minute without stopping. The ventilations will occur with 1 ventilation every 6 seconds. Advanced Airway CPR uses no ratio of compressions to ventilations.
During CPR reassessment should be conducted every two minutes. Response, breathing and pulse should be reassessed every two minutes.
Ceasing CPR can be considered when it becomes obvious that efforts are futile, the rescuers are at risk of becoming exhausted or when the scenes safety is compromised.
Automated External Defibrillator (AED)
AED use is key when the heart is in a chaotic electrical rhythm. The defibrillation (shock) is intended to shut off improper electrical activity allowing the heart to pump normally. An AED should be used immediately when available during cardiac arrest. Unfortunately they are unlikely to be available during mountain travels. Cardiac arrest in mountainous terrain however is much less likely to be caused by the electrical disturbances fixable by an AED.
The first steps to using an AED is to turn it on. You will know the AED is powered on because it will verbally say so. It will then direct the next steps. Follow the prompts demanded by the AED. The AED will prompt you to stand clear of the patient during the shock. Immediately after the shock CPR should be resumed beginning with chest compressions unless the victim shows obvious signs of life.
Rescue Breathing
Rescue Breathing is the intervention for respiratory arrest. If the victim is not breathing and has an adequate pulse only ventilations should be given. An adequate pulse is considered one that is present in an adult and greater than 60 in non-adults.
The rate of ventilations for adult Rescue Breathing is 1 ventilation every 5-6 seconds. The rate for infants and children is 1 ventilation every 3-5 seconds. Pulse checks should occur every 2 minutes to ensure that the victim does not now require CPR.
Foreign Body Airway Obstruction (FBAO)
FBAO commonly called choking is a fundamental part of BLS. The most simple explanation of how to help a choking person is to know how to do Abdominal Thrusts and CPR.
Assessment of the choking victim. People will typically make their choking well known. The hands around the neck signal is quite universally understood. Most "choking" cases however are partial obstructions that self resolve. Encourage these people to cough forcefully.
If the airway if fully blocked and no or little sound can be made due to the inability to pass air abdominal thrusts must be started. An abdominal thrust (Heimlich Maneuver) forces air up the airway pushing the obstruction.
Infants received back slaps and chest thrusts rather than Abdominal Thrusts.
Very obese or pregnant victims receive standing chest thrusts.
If the victim becomes unresponsive it is now very important to activate the emergency response system if not already done. Unresponsive victims of FBAO receive CPR.
Team Dynamics
The interaction of the rescuers is becoming increasingly realized as a key component in victim survival. Examples of important team dynamics include: Closed loop communication, Error Correction, Clear Roles and concise messages.
Closed loop communication- If you are asked to go for help it is important state the understanding of the assignment.
Error Correction- If you see someone putting AED pads on incorrectly address it immediately.
Clear roles- Everyone involved should know who the team leader is as well as other roles.
Concise messages- It is important to prevent the amount and length of talk from becoming a distraction from providing quality care during the emergency. Short simple phrases help prevent the scene of the accident from becoming more chaotic.
Summary
Basic Life Support encompasses skills and knowledge that would ideally be known to the vast majority of humanity.
Conclusion
Basic First Aid is a skill every mountain traveler should have. Most of the truly life saving skills are pretty obvious to the average person. The efficiently gained through practice with a professional instructor and follow up self practice will make an enormous difference when you need to save your partners life.
Recognition of Cardiac arrest
Unresponsive, not breathing and pulseless.
CPR- combination of chest compressions and ventilation system
Ventilations versus breaths or rescue breaths
Organ donation CPR
Defibrillation. Does not jump start heart.
See appendix 6 video ??? Cadaver defib vid?? Permission from????
