First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada Introduction

Each day CRC responds to health inequities, social emergencies, and natural disasters. Often overlooked within health systems, first aid education is uniquely positioned to build resiliency— equipping communities/individuals with knowledge, skills and attitudes to address emergencies of acute illness/injury. We achieve this through creation and delivery of innovative learning interventions which build learner confidence, increase likelihood to act and ease pressure on our health systems while reducing health disparities.

This critical work is supported by the International First Aid, Resuscitation, and Education Guidelines—coauthored by clinical and education specialists via the Global First Aid Reference Centre. Comprised of representatives from the IFRC, ICRC, Center for Evidence-Based Practice, and more than 50 national societies, these guidelines provide industry-specific expertise designed to support meaningful learning for millions of people around the world.

INCREASING GLOBAL ACCESS TO EVIDENCE-BASED PRACTICES IN FIRST AID EDUCATION The International First Aid, Resuscitation, and Education Guidelines provide learner-centred, evidence-based guidance on best practice in first aid education. Our team of medical, academic, and educational experts have systematically reviewed a wide range of first aid and resuscitation-related topics and have considered clinical best practice, environmental considerations, and educational techniques to help ensure first aid courses meet the needs of learners.

The guidelines are intended primarily for those developing first aid programming but should also be used by instructors and program managers to ensure that their delivery aligns with the scientific foundations. CRC will continue to revise our programs to reflect the latest Guidelines, and we will be actively contributing to Strategy 2025.

The Canadian Red Cross recognizes the excellent work of our peers and domestic contributors! Thank you for sharing your time and talents to continue advancing first aid education!

ABOUT THIS DOCUMENT This document is a summary of the 2020 Canadian Guidelines on First Aid, Resuscitation, and Education. The full Guidelines consist of a detailed worksheet on each of the topics that is summarized here.

This summary document focuses on key content and examples from the full content contained in the individual topic worksheets, with special focus on the changes to medical science (clinical evidence base) and educational science (how we engage learners).

Individual worksheets for each topic will be available at https://www.firstaideducation.net. They will include: • Enhanced considerations for education (as learning modalities & considerations for specific clinical topics) • Considerations for unique contexts: conflict, disaster, mass casualty situations, water safety (aquatics) remote, and pandemic • Fluid links between themes and resources • Intentional links between the Chain of Survival Behaviours and specific clinical topics • Background on the guidelines process • Considerations for local adaptation • Guidelines for effective water safety and rescue training for laypeople (including four emerging research questions) • Each worksheet will include the following elements: o Key action o Introduction o Guidelines o Good practice points o Education considerations

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 2 o Scientific foundation o References

ACKNOWLEDGEMENTS The Canadian Red Cross would like to thank the following for their amazing contributions to the development this document: Michael Nemeth, Lyle Karasiuk, Domenic Filippelli, Dr. Andrew Macpherson, Joanna Muise, Meghan Riley, Carolyn Tees, and George Hill.

ETHICS Ethics behind first aid are not found in scientific publications or in randomized controlled trials. They are found in greater principles, such as the Fundamental Principles of the Movement: Humanity, Impartiality, Neutrality, Independence, Voluntary Service, Unity, and Universality. In serving these principles, we strive to treat affected people in the most humane and ethical manner. (Guidelines 2016)

PROCESS National first aid guidelines have been developed by Red Cross and Red Crescent national Societies for more than 100 years. For more than 20 years, several Red Cross and Red Crescent national societies have had evidence-based processes and published guidelines based on the same. In 2011, the IFRC published its first evidence-based guidelines based on the Red Cross and Red Crescent national societies’ experiences. Work on the 2020 version began in 2016 through identifying subject matters experts, determining the list of topics to address, identifying evidence reviews, cataloguing existing evidence-based processes, and working together to review new clinical and education science.

The 2020 Guidelines are developed based on the principles of evidence-based practice:

Figure 1. Evidence-based Practice

First, the best available scientific evidence is collected from databases of scientific studies. Next, this is integrated with the practical experience and expertise of experts in the relevant fields and the preferences and available resources from the target groups (such as first aid providers and people receiving first aid) in order to formulate recommendations.

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 3 The worksheet for each topic in the Guidelines was generated through collaboration between members of the clinical and education sub-committees, with adequate opportunity for input and review by both teams to best meet the needs of our stakeholders. After the content was established, editors reviewed and revised the entire worksheet in conjunction with other stakeholders in order to ensure common, simple language was used. More detailed information about the process of developing these Guidelines will also be available at https://www.firstaideducation.net.

EDUCATION Education is represented in two ways within the Guidelines: • As individual learning modalities (supported by a scientific foundation) • As education considerations within each clinical topic

The 2020 Guidelines continue to recognize two key concepts presented in 2016: a) The Chain of Survival Behaviours (Figure 1). b) Utstein Formula for Survival

Figure 2. Chain of Survival Behaviours

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 4 CONTEXT FOR CANADIAN RED CROSS FIRST AID EDUCATION In 2017 the Canadian Red Cross articulated a new vision for meaningful, learner-focused first aid education. This context is the backbone of our programs—it drives our learning design and showcases how our program approach is distinct from that of other training agencies in Canada and around the world. In adopting this learning philosophy, we recognized the need to support our instructional personnel through a comprehensive Instructor Development Program, designed to prepare them to support dynamic, learner-centred classroom environments.

All CRC first aid programming is planned and delivered in accordance with the following Context for Canadian Red Cross First Aid Education, released in 2017:

Building your participants’ confidence in their ability to provide first aid is one of your main goals as a Canadian Red Cross First Aid & CPR Instructor. As an Instructor, you can increase your participants’ confidence by: • Helping them understand the causes of injuries and illnesses. • Giving them tips on how to avoid injuries and illnesses. • Teaching them the latest in first aid skills and knowledge.

Backed with this foundation of know-how, participants are likely to be more confident in their first aid skills and more willing to act in an emergency. As a practice, first aid should prevent further suffering, protect life, and promote recovery. First aid training should support communities and people—whether or not they are certified First Aiders—in caring for others and should provide individuals with the confidence to: • Recognize illnesses and injuries. • Provide care. • Recognize personal limitations and the need for more advanced care.

The curriculum focuses on the needs and interests of your participants—the learners—to increase their confidence and understanding of the content. The safe, enjoyable, meaningful, and cooperative aspects of our classrooms create a supportive environment that allows people to increase their self-confidence and understanding of first aid behaviours and techniques. Each in- class learning activity or intervention should offer opportunities to build the participants’ confidence and connect the content to the underlying principles of first aid. The Canadian Red Cross is committed to developing our Instructors in a way that supports a learner-centred approach to education.

In addition to assessing the scientific foundation for the Guidelines, reviewers were asked to provide guidance based on the following lenses (when appropriate), which help to strengthen the learning intervention by helping program developers customize the approach to the learner audience and local environment:

Learner audience: Identifies factors that program developers should consider about learners (e.g., how you might teach the topic depending on the learner's age or language use).

Facilitation tips: This section includes teaching approaches, adaptations, and points to emphasize. Reviewers were also permitted to add in novel teaching ideas or provide resources which could be valuable to others when facilitating.

Facilitator tools: This section includes tools to strengthen learning (e.g., using the acronym FAST as a cognitive aid when exploring care for a person experiencing a stroke).

Learning connections: This section includes connections to other first aid topics or general concepts of care (e.g., some clinical topics will not make sense to learners unless they have previously explored other topics).

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 5 Click for Index 2020 Education Topics

Please note, full worksheets will be available directly from the Guidelines website: redcross.ca/firstaidguidelines

Education Considerations Topic Key Action Introduction Guidelines Good Practice Points (sample) (sample) Motivation to Consider the People have different • First aid program designers • Certain factors, such as cost, • When learners’ motivations are Learn First individual’s specific motivations to learn first should advocate that decision location, and method of learning, understood, program designers Aid motivation to learn and aid, the strongest being a makers should make first aid might influence the decision to can adapt first aid programs to use this to inform the requirement to attend learning a requirement for learn. These factors should be focus on different aspects of the planning and content (e.g., for work). Other specific groups, such as school adapted to meet the needs of each Chain of Survival Behaviours. included in first aid motivations include if the children, new drivers, and group and encourage learning. For example, parents with young education. learner has a family employees. • For maximum engagement, babies may want to be prepared member at risk of illness • Self-led learning completed in a learning opportunities should be if their baby starts Choking. or injury, or if they live far familiar context (e.g., at home) adapted to meet learners’ needs Someone living with an elderly away from healthcare may improve individuals’ and preferences. The content relative may want to be able to services. When people motivation to successfully should be limited to what is relevant recognize the signs of Stroke. are motivated to learn, achieve the learning outcomes. and necessary for the learners. • Encourage learners to share they will likely be more their first aid experiences as this engaged with the will help you to understand their process. motivation for attending and resolve any concerns they have about providing care in an emergency. • Avoid overwhelming learners with too much information as this could weaken their confidence and demotivate them.

First Aid Encourage children to First aid education refers • First aid program designers • Relevant, engaging scenarios that • Avoid using overly medical terms Education for develop their first aid to developing first aid should refer to the educational encourage children to apply their or high-level language to Children knowledge and skills knowledge and skills in pathway provided by the Centre life experiences should be used to describe illnesses and injuries. and become lifelong children. This topic for Evidence-Based Practice support learning. Language should be appropriate learners. explores how to develop (CEBaP) to create contextually • Considerations when developing to the age and experiences of first aid abilities in relevant educational programs programming for children whose the children. children of different ages according to children’s contexts make access to care • Start by asking young learners and the methods to help intellectual, social, and difficult: what they know about how the them retain their behavioural abilities.

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 6 Click for Index Education Considerations Topic Key Action Introduction Guidelines Good Practice Points (sample) (sample) knowledge, skills, and • When combined with a o Though the educational body works and why providing attitudes in both high- and secondary method (e.g., pathway recommends teaching first aid is important. low-resource settings. educational songs), hands-on children how to access medical • Build on children’s interest to training may help children to care at ages seven to eight, we learn first aid by incorporating retain knowledge and skills as recommend waiting until they first aid education into different well as increase their are ages nine to ten. Reinforce subjects and activities, such as confidence and willingness to this information regularly until biology class or sports. act. they are 18 years old. • Training teachers to facilitate o Due to the presence of first aid education may be more infectious diseases, facilitators productive, time-efficient, and should teach children to wash relevant than bringing in their hands before and after medical facilitators. providing first aid. Repeat this skill until they are 18 years old. o Children may be taught to recognize their role in a first aid emergency with age- appropriate activities such as assessing the scene and calling for help. This approach will also encourage them to learn about the importance of scene management.

Online Use online learning to Online learning refers to • Online learning is a beneficial No specific good practice points were • Online learning is most effective Learning develop learners’ first self-directed or facilitator- tool and could be as effective identified for this topic. when the appropriate technical (Adults) aid knowledge. led interactive learning as face-to-face learning for resources are available. This tools accessed on digital adult audiences. factor may present a barrier in devices, such as tablets, • Online learning may improve areas without these resources or phones, and computers. learners’ knowledge of asthma when regulation exists for Approaches include digital treatment, burns treatment, and limiting access. Consider how education programs, CPR techniques, but may not learners will access online mobile apps, online lead to an improvement in learning, including the availability games, and multimedia. skills. of offline access (e.g., through Online learning is suitable • Given the increased use of an app). for a variety of audiences social media and smartphones, • Adequate safeguarding because of its as well as technological measures should always be accessibility and expertise, online learning may implemented, especially for more flexibility. be a cost-effective method to vulnerable learners. Consider

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 7 Click for Index Education Considerations Topic Key Action Introduction Guidelines Good Practice Points (sample) (sample) spread public information how you will maintain a safe campaigns to a broad online learning environment. audience. • Online learning can have social benefits if learners can interact and collaborate.

Online Use online learning to Online learning refers to • Online learning may be most • Online learning may be useful when • Learners’ cultural and Learning increase children’s first self-directed or facilitator- beneficial when paired with the child has a preferred location in socioeconomic backgrounds (Children) aid knowledge. led interactive learning face-to-face learning. which they like to learn, or when may influence their confidence tools accessed on digital • Online learning could be as there are limited time and and ability to complete online devices such as tablets, effective as face-to-face resources. learning. phones, and computers. learning to develop first aid • Safeguarding measures are crucial • It is important to determine how Approaches include digital knowledge for conditions such for online learning and national and you will protect children as they education programs, as heart attack, stroke, lifestyle organizational protocols for engage in online learning. mobile apps, online factors, and using a protecting children online should Consider how they will interact games, and multimedia. defibrillator. always be followed. with the tool and who can Online learning is suitable interact with them while they are for a variety of audiences using it. Research the data and because of its child protection laws for your accessibility and context and organization (e.g., flexibility. school) and follow the regulations and guidelines carefully. • You can deliver online learning in a variety of ways such as mobile apps, games, and multimedia (e.g., 3D videos or virtual reality). Children learn through play, so gamification is an important method to consider.

Blended Use blended learning Blended learning is a No specific guidelines were • Self-directed components should be • This approach can be used with Learning to increase the formal educational identified for this topic. paired with a facilitated session that a variety of audiences (e.g., flexibility of first aid method that consists of focuses on learning and practising youth or older adults, people in learning. two parts: first aid skills with the support of a the workplace, those travelling or 1. A self-guided or trained facilitator (this could be living in remote areas, or those independent learning face-to-face in a classroom or training to be professional where the person has responders). It is important that

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 8 Click for Index Education Considerations Topic Key Action Introduction Guidelines Good Practice Points (sample) (sample) some control over the facilitated virtually in real time the self- and facilitator-led time, place, path, and through video communication). methods have a meaningful, pace. • The optimal “blend” of learning integrated connection and form 2. A supervised session methods and the order most an enhanced learning led by a facilitator. effective for different audiences is experience. We advise program environment led by a unknown. Regardless of the designers to consider which facilitator. combination, blended learning may elements need reinforcement provide an opportunity to reinforce based on the learners’ needs. The modules within a learning through repetition. • Prepare facilitators on how to blended learning course • The self-led learning segment may bring the self-guided and are connected to provide come before or after the facilitator- supervised learning components a unified learning led segment but must be a separate together. Time with a facilitator experience. The session (i.e., playing a video during should enhance learning, not recommendations and the facilitator-led segment is not repeat it. considerations included blended learning. Learners must • Encourage learners to revisit the for this topic apply to both watch the video before or after their self-guided learning components adults and children unless time with the facilitator for it to be as this may increase their specified otherwise. considered blended learning.) retention of the content.

