advanced resuscitation techniques certificate · 2018-10-13 · techniques certificate learner...

Advanced Resuscitation Techniques CertificateLearner Guide

PUAEME003C Administer oxygen in an emergency situationPUAOPE010C Operate an automated external defibrillator in an emergencyHLTFA404A Apply advanced resuscitation techniquesSeptember 2012

Candidate Name:

Assessment ID:

Registered Training Organisation 21799

THIS BOOK MUST BE COMPLETED IN FULL AND RETURNED TO LIFE SAVING VICTORIA BEFORE AWARD PROCESSING WILL BEGIN

1

Advanced Resuscitation Techniques Certificate

Learner Guide

Plagiarism declaration:

All of the information and evidence provided in and attached to this workbook is authentic and my own work.

Candidate signature: Date: / /

2 Advanced Resuscitation Techniques Certificate Learner Guide

Acknowledgments

This education resource has been developed by the Australian Lifesaving Academy.

Surf Life Saving Australia (SLSA) wishes to thank the editorial team for who developed the resources

for this course:

Marcia Fife (Surf Life Saving Queensland), Debbi Booth (Surf Life Saving New South Wales), Nikki

Chubb (Surf Life Saving New South Wales), Roslyn McMahon (Surf Life Saving New South Wales),

Robert O’Brien (Surf Life Saving Australia) and Bob Powell (Surf Life Saving New South Wales).

SLSA would also like to acknowledge the following people who contributed their time and expertise to

support the development of this resource:

Surf Life Saving Sydney Branch members: Michael Bretherton, Gary Daly, Keith Grima, Marissa Jank

and Peter Quartly.

Life Saving Victoria (LSV) wishes to acknowledge the following people who contributed their time and

expertise to adapting this resource for Victoria:

• StuartWall–Director–StateTrainingandAssessment

• DanielleSmith–StateResearchResourceandDevelopmentOfficer

• MurrayColvin–FirstAidandEmergencyCareSpecialInterestGroupMember

• EmmaEichhorn–BrightonLifeSavingClub

• JeremySturges–BrightonLifeSavingClub

SLSA would like to acknowledge the financial support it has received from the Federal Department

ofEducation,EmploymentandWorkplaceRelations.Theviewsexpressedhereindonotnecessarily

represent the views of the Commonwealth of Australia. The Commonwealth of Australia does not give

any warranty or accept any liability in relation to the content of this work.

© Surf Life Saving Australia Ltd 2011.

This work is copyright, but permission is given to SLSA trainers and assessors to make copies for

use within their own training environment. This permission does not extend to making copies for use

outside the immediate training environment for which they are made, or the making of copies for hire

or resale to third parties.

For permission outside these guidelines, apply in writing to:

Surf Life Saving Australia

Locked Bag 1010, Rosebery NSW 2018

Ph: (02) 9215 8000

Fax: (02) 9215 8180

Web www.sls.com.au

For information on other training programs available from the Australian Lifesaving Academy please

visit our website at www.ala.edu.au

3Advanced Resuscitation Techniques Certificate Learner Guide

Contents

Acknowledgments 2Terminology 5Icons 6CourseIntroduction 7

Prerequisites 7Courseoutcomes 7Your current skills and knowledge 8What you need to complete this course 9How to use this Learner Guide 9

How to supply feedback on improving this resource 9Course enrolment 11VETCodeofPractice 12Topic1–FirstAidandResuscitationReview 14

Introduction 14Reviewoffirstaidandresuscitationprinciplesandlegalities 14Activity(individual)1.1:Advancedresuscitationandthechainofsurvival 17Emergencyactionplan 17Activity (group) 1.2: Jaw thrust 19Activity (group) 1.3: CPR review 20Assessment Task 1: Written questions 22

Topic2–AdvancedResuscitationandOxygenAdministration 23Why use oxygen? 23Respiratory system 23Oxygenresuscitationequipment 27Activity (group) 2.1: Oxygen equipment 30Routine check of equipment 30Oxygen equipment 31Activity (group) 2.2: Routine equipment checks 32Storing oxygen equipment 32Administering oxygen therapy 32Mouth-to-mask resuscitation with oxygen 33Airbag oxygen resuscitator 33Airbagchecks 34Activity(group)2.3:Airbagchecks 34AssessmentTask2:Peerassessment–oxygenequipmentchecks 34Usingoxygenandairbagduringresuscitation 34Activity(group)2.4:CPRwithoxygen 36Equipmentmaintenance 36AssessmentTask1:Writtenquestions 36Oropharyngealairways 37Activity(group)2.5:InsertingOPairways 39AssessmentTask3:Peerassessment–oropharyngealairway 39Assessment Task 1: Written questions 39


Topic3–Suction 40Suction 40Activity(individual)3.1:Suctionequipment 42Activity(group)3.2:Administeringsuction 43AssessmentTask4:Peerassessment–suction 43AssessmentTask1:Writtenquestions 43

Topic4–Defibrillation 44Whatisdefibrillation? 44Circulatorysystem 44Electrocardiogram(ECG) 46Automatedexternaldefibrillators(AED) 47Defibrillationpads 49AEDoperation 50Set protocols for shock delivery 51Activity(group)4.1:ApplyinganAED 52Post-defibrillation casualty care 52Post-defibrillation equipment maintenance 52Assessment Task 1: Written questions 52Activity(group)4.2:Usingoxygenequipment,oropharyngealairways, suctionandanAEDduringresuscitation 53

AssessmentInformation 54AssessmentTasks 54Assessmenttask1:Writtenquestions 54AssessmentTasks2,3and4:Peerassessment 54Assessmenttask5:Scenario–airwaymanagementandoxygenuse 55AssessmentTask6:Scenarioreview–verbalquestions 56Assessmenttask7:Scenario–defibrillation 56Assessmenttask8:Incidentdocumentation 56

AssessmentPortfolio 57Learnerdetails 57Competencyrecord 57Assessment Summary 58

Assessment task 1: Written questions 59Assessmenttask2:Peerassessment–oxygenequipmentchecks 65Assessmenttask3:Peerassessment–OPairway 66Assessmenttask4:Peerassessment–suction 67AssessmentRask8:Incidentdocumentation 68Courseevaluation 71AdvancedResuscitationTechniquesCertificate–checklist 73


Terminology

The following terms are used throughout this guide.

Arrhythmia an abnormal rhythm of the heart

Perfused the passage of a fluid through the vessels of a specific organ or tissue

Occlude to obstruct the path. Also used to describe blocking the vent on a suction catheter used with an oxygen or electric powered device, which then ensures that air is drawn through the end of the catheter, creating the suction

Stress a disturbing physiological or psychological influence which produces a state of severe tension in an individual

Agonal respirations intermittent gasps from a casualty who is unresponsive. Agonal respirations are not classed as normal breathing.

Pre-operational check inspection and testing of equipment to confirm its suitability for its intended purpose before commencing shift as a first aider


Icons

The following icons (symbols) are used throughout Australian Lifesaving Academy training resources to indicate the types of activities you will be undertaking as you work through your course.

Course Aim and ObjectivesThis icon is used to bring attention to the course aim and objectives.

ReadingThis icon indicates that learners are required to undertake an individual reading task.

Individual Learning ActivityThis icon indicates that learners are required to undertake an individual learning activity. This will usually involve the documenting of individual thoughts and ideas.

Group Learning ActivityThis icon indicates that learners are required to undertake a group learning activity. Group activities may be completed in pairs, trios or larger groups.

Case StudyThis icon indicates that learners are required to undertake an analysis of a particular case or situation used as a basis for drawing conclusions in similar situations.

Remember this!This icon is used to recap important and critical issues or content that learners should pay particular attention to.

Assessment ActivityThis icon indicates that learners are required to undertake an individual assessment of their skills and/or knowledge. This may involve completion of a scenario, a set of multiple choice questions and/or a written exam.


CourseIntroduction

The aim of the Advanced Resuscitation Techniques Certificate course is to develop your skills and

knowledge to use oxygen, airway management devices, and automated external defibrillators during

resuscitation, and to administer oxygen to conscious or unconscious breathing casualties.

You will also develop knowledge and skills to enable you to demonstrate competence in the nationally

recognised units of competency:

•HLTFA404CApplyadvancedresuscitationtechniques

•PUAEME003CAdministeroxygeninanemergencysituation

•PUAOPE010COperateanautomatedexternaldefibrillatorinanemergency

The Public Safety Training Package units (units starting with PUA) form a part of the nationally

recognisedPUA31310CertificateIIIinPublicSafety(AquaticSearchandRescue).

PrerequisitesCandidates must meet ALL of the following conditions:

• beatleast15yearsofageonthedateoffinalassessment

• holdONEofthefollowingSLSAawards:

– BronzeMedallion/CertificateIIinPublicSafety(AquaticRescue),OR

– Basicemergencycarecertificate,OR

– Apply(Senior)firstaidcertificate,OR

– Resuscitationcertificate

• HavealreadyachievedONEofthefollowingunitsofcompetency:

– HLTCPR201A/BorHLTCPR211A-PerformCPR,OR

– HLTFA201A/BorHLTFA211A-Providebasicemergencylifesupport,OR

– HLTFA301B/CorHLTFA311A-Applyfirstaid

Course outcomesBy the end of this course, you should be able to:

•assessthecasualtyanddevelopamanagementplan

•checkresuscitationequipment

•maintainanairwayby:

– usingsuction

– usingoropharyngealairways(OPairways)

•resuscitateacasualtyusingoxygen

•useoxygentoprovidetherapy

•recoverandrestoreoxygenequipment

•checkdefibrillationequipment

•attachandoperateadefibrillator

•recoverandrestoredefibrillationequipment.


Your current skills and knowledgeYou may already have some of the required skills and/or knowledge for this course. Perhaps you have

completed similar training activities in previous work, learned them from performing your job or in

another training course.

IfyoucandemonstratetoyourFacilitator/Assessorthatyouarecompetentinaparticularunitof

competency, you will not need to repeat the training for it. This is called Recognition of Prior Learning

or RPL.

Ifyoufeelconfidentyoualreadyhavesomeorallofthecompetenciesdeliveredinthiscourse,ask

yourFacilitator/AssessorforacopyoftheRPLInformationKitwhichincludesaSelf-Assessment

Checklist. You can check if you are likely to be found competent by completing the checklist.

Ifyoufeelthatyoucandemonstratecompetency,talktoyourFacilitator/Assessorabouthavingthis

formally recognised. Your Facilitator/Assessor will then help you to provide evidence of competency.

Competency can be demonstrated in a number of ways, and most commonly it is done by:

•showingthatyoualreadyhavearecognisedqualificationwhichdeliveredthesameunit/sof

competency OR

•undertakingtheassessmenttasksforthecourse.

Talk to your Facilitator/Assessor for more information about RPL.


What you need to complete this courseYou need:

•atrainer/facilitator

•acopyofthisLearnerGuide

•accesstoaCPRtrainingmanikin

•accesstooxygenequipment

•accesstoasuctiondevicefortraining

•accesstoatrainingdefibrillator

•tobeapartofatrainingsquadoffourorhaveadditionalpersonneltoparticipateintraining

scenarios with you.

How to use this Learner Guide• thiscoursewillbedeliveredusingavarietyofstrategiesforlearning

• readthroughtheguidecarefully.Thetopicscovertheknowledgeandskillsrequiredtocomplete

this course and to prepare you for the assessment activities

• workthroughtheinformationandcompletetheactivities

• youwillbesupportedbyyourTrainer/Facilitatorwhowillshowyouthecorrectwaytodothings

• therewillbeopportunitiesforyoutoaskquestionsandseekguidancewhileworkingthroughthe

guide

• oncompletionofthecourseyouwillbeaskedforfeedback.

How to supply feedback on improving this resourceAll resources developed by the Australian Lifesaving Academy are reviewed at least annually and

updatedasrequired.FeedbackcanbesuppliedthroughtheonlineImprovementRequestsformon

the Resource Development Page at www.sls.com.au or in writing to:

TrainingImprovementRequestsSurfLifeSavingAustraliaLockedBag1010

RoseberyNSW2026


Course enrolment

TO ENROL

Simply fill in the enrolment form and submit with your completed learner guide to your assessor or directly to:

LifeSavingVictoriaPOBox353SouthMelbourneDCVIC3205 | Phone0396766900 | Fax0396818211

Course type: Advanced Resuscitation Techniques Certificate

Course Venue Course Date / /

ENROLMENT FORM [all fields are mandatory]

Mr Miss Ms Mrs Other (tick one box) First Name Surname

Residential Address Postcode

Postal Address (if different from residential) Postcode

Phone(h) Phone(w) Mobile Email

Male Female Date of Birth / / Victorian Student Number (if known)

1) CULTURAL BACKGROUND & LANGUAGE

Were you born in Australia? Yes No (if no, please specify)

DoyouspeakalanguageotherthanEnglishathome? No,Englishonly Yes, other (please specify)

HowwelldoyouspeakEnglish?(tickonebox) Very well Well Not well Not at all

AreyouofAboriginalorTorresStraitIslanderorigin? No Yes, Aboriginal Yes,TorresStraitIslander

2) MEDICAL CONDITION

Do you consider yourself to have a disability, impairment or long term condition? Yes No (if yes, tick any of the applicable boxes below)

Vision Hearing/Deaf Intellectual AcquiredBrainImpairment MentalIllness

Learning Physical Medical Condition Other (please specify)

3) EDUCATION

WhatisyourhighestCOMPLETEDschoollevel?(tickoneboxonly)

Year 12 or equivalent Year 11 or equivalent Year 10 or equivalent Year 9 or equivalent Year 8 or below

Inwhichyeardidyoucompletethatschoollevel? Areyoustillattendingsecondaryschool? Yes No

4) PRIOR QUALIFICATIONS

Have you successfully completed any of the following qualifications? (see below) Yes No (if yes, please tick appropriate boxes)

Bachelor Degree or Higher Advanced Diploma or Associate Degree Diploma CertificateIV

CertificateIII CertificateII CertificateI Certificate other than above

5) EMPLOYMENT

Of the following categories, which best describes your current employment status? (tick one box only)

Full-timeEmployee SelfEmployed–Notemployingothers Part-timeEmployee

Employer NotEmployed–Notseekingwork Employed–Unpaid,workinginafamilybusiness

Unemployed–Seekingfull-timework Unemployed–Seekingpart-timework

6) STUDY REASON

Of the following categories, which best describes your main reason for undertaking this course/traineeship/apprenticeship? (tick one box only)

To get a job To develop my existing business To start my own business

To try for a different career To get a better job or promotion Itwasarequirementofmyjob

Iwantedextraskillsformyjob To get into another course of study For personal interest or self-development

Other reasons

IhavereadandunderstoodtheVETCodeofPracticeandterms&conditionsattached Signed Date / /


VETCodeofPractice

Life Saving Victoria (LSV) has developed a Code of Practice to address and establish its commitment to the maintenance of high standards in the provision of vocational education and training. This code of practice pervades all policies and procedures and it is a requirement ofemploymentthatallLSVpersonnel(includingfull-time&casualemployeesandvolunteers),members and clients abide by it.

LEGISLATIONInformationaboutcurrentlegislativeandregulatoryrequirementseffectingparticipant’strainingcan be found in:• VictorianRegistration&QualificationsAuthority:providesfortheadministrationofa

vocational education and training system www.vrqa.vic.gov.au Australian Quality Training Framework: www.training.com.au

• OccupationalHealthandSafetyAct2004:providesfordutiesandobligationsrelatedtoworkplace health and safety.

