In case you missed it, the American Heart Association (AHA) published updates to select parts of 2015 guidelines for first aid, cardiopulmonary resuscitation (CPR), and emergency cardiovascular care (ECC) in late 2019.
In this 3-part series we aim to tell you, the safety professional in charge of a workplace first aid program or first responder team, exactly what you need to know about the changes that were made to 2019 AHA guidelines. First thing’s first: Which guidelines were updated? Which ones matter to health & safety professionals in industry? And, what’s OSHA got to say about it?
All Guidelines Updated
American Heart Association focused updates to CPR/ECC Guidelines:
Systems of Care and Continuous Quality Improvement: dispatcher-assisted CPR (DA-CPR) for adults and the potential role of cardiac arrest centers (CACs)
Adult Advanced Cardiovascular Life Support: use of advanced airways, vasopressors, and extracorporeal CPR (ECPR) during resuscitation
Pediatric Basic Life Support and Cardiopulmonary Resuscitation Quality: DA-CPR in infants and children
Pediatric Advanced Life Support: use of advanced airway interventions in pediatric cardiac arrest, ECPR for in-hospital cardiac arrest (IHCA), and post–cardiac arrest targeted temperature management (TTM)
Neonatal Resuscitation: initial oxygen concentration for term and late-preterm newborns (35 weeks of gestation or more) and initial oxygen concentration for preterm newborns (less than 35 weeks of gestation)
American Heart Association and American Red Cross focused update to First Aid Guidelines:
First Aid: 2015 American Heart Association and American Red Cross Guidelines Update for First Aid: presyncope
Updates for Safety Professionals
While a portion of AHA’s revised content in 2019 applies to medical professionals with advanced training some updates call on non-professional resuscitation providers (e.g., first responders in the workplace) and include:
Guidance on first aid for presyncope¹; physical counterpressure maneuvers (PCMs) recommended to increase blood pressure and prevent escalation to syncope²
Use of dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) by emergency dispatch centers; CPR guidance and instruction offered to 9-1-1 callers until emergency medical services (EMS) arrive
The recommendation for dispatcher guidance during CPR does not change AHA’s accepted steps and techniques for adult, child, and infant Basic Life Support (BLS), the foundation for saving lives. Regardless of exclusion from 2019 revisions, review of the BLS sequence is highly recommended and can be found in Part 3.
OSHA First Aid and CPR Requirements
Federal OSHA’s standards, directives (instruction to OSHA staff), and letters of interpretation (official letters of interpretation of the standards) related to medical and first aid requirements call upon industries including General Industry (29 CFR 1910) , Shipyard Employment (29 CFR 1915) , Marine Terminals (29 CFR 1917), Longshoring (29 CFR 1918), and Construction Industry (29 CFR 1926) for compliance, while 28 OSHA-approved state plans exist and are required to have programs that are at least equal to those outlined by the federal agency (OSHA.gov).
Essentially, organizations must train employees and provide first aid/CPR supplies when certain hazards are present and when an infirmary clinic, hospital, or physician is not reasonably accessible in terms of time and distance to the worksite. While the standards lack a prescription for the number of minutes to define “reasonably accessible,” OSHA has long interpreted the term “near proximity” to mean that emergency medical responders are available and able to render first aid or emergency care within 3 to 4 minutes of the activation of the emergency response system. [OSHA.gov]
OSHA endorses first aid and CPR training programs such as American Red Cross (ARC), which adheres to AHA guidelines, as well as U.S. Bureau of Mines and National Safety Council.
More Info on Updates
For details on first aid treatment for presyncope and how DA-CPR fits into the chain of survival, head over to Part 2. And check out Part 3 for a refresher on the basic life support sequence, which received its last significant update in 2015.
¹ The state preceding loss of consciousness; near-fainting
² Loss of consciousness