Media Use media to raise We have defined “media” • Media may be used to: • Media may be used to reach a • Consider the audience’s literacy awareness, change as communication outlets o Increase awareness of first broad audience for a relatively low level and select the media outlet attitudes and beliefs, such as television, radio, aid or the motivation to cost. that will best engage people. and motivate people to newspapers, magazines, learn it • Radio may provide the opportunity Consult the target audience on learn or recall basic posters, and the internet. o Change attitudes and to engage with audiences who are which media outlets they prefer first aid knowledge and Media should be used to beliefs about first aid harder to reach. to use. skills. reach local, regional, o Increase first aid • Narrowcasting may be an effective • Use testimonials from people national, or global knowledge method to communicate very who have seen or heard first aid audiences and share first • Media may not be an effective specific messages. media content and intend to aid information. The method to improve skills or change their behaviour because media outlet should be specific actions associated with of it. This may encourage others appropriate for the providing first aid. to change too. audience, and the • Consult with the target audience message should contain The following recommendations when developing key messages authentic, relevant are for first aid program designers and media content to ensure content that is engaging, and the marketing and they resonate with them and are entertaining, and communications teams with which culturally appropriate. educational. they work: • Media may be used intensively over time to repeat multiple,

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 9 Click for Index Education Considerations Topic Key Action Introduction Guidelines Good Practice Points (sample) (sample) refined messages aimed at a target audience. • Messaging may be most effective when it is specific to a target audience and communicated through the appropriate outlet. • Collaboration between program designers or marketing teams and a target audience may produce authentic and relevant educational content.

Gamification Apply gamification Gamification is the No specific guidelines were • Gamification may be used to deliver • Consider how gamification will techniques to first aid application of game identified for this topic. first aid content either best serve learners’ needs and education to reach a elements (e.g., collecting independently or as part of a preferences. Some gamification broader range of achievements, earning comprehensive educational elements may be inappropriate learners, repeat points, or team play) to strategy. in certain contexts. For example, learning over time, or first aid education with the • Gamification should be purposeful competition between individual reinforce learning from intent to increase learner and supported by an educational learners may be irrelevant for other sources (e.g., engagement. An example approach that identifies its benefits some age groups or religious facilitator-led of this is a mobile to the intended learning outcomes. backgrounds, or in cultures that sessions). application that tests the strongly value unity. The use of ability to assess various gamification should respect the scenes for hazards. local context in which it is used. Gamification in electronic • Ensure the learning outcomes and non-electronic forms are clear and the gamification can captivate learners’ elements are directly applicable interest and provide the to the learning process (e.g., opportunity to re-engage evaluate the gamification with the content on a elements using test and retest or regular, independent learning to prioritize actions). If basis. they are not, learners may Given the increased become disinterested with the popularity of mobile content. technology, electronic • Evaluate the effectiveness of the gamification offers the gamification elements by chance to reach a much measuring key learning broader audience, and as outcomes such as first aid

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 10 Click for Index Education Considerations Topic Key Action Introduction Guidelines Good Practice Points (sample) (sample) such, is the focus of this knowledge, skills, and attitudes. topic. Secondary outcomes may include an increase in the rate with which learners re-engage with the content or the number of individuals they encourage to complete first aid education.

Peer Learning Use peer learning to Peer learning is a term No specific guidelines were • Peer-led learning or cooperative • While cooperative learning add extra value to that has many identified for this topic. learning may encourage individuals typically requires few resources education, as it allows interpretations and to share their first aid experiences, to develop (human and users to support each includes a wide variety of which may benefit the learning of financial), developing people to other and provide learning approaches. It others. When a peer shares insight become effective peer facilitators different perspectives, has no universally agreed or experience, they bring valuable can take time and effort, and adding extra value to definition, nor is there a authenticity to the subject matter, care should be taken to do this the educational standard method to its supporting the learning (e.g., in sensitively. experience. delivery. All at once, it is conflict contexts or working with • Either cooperative or peer-led an approach, a vulnerable people). learning can be used with a communication channel, a • Although peers bring value to the variety of audiences where the method, a philosophy, learning experience, they should influence of likeness is valued. and a strategy. Other not be considered a substitute for Some examples include: terms used to describe professional facilitators. o Young children (pre-school peer learning include co- • Where peers are encouraged to and elementary ages) learning, cooperative provide some form of facilitation o Ageing populations learning, peer tutoring, (peer-led learning), they should not o Those with a specific shared peer-led instruction, peer- be viewed as interchangeable with influence (new parents, mediated instruction, peer professional educators or trainers. grandparents/caregivers, evaluation, peer coaching, The peer relationship should enrich homeless persons, those and reciprocal learning. the learning experience and benefit struggling with substance both the learner and facilitator. abuse, etc.) For these Guidelines, o Those living in similar peer learning can be conditions (rural, remote, divided into the following conflict, etc.) two categories: • Engage peer facilitators in 1. Cooperative learning: program development to ensure Peers learn alongside that the programs are connected one another (i.e., with the content, approach, and reciprocal learning). audience.

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 11 Click for Index Education Considerations Topic Key Action Introduction Guidelines Good Practice Points (sample) (sample) 2. Peer-led learning: Peers play a facilitator role and share their knowledge and experience with others.

A peer is defined as someone from a “like group” who shares some (or all) of the following characteristics: gender, age, cultural background, religion, and socioeconomic circumstances. Peer learning is often used with youth or other specific audiences who may not recognize themselves (or their values and experiences) in a traditional facilitator. The familiarity of a peer can create new opportunities to share knowledge or change behaviour because the relationship is often based on trust and openness. It is especially beneficial to reach audiences who may be underserved by traditional forms of education.

Video Provide learners with Video learning consists of • If the learner has access to a • Video learning could be effective in • The opportunities to meet Learning skill demonstration individuals watching a personal mannequin, videos situations where there would individuals’ learning needs are videos ahead of face- video to learn about a otherwise be no training. changing due to continuous

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 12 Click for Index Education Considerations Topic Key Action Introduction Guidelines Good Practice Points (sample) (sample) to-face sessions to specific topic. This can be an effective tool to learn • Video learning can provide a view advances in technology. improve the time spent method is an easy way to CPR. of realistic scenarios which situate Educators increasingly use with the facilitator. address diverse • Videos may encourage learners the first aid skill within the context of social media and online learning, audiences and provide to respond to an emergency an emergency. and therefore the role of videos them with standardized and start CPR or other first aid has expanded as well. Consider information. care. which platforms your audience There are two basic • Video learning may strengthen uses to consume content and approaches to video facilitator-led training but should what type of first aid education learning: not replace it. video will resonate with them. 1. Individuals watch a • Use video learning to support video and learn from face-to-face facilitation, but not it. to replace it. (Exceptions include 2. Individuals watch a refresh and retrain sessions or if video and apply what face-to-face learning is not an they learned using option.) first aid equipment. • Provide the opportunity for learners to practise what they see in the video.

Feedback Use automated Feedback devices are No specific guidelines were • Devices that provide immediate • Feedback devices may provide Devices feedback devices to tools that provide identified for this topic. feedback may be used during CPR effective learning opportunities teach first aid skills, feedback to the learner training to improve the quality of when a facilitator is absent. such as CPR. through auditory, visual, performance. However, they may be less or physical (i.e., tactile) • Feedback devices may be used to effective in contexts where cues. For example, there improve learners’ skills by providing learners respect or expect are devices that give individualized feedback in real facilitator-led programming. feedback on the depth time. • Consider the learner audience and rate of chest • Feedback devices should be and their intended learning compressions. These selected to serve the needs of the context (e.g., devices that may devices are most useful learners (e.g., selecting a device work for first aid providers may when tailored to how a that provides visual feedback may not fit the needs of professional learner best receives be better suited for learners with responders.) feedback. For example, hearing difficulties). • Train facilitators to set up the an auditory-only device devices, introduce them to may be suitable for a learners, monitor and support learner with a visual the feedback provided, and impairment, but is less resolve any technical difficulties. effective for one who is deaf or hard-of-hearing.

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 13 Click for Index Education Considerations Topic Key Action Introduction Guidelines Good Practice Points (sample) (sample) Refresh and Provide opportunities “Refresh” refers to • Knowledge and skills decline No specific good practice points were • Plan to provide refresh and Retrain for learners to maintain strengthening or dramatically over time, identified for this topic. retrain opportunities three to six their knowledge and reminding learners of first especially more than a year months after the initial education skills after completing aid knowledge and skills, after completing an initial first session to improve retention. an initial first aid while “retrain” means re- aid education session. Refresh • There is little evidence to education session. learning skills that they and retrain strategies should be suggest the most suitable may have forgotten after considered to maintain first aid method for implementing a the initial educational learning outcomes. refresh and retrain strategy. experience. Methods can • All methods reviewed However, posters, flashcards, include face-to-face, (video learning, feedback video lectures, feedback online, or video learning, devices, face-to-face learning, devices, and videos or or a combination (see etc.) may be considered as animations viewed on mobile Blended learning). A appropriate refresh and retrain phones may effectively improve refresh and retrain methods. knowledge and skill retention. strategy supports all • Refresh and retrain sessions • Digital methods used to deliver learners in maintaining may be delivered between three refresh and retrain sessions can their first aid knowledge and six months after the initial be scaled and made available to and skills over time. educational experience. Waiting meet the needs of the learner longer will lead to less effective (e.g., sending periodic text learning. messages or emails with first aid • While there is no recommended tips to refresh learners’ session length, refresh and knowledge.) retrain interventions of 45- minutes or less could be valuable.

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 14 Click for Index Contexts For Learning

In addition to modalities, the Guidelines considered how location, environment, access to resources, and other local factors may influence how a topic is taught. Each of these contexts is included for the first time in 2020. It is important to recognize that these contexts can look very different for Canadian audiences compared to other countries and could even differ between different domestic regions. While we may not experience all contexts in Canada, we continue exploring the urban, rural, and remote learning environments.

Education Considerations Topic Key Action Introduction Guidelines Good Practice Points (samples) (samples) Conflict Emphasize that first aid Conflict areas are • First aid education may be • First aid education within a conflict • In general, there are three distinct providers must consider common and ever- adapted to the type of conflict context should acknowledge that conflict phases that education their own safety and changing; preparing learners will experience. safety, security, and military tactical should cover: highly dangerous, security before giving people for the injuries • Exposure to the relevant conflict, objectives (if applicable) often take medium safety, safe to act. life-saving first aid care. they may encounter in as well as practising the skills priority over providing care. • Emphasize the aim of the first aid these situations is they will need, can be critical to • First aid education should focus on technique, rather than the important across the success of the first aid care the needs of the learners, such as technique itself. For example, cultural, political, and learners will provide. the kinds of resources they have emphasize the need to stop societal divides. Any access to (they may not have a bleeding, rather than how to tie a group that faces conflict standard first aid kit) or the bandage. While this is true for situations will benefit dangerous situations they are in any first aid education, this from this type of first aid when providing care. approach will help to address the education. • Program designers should work kind of stress a learner might together with learners (or those who experience in a conflict context. represent them) to develop context- • Emphasize that first aid providers specific programs, rather than must assess their own safety relying on a predetermined set of first. In conflict contexts, the ill or knowledge and skills. injured person plays a bigger role in responding to an emergency. For example, if the provider cannot reach the person, they can instruct the person to apply pressure to the wound.

Disaster Develop the Disasters can be natural No specific guidelines were • First aid education should • Make time to explore the preparedness of (earthquakes or identified for this topic. emphasize the hazards in different responses people might have to individuals, families, flooding), man-made disaster settings, as well as what a disaster such as experiencing communities, and (explosions or chemical help might be available and how to high emotions or filming it on emergency services to spills), or a combination access it. camera. Discuss how to manage respond to disaster of both (fires). The • First aid providers should be flexible emotions and the positive or situations. unexpected nature and and able to adapt to the disaster's

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 15 Click for Index Education Considerations Topic Key Action Introduction Guidelines Good Practice Points (samples) (samples) scale can affect large context and any limitations they negative outcomes of numbers of people and might face (such as reduced access behaviours. all aspects of a to water or equipment). • Concentrate on bleeding control, community. People in • First aid education should focus on maintaining an open airway, and disaster situations often life-saving skills (e.g., putting caring for shock. A focus on suffer injuries and pressure on a severe bleed) and the simple steps for stabilizing life- require life-saving first use of improvised equipment (e.g., threatening conditions is aid. Communities with using a shirt to stop the bleeding). It paramount. the confidence and should also include content on • Emphasize the importance of willingness to act and recovery and minimizing further infection prevention, especially as the skills to provide care injury and the risk of infection. first aid supplies may not be will be better prepared readily available. to respond to a disaster.

Mass Acknowledge that first A mass casualty • First aid providers trained in first • A lack of first aid equipment should • First aid education should Casualty aid providers can be incident is an event that aid skills may feel confident to not be a barrier to providing care; prepare learners for the type of essential to the survival results in multiple provide first aid in a mass first aid providers should use mass casualty incidents they are and care of people injured people, casualty incident. whatever resources are available to most likely to encounter. For injured in mass casualty outnumbering and • Simulations are an educational them. example, in areas where there incidents. overwhelming tool that may be used to develop • Filming a mass casualty incident is are frequent motor vehicle emergency medical critical-thinking skills, inappropriate and problematic, collisions, learning should services. In this context awareness, and preparedness particularly if it blocks the path of reference these and identify the we include road traffic for a mass casualty incident professional responders. First aid level and availability of accidents, terror attacks, among first aid providers and education should raise awareness emergency services. mass shootings, and healthcare professionals. of this fact. • In preparing people for events natural disasters. While • First aid providers should learn such as terror attacks, include there are personal Bleeding control as it is a key skill individual safety measures and safety issues to for a mass casualty context. local regulations in the first aid consider, first aid education. providers who are first to the scene can provide life-saving care. Their contribution should be considered within official preparedness plans, and communities should be educated to act accordingly.

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 16 Click for Index Education Considerations Topic Key Action Introduction Guidelines Good Practice Points (samples) (samples) Water Develop a culturally Rivers, lakes, pools, • Delivering water safety • The development of water safety • Water Safety Education should Safety inclusive program with seas, and oceans messages to children should be messages should be based on be developed in the framework of (Aquatics) key water safety provide people with their part of a layered approach that evidence of local risk factors for the Haddon Matrix. This involves messages that address livelihoods, places of includes engaging and drowning and be mindful of the risk- evaluating personal, equipment, local risk factors. leisure, and vital educating caregivers on reduction measures to implement at and environmental factors resources for daily life. drowning prevention with a each phase of a drowning event. associated with aquatic activities, However, drowning is particular focus on the • Messages should be developed and which in turn allows you to the third leading cause importance of close supervision. delivered using appropriate theories determine the knowledge and of unintentional injury- • When developing and teaching to change behaviours. skills learners need to reduce related death worldwide. water safety messages, • Owing to the lack of evidence on their risk, stay safe during aquatic Over 320,000 people die Stallman et al.'s water the effectiveness of water safety events, and survive aquatic from drowning annually. competencies concept should be messaging, organizations should incidents. This approach supports Over 90% of these integrated into activities that consider developing an evaluation the ongoing development of deaths occur in low- and promote learning a broad framework that allows them to safety-conscious attitudes and middle-income countries spectrum of physical and mental monitor the effects of the safe behaviours in, on, and where there is less aquatic competencies. messaging on children and around the water. access to drowning • Once evaluated as appropriate caregivers’ behaviour when • Create educational opportunities prevention and learn-to- for the local context, the exposed to an aquatic environment. that engage the learner with swim programs and International Task Force on This framework should ensure the content appropriate to the people carry out daily Open Water Drowning messaging does not increase risk- developmental milestones activities on the water. Prevention's guidelines can be taking behaviour. (mental and physical) of the Children are considered to develop water learner. disproportionately safety messages. • Introduce and reinforce skills and affected by drowning, knowledge using a variety of and in many countries instructional approaches to drowning is the leading engage the learner in decision- cause of death in making activities to apply risk children between the reduction strategies using water ages of one and four. safety education and skills. • Apply water safety education to the variety of aquatic environments that the learner is likely to encounter (e.g., flat water, moving water, cold water, frozen water, swimming pools, decorative water features).