• EqualOpportunityAct1995:providesforprohibitionofdiscriminationandotherspecifiedconduct and provides for the investigation into complaints in relation to discrimination.

• HealthAct1958:Specifically–Health(InfectiousDiseases)Regulations2001

All of the above are available on the Victorian Legislation and Parliamentary Documents website: www.legislation.vic.gov.au• FederalPrivacyAct:Relatingtothecollection,useandstorageofpersonaldataisavailable

on: www.privacy.gov.au• www.comlaw.gov.au

ACCESS, EQUITY, PARTICIPANT SELECTION AND ADMISSIONEveryparticipantwhomeetstheentryrequirements(ifapplicable)asprescribedbytheappropriate Training Package will be accepted into any training/assessment program.

LSV incorporates the principles of equity into all programs.

LSV’s personnel have been instructed in their responsibilities with regards to Access and Equityprinciples.

Participants have equitable access to all programs irrespective of their gender, culture, linguistic background, race, location or socio-economic background.

InthePublicSafetyIndustrythereis,duetothenatureofworkperformed,arequirementfor the majority of people to be able-bodied. However, to enable participation in the training offered by LSV by all members of the community, special needs may be addressed in relation to those units, which can accommodate special needs.

This will see all non-discriminatory enrolment criteria fulfilled along with further aquatic safety evaluation, deemed necessary by LSV and upon the advice of special interest groups.

The importance of water safety, rescue and survival cannot be over stressed when conducting training for aquatic based community rescue activities, for all training conducted under the auspices of LSV. (Further detail regarding participation requirements please refer to the Limiting and Permanent Disability Policy).

Some programs may have a limited number of vacancies and these will be filled in a chronological order upon completion of enrolment.

Admission procedures will therefore be free of discrimination, and if an individual does not meet entry requirements, all attempts are made to assist them to identify alternative courses of action.

NATIONAL RECOGNITION AND RECOGNITION OF PRIOR LEARNINGLSV recognises the Australian Qualifications Framework (AQF) qualifications and statements of attainment issued by any other Registered Training Organisation (RTO). Where relevant national recognition of qualifications is applied at no cost to the candidate.

Recognition of prior learning/current competence assessment is available to all participants. Participants wishing to be assessed in this mode can either provide sufficient evidence of competence or undertake the required assessment tasks. Participants wishing to apply for Recognition should contact their trainer/assessor. A fee may apply to Recognition of prior learningassessments.Ifthereisacost,thiswillbeevaluatedonanindividualbasisinrelationto the amount of work required and the level of assessor involvement required.

ENROLMENT INDUCTION AND ORIENTATIONLSV conducts an enrolment, induction and orientation program for all participants. This program reviews the Code of Practice and also includes the completion of an enrolment form and any specific needs of the individual participant with regard to:

• language,literacyandnumeracysupport;• venuesafetyandfacilityarrangements;• relevantlegislativerequirementsandaccessibility;• reviewofthetrainingandassessmentprogramandflexiblelearningandassessment;• participantsupport,welfareandguidanceservicesarrangements;• appealsandcomplaintsprocedures;• disciplinaryprocedures;and• recognitionarrangementsandcredittransfer.

PRIVACYLSV collects personal information solely for the purpose of operating under the Australian Quality Training Framework administered by the Victorian Government who is the registering authority. Pursuant to this role the registering authority may require the release of your personal information for the purposes of audit and survey. This may include surveys conducted by The Social Research Centre on behalf of the National Centre for Vocational EducationResearch(NCVER)whocollectinformationaboutpeoplewhohavecompletedrecognised vocational training in the previous calendar year and provides information on vocational education and training in Australia to governments, the education and training sector, industry and the community. Under the National Privacy Principles you can access personal information we hold on you and you may request the correction of information that is incorrect or out of date.

MARKETINGShould LSV market or advertise its products and services, it will do so in an ethical manner. LSV will market its products and services with integrity, accuracy and professionalism, avoidingvagueandambiguousstatements.Intheprovisionofthisinformation,nofalseormisleading comparisons will be drawn with any other provider or course. Specific course information, including content and vocational outcomes is available prior to enrolment.

Ethical Marketing Practices:LSV will adopt policies and management practices which maintain highly professional standards in the marketing and delivery of its products and services and which safeguard the interests and welfare of all participants.

LSV will maintain an educational environment that is conducive for all participants to achieve the pre-determined competencies.

LSV will always gain a participant’s written permission before using information about that individual in any marketing materials and will respect any conditions of permission imposed by the participant.

LSV will always accurately represent training products and services to prospective participants.

LSV ensures that participants are provided with full details of conditions in any contractual arrangements with the organisation.

Accurate and Clear Marketing:Where advertisements and/or advertising materials refer to LSV’s RTO status, the products and services covered by the organisation’s scope of registration are clearly identified. LSV only advertises those AQF qualifications it is registered to issue. Advertisements and advertising materials utilised by LSV identify nationally recognised products separately from courses recognised by other bodies or without recognised status. The names of training packages, qualifications and/or accredited courses listed in advertising materials utilised by LSV comply with the names/titles recognised by the State Registration Authority. Full information on specific courses is available from LSV prior to enrolment.

LANGUAGE, LITERACY AND NUMERACYLSV recognises that all vocational training includes language, literacy and numeracy tasks and all LSV trainers and assessors provide:• materials,resourcesandassessmenttoolsandtasksthatdonotrequireparticipantsto

have language, literacy and numeracy skills of more complexity than those used in the workplaceforthecompetenciesbeingtaught/assessed;

• clearmodelsofthelanguage/literacy/numeracytask;• opportunitiesforrepeatedandsupportedpractice;and• opportunitiesforindependentpractice

Where some participants require additional practice and training, LSV arranges appropriate language, literacy and numeracy support.

DELIVERYLSV ensures that all resources meet the requirements of the relevant endorsed training package(s) and/or accredited course(s), for the delivery, assessment and issuing of qualifications, LSV affirms that it has in place and applies the following resources:• deliverypersonnelwithappropriatequalifications,andexperience,includingassessor

requirementsasidentifiedintherelevantTrainingPackageassessmentguidelines;• deliveryandassessmentresourcesappropriatetothemethodsofdeliveryandassessment

requirements;and• relevantTrainingPackageand/oraccreditedcoursedocumentsandsupportmaterials,

with necessary copyright authorisations

Delivery strategies utilised by LSV are always selected to best achieve the required elements of competence while giving full consideration to the learning style of the participant. The provision of training may include a flexible combination of off and on-the-job delivery and assessment.

ASSESSMENTLSV has demonstrable experience and skill in providing or facilitating assessments which meet the endorsed components of relevant training package(s) and/or accredited courses in the areas of recognition sought. LSV is committed to ensuring valid and reliable assessment of achievements against industry competency standards and all assessment undertaken by LSV remains consistent with the National Assessment Principles and the requirements of Training Packages.

Assessment Principles:LSV ensures that all assessment conducted within the organisation is reliable, flexible, fair and valid.• Reliable–Allassessmentmethodsandprocedureswillensurethatunitsofcompetency

are assessed consistently and that there is always consistency in the interpretation of evidence.

• Flexible–Assessmentwillbeofferedintheworkplace(on-the-job),inthetrainingenvironment (off-the-job), in a combination of both or via recognition of prior learning/recognition of current competence. LSV will ensure that all assessment methods and practices allow for diversity with regard to how, where and when competence has been/will be acquired.

• Fair–Assessmentmethodsandprocedureswillnot,underanycircumstance,disadvantage any participant.

• Valid–Assessmentactivitieswillalwaysmeettherequirementsasspecifiedintheunitof competency. Sufficient evidence will always be collected, and will be relevant to the standard/module being assessed.


Assessment Pathways:LSV offers participants a number of assessment pathways appropriate to the qualification outcome. Assessment conducted for the purposes of national recognition may lead to a part or a full qualification under the Australian Qualifications Framework (AQF). The main assessment pathways to a qualification can be listed as follows:• off-the-jobtrainingandassessment• workplaceassessment• recognitionofpriorlearning/recognitionorcurrentcompetence• nationalrecognition/credittransfer• on-the-jobtrainingandassessment

Assessor Qualifications:LSV ensures that personnel involved in assessment activities always meet the assessor requirements as set by either:• theassessmentguidelinesoftrainingpackages;and/ortheassessmentrequirements

ofaccreditedcourses;IfLSVpersonneldonothavethevocationalcompetencetoassess identified areas, appropriately qualified personnel will be employed to provide this expertise within the assessment process. LSV may also utilise auspiced assessment arrangements in situations where individual LSV personnel do not meet the total assessor requirements. Such auspiced arrangements may involve LSV personnel assessing in conjunction with workplace supervisors, industry specialists and/or qualified external assessors.

Assessment Resources:LSV, when designing assessment resources, ensures that all aspects of competence are covered, including:• taskskills(performanceofindividualtasks);• taskmanagementskills(managinganumberofdifferenttaskswithinthejob);• contingencymanagementskills(respondingtoproblems,breakdownsandchangesin

routine);and• job/roleenvironmentskills(dealingwiththeresponsibilitiesandexpectationsofthe

workplace)

All assessment reporting systems will indicate the units of competency that the individual has attained.

Conducting Assessment:When conducting assessment, LSV ensures it has personnel with appropriate qualifications and adheres to the requirements of the Training Package and the Australian Qualifications Training Framework Standards for Registered Training Organisations.

LSV ensures that the personnel conducting assessment utilise appropriate methods for recording, storing and accessing assessment outcomes.

Assessment activities undertaken by LSV always follow the methodology outlined below:1. Assessment procedures are fully explained to participants. Throughout all training,

participants are regularly reminded of the ongoing opportunity to be assessed when they are ready.

2. Opportunities for Recognition (recognition of prior learning/recognition of current competence and credit transfer) are also discussed, as are any available flexible methods of assessment. The appeals and reassessment process is also outlined.

3. The assessment requirements of the unit(s) of competence/module(s) are outlined, and any particular arrangements for the workplace/training environment are arranged.

4.Allevidence-gatheringmethodsremainreliable,flexible,fairandvalid.5. As assessments are undertaken, LSV trainers/assessors record individual participant

assessment results. Sample copies of the assessment instrument are kept by the trainer/assessor.

6.Post-assessmentguidanceisalwaysavailabletoparticipants.7.Studentswillbegiventheopportunityforatleastonereassessmentforanycompetencies

not achieved on the first attempt.8. A fair and impartial appeals process is always available.9.Evaluationofassessmentprocessesandproceduresisgatheredonanon-going

(informal) basis.

EvidencegatheringmethodscommonlyutilisedbyLSVinclude,butareinnowaylimitedto:• graphicpresentation • questioning• projects/assignments • workplaceperformance• audio/visualdisplay • role-play• writtentests • simulation• skillsportfolio • oralpresentation• demonstration

CHEATING AND PLAGIARISMCandidates must not engage in any action that provides an unfair advantage or disadvantage to themselves or any other person in any assessment situation. Plagiarism, collusion, fabrication and cheating are not acceptable.

COMPLAINTSParticipantfeedbackisimportanttothecontinuousimprovementoftheVETservicesprovided by LSV. Should a participant have a complaint about a training course, the participantshouldcontacttheManager–TrainingServices.

Where training is conducted for a member by a lifesaving club, the participant can make their initial complaint to their club committee representative responsible for training and assessment,generallytheclubChiefInstructor.Allcomplaintsmadeinwritingwillreceiveawritten response. Appeal to the outcome of a complaint is available and will be heard by an independent person/panel.

APPEALS PROCESSAn appeals and reassessment process is an integral part of all training and assessment pathways leading to a nationally recognised qualification or Statement of Attainment under the Australian Recognition Framework.

AfairandimpartialappealsprocessisavailabletoparticipantsofLSV.Ifaparticipantwishesto appeal his/her assessment result, he/she may first discuss the issue with the trainer/assessor.Iftheparticipantwouldliketoproceedfurtherwiththerequestafterdiscussionswith the trainer/assessor a formal request is made in writing outlining the reason(s) for the appeal. LSV’s time period for the acceptance of appeals is 28 days after the participant has been informed of the results of their assessment.

Everyeffortismadetosettletheappealtoboththeparticipant’sandLSV’ssatisfaction.Eachappealmaybeheardbyanindependentpersonorpanel.Eachappellanthasanopportunityto formally present his or her case and is given a written statement of the appeal outcomes, including reasons for the decision. Should the outcome not be acceptable to the participant, they will be informed, in writing, of the opportunity to lodge a complaint with the Victorian Qualifications Authority.

FEES, CHARGES & REFUNDSWhere a program is conducted by a lifesaving club, the club will be invoiced the set fees and charges upon issue of the certification. Standard terms will apply to the payment of invoices. LSV does not receive payment of course fees more than ten weeks in advance of a course.

Cancellation Fee:As per club guidelines

Transfer Fee:As per club guidelines

TESTAMURSIssuance of TestamursThe LSV will issue a Certificate where a participant has successfully completed all the requirements for a qualification (as specified in the appropriate Training Package).

When a Certificate for a qualification is issued, a Statement of Attainment listing all the units of competency or modules that the participant has completed for that Certificate will also be issued.

A Statement of Attainment will be issued to participants when they withdraw or cancel their enrolment in the qualification. However, a Statement of Attainment will only be issued if a participant has successfully completed one or more units of competency or modules or an accredited short course, but has not otherwise met the requirements for a qualification (as specified in the appropriate Training Package). The Statement of Attainment will list all of the units of competency or modules completed by the participant.

Forfeiture or Returning TestamursThe LSV may forfeit a Certificate or require the participant to return a Certificate to the issuing RTO in circumstances where:• theQualification/Certificate/StatementofAttainmenthasbeenimproperlyobtained• applicationismadeforareplacementCertificateduetodamageorlegalnamechange• aQualification/Certificate/StatementofAttainmenthasbeenproducedinerror

Reprinting TestamursReprint of Certificates or Statements of Attainment which contain an error are processed and issued at no charge to the participant. Reprint of lost Certificates or Statements of Attainment will incur a fee of $5.50.

PARTICIPANT WELFARE, GUIDANCE AND SUPPORT SERVICESAll participants of the LSV RTO are treated as individuals and are offered advice and support services which assist participants in achieving their identified outcomes.

LSV does not offer formal welfare or guidance services but every effort will be made to assist participants to access appropriate support agencies.

DISCIPLINARY PROCEDURESAll LSV participants are expected to take responsibility, in line with all current workplace practices and legislation, for their own learning and behaviour during both on- and off-the-job training and assessment. Any breaches of discipline will result in the participant being given a verbal warning. Further breaches will result in the participant having to “show cause” as to why they should not be excluded from further participation in the program.

ACCESS TO PARTICIPANT’S RECORDSEachparticipant’srecordsareavailabletothemonrequest.Participants’recordsarenotavailable to other people unless LSV is requested in writing by the participant to allow such access.

WAIVERImeettheprerequisiterequirementsofthecourseIamenrollinginaboveandhaveattachedevidence for non-LSV qualifications.

Irecognisethatthecomponentsoftheaquaticcoursesinvolveactivitiesthatmaybecarriedout in both deep and shallow water, some of which are quite strenuous and require a reasonableleveloffitnessandswimmingability.IauthoriseLSVtoobtainmedicalassistancethattheydeemnecessaryshouldanymedicalproblemoraccidentoccur,andIagreetopayallmedicalexpensesincurredonmybehalfandIfurtherauthorisequalifiedmedicalpractitioners to administer an anaesthetic if necessary.

