American Heart Association Training Centers and Instructors

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1 Training Memo: Heartsaver First Aid nline With CPR and AED Renewal National Center 7272 Greenville Avenue Dallas, Texas Tel 888-CPR-LINE americanheart.org/ecc DATE: March 23, 2007 T: American Heart Association Training Centers and Instructors Purpose This memo explains the Heartsaver First Aid nline With CPR and AED Renewal skills session. This session is designed to give the student the opportunity to review and practice first aid skills and be tested on CPR and AED skills. Background Heartsaver First Aid nline With CPR and AED Renewal is designed as a flexible way to learn and practice the skills of first aid, CPR, and AED. The course is designed to include CPR and AED renewal. Students should be renewing and not taking CPR and AED skills for the first time. Prior first aid training is not necessary. Students complete the online portion and bring the completion certificate to the skills session. Skill sessions must be completed within 60 days of completion of the online part of the course. Instructor Requirements Any current BLS or Heartsaver instructor aligned with a BLS Training Center may conduct the skill sessions. Instructor Preparation Instructor preparation is essential for this skills session. Instructors will not be teaching during the session, but students may have questions about the course content. Because instructors should be able to answer questions, it is highly recommended that any instructor conducting these skill sessions review the online course in advance, using either a student key (purchase required) or the demonstration version available online. Lesson Maps The lesson maps are similar to those for other Heartsaver courses. It is important that instructors be familiar with these lesson maps to ensure a successful session. Use the Heartsaver First Aid nline With CPR and AED Renewal course lesson maps included with this training memo. Required and ptional Skills The session has required and optional skills in first aid, CPR, and AED. Student practice is an important component of the course. Students with limited previous CPR training should be offered an optional practice opportunity using Lesson Maps

2 8A through 8D before being tested on CPR and AED. All students must practice Head tilt chin lift Finding the Problem Controlling Bleeding, Treating Shock, and Removing Gloves Using an Epinephrine Pen Adult/Child Choking Tested Skills Adult/Child CPR and AED, Using Heartsaver CPR Testing Checklist ptional skills are Bandaging Splinting Infant CPR Room Requirements You can teach 2 students per instructor. The room should comfortably accommodate students with enough floor space for 1 student to play the victim and with additional space for tables and chairs. Floors should be padded or padding should be available. Multiple skill practice sessions with additional instructors may be set up in the room if space is adequate. Equipment The following table lists the equipment for the Heartsaver First Aid nline skills practice session. Use the equipment checklist on the Heartsaver instructor CD as you set up the course to make sure you have all the equipment you need for the course. First Aid Skills Pair of latex-free gloves Epinephrine pen trainer A small stack of gauze pads (4 4 inches) 1/student 1/every 2 students 1/every 2 students 1 bandage (roll of gauze) optional 1/every 2 students 1 biohazard bag 1/every 2 students 1 sheet, blanket, or other cover 1/every 2 students 1 item about 12 inches high to support legs 1/every 2 students 1 item such as cardboard or a magazine for splinting optional 1/every 2 students Training Memo: Heartsaver First Aid nline With CPR and AED Renewal, March 23,

3 CPR and AED Skills Adult manikin AED trainer Infant manikin optional Adult mask Infant mask optional 1-way valve Manikin spare lung and manikin wipes 1/every 2 students 1/adult manikin 1/every 2 students 1/every 2 students 1/every 2 students 1/student varies Course Completion Requirements The first aid skills to be practiced are listed on the accompanying Heartsaver First Aid Skills Review sheet. First aid skills are performed by pairs of students, or if there is one student, the instructor takes the role of the victim. There are no absolute pass or fail criteria for how a student performs a first aid skill. All attempts at performing first aid skills are considered satisfactory. Instructors may offer feedback and coaching to students, but remediation or retaking a skills check because of errors is not required. To receive a course completion card, students must pass the CPR and AED skills tests by successfully demonstrating competency in these skills: Adult/Child CPR Infant CPR Use the Heartsaver CPR AED Testing Checklist for skill testing. Instructors offer feedback and coaching to students for immediate remediation or, if necessary, arrange for a second skills check at a later date. Course Card A Heartsaver First Aid With CPR and AED course completion card is issued when the student successfully completes the online course and the CPR and AED testing. Completing the Course Roster Instructors will submit a Heartsaver First Aid course roster to their Training Center for issuance of course cards. The online completion certificate or copy and the skill sheet may be submitted along with the roster if the Training Center requests. Instructors should consult their Training Center Coordinator for further guidance and instructions on submitting course rosters. March 23, 2007 Training Memo: Heartsaver First Aid nline With CPR and AED Renewal, March 23,