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 17 Click for Index Education Considerations Topic Key Action Introduction Guidelines Good Practice Points (samples) (samples) Remote Differentiate first aid Examples of remote No specific guidelines were • First aid programs should reflect the • Base educational content for education according to contexts include identified for this topic. differences between visiting and remote contexts on the risks the learners’ context wilderness living in a remote location. posed in those specific (e.g., the program for environments, isolated • Where possible, learners should be environments. For example, those living in a remote communities, and rural involved in the development of where medical assistance is community should differ areas with limited educational content. limited or requires longer travel from one aimed at resources. Advanced • If learners plan to visit a remote times, learners need to know how people visiting a remote medical care may be place, they should be advised to to prioritize and provide care area). limited or take a long plan their route, as well as inform for life-threatening injuries. time to access in this family and friends of where they are • Draw attention to context-specific context. Additionally, going and when they expect to illnesses such as Hypothermia, individuals and return. Hyperthermia, and Altitude communities may Sickness. Provide general advice experience longer wait such as avoiding alcohol, drinking times for medical help plenty of water, and developing and have to consider ways to protect against the extra factors—such as weather (e.g., by building a environmental shelter or starting a fire) to help hazards—compared to learners prepare for such those living in urban conditions. areas. • Encourage learners to improvise when they do not have appropriate first aid equipment. Help them to understand the purpose of the equipment, rather than the need for something specific. For example, if they are in a cold environment and do not have a blanket, encourage them to think about building a shelter or a fire instead.

Public Develop an COVID-19 is transmitted No specific guidelines were • Proper use of personal protective • Learners should be advised that Health understanding of how to from person to person identified for this topic. equipment (PPE) is extremely they must be wearing a face Emergency offer first aid knowledge through close contact by important; improper use could mask or face covering and gloves and apply skills safely airborne droplets. It is potentially increase the risk of to enter the classroom and during times of a public possible that a person infection, especially when providing complete training if they are health emergency such could catch the virus by first aid care. unable to maintain a two-metre touching a surface or (six-foot) distance between

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 18 Click for Index Education Considerations Topic Key Action Introduction Guidelines Good Practice Points (samples) (samples) an outbreak, epidemic, object on which the virus • It is recommended that first aiders themselves and all others in the or pandemic. is found, and then take training on preventing disease space at all times. touching the mouth, transmission that includes how and • Easy, visible access to nose, or eyes. The most when to use PPE, donning and sanitization stations must be effective defense doffing PPE, and disposing of all provided near the classroom against the transmission PPE. space. Sanitization stations must of this disease is • Maintain a physical distance of two include a space to wash hands maintaining a two-metre metres, unless it is medically (either with soap and water or an (six-foot) distance necessary to be near the person. alcohol-based hand rub (ABHR) between individuals and with at least 70% alcohol) and the use of gloves and a paper towels instead of cloth face mask/covering. towels. Providing first aid during • Have learners reduce exposure the COVID-19 pandemic by working with the same can raise questions partners and groups for the entire around safety and class or course. Avoid mixing up transmission. Outlined groups and partners for activities. to the right are the first aid protocols that should be followed when attending to an ill or injured person.

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 19 Click for Index Clinical

1.0 General Approach

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations

De-escalation Nothing noted in 2016 Guidelines • Identify individuals and situations that may • Practice first aid in • Violence at all levels can disturb Techniques become dangerous due to other people’s emotionally stressful contexts healthcare provision when behaviour. to develop competencies. services are most needed, be it • Call for help or extra support when needed. • Learn means to de-escalate during first aid/stabilization or • Decide to stop care due to potential or imminent volatile situations. referral and access to danger. • Anticipate stress due to healthcare facilities. context and recognize cues • Organizations need to given by ill/injured people or undertake a comprehensive bystanders. assessment of situations where trainers or volunteers might encounter violent or aggressive behaviour and provide training on de-escalation techniques. Potential situations might include training within prisons or mental health facilities.

Oxygen Nothing noted in 2016 Guidelines • The use of supplemental oxygen should be No specific good practise points • Oxygen administration may not Administration limited to first aiders with specific training in were identified for this topic. be feasible for some learners, oxygen administration. depending on their line of work • Supplemental oxygen should only be given to a or activities in which they patient with normal, spontaneous breathing. participate. For example, a rural • Until emergency medical care is available, it is rescue team may not be able to reasonable for specially trained first aiders to carry the required equipment to provide supplemental oxygen to scuba divers provide supplementary oxygen suffering from decompressions illness. and, therefore, are less likely to • Giving supplemental oxygen by a specifically use this skill. trained first aid provider for patients with • Stress the importance of advanced cancer having dyspnea and/or understanding the logistical hypoxemia may be reasonable. aspects of the equipment, • When oxygen is given, it is ideal to titrate including how to maintain and oxygen supplementation to keep the patient’s store it, as well as how to care SpO2 at 94 percent (at sea level) if the first aid for the compressed gas responder has been trained in transcutaneous cylinders. Learners should also First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 20 Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations pulse oximetry and has a proper tool for be aware of and follow any local measurement. regulations around testing and • Until emergency medical care is available, it is inspections. reasonable for specially trained first aiders to • Emphasize that it is critical that provide supplemental oxygen to patients who learners take extra precautions are suffering from carbon monoxide exposure. when using oxygen administration equipment as it can be a fire hazard. Learners must complete the necessary training on how to use the equipment if it is relevant to them. • The SpO2 reading from a pulse oximetry reading often determines the use of oxygen. Therefore, learners may be required to complete additional training on the use of pulse oximetry equipment. • Provide time for learners to practise using the different devices associated with administering oxygen, such as nasal prongs, simple masks, and partial rebreather masks. • Develop scenarios that assess learners on their ability to: o Determine when supplemental oxygen is indicated. o Identify the potential benefits of oxygen administration. o Demonstrate how to administer oxygen safely. o Store oxygen administration equipment properly.

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 21 Click for Index 2.0 Medical

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations

Poisoning For ingestion poisoning: • Poisoning occurs when a person is exposed to • The first aid provider should • Establish with learners what • The casualty should preferably be laid a substance that can damage their health or stop or limit further effects of substances and sources are on their left side. endanger their life. Most poisons are swallowed the poison by stopping most likely to lead to poisoning For gaseous poisoning: or inhaled; however, they can also be injected continued exposure. In the in their context, and discuss • Flammability warning: In rooms which or absorbed through the skin. Many poisonous cases of inhalation of toxic ways to reduce the likelihood of are potentially filled with carbon substances are found in homes and gas, the person should be poisoning. For example, discuss monoxide, all sources of ignition such workplaces. Examples include some cleaning removed from the area, but living or work conditions and as naked flames, electrical equipment, products, illicit drugs, medications, and certain only if it is safe for the first aid how to store harmful oxidizing chemicals, and smoking plants. Worldwide, international organizations provider to do so. substances. tobacco products should be are working to remove toxins such as lead, • If life-threatening conditions • Give learners opportunities to prevented. mercury, and asbestos from paint and other are present, the first aid assess danger through photos or • Move the casualty out of the area with building supplies. provider should access scenarios, for example of a gas immediately, but only if this can be emergency medical services chemical spill or a gas-filled done without endangering the first aid (EMS) and start CPR or other room. Discuss what signs they provider. In most cases the rescue has first aid as necessary. should look for. Explore how to be carried out by professional • If only non-life-threatening they keep themselves safe. This rescue service. conditions are present, the may be particularly relevant to • Only trained first aid providers should first aider should access and some workplaces. administer oxygen to casualties of follow the instructions of the • Tailor education to specific carbon monoxide and carbon dioxide poison control centre (or local learning needs. For example, poisoning. equivalent) or EMS. child first aid courses aimed at parents and care providers may require more content on prevention.

Breathing The 2016 Guidelines only included • First aid providers may help the person to sit 1. Help the person into a • Educators should be mindful of Difficulties considerations related to asthma under upright and lean forward. comfortable position (usually the cultural, gender, and age- this topic. • If the person is experiencing severe breathing seated) and reassure them. based factors that may influence difficulties (as well as a change in mental status 2. Help them to use their learners' understanding of and poor perfusion) the first aid provider should medication if they have any. breathing difficulties and access emergency medical services (EMS) and Loosen any tight clothing. severity. Ensure first aid continue to observe and assist the individual 3. Access EMS immediately if: program content is inclusive. until help arrives. o the person’s medication • Non-emergency medical support • In certain cases, a specially trained first aid is ineffective. services can treat breathing provider can give supplementary oxygen to the o the person is difficulties that occur slowly over person having breathing difficulties. experiencing severe time. First aid education should breathing difficulties.

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 22 Click for Index

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations

o the person has a change include advice about the local in mental status, such as options available. confusion, aggression or • In remote areas, it may be unresponsiveness. beneficial to drive towards the o the person’s breathing nearest medical facility and meet becomes slow. the EMS vehicle en-route. First aid program designers should know the availability and response time of pre-hospital services in their areas. Education should emphasize that early recognition of potentially time-critical situations is essential.

Asthma • First aid providers may help the • People with breathing difficulty should be • Specifically-trained first aid • In both high- and low-resource Attack person to sit upright leaning forward. moved to a comfortable position (usually providers can give settings, a person with asthma • It is reasonable to expect that first aid sitting), and any restrictive clothing should be supplementary oxygen to a may not have an inhaler with providers are familiar with the loosened. person having an asthma them. Give learners the commonly used bronchodilator • A first aid provider familiar with the commonly attack, if local regulations opportunity to practise what to inhalator devices and able to assist a used bronchodilator inhaler devices (inhaler) allow this. If the person has do when there isn’t an inhaler person in using these devices if they may assist a person in using the person’s own no inhaler or the inhaler is available. This may include experience breathing difficulties. inhaler if local regulations allow. ineffective, or if the person is actions to calm the person or • A first aid provider who is carrying a • A first aid provider specifically trained may experiencing severe help them breathe more easily, bronchodilator inhaler and specifically administer a bronchodilator at their discretion, if breathing difficulties (change such as loosening clothing and trained to use it may administer the local regulations allow. in mental status, slow and helping them to sit up. You may bronchodilator at their discretion, if less noisy breathing), the first also move the person away from local regulations allow this. aid provider should access the trigger causing the asthma emergency medical services attack (such as smoke). (EMS) and continue to • In areas where EMS services observe and assist the are extremely limited or non- person until help arrives. existent, individuals should learn • The first aid provider should strategies that can help to ease move the person away from breathing until the attack passes. things that may be triggering • Check legal restrictions that the attack, such as smoke or govern the help first aid dust. providers can give and educate within these. If necessary,

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 23 Click for Index

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations

include these laws in the educational content.

Croup • The child may lie in any position that is • The child may lie in any position that is No specific good practise points No specific educational comfortable for them and ideally comfortable and enables easy breathing. were identified for this topic. considerations were identified for enables easy breathing. • If there is a significant shortness of breath, this topic. • If there is a significant shortness of advanced medical care should be accessed, breath, EMS should be activated, otherwise the child should be taken to their otherwise the child should be taken to regular healthcare provider. a healthcare provider or medical doctor.

Chest Pain • Patients experiencing chest pain, • If a heart attack is suspected, emergency • If the person has medication, • In places with ambulances, EMS believed to be cardiac in origin, should medical services (EMS) should be accessed is diagnosed with angina, and can provide treatment during chew 1 adult or 2 low-dose aspirins immediately. is showing signs of acute transport to the hospital, which while waiting for health-care • While waiting for EMS to arrive, the person chest pain, the first aid can improve the person’s professional assistance to arrive, suspected of having heart attack should take a provider should help them outcomes. unless there is a contraindication, single oral dose of 150–300 mg chewable take their medication. The • Be aware of the recommended such as an allergy or bleeding aspirin expect in the following cases: there is a medication should take effect medications available in your disorder. known reason that the medication would cause within a few minutes. region or jurisdiction, for the person harm (e.g., they are allergic or have • Accessing medical care example glyceryl trinitrate for a bleeding disorder), or the person takes aspirin should always be considered. angina or aspirin for a heart regularly and has just taken the recommended Urgent access is necessary if attack. Additionally, be aware of dose. the pain is intense, the the laws surrounding whether a • The first aid provider should help the person get person has shortness of first aid provider can assist with into a comfortable position (usually semi-sitting); breath, the person is clammy, or administer medication. the person should refrain from physical activity. pale, or has a bluish colour to • Emphasize that sitting in a their skin, nails, or lips, or if comfortable position eases the the pain does not subside strain on the heart, and if the after a few minutes. person collapses, they are less • If EMS is delayed, get an likely to injure themselves. automated external defibrillator and keep it close to the person in case it is needed. • If trained to do so and local protocols allow, the first aid provider may give the person

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 24 Click for Index

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations

aspirin and instruct them to chew it.

Stroke • Use of a stroke assessment system, • First aid providers should use a stroke • Mild stroke-like symptoms • Learners’ access to care, such as FAST, should be employed. assessment system, such as FAST, to that last less than a few available transport, and distance o Face, Arms, Speech, Time recognize the symptoms of a stroke. minutes indicate a transient to the nearest medical facility will • First Aid providers should note the ischemic attack (TIA) or “mini vary depending on their local time of stroke symptoms/signs onset. stroke”. The person context. Work with learners to experiencing these symptoms define what EMS access looks should seek advanced like in their community. In some medical care as soon as settings, an ambulance will possible to decrease the risk arrive within minutes after EMS of more permanent is called, while in others the ill or outcomes. injured person may need to wait • For a person showing stroke for a medical professional to signs and/or experiencing come to them. In some cases, stroke symptoms, EMS must the first aid provider must be accessed as soon as transport the person to the possible. medical facility by car, boat, or • First aid providers should other means. help the person into a • A quick response time is critical comfortable position. There is to caring for someone who is limited evidence in favour of having a stroke. Understanding supine position or sitting the EMS in their community position. builds learners’ confidence to act quickly and determine the fastest method to transport the person to a medical facility. • In many homes there are ways to measure blood glucose because a family member has diabetes. If possible, the first aid provider may be able to perform a blood glucose test for the person who has had a stroke and may use a stroke scale assessment including glucose measurement in relation with the EMS system.

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 25 Click for Index

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations

Dehydration First aid providers could use three percent • First aid providers should rehydrate the person • Emergency medical services • Ask learners to identify those to eight percent carbohydrate-electrolyte using either commercially prepared oral (EMS) should be called if the most at risk of dehydration in drinks for exertion-related dehydration. rehydration salts (ORS) or a pre-prepared salt person's responsiveness is their own lives and how to help package that complies with the World Health altered (trouble waking up, to prevent it. If three percent to eight percent Organization's recommendations for ORS confusion) or if the person • Help learners recognize that carbohydrate-electrolyte drinks are not solutions. becomes unresponsive. dehydration can also occur in available or not tolerated, alternative • First aid providers could use three to eight • First aid providers should cold settings when people wear beverages for rehydration include water, percent carbohydrate-electrolyte drinks for seek medical advice if they too many layers and overexert 12 percent carbohydrate-electrolyte exertion-related dehydration. If these are not are in doubt, or if the person: themselves. solution, coconut water, two percent milk, available or not tolerated, alternative beverages o Is a baby or older adult. • Provide learners with visual, tea, tea-carbohydrate-electrolyte, or include water, 12 percent carbohydrate- o Loses more fluid than written, or verbal information caffeinated tea beverages. electrolyte solution, coconut water, two percent they take (e.g., severe about how to recognize milk, tea-carbohydrate-electrolyte drinks, and vomiting). dehydration. caffeinated or non-caffeinated tea. o Urinates very little (especially if the urine is a dark colour) or does not urinate at all. o Has fever or signs of heat exhaustion. (See Hyperthermia.)

