Talk:First Aid/B for Breathing

Image request
The image that was on this page to show a proper breathing check doesn't. The head-tilt chin-lift wasn't maintained during that breathing check. Does anyone have a picture showing a good breathing check maintaining an open airway? Mike.lifeguard 16:12, 19 June 2007 (UTC)

O2 Claim
The following was removed as a dubious claim, especially considering that ILCOR's paper claims that O2 isn't proven to be effective. A patient whose lungs are full of pure oxygen can stay in apnea for nearly 30 minutes (half an hour). Thus, pure oxygen is a great help which will allow you to perform urgent duty and leave the patient for a few minutes if necessary. Mike.lifeguard 16:17, 19 June 2007 (UTC)

proposed chapter for advanced topics
I really like using D for Deadly Bleeding, as it reinforces that there needs to be a "wet check" (aka "gross blood check" or "Rapid Body Survey"). How do we feel about using D for that, and finding another way to integrate AED in another section. We could have a chapter on more advanced aspects of first aid, such as AED and O2 (which is currently included in B for Breathing, which I don't like)?? So AED and O2 (and possibly some other stuff) would get moved to a chapter called "Advanced First Aid Topics" or something, and D would turn into a section on deadly bleeding, which would remove that section from External Bleeding. Comments? Mike.lifeguard 01:33, 24 June 2007 (UTC)


 * ILCOR's protocol is clearly to use D for defibrillation as part of BLS, so we should use this, as we are keeping the entire book based on their procedures. Owain.davies 20:35, 13 July 2007 (UTC)


 * (Copied from MLs talk page) As for D for defibrillation, they do advocate further training, but they also clearly give ABCD with the D as defibrillation : See Part I: Introduction of the ILCOR protocol, under "The Universal Algorithm".  Even the title suggests that they are trying to get this adopted by everyone.  As we are following ILCOR so far as possible, there really is no option but to use this variant!  Owain.davies 08:19, 14 July 2007 (UTC)

B for breathing
I've been back and checked, and the protocols i added there are definitely correct. The two rescue breaths were dropped in the last revision, as there is no clinical requirement for them - once cardio-respiratory arrest had taken place, the gases are stuck where they are (because no respiration can take place whilst there is no blood or pulmonary movement! - i.e. the blood is still full of oxygen until circulation and breathing start again.)

Rescue breaths are only appropriate for trauma and paeds. In children, they are more likely to enter respiratory arrest only, making the use of breaths first to stimulate them to breathe on their own appropriate. For trauma, due to the mechanism, the gases are likely to be used up as the body struggles to keep going. For this reason, the number was upped to five.

As for the hand on the chest, i find that to be the most reliable of the indicators for breathing when in a stressful situation.

On that basis, i have reverted back to my edits (although fixed the spelling!)

Owain.davies 17:08, 11 July 2007 (UTC)


 * Your rationale may or may not be legitimate, but is totally irrelevant. Resuscitation is not defined by either of us. As I noted on your talk page, ILCOR LSS and AHA disagree with the protocols you've put here. I need to see a citation - then we can think about including it. I've reverted to a previous edit; please don't add these protocols again without a good citation and discussion with other editors. I will do this shortly, but I have to run for a few minutes.  – Mike.lifeguard  | talk 17:14, 11 July 2007 (UTC)


 * Done  – Mike.lifeguard  | talk 17:20, 11 July 2007 (UTC)


 * So apparently the UK didn't go along with ILCOR. The point of this text is that it's international in nature - the main protocols should be from ILCOR, and the ones you sent to me (btw do you have a link so everyone else can see that pdf?) should be included as regional differences. Feel free to make a separate section for them, or use . Note that those standards come from the Red Cross and SJA of the UK only.  – Mike.lifeguard  | talk 01:02, 13 July 2007 (UTC)

ILCOR/AHA only, or include regional standards?
Owain.davies, let's finish discussing this issue before making changes. I reverted to the previous version, which is correct - it includes ERC and ILCOR/AHA protocols. The issue here is whether we're going to go strictly by what ILCOR says or whether we're going to include notes about regional differences. I think it's entirely appropriate to include regional differences from ILCOR's protocols. However, you seem to be misinterpreting the CoSTR. As you know, the AHA hosted the conference in Dallas; they also interpreted the standards. Instead of a dense technical paper aimed at the resuscitation community, the AHA published a concise interpretation aimed at those implementing the changes.

