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66-688: Prior to 1974, ambulance services in British Columbia were provided by a mixture of volunteer ambulance brigades, fire departments, funeral homes, and private operators. As a result of recommendations made by the Foulkes Commission's report on health care, titled "Health Security for British Columbians" released in 1973, the Government of British Columbia created the Emergency Health Services Commission (EHSC), which in turn created

132-548: A CCP. Secondary Triage Clinicians are experienced primary care paramedics who conduct follow-up assessments on low acuity patients to determine the most appropriate care plan and response. STCs provide advice via telephone and live video to activate self-care and alternative conveyance pathways for their patients across the province. Low Acuity Patient Navigators are primary care paramedics who support and assess low acuity patients to refer them to alternate care and conveyance pathways. This includes taxi conveyance, UPCC referrals and

198-492: A Low Acuity Dispatcher. Wages are paid according to license qualification, years of service and supervisory status. Additional service pay is gained at 10, 15, 20, and 25 years of service. Casual/on-call staff receive $ 12/hour for on-call shifts until they are called to respond, at which point they receive their full wage. Part-time and full-time PCP positions are considered separate internal job postings and are filled according to seniority. Selection for full-time PCP positions

264-714: A controversial wage increase for 118 senior managers during a province-wide wage freeze for the public health sector. PHSA has been consistently named a top employer in Canada, and in October 2013 was again recognized with a national top employer honour. Cardiopulmonary resuscitation Cardiopulmonary resuscitation ( CPR ) is an emergency procedure consisting of chest compressions often combined with artificial ventilation , or mouth to mouth in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in

330-464: A heart rhythm that may be shockable. In general, CPR is continued until the person has a return of spontaneous circulation (ROSC) or is declared dead. CPR is indicated for any person unresponsive with no breathing or breathing only in occasional agonal gasps, as it is most likely that they are in cardiac arrest . If a person still has a pulse but is not breathing ( respiratory arrest ), artificial ventilations may be more appropriate, but due to

396-480: A licence level referred to as PCP-IV, which authorizes Primary Care Paramedics to initiate and maintain an IV as well as administer certain medications and crystalloid fluids through an IV line. Selected PCPs and ACPs are able to administer NA-1 (if endorsed and authorized) after consultation with a transport advisor as part of the FRONTIER stroke trial. If successful, this trial will change stroke management and highlight

462-467: A maximum distance of 200 miles (320 km), serving a 100 mile radius from their base. In 2023, BCEHS announced Ascent Helicopters Ltd. was awarded a 10-year, $ 554.4 million (CAD) contract to provide air ambulance service. Seven Leonardo AW169 helicopters were expected to enter service in the fall of 2024, replacing existing Helijet service. Paramedics qualified in British Columbia are broadly grouped as emergency medical assistants (EMAs) and are licensed by

528-653: A more stable patient off to a layered or co-responding PCP ambulance. The team currently consists of only 25 specially trained paramedics for the entire province. Critical Care Paramedics (CCPs) provide the most sophisticated care, including transporting patients by air and ground. CCPs specialize in the transport of complex critically injured or ill patients to specialized centres. Paramedic Specialists are licensed advanced care and critical care paramedics who are trained to handle disasters and mass casualty events. BC Ambulance has clinical consultation available for paramedics where paramedic specialists are enabled and empowered by

594-528: A nearby AED defibrillator should be used on the patient as soon as possible. As a general reference, defibrillation is preferred to performing CPR, but only if the AED can be retrieved in a short period of time. All these tasks (calling by phone, getting an AED, and the chest compressions and rescue breaths maneuvers of CPR) can be distributed between many rescuers who make them simultaneously. The defibrillator itself would indicate if more CPR maneuvers are required. As

660-405: A person who is in cardiac arrest . It is recommended for those who are unresponsive with no breathing or abnormal breathing, for example, agonal respirations . CPR involves chest compressions for adults between 5 cm (2.0 in) and 6 cm (2.4 in) deep and at a rate of at least 100 to 120 per minute. The rescuer may also provide artificial ventilation by either exhaling air into

726-464: A pulse), if the victim is a child. It can be difficult to determine the presence or absence of a pulse, so the pulse check has been removed for common providers and should not be performed for more than 10 seconds by healthcare providers. For untrained rescuers helping adult victims of cardiac arrest, it is recommended to perform compression-only CPR (chest compressions hands-only or cardiocerebral resuscitation, without artificial ventilation ), as it

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792-445: A rate of 1 breath every 6 to 8 seconds (8–10 ventilations per minute). In all victims, the compression speed is of at least 100 compressions per minute. Recommended compression depth in adults and children is of 5 cm (2 inches), and in infants it is 4 cm (1.6 inches). In adults, rescuers should use two hands for the chest compressions (one on the top of the other), while in children one hand could be enough (or two, adapting

