STUDENT BOOK

STUDENT BOOK
PREVIEW

BasicPlus
CPR, AED, and
First Aid for Adults
BasicPlus
CPR, AED, and First Aid For Adults

Student Book Version 8.0

Purpose of this Guide
This MEDIC First Aid BasicPlus Version 8.0 Student Book is solely intended to facilitate certification
in a MEDIC First Aid BasicPlus CPR, AED, and First Aid training class. The information in this book
is furnished for that purpose and is subject to change without notice.

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MEDIC First Aid certification may only be issued when a MEDIC First Aid–authorized Instructor

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verifies a student has successfully completed the required core knowledge and skill objectives of

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the program.

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Notice of Rights

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No part of this MEDIC First Aid BasicPlus Version 8.0 Student Book may be reproduced or transmit-
ted in any form or by any means, electronic or mechanical, including photocopying and recording, or
by any information storage and retrieval system, without written permission from MEDIC FIRST AID
International, Inc.

Disclaimer
HSI has used reasonable effort to provide up-to-date, accurate information that conforms to gen-
erally accepted treatment recommendations at the time of publication. These recommendations
supersede recommendations made in previous MEDIC First Aid® programs. Science and technology
are constantly creating new knowledge and practice. Like any printed material, this publication may
become out of date over time. Guidelines for safety and treatment recommendations cannot be
given that will apply in all cases/scenarios as the circumstances of each incident often vary widely.
Signs and symptoms may be incomplete and can vary from person to person. Do not use the infor-
mation in this program as a substitute for professional evaluation, diagnosis, and treatment from
an appropriately qualified physician or other licensed healthcare provider. Local or organizational
physician-directed practice protocols may supersede treatment recommendations in this program.
Alert emergency medical services (EMS) or activate your emergency action plan immediately if you
are not sure an emergency exists or when any person is unresponsive, badly hurt, looks or acts very
ill, or quickly gets worse.

Trademarks
MEDIC First Aid and the MEDIC First Aid logo are registered trademarks of MEDIC FIRST AID
International, Inc.
MEDIC FIRST AID International, Inc.
1450 Westec Drive n Eugene, OR 97402
800-447-3177 n 541-344-7099
E-mail: [email protected] n Visit our website at hsi.com/medicfirstaid
Copyright © 2016 MEDIC FIRST AID International, Inc.
All Rights Reserved. Printed in the United States of America
First Edition—2016

MEDIC First Aid is a member of the HSI family of brands.

ISBN 978-1-936515-62-2 5080
Table of Contents

B asic Plus CPR, AED, and First Aid for Adults

May 2016

Preparing to Help
First Aid Provider . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
First Aid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Recognizing an Emergency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Personal Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Deciding to Help . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Protecting Yourself . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Infectious Bloodborne Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Standard Precautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Personal Protective Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

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Skill Guide 1 — Removing Contaminated Gloves . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

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Legal Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

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Consent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

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Implied Consent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

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Abandonment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Good Samaritan Laws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Calling for Help . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Emergency Medical Services (EMS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Emergency Action Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Poison Help Line . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Emergency Moves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

CPR and AED

Cardiac Arrest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Oxygen and the Human Body . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Sudden Cardiac Arrest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Cardiopulmonary Resuscitation (CPR) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Early Defibrillation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Chain of Survival . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Secondary Cardiac Arrest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Opioid Overdose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Chest Compressions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Skill Guide 2 — Chest Compressions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

BasicPlus CPR, AED, and First Aid for Adults MEDIC First Aid i
 Rescue Breaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Establishing an Airway . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Using Barrier Devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Delivering Breaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Skill Guide 3 — Rescue Breaths — CPR Mask . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Skill Guide 4 — Rescue Breaths — CPR Shield . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Automated External Defibrillation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
AED Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
AED Troubleshooting & Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Skill Guide 5 — Using an AED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Primary Assessment — Unresponsive Person . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Recovery Position . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Skill Guide 6 — Primary Assessment — Unresponsive Person . . . . . . . . . . . . . . . . . 33

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Skill Guide 7 — Recovery Position . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

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Caring for Cardiac Arrest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

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Skill Guide 8 — Caring for Cardiac Arrest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

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Multiple Provider Approach to CPR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Skill Guide 9 — Multiple Provider Approach to CPR . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Choking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Mild Obstruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Basic Plus CPR, AED, and First Aid for Adults