Abdominal Nothing noted in 2016 Guidelines • Paracetamol may be effective to relieve mild • Even mild cases of • Incorporate prevention education Pain period pain. Non-steroidal anti-inflammatory abdominal pain may require a around food hygiene and hand drugs (ibuprofen, diclofenac, naproxen, etc.) medical examination although washing. may also be effective, however, they may have the need is not necessarily • Explore different causes of side effects (e.g., upset stomach or conflict with urgent. abdominal pain and focus on other medications). The person should take • Reassurance and ensuring which instances are considered painkillers with regularity on the days with pain the person is comfortable are emergencies and when medical according to the recommended dose and time important: lying on the ground care is required. interval. with both legs up can relieve • Draw on learners’ own pain. experiences of stomach pain to • A hot water bottle or heated contextualize their learning. wheat bag held against the abdomen may relieve the pain, anxiety, or nausea.

Unresponsive- • First aid providers should start CPR if • If a person is found motionless, usually lying on • The level of responsiveness • A person can become ness needed. Be aware that sometimes a the ground and/or in an unusual position, can be determined with the unconscious suddenly (e.g., due AVPU scale: Alert—Verbal— to a stroke, electrocution, or

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 26 Click for Index

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations

person in cardiac arrest may initially unconsciousness should be assumed and Pain—Unresponsive, head injury) or gradually (e.g., in present a short seizure-like activity. checked immediately: describing what kind of certain poisonings or • Consider other causes such as o Shout and shake the person gently stimulus the patient reacts to, progressive hyperglycemia). poisoning, diabetic emergency, head o Open the person’s airway if any. • An altered mental status may injury, etc. o Check for normal breathing for no longer precede unconsciousness, and • First aid provider should put the than 10 seconds the first aid provider may person in the recovery position and o If the person does not breathe normally, intervene before loss of call for EMS. start chest compressions (see consciousness occurs, as in Resuscitation) cases of hypoglycemia. In 2016 this topic was listed as • If normal breathing is present, but the person • An altered mental state may be “Unresponsive and Altered Mental does not respond, he or she is very likely a forerunner of States.” unconscious unconsciousness, but the person • If the person reacts only to Pain, or is may also experience normal Unresponsive, airways should be kept opened: responsiveness or even o If cervical spine injury is suspected, by jaw hyperactivity following an altered thrust only, if not: mental state. o By head tilt-chin lift maneuver or by establishing recovery position, o Checking regularly whether normal breathing is still present

Feeling Faint • If the person is breathing normally but • First Aid providers should assist the person in • A person who is feeling faint • Fainting is a common remains unresponsive, maintain a doing physical counterpressure manoeuvres. should be helped into a safe occurrence, particularly in warm patent airway by considering head- • While in a safe and comfortable position, people and comfortable position, climates and in areas with little tilt/chin-lift, or recovery position. feeling faint can perform counterpressure such as sitting or lying on the fresh air. Ask learners for • If there is abnormal or no breathing, manoeuvres on their own to lessen the feeling. floor, so they cannot fall and examples of when they have felt resuscitation should be started to lessen the faint feeling. faint. What was the immediately. • The first aid provider should temperature? Were they • An unresponsive person should be immediately assess an hungry? Tired? Stressed? rapidly assessed for breathing/signs of unresponsive person’s • Individuals who regularly circulation and perfusion (if trained to breathing and circulation. encounter or interact with do this assessment). • Advanced medical care pregnant women should learn • If the person is face down and should always be accessed how to support and lay the unresponsive (prone position), the first for a person who loses woman on her left side if she is aid provider should turn their face up consciousness as the cause feeling faint. (supine position) to check breathing. could range from minor to • The first aid provider should activate life-threatening (see Diabetic EMS for a person who loses Emergency, Stroke, Head

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 27 Click for Index

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations

consciousness as causes can range and Spine Injury, and from not serious to life-threatening. Poisoning.) • First aid providers should consider that any person who loses consciousness may have had a stroke or seizure, or may have low blood sugar or another serious condition.

Earache Nothing noted in 2016 Guidelines • First aid providers should provide paracetamol • Medical advice should be • Individuals who look after for pain relief. sought when there is fever, children or spend time in water fluid draining from the ear, contexts (e.g., public swimming vertigo, or loss of or pools) could benefit from decreased hearing learning about earaches. associated with ear pain. • The person should seek medical advice if the symptoms don’t get better (or get worse) within 48 hours. • A source of heat can be held against the affected area and may reduce pain.

Sore Throat Nothing noted in 2016 Guidelines • Paracetamol should be considered to reduce the • The first aid provider should • Emphasize that while sore pain caused by a sore throat. encourage the person to drink throats are usually not serious, • Nonsteroidal anti-inflammatory drugs (such as water in small amounts. they may be a symptom of a aspirin and ibuprofen) can be used as second- • Harsh or high-pitched more severe condition and line treatment for sore throat, should paracetamol breathing sounds, the inability learners must recognize the be ineffective. to swallow, or drooling may situations in which to access • A single nighttime dose of honey may have a indicate epiglottitis. All cases advanced medical care. small positive effect on a cough and sleep in of epiglottitis should receive • It can be difficult for people to children over a year old. urgent medical care. identify the cause of a sore • If a first aid provider suspects throat (viral, bacterial, or the person has epiglottitis, environmental). Early actions, they should help the person such as giving the ill person a rest in a comfortable position drink, can help to eliminate some until they can access medical causes and help the learner to care. identify if the condition is more serious.

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 28 Click for Index

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations

• Encourage learners to look for other signs and symptoms, and to consider causes, such as whether the person has been near another person who has a cold or flu, as this will help to inform treatment.

Headache Nothing noted in 2016 Guidelines 1. Reduce anything that may worsen the • Paracetamol and other • Emphasize rest, hydration, headache (such as direct sunlight or noise). painkillers should only be relaxation techniques, and a cool 2. Advise the person to rest in a dark, quiet room used if a headache results cloth on the forehead or neck as with an ice-pack or cold towel applied to the from minor causes such as effective first aid support for mild affected area. flu, tiredness, or stress, but headaches. 3. Seek medical care if : never in emergency • Emphasize that while a o The pain follows a Head and Spine Injury. situations. headache is usually not serious, o The person is also showing signs of a • Applying an ice pack or cold it may be a symptom of a more Stroke. compress to the head or back severe condition and learners o The person is experiencing a severe of the neck may provide relief must recognize the situations in headache for the first time. from migraine symptoms. which to access advanced o The headache is severe and happens very • Bright lights (e.g., from an medical care. quickly with no known cause, and the office or phone screen) may person feels sick. make a headache or migraine o The headache is serious and the person worse. If the individual with also has a fever, a sore or stiff neck, or either condition is sensitive to drowsiness, or is vomiting. light, they should sit or lie in a o The headache started suddenly within the dark or dimly lit room. last three months of pregnancy. Individuals with a headache should get fresh air, enough sleep, regularly drink water (see Dehydration), and take time to relax.

Hiccups Nothing noted in 2016 Guidelines • Harmless home remedies such as holding the • The use of gripe water is not • This topic does not usually form breath for a short time, breathing into a paper recommended. part of first aid education, bag, sipping ice-cold water, swallowing some • A person with hiccups should however it may be useful for granulated sugar, biting into a lemon, or tasting seek immediate medical help some audiences such as school vinegar may be effective and could be if hiccups last longer than 48 nurses, new parents, or other attempted. hours or if they have other people who care for children. symptoms in combination

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 29 Click for Index

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations

with hiccups, such as chest • Define what a hiccup is and how pain, weakness in their limbs it happens, and discuss different or face, headache, or trouble safe home remedies. keeping their balance.

Back Pain Nothing noted in 2016 Guidelines • Paracetamol does not relieve the symptoms of • The person should sit or lay • Emphasize that lower back pain lower back pain but may provide short-term down in the position most has many different causes relief for osteoarthritis. comfortable to them. (some are common and mild • Nonsteroidal anti-inflammatory drugs (NSAIDs) while others can be serious). may be as effective as paracetamol at relieving Helping the person to access acute lower back pain. professional medical advice is • Heat wrap therapy may provide some short- an important first aid action as it term pain relief and reduce disability in those will help them learn how to with a combination of acute and subacute low manage their pain. back pain. There is insufficient evidence on the • Use scenario-based learning to effects of applying a cold source to reduce low practise recognizing and back pain. managing back pain (e.g., participants could recognize that someone who has back pain may have been involved in a motor vehicle collision in the past). • Learners may have different beliefs as to what lower back pain is and what causes it. Facilitate a discussion to better understand these beliefs.

Fever • If the person is suffering from fever, • Paracetamol or acetaminophen should be given • When sponging, cold water • Since fever can indicate a more paracetamol or acetaminophen should to the person with a fever. should not be used. It can serious illness or trigger a be given to them. • Paracetamol or acetaminophen should be either cause the blood Seizure, it is important for • Paracetamol or acetaminophen can be combined with sponging the person with warm vessels to constrict and learners to understand their role combined with sponging with tepid water (29°C to 33°C, or 84.2°F to 91.4°F) as prevent the body from giving in looking out for signs that water (from 29°C to 33°C) as long as it long as it does not make them upset or start to off heat or cause the person indicate the need to access does not cause the person to get shiver. to produce more heat by medical care. upset or to start shivering. • When sponging, cold water should not be used as shivering. • Discuss clothing in the context of • Do not use cold water for sponging as it will cause more discomfort. • A person with a fever your climate—what clothing or this results in more discomfort. requires immediate care if layers will make the person most they also have:

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 30 Click for Index

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations

• Do not use cold water for sponging as o A rash comfortable and not cause them this can have the opposite reaction, o A persistent cough to overheat or feel cold? i.e., heat the body more. o A change in mental status • Consider which fluids will best • The infant, child, or adult should be o A headache or stiff neck keep the person hydrated and referred to a healthcare professional o Difficulty breathing cool (e.g., a baby should have as soon as possible, if the: o Severe abdominal pain their breast or bottle milk while o infant under two months of age o Signs of shock an adult will benefit more from has fever • A person with a fever should cool water). o children up to two years of age rest and drink fluids to has fever higher than 39°C or replace the loss caused by 102.5°F sweating. o person is over 65 years of age • A person with a fever should o person suffering from fever has dress lightly, and the first aid cancer, a weakened immune provider should avoid system, sickle cell disease, layering them with excessive medications which affect immune blankets or coverings. system o fever does not decrease o fever is accompanied by a rash o fever is accompanied with a persistent cough o fever is accompanied with abdominal pain • The person requires immediate care in cases of: o fever with change in mental status o fever with difficulty breathing o fever with headache or stiff neck o fever with severe abdominal pain o fever with any signs of shock • Persons with fever should rest and drink fluids to replace the loss of fluids due to sweating. • Persons with fever should dress lightly and one should avoid covering them with excessive blankets or coverings.

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 31 Click for Index

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations

Seizure • First aid providers may place a person No specific guidelines were identified for this topic • Protect the person from harm • Address any misconceptions experiencing a seizure on the floor to by moving any nearby objects about epilepsy and seizures to prevent them from being injured. that may hurt them. Avoid reduce stigma and prejudice. • Once the seizure has ended, first aid moving the person unless • Discuss learner’s experiences providers should assess the airway they are in immediate danger with seizures and address any and breathing and treat accordingly. (e.g., they are in oncoming barriers to providing care. traffic). • Acknowledge common mistakes • Place soft padding under the when caring for a person person's head to protect it. experiencing a seizure, such as Remove eyeglasses and trying to: loosen any restrictive clothing o Open the person’s mouth from around their neck. Do o Put something in the not restrain the person. person’s mouth • Access emergency medical o Restrain the person services (EMS) or the next available higher level of care if the person has hurt themselves, it is the person’s first seizure, the seizure lasts for more than five consecutive minutes, or they have repeated unexpected seizures. If further care is not available, follow the first two bullet points above as this will help the person. • Note the start and stop time of the seizure, as well as if it reoccurs. Communicate this information to EMS if available. • When the episode is over, check the person's breathing. If they are breathing normally, move them on to their side and ensure their airway is open. If they have irregular breathing, see Unresponsiveness or the

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 32 Click for Index

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations

Adult or Child, Infant, and Neonatal CPR sections.

Notes • Do not put anything in the person’s mouth. • If you do not know the person, look for any medical information they may have on them, such as a medical bracelet with details of their condition, before accessing help. • If present, ask a family member or caregiver if the person has any anti-seizure medication. There are many ways this medication can be administered, including orally, a spray in the nose, an injection, or rectally. Assist the caregiver if you feel comfortable doing so. • Protect the person’s dignity. For example, move bystanders along or cover any signs of accidental urination. • If the person has a mild seizure, stay calm and keep the person safe. Stay with them until the seizure has passed.

Babies and Children • In addition to the steps above, check the baby or child's temperature. If they are too hot, cool them by

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 33 Click for Index

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations

removing any excess clothing and expose them to fresh, cool air. Treat any Fever if necessary.

Diabetic • First aid providers should use 15 g to • 15 g to 20 g of glucose tablets should be used • If it is unclear if the person is • Introducing the terms Emergency 20 g glucose tablets for treating to treat symptomatic hypoglycemia in conscious hypoglycemic or hyperglycemia and hypoglycemia symptomatic hypoglycemia in adults, children, and infants. hyperglycemic, the first aid is important, however, you may conscious individuals. • Glucose should be repeated if symptoms provider should care for consider keeping language to • First aid providers should use 15 g to continue after 15 minutes. hypoglycemia. “high blood sugar” and “low 20 g glucose tablets for treating • If glucose tablets are unavailable, other forms of blood sugar”, particularly when symptomatic hypoglycemia in dietary sugars such as candy (e.g., jellybeans, the learners are children. conscious children and infants. Mentos), sugar cubes, or orange juice may be • Emphasize the importance of • Glucose may be repeated if symptoms used to treat symptomatic hypoglycemia in recognizing hypoglycemia as it persist after 15 minutes. conscious individuals. requires immediate care. If the • If glucose tablets are not available, brain is deprived of sugar, this can various forms of dietary sugars such lead to Seizures and possible as Skittles, Mentos, sugar cubes, brain damage. jellybeans, and orange juice can be • Affirm that providing care for used to treat symptomatic hypoglycemia will rarely worsen hypoglycemia in conscious individuals. hyperglycemia and may prevent • If uncertain whether the symptoms or treat life-threatening displayed are for hypoglycemia or conditions. Also see hyperglycemia, it is reasonable to treat Unresponsiveness, Seizures, for hypoglycemia. and Stroke.