Special cardiac arrest circumstances
Trauma/ hemorrhage
Anaphylaxis IM epi
Hypothermia
ABC first conditions-
Drowning
Asphyxiation
glorious day, the air as delicious to the lungs as nectar to the tongue.“
My First Summer in the Sierra , 1911
Basic Life Support (BLS) is a term commonly used to label actions performed prior to the ability to provide Advanced Life Support (ALS). A healthcare professional will provide high quality BLS prior to beginning ALS if inadequate numbers of rescuers are at the scene. BLS is the foundation for all ALS skills. It is fortunate that many life saving interventions fall within the BLS category. Basic Life Support standards have changed dramatically over decades. Basic Life Support is also the name of several types of certification courses. There are numerous organizations that offer courses and the quality varies greatly between them and their individual instructors. The American Heart Associations' most comprehensive level of CPR class is named BLS for the Healthcare Provider. It is very common for health care providers including Wilderness First Responders to maintain current proof of training in BLS. If you are pursuing a course completion card in Basic Life Support it is important that you determine the specific requirements of any employer, education system or other organization that may need it as proof of training. Basic Life Support consists of five interrelated but distinct areas of study and skill performance. 1. Cardiopulmonary Resuscitation (CPR) 2. Rescue Breathing 3. Automated External Defibrillator (AED) 4. Foreign Body Airway Obstruction (FBAO). 5. Team dynamics Deciding to Withhold Care Not trying goes against the very base nature of most climb Scene safety and Activation of Emergency Systems The first concern when presented with an emergency is ensuring the rescuers will not become victims. In mountainous terrain this includes checking personal anchors and the rescuers exposure to the incidents cause. This decision also included determining if the rescuer has a reserve of health and endurance sufficient to both assist the victim and safely move themselves out of the mountainous terrain. A general rule regarding calling for help is to error on the side of doing so. It is generally better to call for assistance and then self rescue than to activate emergency systems later in the incident. Patient Assessment for BLS Determining how to best help requires assessing for the victims primary problem. This is best done following a series of steps that will reveal and/or rule out serious life threats first. It is also important to understand that there are injuries that make assessment and treatment unnecessary. This is commonly called obvious death. Obvious death signs include but are not limited to decapitation and crushing injuries to the head, significant blood loss, clearly damaged abdominal/chest organs and massive burns. The decision to not begin care for a human being is difficult and specific to individual circumstances. As a general rule care should be provided unless doing so is completely futile. 1. Determine responsiveness. This is frequently done by asking the victim if they are OK. If the victim is responsive further assessment would be done using First Aid assessment skills. Determine if they are: Alert- Looking at you and asking/answering questions. Verbally Responsive- Will only interact after the rescue speaks loudly. Responsive to Pain- Only responds after given a painful stimulus. Unresponsive- Does not respond to a painful stimulus. This can be remembered and measured using the AVPU pneumonic. (Pronounced avpoo) 2. Breathing status. Determine if the victims is breathing normally. Abnormal gasping (agonal) breaths do not count and should be disregarded. Look at and feel the victims chest for movement. Listen for sounds coming from the victims mouth. If the victim is breathing additional assessment is required using First Aid skills. 3. Check the victims pulse. Using two fingers feel (palpate) the victims carotid artery located between the windpipe (trachea) and the thick muscle on the side of the neck. This entire process of BLS assessment should be done in less than 10 seconds. Ideally it becomes a simultaneous process of steps. If there is any doubt begin the appropriate intervention. A victim who is not breathing and has a pulse is in Respiratory Arrest. A victim who is not breathing and dose not have a pulse is in Cardiac Arrest. Cardiopulmonary Resuscitation (CPR) CPR is the act of providing chest compressions and ventilations (Breaths). This is normally done for victims who are in cardiac arrest. CPR should be started immediately upon finding a victim without response, breathing and pulse and the CPR should begin with compressions first. The pneumonic CAB can be used to remember the importance of early effective compressions followed by airway and breathing. If you find yourself alone ensure to call for assistance and request an Automated External Defibrillator (AED) If you find yourself with a victim in cardiac arrest and you have an AED use it immediately. Chest compressions provide blood flow to the brain and the heart itself when the heart is not pumping blood adequately or at all. The key points to remember when giving chest compressions are: Give compressions fast, deep, allowing full recoil after each downward compression and minimizing all delays to less than 10 seconds. More specifically these key points are grouped differently for adults, children and infants. An adult for BLS purposes is any human who shows any signs of puberty. A child is over the age of one year showing no signs of puberty. An infant is less than one year of age. If there is doubt about age or puberty status provide care based on the more developed stage. Adult compressions- At least two inches deep but not more than 2.4inches. Adult Depth is 2-2.4 inches. Maintain a rate of at least 100 compressions per minute but not more than120 compressions per minute. Adult Rate 100-120 compressions per minute. Allowing for full recoil after each downward compression and with all delays less than ten seconds. Child Compressions- About 2 inches deep. Infant Compressions- About 1.5 inches deep. Ventilations (breaths) provide oxygen to the lungs. Oxygen is an important nutrient for the cells of the body. It would be reasonable to begin CPR with breathing first for victims who clearly suffered cardiac arrest do to an a oxygen absence such as drowning or respiratory disease. For the purposes of simplicity however and the fact that the delay of breaths would be minimal following the CAB sequence of Compressions first is recommended. A ventilation is the pushing of air into the mouth of a victim into the lungs. Effective ventilations should result in chest rise and fall upon every ventilation. In order to achieve this it is necessary to ensure that the victim has and open and clear (patent) airway. The initial technique for opening an airway is the Head-Tilt Chin- Lift method. Providing ventilations does provide a small risk of disease transfer and a moderate risk of vomit transfer. To minimize this risk barrier devices should be considered a part of every first aid kit. Mouth to Mouth breaths are an effective way to oxygenate the lungs but barrier devices are preferred when available. Compressions and Ventilations should be done using the appropriate ratio. The most common ratio is 30:2. 