The only citation you gave for ILCOR wanting EMS to be called after checking breathing is the diagram for the universal algorithm. Unfortunately, the text of the document contradicts the algorithm on that exact issue. Luckily for us, we don't have to guess at whether the diagram is correct or whether it's an oversimplification and instead we're supposed to implement what's in the text of the paper. The AHA has already done that for us, and it turns out that the universal algorithm you cited was an oversimplification.

It should be noted that the CoSTR is not technically a set of protocols - the ERC went in a different direction on several major points, which is their right. And those differences are highlighted for people in those areas. So far as I know, the rest of the ILCOR member councils followed ILCOR's lead though. It makes sense that the modules should reflect the consensus (from ILCOR, as interpreted by AHA if need be) and any deviation from that (ERC standards) should be highlighted in boxes as is done currently. I don't see how that's a problem.  – Mike.lifeguard  | talk 01:52, 17 July 2007 (UTC)


 * I can't find anywhere in the text that contradicts it (except for paeds where summon ems comes after a round of CPR). The AHA, ERC and the others all make their own decision based on ILCORs consenus.  I think that including regional variations is confusing for any potential rescuers as it intimates that you should do things differently in different places (and also weakens the rationale for any given procedure).  For that reason, i think you were right in the first place, and we should undertake to follow the original ILCOR text (regardless of whether adopted by all or any of the member councils), as these guidelines will be good, understandable and based on sound science, without confusing any potential reader.


 * On this basis we should:


 * Change to D for defibrillation
 * Move to Call for help after unconscious and call for ems after breathing (except paeds)
 * Keep the 2 initial breaths in for adults


 * If we keep within one set of protocols, we can manage a clear document, based on the outputs of the highest authority (rather than regional variations). Owain.davies 06:39, 17 July 2007 (UTC)


 * Here's one contradiction, on the same page:


 * You'll notice that EMS comes before CPR for adults and after CPR for children and infants.
 * They also noted on the same page that the Universal Algorithm diagram is not to be taken literally:


 * They also require training for AED use by lay responders, which would require keeping in Advanced Topics:


 * If you want to follow what ILCOR's paper recommends, I suggest you read it in-depth, since you've already made several errors of fact.
 * Change to D for defibrillation Not supported by ILCOR
 * Move to Call for help after unconscious and call for ems after breathing (except paeds) Also not supported by ILCOR
 * Keep the 2 initial breaths in for adults ✅
 * That's what we have already. If you want to keep ERC protocols, go ahead - I think it's a good idea. But now that you've pushed so hard to accept only what ILCOR's paper says, I'm sure you'll want to throw those out the window, right??  – Mike.lifeguard  | talk 14:26, 17 July 2007 (UTC)


 * my errors of fact? let me point you in the correct direction.
 * Change to D for defibrillation - Supported by ILCOR where is says "Defibrillation is both a BLS and ALS skill"
 * Move to call for help after unconscious and ems after breathing - in black and white on the text. You're saying that EMS comes before CPR - exactly right and what i've been saying.  Before CPR, not before breathing checks. The only 'variation' it points to in the whole document is for paeds, where is CPR before calling.  The important first step to the chain of survival is 'recognition of the emergency' - i.e. you must recognise that they are not breathing before moving to stage two.  Elementary my dear Mike.
 * Keep to 2 breaths - all fine, we can agree (it's called compromise - i can see that ILCOR varies to the ERC protocol and therefore will accept it. Now if you'd just accept that ILCOR varies to your AHA protocol in some places too, we could get on with it)


 * They do intend the universal algorithm to be taken literally, with an exception for paeds. We should teach one system to avoid confusion, and keep with the ILCOR guidelines.  Stop trying to force your regional variation on it! Owain.davies 17:18, 17 July 2007 (UTC)