Shock • For a person experiencing or • First aid providers should prevent heat loss for a • Advanced medical care should • As many of the sudden illnesses threatened by shock, body person experiencing (or with potential to be accessed if it appears the and injuries that are covered in a temperature should be maintained by experience) shock. person may experience or First Aid course can lead to preventing heat loss. • The person in shock should be placed in a shows symptoms of shock. shock, it is recommended that • First aid providers should place the supine position (lying on their back). • If a known heart attack treatment for shock be facilitated person in shock in the supine (lying on • If the person is unresponsive and breathing causes shock, a supine early in the course (with the back) position. normally, the first aid provider should place the position with the upper body basic steps of First Aid) and re- • First aid providers should position the person on their side in the recovery position, slightly elevated should be emphasized throughout the person who is unresponsive and ensuring their airway is open. considered. course breathing normally on their side while • If the person has difficulty • Since there are a variety of signs ensuring that their airway is open breathing or is uncomfortable of shock, draw on learner (recovery position). in a supine position, they may experiences and stories of what be placed in the position most they might have observed to

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 34 Click for Index

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations

• First aid providers may raise the non- comfortable to them, such as underline the need to be alert to injured person’s legs 30 degrees to 60 semi-sitting or sitting while different ways to recognise degrees if it makes them feel better; leaning forward. shock. this may improve the vital signs for a few minutes. • First aid providers should activate EMS if the person seems to be threatened by shock or shows signs and symptom of shock. • For people experiencing shock caused by a known heart infarction, different positioning (like supine position with slight elevation of the upper body) should be considered. • If the person is having breathing difficulties and will not tolerate being supine, first aid providers may help the person to get in a position being most tolerable or comfortable for them (usually semi-sitting or sitting position leaning forward).

Motion Nothing noted in 2016 Guidelines • Controlled breathing and distracting the ill • If possible, stopping the • Include the types of transport and Sickness person with an activity (e.g., listening to music) means of transport may related first aid care that are may help to reduce symptoms. decrease nausea. relevant to learners and their • Looking straight ahead at a central point may • Those that have used environment. decrease nausea. medications such as • Some areas may have safety antihistamines to relieve considerations that prevent motion sickness in the past learners from stopping their should continue to use them. vehicles. The first aid education • Either looking outside and should acknowledge and discuss fixing the gaze on a central these considerations in a learning point on the horizon or activity. restricting one’s view (e.g., • People who may travel with closing one’s eyes) may help to children (teachers, parents, prevent motion sickness. coach drivers) may find it useful to learn about motion sickness.

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 35 Click for Index 3.0 Injury

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations

Burns • Burns should be cooled with cold water • The burn should be cooled with running water • Further injury should be • Prevention is a key focus of as soon as possible for a minimum of for 10 minutes. prevented where appropriate burns. Consider the context of ten minutes. • After the burn has been cooled, a dressing like by dealing with the source of learners and adapt their • As clean water is available in many hydrogel that maintains a moist environment, danger, for example by prevention material accordingly, areas of the world, clean tap water contours easily to the wound, and is non-stick covering a pot of hot oil. identifying the source of burns should be used. should be used. • Clothing and jewellery in that learners are most likely to • Ice and ice water should NOT be • Chemical burns of the skin and/or eyes should contact with or close by the experience. applied to burn wounds. be rinsed with drinking water and, if available, burned skin should be • Approach topics which have • After cooling, it is recommended that with diphoterine. removed to support cooling myths or incorrect information burn wounds should be dressed with a and reduce additional attached to them, such as the sterile dressing dependent on the local discomfort. belief that only people with burn treatment policies. (Good Practice • After a burn has been lighter skin can be sunburned. Point) cooled, covering it in a clean Using sunscreen and avoiding • In cases of minor burns that will not be cloth or plastic film can long periods in direct sunlight is seen by a medical health professional, protect it during transit to important across all ethnicities honey or aloe vera may be applied to further medical care. and skin types to reduce burning the wound. and the increased risk of skin • NO remedies should be applied before cancer that accompanies it. a medical practitioner has reviewed the • Emphasize that cooling the burn wounds. is important to reduce the • Care must be taken when cooling large damage to tissue. The cooking burns or burns in infants and small effect continues even after the children so as not to induce skin has been removed from the hypothermia. A first aid provider should source of heat. NOT burst the blister(s). Friction Nothing noted in 2016 Guidelines • Keeping a blister intact may decrease the risk of • Draining a friction blister that • Emphasize prevention and Burns bacteria entering the body and causing an is filled with fluid will preparedness as these are the infection, compared to draining it (aspiration) or immediately reduce the pain most effective strategies for removing the top layer of the blister (deroofing). associated with the blister. If managing blisters. drained, the blister should be • Explore dressings that might be covered with a sterile used to treat blisters. dressing to ensure the roof • Education may also cover the attaches to the underlying removal of dressings which skin and that the blister does should, if possible, not damage not refill with fluid. the blister. Adhesive-removal • Antibiotic ointments are sprays are available in some advocated for the immediate

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 36 Click for Index

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations treatment of friction blisters pharmacies and may make only. removing dressings easier. • Friction blisters can lead to open wounds, bleeding, and infection, limiting an individual’s mobility. In these situations, the person should stop the activity causing the blister, cover the blister with a sterile dressing and seek medical advice.

Abrasions/ Superficial wounds and abrasions should • Superficial abrasions and wounds should be • If warmth, redness, or pain • Particular local risks, as well as Wounds be irrigated with clean water, preferably tap cleaned with potable water, preferably from a develops around the wound access to clean water and water because of the benefit of pressure. tap to provide pressurized water flow. area, or if the person dressings, need to be considered • First aid providers may apply antibiotic • An antibiotic ointment may be applied to skin develops a fever, this is an when teaching this topic. ointment to skin abrasions and wounds abrasions and wounds to help them heal faster indication of Infection and • Different populations respond to to promote faster healing with less risk and lessen the risk of infection. the person should seek wounds (particularly minor of infection. • An occlusive dressing (an air- and water-tight medical advice immediately. abrasions) in different • First aid providers may apply an dressing) may be applied to abrasions and ways. While children can react to occlusive dressing to wounds and wounds with or without antibiotic ointment. the shock of the injury by abrasions with or without antibiotic demonstrating high levels of ointment. pain, adults might be • The use of triple antibiotic ointment may embarrassed to ”cause a be preferable to double- or single-agent fuss.” Educators can establish antibiotic ointment or cream. how different learners might • If antibiotic is not used, antiseptic could respond by discussing be used. experiences with different • There is some evidence that traditional wounds of different severities, approaches, including applying honey, and how they would approach are beneficial and may be used on providing care. wounds by first aid providers. • There are myths and social • People with wounds that become red, conventions around wound warm, or painful, or that are treatment. It is important to let accompanied by a fever, should seek learners share these in order to assessment from a healthcare provider. build knowledge about what the most appropriate and available treatment might be.

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 37 Click for Index

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations

Bleeding • First aid providers must control external • External bleeding should be controlled by No specific good practise points • The inclusion of topical bleeding by applying direct pressure. applying direct pressure. were identified for this topic. hemostatic agents in the • The use of pressure points and • Pressure points and elevation should not be curriculum should be based on elevation is NOT recommended. used to stop bleeding. the availability of these • When direct pressure fails to control • When direct pressure fails to control life- substances and the question of life-threatening external limb bleeding threatening bleeding from an external limb or it whether laypersons are legally or is not possible (e.g., multiple injuries, is not possible to apply (e.g., due to multiple allowed to use them. inaccessible wounds, multiple injuries, inaccessible wounds, or when injured • If tourniquets and/or topical casualties), tourniquets could be people outnumber first aid providers), hemostatic agents are included considered in special circumstances tourniquets may be used in certain in first aid education, training in (such as disaster, war-like conditions, circumstances, such as disaster events, war-like the application techniques and remote locations, or instances where conditions, or remote locations. proper assessment of severe specially trained first aid providers are • Tourniquets may be used by specially trained bleeding is required. Learners providing care). first aid providers. should be aware that these • Localized cold therapy with or without • With or without pressure, the application of cold techniques should only be pressure may be beneficial in therapy may be beneficial to achieve applied in life-threatening hemostasis for closed bleeding in hemostasis for closed bleeding in extremities. situations where direct pressure extremities. Caution is advised when • When it is impossible to apply standard could not be applied or is not applying this recommendation to techniques, or when they are not working, the effective. See Shock. children due to a potential for application of a topical hemostatic agent could hypothermia. be considered to control life-threatening • The out-of-hospital application of a bleeding, so long as the first aid provider has topical hemostatic agent to control life- the appropriate training. threatening bleeding not controlled by standard techniques and in situations where standard techniques could not be applied could be considered with appropriate training.

Head and • First aid providers may suspect a spinal • Any person suspected of sustaining trauma (a • If the person has an altered • If your region has specific Spine Injury injury if an injured person displays any forceful bump, blow, or jolt to the head or body mental status (e.g., programs for sport contexts, of the following risk factors: that results in the rapid movement of the head Unresponsiveness), a consult with local experts to o over 65 years of age and brain), along with any of the symptoms of a blocked airway or abnormal determine if first aid providers o driver, passenger, or pedestrian in concussion, must be presumed to have a minor breathing, a seizure, should be taught specific a motor vehicle, motorized cycle, or traumatic brain injury (mTBI) or concussion. impaired vision, abnormal screening tools to identify a bicycle crash • Any person with a mTBI or concussion must functioning anywhere in the concussion. o fall from a greater than standing stop any activity and seek advanced medical body, or bleeding from the • Correct application of a cervical height care from a healthcare professional qualified to nose, ear, or mouth, collar requires training and o tingling in the extremities evaluate and manage a concussion. advanced medical care must regular practice; therefore be accessed immediately. emphasize the first aid provider’s

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 38 Click for Index

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations

o pain or tenderness in the neck or • The person may have a spinal injury if they have • If the sports concussion role in differentiating between back any of the following risk factors: assessment tool (SCAT3) has high-and low-risk individuals o sensory deficit or muscle weakness o Over 65 years old been used to assess a person when a collar might have to be involving the torso or upper o Driver, passenger, or pedestrian in a motor with a suspected concussion, applied. extremities vehicle or bicycle crash healthcare professionals may o not fully alert or is intoxicated o Fall from higher than standing height use this assessment as o other painful injuries, especially of o Tingling in the extremities recognition of the concussion the head and neck o Pain or tenderness in the neck or back for further care. o children with evidence of head or o Sensory deficit or muscle weakness in the • If a cervical spine injury is neck trauma torso or upper extremities suspected, the head should • For layperson first aid providers the o Altered mental status, possibly intoxicated be manually supported to limit routine application of cervical collars is movement until advanced NOT recommended. medical care is available. • First aid providers should NOT strap the head or neck. • In the case of suspected cervical spine injury it is recommended to manually support the head in a position limiting angular movement until experienced healthcare provision is available.

Chest Injury • For open chest wounds, first aid • An open chest wound may be left open, without • First aid providers should • In high-resource settings this and providers may leave the wound free the application of a dressing. care for Shock and place the may be delivered with Abdominal without applying a dressing. • If a wound dressing is necessary, a non- person in a comfortable presentation Injury • If a wound dressing is necessary, non- occlusive dressing could be used. position. software/video/simulation occlusive wound dressings could be • A sterile dressing may be mannequins. These tools can be used (that is, one that does not seal the placed on open abdominal especially useful in providing the wound). wounds. opportunity to practice direct • For chest and abdomen injuries, first • Internal organs should not be pressure and the application of aid providers should manage shock and pushed back into the body. dressings around place the person in a comfortable • Impaled objects in the body impaled/embedded objects. position. should be stabilized. • For open abdominal wounds, first aid • If there is significant external providers may place a sterile dressing bleeding from a chest on the wound. wound, direct pressure • First aid providers should not push back should be applied, providing viscera (internal organs). it does not completely seal • First aid providers should stabilize the wound. (See Bleeding.) impaled objects.

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 39 Click for Index

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations

• If there is significant external bleeding, direct pressure to the chest wound with a hand and/or a dressing should be applied. Care must be taken that it does not become occluded.

Fractures, A first aid provider could cool a sprained • Ice or cooling may be applied to sprained joints • Early recognition of the • Individuals may benefit from Sprains, and joint or soft-tissue injury. and soft-tissue injuries. injury, early transport to a learning how to take the pulse of Strains • First aid providers should assume that medical facility, and the injured person and use their any injury to an extremity could include stabilizing the injury to findings to identify more severe a potential bone fracture and manually minimize pain should be injuries. While program designers stabilize the extremity injury in the encouraged. may consider including this in position found. • It should be assumed that training, it should not deter • There is insufficient information to make any injury to an extremity learners from helping the injured recommendations for straightening an (limb) could include a person in other ways if they are angulated fracture. For remote potential bone fracture and unable to take a pulse properly. situations, wilderness environments, or should be manually special circumstances with a cool and stabilized in the position Facilitation Tips pale extremity this may be considered found. • Spend more time practising by a trained first aid provider. • When in a remote or immobilisation techniques, • Ice or cooling should NOT be applied wilderness environment (or especially improvised splints and for more than 20 minutes. one with limited resources) bandages, and less time reviewing • First aid providers should assess for and the angulated fracture is the key concepts behind fractures, hemorrhage in all fractures and treat for cool and pale, the first aid sprains, and strains. shock in fractures involving long bones, provider may consider Focus on application. especially femur, due to possibility of straightening it if trained to • Make note that even when ice is significant internal hemorrhage. do so. not available, applying a splint or • Based on training and circumstance, • Ice or cooling should be sling to an injured limb may help to providers may need to move an injured applied for 20 minutes or reduce the pain. limb or person. In such situations, less. • Brainstorm as a group what you providers should protect the injured • All fractures should be could use as an improvised person. This includes splinting in a way assessed for internal and bandage. Provide time for that limits pain, reduces the chance for external bleeding and the learners to practise bandaging. further injury, and facilitates safe and injured person treated for • Use scenario-based learning to prompt transport. Shock, especially if the practise accessing medical care fracture involves a long bone and minimizing pain during such as the femur. transportation. • Facilitate discussions on learners' experiences with fractures, sprains, and strains First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 40 Click for Index

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations and expand on the learning outcomes as they come up in conversation. This activity can help build learners' confidence.

Dental The avulsed tooth may be placed in Hank’s • The tooth may be placed in Hank’s balanced • First aid providers may not • The use of the solutions Avulsion Balanced Salt Solution. If not available, the salt solution. If this is not available, the preferred re-implant the tooth. mentioned in the Guidelines tooth may be placed (in order of order of solutions is: propolis, egg white, • The tooth should be held at depends on local laws, preference) in propolis, egg white, coconut coconut water, Ricetral, whole milk, saline, the crown, not the root. (The regulations, and processes— water, Ricetral, whole milk, saline, or phosphate-buffered saline. crown of a tooth is the area including liability protection. In Phosphate Buffered Saline. that sits above the gum.) some regions you may need to • The tooth should not be vary the list of recommended cleaned as this could solutions according to the damage vital tissues still educational opportunities within attached to the tooth. the local context. • The person should be referred to a dentist as soon as possible.