858-1358: A regional health authority or hospital. Community paramedic classification is neither a licence nor a certification received from an external educational institution. Unlike previously mentioned levels of care, CPs are certified internally, and the services they provide are consistent with their pre-existing licence level. CPs are trained in community outreach and awareness, prevention care services for elderly patients, fall prevention assessments, scheduled and unscheduled home visits, and community public health promotion and education. Advanced Care Paramedics (ACPs) are trained to handle more complex cases, including serious trauma and cardiac resuscitation. ACPs work in large population centres such as Vancouver, Victoria, Nanaimo, Kamloops, Kelowna, and Prince George. The Infant Transport Team (ITT) are specialized critical care paramedics who are specifically trained in management of perinatal, neonatal and pediatric patients. Formerly, they were primary care paramedics (with many ACP Schedule 2 endorsements) with advanced training to provide emergency medical care to pediatric, neo-natal and high-risk obstetric patients. ITT paramedics work in close collaboration with practitioners at BC Children's & Women's Hospital in Vancouver. The team functions as an extension of

924-497: A slight variation for that sequence, if the rescuer is completely alone with a victim of drowning, or with a child who was already unconscious when the rescuer arrived, the rescuer would do the CPR maneuvers during 2 minutes (approximately 5 cycles of ventilations and compressions); after that, the rescuer would call to emergency medical services, and then it could be tried a search for a defibrillator nearby (the CPR maneuvers are supposed to be

990-416: A sort of arrhythmia that will stop the heart immediately), it is recommended that someone asks for a defibrillator (because they are quite common in the present time), for trying with it a defibrillation on the already unconscious victim, in case it is successful. Order of defibrillation in a first aid sequence It is recommended calling for emergency medical services before a defibrillation. Afterwards,

1056-511: A sufficient speed and depth of compressions, completely relaxing pressure between compressions, and not ventilating too much. It is unclear if a few minutes of CPR before defibrillation results in different outcomes than immediate defibrillation. A normal CPR procedure uses chest compressions and ventilations (rescue breaths, usually mouth-to-mouth) for any victim of cardiac arrest, who would be unresponsive (usually unconscious or approximately unconscious), not breathing or only gasping because of

1122-516: Is also non-regional and highly dispersed. The five other health authorities in the province have regional jurisdiction. Services are provided either directly through PHSA agencies or through funding or collaboration with regional health authorities. PHSA operates and manages a number of well-recognized specialized programs/services: The PHSA concentrates on doing three things to meet its responsibilities in health care: Because of its provision of province-wide specialized care, PHSA has repeatedly had

1188-1226: Is an independent regulatory body responsible for licensing paramedics. BCEHS's air ambulance program consists of a fleet of ten fixed-wing aircraft with three each in Vancouver and Kelowna, two in Prince George, and one each in Nanaimo and Fort St. John. Additional aircraft are chartered on an as-needed basis. In addition to its planes, BCEHS operates six dedicated air ambulance helicopters, two based in Vancouver, one in Nanaimo, one in Kamloops, one in Prince George, and one in Prince Rupert. BCEHS also utilizes approximately 35 pre-qualified charter carriers throughout British Columbia. Helijet , an airline based in Richmond, B.C., provides helicopters, pilots, and maintenance crews to their Sikorsky S76 helicopters contracted by BCEHS in Vancouver and Prince Rupert. Helijet has been servicing BCEHS since 1988, expanding to Prince Rupert in 2011. The Sikorsky air ambulances can carry up to 2 stretchers and 4 medical attendants and can travel

1254-530: Is currently approaching zero months. Provincial Health Services Authority Provincial Health Services Authority ( PHSA ) is a publicly funded health service provider in the province of British Columbia . PHSA is unique in Canada as the only health authority having a province-wide mandate for specialized health services, although within British Columbia the First Nations Health Authority

1320-418: Is determined by total full-time seniority and then, if there are no more full-time PCP applicants, total part-time seniority. Stations in Vancouver typically have the lowest entry threshold for full-time PCP positions. While this has traditionally meant working for in smaller towns to accumulate at least five years of part-time seniority, the required part-time seniority for accepting a full-time spot in Vancouver

1386-418: Is easier to perform and instructions are easier to give over a phone. In adults with out-of-hospital cardiac arrest , compression-only CPR by the average person has an equal or higher success rate than standard CPR. The CPR 'compressions only' procedure consists only of chest compressions that push on the lower half of the bone that is in the middle of the chest (the sternum ). Compression-only CPR

