Part II: Emergency first aid

Resuscitation

1. Chain of survival

When a victim is suffering a cardiac arrest, it is vital to start the correct treatment as quickly as possible. The chances of survival are increased by a quick response in every link of the chain:

Call 112 immediately
Start resuscitation immediately
Prompt defibrillation
Prompt specialised resuscitation

2. Recognising a cardiac arrest

Determine whether resuscitation is necessary:

Ensure the situation is safe
Check whether the victim is conscious
- Carefully shake the victim by the shoulders
- Ask him clearly and audibly if he is alright

A. If the victim does not respond, he is unconscious

- Call 112 (if possible in speaker mode)
B. If the victim does respond

- Find out what the problem is and, if necessary, call for assistance
- Keep checking the victim

3. Cardio-pulmonary resuscitation (CPR)

Steps in CPR:

4. Points for attention when performing CPR

Causes of an incorrect assumption that the victim is not suffering from a cardiac arrest (3 most important):

Agonal respiration / gasping: in the first few minutes after a cardiac arrest, it is possible that the victim hardly breathes or irregularly or noisily gasps for air. Do not confuse this with normal breathing. On the contrary, it is an indication of a cardiac arrest!
Convulsions: in the early stages of a cardiac arrest, the victim can experience convulsions that are similar to those that occur during an epileptic seizure.
Diabetes: diabetes patients can lose consciousness if their blood sugar level is too high or too low. In the case of an excessively high sugar level, the patient will in the first instance feel thirsty. If his sugar level is too low, the patient will slowly become more lethargic and difficult to speak to and understand, and may even become aggressive. In the case of a cardiac arrest, the victim loses consciousness suddenly and often without warning.

Research has shown that starting CPR on a victim who has not suffered a cardiac arrest is almost never harmful! It is also safe to use an AED when the victim has not suffered a cardiac arrest.

If you or someone else calls 112:

First make clear that you need an ambulance and where you need it

Then you will be transferred to a receptionist at the ambulance incident room, he will ask for:

Your name and phone number
The exact address where the ambulance is needed

After this the receptionist will ask for extra information and will help you with CPR by giving you specific instructions while the phone is on speaker mode.

Points of attention when attaching the electrodes:

Chest is wet: dry it quickly
Chest hair: quickly shave if possible
Plasters: remove them to avoid sparks and burns
Pacemakers and implantable cardioverter defibrillators (ICDs): if you see one of these in the place where the electrode should be attached, place the electrode just below it
Jewellery: try to remove it if it is at the place where the electrodes have to be attached, if that is not possible attach the electrode next to it

If the AED is analysing his heart rhythm and administering a shock it is important that no one touch the victim. If you are sure that neither you nor any bystanders have touched the victim and the AED indicates movement, check the victim’s breathing. You may only stop CPR if the victim is breathing normally again.

AED accessories:

Flannel / towel: to dry the victim
Razor: to shave the chest hair
Resuscitation mask: to prevent yourself against infection
Gloves

If the chest does not rise after you have given the first of two breaths, proceed as follows:

Look quickly in the mouth to see if there is an object that you can easily remove. If so remove the object.
Try to tilt the head and lift the chin a little more

If the chest still does not rise after two breaths, continue performing chest compressions.

If you are not willing or able to give artificial respiration, always perform chest compressions.

If vomit flows into the victim’s mouth, turn the victim quickly onto his side to prevent the vomit from flowing into the airway.

In principle, you always start CPR when it is necessary. You should not start if:

Your own life is in danger
The victim has a Do Not Resuscitate (DNR) statement or medallion

You can stop CPR if:

You are unable to continue due o exhaustion
Someone else takes over. If there is someone else who can perform CPR, change every two minutes. That will decrease your exhaustion and improve the quality of the CPR
You find a DNR statement or medallion belonging to the victim
The victim moves, opens his eyes and you are sure he is breathing normally
An ambulance crew member arrives and tells you to stop
You are unable to contact the 112 centre within 20 minutes. If the victim has hypothermia continue for 60 minutes

CPR and children:

Depress the sternum only 1 to 3 centimetres
Furthermore you can perform CPR in the same way
Also the AED can be used the same way, it is advisable in the case of children of 8 years old and younger to use an AED adapted for children and/or special electrodes

5. Recovery position

If a victim is breathing normally or starts to breathe normally again, place him in the recovery position (Step 1 | Step 2 | Step 3 | Step 4 | Step 5 | Step 6). This will prevent the tongue (which has become limp) from blocking the airway. If a victim is unconscious after a serious accident, do not place him in the recovery position, unless his breathing is at risk of being obstructed.