Training Links. New AHA Guidelines: Summary of Key Issues & Major Changes in First Aid. Inside this issue:

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1 Training Links Inside this issue: New AHA Guidelines: Key First Aid Changes Training to Save Lives in North Carolina Mixed Results for Stroke Outcomes in the U.S. AHA News for Instructors! Right Place / Right Time: A Choking Child Saved Most People Want to Help! TCLS Training Center News New AHA Guidelines: Summary of Key Issues & Major Changes in First Aid The use of stroke assessment systems can assist first aid providers with identifying signs and symptoms of stroke. While glucose tablets are preferred for care of mild hypoglycemia, they may not be readily available. In these cases, other forms of sugar found in common dietary products have been found to be acceptable alternatives to glucose tablets for diabetics with mild symptomatic hypoglycemia who are conscious and are able to swallow and to follow commands. It is acceptable for a first aid provider to leave an open chest wound open and uncovered. If a dressing and direct pressure are needed to control bleeding, care should be taken to ensure the dressing does not inadvertently convert to an occlusive dressing. There are no single-stage concussion assessment systems to aid first aid providers in the recognition of concussion. When re-implantation of an avulsed tooth will be delayed, temporary storage of the tooth in an appropriate solution may help prolong viability of the tooth. When caring for an unresponsive person who is breathing normally, and in the absence of major trauma such as to the spine or pelvis, placing the person into a lateral, side-lying position may improve airway mechanics. The modified High Arm in Endangered Spine (HAINES) recovery position is no longer recommended. The recommendations still state that while awaiting the arrival of EMS providers, the first aid provider may encourage a person with chest pain to chew aspirin if the signs and symptoms suggest that the person is having a heart attack and the person has no allergy or contraindication to aspirin, such as recent bleeding. Epinephrine is recommended for the life-threatening condition of anaphylaxis, and those at risk typically carry epinephrine auto-injectors, often as a 2-dose package. When symptoms of anaphylaxis do not resolve with an initial dose of epinephrine, and EMS arrival will exceed 5 to 10 minutes, a second dose of epinephrine may be considered. The primary method to control bleeding is through the application of firm, direct pressure. When direct pressure is not effective for severe or life-threatening bleeding, the use of a hemostatic dressing combined with direct pressure may be considered but requires training in proper application and indications for use. Use of cervical collars by first aid providers is not recommended. For injured persons who meet high-risk criteria for spinal injury, the ideal method for a first aid provider to help prevent movement of the spine requires further study but may include verbal prompts or manual stabilization while awaiting arrival of advanced care providers. Topics covered in the 2015 Guidelines Update that have no new recommendations since 2010 include the use of bronchodilators for asthma with shortness of breath, toxic eye injury, control of bleeding, use of tourniquets, treatment of suspected long bone fractures, cooling of thermal burns, burn dressings, and spinal motion restriction. ~~American Heart Association / American Red Cross:

2 Statewide Training on Cardiac Arrest Saves Lives in NC March 23, 2016 (HealthDay News) -- A North Carolina program to increase bystander action in cases of cardiac arrest saved lives and reduced brain damage among survivors, a new study shows. The statewide program trained family members and the general public to recognize the signs of sudden cardiac arrest and to perform CPR and use automated external defibrillators (AEDs). "You can do something," said study author Dr. Christopher Fordyce, of the Duke Clinical Research Institute in Durham, N.C. "You don't have to just call 911 and stand while your loved one is on the floor. Start chest compressions immediately. Your actions actually make a difference." Cardiac arrest is the sudden loss of heart function in someone with or without known heart disease, according to the American Heart Association. The North Carolina study found that the rate of bystander CPR for cardiac arrests that occurred in public places rose from 61 percent in 2010 to more than 70 percent in And, the rate of bystander CPR for cardiac arrests that occurred in homes rose from just over 28 percent to just over 41 