4.0 Environmental

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations

Hypothermia Nothing noted in 2016 Guidelines • A person experiencing hypothermia who is • People experiencing Key topics to cover when planning responsive and shivering vigorously should be hypothermia should be and delivering a first aid program warmed passively with a polyester-filled treated with care. They should include: blanket. should be removed from the • How to prevent hypothermia and • If the person is responsive and shivering but a cold source and have their Frostbite in cold environments. polyester-filled blanket is not available, wet clothes removed. If the • How to reduce the risk of alternative equipment may be used including a person is moderately to experiencing an avalanche, dry blanket, warm, dry clothing, and severely hypothermic, including familiarizing learners reflective/metallic foil. clothes should be cut off to with local avalanche warning • If the person is not shivering, and if resources minimize their movement. signs and safe behaviours to are available, first aid providers should actively • Care should then be taken to follow (e.g., avoid closed ski warm the person. insulate the person by slopes). placing a barrier between • How to access help in rural or them and the ground (e.g., a remote environments. tarp and sleeping bag) to

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 41 Click for Index

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations

minimize conductive heat • The fact that hypothermia can loss. The head and body also occur in the home (e.g., in should be covered to older people who are unable or minimize convective and who choose not to turn on the evaporative heat loss. heat in cold weather, or people • For all cases of hypothermia, who slip on icy steps and cannot EMS should be activated help themselves up). and the person’s airway, • The fact that hypothermia can breathing, and circulation even occur in warm temperatures should be reassessed if a person is wet and inactive. frequently.

Snow Nothing noted in 2016 Guidelines Snow blindness, also called arc eye or flash eye, is • If applicable, the person • Learners who are at a higher risk Blindness a painful condition in the eye caused by should remove their contact of snow blindness, for example overexposure to ultraviolet (UV) light. It is like the lenses. those who weld, work with or use cornea (the transparent outer layer of the eye) has • The person should stay sunbeds, or spend time in the a sunburn. Snow blindness is most likely to indoors and wear snow or at the sea, may benefit happen to people who take part in outdoor sports sunglasses to relieve pain or from learning about this topic. or activities in relatively high altitudes or at sea, discomfort. • Use relevant or local terminology where surfaces reflect light into the eyes. • The person’s eyes should be for this condition. For example, However, artificial sources of UV radiation, such as kept moist (e.g., using saline welders may refer to the a welder's torch or sun lamp, have the same effect. solution or eye drops). condition as arc eye or flash eye, • A cool, damp cloth over whereas learners who spend closed eyelids may be time in the snow may call it snow comforting. blindness. • The person should avoid rubbing their eyes. • If symptoms last longer than a day, or if they worsen, the person should seek advanced medical care. Depending on the cause, this could be an eye doctor or emergency care (in the case of a welding accident).

Hyperthermia Nothing noted in 2016 Guidelines • The person should stop all physical activity and Heat Exhaustion • Combine this topic with other first be removed from the heat source. 1. Help the person rest in a aid emergencies (such as • The person should be immersed in ice-cold cool place and remove any Breathing Difficulties or Seizures) water. If this is unavailable, they should be excess clothing. so learners can recognize and First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 42 Click for Index

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations cooled with water or ice packs placed in the 2. Give them some water to differentiate the symptoms of armpits or on the neck and groin area. drink. Sport drinks or water hyperthermia. • Drinking water or a water and salt/sugar with sugar or salt may also solution may be beneficial. be helpful. 3. Reassure the person and monitor their breathing and temperature. If their condition worsens, access emergency medical help.

Heat Stroke 1. Help the person rest in a cool place and remove any excess clothing. 2. Cool the person down by immersing them in ice-cold water. If this is not available, wet the person with cold water and place ice packs on their neck and groin. Fanning them may also increase the cooling action. 3. Access emergency medical services (EMS). 4. Give the person some water to drink. Sport drinks or water with sugar or salt may also be helpful. 5. Monitor the person’s breathing and temperature. Try to reduce their temperature to 38°C.

Access Help If the person shows signs of severe hyperthermia, access advanced medical care immediately.

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 43 Click for Index

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations

Radiation • Avoid touching suspected radioactive Nothing noted in 2020 Guidelines • Avoid touching or • Encourage learners to become Injuries items. approaching suspected familiar with the “radioactive” • Keep distance and do NOT approach radioactive materials or symbol and be aware of suspected radioactive items or accident scenes. emergencies that are dangerous accident scenes. • The injured person should due to potential radioactivity. • Remove casualties from the scene as be removed from the scene quickly as possible. as quickly as possible . • Avoid the smoke within 100 metres of • First aid providers should a fire or explosion that involves a stay more than 100 metres potentially dangerous radioactive away from smoke caused by source. a fire or explosion involving a • Keep your hands away from your potentially dangerous mouth and do NOT smoke, eat, or radioactive source. drink until your hands and face are • To avoid accidentally washed (to avoid inadvertent ingesting radioactive ingestion). material, you should wash • Exposure to sealed sources does not your hands and face after require decontamination. To limit touching them and before exposure, stay away or place an smoking, eating, or drinking appropriate shield (lead apron for if you have been exposed to example) between the source and the suspected radioactive exposed persons. materials. • Special trained forces should take • To limit exposure to care of the decontamination process radioactive sources, stay but potentially contaminated persons away or place a shield should be instructed to remove any between the source and clothing while awaiting such teams, those who may be exposed which may be of benefit. (e.g., a lead apron). • Medical specialists must examine all • Exposure to a sealed source persons who might have been does not require exposed to radioactivity as soon as decontamination. possible. • The decontamination process should be handled by those specially trained to do so. Everyone who may have been exposed should replace any clothing on their persons while waiting for specialists to arrive.

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 44 Click for Index

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations

• Everyone who may have been exposed to radiation must be examined by medical specialists as soon as possible.

Altitude Nothing noted in 2016 Guidelines • People experiencing AMS, HACE, or HAPE No specific good practice points • Emphasize how to prevent and should stop their ascent immediately and start were identified for this topic. recognize the symptoms of to descend safely, with support, until their altitude illnesses as often the symptoms lessen. person affected may not realize • First aid providers trained in its use may they have it. administer oxygen to individuals experiencing • Use visual materials (pictures and AMS, HACE, and HAPE. videos) to illustrate signs and • If a person has prescribed medication for symptoms of the different types of altitude illness with them (such as illness that high altitudes can acetazolamide, nifedipine, or dexamethasone), cause. the first aid provider may assist them in taking it based on the label instructions. • Where local laws, regulations, or protocols permit, specially trained first aid providers may give medications (such as acetazolamide or dexamethasone) to individuals experiencing altitude illness. • People experiencing altitude illnesses should be kept from getting cold or overheated. • Ascending to higher altitudes more gradually can reduce the risk of altitude illness. • Adequate hydration should be maintained (though not forced) as symptoms of Dehydration can mimic those of AMS.

Decompression Nothing noted in 2016 Guidelines • In case of suspected decompression illness, • Oxygen is a widely accepted No specific educational Illness first aid providers should administer oxygen at first aid measure for cases of considerations were identified for the highest concentration available (e.g., decompression illness. In this topic. through a non-rebreather mask) which may some countries, laws make it reduce the symptoms substantially. The mandatory for professional oxygen should be continued until definitive diving operations to have treatment is obtained. oxygen readily available (e.g., diving training institutions). Therefore, the

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 45 Click for Index

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations

• In cases of cardiac arrest after resurfacing, likelihood of oxygen being CPR should be administered with rescue available is high at dive sites breathing. and likely immediately • First aid providers should call EMS available if called for by the immediately, then the Divers Alert Network first responder. (DAN), and indicate the likelihood of • First aid learners should be decompression illness so that transport of the informed about the National person to a recompression chamber can be First Aid Guidelines for arranged as soon as possible (definitive decompression illness, as treatment is often hyperbaric oxygen provided well as the local procedures in a recompression chamber.) for care. • In locations requiring extended or complicated transport to a recompression chamber, rapid transport to a nearby emergency department capable of resuscitation should be prioritized so the person can be stabilized prior to being transported to the chamber. • Scuba diving is a special circumstance for which oxygen during resuscitation may be helpful despite the measurement of adequate oxygenation.

Frostbite • People experiencing severe bleeding • Frostbite is damage to the skin and other • Warming should be achieved • As frostbite is relatively or major trauma should be kept warm. tissues caused by extreme cold. When it is cold by immersing the affected uncommon, help learners • When providing first aid to a person (at or below 0ºC) or there are strong winds, the area in water between 37ºC recognize it by including images experiencing frostbite, rewarming of human body tries to preserve its core body (i.e., body temperature) and in your education material. frozen body parts should be done only temperature by narrowing the blood vessels 40ºC (98.6ºF and 104ºF) for • Help learners to identify how they if there is no risk of refreezing. close to the skin. In extreme cases, this can 20 to 30 minutes. would get medical help in an • Rewarming should be achieved by reduce the blood flow in some areas of the • Chemical warmers should emergency if extreme cold was immersing the affected part in water body to dangerously low levels, resulting in not be placed directly on disrupting normal between 37ºC (i.e., body temperature) frostbite. The fingers and toes are most frostbitten tissue because communications and/or EMS and 40ºC (98.6ºF and 104ºF) for 20 to vulnerable. Frostbite can lead to permanent they can reach temperatures activities. 30 minutes. damage but this can be avoided if it is higher than the target • For severe frostbite, rewarming recognized and treated quickly. temperature and may cause should be accomplished within 24 burns. hours. • Warming frozen body parts • Chemical warmers should NOT be should be done only if there placed directly on frostbitten tissue is no risk that they might since these can reach temperatures refreeze.

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 46 Click for Index

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations

that result in burns and exceed the • After warming, the frostbitten targeted temperatures. area should be protected • After rewarming, efforts can be made from refreezing and the to protect frostbitten parts from person should seek medical refreezing and to quickly transport the care as soon as possible. person for further care. • Affected body parts should • Affected body parts may be dressed be dressed with sterile with sterile gauze or gauze placed gauze until the person can between digits until the person reach medical care. If fingers concerned can reach medical care. or toes are affected, the • The use of non-steroidal anti- gauze should be placed inflammatory drugs for treatment of between them. frostbite as part of first aid is NOT recommended based on potential side effects of these drugs (e.g., allergies, gastric ulcer bleeding).

5.0 Animal-Related Injuries

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations

Marine Animal • Topical application of seawater, • Seawater, baking soda, vinegar, or heat (e.g., • First aid providers should • Emphasize preventative Injuries baking soda, vinegar, or heat can be hot water) should be topically applied to treat a wear proper protection measures, such as identifying applied for nematocyst deactivation. marine animal sting. Fresh water may cause (gloves) and may either use warning signs at the beach and Fresh water may cause further further stinging. The choice of agent must be their fingers or a flat object, wearing protective suits when envenomation. The choice of agent specific to the species of jellyfish: such as a credit card, to partaking in aquatic activities in must be individualized to the • For most jellyfish, remove the tentacles and remove any tentacles on the the ocean or sea. geographic area and species of rinse the site with seawater. skin. • Share photos of local jellyfish and jellyfish: • For specific types of jellyfish such as sea • First aid providers should provide basic information such as o For most jellyfish, remove nettles and mauve stingers, apply a baking prevent the person from where they can be found. tentacles and rinse the injury in soda paste. rubbing the sting site. • Share photos of local jellyfish seawater. • If the jellyfish is positively identified as a • In areas with lethal jellyfish, stings to help learners identify o For jellyfish species, sea nettle bluebottle, do not use vinegar as it will cause advanced medical care what these look like. and mauve stinger, apply baking further stinging. should be accessed soda paste. • The sting site should be immersed in hot water immediately. First aid o For box jellyfish stings, douse the for at least 20 to 30 minutes until the pain is providers should assess the injured area in vinegar for 30 gone. person’s airway, breathing, seconds. and circulation while

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 47 Click for Index

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations

o If the jellyfish is positively • Pressure bandages should not be used to treat providing care for any other identified as a bluebottle or jellyfish stings. symptoms caused by the Physalia utriculus, do NOT use • Aluminium sulphate, meat tenderizer, and sting. vinegar, as it triggers further water should not be used for pain relief. envenomation. • After removing the stinger and treating the sting • The hot water immersion should site, hot water immersion may be used to continue until pain is resolved or at reduce the pain. least for 20 to 30 minutes. • Pressure bandages should NOT be used for the treatment of jellyfish stings. • Topical application of aluminium sulphate, meat tenderizer, or water should NOT be used for the relief of pain. • After treatment to remove and/or deactivate nematocysts, hot water immersion could be used to reduce pain. • Any adherent tentacles may be picked off with fingers or can be scraped off with a flat object, such as a credit card. The rescuer must wear proper protection. The stung area should be rinsed well with seawater to remove stinging cells that can be seen. • Stop the person from rubbing the sting area. • For areas with lethal jellyfish, first aid providers should immediately summon EMS and assess and treat airway, breathing, and circulation while providing other therapies.

Insect Bites • Use of gasoline, petroleum, and other • The following tick-removal methods must be • The bitten or stung area • Ask learners to share and Stings organic solvents to suffocate ticks, as avoided: using gasoline, petroleum, or other must be thoroughly experiences of being bitten or well as burning the tick with a match, solvents to suffocate the tick, and burning the disinfected with alcohol or stung, including how it feels and must be avoided. tick with a match. another antiseptic solution. how they responded, to develop • A bee’s sting should be removed from the skin • If warmth, redness, or pain the group’s confidence to handle as soon as possible. develops around the area, or this type of injury.

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 48 Click for Index

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations

• In case of a bee sting, the sting • The first aid provider may grab the tick as close the person develops a fever, • Demonstrate how to use should be removed as soon as to the skin as possible with very fine forceps or this is an indication of tweezers to effectively remove a possible. tweezers and pull it gradually and firmly out of infection and the person tick and credit cards to remove a • To remove a tick, grab the tick as the skin. should seek medical advice sting. close to the skin as possible with a • If a commercial tick removal device, such as a immediately. Antibiotics or • Help learners identify how a rash very fine forceps or tweezers and pull hook with a slip, is available, the tick may be vaccinations may be from an insect bite differs from it gradually, but firmly, out of the skin. removed with the device according to the needed. other types of rashes by • In case a commercial tick removal manufacturer’s instructions. • First aid providers should emphasizing the symptoms device, such as a hook with slip recognize the symptoms of associated with an insect bite, device, is available, the tick may be an allergic reaction or distinctive visual differences, and removed with the removal device anaphylaxis and provide the the context of where the person according to the manufacturer’s appropriate care. was when the rash developed. instructions. • The person should avoid • The bitten area must be thoroughly scratching the area as this Facilitation Tools disinfected with alcohol or another can cause an infection, • Share photos of local insects and skin antiseptic solution. First aiders especially if the fingernails their associated injuries or should avoid squeezing the tick during are dirty. infections to help learners identify removal since this may inject • Travellers should check to them. infectious material into the skin. see what insect-related risks • Bring a variety of tick removal • If a rash, warmth, or pain develops are prevalent in the area tools to show learners. around the bitten area or the bite they are travelling to and leads to fever, the person should see seek medical advice. They a physician in case antibiotics or may need vaccinations or vaccinations are needed. medication before leaving • The first aid provider should recognize home. signs of an allergic reaction or signs of anaphylaxis and treat.