30 compressions followed by 2 ventilations. 30:2 is always the ratio when a single rescuer is present. When two rescuers are present with a non-adult victim the ratio becomes 15:2. 15:2 is the ratio for children and infants when two rescuers are present. Child and Infant CPR should be started if the pulse is found to be less than 60. Whereas an adult heart can provide sufficient blood flow with a slow pulse children and infants need compressions to prevent cardiac arrest when their heart is pumping less than 60 times per minute. Should advanced help arrive and secure the patients airway with a tube that passes directly into the trachea CPR is no longer conducted using a ratio of compressions and ventilations. In the case of this Advanced Airway being placed a bag ventilation device will be attached directly to the airway tube. The compressions and ventilations will now occur without coordination. The compressions will happen at the same rate of 100-120 per minute without stopping. The ventilations will occur with 1 ventilation every 6 seconds. Advanced Airway CPR uses no ratio of compressions to ventilations. During CPR reassessment should be conducted every two minutes. Response, breathing and pulse should be reassessed every two minutes. Ceasing CPR can be considered when it becomes obvious that efforts are futile, the rescuers are at risk of becoming exhausted or when the scenes safety is compromised. Automated External Defibrillator (AED) AED use is key when the heart is in a chaotic electrical rhythm. The defibrillation (shock) is intended to shut off improper electrical activity allowing the heart to pump normally. An AED should be used immediately when available during cardiac arrest. Unfortunately they are unlikely to be available during mountain travels. Cardiac arrest in mountainous terrain however is much less likely to be caused by the electrical disturbances fixable by an AED. The first steps to using an AED is to turn it on. You will know the AED is powered on because it will verbally say so. It will then direct the next steps. Follow the prompts demanded by the AED. The AED will prompt you to stand clear of the patient during the shock. Immediately after the shock CPR should be resumed beginning with chest compressions unless the victim shows obvious signs of life. Rescue Breathing glorious day, the air as delicious to the lungs as nectar to the tongue.“ - My First Summer in the Sierra , 1911 Rescue Breathing is the intervention for respiratory arrest. If the victim is not breathing and has an adequate pulse only ventilations should be given. An adequate pulse is considered one that is present in an adult and greater than 60 in non-adults. The rate of ventilations for adult Rescue Breathing is 1 ventilation every 5-6 seconds. The rate for infants and children is 1 ventilation every 3-5 seconds. Pulse checks should occur every 2 minutes to ensure that the victim does not now require CPR. Foreign Body Airway Obstruction (FBAO) FBAO commonly called choking is a fundamental part of BLS. The most simple explanation of how to help a choking person is to know how to do Abdominal Thrusts and CPR. Assessment of the choking victim. People will typically make their choking well known. The hands around the neck signal is quite universally understood. Most "choking" cases however are partial obstructions that self resolve. Encourage these people to cough forcefully. If the airway if fully blocked and no or little sound can be made due to the inability to pass air abdominal thrusts must be started. An abdominal thrust (Heimlich Maneuver) forces air up the airway pushing the obstruction. Infants received back slaps and chest thrusts rather than Abdominal Thrusts. Very obese or pregnant victims receive standing chest thrusts. If the victim becomes unresponsive it is now very important to activate the emergency response system if not already done. Unresponsive victims of FBAO receive CPR. Team Dynamics The interaction of the rescuers is becoming increasingly realized as a key component in victim survival. Examples of important team dynamics include: Closed loop communication, Error Correction, Clear Roles and concise messages. Closed loop communication- If you are asked to go for help it is important state the understanding of the assignment. Error Correction- If you see someone putting AED pads on incorrectly address it immediately. Clear roles- Everyone involved should know who the team leader is as well as other roles. Concise messages- It is important to prevent the amount and length of talk from becoming a distraction from providing quality care during the emergency. Short simple phrases help prevent the scene of the accident from becoming more chaotic. Basic Life Support for Children and Infants The interaction of the Special BLS Considerations for the climber Steep terrain Drowning Hypothermia Hyperthermia Traumatic Arrest Anaphylaxis High altitude Lightning Summary Basic Life Support encompasses skills and knowledge that would ideally be known to the vast majority of humanity. Conclusion Basic First Aid is a skill every mountain traveler should have. Most of the truly life saving skills are pretty obvious to the average person. The efficiently gained through practice with a professional instructor and follow up self practice will make an enormous difference when you need to save your partners life. CPR- combination of chest compressions and ventilation system Ventilations versus breaths or rescue breaths Organ donation CPR Defibrillation. Does not jump start heart. See appendix 6 video ??? Cadaver defib vid?? Permission from???? Skeleton demonstrations of anatomy
Basic Life Support consists of five interrelated but distinct areas of study and skill performance.