4 PRE A Prior to Session Resources: HS FA nline access key unless obtained by student Student precourse letters Student Role: Register for session Complete the online course Student bjectives: Become familiar with course content Your Role: Determine course specifics ptional skills Number of students Special needs or equipment Reserve equipment Schedule room Schedule additional instructors if needed Send students precourse letter from Instructor CD Confirm additional instructors Review the HS FA online course or demo version in advance REFERENCE: Instructor Manual p, Instructor CD Demo:

5 PRE B Day Prior to Session Resources: Required equipment Recommended equipment Student Role: Your Role: Set up room Coordinate assignments with additional instructors if needed Use equipment checklist to ensure that all equipment is available and working Ensure that all course paperwork is in order Student bjectives: Reference: Instructor Manual p, Instructor CD

6 PRE C Day of Session Resources: Required equipment Recommended equipment Student Role: Meet instructors Your Role: Greet students as they arrive Fill out course roster Assign students to pairs Be prepared to pass out HS FA Student Review Guide if students ask you for it (available in the Training Memo, pages - ) Student bjectives: REFERENCE: Instructor Manual p, Instructor CD, AHA Instructor Network

7 START Welcome 0:00 1:00 Resources: Student Role: Introduce self Your Role: Introduce instructors Explain housekeeping issues, including restrooms Explain that the course is somewhat strenuous; ask to advise if anyone has a medical concern, such as knee or back problems Tell the students: The session will last approximately 1 hour Student bjectives: Know course instructors and students Know course logistics Reference: none

8 1 Head tilt Chin lift Practice 0:00 2:00 Resources: Manikin with movable head Student Role: Follow along in HS FA Student Review Guide Your Role: Introduce session: In this station you will practice opening the airway with a head tilt chin lift. Read the scenario to each student Have students practice opening the airway with a head tilt chin lift Student bjectives: Demonstrate opening the airway with a head tilt chin lift Reference: FA Student Workbook, First Aid Basics

9 2A Finding the Problem Practice 0:00 8:00 Resources: Heartsaver First Aid nline Skill Sheet Student Role: Listen to scenario Practice the skill Follow along in HS FA Student Review Guide Your Role: Assign students into pairs Tell students to use their emergency response number (or 911) during practice Introduce session: In this station, you will practice helping a victim who is sick or hurt. Read the scenario from the Heartsaver First Aid nline Skill Sheet to the student Students practice finding the problem Student bjectives: Show how to find what the problem is Reference: FA Student Workbook, First Aid Basics

10 2B Finding the Problem Practice Practice Session Details Do Not re-demonstrate skills Do Not lead discussion Students practice in pairs Student 1 role-plays victim who does not respond but is breathing Student 2 role-plays rescuer Students switch roles so that each student has a chance to be the rescuer. Instructor may need to play the role of the victim.

11 3A Controlling Bleeding, Treating Shock, and Removing Gloves 0:00 6:00 Resources: Gauze pads Gloves Biohazard bag Blanket Box to elevate legs Heartsaver First Aid nline Skill Sheet Student Role: Follow along in HS FA Student Review Guide Student bjectives: List the first aid actions for bleeding you can see Your Role: Introduce session: In this station you will practice controlling bleeding, treating shock, and removing gloves. Read the scenario from the Heartsaver First Aid nline Skill Sheet to the student Have students practice stopping bleeding you can see and then demonstrate steps for shock Students practice taking off gloves and disposing of gloves in biohazard bag Give positive and corrective feedback Tell students to verbalize about gloves and scene safety from now on in the course (gloves do not have to be worn) Reference: FA Student Workbook, Injury Emergencies, Medical Emergencies, and First Aid Basics