Snake Bites • Suction should NOT be applied to • The extremity injuries may either be kept still as • The person should limit • Emphasize the importance of snake envenomation because it is much as possible or be immobilized by physical activity. getting treatment quickly: even if ineffective and may be harmful. applying a non-elastic bandage. • A cold compress should not the snake is not venomous, the • Tourniquet should NOT be applied to • The person should not walk on an immobilized be applied to a snake bite. bite can quickly become infected. snake envenomation because it is not leg unless no other option is available. • Washing the wound is not • Use pictures of the most common effective and may result in prolonged • It is reasonable to keep the injured area at or considered a routine first aid snakes in the region to increase hospitalization. lower than the level of the heart. measure. learners’ ability to identify snakes • The extremity injuries may be kept still • Specially trained first aid providers may use and raise awareness of the as much as possible or be compression for special situations such as danger. immobilized by applying a non-elastic remote locations and wilderness environments. • Use pictures of the signs and bandage. • It is reasonable to wash the wound if this does symptoms to help learners not delay hospital transport.

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 49 Click for Index

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations

• Specially trained providers may use • Suction should not be applied to a snake bite understand the seriousness of compression for special situations because it is ineffective and may be harmful. snake bites. such as remote locations and • A tourniquet should not be applied in cases of • Be clear about when to use wilderness environments. snake envenomation because it is not effective pressure bandaging with • The casualty should limit physical and may result in an extended hospital stay. immobilization, what it is, and activity. • The pressure immobilisation technique is not how to apply it. recommended following bites from a pit viper. • Dispel myths about snake bites if • If properly trained to do so, first aid providers they are prevalent among the may consider the pressure immobilisation learner audience: technique, using an elastic bandage, following o Do not cut or incise the bite. the bite of a suspected coral snake (providing o Do not use an arterial this does not delay transport time to the tourniquet. hospital). o Do not suck the bite.

6.0 Resuscitation

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations

Choking • Chest thrusts, back blows, and • In responsive adults and children who are • A person with partial choking • Because choking often happens (FBAO) abdominal thrusts are equally choking, chest thrusts, back blows, and should be monitored until while eating, a choking effective for relieving foreign body abdominal thrusts are equally effective. they improve as it could emergency could happen in a airway obstruction (FBAO) in • If an adult or child is unresponsive, they should develop into complete public place. Program designers conscious adults and children older receive chest compressions to clear the object choking. may consider framing this as a than one year. from their airway. • Although injuries have been "helping behaviour" topic as it is • In adults and children older than one • Unresponsive infants should receive chest reported after using an one where the bystander effect year, the unconscious person should compressions, back blows, or a combination of abdominal thrust, there is not could result in people feeling receive chest compressions for the two to clear the object from the airway. enough evidence to uncomfortable stepping forward clearance of the foreign body. • Responsive infants may receive back blows determine whether chest to help. Emphasize that the first • Unconscious infants up to one year followed by chest compressions to clear the thrusts, back blows, or step is asking the person if they old should receive either a object from the airway. abdominal thrusts should be are choking. combination of back blows followed • The finger sweep method may be used in used first on responsive • Learning to give back blows can by chest compressions, or chest unresponsive adults and children, providing the adults and children. be challenging as it is not compressions alone for clearance of object is solid and visible in the airway. • Chest thrusts, back blows, possible to practice this on FBAO. • There is not enough evidence to suggest a and abdominal thrusts another person for fear of hurting • Combination of back blows followed different approach for an obese adult or should be applied in quick them. Stress that a gentle slap by chest compressions may be used pregnant woman who is choking. succession until the object will not expel an object stuck in for clearance of FBAO in conscious • When helping a responsive person, first aid has been cleared from the someone’s throat: force is infants up to one year old. providers must be able to recognize the signs airway. More than one

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 50 Click for Index

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations

• The finger sweep could be used in of partial choking (the person is able to speak, technique may be needed in needed to dislodge the object unconscious adults and children older cough and breathe) and complete choking (the responsive adults and even if this might hurt the person. than one year with an obstructed person is unable to speak, has a weakened children. • Learners practising back blows airway if solid material is visible in the cough, and has difficulty breathing). and chest thrusts for a choking airway. baby should sit or kneel. • There is insufficient evidence for a Note Although it can be easy to hold a different treatment approach for an • “Child” refers to someone who is a year or mannequin baby in one arm obese adult or pregnant woman with older. ”Infant” refers to someone who is less (straddle arm technique), it can FBAO. than a year old. be more challenging with a real • Although injuries have been reported baby, especially for younger with the abdominal thrusts, there is learners. Supporting the baby on insufficient evidence to determine their lap can be safer and more whether chest thrusts, back blows, or effective. abdominal thrusts should be used first in conscious adults and children older than one year. • These techniques should be applied in rapid sequence until the obstruction is relieved; more than one technique may be needed in conscious adults and children older than one year.

Mild Airway Obstruction • In the case of a conscious person, the first aid providers must be able to recognize signs of a complete airway obstruction (the person is unable to speak, has a weakening cough, is struggling or unable to breathe) and signs of a mild obstruction (the person is able to speak, cough, and breathe). • The person with a mild airway obstruction should remain under continuous observation until he or she improves since severe airway obstruction may develop.

CPR • All dispatchers must be trained to • If a person is unresponsive with abnormal or • First aid providers should • The tools, locations, and recognize cardiac arrest over the absent breathing, it is reasonable to assume perform chest compressions methods you choose to use when phone. the person is in cardiac arrest. for all adults who are teaching first aid should be

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 51 Click for Index

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations

• All dispatchers should consider a • The first aid provider should determine if a unresponsive with abnormal selected based on what will be person described as being person is unresponsive with abnormal or absent breathing. accessible for learners in an unconscious with abnormal or no breathing. • To achieve more effective emergency and on their needs breathing to be in cardiac arrest • Palpation of the pulse as the sole indicator of chest compressions, the and abilities. during a calling. the presence or absence of cardiac arrest is dominant hand should be • Prioritize training for community • All dispatchers must provide CPR unreliable. placed against the sternum members most likely to instructions to callers who report a • First aid providers who are trained, able, and with the non-dominant hand encounter cardiac arrest person in suspected cardiac arrest. willing to give rescue breaths and chest over the first. emergencies. Members include compressions may do so for all unresponsive but are not limited to medics, adults with abnormal breathing. police officers, firefighters, and • CPR should start with compressions rather lifeguards. Also, consider that than rescue breaths. these groups, given their status • Chest compressions may be performed on the and role in the community, might centre of the chest (i.e., the lower half of the make effective educators for the sternum or breastbone) on adults who are general public. unresponsive with abnormal breathing. • Previous studies noted that • Chest compressions should be performed at a bystanders have concerns about rate of 100 to 120 per minute. disease exposure and • Chest compressions must be done to a depth transmission through standard of approximately 5 cm; a compression depth of CPR, which has caused a more than 6 cm should be avoided. significant decrease in their • First aid providers should avoid leaning on the willingness to provide it to both chest between compressions to allow full strangers and family members. chest-wall recoil. Compression-only CPR is the • A ratio of 30 compressions to 2 rescue breaths preferred method in these cases. (30:2) should be used on people who are • Consider the gender makeup of a unresponsive with abnormal breathing. group of learners. There is limited • If in doubt whether a person is experiencing evidence to demonstrate that cardiac arrest or not, the first aid provider women-only learner groups are should start CPR without concern of causing beneficial to women learners, but additional harm. there is evidence to support the • Interrupting chest compressions to deliver two position that men are more likely rescue breaths should take less than ten to learn in mixed groups. seconds. • Emergency medical dispatchers • First aid providers should continue to perform play a critical role by promptly CPR while the defibrillator is set up and pause recognizing cardiac arrest, only when it is ready for analysis and, if providing CPR instructions by indicated, provides a shock. phone, and dispatching EMS • In any setting, chest compressions can be personnel with a defibrillator. resumed immediately after shock delivery for

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 52 Click for Index

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations adults who are unresponsive with abnormal Consider as part of the education breathing. Total pre-shock and post-shock for this role: pausing between compressions should be as o The use of scripted protocols short as possible. as a helpful way to confirm when a person is in cardiac arrest. o Additional training around the recognition of abnormal breathing. o How to provide CPR instructions to an adult. o How to provide instructions for both rescue breaths and compressions if the person in cardiac arrest is a baby, child, or adult. • Dispatchers who communicate using video-assisted emergency calls may need more training for this tool to be effective and widespread within CPR education. Adult • For an adult, chest compression • If a person is unresponsive with abnormal or • First aid providers should • Emphasize that time is critical to depth should be approximately 5 cm absent breathing, it is reasonable to assume perform chest compressions a successful outcome for the but not more than 6 cm. the person is in cardiac arrest. for all adults who are unresponsive person. Evidence • First aid providers should NOT lean • The first aid provider should determine if a unresponsive with abnormal indicates survival relies upon: on the chest between compressions person is unresponsive with abnormal or absent breathing. o Immediate recognition that so that the chest is allowed to recoil breathing. • To achieve more effective someone is unresponsive fully. • Palpation of the pulse as the sole indicator of chest compressions the with abnormal breathing. the presence or absence of cardiac arrest is dominant hand should be o Early access to help and unreliable. placed against the sternum access to EMS. • First aid providers who are trained, able, and with the non-dominant hand o Early high-quality CPR. willing to give rescue breaths and chest over the first. o Early defibrillation with an compressions may do so for all unresponsive automated external adults with abnormal breathing. defibrillator. • CPR should start with compressions rather • Emphasize the importance of the than rescue breaths. first aid provider, other • Chest compressions may be performed on the bystanders, and EMS working centre of the chest (i.e., the lower half of the together to provide quick and effective care.

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 53 Click for Index

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations

sternum or breastbone) on adults who are • Help learners understand that the unresponsive with abnormal breathing. desired outcomes of CPR—to • Chest compressions should be performed at a pump blood around the body rate of 100 to 120 per minute. (chest compressions) and get • Chest compressions must be done to a depth oxygen into the lungs (rescue of approximately 5 cm; a compression depth of breaths)—keep the brain and more than 6 cm should be avoided. vital organs functioning until • First aid providers should avoid leaning on the defibrillation and advanced care chest between compressions to allow full chest can take place. wall recoil. • Define proper compression rate • A ratio of 30 compressions to 2 rescue breaths and depth and highlight that (30:2) should be used on people who are these are critical factors in the unresponsive with abnormal breathing. health outcomes of the patient. • If in doubt whether a person is experiencing • Emphasize that starting CPR cardiac arrest or not, the first aid provider early has a significant impact on should start CPR without concern of causing the likelihood of achieving the additional harm. return of spontaneous circulation • Interrupting chest compressions to deliver two for people experiencing cardiac rescue breaths should take less than ten arrest. seconds. • Ensure that learners understand • First aid providers should continue to perform the fundamental components of CPR while the defibrillator is set up and pause standard CPR before being only when it is ready for analysis and, if taught compression-only CPR. indicated, provides a shock. • Some massive multiplayer virtual • In any setting, chest compressions can be worlds allow learners to play a resumed immediately after shock delivery for role and experience “real life” adults who are unresponsive with abnormal scenarios and environments in breathing. Total pre-shock and post-shock which to practise their CPR skills. pausing between compressions should be as If implementing this tool, ensure short as possible. facilitators understand how to use it and that the technology is not too complex (see Gamification and Online Learning [adults].) • Providing CPR instructions using video-assisted technology does not significantly improve the overall quality of bystander CPR compressions or rescue breaths. • For learners who train regularly and are knowledgeable in CPR,

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 54 Click for Index

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations extend skills training to include performing CPR in different settings and situations (e.g., in noisy or distracting environments, with anxious relatives present, in crowds or small spaces with restricted access). Such training exercises stimulate team-based approaches and lateral thinking. • Use film clips to improve learners’ ability to recognize agonal breathing.

Child, Infant, • All dispatchers must be trained to • First aid providers should use a response • First aid providers who are • Focusing on prevention is critical and Neonatal recognize cardiac arrest over the check and breathing check to ascertain unwilling, untrained, or for the survival of babies and phone. whether a baby or child is unresponsive and unable to perform rescue children. • All dispatchers should consider a not breathing normally. Checking for a pulse is breaths can perform • Emphasize the importance of the person described as being not needed. compression-only CPR. first aid provider, other unconscious with abnormal or no • In babies and children who are unresponsive bystanders, and EMS working breathing to be in cardiac arrest with abnormal breathing, CPR should be together to provide care quickly during a calling. performed with rescue breaths. and effectively. • All dispatchers must provide CPR • Chest compressions on children may be • Consider providing training in instructions to callers who report a performed with one or two hands. both the two-finger and two- person in suspected cardiac arrest. • In babies or newborns, chest compressions thumb techniques when • In situations when a first aid provider can be performed with the two-thumb-encircling facilitating baby CPR. When in a is performing CPR and following hand method or with the two-finger technique. stressful situation, learners may telephone instructions from a In newborns, the former approach is preferred. choose the one with which they dispatcher when treating an adult, • For babies and children, rescue breaths should are most comfortable. compression-only CPR should be be given before compressions. Either two or • Change management requires used. In children and infants it should five initial rescue breaths may be given. not only highlighting positive be full CPR. • In instances where there is one first aid changes to practise, but also • Chest compressions should be provider only, a compression-to-rescue-breath explicitly noting when techniques performed on the centre of the chest, ratio of 30:2 may be used. are to be removed from practice i.e., the lower part of the breastbone. • In instances where there are two first aid (and the reasons for their • Compression rate should be 100 to providers, a compression-to-rescue-breath ratio removal). 120 per minute. of 15:2 may be used. • If using mannequins, ensure they • First aid providers should NOT lean • For a child, chest compression depth should be are realistic in terms of size, on the chest between compressions one-third of the depth of the chest weight, and features so learners so that the chest is allowed to recoil (approximately 5 cm but not more than 6 cm). can get a sense of how to fully. perform the skill correctly.

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 55 Click for Index

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations

• Interruption of chest compressions to • For a baby, chest compression depth should be • Help learners understand that the give breaths should be less than ten at least one-third of the chest’s depth desired outcomes of CPR—to seconds and pre- and post-shock (approximately 4 cm). pump blood around the body pauses should be as short as • The rate of chest compressions for babies and (chest compressions) and get possible. children should be 100 to 120 per minute. oxygen into the lungs (rescue • For a person in cardiac arrest an AED • All emergency medical dispatchers should breaths)—keep the brain and should be used and as early as provide CPR instructions (referred to as vital organs functioning until possible. dispatcher-assisted CPR) to first aid providers defibrillation and advanced care • The first aid provider should always who call regarding an unresponsive baby or can take place. ask if an AED is available. child with abnormal breathing, including when • Emphasize that rapid and • When an AED is available the first aid no bystander CPR is in progress. continuous compressions are provider must always do CPR while critical for a positive outcome. waiting for the AED to be available Have learners practise keeping and made ready for use. the time it takes to give rescue • A standard AED should be used for breaths or find the right personal adults and children aged eight years protective equipment to a and over. minimum. • For infants and children up to eight • Emphasize that the goal of years of age, a pediatric AED must be resuscitation remains the same used. If not available, a standard AED for all ages and that only the should be used with pediatric pads. If approach is modified. However, that is not available, a standard AED first aid providers who know how should be used. to perform adult CPR, but do not • For infants, children and casualties of know baby or child CPR, may drowning the preferred method of use the same sequence as is CPR is compressions with breaths. used for adults. • For infants and children in cardiac • Highlight that the decision to start arrest being treated by unwilling CPR should be immediate and untrained or people unable to do without delay. Time is critical to a conventional CPR, compression-only positive outcome. CPR should be used. • Learners can gain knowledge • First aid providers may use a and some basic skills through compression-ventilation ratio of 30:2 self-directed learning. The in cardiac arrest for adults and for improved efficiency of the self- children and infants with one provider. directed curriculum may allow • First aid providers may use a facilitators to use in-person compression-ventilation ratio of 15:2 session time on critical in cardiac arrest for children and interpersonal interaction between infants with two providers. learners.