Cardiopulmonary Resuscitation (CPR)
Rescue Breathing
Automated External Defibrillator (AED)
Foreign Body Airway Obstruction (FBAO).
Team dynamics
Patient Access:
T—Transition. From up to down, down to up, terrain types and from recreational to rescue mind
R— Raising. Mechanical advantage, ratchets/progress capture.
A—Ascend-- rope climb, lead, counterbalance ascent, rope solo,
P-Prevention. Evaluate scene and prevent further harm.
D-Descend. Rappel, downclimb, Lower, Hike
Basic Life Support Anatomy
In order to best provide care to our climbing partners and members of other communities it is helpful to have an understanding of human body structure.
Skeleton demonstrations of anatomy
STERNUM
JAW
MOUTH
TOUNGE
NOSE
LUNGS
TRACHEA
Deciding to Withhold Resuscitative Care
Not trying goes against the very base nature of most climbers.
Obviousdeaths
Rescuer exhaustion
Unsafe scene
Scene safety and Activation of Emergency Systems
The first concern when presented with an emergency is ensuring the rescuers will not become victims. In mountainous terrain this includes checking personal anchors and the rescuers exposure to the incidents cause. This decision also included determining if the rescuer has a reserve of health and endurance sufficient to both assist the victim and safely move themselves out of the mountainous terrain.
A general rule regarding calling for help is to error on the side of doing so. It is generally better to call for assistance and then self rescue than to activate emergency systems later in the incident.
Patient Assessment for BLS
Determining how to best help requires assessing for the victims primary problem. This is best done following a series of steps that will reveal and/or rule out serious life threats first.
It is also important to understand that there are injuries that make assessment and treatment unnecessary. This is commonly called obvious death. Obvious death signs include but are not limited to decapitation and crushing injuries to the head, significant blood loss, clearly damaged abdominal/chest organs and massive burns.
The decision to not begin care for a human being is difficult and specific to individual circumstances. As a general rule care should be provided unless doing so is completely futile.
Determine responsiveness. This is frequently done by asking the victim if they are OK. If the victim is responsive further assessment would be done using First Aid assessment skills. Determine if they are: Alert- Looking at you and asking/answering questions. Verbally Responsive- Will only interact after the rescue speaks loudly.
Responsive to Pain- Only responds after given a painful stimulus.
Unresponsive- Does not respond to a painful stimulus.
This can be remembered and measured using the AVPU pneumonic. (Pronounced avpoo)
2. Breathing status. Determine if the victims is breathing normally. Abnormal gasping (agonal) breaths do not count and should be disregarded. Look at and feel the victims chest for movement. Listen for sounds coming from the victims mouth. If the victim is breathing additional assessment is required using First Aid skills.
3. Check the victims pulse. Using two fingers feel (palpate) the victims carotid artery located between the windpipe (trachea) and the thick muscle on the side of the neck.
This entire process of BLS assessment should be done in less than 10 seconds. Ideally it becomes a simultaneous process of steps. If there is any doubt begin the appropriate intervention.
A victim who is not breathing and has a pulse is in Respiratory Arrest.
A victim who is not breathing and dose not have a pulse is in Cardiac Arrest.
Cardiopulmonary Resuscitation (CPR)
CPR is the act of providing chest compressions and ventilations (Breaths). This is normally done for victims who are in cardiac arrest.
