Question:
(1)   What is a 'Healthcare Professional with a duty to respond', specifically in relation to:
  · General practitioners
  · Health Visitors who are running a baby clinic or similar
  · School nurses
  · Mental health nurses working in the child mental health units?
 
Answer:
The full paediatric BLS sequence is for healthcare professionals with a duty to respond to paediatric emergencies (e.g. A&E staff, paediatric doctors and nurses, paramedics). These people usually work in teams of two or more rescuers.

Lay providers who are particularly likely to attempt resuscitation of a child should be taught the adult sequence with the paediatric modifiers (note 1). It is recognised, however, that there are groups that fall between these two definitions, such as those mentioned above, where it is unclear which sequence is the more appropriate. The decision as to what should be taught may be made locally (for example, by the Resuscitation Committee) according to circumstances and available resources. In coming to a decision, it may be helpful to ask the following questions:

  · Are the providers healthcare professionals? (note 2)
  · Would they normally be expected to have to resuscitate an infant or child
    during the course of their work?
  · Do they usually work alone or in a team?
 
Generally, the full paediatric sequence should be taught to those who give a positive answer to all 3 questions.

General Practitioners, Health Visitors, and School Nurses, for example, are healthcare professionals working with children, but they often work alone. Although they may have to resuscitate a child (or indeed an adult), this would not be a part of their normal role, and would be very unusual event. It would be sufficient to teach these groups the adult sequence with the paediatric modifiers unless they expressed a particular wish or interest to learn the full paediatric sequence.

Mental Health nurses working in child mental health units are healthcare professionals working in teams of 2 or more. Although it would be unusual in most such units to have to resuscitate a child, some may treat high-risk children (such as those with severe anorexia nervosa) so it would be reasonable to allow training decisions to be based on local circumstances.

Notes:
1. Paediatric modifiers:
     Give 5 initial breaths before starting chest compression. 
     If on your own, perform 1 minute CPR before going for help. 
     Compress the chest approximately one-third of its depth.   Use two
       fingers for an infant under 1 year; use one or two hands for a child over
       1 year as needed to achieve an adequate depth of compression.
 
2. Healthcare professionals:
With the introduction of Guidelines 2000, the Resuscitation Council(UK) defined a Healthcare Professional as “a person who holds a recognised vocational qualification in a medical or related discipline whose employment of work includes at least some degree of clinical responsibility. A first aider is not a healthcare professional”.
 

Question:
(2)   Childminders, parents, and ‘early years workers’ are not healthcare professionals but they perceive they have a duty to respond.   Which guidelines should be taught to this group of people?
 
Answer:
It is important that laypeople who have been taught adult resuscitation should know they can use the same techniques on children. The guidelines have been deliberately simplified for ease of teaching and retention.

Child minders, parents, and early year workers are laypeople. They should be taught the adult sequence. However, this group may also be taught the following minor modifications to make CPR even more suitable for use in children:
     Give 5 initial breaths before starting chest compression. 
     If on your own, perform 1 minute CPR before going for help. 
     Compress the chest approximately one-third of its depth.   Use two
       fingers for an infant under 1 year; use one or two hands for a child over
       1 year as needed to achieve an adequate depth of compression.

As a general rule parents (e.g. in parent and baby classes) should be taught standard adult resuscitation with the paediatric modifiers, as they are just as likely to have to resuscitate an adult as a child.

There are some parents of children at high risk of needing resuscitation who are extremely motivated and wish to learn the full guidelines “for health professionals with a duty to respond”. The Resuscitation Council (UK) considers it is acceptable for instructors to teach the full paediatric guidelines to this particular group if they feel it is in their best interests and that they would be able to retain the information.
 

Question:
(3)   What should laypeople be taught as the treatment of the unconscious child or infant who has choked?   Should they provide 5 rescue breaths prior to CPR?
 
Answer:
For both adults and children who are choking and have become unconscious, the aim is to provide chest thrusts to relieve the airway obstruction and occasional positive pressure breaths in case the obstruction has moved sufficiently for chest inflation to be possible. Since chest compressions given during CPR are the same as chest thrusts, it is simpler to teach that rescuers should start CPR in such cases; they don't have to learn any modification to the basic technique of CPR that they have been taught, for the special circumstance of choking.

For the unconscious child or infant who is choking rescuers should start CPR in whichever way they have been taught. Thus, if they have been taught adult CPR they go straight for chest compressions; if they have been taught the modifications to the adult sequence (as described above), they may attempt to give 5 rescue breaths first and if there is no response proceed immediately to chest compression. The important thing is that there should be no delay whilst the rescuer tries to decide which sequence to use – there is no evidence that one is better than the other.
 

Question:
(4)   In Paediatric BLS, page 73: rescue breaths for an infant, there is slightly conflicting advice on airway position.   The first bullet point says ‘ensure a neutral position’, the fourth bullet point assumes that there is head tilt.   Which is correct?
 
Answer:
Infants have prominent occiputs, and the unconscious infant, lying on his back, will have head flexion. Because of this, some head tilt is necessary to achieve a neutral position. This is illustrated in the EPLS manual Chapter 3, Figs 1-5.
 

Question:
(5)   In Paediatric ALS it states that after the first shock, CPR should be resumed for 2 min without assessing rhythm or pulse.   What happens if VF reverts to sinus rhythm after the first shock and there is an output?   Do you give 2 min CPR regardless?
 
Answer:
Although the first shock may result in ECG complexes, there is often a delay between this and the resumption of a perfusing rhythm. It is vital to restart chest compressions as soon as possible after each shock is given. Failure to do this in the case of an unsuccessful shock will compromise the efficacy of the next shock because coronary perfusion has not been maintained. On the other hand, compressions given to a beating heart should not cause harm, and may well be beneficial during the ‘stunned’ phase after successful defibrillation and before a perfusing rhythm is fully established.
 
 
 
 
 

	© Resuscitation Council (UK)  2006   This page last updated: 19 April 2006