BLS

East of England Ambulance Service
NHS Trust
Basic Life Support and

Automated External Defibrillation
12/02/2015
BLS & AED
Objectives
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.
Introduction to operating an automated external
defibrillator (AED) safely.
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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.
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BLS & AED
Anyone can do it?

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BLS & AED
2% 4% 30%

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BLS & AED
Angina
Suspected Heart Attack
CARDIAC CONDITIONS
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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 about 1 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 age.
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Blood returning from
upper body
BLS & AED
Oxygenated blood to upper body
Blood to lungs
Blood to
lungs
Oxygenated Oxygenated blood from

blood from lungs lungs
Blood returning from lower body

Oxygenated blood to lower body

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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)
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BLS & AED

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BLS & AED
Heart Attack

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-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, no two
Heart attacks are the same......
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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

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Date 12/02/2015
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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

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Date 12/02/2015
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Primary Survey
Performing CPR
Recovery Position
BASIC LIFE SUPPORT

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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
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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.

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BLS & AED
Approach safely
Check response
Shout for help
Open airway
Check breathing
Recovery Position?
Dial 999/112
Monitor Patient
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BLS & AED
APPROACH SAFELY!
Approach safely
Rescuer Check response
Shout for help
Scene
Open airway
Victim Check breathing

Recovery Position
Bystanders Dial 999/112
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BLS & AED
CHECK RESPONSE
Approach safely
Check response
Shout for help
Open airway
Check breathing
Recovery Position?
Dial 999/1123
Monitor
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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.
If no response.....
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BLS & AED
SHOUT FOR HELP
Approach safely
Check response
Shout for help
Open airway
Check breathing
Recovery Position?
Dial 999/112
Monitor
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BLS & AED
OPEN AIRWAY
Approach safely
Check response
Shout for help
Open airway
Check breathing
Recovery Position
Dial 999/112
Monitor
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Date 12/02/2015
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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 breathing is not
normal
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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 cardiac arrest
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Agonal Breathing

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BLS & AED
Approach safely
Check response
Shout for help
If no help arrives and you Open airway

are alone dial 999/112 Check breathing
After putting into Recovery Position
recovery position.
Dial 999/112
Monitor
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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.

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BLS & AED
Recovery position 2
Grab and bend the person's far knee

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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

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

2 rescue breaths
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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

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BLS & AED
If Not Breathing

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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 CPR
operator every 2 min
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BLS & AED
RESCUE BREATHS
Approach safely
Check response
Shout for help
Open airway
Check breathing
Dial 999/112
30 chest compressions
2 rescue breaths
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BLS & AED
RESCUE 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 delay
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BLS & AED
Combine Compressions and Rescue breaths
at a ratio of 30:2
30 2
30
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BLS & AED
ANY QUESTIONS ?
Time to practice.....
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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.
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BLS & AED
Children and babies

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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 by
trained lay rescuers and
professionals.
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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
Qualified help arrives and takes
over
You become exhausted
It is unsafe to continue
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BLS & AED
Pocket Mask
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.

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BLS & AED
ANY QUESTIONS ?
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BLS & AED
Understanding Defibrillation
Safe use of an AED
DEFIBRILLATION
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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 the presenting rhythm
only advise a shock for a shockable rhythm
advise the operator step-by-step what to do
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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 to shock delivery and
correct pad placement.
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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 training

you will be able to use any make or model
AEDs can be found in many public
buildings e.g. Sports centres, Railway
stations, Shopping centres and Schools
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BLS & AED
2% 4% 30%

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BLS & AED
The hearts pumping action
controlled by electrical
system
Sinus Rhythm
Electrical rhythm normally
very organized
Normal hearts rhythm is
called Sinus Rhythm
Normal heart rate of 60 -
100 beats per minute

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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 10-15 minutes
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BLS & AED
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
effective cure for VF!

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Date 12/02/2015
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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 prompts
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Date 12/02/2015
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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
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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 deliver a shock

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BLS & AED
DEFIBRILLATION SAFETY !
THE PATIENT. THE AED.
5 point check In good working order
Pacemaker Do Not use in Heavy rain
Jewellery Do Not use if they lay in a
Hair on chest pool of water
Damp/Wet skin Do Not use in an
Patches (GTN) explosive environment !

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BLS & AED
ATTACH PADS TO CASUALTYS
BARE CHEST

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ANALYSING RHYTHM
DO NOT TOUCH PATIENT

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BLS & AED
SHOCK ADVISED
Stand clear
Everyone !
TOP
MIDDLE
BOTTOM
MYSELF
BEHIND YOU
DELIVER SHOCK
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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.

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DEFIBRILLATION

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SHOCK DELIVERED
FOLLOW AED INSTRUCTIONS

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COMMENCE CPR (2 Mins)

30 2
30 2
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NO SHOCK ADVISED
FOLLOW AED INSTRUCTIONS

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COMMENCE CPR (2 Mins)
30 2
30 2
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ANY QUESTIONS ?
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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.

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Follow up what to do after?
If you have used an Automated External 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
If you require any equipment to be replaced, i.e. pads,
pocket masks, razors etc. Please contact your named
person as soon as possible.
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BLS & AED
WHEN NOT TO RESUSCITATE
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
It is unsafe to continue
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OR IF YOU SEE THIS HAS

OCCURRED !

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Oops ??

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ANY QUESTIONS ?

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Bleeding

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Bleeding
Raise Limb
Cover with clean dressing or cloth
999 or 112
Reassure
Lay down
Raise legs
Monitor
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BLS & AED
Shock

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Shock

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Choking

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Choking

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Choking

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ANY QUESTIONS ?
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BLS

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East of England Ambulance Service

Basic Life Support and

East of England Ambulance Service

East of England Ambulance Service

Oxygenated Oxygenated blood from

Blood returning from lower body

East of England Ambulance Service

How many times does the

100,800 beats per day

Suspected Heart Attack

East of England Ambulance Service

East of England Ambulance Service

East of England Ambulance Service

If in any Doubt dial 999 or 112

East of England Ambulance Service

BASIC LIFE SUPPORT

Airway Open Airway Closed Airway Obstructed

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

East of England Ambulance Service

Victim Check breathing

East of England Ambulance Service

If no help arrives and you Open airway

Kneel next to the person. Place the arm

East of England Ambulance Service

Grab and bend the person's far knee

East of England Ambulance Service

Protecting the head with one hand, gently

East of England Ambulance Service

East of England Ambulance Service

East of England Ambulance Service

East of England Ambulance Service

East of England Ambulance Service

However, chest compression

East of England Ambulance Service

Automated External Defibrillators

There are 2 types of AED:

Once you have completed this training

East of England Ambulance Service

East of England Ambulance Service

East of England Ambulance Service

If 2 rescuers, provide good quality CPR while

Interrupt CPR only when it is necessary to

East of England Ambulance Service

East of England Ambulance Service

East of England Ambulance Service

East of England Ambulance Service

East of England Ambulance Service

East of England Ambulance Service

East of England Ambulance Service

COMMENCE CPR (2 Mins)

East of England Ambulance Service

East of England Ambulance Service

East of England Ambulance Service

East of England Ambulance Service

Qualified help arrives and takes over

OR IF YOU SEE THIS HAS

East of England Ambulance Service

East of England Ambulance Service

East of England Ambulance Service

East of England Ambulance Service

East of England Ambulance Service

East of England Ambulance Service

East of England Ambulance Service