CPR should be started immediately upon finding a victim without response, breathing and pulse and the CPR should begin with compressions first. The pneumonic CAB can be used to remember the importance of early effective compressions followed by airway and breathing.
If you find yourself alone ensure to call for assistance and request an Automated External Defibrillator (AED)
If you find yourself with a victim in cardiac arrest and you have an AED use it immediately.
Chest compressions provide blood flow to the brain and the heart itself when the heart is not pumping blood adequately or at all. The key points to remember when giving chest compressions are:
Give compressions fast, deep, allowing full recoil after each downward compression and minimizing all delays to less than 10 seconds.
More specifically these key points are grouped differently for adults, children and infants.
An adult for BLS purposes is any human who shows any signs of puberty.
A child is over the age of one year showing no signs of puberty.
An infant is less than one year of age.
If there is doubt about age or puberty status provide care based on the more developed stage.
Adult compressions- At least two inches deep but not more than 2.4inches. Adult Depth is 2-2.4 inches. Maintain a rate of at least 100 compressions per minute but not more than120 compressions per minute. Adult Rate 100-120 compressions per minute. Allowing for full recoil after each downward compression and with all delays less than ten seconds.
Child Compressions- About 2 inches deep.
Infant Compressions- About 1.5 inches deep.
Ventilations (breaths) provide oxygen to the lungs. Oxygen is an important nutrient for the cells of the body. It would be reasonable to begin CPR with breathing first for victims who clearly suffered cardiac arrest do to an a oxygen absence such as drowning or respiratory disease. For the purposes of simplicity however and the fact that the delay of breaths would be minimal following the CAB sequence of Compressions first is recommended.
A ventilation is the pushing of air into the mouth of a victim into the lungs. Effective ventilations should result in chest rise and fall upon every ventilation. In order to achieve this it is necessary to ensure that the victim has and open and clear (patent) airway. The initial technique for opening an airway is the Head-Tilt Chin- Lift method.
While sending oxygen to the lungs is extremely important it should also be understood how necessary it is to allow carbon dioxide to exit the body. The ventilation of air into the lungs should be followed by a full outward exhalation to allow this to happen. A build of of acidic carbon dioxide reduces the ph balance of the body which should remain between 7.35 and 7.45. It is interesting that both pH and climbing grades use a scale between 0 and 15.
Providing ventilations does provide a small risk of disease transfer and a moderate risk of vomit transfer. To minimize this risk barrier devices should be considered a part of every first aid kit. Mouth to Mouth breaths are an effective way to oxygenate the lungs but barrier devices are preferred when available.
Compressions and Ventilations should be done using the appropriate ratio. The most common ratio is 30:2. 30 compressions followed by 2 ventilations. 30:2 is always the ratio when a single rescuer is present. When two rescuers are present with a non-adult victim the ratio becomes 15:2. 15:2 is the ratio for children and infants when two rescuers are present.
Child and Infant CPR should be started if the pulse is found to be less than 60. Whereas an adult heart can provide sufficient blood flow with a slow pulse children and infants need compressions to prevent cardiac arrest when their heart is pumping less than 60 times per minute.
Should advanced help arrive and secure the patients airway with a tube that passes directly into the trachea CPR is no longer conducted using a ratio of compressions and ventilations. In the case of this Advanced Airway being placed a bag ventilation device will be attached directly to the airway tube. The compressions and ventilations will now occur without coordination. The compressions will happen at the same rate of 100-120 per minute without stopping. The ventilations will occur with 1 ventilation every 6 seconds. Advanced Airway CPR uses no ratio of compressions to ventilations.
During CPR reassessment should be conducted every two minutes. Response, breathing and pulse should be reassessed every two minutes.
Ceasing CPR can be considered when it becomes obvious that efforts are futile, the rescuers are at risk of becoming exhausted or when the scenes safety is compromised.
Automated External Defibrillator (AED)
AED use is key when the heart is in a chaotic electrical rhythm. The defibrillation (shock) is intended to shut off improper electrical activity allowing the heart to pump normally. An AED should be used immediately when available during cardiac arrest. Unfortunately they are unlikely to be available during mountain travels. Cardiac arrest in mountainous terrain however is much less likely to be caused by the electrical disturbances fixable by an AED.
The first steps to using an AED is to turn it on. You will know the AED is powered on because it will verbally say so. It will then direct the next steps. Follow the prompts demanded by the AED. The AED will prompt you to stand clear of the patient during the shock. Immediately after the shock CPR should be resumed beginning with chest compressions unless the victim shows obvious signs of life.