Itakefullresponsibilityforanyinjury,illness,lossordamagetomypersonand/orpropertythat may directly or indirectly result from my participation in the training program. This waiver, release and discharge shall be and operate separately in favour of all persons, corporations and bodies involved or otherwise engaged in promotion or staging the training program and the servants, agents, representatives and officers of any of them and shall so operate whether or not the loss, injury or damage is attributed to the act neglect of any or more of them.

Iagreetodiscloseanydisability,medicalorotherissuethatmayinhibitmyabilitytoundertaketheprogramasoutlined/Iknowofnoreasonmedicalorotherwisethatwouldinhibit me from participation.


IntroductionThe prerequisites of this course are that participants already have an understanding of resuscitation

and basic first aid. This topic is a review of relevant first aid and resuscitation principles to assist

participants with understanding where the use of advanced resuscitation techniques, such as

defibrillation, oxygen and advanced airway management techniques, will support and improve the care

they can provide to a casualty.

Participants who require more information in this topic can find complete descriptions in the Australian

LifesavingAcademyFirstAidTrainingManual2ndEditionortheSurfLifeSavingAustraliaPublic

SafetyandAquaticRescue33rdEditionmanual.

Review of first aid and resuscitation principles and legalities

What is first aid?

First aid is the initial care of the suddenly sick or injured until medical aid arrives or the casualty

recovers. Medical aid, on the other hand, is professional medical treatment by a doctor, registered

nurse, or ambulance paramedic.

Aims of first aid

The aims of first aid are to:

•preservelife

•protecttheunconscious

•preventtheconditionfromworseningandtorelievepain

•promoterecovery.

As a first aider you also aim to prevent:

•furtherdamagetoyourself,othersandthecasualty

•thecasualty’sconditionfrombecomingworse

•delayinthecasualty’srecovery

•anyharmfulintervention.

Legalities of first aid

Consent

A person who is touched without consenting to it can take legal action for assault. A first aider must

seekpermissionfromthevictimbeforeprovidingfirstaid.Ifthevictimisunresponsiveorunableto

communicate,thelawassumesthatconsentwouldhavebeengiven.Ifthevictimisachild,consent

forfirstaidmustbeobtainedfromaparentorlegalguardian.Ifthereisthreattolifeandaparentor

guardian is unavailable, consent is implied and first aid should be provided.

Duty of care

Australian law does not impose a duty of care on any person to give assistance unless that person

already owes a duty of care to the sick or injured person. A first aider at a work site has an implied

duty of care, as does someone caring for children. There is no such clear duty for a volunteer, but

once a person starts to act, that person becomes the caregiver and should stay with the sick or

injured person until professional help arrives.

Always work within your training, following organisational procedures and manufacturers’ instructions

for equipment where required.

Topic1–FirstAidandResuscitationReview


Documentation (record keeping) Documentation serves the following purposes:

• toassistthefirstaiderinmanagingtheircasualty’sinjuriesorillnessesandbeingabletoperforman

accurate handover to ambulance personnel

• tobealegalrecordandstatisticalinformation.

Organisations providing a first aid service will have first aid forms to assist in information gathering

andreporting.(SLSAmembersshouldfilloutanIncidentReportformforallmajorfirstaidand

resuscitation cases).

Confidentiality

All information relating to a casualty’s injury or condition must be kept confidential. However, you must

give all relevant information to medical personnel when they arrive.

First aid safety

Infection control

First aiders should always follow standard precautions when performing first aid. These include using

the following barrier devices during first aid and resuscitation:

•gloves

•resuscitationmask

•safetyglasses

Contaminated waste disposal

First aid supplies and tools or other items that have come in contact with bodily fluids such as vomit or

blood should be disposed of in clinical waste bags.

Post-traumatic stress

An unsuccessful resuscitation, not knowing the ultimate outcome, or even a successful resuscitation

or emergency response can all take an emotional toll on the first aider. This is known as post-

traumaticstress.Ifyou,oracolleague,areexperiencingstressafteranincident,itisimportanttoseek

out support. Surf Life Saving provides support to its members. Further information regarding stress

management after a critical incident can be found in Volume One of the Guidelines for Safer Surf

Clubs.

Airway obstructions

An airway obstruction (blockage) can be either partial or total. The more the airway is blocked, the

more the casualty is in danger of losing consciousness. Causes of airway obstructions include swelling

of the throat tissues and choking.

Figure 1.1 Flow chart for management of foreign body airway obstruction (Source: Australian Resuscitation Council)

Conscious Unconscious

Effective CoughMild Airway Obstruction

Encourage Coughing

Continue to check victim until recovery

or deterioration

Call ambulance Call ambulance

Give up to 5Back Blows.If not effectivegive up to 5

Chest Thrusts

Call ambulance

Commence CPR

Ineffective CoughSevere Airway Obstruction

Assess Severity


Chain of survival

Figure 1.2 Chain of survival

In1990,theAmericanHeartAssociationintroducedatreatmentmodelforcasualtiesofsudden

cardiacarrestcalledthechainofsurvival.Itoutlinesthespecificsequenceofeventsthatneedsto

happen for a casualty to survive and recover from sudden cardiac arrest.

Early access

This first step occurs when someone suspects or determines that the casualty is in sudden cardiac

arrest and calls for help.

Early CPR

This second step is about buying time for the casualty. Cardiopulmonary resuscitation (CPR) keeps the

casualty’s blood flowing until defibrillation can begin. At this stage any attempt at CPR is better than

no attempt. While a person with current training in CPR is ideal, any attempt by a bystander whether

trained or not will contribute to this stage in the chain.

Early defibrillation

This third step is about resetting the heart’s rhythm by shocking the casualty as quickly as possible

with a defibrillator. Studies show that this is the most critical link in the chain of survival.

Early advanced life support

This fourth step occurs when medical personnel provide advanced care that can include airway

support, medications and hospital.

Early access Early CPR Early defibrillation Early advanced life support


management equipment will contribute to the chain of survival.

Emergency action plan

Many variables exist when dealing with emergencies. Knowing when to do what in a first aid situation,

despite the number of possible variables, is the key to giving the casualty or casualties the best

chance of a full recovery.

Inanyfirstaidsituationthefirstaidermusthaveanactionplan.Theplanofactionforfirstaidersis

knownastheemergencyactionplan(EAP).ThestepsintheEAParelistedbelow:

• pauseandplan

• callforemergencyassistance

• primaryassessment

• secondaryassessment

– managementofinjuries

– vitalsignssurvey

– history

– bodycheck

– treatment

• ongoingmanagement

Pause and plan

The aim of pause and plan is to remind the first aider to remain calm, and to stop and think.

Any time you are called to an incident, consider the following questions:

• istheareasafe?

• doyouhavetheappropriatefirstaidkitandequipmenttomanagetheincident?

As a first aider trained in advanced resuscitation techniques, you should also consider bringing

oxygen equipment and a defibrillator with you when responding to an incident.

• howlongcouldyoubeoutintheelements?

• doyouhavearadioormobilephone?

• areyoulikelytoneedassistance?

• doyouneedtocall000beforeyouattendtheincident?

Through an understanding of your environment and the injuries you are likely to encounter you should

already have answered most of these questions. The couple of seconds it takes to pause and plan will

save you minutes down the track.

Activity (individual) 1.1: Advanced resuscitation and the chain of survivalDuring this course you will be learning how to use oxygen resuscitation equipment, airway

management devices (oropharyngeal airways and suction) and a defibrillation unit. The value of

defibrillation is clearly defined in stage three of the chain of survival.

Using your current knowledge of CPR, identify where the use of oxygen resuscitation and airway


Call for emergency assistance

Itisessentialthatemergencyservicesarecontactedassoonaspossible.Thisisnowpartofthe

Primary assessment and should occur after checking for a response.

The four Ps: Position, Problem, People and Progress can be used to remember the information

that will need to be supplied to an emergency services operator or, when working as part of a first

responder organisation such as surf lifesaving, via radio to your communications centre.

Position What is the exact location of the emergency?

The first aider should be ready to give the street address and suburb, or a description of

thelocationsuchasthenearestintersectionorlandmark.Itisalsousefultopassonthe

telephone number they are calling from.

Problem What is the problem?

The caller should be ready to explain what has happened.

People How many people are hurt (sick)? The caller must be prepared to list the number of

people involved in the incident including their gender, ages and condition.

Progress What has been done (progress) to assist the casualty?

The caller may be asked if he or she is with the casualty at the time and what treatment

has been provided so far.

Primary assessment

As covered in previous training, primary assessment is the initial assessment of the scene and the

casualty for dangers to the first aider, bystanders and the casualty, and for response and breathing of

the casualty. Primary assessment also includes cardiopulmonary resuscitation and defibrillation.

Danger

Make sure that there is no danger to yourself and no further danger to bystanders or the casualty.

Response

Assess the consciousness of the casualty.

Send for Help

Call for emergency assistance.

Airway

Ensuringaclearairwayisakeyaspectofsuccessfullyresuscitatingacasualty.Theuseofsuction

devices to clear foreign matter from the mouth, and the use of oropharyngeal airways to assist in

ensuring that the tongue does not block the airway, can assist in maintaining the casualty’s airway.

These devices are an addition to good airway management, first aiders should continue to manage

the airway ensuring head tilt and chin lift. When using an airbag during resuscitation, the jaw

thrust method should be used to apply head tilt and chin lift and ensure a good seal between the

resuscitation mask and the casualty’s face.


Activity (group) 1.2: Jaw thrustYou should have learned how to perform jaw thrust in your previous first aid training. This technique is

essential when using an airbag during CPR. Refresh your skills in jaw thrust by practising on a partner

or a resuscitation manikin.

Ifyouhavenotpreviouslylearnedjawthrust,askyourtrainertoexplainhowthisisdonenow.Afull

explanation of how to perform jaw thrust can be found in chapter two of the Australian Lifesaving

AcademyFirstAidTrainingManual2ndEditionorinchapterfouroftheSurfLifeSavingAustralia,

PublicSafetyandAquaticRescue33rdEditionmanual.

Breathing

Performing rescue breaths using expired air during resuscitation will provide the casualty with

approximately16%oxygenineachbreath.Usinganoxygenresuscitationdevicesuchasanairbag

resuscitatorwithareservoirattachedwillprovideupto95%oxygenwitheachcompressionofthe

airbag. The benefit of this additional oxygen during CPR is invaluable and should be used during CPR

whenever equipment and a trained operator is available.

Compressions

CPR should be commenced if the unconscious casualty is unresponsive and not breathing normally.

BasicCPRskillsareessentialtoensurethebestoutcomeforacasualty;theseskillsshouldnotbe

neglected in favour of using other resuscitation devices. As an experienced first aider, other first aiders

in your team may look to you for guidance. You will need to be confident in your resuscitation skills to

be able to provide direction to your team. You may also be required to instruct bystanders in assisting

with CPR to allow you to access and use the additional equipment in which you have been trained.

CPR rates

Body type

Compression: rescue breaths

Cycles per 2 minutes

Depth of compression

Number of hands

Location of compression Head tilt

Adult 30:2 51/3 depth of

chest2 hands

centre of chest

maximum

Child 30:2 51/3 depth of

chest1–2hands

centre of chest

maximum

Infant 30:2 51/3 depth of

chest2 fingers

centre of chest

no head tilt


Activity (group) 1.3: CPR reviewYou will have learned basic CPR skills in your first aid training. Working in pairs, refresh your skills in

CPR by practising on a resuscitation manikin. Have your partner or your trainer provide feedback on:

• yourhandpositioning

– isitinthecentreofthechest?

– isyourcompressingarmstraight?

– areyourcompressionsvertical?

• thedepthandrateofyourcompressions

– areyourcompressionsdeepenough?

– areyoucomingallthewayupattheendofeachcompression?

– areyourcompressionsfastenough?

• rescuebreaths

– areyouprovidingadequateheadtiltandjawthrust?

– areyoublowingintoomuch/toolittleair?

Once you have refreshed your CPR skills, work with your partner and practise giving them directions

as if they do not know CPR or have not refreshed their knowledge in many years.

A full explanation of basic CPR can be found in chapter two of the Australian Lifesaving Academy First

AidTrainingManual2ndEditionorinchapterfouroftheSurfLifeSavingAustralia,PublicSafetyand

AquaticRescue33rdEditionmanual.

Defibrillation

Defibrillation should be administered as soon as possible. When working in a team, a first aider who

is trained in the use of a defibrillator should be the operator. The operator of the defibrillator must take

control of the team performing resuscitation as they will be responsible for the delivery of the shock

and ensuring the safety of the team.

Secondary assessment

The secondary assessment is a systematic means of finding other conditions that were not apparent

during the primary assessment. The secondary assessment should not be undertaken if life-

threatening conditions are still present.

Before conducting a secondary assessment, always:

• introduceyourselftothecasualtyandasktheirname

• explainyourintentionstothecasualty

• seekconsenttotreatthecasualty

• considerandrespectthecasualty’sprivacy.

Management of injuries

After completing the primary assessment and having identified that the casualty is breathing, the first

aidercanbeginmanagingotherinjuries.ItisimportanttorememberthatCPRmustnotbeinterrupted

to treat other injuries.

Order of treatment

The control of major bleeding is the first priority after the completion of the primary assessment. Then

manage any major burns, treat the casualty for shock, stabilise any fractures and treat any other

injuries.

NOTE:

A key issue in managing a casualty is treating shock. Beyond treating the cause of shock (e.g. a

major bleed), the introduction of oxygen to provide therapy at this stage is the single most effective

treatment available to a first aider.


Casualty position

The casualty should be moved or assisted into the most comfortable position for their condition. Does

the casualty require protection from the sun, wind or rain?

Call for further assistance if required

The first aider should now consider what further assistance or equipment may be needed to treat the

casualty, and call 000 if necessary and not already done.

Vital signs

Vital signs are essential for not only establishing how well or sick the casualty is, but for monitoring

trends in their condition and assessing the effectiveness of the treatment.

ADULT NORMAL ABNORMAL

Pulse 60–100beatsperminute <60or>100beatsperminute

Breathing 12–20breathsperminute >20breathsperminute

Skin (colour and temperature) Warm and pink Cool or hot, pale, moist,

flushed/red, blue/cyanosed

Conscious state Alert and orientated Drowsy or unconscious

History

A history is relevant information about a casualty’s current injury/illness, their present symptoms and

relevant previous illnesses. You can obtain a history by:

• observingthescene

• listeningtowhatissaidbythecasualtyandbystanders

• askingquestions.

AppropriatequestionscanberememberedbytheacronymSAMPLE:

• Signsandsymptoms

• Allergies

• Medication

• Previousmedicalhistory(lookforaMedicAlertbraceletornecklace)

• Lastoralintake

• Event.

Ifthecasualtyisunconsciousorhasanalteredlevelofconsciousness,theremaybecompanions

or bystanders who have witnessed the incident and who can be asked for information about what

happened. You can make the casualty feel less anxious by remaining calm, speaking clearly and

simply, reassuring the casualty and referring to them by name.

Body check

The body check is a systematic check of the casualty which may be done in the following order:

1 neck, up over the head and down across the face

2 shoulders and front of the chest, abdomen and pelvis including ribs

3 front and back of upper limbs

4 frontandbackoflowerlimbs

5 back


Ongoing management

After completing treatment of injuries and illnesses identified during the primary and secondary

assessments, the first aider will need to decide if referral to hospital or other medical aid is required,

and call 000 for an ambulance if necessary.

Once the decision has been made to refer the casualty to medical aid, ongoing monitoring and

management of the casualty’s condition is important. Using oxygen to provide

Therapytoacasualtywithotherillnessesandinjuriesisalsouseful.Itcanbegivensafelytoany

casualty that the first aider is concerned about.