 * EMS: I think we're using the same words to mean different things. CPR is open airway-check breathing-2 breaths-30 compressions-repeat. You're using CPR to mean 30 compressions-2 breaths-repeat. I'm pretty sure that they want EMS to come before the BLS sequence of ABC. AHA standards don't vary from ILCOR. If you're interested, I checked in Critical Care and Resuscitation for the standards from the ANZCR, I checked the RCSA standards, I checked HSFC standards, and I checked the standards for IAHF, and they have all disagreed with your interpretation on this point. Everyone else seems to think that ILCOR's paper says to activate EMS before even starting ABCs for adults. If the founding members of ILCOR agreeing on a single interpretation (with one exception - ERC, but they didn't follow ILCOR on several major points) isn't clear enough for you to accept it, I'm not sure what would be. The only regional variation from call first is from the ERC. Since you're so committed to not including regional variations, you should delete those regional notes highlighting ERC protocols.
 * AED: AED may be part of BLS, and I think that's great. But the treatment recommendations from the CoSTR specifically say that additional training is required and go on to outline how PAD programs should be set up... which includes training of responders (Circulation Volume 112, Issue 22 Supplement; November 29, 2005; Page 18; 1st column; under Treatment Recommendations). Perhaps in light of that, we should rename the chapter to Primary Assessment & CPR for clarity. But certainly we need to recognize that specific additional training is required, and reflect that in the text.
 * 2 breaths: Keep to 2 breaths - of course. Please delete the ERC variations.
 *  – Mike.lifeguard  | talk 18:07, 17 July 2007 (UTC)


 * I've had a busy couple of weeks, so i've not been here, but i'm back and i've been doing some checking. I have to say i think you are slightly misguided.  CPR is simply the process of compressions and ventilations - it doesn't include the checking.  The ILCOR guidelines are clear (and these respected doctors and scientists don't make it up for fun).  As for the other societies, i'm having real difficulties finding their guidelines on the internet (so if you have links that would be appreciated), but i'm sceptical - ILCOR is clear and made up of the opinion of its members.  You can't reach that sort of consensus with just 1 member agreeing!  Until you can present actual evidence, the call for ambulance must stay after the breathing check. Owain.davies 07:07, 28 July 2007 (UTC)


 * The ANZCR standards are published in Critical Care and Resuscitation (you'll need to do some sort of database search - I used my university database account to gain access.
 * The AHA standards are in First Aid/Appendix C: Sources
 * RCSA standards, HSFC standards (I went from memory, as this is what I teach, but it's certainly published online somewhere), and IAHF (in Spanish, but explicitly uses AHA standards) standards are all posted on their websites.
 * ERC standards are in First Aid/Appendix C: Sources
 * Of all these member councils, only ERC calls EMS after opening the airway and checking breathing. Since the ERC didn't go along with ILCOR on several other major points, we can't even assume that their policy on this issue is an attempt to interpret the CoSTR, whereas we can say with certainty that the other councils have done exactly that, and agreed on a single interpretation.
 *  – Mike.lifeguard  | talk 12:32, 28 July 2007 (UTC)


 * I think we can assume that, given that ILCOR explicitly write it in the text! The sites you give are a bit wooly on detail, so i still say we stick with what is written as the universal algorithm. They didn't write it for fun, and they are highest authority. Owain.davies 23:18, 29 July 2007 (UTC)


 * We've already been over the universal algorithm issue. The text of the paper contradicts the diagram, and all the founding members of ILCOR except ERC agree with the text - not the diagram. I quoted the text of the paper before, and I'll do it again:


 * Again: all the founding members have that exact policy in their standards - only ERC disagrees (as is their right). I don't mind having those differences mentioned; that's why I created . The websites are not "wooly" on detail; I checked them myself - they all agree on this point:
 * AHA:


 * HSFC and IAHF collaborated with AHA on those standards, and simply reference the paper in Circulation. HSFC publishes their standards in print; IAHF standards are in Spanish, but are identical to the AHA standards, because... they are the AHA standards.
 * RCSA:


 * ANZCR: Is published in Critical Care and Resuscitation, so if you can't take my word for it, you'll have to do a database search somehow.
 * That's clear enough for me. EMS before Airway or Breathing according to ILCOR CoSTR text (although their Universal Algorithm diagram has caused confusion in some), AHA, HSFC, IAHF, RCSA, with ERC dissenting.
 *  – Mike.lifeguard  | talk 04:22, 30 July 2007 (UTC)


 * I found a poster I could copy ANZCR standards from:


 *  – <font color="Indigo">Mike.lifeguard  | <font color="Indigo">talk 04:26, 30 July 2007 (UTC)

I agree that the ANZCR and RCSA standards give to call the ambulance before checking breathing. However, that first ILCOR quote and the AHA one do not lead to believe that. It says to call before commencing CPR, not before checking breathing. CPR is ONLY the performance of breaths of compressions. This therefore backs up the universal algorithm diagram given. As for the AHA, i think they mean the same thing because you wouldn't see that the patient was unresponsive and then immediately leave to get an AED - that verges on criminal negligence. If they were able to breathe on their own and just needed their airway opened, then you've effectively just killed them by going away to get something you didn't need, where the recovery position would have been adequate.

In conclusion the ILCOR text matches the diagram perfectly, and the AHA guidance is either poorly written (because it causes confusion) or just negligent. Owain.davies 17:36, 30 July 2007 (UTC)


 * Your concern about leaving a victim with a closed airway to get an AED and activate EMS is appropriate - first aiders should move the victim into the semi-prone position so that the airway is protected while they're gone. This applies whether they're breathing or not, so checking before activating EMS is an unnecessary delay.
 * The reason I think that ILCOR meant CPR to mean what I said is that they go on to describe it that way. They say, in essence, "If your victim isn't responsive, call 911" and then go on to describe CPR as "Open the airway, check breathing..." The AHA does the same thing (including in the quote you though wasn't clear on that issue), and makes it abundantly clear in their candidate- and instructor-level resources (for example, the ones posted in First Aid/Appendix C: Sources) The quote I gave from the AHA above says "The lone rescuer should telephone the emergency response system and retrieve an AED (if available). The rescuer should then return to the victim... The lay rescuer should open the airway and check for normal breathing. If no normal breathing is detected, the rescuer should give 2 rescue breaths. Immediately after delivery of the rescue breaths, the rescuer should begin cycles of 30 chest compressions and 2 ventilations." Does that not clearly mean that they want rescuers to call EMS, then open the airway, check for breathing and (if the victim isn't breathing normally) give 2 rescue breaths?? I think it does mean that.
 * The ILCOR text only matches their diagram because you're misreading it that way. Similarly, you've misread the AHA's position; they've endorsed all the programs which have produced the resources I'm going from - resources which make this issue abundantly clear. Again, all the founding members except ERC thought that the CoSTR wanted EMS to be activated before starting ABCs, so the most of the experts responsible for interpreting the document agree with what I've been saying here.
 *  – <font color="Indigo">Mike.lifeguard  | <font color="Indigo">talk 16:17, 5 August 2007 (UTC)


 * Without meaning to be flippant, do you think it is more likely that the highly learned doctors and scientists of ILCOR released this paper with the consistent message which i am reading out of this document (and you still haven't come up with any repudiation of from the ILCOR document itself) or do you think its more likely that this respected, pier reviewed group decided to give two different sets of instructions in their paper! Even less likely is that this is an oversight (as it would have been picked up and ammended as one of the published erratum).  I'm sorry Mike, but the ILCOR document follows my interpretation only.  If some of the member societies chose to ignore this part (as they chose to ignore other parts) then so be it, but the ILCOR guideline is unequivocal. Owain.davies 18:19, 7 August 2007 (UTC)
 * Your own words, in discussing how-tos concerning CPR on Wikipedia (emphasis mine):

"Strongly Disagree - Wikipedia is not an instruction manual, nor does it need to link to one at the top of the page. The first action for anyone witnessing cardiac arrest is calling an ambulance. The ambulance controller will talk them through CPR - far more effective than running back to your computer screen. I can't imagine anyone looking up CPR in wikipedia as the first thing they do if someone they know collapses. Owain.davies 09:47, 17 June 2007 (UTC)"


 * – <font color="Indigo">Mike.lifeguard  | <font color="Indigo">talk 21:29, 19 September 2007 (UTC)


 * That, of course, is for someone who is not trained in first aid! The question there surrounded whether someone might run to their computer for first aid instructions, rather than the phone when they realise the person is not breathing or not well.  The first aider should always be opening the airway and checking breathing before calling an ambulance.  This is still the ILCOR position, and isn't likely to change until the next revision (2010 i believe).  Owain.davies 06:48, 20 September 2007 (UTC)