12 3B Controlling Bleeding, Treating Shock, and Removing Gloves Practice Session Details Students must acknowledge scene safety and gloves. Students practice in pairs. First student has simulated cut on forearm. Second student: Applies gauze and pressure to cut on arm (blood soaks through gauze) Applies more gauze and continues pressure Has injured student lie down Elevates legs (unless painful) Applies blanket Properly removes gloves and verbalizes (or does) proper disposal in biohazard bag Students switch roles and repeat. Instructor may need to play the role of the victim

13 4A PT ptional Bandaging Practice Resources: Gauze pads Bandages Heartsaver First Aid nline Skill Sheet Student Role: Practice bandaging Student bjectives: Show how to put on a bandage 0:00 4:00 Your Role: Have students practice putting a bandage on a partner Tell students where the injury is, such as the forearm REFERENCE: FA Student Workbook, Injury Emergencies P T I N A L

14 4B PT ptional Bandaging ptional Practice Session Details P This is an optional practice lesson on bandaging. Resources: Gauze pads and bandages First student has simulated cut on forearm. Second student: Uses gauze and pressure to stop the bleeding Uses bandage to wrap the forearm and hold the gauze in place Students switch roles and repeat. T I N A L

15 5A Epinephrine Pen Practice 0:00 2:00 Resources: Epinephrine pen trainers (1 for each pair of students) Heartsaver First Aid nline Skill Sheet Student Role: Follow along in HS FA Student Review Guide YUR RLE: Get equipment ready Pass out epinephrine pen trainers Have students pair up and practice using epinephrine pen trainers on each other Remind students that trainers do not actually have needles or inject medicine Give positive and corrective feedback Read the scenario from the Heartsaver First Aid nline Skill Sheet to the student Student bjectives: Know the signs of a bad allergic reaction Show how to use an epinephrine pen Reference: FA Student Workbook, Medical Emergencies

16 5B Epinephrine Pen Practice Practice Session Details Students must acknowledge scene safety and gloves. Students practice in pairs. First student has simulated allergic reaction. Second student uses epinephrine pen trainer on first student. Ensure the student removes safety cap and presses the correct (needle end) end into victim s thigh at the correct location. Students switch roles and repeat.

17 6A Adult/Child Choking 0:00 1:00 Resources: Manikin is optional Heartsaver First Aid nline Skill Sheet Student Role: Follow along in HS FA Student Review Guide Your Role: Introduce session: In this station, you will practice helping a choking victim. Break students into pairs Tell students to use their emergency response number (or 911) during practice Student bjectives: Show how to relieve choking in a victim age 1 year and older Reference: FA Student Workbook, Medical Emergencies

18 6B Adult/Child Choking Practice Session Details Students practice in pairs. Students practice correct hand placement for abdominal thrusts on live partner or on manikin. Assessment question is Are you choking? Carefully observe each student. Give positive and corrective feedback. Do not allow students to actually do abdominal thrusts on each other. Evaluate correct hand placement.

19 7A PT ptional Splinting Practice 0:00 8:00 P Resources: Splinting materials Heartsaver First Aid nline Skill Sheet Student Role: Follow along in HS FA Student Review Guide Student bjectives: Show the first aid actions for broken bones and sprains Your Role: Introduce session Have students practice putting a splint on a partner Tell students where the injury is, such as the forearm Reference: FA Student Workbook, Injury Emergencies, Instructor CD T I N A L

20 7B PT ptional Splinting Practice Practice Session Details P Resources: Magazines or other household products and bandages Guide the students through the practice. Students practice in pairs Students must acknowledge scene safety and gloves First student has simulated wrist injury Second student uses magazines or other household products and bandages to splint Students switch roles and repeat T I N A L

21 PRAC 8A ptional CPR Practice Session 0:00 Variable Resources: Adult manikin Infant manikin (optional) Mask with 1-way valve Decontamination supplies Student Role: Student bjectives: Your Role: Determine when the student last practiced CPR skills Ask student if they would like to practice the skills of breaths with a mask and chest compressions before being tested Allow students to practice skills as time allows Use the Lesson Maps 8B-8D for practice sessions Reference: P T I N A L

22 PRAC 8B ptional Practice: Breaths with a Mask 0:00 Variable Resources: Adult manikin Infant manikin (optional) Mask with 1-way valve Decontamination supplies Student Role: Practice giving breaths with a mask Student bjectives: Perform head tilt-chin lift Give 10 breaths using a mask Your Role: Students practice giving breaths for 1 minute Give positive and corrective feedback Emphasize visible chest rise Emphasize giving 1 breath every 6-8 seconds Reference: P T I N A L