Ongoing monitoring and management while waiting for medical assistance should include:

• reassessingthecasualty’svitalsignsatregularintervals

• continuingtoidentifyactualorpotentialproblemsandplanappropriatecare

• notifyingtheambulanceserviceofanychangetothecasualty’sstatusasappropriate

• handingoverthecasualtytoambulancepersonnel.

Who should be sent to hospital?

Anyone to whom any of the following applies should be sent to hospital:

• haslostconsciousness,evenforabriefperiod

• hasrequiredeitherinitialrescuebreathingorCPR

• mayhaveasecondarycondition,suchasaheartattackoraneckinjury

• hasapersistentcoughoranabnormalskincolour

• mayhaveinhaledanyamountoffluidorgas.

Ifnoneofthepreviousconditionsapplies,butifthefirstaiderhasanydoubtaboutthecasualty’sstate

of health, the casualty should be advised to seek medical advice as soon as possible.

Hand over

Ifanambulancehasbeencalled,thefirstaidershouldremainwiththecasualtyuntiltheycanhand

over to the ambulance paramedics. You should be aware of the standard ambulance response times

to your club/area of operation.

Assessment Task 1: Written questionsCompletequestions1–10inyourassessmentportfolionow.


Why use oxygen?Oxygen administration is useful for any casualty who does not appear to be adequately perfused or

is not maintaining sufficient oxygen levels. Qualified personnel may safely administer oxygen to any

casualty who is not adequately perfused. Casualties likely to benefit from oxygen include those with

the following conditions, signs or symptoms:

• unconsciousness

• shock

• bloodloss

• chestpain

• shortnessofbreath,includingasthma

•severepain

• injuries

•afterresuscitation

•absentbreathing

•abnormalbreathing

•circulatorydistress

Respiratory systemThe respiratory system supplies the body with a constant supply of oxygen.

Figure 2.1 The respiratory system

Topic2–AdvancedResuscitationandOxygen Administration


Upper respiratory tract

The upper respiratory tract includes the nostrils, nasal cavity, mouth, pharynx (throat) and larynx (voice

box).Thethroatisacommonpassagewayforbothfoodandair.Itstarts

from the cavity at the back of the mouth and nose and extends down to where it divides into two

separate tubes, the trachea and the oesophagus. The trachea allows the passage of air to and from

thelungs.Itsitsinfrontoftheoesophagusandisclosesttotheskin.Theoesophaguscarriesfood

and liquid to the stomach from the mouth and in reverse during vomiting or regurgitation.

The upper respiratory tract is the most common location for an airway obstruction.

Lower respiratory tract

The lower respiratory tract consists of the trachea and the bronchi which divide into two, going into

the left and the right lung. The bronchi then progressively divide into smaller bronchioles and eventually

end up as alveoli and alveolar sacs.

The lungs fill most of the chest cavity, which is separated from the abdomen by a large sheet of

muscle known as the diaphragm. The lungs are spongy, elastic organs that move during inhalation

and exhalation.

The breathing process

Breathing is the act of moving air in and out of the lungs.

Breathinginisknownasinhalation.Itisaninvoluntarymuscleactioncausedwhenthediaphragmis

pulled down (contracts) and flattened. This sucks air into the body via the mouth or nose.

Breathing out is known as exhalation. When muscles relax they recoil back to their original location

and force the air out of the mouth or nose.

Theaverageadulttakesabout12–15breathsperminute.Theaverageamountofairinhaledand

exhaledisabout500ml(anormalbreath).Ininfantsthenormalbreathingratecanbebetween25–50

breaths per minute.

Respiratory noises

Inahealthypersonthereshouldbenoaudiblesoundastheybreatheinandout.Whereacasualty

has some respiratory distress, this may be accompanied by noises. Noises can include cough,

inspiratory/expiratorywheeze,stridororwetgurglingnoises.Acasualtyinsevererespiratorydistress

may make no sound at all.

Cough a sudden expulsion of air from the lungs (with a characteristic noise), may be associated

with mild airway obstructions, or inflammation of the upper and/or lower airways

Wheeze a whistling sound when breathing in or out, most commonly encountered by first

aiders treating casualties with asthma and may also be associated with other chronic

obstructive airways diseases

Stridor alouderorharshersoundthanawheeze,maybeassociatedwithapartialairway

obstruction

Gurgling a broken irregular sound similar to moving water may be associated with fluid or mucus

in the lower airways

No sound no vocal sound, even with a casualty showing an effort to breathe. A casualty with a

complete airway obstruction may make no sound, the effort to breathe may also take in

the use of accessory muscles.

First aid conditions which require additional oxygen

The body requires a constant supply of oxygen and when it does not receive enough, hypoxia results.

Itisessentialtobeabletorecognisebreathingdifficultiesandtoprovideimmediatefirstaidincluding

supplementary oxygen to treat the casualty.


Respiratory distress or hypoxia can be caused by:

• airwayobstruction,suchas:

– foreignmaterialorvomit

– tissueswelling(allergicreaction)

– incorrectheadpositionduringunconsciousness(acasualtyslumpedforwardintheseatoftheir

vehicle after a car crash)

• trauma(headinjury)

• drugs(egheroin,whichslowsdownbreathingtothepointwhereacasualtymaystopbreathing

altogether)

• neardrowning

• asthma

• impairmentofnervesand/ormusclesofbreathing

– spinalcorddamage

– chestinjuries

– somepoisonsandvenom.

Hypoventilation

Hypoventilation is breathing that is not adequate to meet the needs of the body (too shallow or too slow),

or reduced lung function. The carbon dioxide level rises, leading to inadequate oxygen in the blood.

Respiratory arrest can follow if a casualty’s condition deteriorates, and is a life- threatening emergency.

Ifthebody’sothersystemsarenotreceivingoxygentheywillfailtofunction.Forexample,ifbreathing

stops, the heart will stop beating soon after.

Asthma

Asthma is an inflammatory disorder of the lower respiratory system in which the lungs and air

passages become sensitive and sometimes narrow, making it hard for the person to breathe.

Managing an asthma attack

Ifthecasualtyhastheirownasthmaplan,youshouldfollowit,butifthereisnoplanoritisasevere

asthma attack, follow the plan below:

Step 1

• sitthecasualtyinanuprightposition

• don’tleavethecasualtyalone

• remaincalmandreassurethecasualty

• administeroxygentherapy

• havesomeonebringyouthecasualty’smedicationortheasthmaemergencykit/bluerelieverpuffer

and spacer.

Step 2

• shakethebluerelieverpufferandremovethecap

• insertthepufferintothespacer,ensuringthatthecasualtyplacestheirmouthoverthemouthpiece

and gets a good seal

• pressdownonceonthepufferthenhavethecasualtybreatheinandoutfourtimes

• repeatsothatthepersonreceivesfourseparatepuffs,takingfourbreathsaftereachpuff

• continueoxygenadministrationbetweenadministrationsofmedication.

Step 3

• waitfourminutes

• ifasthmaisrelieved,discontinuemedication.

Step 4

• ifthereislittleornoimprovementrepeatsteps2and3(fourpuffs,takefourbreathsaftereachpuff;

wait four minutes)

• ifthereisnoimprovement,thecasualty’sconditionworsens,oryouareconcerned:

– callanambulanceimmediately(000)

– continuetorepeatsteps2and3whilewaitingfortheambulance

• CPRmayberequiredifthecasualtybecomesunconscious.


Chronic Obstructive Airways Diseases (COAD)

Chronic Obstructive Airways Diseases (COAD) include emphysema, chronic bronchitis and other

airways diseases. COAD is an ongoing illness, the casualty will be aware of their condition and,

subject to having enough breath to speak, will be able to tell you of their condition.

Inhealthypeople,highcarbondioxidelevelsareastimulustobreathe.COADcasualties,who

chronically have high carbon dioxide levels, loose this reflex and instead their breathing control centre

relies on low levels of oxygen in their body to stimulate them to breathe.

Due to their body relying on low levels of oxygen to stimulate breathing, casualties with COAD are

normallytreatedwithlowlevelsofoxygen(eg:twolitresperminute).Ifthehigherconcentrationsof

oxygen commonly available in first responder oxygen equipment (eight litres per minute or more) are

used to treat a COAD casualty it may cause them to under breathe.

Management of COAD

• DRSABCD

• reassurethecasualty

• provideoxygentherapy,withthecasualtysittinginanuprightpositiontoensuremaximumspace

for lung action

• continuallymonitorresponse,airwayandbreathingandcommenceCPRifthecasualtyis

unresponsive and not breathing normally.

• seekmedicalaid–call000foranambulanceifrequired.

• donotleavethecasualtyunattended,especiallyifreceivingoxygen.Documentobservationsin

order to identify trends.

NOTE:Anycasualtypresentingwithbreathingdifficultiesshouldbetreatedwithoxygen.

Supplemental oxygen administration must take precedence over the concern that a casualty may

under breathe due to being administered high oxygen concentration levels.

Hyperventilation

Hyperventilation is the result of over-breathing that can be stress-related, deliberate or from medical

conditions. The rate and depth of breathing are more than is necessary to maintain a normal level of

carbon dioxide in the blood. As hyperventilation does not cause a lack of oxygen, the casualty should

not be administered oxygen therapy in this situation.

Management of hyperventilation

• DRSABCD

• reassurethecasualty

• removethecasualtyfromtheenvironmentcontributingtotheover-breathing

• encouragethecasualtytobreathenormallybyhavingthemcopyyouasyoubreatheinthrough

your nose and out through your mouth

• seekmedicalaid–call000foranambulanceifrequired.


Oxygen resuscitation equipment

Approval of equipment

All oxygen resuscitation kits must meet Australian Standards. To check that your equipment meets

Australian Standards, look for the Australian Standards logo on your equipment or packaging.

Figure 2.2 Examples of oxygen resuscitation kits

NOTE:

For use within surf lifesaving, new types of oxygen equipment must be trialled in accordance with

policy1.6(newandModifiedEquipment),beforetheyarecertifiedforapprovalassurfrescue

equipment.

TheSLAOxygenEquipmentPolicyislocatedontheSLSAwebsiteatwww.sls.com.au


The components of oxygen resuscitation equipment

Itisimportantforthosetrainedintheuseofoxygenresuscitationunitstoensurethattheyarefamiliar

with the components and operation of the unit(s) in use at their location. The basic components are

labeled below:

Figure 2.3 Components included in an oxygen resuscitation kit

Equipment descriptions

Protective case

Thishousesalltherelevantequipment.Itmaybeasoftbagorhardplasticormetalcase.Insome

models, it incorporates the oxygen cylinder itself.

Medical oxygen cylinder

Medical oxygen cylinders are all white. Previously cylinders were black with a white shoulder, and this

was phased out between September 2009 and June 2011.

The cylinder has two locating pin holes next to the main outlet. These holes mate with pins on the

mounting yoke of the oxygen equipment. A fresh, full cylinder will usually have a protective wrapping

of blue or white plastic around the oxygen outlet to prevent dust and dirt from entering during

transportation. Before attaching the cylinder to the oxygen equipment, all wrapping must be removed

and the cylinder ‘cracked’ by quickly opening and closing the outlet valve.

Cylinder cradle

This provides support for the oxygen cylinder.

Cylinder yoke

Thisistheconnectionfortheoxygencylinder.Insomeinstances,itispartofthecase;otherwise,it

may be attached as part of the regulator.

Sealing washer

This fits in the yoke to prevent leakage from the cylinder joint. Spare seals are kept in the oxygen

equipment case.

Locating pins

These are positioned in the yoke, so that the operator can locate the oxygen cylinder correctly.

Thumb screw

This helps to secure and maintain the cylinder in position.


Cylinder key wheel

This is used to open or close the cylinder valve.

External cylinder connection

Thisallowslargeroxygencylinderstobeattached.Itisimportanttorememberthatwhenanexternal

cylinder is in use, a small cylinder or the yoke plug should be firmly in place to prevent oxygen leaking.

This connection is not found on all units.

Contents gauge

This indicates the amount of oxygen in the cylinder.

Regulator

This regulates the oxygen pressure and flow of oxygen.

OP airways

Oropharyngeal airways help maintain a clear airway.

Airbag

Thissilicone-basedapparatusisusedforinflatingacasualty’slungsbysqueezing,whichsupplies

oxygen from an oxygen reservoir bag.

Oxygen reservoir bag

Isattachedtotheairbagandstoresoxygentoensurethatmaximumoxygenisdeliveredtothe

casualty.

Tubing

Depending on the unit, there will be either one or two tubes, usually clear and/or green in colour.

Control valves

These are turned on when using the airbag resuscitator or oxygen therapy, giving a fixed flow rate of

oxygen. On some models, the control valve and flow rate are built into the regulator.

Resuscitation masks

Eachunitshouldcontainatleastoneadultandonechild-sizedmask.

Therapy masks

Eachunitcontainsatleastoneadultandonechild-sizedmask.Thesemasksmaybethetherapytype

or the non-rebreather type of mask. Therapy masks are single use only.

Chalk

This is used to mark the volume of oxygen in the cylinder.

Gloves

Used for personal protection.

Pens, pencils and paper

Used for taking records during oxygen usage.

Patient filter (optional)

A patient filter is inserted between the resuscitation mask and the patient valve on the airbag. This filter

stops any vomit, blood or saliva from entering and clogging the patient valve during resuscitation. The

patient filter is single use only.

Other equipment

The equipment below may also be a part of your oxygen resuscitation kit.

Automatic oxygen-powered resuscitator

These devices deliver oxygen under high pressure to inflate the lungs of casualties who are not

breathing. (These devices are not approved for use by surf lifesaving members).

Suction

This feature helps the operator to remove fluids from the casualty’s mouth.


Activity (group) 2.1: Oxygen equipmentInpairsorsmallgroups,taketurnsatnamingallthepiecesofequipmentinyourkit.Assome

equipment may vary slightly, you may need to check with your trainer. Once you and your partner are

confident that you can remember all the items, remove an item or two without your partner watching,

and then have them review the kit and identify the missing item(s).

protective case

medical oxygen cylinder

cylinder yoke

sealing washer

thumb screw

cylinder key wheel

contents gauge

regulator

OP airways (Oropharyngeal airways)

airbag

oxygen reservoir bag

tubing

control valve(s)

resuscitation masks (adult and child)

masks–therapyornon-rebreather(adultandchild)

chalk

gloves

pen/pencil and paper

Routine check of equipment

Oxygen cylinder

•beforeacylinderisfittedtotheoxygenequipment,checktheheatwarningtag(rejectanycylinders

with melted or deformed tags), and remove the protective plastic wrapping

•‘crack’thecylinderbyturningitonandoffverybriefly,keepingitasuprightaspossibleandtaking

care that the outlet is not pointed at any person or potential danger (eg sand). Cracking the cylinder

removes any foreign matter from its valve opening

•checkthatthesealingwasherispresentandisnotdamagedordirty.Replacemissingordamaged

sealing washers, otherwise the equipment is inoperable and cannot be used

•thecylindermustbeinsertedintotheyoke

ensuring that the inlet and outlet holes are

aligned. This is achieved by ensuring that the

locating pins on the yoke are aligned to the

locating pin holes on the cylinder valve. Then

tighten the thumb screw

•checkthecontentsofthecylinderbyusing

the cylinder key wheel to slowly open the

cylinder valve until the gauge reaches a

steady point. This slow build-up of pressure

saves damage to the regulator and gauge,

which can occur from a sudden rush of

pressure. Open the cylinder valves fully, and

then turn the key wheel back half a turn to

prevent locking. The gauge should register

‘full’. This may be indicated by the word ‘full’

or a green mark on the cylinder. Where a

cylinder is less than half full, reject it and fit a

new cylinder.Figure 2.3 Components of a medical oxygen cylinder

cylinder Valve

oxygen outlet

locating pin holes

heat tag

white shoulder

label

black body

(changing to an

all white cylinder

between September

2009 and June

2011)


Control valve Oxygen nipple Gauge Yoke Thumb screw

Figure 2.4 Components of an oxygen regulator

SAFETYPRECAUTIONSWHENUSINGOXYGEN:

Oxygen must be used with care and respect at all times:

• neveruseoxygennearanopenflame

• neveruseoxygennearcigarettes

• neverusegreaseoroilwithoxygenequipment

• neveruseoxygenwhendeliveringashockviaadefibrillator(refertopage44)

Oxygen equipment

To ensure that oxygen equipment is ready for use:

• checktheoxygentubingforcracksorotherdamage.Ensurethattheopenendwillfiteasilytoboth

therapy masks, as well as the oxygen nipple of the airbag

• checktheflowofoxygenfromthecylinderthroughthetubing

• checkthatthereisnoodorfromtheoxygenbeingexpelledfromthetubing

• checktheairbag

• closethecylindervalve,andthendrainoxygenfromthesystembyoperatingthedeliverysystem

(where the unit has two ensure both are operated) and check that the needle on the contents

gaugefallstozero

• markthecylinderwiththecontents,timeanddateofinspection.