Rescue Breathing
glorious day, the air as delicious to the lungs as nectar to the tongue.“
My First Summer in the Sierra , 1911
Rescue Breathing is the intervention for respiratory arrest. If the victim is not breathing and has an adequate pulse only ventilations should be given. An adequate pulse is considered one that is present in an adult and greater than 60 in non-adults.
The rate of ventilations for adult Rescue Breathing is 1 ventilation every 5-6 seconds. The rate for infants and children is 1 ventilation every 3-5 seconds. Pulse checks should occur every 2 minutes to ensure that the victim does not now require CPR.
Foreign Body Airway Obstruction (FBAO)
FBAO commonly called choking is a fundamental part of BLS. The most simple explanation of how to help a choking person is to know how to do Abdominal Thrusts and CPR.
Assessment of the choking victim. People will typically make their choking well known. The hands around the neck signal is quite universally understood. Most "choking" cases however are partial obstructions that self resolve. Encourage these people to cough forcefully.
If the airway if fully blocked and no or little sound can be made due to the inability to pass air abdominal thrusts must be started. An abdominal thrust (Heimlich Maneuver) forces air up the airway pushing the obstruction.
Infants received back slaps and chest thrusts rather than Abdominal Thrusts.
Very obese or pregnant victims receive standing chest thrusts.
If the victim becomes unresponsive it is now very important to activate the emergency response system if not already done. Unresponsive victims of FBAO receive CPR.
Team Dynamics
The interaction of the rescuers is becoming increasingly realized as a key component in victim survival. Examples of important team dynamics include: Closed loop communication, Error Correction, Clear Roles and concise messages.
Closed loop communication- If you are asked to go for help it is important state the understanding of the assignment.
Error Correction- If you see someone putting AED pads on incorrectly address it immediately.
Clear roles- Everyone involved should know who the team leader is as well as other roles.
Concise messages- It is important to prevent the amount and length of talk from becoming a distraction from providing quality care during the emergency. Short simple phrases help prevent the scene of the accident from becoming more chaotic.
Basic Life Support for Children and Infants (Pediatric Patients)
The interaction of the
Special BLS Considerations for the climber
Steep terrain
Drowning
Hypothermia
Hyperthermia
Traumatic Arrest
Anaphylaxis
High altitude
Lightning
Transfer of Patient care
MIST Report
M- Mechanism/Medical complaint
I- Injury/Illness
S-Signs/Symptoms:
T-Treatments
Training the BLSC Skills
This course has provided the knowledge necessary to save a person needing BLS skills. In order to transition the knowledge into skills training is necessary.
Gaining a Course Completion Card
Numerous organizations offer proof of course completion certificates, cards and in digital form.
Summary
Basic Life Support encompasses skills and knowledge that would ideally be known to the vast majority of humanity.
Conclusion
Basic First Aid is a skill every mountain traveler should have. Most of the truly life saving skills are pretty obvious to the average person. The efficiently gained through practice with a professional instructor and follow up self practice will make an enormous difference when you need to save your partners life.
CPR- combination of chest compressions and ventilation system
Ventilations versus breaths or rescue breaths
Organ donation CPR
Defibrillation. Does not jump start heart.
See appendix 6 video ??? Cadaver defib vid?? Permission from????
Skeleton demonstrations of anatomy
Credits, References and Recommendations
Vertical Medicine Resources, Vertical Aid
Wilderness EMS
Highlights of the 2015 AHA Guidelines Update for CPR and ECC, American Heart Association
Basic Life Support Provider Manual, American Heart Association, 2016
Www.heart.org/cpr
Basic Life Support (BLS) is a term commonly used to label actions performed prior to the ability to provide Advanced Life Support (ALS). A healthcare professional will provide high quality BLS prior to beginning ALS if inadequate numbers of rescuers are at the scene. BLS is the foundation for all ALS skills. It is fortunate that many life saving interventions fall within the BLS category.
Basic Life Support standards have changed dramatically over decades.
Basic Life Support is also the name of several types of certification courses. There are numerous organizations that offer courses and the quality varies greatly between them and their individual instructors. The American Heart Associations' most comprehensive level of CPR class is named BLS for the Healthcare Provider. It is very common for health care providers including Wilderness First Responders to maintain current proof of training in BLS. If you are pursuing a course completion card in Basic Life Support it is important that you determine the specific requirements of any employer, education system or other organization that may need it as proof of training.