23 PRAC 8C ptional Practice session: Compressions 0:00 Variable Resources: Adult manikin Infant manikin (optional) Decontamination supplies Student Role: Practice performing chest compressions Student bjectives: Perform compressions Show proper hand position Perform 100 compressions to correct depth without stopping Push Hard Push fast Let chest return to normal position Your Role: Students practice giving compressions for 1 minute Carefully observe each student Give positive and corrective feedback Emphasize core concepts of push hard, push fast; let chest return to normal; minimize interruptions in compressions; watch for chest rise Reference: P T I N A L

24 PRAC 8D ptional CPR Sequence Practice 0:00 Variable Resources: Adult manikin Infant manikin (optional) Mask with 1-way valve Decontamination supplies Student Role: Practice the CPR sequence for 2 minutes (5 cycles) Student bjectives: Acknowledge scene safety Check for response Check for normal breathing Phone emergency response number (or 911) Give 2 breaths Perform 5 sets of 30:2 Your Role: Make sure students acknowledge scene safety Carefully observe each student Give positive and corrective feedback Empasize core concepts of push hard, push fast; let chest return to normal; minimize interruptions in compressions; watch for chest rise Use stopwatch to familiarize students with being timed compressions Reference: P T I N A L

25 9 Adult CPR + AED Testing 0:00 10:00 RESURCES: Adult manikin AED trainer Mask with one-way valve Adult pads Child pads or child pad picture page CPR Testing Checklist Stopwatch STUDENT RLE: Demonstrate full sequence of CPR with AED YUR RLE: Carefully observe each Ss doing CPR and using AED SKILLS TEST: test Ss competency Test one Ss at a time Emphasize following AED prompts Using the CPR Testing Checklist, check off each skill as S demonstrates competency Use stopwatch to time compressions Do not coach during testing Refer Ss for remediation if test is unsuccessful STUDENT BJECTIVES: Show how to use an AED with all steps of CPR Show competency in each skill of CPR and AED REFERENCE: Instructor CD and HS FA with CPR and AED nline Renewal Training Memo

26 10 PT ptional Infant CPR Testing 0:00 10:00 RESURCES: Infant manikin Masks with one-way valves STUDENT RLE: Demonstrate full sequence of CPR STUDENT BJECTIVES: Demonstrate full sequence of CPR for infants Show competency in each skill of infant CPR YUR RLE: Carefully observe each Ss doing CPR and using AED SKILLS TEST: test Ss competency Test one Ss at a time Emphasize following AED prompts Using the CPR Testing Checklist, check off each skill as S demonstrates competency Do not coach during testing Refer Ss for remediation if test is unsuccessful REFERENCE: Instructor CD and HS FA with CPR and AED nline Renewal Training Memo P T I N A L

27 END Remediation 0:00 Variable Resources: Adult and/or infant manikin HS FA Student Review Guide Heartsaver First Aid nline Skills Sheet CPR testing Checklists Student Role: Learn skills not previously learned Practice skills Student bjectives: Demonstrate skills required for successful course completion Your Role: Determine where student is having trouble Have student practice skills to ensure learning Use Heartsaver First Aid nline Skills Sheet and CPR Testing Checklists Some students may need additional practice until they demonstrate confidence in skills performance nly students who practiced each required first aid skill and successfully demonstrate CPR and AED skills achieve a course completion card Reference: Instructor Manual p, Instructor CD, AHA Instructor Network

28 PST Post-course Activities Resources: Course completion cards Student Role: Your Role: Collect and arrange all course paperwork Rearrange room Clean and store equipment Read and consider comments from course evaluations Send students course completion cards if not already distributed Student bjectives: Reference: Instructor CD

29 Heartsaver First Aid nline Skills Review Purpose The skills review session is designed to give the Heartsaver First Aid nline student the opportunity to review and practice first aid skills Implementation The student must have completed the tutorial within the past 60 days. Heartsaver First Aid students often have varied levels of competency in first aid skills. The instructor s task is to work with students and allow sufficient time for them to practice skills. The time needed will vary from student to student. Students should practice until they demonstrate confidence in skills performance. Recommended Sequence of Review The student should practice skills in the sequence listed. The final step will be to integrate multiple skills in a scenario. Points to Remember Completion time will vary from student to student. This is not a testing session; this is skills practice. Students may repeat a skill until they are comfortable with the skill. Before Skills Evaluation Extra time may be allowed to practice the following skills: Removal of gloves Use of epinephrine pen Head tilt chin lift with breath check , American Heart Association