Ancillary equipment

To ensure that ancillary equipment is ready for use:

• checkboththerapymasksforcleanlinessandserviceability

• checktheconditionoftheresuscitationmaskcuffsforfit,perishingorcracks

• ensurethataminimumoftwolarger(adult)sizeoropharyngealairwaysarepresentandsealedin

their original packaging

• checkinthecasefor:

– chalk,formarkingtheamountofoxygeninthecylinder

– pens,pencilsandpaperforkeepingrecords

– gloves,forpersonalprotectionduringemergencycare

– sparesealingwashers,toreplacedefectiveormissingseals,asrequired.

Casing and additional equipment

General care of the case and optional equipment includes:

• keepingthewholeunitcleanandfreefromsand,seawater,oilandgrease

• checkingadditionalequipment(egsuction,automaticoxygen-poweredresuscitators).


Activity (group) 2.2: Routine equipment checksInpairsorsmallgroups,taketurnscheckingthattheoxygenequipmentandancillaryitemsare

available and serviceable. Have your partner test you by following the processes outlined previously.

Storing oxygen equipment

Oxygen equipment should be stored:

• inacoolbutaccessibleplace,asheatcausesrubberandplasticcomponentstodeteriorate(spare

oxygen cylinders should be stored in a cool and accessible place, near the oxygen equipment)

• awayfrombusytrafficareasandsandanddustcontamination

• awayfromoilorgrease–thesesubstancescancausefirewhenincontactwithhigh-pressure

oxygen

• inaventilatedspace–anyleakageinanenclosedspacecouldcauseanincreasedconcentration

of oxygen which could be dangerous in the event of a fire

• uncovered–anyleakageofacoveredunitcouldcauseanincreasedconcentrationofoxygeninthe

unit

• withoutanypressureinthesystem–turnoffthecylinderthendrainoxygenfromthesystemby

operating the delivery system

• inalocationdesignatedasano-smokingareaandnotnearnakedflames;leakingoxygencanfuel

a fire.

Emptyoxygencylindersshouldbereturnedforrefillingwithoutdelay.Cylindersthatarehalffullorless

can be used for training.

Material Safety Data Sheets (MSDS)

YourcluborserviceshouldhaveaMaterialSafetyDataSheetforeachhazardoussubstancestored

on the premises. These may be stored in a central folder or each sheet may be stored with the

hazardoussubstance.Materialsafetydatasheetscontaininformationonhowthesubstanceshould

be stored and what to do if poisoning occurs.

Administering oxygen therapy

To administer oxygen therapy:

• checkoxygenequipmentbeforeeachuse

• placetheequipmentsothattheoperatorcanreachiteasilyandseethe

contents gauge

• connectthetherapymasktothetubingandturnontheoxygen;you

should be able to feel and hear the oxygen coming through the mask

• reassurethecasualtyandtellthemwhatyouareabouttodo,thenput

the mask on the casualty’s face and ensure that it is secure by adjusting

the elastic and pinching the metal noseband

• placeunconsciouscasualtiesinthelateralposition.

Figure 2.6 Correctly fitted therapy mask

NOTE:

Ifaconsciouscasualtydoesnotwanttousethemask,theycanholdthemaskinfrontoftheir

face, or remove the tubing from it and direct the oxygen flow around the mouth and nose


Mouth-to-mask resuscitation with oxygen

Research has shown that adding oxygen during mouth to mask resuscitation can increase the oxygen

receivedbythecasualtyfrom16%to50%(16%istheoxygencontentofexpiredair).Ifthetherapy

setting of eight litres per minute is used, the concentration of oxygen in the casualty’s lungs will be

almost45%,butiftheresuscitationsettingof14–15litresperminuteisusedandthesealisgood,the

concentrationforthecasualtywillbegreater(ie>50%).Itisrecommendedthatthehighersettingbe

usedifthereisenoughoxygenavailableforthetimeresuscitationisexpectedtolast.Ifnot,theflowof

eight litres per minute is satisfactory.

A number of different facemasks are approved for use in mouth-to-mask resuscitation. Some of these

have oxygen ports that allow the oxygen therapy tubing to be connected.

Mouth-to-maskresuscitationwithoxygencanbeaone-personoperation;however,itispreferable

that two operators are used. One person needs to do mouth-to-mask resuscitation while a second

person handles the oxygen unit. The oxygen is turned to the appropriate setting and the tubing fitted

either to the oxygen port, through the opening of the mask, or between the cheek and the mask if an

adequate seal is maintained. Masks with ports are highly recommended for this procedure.

Airbag oxygen resuscitator

Figure 2.7 Components of an airbag resuscitation device

The airbag resuscitator with oxygen reservoir is a manually operated, soft-recoil silicone bag with a

secondary bag attached. This secondary bag acts as a reservoir for oxygen when connected to an

external oxygen supply.

Theresuscitatorwithoxygenreservoirwillprovidethecasualtywithupto95%oxygenwhen

connectedtoanoxygensupply,withaflowrateof14–15litresperminute.

Casualties who are not breathing should be treated initially using CPR, but they will always benefit

from the administration of oxygen by trained personnel.

When the oxygen unit arrives and is being set up, the first operator should continue with the mouth-

to-mask resuscitation method (or change to it, if a mask was not previously available) while preparing

to change over to the bag. This may take some time, however, and resuscitation must continue during

thechangeoverperiod.Itispossibletogivemouth-to-maskresuscitationwithoxygenbrieflyusing

the therapy tubing before the bag is ready, with units that have two separate tubes (eg Oxyviva brand

units).

Patient valve Airbag

Oxygen nipple

Patient

filter

Resuscitation

mask Oxygen reservoir Air inlet valve


Airbag checks

To ensure the airbag is ready for use:

•checktheairbagforleaksanddirectionofairflowby:

– blockingthepatientvalvewiththethumborhandandcompressingthebagunderreasonable

pressure

– checkingthatairdoesnotleakoutoftherearvalve,thebagorthecasualtyvalve

– releasingthethumborhand,whenthebagshouldcompressandrefillrapidly

• checkthefunctionoftheyellowdiscmembraneonthepatientvalveby:

– placingtheoxygenreservoirbagoverthecasualtyvalveandinflatingitfullybysqueezingthe

ventilation bag

– squeezingthereservoirbaggently.Theyellowdiscmembranewilllift(duringresuscitation,the

casualty exhales through this disc membrane)

•checktheoverflowvalveoftheoxygenreservoirby:

– inflatingthereservoirbagasdescribedaboveandconnectingittothereservoirvalve

– compressingthereservoirbagrapidlyandwatchingthediscinthevalvelift(thismembrane

ensures that the reservoir bag cannot be overfilled with oxygen)

• checktheair-intakemembranewhichislocatedintherearvalveoftheairbagby:

– checkingitsfunctionbyinflatingthereservoirbagasdescribedaboveandconnectingittothe

airbag

– repeatedlycompressingtheairbag.Thereservoirbagwillemptyandtheairbagwilldrawinair

through the air-intake membrane.

Activity (group) 2.3: Airbag checksInpairsorsmallgroups,taketurnscheckingthatthevalvesoftheairbagareoperationalandall

components are serviceable. Have your partner test you by following the processes previously

outlined.

Assessment Task 2: Peer assessment – oxygen equipment checksAsk a peer to assess you as you check the oxygen equipment for operational readiness

(detailspage65).

Using oxygen and airbag during resuscitation

Setting up the airbag

• theoperatorneedstoinformotherfirstaidersaboutwhotheyareandtheirqualificationstooperate

the equipment

• theoperatorsetsuptheequipmentclearofthecasualtyandfirstaiders,butinapositionwherethe

gauge is clearly visible

• immediatelyonopeningthecase,asuitablysizedresuscitationmaskispassedtotherescue

breathingoperatortochangetothemouth-to-maskresuscitationmethod.Ifmouth-to-mask

resuscitation is in progress, however, the airbag oxygen resuscitator can be fitted directly to the

mask (after an operational check)

• theoperatorshouldquicklycheck:

– thecorrectoperationofthepatientvalve

– thevalvetotheoxygenreservoirbag

– theconnectiontotheoxygensupply

• theoxygenisthenturnedonto14–15litresperminutetoallowinflationoftheairbagreservoir

• whenthereservoirbagisinflated,compresstheairbagtoexpelanyairfromtheunit.

Thisshouldthenleavetheairbagwith100%oxygen


Operating the airbag

To apply the airbag during resuscitation:

• telltheotheroperatorthattheairbagisreadyforuse,whentheoxygenreservoirisinflatedagain

• positionthecasualtyvalveintheresuscitationmaskandcompresstheairbagsothatthereisno

change at all in the timing of resuscitation, which is important if CPR is being performed

• compresstheairbagwithtwohands(foranadult)usingagentlesqueezingmotion,takingatleast

1.5–2secondsforthechesttorise.Theamountofoxygentobeforcedintothecasualty’schestis

the amount required to make the chest rise

• releasetheairbagandallowittorefillreadyforthenextventilation

NOTE:

The rise and fall of the casualty’s chest should be watched at all times during this procedure

• therescuebreathingoperatorcontrolsthebackwardheadtiltandensuresapropersealbetween

the mask and the casualty’s face

• ensurethatthecasualty’schestriseswitheachinflationandfallsasairexitsthelungs:

– boththeairbagrescuebreathingoperatorsareresponsibleforthis

– ifatanytime,eitheroperatorisnothappywiththefunctioningoftheoxygenequipment,the

equipment must be removed immediately and rescue breathing must continue by the mouth-to-

mask, mouth-to-mouth or mouth-to-nose method.

IftheairbagoxygenresuscitatorisbeingusedduringCPR,atleasttwofirstaidersmustbepresent,

although it is highly recommended that there are three. One controls the casualty’s airway and ensures

thesealoftheresuscitationmask;thesecondactivatestheoxygenequipment;andthethirdperforms

chestcompressions.Ifonlytwooperatorsarepresent,oneshouldcontroltheairway,ensurethemask

seal and activate the oxygen equipment while the second operator performs chest compressions.

Ifoxygenequipmentisbeingusedonachild,thepaediatricairbag(ifavailable)shouldbeusedand

compressed with one hand. When the child’s chest is seen to rise, stop compression of the bag.

Airbag resuscitators not specifically manufactured for the exclusive use on infants should not be used

on infants.

Iftheoxygenbottleisdepletedduringresuscitation,continuetousetheairbagresuscitatorequipment

and remove the reservoir bag.


Activity (group) 2.4: CPR with oxygenInteamsofthree,practiseperformingCPRusingtheairbagresuscitator

Operational time

Afull‘C’cylinder(440–490litres)willhavethefollowingapproximateoperationaltimes:

• 50minutes,withcontinuoususeofoxygentherapyat8litresperminute

• 30minutes,withcontinuoususeofairbag(andoxygen)at14–15litresperminute

Equipment maintenance

General care

• themachineshouldbekeptcleanandfreeofsandandforeignmaterials

• toensureitscorrectoperation,equipmentmustbecheckedbeforestartingoperationalduties(eg

patrol) each day and after any use (including training sessions)

• whenevertheoxygenequipmentshowsdefectsthatmaycauseittooperateincorrectly,the

machine must be taken out of service immediately and repaired by the manufacturer

• theoxygenequipmentshouldbeservicedatleastevery12months,oraccordingtothe

manufacturer’s recommendations.

Care after use

After every use, the resuscitator should be disassembled, cleaned, disinfected, reassembled and

tested in an orderly sequence by:

• sendingoxygentherapymaskstohospitalwiththecasualtyordisposingofthemafteruse

• washingtheresuscitationmasksthoroughlyinwarmsoapywatersothatallforeignmaterialis

removed, then rinsing them with fresh running water

• disassemblingandwashingthecasualtyvalveandtherearvalveinwarmsoapywater,thenrinsing

them in fresh running water and reassembling them

•washingtheairbaginwarmsoapywater,thenrinsingitinfreshrunningwater

• washingthereservoirvalve(ontheLaerdalbag)andoxygenreservoirinwarmsoapywater,then

rinsing them in fresh running water

• soakingallcontaminatedpartsinasolutionof70%alcoholicchlorhexidineorahypochlorite

solution (bleach) for at least two minutes, then rinsing and drying them

• testingallpartsoftheequipmentafterdryingandbeforestoragetoensurethattheequipmentis

ready for use the next time it is needed.

Major faults

A major fault is any fault that cannot be repaired through basic maintenance (eg cleaning and

replacement of spare or missing parts that are routinely stocked in the first aid room) and that

affects the safety or ability to use the equipment properly. All major faults should be logged in the

appropriate organisational logs (eg SLSA Patrol log for SLSA members) and reported to the Club/

Service First Aid Officer.



Oropharyngeal airways

Oropharyngeal (OP) airways are curved plastic devices that help keep the airway clear in the

unconscious casualty by depressing the tongue and keeping the teeth and lips apart. The OP airway

by itself does not replace correct airway management practices and should be considered only as a

tool to assist in the management of a casualty’s airway. An OP airway is a plastic device consisting of

a rigid flange and a hollow curved tube. The flange, when properly fitted, rests against the casualty’s

lips. This flange does not prevent an adequate seal from a facemask being achieved.

OPairwayscomeinvarioussizesfordifferent-sizedcasualties.

The smallest OP airways are approximately 5 cm long and the

largest are more than 10cm. OP airways are inserted using the

‘rotation’ method which is explained in the following pages. This

method is not recommended for infants or children under the

age of eight because the roof of their mouth is still soft and easily

damaged. SLSA does not teach members the methods for OP

airway insertion into infants and children, therefore members

should not attempt to insert an OP airway into children under the

age of eight years.

Figure 2.8 An airway blocked by the tongue (top) and

using an OP airway to assist with a clear airway (bottom)

NOTE:PersonalProtection

For first aiders’ own safety, it is strongly recommended that they wear protective gloves and use a

resuscitation mask for every resuscitation case.

Care of OP airways

OP airways must be kept in their original packaging. They should be easily accessible in the first aid

kit, oxygen unit and first aid rooms. OP airways packaging should be checked to ensure that it has not

been opened and is still intact.