Severe Obstruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Skill Guide 10 — Choking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Assessment
Primary Assessment — Responsive Person . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Skill Guide 11 — Primary Assessment — Responsive Person . . . . . . . . . . . . . . . . . . 46
Secondary Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Skill Guide 12 — Secondary Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Sudden Injury
Control of Bleeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Tourniquets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Hemostatic Dressings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Skill Guide 13 — Control of Bleeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Using a Tourniquet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Skill Guide 14 — Using a Commercial Tourniquet . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Skill Guide 15 — Using an Improvised Tourniquet . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Using a Hemostatic Dressing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Skill Guide 16 — Using Hemostatic Dressings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

ii MEDIC First Aid BasicPlus CPR, AED, and First Aid for Adults
Shock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

B asic Plus CPR, AED, and First Aid for Adults

Internal Bleeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Amputation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Impaled Objects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Impaled Object in the Eye . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Open Chest Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
Open Abdominal Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Head, Neck, or Back Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Spinal Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Brain Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Concussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Skill Guide 17 — Manual Spinal Motion Restriction . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Swollen, Painful, or Deformed Limb . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70

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Skill Guide 18 — Manual Stabilization of a Limb . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72

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Burns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

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Thermal Burns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

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Electrical Burns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
Chemical Burns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Chemicals in the Eye . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
Minor Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Nosebleed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Injured Tooth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77

Sudden Illness
Sudden Illness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Altered Mental Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Fainting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Stroke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Hypoglycemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
Seizure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Breathing Difficulty, Shortness of Breath . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Asthma and Inhalers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Severe Allergic Reaction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Pain, Severe Pressure, or Discomfort in Chest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Poisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Ingested Poisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Inhaled Poisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
Severe Abdominal Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92

BasicPlus CPR, AED, and First Aid for Adults MEDIC First Aid iii
 Environmental Emergencies
Heat Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Heat Exhaustion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Heat Stroke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Cold Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Hypothermia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Frostbite . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98

Bites and Stings

Stinging Insects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Snakebites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
Pit Viper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
Coral Snake . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103

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Spider Bites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104

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Tick Bites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105

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Marine Animal Stings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106

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Jellyfish . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106

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Stingray . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Animal and Human Bites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Basic Plus CPR, AED, and First Aid for Adults

Additional Considerations
Emotional Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109

Additional Information
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Endnotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Knowledge Check Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
Class Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123

iv MEDIC First Aid BasicPlus CPR, AED, and First Aid for Adults
Cardiac Arrest

CPR and AED

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P
Because the human body cannot store oxygen, it must continually supply tis-
sues and cells with oxygen through the combined actions of the respiratory
and circulatory systems.

Oxygen and the Human Body

The respiratory system includes the lungs and the airway, the passage from the
mouth and nose to the lungs. Expansion of the chest during breathing causes
suction, which pulls outside air containing oxygen through the airway and into
the lungs. Relaxation of the chest increases the pressure within and forces
used air to be exhaled from the lungs.
The circulatory system in­
cludes the heart and a body-
wide network of blood vessels.
Electrical impulses stimulate
contractions of the heart to
create pressure that pushes
blood throughout the body.
Blood vessels in the lungs
absorb oxygen from inhaled
air. The oxygen-rich blood
goes to the heart, then out to the rest of the body.
Large vessels called arteries carry oxygenated blood away from the heart.
Arteries branch down into very small vessels that allow oxygen to be absorbed
directly into body cells so it can be used for energy production. Veins return
oxygen-poor blood back to the heart and lungs, where the cycle repeats.

BasicPlus CPR, AED, and First Aid for Adults MEDIC First Aid 13
 The brain is especially sensitive to a lack of oxygen. When oxygen is cut off to
the brain, brain cell damage, and death, can occur within a matter of minutes.

Sudden Cardiac Arrest (SCA)

Cardiac arrest is the loss of the heart’s ability to pump blood to the body. The
most dramatic occurrence, sudden cardiac arrest, can happen with little or no
warning. Victims abruptly become unresponsive and collapse. Abnormal gasp-
ing can occur. Breathing may stop completely.
The most likely cause of sudden cardiac arrest is an unexpected disruption
to the heart’s electrical system, in which normally organized electrical pulses
within the heart become disorganized and a chaotic quivering condition known
as ventricular fibrillation occurs. Blood flow to the body, along with the oxygen
it carries, stops. Without blood flow, brain damage occurs rapidly and quickly
leads to death.

i e w
Cardiopulmonary Resuscitation (CPR)

e v
Cardiopulmonary resuscitation (CPR) is the immediate treatment for a sus-

r
pected cardiac arrest. CPR allows a bystander to restore limited oxygen to

P
the brain through a combination of chest compressions and rescue breaths.
However, CPR alone is not enough.