30 Heartsaver First Aid nline Skills Sheet Name: Date: Instructor: Instructor Note: Before each skills practice, remind students to state that they are wearing gloves. This will reinforce the importance of wearing gloves. Head Tilt Chin Lift Instructor tells student: In this station you will practice opening the airway with a head tilt chin lift. Step 1 Tilts the head by pushing back on the forehead. Action 2 Lifts the chin by putting fingers on the bony part of the chin. Do not press the soft tissues of the neck or under the chin. 3 Lifts the chin to move the jaw forward. R If done Finding the Problem Instructor tells students: In this station you will practice helping a victim who is sick or hurt. Here is your scenario: You enter your company s restroom and find a coworker lying on the floor. She is not moving and appears to be unresponsive. What should you do? Step Action 1 Checks for scene safety. 2 Phones or sends someone to phone the emergency response number (or 911) and bring the first aid kit and AED if available. 3 Puts on personal protective equipment (can be verbalized). 4 Determines if victim responds: Taps victim and shouts Are you okay? Instructor tells student: The victim does not move or respond in any way when you tap and shout. 5 pens the airway using head tilt chin lift: Tilts the head by pushing back on the forehead. Lifts the chin by putting fingers on the bony part of the chin. Lifts the chin to move the jaw forward. 6 Places his/her ear near victim s nose and mouth, looks toward the chest and looks, listens, and feels for breaths. Instructor tells student: You feel breaths on your cheek and see the victim s chest rise. 7 Looks for obvious signs of injury such as bleeding, broken bones, burns, or bites. 8 Checks for medical identification jewelry such as a bracelet or necklace. Instructor asks student: What is the significance of medical identification? R if done

31 Name: Controlling Bleeding, Treating Shock, and Removing Gloves Instructor tells student: In this station you will practice controlling bleeding, treating shock, and removing gloves. Here is your scenario: You are caring for a victim who was struck by a falling tree limb. The victim is bleeding from a cut on his arm and complains of pain in his arm and stomach. What should you do? Step Action 1 Checks for scene safety. 2 Phones or sends someone to phone the emergency response number (or 911) and bring the first aid kit. 3 Puts on personal protective equipment. If able, has victim place pressure over the wound with a clean dressing while student puts on gloves. 4 Applies pressure to bleeding from cut on forearm. 5 Instructor tells student: The bleeding does not stop. Student states he/she will press harder and add a second dressing to control bleeding. 6 Checks for signs of shock. 7 Instructor tells student: The victim becomes cold, weak, and dizzy. He does not have pain in his legs or hips. 8 Helps victim lie on his back. Raises and supports victim s legs just above the level of the heart. 9 Covers victim to keep victim warm (use a Mylar blanket if one is in the first aid kit). ptional Bandaging Practice Student applies bandage over gauze 10 Instructor tells student: EMS has arrived and takes over care. You can now remove your gloves. Student removes gloves: Grips one glove on the outside near the cuff and peels down until glove comes off inside out. Cups glove with the other gloved hand. Places 2 fingers of the bare hand inside cuff; peels it down until it comes off inside out with the dirty glove inside. 11 Verbalizes proper disposal of dirty gloves. R If done