After use on a casualty, the contaminated OP airway should be disposed of in a safe manner,

preferablyinaclinical-wastebagprovidedbyattendingambulanceormedicalpersonnel.Ifthisisnot

possible, the contaminated OP airway should be placed in a clinical-waste bag and stored in a safe

place until proper disposal can be organised.

Choosing the appropriate-sized OP airway

NOTE:

OP airways must be inserted only into deeply unconscious casualties.

TochooseanOPairwayofthecorrectsize,placetheairwayagainstthe

side of the casualty’s face. The flange (top flattened end) of the airway will

extend just past the centre of the casualty’s lips. The curve of the airway is

thenrunsidewaysalongthecasualty’sjaw.Thecorrectsizedairwayisthe

one that reaches the angle of the casualty’s jaw.

When to insert an OP airway

The use of an OP airway is optional. First aiders should take less than 15

secondstocorrectlysizeandinsertanOPairwayintoacasualty’smouth.

Whether an OP airway is used or not, the management principles of

DRSABCDdonotchange.Ideally,theOPairwayshouldbeinsertedinto

an unconscious casualty’s mouth after the casualty has been rolled onto

their side and their airway cleared.

Figure 2.9 Measuring an airway from the centre of the lips to the corner of the jaw


TheairwaycanalsobeinsertedduringCPRwhilethecasualtyisontheirback.Inthiscase,stopCPR

and quickly insert the airway before continuing resuscitation.

IMPORTANT:

OP airways should not be used:

• ifthecasualtyisconsciousorsemi-conscious–insertionofanOPairwayintoaconscious

casualty may induce vomiting or gagging

• ifanairwayofthecorrectsizeisnotavailable

• ifthereisalargeamountofvomit

• ifthecasualtyisundereightyearsofage

Inserting an OP airway

Onceyouhaveselectedthecorrectsizeairway:

• tiltthecasualty’sheadbackwards;openthecasualty’s

mouth with one hand using jaw support or jaw thrust, if

necessary

• visuallycheckthecasualty’sairway,andmanuallyclearit,if

necessary

• measureandchooseanOPairwayofthecorrectsize

• removetheOPairwayfromthepacketandlubricateit,using

moisture from the lips of the casualty, or water

• holdtheOPairwaybytheflange.Withthetippointing

towards the roof of the casualty’s mouth, insert the airway to

approximately one-third of its length

• whenone-thirdoftheairwayisinsidethemouth,rotateit

180° until the tip points downwards, at the same time sliding

it over the casualty’s tongue in one smooth movement into

the back of the pharynx until the flange is touching the lips

• itshouldslipeasilyintoplace.Ifitisdifficult,stopand

reposition the casualty’s lower jaw and tongue before trying

again. Never force it into position. Care is needed to avoid

damage to the mouth and throat.Figure 2.10 Inserting an OP Airway

NOTE:

The OP airw cardiac co the airway should not be inserted during the delivery of external cardiac

commpressions, as this may impede the successful and cause unnecessary injury to the casualty


Activity (group) 2.5: Inserting OP airwaysInpairs,practisechoosingthecorrectsizeOPairwayforyourpartner.Ifanairwaymanikinisavailable,

practiseinsertingtheOPairway;otherwisedescribetheprocesstoyourpartnerinyourownwords.

NOTE:PrecautionwheninsertinganOPairway

• ensurethatthelowerlipisnotpinchedbetweenthecasualty’steethandtheOPairway

• ensurethattheOPairwaydoesnotpushthetonguebackwardsandblockthecasualty’sairway

• ensurethatyouhaveadequateheadtiltbeforeinsertingtheOPairway

• don’tforcetheOPairwayintothemouth–itshouldslideineasily.

Removing the OP airway

IfthecasualtyshowsanysignsofrejectingtheOPairway,removeitimmediately.Inmanycases,the

casualty may spit it out. The OP airway can be removed easily by sliding it out of the mouth following

its natural curve.

NOTE:

Donotattempttorotatetheairwayonremoval.Itisunnecessaryandmaycausedamagetothe

mouth and throat

Assessment Task 3: Peer assessment – oropharyngeal airwayAskapeertoassessyouasyousizeandinsertanOPairway(detailspage66).



Suction

Clearing of a casualty’s airway can be achieved by using

manual finger sweeps. However, if you have a unit available

with suctioning capability, you may clear additional fluids from

the upper airway by using the suction component of the unit.

Suctioning is a skill that will require practice to become

proficient. Regular checking and cleaning of the suction device

will ensure that you remain familiar with the device(s) used by

your club/service.

Figure 3.1: Using suction to clear a casualty’s airway

Suction comes in three types:

•manual

•oxygenpowered(vacuumbottle)

• battery(orelectric)powered.

Suction device components

While there are many variations to suction devices based on

the type and the manufacturer, there are four components

common to most suction devices. These are:

Suction catheter: A plastic tube which is inserted into the

casualty’s mouth to suction out any foreign material. Suction

catheters are single use only and should be disposed of in

clinical-waste containers.

Collection jar: Fluids and foreign material suctioned from the casualty are collected in the jar.

Collection jars are usually single-use with the jar being disposed of along with the contents in clinical-

waste containers.

Jar cap and connection port: The jar cap and connection port keeps the contents in the collection

jar and includes the fittings to connect the suction catheter and the device which provides the suction

power.

Suction device: The device which provides the suction power and is the suction pump handle in

manual devices, oxygen equipment in oxygen powered devices or the electric pump in a battery or

electric powered device.

NOTE:

SLSA has currently approved the use of manual suction devices only during surf lifesaving

operations

Hypoxia cause by suction

Hypoxia (lack of oxygen) is always a risk when suction is used. For this reason manual suction should

be on for only 15 seconds at a time with a break for at least five seconds in between operations.

This reduces the amount of oxygen taken from the casualty. Due to their constant suctioning action,

powered suctioning devices should only be used for five seconds before a five second break.

Topic3–Suction

Figure 3.2: Components of a manual suction device


Suction checks

• ensurethatthedeviceiscleanandthatallcomponentsare

available including:

– suctioncatheter

– collectionjar

– collectionjarcap

– suctiontubing(ifrequired)

– suctiondevice

• operatethemanualsuctiondevice(orturnsuctiononfor

powered devices)

•testforsuctionagainstthumborfingerbyplacingitoverthe

vacuum port (port should stick to the thumb or finger)

• turnoff(powereddevicesonly)

• returnthesuctiondevicetothecaseinitsoriginalposition.

Figure 3.3: Vacuum port


Activity (individual) 3.1: Suction equipmentLook at the suction equipment that your club/service has available for use or the equipment you have

beenprovidedtotrainwith.Identifythefollowingcomponents:

•suctioncatheter

•collectionjar

•jarcapandconnectionport

•suctiondevice

•vacuumport

Ifyoucannotidentifyallofthecomponentscheckwithyourtrainer.Yourdevicemaynothavethese

exact components but will have something that performs the same function

Test the function of your suction device by performing the checks described above.

Administering suction

To remove mucus, fluid or blood from a casualty’s airway using suction, follow the steps outlined

below:1 check the suction device for correct operation

(asdescribedonpage40)

2 select the catheter and remove it from the

sealed packaging, leaving a contact point

within the wrapper

3 put on gloves

4 connectthesuctioncathetertotheconnection

port (or tubing for powered suction devices)

5 completely remove catheter from wrapper (turn

on the suction source for powered devices)

6 measurethemaximumlengthofinsertionby

placing the tip of the catheter at the corner of

the jaw and measuring to the centre of the lips.

Mark this point with a finger. (This will ensure

that you insert the catheter no further than the

back teeth)

Figure 3.4 Measuring insertion length

7 insertthecatheterintothelowercheekofthe

casualty (in the lateral position), ensuring that

the catheter is inserted no further than the

point marked by the operator’s finger

Figure 3.5 Inserting catheter no further than length marked by fingers

8 do not operate manual suction during

insertion (or occlude the catheter to operate

powered suction devices)

9 operate suction for no longer than 15

seconds with manual suction devices before

afivesecondbreak.(Ifusingpowered

devices suction only for five seconds before a

five second break).

10 rotate the catheter within the casualty’s lower

cheek, ensuring that the action is smooth and

gentle, to prevent damage

11 ensure that only two-thirds of the container is

filled

12 turn off suction on the completion of the

procedure (if using powered suction)

13 dispose of the catheter in the appropriate

manner.


Activity (group) 3.2: Administering suctionInpairsorgroupsofthree,practiseassemblingyoursuctionequipmentandsizingtheinsertion

distanceonyourpartner.Ifanappropriatemanikinisavailablepractiseperformingsuction.

NOTE:

To ensure infection-free training, do not place the suction catheter in your own mouth or that of

your partner(s).

Post-use maintenance of the suction unit

• disposeofdisposablejarsinasuitablemanner

• reusablejarscanbeflushedwithcleancoldwaterandrinsedwithantisepticsolution

• ensurethatallunitcomponentsaredisassembledandthoroughlycleanedasperARCguidelines.

Trouble shooting suctioning

Thereareanumberofreasonswhysuctionequipmentcanfailornotoperatecorrectly.Ifexperiencing

problems, check the following:

•isthesuctiontubingblocked

•isthecontentsbottlefullorcracked

•isthesealmissingorperished

•istheunitnotturnedon

•istheoxygensupplyexhausted(foroxygenpoweredunits)

•isthebatteryflat(ifbatterypoweredunit).

Assessment Task 4: Peer assessment – suctionAskapeertoassessyouusingthesuctiondevicetoprovideclearanairway(detailspage67).



Topic4–Defibrillation

What is defibrillation?Defibrillation is the delivery of an electrical current to the heart to correct an ineffective irregular heart

beat. The electricity is delivered indirectly to the heart via the chest wall.

Today in Australia public access defibrillators are becoming more widely available and training in their

use is easily accessed.

The Australian Resuscitation Council supports the implementation of public access defibrillation

programs and recommends that defibrillation should preferably be undertaken by trained lay people or

health professionals.

Figure 4.1 Comparison of survival rates from sudden cardiac arrest showing the difference made by defibrillation

Circulatory systemDespiteitsvitalimportance,theheartdoesnotworkalone.Itispartofthecardiovascular(circulatory)

system which also includes the kilometres of blood vessels that run through the body. Tissue cells

takeinnutrientsandoxygenandexpelwaste24hoursperday.

This can happen only with the continuous beating of the heart, a muscular organ that pumps blood

through a system of arteries and veins.

Arteries are large blood vessels which carry oxygen-rich blood from the heart to the rest of the body.

The arteries subdivide into smaller blood vessels and ultimately become capillaries. The capillaries

transport blood to all the cells of the body. After the oxygen is given to the cells, veins carry the blood

low in oxygen back to the heart.


Conditions which require first aid and defibrillation

The delivery of oxygen to the body can be threatened by the following cardiovascular conditions:

• bloodlosscausedbyseverebleeding(internalorexternal)

• impairedcirculation

• failureofthehearttopumpadequately,egheartattack,ordysrhythmia(irregularheartbeat).

Ifbodytissuesdonotreceiveoxygen,theyaredamagedbeyondrepair,egstroke.Strokeiswhenone

of the arteries supplying the brain is blocked or ruptures, resulting in an area of the brain receiving no

blood and the tissues becoming damaged. A similar effect occurs when one of the arteries supplying

theheartwithbloodbecomesblocked;thehearttissuesaredamagedbythelackofoxygenanda

heart attack is a possible outcome.

Iftheheartstopsbeating(cardiacarrest),itisinevitablethatbreathingwillalsocease.Theremaybe

some agonal respirations but these are not enough to sustain life.

The heart

Therelativesizeandweightoftheheartcontradictsitsincrediblestrengthandendurance.Aboutthe

sizeofyourfist,thehollowconeshapelooksnothingliketheheartthatistraditionallyshown.The

heartweighsabout250–350gramsandisabout12–14cmlong.Approximatelytwo-thirdsofthe

heart is located just to the left of the sternum (breastbone).

Thehearthastwoactions,mechanicalandelectrical.Electricalstimuluscausesmechanicalreaction

which results in a coordinated pumping action leading to effective circulation.

Mechanical action

The mechanical action of the heart pumps blood through its structures in the following way:

• fromthebody(upperandlower)

– totherightatrium

– totherightventricle

– tothelungs

• thenfromthelungs

– totheleftatrium

– totheleftventricle

• andouttothebody(upperandlower).

Electrical action

Inanormalheart,electricalimpulsestravelawell-defined

pathway:

• sinoatrial(SA)node

• atrioventricular(AV)node

• rightandleftbundlebranches

• conductionpathways(Purkinjefibres)

This electrical conduction pathway synchronises the atria

and ventricles to contract and relax in a coordinated motion

necessary to pump blood efficiently.

From lower body To lower bodyFigure 4.2 Mechanical action of the heart

Figure 4.3 Electrical action of the heart


Electrocardiogram (ECG)

The electrical impulses passing through the heart can be mapped on a graph called an

electrocardiogram(ECG).Whenaperson’sheartbecomesstressed,changescanbeseeninthe

ECG.

Anautomatedexternaldefibrillator(AED)measurestheelectricalactivityinacasualty’sheart,through

electrodes placed on their chest, and recognises life-threatening abnormal rhythms (arrhythmias) such

as ventricular fibrillation and pulseless ventricular tachycardia.

Sinus rhythm

Thenormalrhythmofahealthyheartiscalledsinusrhythm.AnAEDwillnotrecommendashockifit

detects this rhythm in a casualty.

Figure 4.4 ECG of a sinus rhythm

Ventricular fibrillation

Ventricular fibrillation (VF) is a life-threatening heart arrhythmia which is characterised by chaotic

electrical and mechanical heart activity and which produces a quivering action rather than co-

ordinatedcontractions.Itismostcommonlyassociatedwithcoronaryarterydiseaseandheartattack

(myocardialinfarction).Electricalshock,poisoninganddrowningcanalsocauseventricularfibrillation.

Figure 4.5 ECG of ventricular fibrillation

Ventricular tachycardia (VT)

Ventricular tachycardia occurs when the ventricles beat faster than the rhythm generated by the SA

node. The rate will vary, however it is always faster than 100 bpm and generally slower than 200 bpm.

Figure 4.6 ECG of ventricular tachycardia

Ventricular tachycardia can be life-threatening as it may degenerate into Pulseless Ventricular

Tachycardia, inhibiting effective distribution of oxygenated blood throughout the body, leading to

hypoxia and organ damage, which may lead to death.


Signs and symptoms of VT include:

• fainting

• difficultybreathingorshortnessofbreath

• veryrapidpulseornopulse

• palpitations–thecasualtymayfeelliketheirheartisracing

• light-headednessordizziness

• chestpain

• pale/greyskincolour

• sweating

• nausea.

Management of VT

• minorcasesmayspontaneouslyreverttonormalsinusrhythmwithouttreatment

• pulselessVTwillrequiretreatmentwithanAED.

Asystole

Asystole refers to the absence of electrical activity in the heart.

Note:AnAEDwillnotrecommendashockasitcanonlycorrecttheheart’selectricalactivity,not

create it from nothing.

Figure 4.7 ECG showing asystole

Automated external defibrillators (AED)

AnAEDisusedtoreversetheeffectofacardiacarrest.

Cardiac arrest occurs when a casualty:

• isnotresponding

• isnotbreathing

AnAEDisonlytobeattachedtocasualtieswhoare

unresponsiveandnotbreathingnormally.However,anAED

should be on standby in all first aid situations where there is

a possibility the patient may go into cardiac arrest.

