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Paris Hotel and Casino Las Vegas, Nevada BEST PRACTICES TEACHING CPR Presented by: JOHN CARECCIA EMT-IT

Presenter Disclosure Information [JOHN CARECCIA] [BEST PRACTICES TEACHING CPR] FINANCIAL DISCLOSURE: § I ATTEST THAT No relevant financial relationship (s) exist UNLABELED/UNAPPROVED USES DISCLOSURE: § THERE IS NONE

Presenter Disclosure Information Instructions: 1. JOHN CARECCIA 2. BEST PRACTICES TEACHING CPR 3. NONE 4. I AM A CPR AND FIRST AID INSTRUCTOR AND EMT B. I HAVE NO MONETARY INTEREST OR SUPPORT. MY MAIN CONCERN IS INFLUENCING THE PRODUCTION OF CPR AND FIRST AID TRAINING MATERIALS TO BE THE BEST THEY CAN BE. 5. I HAVE NOTHING TO DISCLOSE OF A MONETARY NATURE 6. I ATTEST THAT No relevant financial relationship (s) exist.

BEST PRACTICES TEACHING CPR • PRESENTED BY: JOHN CARECCIA • EMT B AND BLS INSTRUCTOR TRAINER • DEPUTY CHIEF / TRAINING FOR WOODBRIDGE TOWNSHIP AMBULANCE & RESCUE SQUAD • CPR INSTRUCTOR SINCE 1994

DO YOUR BEST TEACHING CPR USE EFFECTIVE AND EASY TO UNDERSTAND TRAINING MATERIALS THAT COMPLEMENT THE LEARNING PROCESS

HOW TO DO THE BEST WE CAN • • • CONSULT WITH EMS PROFESSIONALS GET IT RIGHT THE FIRST TIME LISTEN TO INSTRUCTORS DO IT CORRECTLY – USE RESOURCES CRITICAL EVALUATION IS A MUST CORRECT IF NECESSARY

CONSULT WITH EMS PROFESSIONALS • Book learning is good, but it is no substitute for experience. Consult with EMS experts in the field to make sure the training materials encourage the student to deliver effective CPR on a consistent basis. • Utilizing different expert points of view will enable the AHA to thoroughly develop effective training materials and aids.

GET IT RIGHT THE FIRST TIME • To make sure the Training Materials are the best they can be everyone should agree they have done their best to make them so. • When the contract for the Video is awarded there should be EMS professional (s) on the set to review the script and make sure the actors accurately depict the procedures as described in the course material.

LISTEN TO INSTRUCTORS • Many CPR instructors I know have cited glaring mistakes in the video portion of the HCP course as it relates to the written lesson material. • If the mistakes are so egregious they should be addressed. Better yet, if we have EMS professionals on the set, the actors can be coached on how to perform required actions correctly before the video is released.

DO IT CORRECTLY • Students need to see an action done correctly. • Actors should not make glaring mistakes. • Safety is First. • Our Motto is: Do No Harm. • Make sure the actor follows the script. • Check to see the action is exactly as described in the book.

CRITICAL EVALUATION IS A MUST • The evaluations should find out what the student really thinks about the training materials. Questions should be directed to specific elements of the subject matter. • Using terms like good, bad, appropriate are asking the student to be subjective. Ask the student if the section or chapter met the objective. Encourage Comments.

CORRECT IF NECESSARY • The good name of the American Heart Association is attached to the lessons presented to the students. Respect and Trust must be maintained. • If there are legitimate critiques of the material that show there areas that should be improved or corrected, correct them either by using handouts or reshooting portions of the video and incorporating it into a new video.

JOB WELL DONE • If the AHA takes pains to produce accurate and easy to understand training materials, they will do everything possible to train confident EMS professionals and people from all walks of life. • Each discipline needs to be scrutinized and supervised during production to turn out the best product possible. Thank You.

WHO IS JOHN CARECCIA • John is an EMT with more than 20 years experience. • John is Deputy Chief and Training Director of Woodbridge Twp. Ambulance & Rescue Squad in New Jersey. • John is a BLS instructor Trainer since 1994 • John teaches CPR and First Aid to members of his community. • John teaches CPR in New York and New Jersey as part of his business.