Early Defibrillation
The most effective way to
end fibrillation is defibrilla-
tion, using a defibrillator and
electrode pads applied to the
chest. A controlled electrical
shock is sent through the heart
to stop ventricular fibrillation,
allowing the heart’s normal
electrical activity to return and
restore blood flow.
Successful defibrillation is highly dependent on how quickly defibrillation
occurs. For each minute in cardiac arrest, the chance of survival goes down by
about 10%. After as few as 10 minutes, survival is unlikely.
Simply activating EMS will not help. Even in the best EMS systems, the amount
of time it takes from recognition of the arrest to EMS arriving at the side of the
injured or ill person is usually longer than 10 minutes.
CPR and AED

14 MEDIC First Aid BasicPlus CPR, AED, and First Aid for Adults
An automated external defibrillator

CPR and AED

(AED) is a small, portable, com-
puterized device that is simple for
anyone to operate. Bystander use
of AEDs has been growing steadily,
with common placements of the
devices in public locations such as
airports and hotels, and workplaces
in general.
Turning on an AED is as simple as
opening a lid or pushing a power
button. Once it is on, an AED provides voice instructions to guide you through
its attachment and use.

w
An AED automatically analyzes the heart rhythm, determines if a shock is

i e
needed, and charges itself to be ready to defibrillate. An operator simply

v
pushes a button to deliver the shock when prompted by the AED.

r e
Chain of Survival

P
The chain of survival is often used to describe the best approach for treating
sudden cardiac arrest. Each link in the chain is essential for a person to survive.
If a single link is weak or missing, the chances for survival are greatly reduced.
The greatest chance for survival exists when all the links are strong:
■■ Early recognition of car-
diac arrest and activa-
tion of EMS
■■ Immediate CPR with
high-quality chest
compressions
■■ Rapid defibrillation, or
electrical shock, to the
heart
■■ Effective basic and
advanced EMS care and transport
■■ Effective post-cardiac arrest care at a hospital

BasicPlus CPR, AED, and First Aid for Adults MEDIC First Aid 15
 Secondary Cardiac Arrest
Unlike sudden cardiac arrest, in which the heart is the primary problem, cardiac
arrest can also be the end result of the loss of an airway or breathing. This is
secondary cardiac arrest.
Problems such as hazard-
ous breathing conditions in
a confined space, drowning,
and drug overdoses can result
in secondary cardiac arrest.
With no incoming oxygen, the
heart progressively becomes
weaker until signs of life
become difficult or impossible

w
to assess.

i e
If the heart is simply too weak to create obvious signs of life, immediate CPR,

v
with an emphasis on effective rescue breaths, may be the only chance to

r e
restore them.

P
Opioid Overdose
The abuse of opioid drugs to get a euphoric high is a serious and growing
health problem. Increasing prescriptions for opioid pain relievers, such as
hydrocodone and oxycodone, have made them more commonly available. The
use of heroin, a highly addictive opioid, also contributes to the problem.
As a result, the number of overdoses and deaths from prescription opioids and
heroin has increased dramatically. Opioids, taken in excess, can depress and
stop breathing. Opioid overdose is a clear cause of secondary cardiac arrest.
Naloxone, also known as Narcan, is
a medication that can temporarily
reverse the life-threatening effects
of opioids. It is easy to adminis-
ter, either through an auto-injector
device or through an aerosol that is
sprayed into the nose. Naloxone is
becoming more readily available to
lay providers.
CPR and AED

16 MEDIC First Aid BasicPlus CPR, AED, and First Aid for Adults
It is reasonable to provide education and training on responding to suspected

CPR and AED

opioid overdoses, including the administration of naloxone, to those most likely
to be involved with this type of emergency. Laws regarding first aid adminis-
tration of naloxone vary by city and state. As with Good Samaritan laws, know
the laws in your area.

