Resuscitation Council (UK) Teaching child and infant resuscitation

Teaching child and infant resuscitation

Question:
(1) Who can train parents (or others) child and infant resuscitation and what qualifications should they hold?

Answer:
There are no statutory legal provisions in the UK relating to the practice of resuscitation, but those who provide training have obligations under common law. Further details may be found in our publication The Legal Status of those who Attempt Resuscitation.

The Resuscitation Council (UK) recommends that those who train others in resuscitation should be appropriately qualified. Provided that they are skilled in teaching and able to demonstrate core competencies the following people are suggested: doctors, nurses, resuscitation officers, statutory ambulance service instructors, voluntary aid society and voluntary rescue trainers, and other individuals such as accredited first aid trainers. This list is not exhaustive.

It is important to be aware that many children do not receive resuscitation because potential rescuers fear causing harm. This fear is unfounded; it is far better to use the adult BLS sequence for resuscitation of a child than to do nothing.

For ease of teaching and retention, therefore, laypeople should be taught that the adult sequence and ratio of 30 compressions : 2 ventilations may also be used for children who are not responsive and not breathing, although the depth of compression will need to be modified to one third the depth of the child’s chest. This modification of compression depth is logical and does not alter the sequence of adult BLS.

There are laypeople who may find themselves responsible for attempting resuscitation in infants or children. Examples of such people include parents with young children, nursery carers, first aiders with a duty to respond, and lifeguards.

The following modifications to the adult sequence, which will make the adult sequence even more suitable for use in children, may be taught, as additional training, to these people.

Give 5 initial rescue breaths before starting chest compressions (Adult BLS sequence of actions 5B).
If you are on your own, perform CPR for approximately 1 min before going for help.
Compress the chest by 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.

This modified sequence should not be taught as part of an initial layperson, community, or first aid course, but should be considered additional training for those who are particularly likely to attempt resuscitation of a child.

Very rarely, parents or carers of children with a specific risk of requiring resuscitation may receive detailed training as for health professionals (see 3. below).

The Resuscitation Council (UK) therefore recommends three levels of promoting and training child resuscitation:

1. During adult BLS courses

The following statement may be given: "Children can be resuscitated using the adult sequence, with the single modification of chest compression depth”.

2. Special courses teaching child resuscitation to specific target groups
who work with children or are likely to have to respond to child
emergencies:

Modification of adult BLS techniques: 5 initial breaths; 1 minute of CPR before going for help; chest compression depth and technique.
Practice on child / infant CPR manikins.

3. Special courses for healthcare professionals, with a duty to respond
to paediatric emergencies, working in teams, who are also
in a position to receive enhanced training

See the Paediatric BLS chapter in Guidelines 2010.

Learning outcomes

On completion of CPR training, the participant should be able to demonstrate resuscitation of an infant and child in cardiac arrest using the paediatric modifications to the adult sequence. This should be assessed during or at the end of the training, using a simulated incident and a resuscitation child/infant training manikin. Adult CPR with modifications for infants and children consists of the following steps, which should be performed sequentially:

1 Safety – check for risks to the victim, any bystanders, and yourself

2 Stimulate – assess the victim to be unresponsive

3 Shout for help

4 Open the airway

5 Establish absence of normal breathing

6 Give 5 initial rescue breaths

7 Assess response to rescue breaths – if no response start CPR
   with 30 chest compressions followed by 2 rescue breaths

8 If alone, perform 1 minute CPR before alerting the ambulance service
   or going for help

9 Compress the chest by 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 required to
         achieve an adequate depth of compressions

10 Maintain CPR with the correct ratio of chest compressions to rescue
   breaths (30:2)