percent. In-home defibrillator use by bystanders rose from about 42 percent to more than 50 percent. There was no increase in AED use in public places, likely due to timely defibrillator use by emergency medical service personnel, according to the study authors. Meanwhile, rates of patients who survived until they left the hospital rose from about 11 percent to nearly 17 percent for public cardiac arrests, and from less than 6 percent to 8 percent for in-home cardiac arrests. Gains in brain function were reported as well. Rates of patients who had minor or no loss of brain function rose from almost 5 percent to slightly more than 6 percent for in-home cardiac arrests, and from 9.5 percent to close to 15 percent for public cardiac arrests, the researchers said. "The absolute rates are small, but the relative changes were pretty large. That's only over five years, so if we continue to educate the public, we can continue to improve outcomes," Fordyce said in a cardiology meeting news release. "What's interesting about this study is it's the first time a statewide intervention has improved both public and residential cardiac arrest outcomes," he noted. Each year, more than 420,000 out-of-hospital cardiac arrests occur in the United States, the researchers said. ~~Robert Preidt, HealthDay Reporter U.S. Stroke Hospitalizations Drop Overall, but Increase for Young People and African-Americans DALLAS, May 11, 2016 Nationwide, fewer people overall are being hospitalized for ischemic strokes, which are caused by artery blockages, but among young people and African-Americans, stroke hospitalizations are rising, according to new observational research in Journal of the American Heart Association, the Open Access Journal of the American Heart Association/American Stroke Association. Between 2000 and 2010, the number of adults admitted to US hospitals with ischemic stroke fell 18.4 percent, according to researchers who analyzed a national database which collects information on about 8 million hospital stays each year. Ischemic strokes are the most common type of stroke. Overall, the hospitalization rate is down, with the greatest drop in people aged 65 and older. We can t say from this study design what factors have led to this decline, but it may be that preventive efforts, such as better Continued on page 4 Page 2 Training Links

3 News You Can Use! Transition to 2016 Heartsaver Courses & Materials Effective June 28, 2016, only new course materials can be used for conducting all Heartsaver courses. Training Centers and Instructors may continue to use previous stock and all Heartsaver interim materials posted on the AHA Instructor Network through June 27, Appropriate course completion cards must be issued for the course materials being used. Please review the official Heartsaver Training Memo for additional information. Q: What are the reading levels of the American Heart Association course materials? A: American Heart Association creates ECC courses for people with a variety of reading levels: COURSE GRADE LEVEL Family & Friends CPR 3 Heartsaver courses 5 BLS 8 PEARS 8-10 ACLS 10 PALS 10 ACLS EP 12 Open Resource Exams in 2015 Guidelines Courses As part of new education methodologies, the AHA has adopted an open resource policy for exams administered in AHA CPR and ECC courses. Open resource means that students may use resources for reference while completing the exam. Resources could include the course provider manual either in printed form or as an ebook on personal devices, any notes the student took during the provider course, the 2015 Handbook of ECC, the 2015 AHA Guidelines Update for CPR and ECC, posters, etc. Open resource does not mean open discussion with other students or the Instructor. For more information on open resource exams, please view the 2015 Guidelines Open Resource Exam FAQ, posted on the AHA Instructor Network in the Additional Tools > Training Updates section. New BLS Exam The new exam for BLS was distributed to all BLS TC Coordinators of record on February 16. BLS Instructors must obtain the new exam from their TCC. TCCs have been provided information on new exam features. Guidance for administering the new exam is provided in the new BLS Instructor Manual. Q: Is there a time limit for students to complete course exams? A: Since exams administered are usually for employment purposes, to help ensure equality for all students who take AHA exams, the AHA does not mandate a time limit for completion. This does not mean that students should be given unlimited time to complete course exams. The amount of time allotted for taking the course exam can be determined by the AHA Instructor and/or Training Center monitoring the