6/11/2021

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6/11/2021

BEST PRACTICES TEACHING CPR • PRESENTED BY: • JOHN CARECCIA • EMT B AND BLS INSTRUCTOR TRAINER • DEPUTY CHIEF / TRAINING DIRECTOR FOR THE WOODBRIDGE TOWNSHIP AMBULANCE & RESCUE SQUAD • CPR INSTRUCTOR SINCE 1994 6/11/2021

DO YOUR BEST TEACHING CPR Use Effective and Easy to Understand Training Materials That Complement the Learning Process 6/11/2021

HOW TO DO THE BEST WE CAN • • CONSULT WITH EMS PROFESSIONALS GET IT RIGHT THE FIRST TIME LISTEN TO INSTRUCTORS DO IT CORRECTLY – USE RESOURCES CRITICAL EVALUATION IS A MUST CORRECT IF NECESSARY A CONFIDENT TEAM IS A GOOD TEAM 6/11/2021

CONSULT WITH EMS PROFESSIONALS • Book learning is good, but it is no substitute for experience. Consult with EMS experts in the field to make sure the training materials encourage the student to deliver effective CPR on a consistent basis. • Utilizing different expert points of view will enable the AHA to thoroughly develop effective training materials and aids. 6/11/2021

GET IT RIGHT THE FIRST TIME • To make sure the Training Materials are the best they can be everyone should agree they have done their best to make them so. • When the contract for the Video is awarded there should be EMS professional (s) on the set to review the script and make sure the actors accurately depict the procedures as described in the course material. 6/11/2021

LISTEN TO INSTRUCTORS • Many CPR instructors I know have cited glaring mistakes in the video portion of the HCP course as it relates to the written lesson material. • If the mistakes are so egregious they should be addressed. Better yet, if we have EMS professionals on the set, the actors can be coached on how to perform required actions correctly before the video is released. • . 6/11/2021

DO IT CORRECTLY • Students need to see an action done correctly. • Actors should not make glaring mistakes. • Safety is First. • Our Motto is: Do No Harm. • Make sure the actor follows the script. • Check to see the action is exactly as described in the book. 6/11/2021

CRITICAL EVALUATION IS A MUST • The evaluations should find out what the student really thinks about the training materials. Questions should be directed to specific elements of the subject matter. • Using terms like good, bad, appropriate are asking the student to be subjective. Ask the student if the section or chapter met the objective. Encourage Comments. 6/11/2021

CORRECT IF NECESSARY • The good name of the American Heart Association is attached to the lessons presented to the students. Respect and Trust must be maintained. • If there are legitimate critiques of the material that show there areas that should be improved or corrected, correct them either by using handouts or re-shooting portions of the video and incorporating it into a new video. 6/11/2021

A CONFIDENT TEAM IS A GOOD ONE • When everyone is confident that they have mastered the techniques of CPR and are comfortable using them, they will be able to function more effectively as individuals, or with the help of other team members be even more effective and productive. 6/11/2021

JOB WELL DONE • If the AHA takes pains to produce accurate and easy to understand training materials, they will do everything possible to train confident EMS professionals and people from all walks of life. • Each discipline needs to be scrutinized and supervised during production to turn out the best product possible. Thank You. 6/11/2021

WHO IS JOHN CARECCIA • John is an EMT with more than 20 years experience. • John is Deputy Chief and Training Director of Woodbridge Twp. Ambulance & Rescue Squad in New Jersey. • John is a BLS instructor Trainer since 1994 • John teaches CPR and First Aid to members of his community. • John teaches CPR in New York and New Jersey as part of his business. 6/11/2021

JOHN’S OTHER PURSUITS • John interacts with other instructors in Discussion groups on Linked In. Some of the ideas presented here came from those discussions. • John has a website devoted to health issues and finding solutions, especially for seniors at www. healthinformationandmore. com • John is an avid Golfer who loves the game and started a website geared to helping seniors and the challenged play golf. www. golfsolutions 4 you. com 6/11/2021