Knowledge Check
The chain of survival is often used to describe the best approach for treating sud-
den cardiac arrest. The first three links of the chain are typically the responsibility
of a trained first aid provider. Describe those links.

r e v i e w
P

BasicPlus CPR, AED, and First Aid for Adults MEDIC First Aid 17
 Chest Compressions

r e v i e w
P
There is a set of basic CPR skills used to provide the most effective approach
to cardiac arrest.
External compression of the chest increases pressure inside the chest and
directly compresses the heart, forcing blood to move from the chest to the
lungs, brain, and the rest of the body.
Quality matters. The better
you compress, the greater the
influence on survival. Focus on
high-quality techniques:
■■ Compress deeply, more
than 2 inches. It is likely
you will not compress
deep enough. While
injury could occur from
deeper compressions,
do not let the fear of this affect compression depth.
■■ Compress fast, between 100 and 120 times per minute. Do not let a
higher compression speed result in shallower compression depth.
■■ Allow the chest wall to fully recoil, or rebound, between compressions.
CPR and AED

Avoid leaning on the chest at the top of each compression.

18 MEDIC First Aid BasicPlus CPR, AED, and First Aid for Adults
When compressing properly, you may hear and feel changes in the chest wall.

CPR and AED

This is normal. Forceful external chest compressions may cause chest injury,
but are critical if the person is to survive. Reassess your hand positioning and
continue compressions.

Knowledge Check
What are the 3 measures of high-quality chest compressions?

r e v i e w
P

BasicPlus CPR, AED, and First Aid for Adults MEDIC First Aid 19
 Chest Compressions
Position Your Hands
■■ Position person face up on a firm, flat
surface. Kneel close to chest.
■■ Place heel of one hand on center of
chest, on lower half of breastbone.
■■ Place heel of your other hand on
top of and parallel to first. You can
interlace your fingers to keep them
off chest.

Position Your Body

e w
■■ Bring your body up and over chest

i
so your shoulders are directly above

v
your hands. Straighten your arms and

e
lock your elbows.

P r Compress
■■ Bending at the waist, use upper body
weight to push straight down at least
2 inches.
■■ Lift hands and allow chest to fully
return to its normal position. Move
immediately into downstroke of next
compression.
■■ Avoid leaning on chest at the top of
each compression.
■■ Continue compressions at a rate of
100–120 times per minute.
Skill Guide 2

20 MEDIC First Aid BasicPlus CPR, AED, and First Aid for Adults
Primary Assessment — Unresponsive Person

CPR and AED

r e v i e w
P
The primary assessment is a simple way to quickly identify if a life-threatening
condition is present. It is the initial approach to anyone suspected of being ill
or injured.
The steps of the primary
assessment are always the
same:
■■ If it is safe to pro-
vide care, check for
responsiveness.
■■ If unresponsive, activate
EMS and get an AED, if
one is available.
■■ Check for normal
breathing.
■■ If normal breathing is found, place an uninjured person in a recovery
position.
■■ If the person is not breathing or only gasping, perform CPR.
If you determine a person is unresponsive, send a bystander to activate EMS
and get an AED. If you are alone, do this yourself and quickly return to the
person.

BasicPlus CPR, AED, and First Aid for Adults MEDIC First Aid 31
 If you have a mobile phone, use it to activate EMS. The speaker function will
allow you to follow instructions from an EMS dispatcher while providing care.
To check for normal breathing, quickly look at the face and chest. Take no lon-
ger than 10 seconds. Normal breathing is effortless, quiet, and regular. If you
are unsure, assume breathing is not normal.
Weak, irregular gasping, snorting, or gurgling sounds can occur early in cardiac
arrest. These actions provide no usable oxy­gen. This is not normal breathing.
If the person is not breathing, or only gasping, perform CPR, beginning with
compressions.
When an unresponsive person is breathing normally, and uninjured, place him
or her in a side-lying recovery position to help protect the airway.
Recovery Position

e w
The recovery position helps

v i
protect the airway by using

e
gravity to drain fluids from the

r
mouth and keep the tongue

P
from blocking the airway.
Frequently assess the breath-
ing of anyone placed in the
recovery position. The per-
son’s condition could quickly
become worse and require
additional care.

Knowledge Check
A fellow employee collapses near you during a staff meeting. As a trained first
aid provider, you move to help. You kneel next to him, squeeze his shoulder, and
loudly ask, “Are you all right?” He is unresponsive, so you direct other employees
to activate EMS and get the company’s AED. You look closely at the face and chest
for breathing; he makes a brief gasping snort, but then remains still. What do you
do next?
CPR and AED

32 MEDIC First Aid BasicPlus CPR, AED, and First Aid for Adults
Primary Assessment — Unresponsive Person

Skill Guide 6
Assess Scene
■■ Pause and assess scene for safety.
■■ If unsafe, or if it becomes unsafe at
any time, GET OUT!