exam process. The course Instructor/Training Center can determine whether a student either does not know the information or may need additional time to successfully complete the exam. Additionally, the AHA has considered the Americans with Disabilities Act (ADA) in the decision not to mandate a course exam time limit. The ADA ensures that individuals with disabilities have the opportunity to fairly compete for and pursue such opportunities by requiring testing entities to offer exams in a manner accessible to persons with disabilities; when needed testing accommodations are provided, test-takers can demonstrate their true aptitude. When a testing entity provides additional time to a student taking an exam, the entity must do so without either advantaging or disadvantaging any student, disabled or non-disabled. Page 3

4 Our Training Sites TCLS Training Virginia Beach EMS The Beat Goes On VA EMS Training Group TCLS Advisory Board L. D. Britt, MD, MPH, Chair, Chairman, EVMS Dept. of Surgery Richard V. Homan, MD, Dean, EVMS Francis L. Counselman, MD, Chairman, EVMS Dept. of Emergency Medicine Phyllis Hope, MD, PALS Medical Director Richard A. Craven, MD, ACLS Medical Director Jeff McPherson, Chair, Training Site Committee David E. Huband, Associate Dean for Business Management, EVMS Mark R. Babashanian, Vice President of Administration and Finance, EVMS Stewart W. Martin, MD, President, Tidewater EMS Council James M. Chandler, Advisory Board Secretary and Center Director School Bus Driver Saves Choking Student MANNFORD, OK, 4/15/16 A school bus driver and teacher s assistant here saved a 5 -year-old student from choking with the Heimlich maneuver and is being hailed a hero. School bus surveillance video shows the boy turning red and gasping for air while Ginger Maxville is behind the wheel. She told KTUL that at first she thought he was teasing her and refusing to sit down, but she soon realized that something was wrong. The boy s sister told Maxville that he swallowed a coin, and Maxville quickly jumped into action. She explained to the news source that she secured the bus and started performing the Heimlich maneuver on the boy, and he coughed up a penny. Maxville added that this is the first time in 17 years that she has used the skills she learned during CPR training. She is being called a hero by many, but Maxville said that keeping students safe is part of her job, according to the news source. She also told KTUL that the boy asked to keep the penny, and she gave it back to him after he promised to never swallow another coin again. Dr. Steve Waldvogel, the superintendent of Mannford Public Schools, told ABC News that the video had been sent around the district so his staff would know what to do in a similar situation. He added that the video spoke volumes for Maxville s character, and We just try to find the best people and we ve got one. Facebook Twitter Google+ Mail U.S. Stroke Hospitalizations (con t) Continued from page 2 blood pressure and blood sugar control, are having the effect that we want in this age group, said Lucas Ramirez, M.D., neurology resident at the Keck School of Medicine at the University of Southern California in Los Angeles. However, while the hospitalization rates fell 28 percent in people aged and 22.1 percent in those 85 and older, there was an increase in younger adults up 43.8 percent in people aged 25 to 44 and up 4.7 percent in those aged Age-adjusted hospitalizations for ischemic stroke declined in both whites (down 12.4 percent) and Hispanics (down 21.7 percent) between 2000 and 2010, but they increased 13.7 percent in African Americans. African Americans already had the highest rate of stroke hospitalizations and it has unfortunately increased. This reinforces that we need to make sure that our efforts for stroke prevention and education reach all groups, Ramirez said. As expected, based on previous studies the 2000 to 2010 data showed that women have lower age-adjusted rates of stroke hospitalization and experienced a steeper decline during the decade (down 22.1 percent) than men (down 17.8 percent). Co-authors are May A. Kim-Tenser, M.D.; Nerses Sanossian, M.D.; Steven Cen, Ph.D.; Ge Wen, M.S.; Shuhan He, M.D.; William J. Mack, M.D. and Amytis Towfighi, M.D American Heart Association Rapid Access Journal Report Page 4