6/11/2021

THE IDEAL CPR TRAINING COURSE • An ideal training course would have written material that follows acceptable ECCU guidelines. • In addition the course should contain a video presentation that accurately depicts the actions and procedures that complement the written training material and operational guidelines. 6/11/2021

HCP COURSE IS A CHALLENGE • There are several additional actions and procedures that are included in the Healthcare Provider Course (HCP). It is extremely important to explain and show them as best you can. Having an EMS professional on the set is critically important to making sure the EMS student is getting the most accurate information possible. 6/11/2021

KEEP LIKE THINGS TOGETHER • The Video Host and materials should end one segment with a lead in to the next (segue) • Explain ending one segment before beginning the next one. • Immediately following infant CPR with the Advanced Airway section without any explanation is confusing to students. 6/11/2021

WHY CAB? • Compressions keep the brain alive. • Effective compressions pump the necessary amount of oxygenated blood to the brain to help keep it alive. • If the brain is kept alive there is a good chance you will be able to revive the victim and have a good outcome. 6/11/2021

WHY THE ADULT RATIO IS 30 TO 2 • Studies have shown that delivering 30 compressions and 2 breaths is best for keeping a fatigued or diseased heart alive and the brain fed with a sufficient supply of oxygenated blood. • The heart has arteries feeding it blood and you must keep up the pressure in those arteries to keep the heart alive. 6/11/2021

YOU CAN MAKE A DIFFERENCE • Everyone is capable of delivering effective compressions. • Effective compressions pump oxygenated blood to the brain, keeping it alive. • If you don’t help the victim, who will? • If the victim could speak, they would say please help me. • A human life should not go to waste 6/11/2021

ADULT CPR – SCENE SAFE • Check for Scene Safety: electricity, hazards • Shake and shout: is the person sleeping? • Check for breathing: lay your hand on the chest and look at the chest. • No breathing: >YOU - call 911 and get AED • Start compressions by placing heel of one hand in center of chest on the sternum between the nipples. • Bring your shoulder over your wrist and keep your arms straight. Push straight down on the chest. 6/11/2021

PUSH FAST AND HARD • To push blood from the heart to the brain effectively push down at least 2 inches and as fast as 100 pushes per minute, about 1½ per second. • Deliver 30 compressions. Concentrate on keeping your shoulder over your wrist and keep the pace up to at least 100 per minute. Faster is better. 6/11/2021

LET THE CHEST COME BACK UP • Push straight down at least 2”, more is better. • Let the chest come completely back up before starting the next compression. • Perform 2 minutes or 5 cycles if you can do so. Switch when you feel tired or when you see yourself leaning on the chest. 6/11/2021

DELIVER EFFECTIVE BREATHS • Place your non-preferred hand over the top of the mask. Tilt the head back by pressing on the forehead. • Put the thumb of the preferred hand over bottom of mask and grip the jaw bone with remaining fingers and lift the chin to take the tongue away from the airway. • Blow air in softly over one second to make the chest rise gently. 6/11/2021

WHAT IF NO ONE COMES • If no one comes you should try to find a phone and an AED, if one is available within 2 minutes of the victim’s location. . • If you don’t know where one is use your cell phone to call 911 and start compressions. • If you can’t switch, rest for the count of 5 then start over again for as long as you can. • If an AED arrives, immediately put pads on while one rescuer continues compressions. 6/11/2021

TURN THE AED ON • Once the AED arrives, TURN IT ON. Follow the prompts. • One rescuer places the pads while the other delivers compressions. • Once the AED pads cord is plugged in, the AED analyzes the victim’s heart rhythm. • Make sure no one touches the victim until the shock sequence is complete. • Once the analyze sequence starts: HANDS OFF AND SWITCH POSITIONS. 6/11/2021

HOW DO YOU SWITCH? • Rescuer 1 moves to the head and Rescuer 2 by the head moves to the opposite side of the victim. Both move in the same direction around the head of the victim. • Once the AED says shock is necessary the rescuer by the head makes sure no one is touching the victim. Do a final check to clear and then push the flashing yellow shock button. • Once the shock is delivered, the other rescuer immediately starts compressions. 6/11/2021