The defibrillation process uses electricity to contract

(depolarise) the entire heart muscle at one time. Following

this, resting (repolarisation) of the whole heart muscle occurs.

Effectivelytheprocessstopstheheart.Oncerepolarisationhasoccurred,itishopedthattheheart’s

normal electrical activity will resume. Defibrillation is the definitive treatment for Ventricular Fibrillation.

Public access defibrillation

Defibrillation technology and training has reached a level in society where it is making an extremely

positiveimpactinthechainofsurvival.AEDsareeasyformembersofthepublictouseandarewidely

available through public access defibrillation programs in public places such as airports, train stations,

stadiums and shopping malls.

WhileAEDsmaybeusedbymembersofthepublic,thebestoutcomesforthecasualtywillbe

achieved when they are used by trained personnel. Accordingly, when working in a team situation,

ateammemberwithspecifictrainingintheuseofanAED(suchasthisAdvancedResuscitation

Techniques Certificate) should operate it.

Figure 4.8 Example of an AED


Use of defibrillators on children

AnAEDcanbeusedonchildrenagedoneandabove.Forchildrenagedonetoeight;iftheAEDhas

asettingthatreducesthejoulesdeliveredthisshouldbeused.Ifthisisnotavailabletheadultsetting

should be used.

AED operator responsibilities

ItistheresponsibilityoftheAEDoperatortoapplyandoperatetheAEDandensurethesafetyof

bystandersandotherfirstaiders.Todothis,theAEDoperatormusttakecontroloftheresuscitation

team,directingteammembersandbystandersasrequiredtoensurethesafeoperationoftheAED.

Approval of equipment

All defibrillation units must meet Australian Standards. For use within surf lifesaving they must also be

trialledbySLSAinaccordancewithPolicy1.6(NewandModifiedEquipment),beforetheyarecertified

for approval as surf rescue equipment.

Defibrillator components

A portable defibrillator of the type commonly used by first aiders consists of a case containing

thebaseunitwithsingle-use,self-adhesiveelectrodepads.InadditiontotheAED,thefollowing

accessories should be kept with the unit (either in the same case if possible or in a case attached to

the unit):

•resuscitationmasks(adult)

•gloves

•shears

•gauzewipes(orsimilar)

•sparebattery(ifapplicabletoAED)

Pre-operational checks

• spareelectrodepads

• spaceblanket

• penandpaper

• chamoisortowel.

AllmodernAEDswillhaveaself-checkmechanismtoensurethattheyareoperational.Thischeck

usually includes ensuring that there is a sufficient level of charge in the battery and that all electronic

components are functioning correctly. You should make yourself familiar with the unit used by your

club/service, including what is included in the automatic self-check and how you check that the unit

has passed the self-check.

At the start of a duty shift, you should check the following:

• AEDhaspassedtheselfcheck

• electrodepadsareindate(thiswillbemarkedontheoutsideofthepackaging)andthatthe

packaging has not been damaged

• alladditionalequipmentaslistedaboveorrequiredbyyourstateorserviceisincludedandinan

operational condition.

Major faults

A major fault is any fault that cannot be repaired through basic maintenance (eg cleaning and

replacement of spare or missing parts that are routinely stocked in the first aid room) and affects the

safety or ability to use the equipment properly. All major faults should be recorded in the relevant

document and reported to the club/service First Aid Officer.


Defibrillation pads

Pad positioning

Correct positioning of the electrode pads is essential

for successful defibrillation to take place. The optimal

position is usually indicated on the electrode pads or on

the packaging they come in:

• placethesternumelectrodepadtotherightofthe

sternum (breastbone) below the collarbone and above

the right nipple

• placetheapexelectrodepadtotheleftofthesternum,

with the upper edge of the pad below and to the left of

the left nipple.

• Ifthecasualtyhasanimplantedpacemakeror

defibrillator, make sure the pads are at least 8cm away

from it.

Prepare the casualty

• exposethecasualty’schest(includingremovingundergarments)

• itmaybenecessarytotrimhairifthecasualtyisveryhairy,withscissor/shearsinthelocations

where pads will be placed in order to have good adhesion to the skin

• drythecasualty’sskinifnecessary,duetoimmersionorsweat

• removeanymetaljewelleryandmedicationpatches

• ensurethatthecasualtyisnotlyingonmetalgrates,inpoolsofwateroronotherconductive

material.

NOTE:

LifeSavingVictorianolongersupportstheuseofarazorwhenremovingchesthairasthe

pressure of the situation leads to an increased risk to both the operator and patient of being cut by

therazorwhichaddsfurtherbiohazardousrisktothefirstaiderandpatient.

Safety precautions

A safe working environment must be created before defibrillation occurs. There are three areas of

danger directly related to the defibrillation process:

• contact

no person or conductive material is to be in direct or indirect contact with the casualty at the time of

defibrillation

• conduction

there should be no conductive items near the casualty, such as:

–water/rain(ensurethatyouareclearoftheincomingtideifinabeachenvironment)

–metal/grates

–moistureonthechest(egvomit,bloodorperspiration)

•explosion

–donotdefibrillateifthereisachanceofexplosionduetothepresenceofgases,fumesor

flammable substances.

–Oxygenmasksshouldbemovedawayduringdefibrillationandtheflowofoxygendirectedaway

from the chest.

Sternum Electrode

Apex Electrode

Figure 4.9 Defibrillator pad placement


AED operation

DangerRemember safety precautions

for using an SEDResponse

Send for HelpAirway

BreathingCompressions

Team – perform CPR while waiting for AED

Individual – retrieve AED rather than performing

CPR– or send a bystander for AED if

possible and perform CPR

Take control of resuscitation(if in a team situation)

Introduce yourself and explain what you will do and what you need the team members to do.

Check AED– Check that AED is not

obviously damaged– Check that self test indicator

is showing ready for use

Turn on AEDPress the ON button or open

the lid as appropriate to device

Prepare casualty’s chestas explained on page 49

Apply pads– Positioning as explained on

page 49– Apply the pads in a roll-on

fashion to expel air and ensure good adhesion

Direct first aiders and bystanders not to touch the casualty

AED will prompt “Do not touch the patient, analysing rhythm”

Ensure that no one is touching the casualty

AED will analyse heart rhythm

No shock advisedAED will advise no shock

AED will advise to commence CPR

Ensure that no one is touching the casualty

Press the button to deliver shock

AED will analyse rhythmContinue CPR as

required

Place casualty in recovery position

Leave pads attachedMonitor responsiveness,

airway and breathing

Perform CPR AED may give CPR

directions – these can be ignored; CPR can be performed in line with

operator training

Check for response and normal breathing

AED will analyse rhythm every two minutesContinue CPR

ORcontinue to monitor airway, breathing and responsiveness

Handover to paramedics

Shock advisedAED will advise shock

AED will chargeAED will advise

“Press flashing button”


NOTE:

• Donotremoveelectrodesevenafteracasualty’sbreathingresumes.Keeptheminplaceto

allow prompt action should the casualty’s condition deteriorate

• Donotplaceelectrodesovermedicationpatches

• Ifthecasualtyhasanimplantedpacemaker,makesurethatthepadsareatleast10cmaway

from it.

Set protocols for shock delivery

TherearethreemainstepsforoperatinganAED:

•turnthemachineon

•applythepads

•respondtotheprompts.

DifferentAEDmachineshavedifferentprotocolsforshockdelivery.Somehavesetjoulesettings,

others have variable joule settings, and some even measure impedance and calculate the joules

needed.

When to introduce the AED

Inateamsituation–afterthecasualtyhasbeendeclaredas‘unresponsive’and‘notbreathing

normally’,commenceCPRimmediately.AsecondoperatorshouldintroducetheAEDatthesame

time CPR is commenced and prior to Oxygen.

Asanindividual–afterthecasualtyhasbeendeclaredas‘unresponsive’and‘notbreathingnormally’

theAEDisintroducedpriortoCPRandOxygen.CPRshouldbecommencedassoonaspossible.


Activity (group) 4.1: Applying an AEDIngroupsofthree,practiseperformingtwo-operatorCPRwiththethirdpersonarrivingandapplying

theAED.RotatetherolesuntileachpersoninthegrouphasperformedtheroleofAEDoperator.

Make sure that you:

• takecontrolofthesituation

• assessresponse,airwayandbreathing

• preparethecasualty’schest

– removeclothing

– cliphair

– removemetaljewellery

– removemedicationpatches

• applypadstothecasualty

– incorrectpositions

– usingarollingmotion

• followthepromptsoftheAED

• ensurethatallfirstaidersandbystandersareclearofthecasualty

• delivertheshockasindicatedbytheAED

• directtheteamtocontinueCPRasrequired.

EachparticipantshouldalsoapplythedefibrillatorandperformCPRasasingleoperator.

Post-defibrillation casualty care

Ifthedefibrillationhasnotbeensuccessfulandwhenthestandardprotocolisexhausted:

• leavethepadsonthecasualty

•continueCPRuntilrelievedorunabletocontinue

•careforfamilyandfriendsofthecasualty.

Ifthedefibrillationhasbeensuccessful:

• leavethepadsonthecasualty

•checkforbreathing

• iftheyarenotbreathing,continueCPR

•iftheyarebreathing,checkforaresponse

•iftheyarenotresponding,placetheminthelateralposition

• iftheyareresponding,reassureandmakethemcomfortable.

Post-defibrillation equipment maintenance

After every use, the defibrillator should be disassembled, cleaned of sand and debris, reassembled

and tested as per the manufacturer’s instructions. Single-use items such as electrode pads and gloves

should be disposed of and replaced from stores in the first aid room. All other equipment should be

cleaned and disinfected and replaced in the kit.



Activity (group) 4.2: Using oxygen equipment, oropharyngeal airways, suction and an AED during resuscitationThroughout the course you will individually have practised using oxygen equipment, oropharyngeal

airways,suctionandanAEDindividually.Resuscitatingacasualtyusingalloftheequipmentavailable

will provide the greatest chance of success.

Unfortunately each piece of equipment complicates the process which may have a negative impact

ofthechanceofasuccessfulresuscitation.Itisimportantthatyouarewell-practicedinusingthe

equipment together to ensure each piece of equipment is used to best effect at the most appropriate

time.

Your trainer will set you some scenarios to practise using the equipment individually and as a part of a

team.Ensurethatyoudebriefaftereachscenariotounderstandwhatwasdonewellandwhatcould

be improved.


AssessmentInformationThere are eight assessment tasks required to complete the Advanced Resuscitation Techniques

Certificate course. Below is a description of the assessment tasks required to demonstrate

competenceinthiscourse;thissectionisforinformationonly.Allevidenceshouldbecollectedinthe

assessment portfolio section of this Learner Guide.

Assessment Tasks

Assessment task 1: Written questionsAll candidates are required to answers the questions outlined in the assessment portfolio section of

this Learner Guide in their own words.

ItisnotacceptabletocopythewordsdirectlyfromtheLearnerGuideoranothersource.

These questions will be reviewed by your trainer. Once your trainer is satisfied that you have correctly

answered all the questions they will sign the appropriate section of the assessment summary of the

assessment portfolio on page 58 in this Learner Guide.

Assessment Tasks 2, 3 and 4: Peer assessmentOxygenequipmentchecks(Assessmentportfoliopage65)OPairway(Assessmentportfoliopage66)

Suction(Assessmentportfoliopage67)

To complete each of these assessment tasks you will need to find a peer assessor who can watch you

complete the task and sign off that you correctly completed all components.

A peer assessor can be someone who is undertaking the course along with you or somebody who

already holds the qualification.

Your peer assessor will tick actions taken by you, providing relevant comment in the peer assessor’s

notes on delivery.

On successful completion of each peer assessment, present the completed checklist to your trainer

or assessor who will sign the appropriate section of the assessment summary of the assessment

portfolio on page 58 in this Learner Guide.


Assessment task 5: Scenario – airway management and oxygen useYour assessor will observe you as you work in a team of three performing CPR using airway

management and oxygen equipment. You will commence the scenario on a live casualty and change

to a manikin when directed.

Your assessor will use the observation list below when judging your competence.

Your assessor will mark the competency outcome and sign the appropriate section of the assessment

summary of the assessment portfolio on page 58 in this Learner Guide.

YourassessormayincludeanothercandidatewhoiscompletingAssessmentTask7inthissame

scenario.

Live Casualty Assessment1. Team checks for danger• hazardsandriskstoself,bystandersand

casualty identified• positionofcasualtyand/orequipment

assessed• PPEputonAssessor to advise that the casualty is unconscious, unresponsive and not breathing• CPRcommencedbyrescuebreathing

operator and chest compression operator

2. Team members assess casualty’s condition• Unconscious,unresponsiveandnotbreathing

normally• physicalappearance• medicalhistory• detailsofincidentandothersignsand

symptoms• callforambulance

3. Oxygen resuscitation operator• selectsappropriateequipment—OPairway

and/or suction (optional)• communicatesactionswithteam.

4.SuctionOxygen resuscitation operator to clear airway using suction, if appropriate to scenario.(Insertiontobedemonstratedonamanikin.)• suctionapparatususedinasafemanner

making sure that the apparatus doesn’t go any further than the back teeth.

• oxygenresuscitationoperatorattachescatheter to suction tubing correctly

• distancemeasuredandcatheterlubricatedcorrectly

• casualty’smouthopenedandheadtiltmaintained

• suctionadministeredcorrectlyensuringprevention of hypoxia and appropriate areas cleaned.

5. OP airway• oxygenresuscitatoroperatortosizeOPairway• OPairwayinsertedinlateralposition,if

appropriate to scenario (use manikin if available otherwise have candidate describe insertion)

CPR and oxygen use on manikin6.Resuscitationmaskandoxygen-

supplemented resuscitation• oxygenresuscitationoperatoradvisesrescue

breathing operator to assume jaw thrust• resuscitationmaskintroducedifnotalreadyin

use• oxygenresuscitatoroperatorprovidesoxygen

therapy tubing for supplemented rescue breathing

7.Oxygenresuscitatoroperator:• demonstratesfullyopenmedicaloxygen

bottle, release pressure by half turn back• checkairbag.(Blockpatientvalvewiththumb

and compress airbag, release and ensure rapid refill)

• checkpatientvalvefunction.(Inflatereservoirbag via patient valve, deflate reservoir bag and check patient valve airflow bypasses return into recoil bag)

• checkoperationofintakevalvefromoxygenreservoir.(Inflatedreservoirbagsqueezedtocheck air flow into recoil bag)

• attachresuscitationtubetooxygenintakenipple.Checkairflowissetat14or15litresper minute

• inflatereservoirbagandpurge• adviserescuebreathingoperatorreadyto

insert patient valve and airbag to casualty• airbagisdepressedcorrectlyforcasualty(two

hands for adult, one hand for child)• reassessthecasualty’sheadtilt,observethe

rise and fall of the casualty’s chest, monitor the OP airway

• maintaincommunicationwithothermembersof the team to facilitate the effective delivery of oxygen.

• assessortoadvisethatcasualty’sbreathinghas resumed

• teamtoreassessbreathingandresponseandmonitor the casualty in appropriate position (lateral unconscious)

• oxygenresuscitatoroperatorprovidesoxygentherapy set at correct flow rate (8 litres per minute)

• oxygenresuscitatorstoresairbagforpossiblere-use

• oxygenresuscitatoroperatorcommunicatesfuture actions with team

• incidentdetailsrecorded• Casualtyreassuredandmadecomfortable

• handovertoambulance.


