There has been one important first aid update since my last blog, which is that for the purposes of CPR, casualties aged from 1 to 18 are now classified as ‘children’ and the child protocol should be followed. This has changed from the previous age definition of ‘1 to puberty’ for children.
What does this mean in practice?
• CPR should start with 5 rescue breaths for everyone aged 0-18, followed by 30 compressions then 2 rescue breaths continuously until medical help arrives.
• If you need to leave your casualty to phone for help do one minute of CPR first, before you leave them to get help (5 rescue breaths then about 3 times through the 30:2 protocol takes around a minute)
Why do children have these 5 initial rescue breaths, and why give a minute’s CPR before getting help?
Clinical research data shows that it is more likely to be a breathing issue that has caused a child to stop breathing, whereas it’s more likely to be a heart issue that has caused an adult to stop breathing. Rescue breaths are therefore critical to the chances of a good outcome with a child requiring CPR and for this reason were not removed from the CPR protocol even during COVID when adult breaths were temporarily removed.
In addition children don’t hold onto their oxygen as well as adults therefore need the input of oxygen from you is more important. Giving 5 rescue breaths at the start of child CPR and a minute’s worth of aid before leaving them for help is therefore more likely to have a positive impact as your breaths could result in a swift improvement and possibly start them breathing again.
Why has the age of a ‘child’ changed?
Clinical research data has shown that up to age 18 (and actually slightly beyond) the cause of the collapse is a breathing issue, therefore the child protocol is likely to be more effective.
How many hands should I use for compressions?
Use as many as you need to make the compressions effective. Up to 1 year old, use 2 fingers in the centre of the chest; from age 1 upwards use one hand or two hands with fingers interlinked according to how strong you are! You’re aiming to compress down about a third of the chest wall. As a guide, most people can compress with one hand to around 10 years of age or so but if you need to use two hands, then do!
What about the positioning of the defibrillator pads?
Up to the age of around 8, pads should be placed in the centre of the chest and the centre of the back. Use paediatric pads if the unit has them, or switch to the paediatric setting. If there is no switch and only adult pads the unit can still be used on the child, just place the pads in the centre front / centre back positions. Over the age of 8 place the pads in the position shown on the unit / pads with the unit in adult mode (one pad just under the right shoulder on the chest, the other on the left hand side of the body about halfway down – the heart should be roughly in the centre of the gap between the pads). Follow the audible instructions as normal.
What if I don’t know how old the ‘child’ is?
Use your best guess – no need to find their birth certificate before deciding where to place the pads or whether to treat them as a child or adult. Remember that anything you do is better than nothing!