CHILDREN ARE DIFFERENT • One: If you don’t see the child collapse and are alone you should deliver 2 minutes of CPR before calling 911 and getting the AED. • Two: If you do see the child collapse right in front of you, you need to call 911 and if possible get the AED if there is one close by. Do not leave the child for more than 4 minutes to get help. 6/11/2021

CHILD CPR • Steps are the same as Adult CPR with some exceptions. • If possible use one hand to deliver compressions to a child. Use 2 if necessary. • The ratio with One Rescuer is 30 -2. With 2 Rescuers it becomes 15 to 2. • Push the sternum down 2 inches. Deliver 2 breaths softly over 1 second each. 6/11/2021

USING THE AED WITH CHILDREN • Do not put the AED pads on until you have delivered 5 cycles of CPR. • Place the pads according to the picture on the pad. • The AED specifies a child as ages 1 to 8 • If the child is older than 8 or if you can’t determine the age of the child as under 8 years, use Adult pads. 6/11/2021

INFANT CPR • When you find an infant who is unconscious, immediately place them on a dressing table or other hard surface. • Tap the bottom of the foot while calling out to the baby. • Place two fingers on the Infant’s belly and look to see if they are breathing. If not, call for help. • Do Not Leave the Baby For Any Reason. 6/11/2021

DELIVER INFANT COMPRESSIONS • To be effective you should place two fingers in vertical alignment on the center of the sternum immediately below the nipples. • Press down with the pads of your fingers to a depth of 1 and ½ inches and allow the chest to come completely back up against your fingers for full recoil. 6/11/2021

OPEN THE INFANT’S AIRWAY • To open an infant’s airway gently tilt the infant’s head back very gradually until the breath goes in. Once the breath goes in stop tilting the head. If you TILT an infant’s head MORE than needed it will CLOSE THE AIRWAY. • Tilt the head gently and stop tilting when the tip of the baby’s nose is pointing straight up. You should not be able to see the baby’s nostrils. 6/11/2021

USING THE AED WITH INFANTS • An infant is defined as being less than one year old, but older than 28 days. • After performing 5 cycles of Infant CPR you can apply the AED pads if you have them. • Even if you only have Adult pads, you can use them on an infant. The pads can’t touch, so • It is better to place one pad over the infant’s chest and one pad over the infant’s back, both in a vertical position. 6/11/2021

HCP- TAKE PULSES CORRECTLY • If the student is required to take a pulse, show them in detail the correct way to do so. Explain the differences between taking the pulse of an Adult, Child, and Infant. If you say 60 beats per minute, you should demonstrate it. If a rescuer takes the pulse for 10 seconds, they should feel 10 beats. 60 beats per minute is one beat per second. 6/11/2021

TAKING INFANT PULSE CORRECTLY • Taking the pulse of an infant is a definite challenge to the best EMS professional. • We know we have to use the brachial, but where is it exactly? Use animation to show exactly where it is. • Show that the thumb is not behind the infant’s arm, the host should explain the importance of keeping your thumb out of play. Make the OK sign. 6/11/2021

HCP - TAKE THE INFANT’S PULSE • To get an accurate reading take the baby’s thumb and put it near their ear. By holding the arm in this position you expose the under arm between the elbow and the shoulder. • Place two fingers (no thumb) directly on the brachial inside the arm. If you take the pulse for 10 seconds you should feel more than 10 beats (greater than 60 beats per minute). 6/11/2021

HCP- USING INFANT BVM • To be effective the rescuer should stand at the infant’s head and place the mask on the infant’s face with the narrow portion at the bridge of the infant’s nose and the bottom resting on the chin. • Place your hand over the mask extending your fingers down on each side of the mask to the jaw line. The thumb is on one side and the fingers on the other side, stopping at the jaw. 6/11/2021

HCP -TWO PERSON INFANT CPR • If someone arrives and knows CPR they can assist in performing Compressions while the first rescuer delivers the breaths. • Rescuer 2 places both thumbs in the center of the infant’s chest just under the nipples. • Deliver 15 compressions and then 2 breaths. • Perform 10 cycles of 2 person CPR at a rate of at least 100 per minute. 6/11/2021