Assessment Task 6: Scenario review – verbal questionsConduct an incident debrief with your resuscitation team. Once you have done this, your assessor will

ask you questions about your club and the scenario you participated in during Assessment Task 5

1 Where are replacement supplies available at your club?

2 IfinAssessmentTask5theoxygenbottlehadmalfunctionedorrunoutofoxygen,whatwouldyou

have done?

3 Atyourclub,hazardousmaterialisdisposedinwhatmanner?

4 Whatwerethreeareasofimprovementidentifiedduringyourdebrief?

5 What would you do if you or a member of your team was experiencing stress after an incident?

Assessment task 7: Scenario – defibrillationYou will operate the defibrillator while working with a team performing CPR (this may be a team

completing Assessment Task 5). You will commence the scenario on a live casualty and change to a

manikin when directed.

Your assessor will use the observation list below when judging your competence.

Your assessor will mark the competency outcome and sign the appropriate section of the assessment

summary of the assessment portfolio on page 58 in this Learner Guide.

Live Casualty Assessment• identifyhazardsandriskstoself,casualtyand

bystanders—isolateelectricity,checksliphazard,etc

• assesspositionofcasualtyand/orequipment• PPEputon

Assessor to advise that the casualty is unconscious, unresponsive and not breathing

• callforambulance

Manikin introducedApplyAED–Defibrillatoroperatorto:• communicateactionswithteam•surroundingareaforhazards—conductors,

placement of oxygen unit, etc• TurnonAEDandfollowprompts• preparecasualty’schestreadytoapply

electrodepads—dry,clipexcessivehair,check for pacemaker, medical patches

• applyelectrodepads• Deliverashockinanappropriateandsafe

manner when prompted.•maintaincommunicationwithothermembers

of the team to facilitate the effective delivery of oxygen and compressions

CPR and oxygen use on manikin• CPRoperatorstocommenceCPR• oxygenresuscitatoroperatortooperateairbag

resuscitator

Casualty is now breathing• teamtoreassessresponseandbreathingand

monitor casualty in appropriate position (lateral position if unconscious)

• teamtotreatcasualtyforshock• electrodepadstoremainoncasualtyuntil

ambulance arrives• defibrillationoperatortocommunicatefuture

actions with team• incidentdetailstoberecorded• reassurecasualtyandmakecomfortable• handovertoambulance• defibrillatorunittobecheckedandmadeready

for use

Assessment task 8: Incident documentationComplete the incident report form, in the assessment portfolio section of this Learner Guide, to record

yourcasualty’sdetailsandactionstakenduringeitherAssessmentTask5or7.

Your assessor will review your log to ensure that you have satisfactorily filled it out with all the relevant

information you received during the scenario and then mark the competency outcome and sign the

appropriate section of the assessment summary on page 2 of the assessment portfolio.


Assessment PortfolioThis portfolio includes all the evidence you are required to submit to your assessor to demonstrate competence in the Advanced Resuscitation Techniques Certificate and the related competencies listed in the competency record below.

Learner details

First name: Surname:

Date of birth: Club / Group:

Telephone:

Email:

Competency record

SLSA Course Co

mp

eten

t

No

t ye

t

com

pet

ent

Advanced Resuscitation Techniques Certificate

Nationally recognised units of competency

PUAEME003CAdministeroxygeninanemergencysituation

PUAOPE010COperateanautomatedexternaldefibrillatorinanemergency

HLTFA404AApplyadvancedresuscitationtechniques

Assessor Name

Assessor Signature Date


Assessment Summary

Assessment Tasks Dat

e C

om

ple

ted

Sat

isfa

cto

ry/

No

t

Sat

isfa

cto

ry (S

/NS

)

Assessor Signature

Task 1: Written questions

Task2:Peerassessment–oxygenequipmentchecks

Task3:Peerassessment–oropharyngealairway

Task4:Peerassessment–suction

Task5:Scenario–airwaymanagementandoxygenuse

Task6:Scenarioreview–verbalquestions

Task7:Scenario–defibrillation

Task8:Incidentdocumentation

Comments


Assessment task 1: Written questionsAll candidates are required to answer the questions in their own words.

ItisnotacceptabletocopythewordsdirectlyfromtheLearnerGuideoranothersource.These

questions will be reviewed and signed off by your trainer/facilitator.

Topic 1 – First Aid and Resuscitation Review1 OxygenresuscitationequipmententerstheChainofSurvivalattheEarlyCPRlink.Trueorfalse?

Circle the correct answer.

TRUE/FALSE

2 You have volunteered to give first aid to competitors at a sporting event. A spectator collapses and

requires resuscitation. Because you are rostered on as a first aider, you have a duty of care to help

thespectator.Isthistrueorfalse?Circlethecorrectanswer.

TRUE/FALSE

3 The catch phrase of the Australian Resuscitation Council is ‘any attempt at resuscitation is better

than no attempt.’ Consider the italicised sentence and explain how bystander CPR contributes to

the Chain of Survival sequence.

4 Explainwhyadvancedresuscitationtechniques(oxygenuseanddefibrillatorshock)canimprovea

casualty’s chance of survival in a cardiac arrest.

5 Once you have gained the award you are training for, what steps can you take to protect yourself

from an action of negligence?

6 Australiaisamulticulturalsocietyandasafirstaideryoumayneedtotreatacasualtywithdifferent

customs and beliefs from you. What should you do to respect their customs and beliefs? Circle the

correct answer.

a do nothing as they may not want you to because of their beliefs

b seek permission before providing any treatment from the casualty or family member if present

c do not worry about their beliefs, providing first aid is more important

d treat them only if a male family member is present to give permission

7 Onceyougaintheawardyouarestudying,whatdoyouneedtodotokeeptheawardcurrent?

8 Following an incident, a fellow club member asks you for specific information about the incident.

Are you able to freely discuss the treatment you provided and give out personal information? Circle

the correct answer.

a yes—solongasthecasualtyisnotidentified

b yes—providedIhaveconsentfromthecasualty

c no—theinformationmustremainconfidential

d no—notevenifthiscasualtyhasgivenconsent


9 What is the standard response time of an ambulance to your club/area of operation?

10 How do you use the first aid and emergency care equipment at your club?

a in accordance with manufacturer’s instructions

b in the lateral position

c in accordance with SLSA standards, policies, procedures and protocols

d both a and c

Topic 2 – Advanced Resuscitation and Oxygen Administration11 On the diagram below:

a label the upper and lower sections of the respiratory system

b label the lungs and draw and label where the diaphragm is located

12 What does inhalation mean and how is it achieved?

13Explainwhathypoventilationis.

14Explainthetreatmentforthefollowingrespiratoryconditions

Asthma

Chronic Obstructive Airways Disease (COAD) (Also note how you will know the casualty has this

illness.)


15 Following resuscitation, you place a casualty in the lateral position. While waiting for the

ambulance you notice that their breathing becomes noisier. What may this indicate to you?

16 Hypoxiaresultsfromless-than-normaloxygencontentintheorgansandtissuesofthebodyand

causesimpairmentoftheirfunction.Belowisonecauseofhypoxia;nametwoothercauses.

1 Reduced gas (oxygen exchange because of water in lungs)

2

3

17 Duringanoxygen-aidedresuscitationattemptyounotethatthecasualty’schestisnotrisingor

falling. What would you do?

18 Complete the following table:

Oxygen delivery rate Oxygen % delivered

Delivery time full ‘C’ sized

cylinder

Oxygen therapy

Resuscitation using airbag

19 What information is marked on the oxygen cylinder during a pre-patrol check?

20 How frequently should oxygen equipment be serviced?

21 How do you know that your oxygen equipment meets Australian Standards?

22 What are two safety considerations for the handling and storage of oxygen equipment?

23 List four casualty conditions that benefit from oxygen therapy treatment.

1

2

3

4


24 Whendeliveringoxygen-aidedresuscitationthecasualty’schestisnotobservedrising.Jawthrust

is checked and the casualty’s airway cleared of foreign material. After re-positioning the mask the

chest fails to rise. What would you instruct your team to do next?

25 What is an MSDS, where is it found and what information found in it will be useful to you as a first

aider?

M S D S

26 Inwhatpositionshouldoxygentherapybeadministeredtoanunconscious,breathingcasualty?

a lying flat, with their legs raised

b in the lateral position

c on their back

d the most comfortable position

27 Listthreesafetyprecautionstofollowwhenusingoxygen.

1

2

3

28 When conducting the pre-operational check you find a faulty reservoir bag in the oxygen

resuscitation equipment carried on the ATV. Write down what you would do and how you would

record your actions.

29 After using your oxygen resuscitator to treat a casualty, what would you do to restore the

equipment ready for use?

Oropharyngeal airways

30 During the pre-operational check of oxygen equipment, what should an OP airway be checked

for?

31 When should you insert an oropharyngeal (OP) airway?

32 How will the OP airway assist in the management of a casualty’s airway?

33 When inserting the OP airway what precautions should you observe?


Topic 3 – Suction34 Howfarcanyouinsertthesuctioncatheterintotheunconsciouscasualty’smouth?

35 What can the operator do to limit hypoxia developing when using suction equipment?

36 Cansuctioncathetersbere-usedonadifferentcasualty?Circlethecorrectanswer.

a yes—inanemergency

b no—mustbediscarded

c yes—aftersterilisation

Topic 4 – Defibrillation37 Fillintheblanksintheparagraphbelow.

stimulus causes a reaction which results in coordinated

leading to effective.

38 Describe the steps you would take to perform a pre-operational check on a defibrillator unit.

39 How frequently should a defibrillation unit be serviced?

40 Duringthepre-operationalcheckyoufindthespareelectrodepadsareoutofdate.Whatwillyou

do to make the defibrillation unit operational?

41 Listthestepsrequiredtoachieveeffectiveadherenceofelectrodepadstothecasualty.

42 Inwhatcircumstanceswouldyounotuseadefibrillatoronacasualty?

43 Thedefibrillatorwillrecogniseandadvisetheoperatorifacasualtyhasashockablearrhythmia.

Circle the term that describes a normal heart rhythm.

a asystole

b ventricular tachycardia

c ventricular fibrillation

d sinus rhythm


44 Defibrillatorpadsshouldberemovedwhenacasualtyregainsconsciousness.Trueorfalse?Circle

the correct answer.

TRUE/FALSE

45 Insomeplacesitmaynotbesafetooperateadefibrillator.Listoneexample.


Assessmenttask2:Peerassessment–oxygen equipment checksInstructionstopeerassessor

•ticktheactionstakenbythecandidate,andproviderelevantcommentsinthepeerassessor’s

notes.

• thecandidateshouldverballyidentifyeachpieceofequipmentchecked.

Observation Tick

1 Cylinder check

• removedprotectiveplasticwrappingfromcylinder

• cylinder‘cracked’

• sealingwasherchecked

• cylinderinsertedintoyokecorrectly—locatingpins

• cylindercontentschecked

2 Contents check

• oxygentubingchecked

• oxygenflowchecked

• ensurednoodourfromoxygen

• operationofoxygennippleschecked

• therapyandresuscitationmaskschecked

• oropharyngealairwayschecked

• chalk/marker,gloves,padandpen,sparesealingwasherchecked

3 Airbag and reservoir bag checks

• airbagcheckedforleaksanddirectionofairflow

• functionofthepatientvalve(onewayflow)checked

• functionoftheoverflowmembraneofthereservoirvalve(Laerdalbagonly)checked

• air-intakemembraneoftheairbagchecked

• reservoirbagcheckedforleaks,perforations

4 Restore equipment

• oxygenisfullydrainedfromsystem

• unitcleaned,ensuringfreeofsandanddebris

Peer assessor’s notes

Theparticipanthassuccessfullycompletedthistask:YES/NO

Peer assessor signature: Date:


Assessmenttask3:Peerassessment–OP airway

Instructionstopeerassessor

• ticktheactionstakenbythecandidate,andproviderelevantcommentsinthepeerassessor’s

notes

• thecandidateshoulddescribewhattheyaredoingastheysizeandinserttheOPairway.

Observation Tick

1 Size OP airway

• OPairwayplacedagainstcasualty’sface

• flangeplacedincentreoflipswithairwayextendingtowardscornerofjaw

• OPairwaysizecheckedbyensuringitreachesangleofthecasualty’sjaw

• stepsrepeateduntilcorrectsizeselected

2 Insert OP airway

• casualty’sairwayopened(jawthrust)

• OPairwayheldbyflange

• lubricateOPairway

• OPairwayinsertedupsidedownonethirdoflengthintomouth

• insertioncontinuedwhilerotatingOPairway180degrees

• insertuntilflangerestsagainstcasualty’slips

• ensurethatlipsarenotpinchedbetweenteethandOPairway

3 Remove OP airway

• OPAirwaypulledstraightout(norotation)followingOPairwaycurve

•OPairwaydisposedofincontaminatedwaste





Assessmenttask4:Peerassessment–suctionInstructionstopeerassessor

• ticktheactionstakenbythecandidate,andproviderelevantcommentsinthepeerassessor’s

notes

• thecandidateshoulddescribewhattheyaredoingastheyusesuction,andidentifyeachpieceof

equipment checked and the reason for checking.

Observation Tick

Suction

• glovesapplied

• suctiontestedbyplacinghandovernozzleandoperatinghandpump

• correctfittingofdisposablesealedjarchecked

• suctioncatheterremovedfromsealedpackagingandattachedtosuctiondevice

• distancefromcentreoflipstoangleofjawmeasured

• fingersplacedoncathetertiptomarkdistance

• casualty’smouthopened

• catheterinsertednofurtherthanbackofteeth(markeddistanceasmeasuredabove)

• suctionoperatedfornolongerthan15secondswithoutabreak


IncidentReportLog





Resuscitation Report Form


Course evaluationCourse date: Location: Your name: (Optional)

Trainer(s) and assessor(s):

Yourevaluationofthisprogramisveryimportant.Itenablesustoimproveourtrainingprogramsandthe quality of our service.

StatementsStrongly disagree

Disagree N/A AgreeStrongly

Agree

Course content

The course was explained to me prior to commencing and met my expectations.

The course had the right balance between theory and practice.

The course was the right duration and intensity.

General comments on course content

Course material

The course materials were clear and easy to follow.

The activities were realistic and effective.

The course materials will be a useful ongoing reference.

General comments on course material

Training personnel

Knowledge was sufficient to effectively deliver the course.

Kept the course interesting and interactive.

Provided clear and complete answers to questions.

General comments for the facilitator

Overall outcomes

My knowledge and skills increased as a result of this course.

This course has helped me meet or clarify my goals.

Course assessment activities were fair and realistic.

General comments about the overall outcomes of the course

Thank you for taking the time to provide this feedback

Advanced Resuscitation Techniques Certificate–checklist

To ensure that your Advanced Resuscitation Techniques Certificate Learner Guide is complete prior to submission, with the assistance of your assessor, please tick the checklist to ensure all items have been completed and attached as required.

CandidatenameandAssessmentIDwrittenonfrontcover

Plagiarismdeclarationsignedanddatedbystudent–page1

Alltasksandactivitiesinworkbookarecompletedbycandidate–pages14–53

Assessment Portfolio is completed with:

AssessmentTask1:Writtenquestions–page59

AssessmentTasks2,3and4:Peerassessment–pages65–67

Assessmenttask5:Scenario–airwaymanagementandoxygenuse–page55

AssessmentTask6:Scenarioreview–verbalquestions–page55

Assessmenttask7:Scenario–defibrillation–page55

Assessmenttask8:Incidentdocumentation–pages68–69

CompetencyRecordcompleted–page57. C / NYC circled, and assessor’s name and signature inserted

AssessmentSummarycompletedandsignedbyassessor/s–page58

CourseEvaluationcompleted–page71