Check for Response

e w
■■ Tap or squeeze shoulder and ask

i
loudly, “Are you all right?”

v
If unresponsive, have someone

e
■■

r
activate EMS and get an AED.

P Look for Normal Breathing

■■

■■
Position person face-up on a firm, flat
surface.
Look at face and chest for normal
breathing. Take no longer than 10
seconds. If unsure, assume breathing
is not normal.
■■ Weak, irregular gasping, snorting, or
gurgling is not normal breathing.

Provide Indicated Care

■■ If person is not breathing, or only
gasping, perform CPR, beginning
with compressions.
■■ If normal breathing is found, place an
uninjured person in recovery position.

BasicPlus CPR, AED, and First Aid for Adults MEDIC First Aid 33
 Recovery Position
Prepare
■■ Place arm nearest you up alongside
head.
■■ Bring far arm across chest and place
back of hand against cheek.
■■ Grasp far leg just above knee and
pull it up so the foot is flat on ground.

Roll

e w
■■ Grasping shoulder and hip, roll

i
person toward you in a single motion,

v
keeping head, shoulders, and body

e
from twisting.

P r
■■ Roll far enough for face to be angled
toward ground.

Stabilize
■■ Position elbow and legs to stabilize
head and body. Ensure there is no
pressure on chest that restricts
breathing.
■■ Make sure head ends up resting on
extended arm and head, neck, and
body are aligned.
■■ If person has been seriously injured,
do not move unless fluids are in
airway, or you need to leave to get
help.
Skill Guide 7

34 MEDIC First Aid BasicPlus CPR, AED, and First Aid for Adults
Pain, Severe Pressure, or Discomfort

Sudden Illness
in the Chest

r e v i e w
P
Acute coronary syndrome (ACS) occurs when there is reduced blood flow to
the tissues of the heart. Often described as a heart attack, ACS is a serious
condition that can result in significant damage to the heart.
Someone with ACS will generally experience pain, pressure, or discomfort
in the chest, although women often do not experience chest pain and may
describe indigestion, weakness, or fatigue. Shortness of breath, nausea, and
lightheadedness can also occur. The person may experience pain in the arms
or back. The person’s skin may become pale, cool, and sweaty.
A person who has had previous heart problems is at risk for reoccurrence.
Ask the person or any bystanders about prior problems, or medications being
taken.
If you suspect a heart-related problem, do not try to transport the person to a
hospital yourself. Activate EMS immediately, even if the person does not want
you to. While waiting for EMS to arrive, follow these guidelines:
■■ If an AED is available, have someone get it so that it’s nearby if needed.
■■ Allow the person to find the most comfortable position in which to
breathe.
■■ Loosen tight clothing.
■■ Calm, comfort, and reassure the person.

BasicPlus CPR, AED, and First Aid for Adults MEDIC First Aid 87
 ■■ A person who is having a heart attack may deny it. This is a common
occurrence in this situation. Accept it, but never let this alter your
approach to care.
■■ The early administra-
tion of aspirin can be
life-saving for a person
having a heart attack.
Encourage the person
to chew and swallow
1 adult (325 mg), or 2
to 4 low-dose (81 mg)
“baby” aspirin.
■■ Do not encourage aspi-
rin use if the person has an allergy to aspirin, evidence of a stroke, a

w
recent bleeding problem, the pain does not appear to be related to the

i e
heart, or if you are uncertain or uncomfortable with giving the aspirin.

e v
■■ Someone with a heart condition may carry a prescribed medication

r
known as nitroglycerin. If so, assist the person in the self-administration

P
of it.
Whenever a heart attack is suspected, be prepared for the possibility of sud-
den cardiac arrest, and the need for CPR and the use of an AED. Continue to
reassure the person until another provider or EMS personnel take over.

Heart Disease
Heart disease, through heart attacks and strokes, is the leading cause of death for men
and women in the United States. Statistics indicate more than 1 in 4 deaths was related
to heart disease; half of the deaths were women.
A healthy lifestyle can lower the risk of heart disease:
■■ Follow a healthy diet to prevent or reduce high blood pressure and high blood
cholesterol
■■ Maintain a healthy weight
■■ Control alcohol intake
■■ Don’t smoke
■■ Exercise regularly

Knowledge Check
Sudden Illness

True or false? A person who is having a heart attack may deny it.

88 MEDIC First Aid BasicPlus CPR, AED, and First Aid for Adults
MEDIC FIRST AID International, Inc.
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hsi.com/medicfirstaid

BasicPlus
CPR, AED, and
First Aid for Adults

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