HCP – CPR - ADVANCED AIRWAY • If the victim has an advanced airway inserted (intubated), you should perform continuous compressions at a rate of 100 per minute. • You should deliver ONE breath every 7 seconds. • Deliver the breath softly and look for chest rise. 6/11/2021

HCP - RESCUE BREATHING • If the victim has a pulse (adult) or pulse that is greater than 60 beats / minute (Child, Infant). • Deliver ONE breath every 6 seconds for Adult. • Deliver ONE breath every 5 seconds for Child or Infant. • Check the pulse every 2 minutes for each. 6/11/2021

ARE YOU CHOKING? • Once you determine the Adult is choking (they can’t speak and are clutching their throat) tell them you are trained and will help them. • Step behind them with your front leg thrust out a little and your back leg set behind you. • Put your arms through the area by the victim’s waist and place your thumb just above the navel. 6/11/2021

THRUST IN AND UP • Grasp the hand with the thumb by the navel with the other and press your fist into the victim’s abdomen with a firm thrust. • Deliver the thrust with an in and up movement, pressing firmly into the victim’s abdomen. • Lean the victim against your chest with your front leg between theirs, and deliver thrusts at a rate of 1 per second. 6/11/2021

VICTIM GOES UNCONSCIOUS • If the victim spits out the foreign matter, tell the victim to remain calm and make them comfortable until EMS arrives. • If the victim goes unconscious, gently lower them to the ground and place them on their back and call for help. • If alone Call 911 and get an AED if you can. Perform CPR. 6/11/2021

UNCONSCIOUS - START CPR • Perform 30 Compressions at a rate of 100 per minute, when you go to give the breath look into the mouth. If you see any foreign matter or food particles? • Use your forefinger to hook what’s there and pull it out. If you get one breath in put in another. • If the breath does not go in, start compressions immediately. 6/11/2021

CHOKING CHILD • Stand or kneel behind as necessary and place thumb of one hand above the navel and grasp that hand with your other and pull back into the victim’s abdomen. • Deliver pushes until the victim spits out or goes unconscious. • If the child goes unconscious start CPR 6/11/2021

CHOKING INFANT • If an infant is choking they can’t cry or make sounds. They start to turn blue around the lips. • Pick the infant up immediately and place them over your lowered arm with the head in the down position. • Strike the baby 5 times with the heel of the hand on the back between the shoulder blades in the center of the upper back. 6/11/2021

CONTROL THE INFANT’S HEAD • Once the strikes are delivered cup the baby’s head in your hands and arms. Turn the baby over so the chest is up and the head is resting against your lowered arm. • Deliver 5 thrusts with 2 fingers at the same location that you performed CPR, just under the nipples in the center of the chest. • Deliver back strikes and chest thrusts until the baby spits up, cries or goes unconscious. 6/11/2021

INFANT GOES UNCONSCIOUS • If the choking infant goes unconscious, lay them on hard surface like a table and begin CPR. • Perform 2 minutes of CPR. Deliver 30 compressions at a rate of 100 per minute. • When you go to give a breath check inside the mouth foreign matter. If you see something use your pinky to hook it and pull it out. Put a breath in and then another. 6/11/2021

INFANT’S AIRWAY STILL BLOCKED • If the infant’s airway remains blocked and the infant does not regain consciousness after 2 minutes of CPR, take the infant in your arms and call 911 and get an AED if one is nearby. • Do Not Leave The Infant Alone For Any Reason • Once you or someone else calls 911 continue CPR as you did before until EMS arrives. 6/11/2021

CONTINUITY IS A MUST • WE should take great pains to make sure the terms and descriptions used in the VIDEO presentation MATCH the terms and descriptions in the WRITTEN TEXT. • When terms and procedures agree, the student learns quickly and efficiently. One enforces the other and the student is able to accomplish both effectively with confidence. 6/11/2021

EXAMPLES OF CONFLICTS • The HCP written training materials speak to doing the best you can to get an accurate pulse, while the video host tells the students that they are not expected to get an accurate reading. When they show the actor taking the pulse there is no hesitation before saying no pulse. They should take the 10 seconds to accurately show the student the proper way to take the pulse. 6/11/2021