5 Most Americans Want to Learn How to Help Those Injured in Disasters April 5, 2016 (HealthDay News) -- Many Americans would take a class to learn how to stop or control bleeding to help victims of shootings, accidents or other emergency situations, a new survey suggests. The telephone poll of more than 1,000 civilians nationwide was conducted in November More than four out of five people said they'd be interested in taking a class to learn how to stop bleeding from an injury. Almost half had already received first aid training. Thirteen percent of that group had trained in the past two years and 52 percent said they had trained in the past five years, the poll showed. People aged 50 to 64 were most likely to have had first aid training (57 percent). Younger people -- those aged 18 to were the least likely (37 percent). Of those who had first aid training, 72 percent said the training included how to control severe bleeding. Among respondents with first aid training, 98 percent said they would be very or somewhat likely to attempt to control severe bleeding from a leg wound in a family member. A random sample of respondents found that 61 percent would be very likely and 31 percent somewhat likely to try to stop severe bleeding in a car crash victim they didn't know. The survey results were published online recently in the Journal of the American College of Surgeons. "We know that to save life and limb, you need to stop the bleeding very early, within five to 10 minutes or victims can lose their lives," Dr. Lenworth Jacobs Jr., director of the Trauma Institute at Hartford Hospital in Connecticut, said in a college news release. "However, until now, there has been no clear indication of how well trained the general public is in bleeding control and how willing they might be to participate as immediate responders until professionals arrive on the scene," added Jacobs. He is also chairman of an American College of Surgeons Committee examining how to improve survival rates in mass casualty events. Another random sample from the poll found that 75 percent of respondents said they would try to give first aid in a mass shooting situation if it seemed safe to act, 16 percent said they would stay and wait to see what happened, and 8 percent said they would leave the area. If the situation was safe, 62 percent said they'd be very likely and 32 percent said they'd be somewhat likely to try to stop bleeding in someone they didn't know. Many respondents said they had concerns about trying to control bleeding in a person they didn't know. Some of those concerns included causing the victim additional pain or injury (65 percent), the risk of catching a disease (61 percent), causing a bad outcome (61 percent), personal safety (43 percent) and the sight of blood (30 percent). Despite those concerns, 82 percent of physically able respondents said they would be very or somewhat interested in taking a two-hour bleeding control course. There was also strong support for placing bleeding control kits (gloves, tourniquets, compression dressings) in public places. "Moving forward, we plan to use these new insights to develop a training program for the public, not health care professionals, so civilians can learn how to act as immediate responders. We want to steer interested people toward getting the right training, and to understand when victims are experiencing the signs of massive bleeding so they can 'stop the bleed' and save lives," Jacobs said. By Robert Preidt, HealthDay Reporter We are very pleased to announce that the American Heart Association has renewed the Training Center agreement with Tidewater Center for Life Support for another 2 years! AHA Regional Faculty Sharon Brooks observed a new BLS Provider course taught by TCLS Instructors Kyle Bosiljevac [Center Faculty] and Deana Kilber [Regional Faculty]. TCLS received a 100% rating by Ms. Brooks! Perfection is not attainable, but if we chase perfection, we can catch excellence. -Vince Lombardi Page 5 Training Links

6 Smith Rogers Hall 358 Mowbray Arch Norfolk, VA Phone: Fax: Staff and BLS/TC Coordinator Gordon Degges ACLS/PALS Sasha Edwards ATLS/Center Director Jim Chandler Administrative Support Specialist Rhonda Coffman, Registration Coordinator--Myra Forbes We re on the Web Visit us on facebook! Vendors for AHA Materials TCLS Training maintains a limited supply of instructor and student manuals, masks and other supplies for ECC courses. Instructors are always welcome to purchase materials directly from vendors, particularly when bulk quantities are needed. Cards are only available from TCLS or your training site coordinator. For ECC training materials, contact one of these approved AHA vendors. Channing L. Bete Co, Inc. 200 State Road South Deerfield, MA Phone: Fax: ww.channing-bete.com Laerdal Medical Corporation PO Box 1840 Wappingers Falls, NY Phone: LMC-4AHA ( ) Fax: WorldPoint ECC 151 S. Pfingsten Rd Ste E Deerfield, IL Phone: x116 Christina Balestri Waverly Hispanica, SA (Spanish and Portuguese) Buenos Aires, Argentina Telephono y Fax: (5411)