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 56 Click for Index

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations

• For infants and children the anterior- posterior placement of AED pad may be preferred. • For infants, children and in drowning cases breaths should be given before compressions. Either two or five breaths may be given.

AED • For a person in cardiac arrest an AED • For an unmonitored cardiac arrest, a short 1. Ask bystanders to access • Advocate that public access should be used as early as possible. period of CPR should be provided until the emergency medical services defibrillators should have clear • When an AED is available the first aid defibrillator is ready for analysis. (EMS), or if you are alone signage and be placed in highly provider must always do CPR while • In any setting, chest compressions should access EMS yourself. If visible locations. waiting for the AED to be available resume immediately after shock delivery for using a phone, activate the • Ensure learners are familiar with and made ready for use. adults in cardiac arrest. speaker function. defibrillator signage or icons and • Self-adhesive defibrillation pads are safe, 2. Ask a bystander to bring a can identify where to find one in effective, and an acceptable alternative to defibrillator as quickly as their local context. standard defibrillation paddles. possible, or get one yourself • Use scenario-based learning to • Paddles or pads should be placed in an if you are alone. provide learners with the anterior (front) position on the chest. 3. Begin CPR immediately. opportunity to practise using a Acceptable alternatives include an anterior- 4. Use the defibrillator as soon defibrillator. Practising will posterior position (for either paddles or pads) or as it is ready and follow the increase their confidence and an apex-posterior position (for pads only). voice prompts. Only pause willingness to act in an • For large-breasted individuals, the left chest compressions when it emergency. electrode paddle or pad should be placed is absolutely necessary. • Have learners practise providing lateral to or underneath the left breast, avoiding 5. Continue CPR unless continuous CPR, minimizing any breast tissue. instructed to pause (either interruptions, while a partner sets • Fast removal of excessive chest hair can be by the defibrillator or a up the defibrillator and applies done before the application of paddles or pads, professional responder). the chest pads. Have them so long as the delay to shock delivery is Pause CPR if the person practice resuming CPR minimal. shows signs of recovery, immediately after the shock. • For optimal external defibrillation in adults, a such as breathing normally, • Emphasize that time is critical to paddle or pad size greater than 8 cm as a coughing, opening their a successful outcome for the specific electrode size should be used. eyes, speaking, or moving unresponsive person. Evidence • After the defibrillator administers a single purposefully. indicates survival relies upon: shock, the first aid provider should resume o Immediate recognition that chest compressions immediately and not delay Note someone is unresponsive for rhythm reanalysis or a pulse check. • Pediatric pads have with abnormal breathing. • Automatic defibrillation is preferred over attenuators that will o Early access to help and manual defibrillation because it is easier to use automatically lower the access to EMS. and may deliver fewer inappropriate shocks. delivered energy, so o Early high-quality CPR.

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 57 Click for Index

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations

• First aid providers should take precautions to pediatric pads should not be o Early defibrillation with an minimize sparking during defibrillation (e.g., used on an adult patient. automated external pay attention to pad or paddle placement). defibrillator. • In an oxygen-rich atmosphere (where high-flow • It is suggested that bystanders oxygen is directed across the chest), first aid using video-assisted dispatcher providers should ensure that defibrillation does defibrillator support do not need not take place. to be previously defibrillator- • For analysis of electrocardiographic rhythms trained in order to use a during CPR, the routine use of artifact-filtering defibrillator successfully, due to algorithms is not recommended. live video feed allowing the • For analysis of electrocardiographic rhythms dispatcher to monitor and correct during CPR, artifact-filtering algorithms should the actions of the first aid be used and assessed in clinical trials or providers in real time. research initiatives. • Emphasize that anyone can use • The implementation of public-access an automated external defibrillation programs is recommended to defibrillator, even someone who improve the outcomes for people with out-of- has never used one before. hospital cardiac arrests. There are voice prompts that will • For adults and children (eight years or older), a tell you what to do. standard defibrillator should be used. • For babies and children up to eight years of age, a pediatric defibrillator should be used. If one is not available, a standard defibrillator with pediatric pads should be used. • For babies and children up to eight years of age, if a pediatric defibrillator and pediatric pads are not available, a standard defibrillator and pads should be used. • For babies or children in cardiac arrest, an initial dose of 2 J/kg of defibrillation waveforms may be considered. • For babies or children in cardiac arrest, self- adhesive defibrillation pads can be used as paddles. • For babies and children, the anterior-posterior placement of self-adhesive pads may be preferred. • In an out-of-hospital setting, CPR should begin immediately (with chest compressions) after a

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 58 Click for Index

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations single shock strategy for children in cardiac arrest. • When compared with monophasic waveforms and for terminating ventricular fibrillation, biphasic waveforms are more effective. In the absence of biphasic defibrillators, monophasic defibrillators are acceptable. • With a BTE waveform for defibrillation of pulseless ventricular tachycardia or ventricular fibrillation cardiac arrest, a selected energy level of 150 to 200 J should be used to start defibrillation. • For any other biphasic waveform, a selected energy level of at least 360 J should be used for both initial and subsequent shocks. For second and subsequent biphasic shocks, the same initial energy level is acceptable. It is reasonable to increase the energy level when possible.

Narcotic Nothing noted in 2016 Guidelines • Based on the outcome of the initial assessment • Specially-trained First Aiders • It is important to mention the Poisoning of the casualty, First Aid measures like like social workers and peer emerging problem of drug/opioid recovery position of unconscious person or support/outreach workers addiction. Information about local CPR in any unconscious person not breathing should be familiar with helplines and support centers normally should be started without delay. naloxone. should be given. • The search for and application of naloxone • Symptoms can vary based • Social workers and peer (narcotic antidote) may be used by lay rescuers on the chemical substance support/outreach workers should in suspected opioid-related respiratory or and dose taken, but clues be trained in the usage and circulatory arrest. Naloxone should not delay may be found on the scene potential side effects of naloxone. basic first aid measures. (e.g., empty bottles, empty This is not just a matter for social blisters of drugs, syringes, workers and peer needles, spoons for support/outreach workers, preparing injections.) These however, but a global epidemic items may point in the affecting everyone. direction of a narcotic • First aid instructors should poisoning. educate participants in a first aid • CPR should be started course on the following: without delay in any 1. How to recognize opioid unresponsive person not poisoning breathing normally, and

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 59 Click for Index

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations naloxone should be used by 2. How to react to an emergency lay rescuers in suspected involving opioid poisoning opioid-related respiratory or 3. How to effectively administer circulatory arrest. naloxone • It is recommended that those 4. How to connect people who whose job may involve have experienced opioid responding to opioid poisoning with community poisoning (e.g., peer support resources (simply support/outreach workers) providing information about be trained in full CPR naloxone will be less effective protocols to the in BLS level than linking the person to and have access to both community resources that can Naloxone and proper PPE. help them) 5. How to provide critical messaging, such as the importance of never using opioids when the user is alone

Note First aid providers are not counsellors, but they often know the local community resources. Just as they would to treat a psychological emergency, first aid providers can provide life-saving care and be able to direct someone, possibly families, to external resources.

7.0 Psychological First Aid

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations

Traumatic Nothing noted in 2016 Guidelines • Single-session debriefings may be harmful to • The following interventions • Consider the different types of Event those who have experienced a traumatic event. are recommended to support vulnerabilities learners are most They are not recommended. those who have experienced likely to encounter. For example, • There is wide support by expert consensus for a traumatic event: are they most likely to provide the benefit of PFA. The following interventions o Engage in conversation support to young children? In this

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 60 Click for Index

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations

are recommended for those who have o Listen to the person’s case, first aid education should experienced a traumatic event: concerns focus on the particular o Engaging in conversation o Offer empathetic support vulnerabilities of children and o Listening to the person’s concerns o Maintain contact acknowledge the link to potential o Offering empathic support o Connect to additional mental and emotional health o Maintaining contact support resources or challenges children may face o Connecting to support networks later on in life as a result of a • Psychological first aid can traumatic event. Conversely, if help during or in the interacting more with older adults immediate aftermath of a who have experienced multiple distressing event and should bereavements and traumas be provided to those who (including significant changes in need it. their health), learners should be • Psychological first aid can aware that this group of people also help in the days, weeks, may have increased loneliness, months and even years after isolation, anxiety and depression. an event has taken place. • Emphasize the importance of self-care. Learners must understand that supporting others in crisis can be overwhelming. They need to learn to recognize their own cues and have strategies in place to maintain their own emotional, mental, and physical health. • Have learners practise active listening. This involves being attentive to the verbal and nonverbal cues (facial expressions and body language) of a person. • Have learners work together to build case studies in which they have to support individuals in coping with traumatic events. • A key factor in successful programming is creating a safe learning environment, starting with the creation of a group

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 61 Click for Index

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations charter that is inclusive and culturally safe. • This curriculum is intended to be very fluid and driven by learners' desire to understand the topics in their own context/environments. The role of the facilitator is to guide the learning journey in a safe way: The focus should be less on steps and protocols and more about attitudes and discussions. • Utilizing a two-facilitator method is key to both facilitator and learner safety. It gives the facilitators space to be able to privately support a learner that is openly emotional and also check in with each other (facilitators) on educational process within the context of the learning (and also emotionally). • Have a plan of communication to let the facilitator or peers know something needs to be addressed. • Interactive activities enable the learners to openly explore the concept of grief and loss with one another. Think-pair-share. • Truth or Myth discussion activities will allow learners to explore their preconceptions of grief and encourage them to consider the impact of common phrases associated with grief and grieving. • Learners will all come with a back story or history and will have

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 62 Click for Index

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations likely experienced elements of trauma, distress, and loss more than those in any other first aid programming. It is very important to acknowledge this early and plan for disclosure and emotions as a facilitation team.

Suicidal • If a person is considered to have • There is wide support by expert consensus for • Be aware of and attentive for No specific educational Ideation suicidal ideation, trained first aid benefit for Mental Health First Aid and PFA. signals of suicidal ideation considerations were identified for providers should directly ask them • There is limited evidence with benefit for and suicide risk. this topic. about the suicidal thoughts. Inquiry staying connected to and befriending the • Ensure physical safety in about suicidal thoughts will NOT person at risk. cases of imminent threat. precipitate a suicide attempt. Instead, • The following interventions are recommended • Be aware that witnesses to a the person will feel being cared for if for suicidal ideation: frightening event, and their the inquiry is performed appropriately. o Engaging in conversation relatives or others close to • If a person is considered to have o Listening to the person’s concerns them, may also be strongly suicidal ideation, a trained mental o Evaluating the risk of suicide affected and need PFA. health provider should evaluate them o Offering empathic support • Approach calmly and immediately or EMS should be o Ensuring safety promote calmness. activated. o Maintaining contact • Speak clearly and softly. • Acknowledge the event. • Express concern. • Listen with empathy and accept the feelings shared. • Offer practical help. • Be direct: ask about and talk openly about suicidal thoughts. • Evaluate the suicidal threat, as well as the threat to you and others. • Respect privacy but do not promise confidentiality. Never agree to keep a plan for suicide a secret. • Provide honest and reliable information. • Promote contact with loved ones or other social support.

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 63 Click for Index

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations

• Collaborate on problem solving. • Encourage professional help and/or take immediate actions (e.g., removing dangerous objects) when suicidal threat or threat to others seems imminent to ensure the person's safety, your safety, and safety of others. Undertake necessary actions supportively. • Avoid leaving a person who is actively suicidal alone. Ask the person’s relatives or friends to accompany them to the hospital or other medical facility, or notify EMS. • Remember the following points: o People do not all react at the same time or in the same way to a critical incident. o Some people are calm and do not react strongly at the time of an event, but may have strong reactions later.

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 64 Index

2020 Education Topics Clinical Blended Learning, p. 8 1.0 General Approach Dental Avulsion, p. 41 Feedback Devices, p. 13 De-escalation Techniques, p. 20 Fractures, Sprains, and Strains, p. 40 First Aid Education for Children, p. 6 Oxygen Administration, p. 20 Friction Burns, p. 36 Gamification, p. 10 Head and Spine Injury, p. 38 Media, p. 9 2.0 Medical Motivation to Learn First Aid, p. 6 Abdominal Pain, p. 26 4.0 Environmental Online Learning (Adults), p. 7 Asthma Attack, p. 23 Altitude, p. 45 Online Learning (Children), p. 8 Back Pain, p. 30 Decompression Illness, p. 45 Peer Learning, p. 11 Breathing Difficulties, p. 22 Frostbite, p. 46 Refresh and Retrain, p. 14 Croup, p. 24 Hyperthermia, p. 42 Video Learning, p. 12 Chest Pain, p. 24 Hypothermia, p. 41 Dehydration, p. 26 Radiation Injuries, p. 44 Snow Blindness, p. 42 Contexts for Learning Diabetic Emergency, p. 34 Earache, p. 28 Conflict, p. 15 5.0 Animal-Related Injuries Feeling Faint, p. 27 Disaster, p. 15 Insect Bites and Stings, p. 48 Mass Casualty, p. 16 Fever, p. 30 Marine Animal Injuries, p. 47 Public Health Emergency, p. 18 Headache, p. 29 Snake Bites, p. 49 Hiccups, p. 29 Remote, p. 18 6.0 Resuscitation Water Safety (Aquatics), p. 17 Motion Sickness, p. 35 Poisoning, p. 22 AED, p. 57 Seizure, p. 32 Choking (FBAO), p. 50 Shock, p. 34 CPR, p. 51 Sore Throat, p. 28 Adult, p. 53 Stroke, p. 25 Child, Infant, and Neonatal, p. 55 Unresponsiveness, p. 26 Narcotic Poisoning, p. 59 3.0 Injury 7.0 Psychological First Aid Abrasions/Wounds, p. 37 Suicidal Ideation, p. 63 Bleeding, p. 38 Traumatic Event, p. 60 Burns, p. 36 Chest Injury and Abdominal Injury, p. 39

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 65 The Canadian Red Cross Society (CRCS) has made reasonable efforts to ensure the contents of this publication are accurate and reflect the latest in available scientific research on the topic as of the date published. The information contained in this publication may change as new scientific research becomes available. Certain techniques described in this publication are designed for use in lifesaving situations. However, the CRCS cannot guarantee that the use of such techniques will prevent personal injury or loss of life.

Copyright © 2020 The Canadian Red Cross Society ISBN: 978-1-55104-914-4