32 Name: Epinephrine Pen Instructor tells student: In this station you will practice using the epinephrine pen. Here is your scenario: A coworker has a bad allergic reaction to seafood. He tells you he has an epinephrine pen in his desk or vehicle. He complains of shortness of breath and a tight feeling in his throat. What should you do? Step Action 1 Checks for scene safety. 2 Phones or sends someone to phone the emergency response number (or 911) and bring the first aid kit. 3 Gets the prescribed epinephrine pen. 4 Instructor tells student: The victim is unable to give himself the injection and asks you to help. Student puts on gloves. Takes off safety cap and holds epinephrine pen in his/her fist, AVIDING both ends. 5 Presses the pen firmly against victim s thigh about halfway between the hip and knee (can be given through clothes) and holds in place for several seconds. 6 Rubs the injection site for several seconds. 7 Instructor asks student: What will you do with the epinephrine pen after using it? Student verbalizes safe disposal of epinephrine pen into sharps disposal or gives to trained help for proper disposal. 8 Notes time of injection and will give that information to trained help when help arrives. 9 Stays with victim until help arrives and takes over. R If done Choking Instructor tells student: In this station you will practice helping a choking victim. Here is your scenario: You are eating lunch in the cafeteria. A colleague at the table next to you suddenly stands and anxiously places both hands over his neck. What should you do? Step Action 1 Asks victim, Are you choking? Instructor tells student: The victim nods his head that he is choking. 2 Kneels or stands behind victim and wraps his/her arms around victim so that student s hands are in front. 3 Makes a fist with one hand. 4 Puts thumb side of fist slightly above the navel and well below the breastbone. 5 Grasps fist with his/her other hand and gives quick upward thrusts into the abdomen. The instructor should tell students NT to practice thrusts on other students. 6 Gives thrusts until object is forced out and victim can breathe, cough, or talk or until he or she stops responding. R If done Splinting ptional Instructor tells student: In this station you will practice splinting. Step Action 1 Student applies a splint using magazine, other household materials, or splint. R If done

33 CPR TESTING CHECKLISTS HEARTSAVER CPR American Heart Association Heartsaver Adult/Child CPR and Infant CPR Side 1 of 2 Name: Date of Test: Skill Step Critical Performance Steps If you teach AED, do not do this test; go to AED test on other side Adult/Child CPR if done correctly Do this test only if you teach infant CPR Infant CPR if done correctly 1 Checks for response 2 Tells someone to phone emergency response number (or 911) and get an AED 3 pens airway using head tilt chin lift 4 Checks breathing Minimum 5 seconds; maximum 10 seconds 5 Gives 2 breaths (1 second each) 6 7 Bares victim s chest and locates CPR hand (infant: finger) position Delivers first cycle of compressions at correct rate Acceptable <23 seconds for 30 compressions 8 Gives 2 breaths (1 second each) 9 Delivers second cycle of compressions at correct hand position Acceptable >23 of 30 compressions 10 Gives 2 breaths (1 second each) The next step is done only with a manikin with a feedback device, such as a clicker or light. If no feedback device, STP THE TEST. 11 Delivers third cycle of compressions of adequate depth with full chest recoil Acceptable >23 compressions STP THE TEST STP THE TEST RECRD ALL TEST RESULTS HERE. SIGN WHERE INDICATED. Test only one of these This test is only if you teach infant CPR TEST SUMMARY PASS = Above steps all checked (done correctly) NR = Needs remediation INDICATE PASS R NR: CPR + AED A/C CPR INF CPR PASS NR PASS NR PASS NR Instructor signature affirms that skills tests were done according to AHA guidelines. Save this sheet with course record. Instructor Signature: Print Inst. Name: Date:

34 American Heart Association Heartsaver CPR + AED Side 2 of 2 Name: Date of Test: Skill Step Critical Performance Steps Do this test only if you teach AED CPR with AED if done correctly 1 Checks for response 2 Tells someone to phone emergency response number (or 911) and get an AED 3 pens airway using head tilt chin lift 4 Checks breathing Minimum 5 seconds; maximum 10 seconds 5 Gives 2 breaths (1 second each) 6 Bares victim s chest and locates CPR hand position 7 Delivers first cycle of compressions at correct rate Acceptable <23 seconds for 30 compressions 8 Gives 2 breaths (1 second each) AED arrives AED 1 AED 2 AED 3 AED 4 Turns AED on Selects proper AED pads and places pads correctly Clears victim to analyze (must be visible and verbal check) Clears victim to shock/presses shock button (must be visible and verbal check) Max time from AED arrival <90 sec Student continues CPR 9 Delivers second cycle of compressions at correct hand position Acceptable >23 of 30 compressions 10 Gives 2 breaths (1 second each) The next step is done only with a manikin with a feedback device, such as a clicker or light. If no feedback device, STP THE TEST. 11 Delivers third cycle of compressions of adequate depth with full chest recoil Acceptable >23 compressions STP THE TEST RECRD CPR + AED TEST RESULTS N BTTM F SIDE 1