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1452-468: Is effective only if performed within seven minutes of the stoppage of blood flow. The heart also rapidly loses the ability to maintain a normal rhythm. Low body temperatures, as sometimes seen in near-drownings, prolong the time the brain survives. Following cardiac arrest, effective CPR enables enough oxygen to reach the brain to delay brain stem death , and allows the heart to remain responsive to defibrillation attempts. If an incorrect compression rate

1518-416: Is manual squeezing of the exposed heart itself carried out through a surgical incision into the chest cavity , usually when the chest is already open for cardiac surgery. Active compression-decompression methods using mechanical decompression of the chest have not been shown to improve outcome in cardiac arrest. A defibrillator is a machine that produces a defibrillation: electric shocks that can restore

1584-406: Is necessary for the ventilations, because of the size of the baby's neck. In CPR, the chest compressions push on the lower half of the sternum —the bone that is along the middle of the chest from the neck to the belly— and leave it rise up until recovering its normal position. The rescue breaths are made by pinching the victim's nose and blowing air mouth-to-mouth. This fills the lungs, which makes

1650-612: Is not as good for children who are more likely to have cardiac arrest from respiratory causes. Two reviews have found that compression-only CPR had no more success than no CPR whatsoever. Rescue breaths for children and especially for babies should be relatively gentle. Either a ratio of compressions to breaths of 30:2 or 15:2 was found to have better results for children. Both children and adults should receive 100 chest compressions per minute. Other exceptions besides children include cases of drownings and drug overdose ; in both these cases, compressions and rescue breaths are recommended if

1716-442: Is not indicated if the patient has a normal pulse or is still conscious. Also, it is not indicated in asystole or pulseless electrical activity (PEA) , in those cases a normal CPR would be used to oxygenate the brain until the heart function can be restored. Improperly given electrical shocks can cause dangerous arrhythmias , such as the ventricular fibrillation (VF) . When a patient does not have heart beatings (or they present

1782-407: Is set at 30 to 2 in adults. CPR alone is unlikely to restart the heart. Its main purpose is to restore the partial flow of oxygenated blood to the brain and heart . The objective is to delay tissue death and to extend the brief window of opportunity for a successful resuscitation without permanent brain damage . Administration of an electric shock to the subject's heart, termed defibrillation ,

1848-473: Is superior to compression-only CPR. Standard CPR is performed with the victim in supine position . Prone CPR, or reverse CPR, is performed on a victim in prone position , lying on the chest. This is achieved by turning the head to the side and compressing the back. Due to the head being turned, the risk of vomiting and complications caused by aspiration pneumonia may be reduced. The American Heart Association's current guidelines recommend performing CPR in

1914-543: Is that the CPR ventilations (rescue breaths) are considered the most important action for those victims. Cardiac arrest in drowning victims originates from a lack of oxygen, and a child would probably not suffer from cardiac diseases. The reason is that the phone call is considered urgent. In 2010, the AHA and International Liaison Committee on Resuscitation updated their CPR guidelines. The importance of high quality CPR (sufficient rate and depth without excessively ventilating)

1980-417: Is used during CPR, going against standing American Heart Association (AHA) guidelines of 100–120 compressions per minute, this can cause a net decrease in venous return of blood, for what is required, to fill the heart. For example, if a compression rate of above 120 compressions per minute is used consistently throughout the entire CPR process, this error could adversely affect survival rates and outcomes for

2046-609: Is used on people in cardiac arrest to oxygenate the blood and maintain a cardiac output to keep vital organs alive. Blood circulation and oxygenation are required to transport oxygen to the tissues. The physiology of CPR involves generating a pressure gradient between the arterial and venous vascular beds; CPR achieves this via multiple mechanisms. The brain may sustain damage after blood flow has been stopped for about four minutes and irreversible damage after about seven minutes. Typically if blood flow ceases for one to two hours, then body cells die . Therefore, in general CPR

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2112-427: Is usually needed to restore a viable, or "perfusing", heart rhythm. Defibrillation is effective only for certain heart rhythms, namely ventricular fibrillation or pulseless ventricular tachycardia , rather than asystole or pulseless electrical activity , which usually requires the treatment of underlying conditions to restore cardiac function. Early shock, when appropriate, is recommended. CPR may succeed in inducing

2178-465: The supine position , and limits prone CPR to situations where the patient cannot be turned. During pregnancy when a woman is lying on her back, the uterus may compress the inferior vena cava and thus decrease venous return. It is therefore recommended that the uterus be pushed to the woman's left. This can be done by placing a pillow or towel under her right hip so that she is on an angle of 15–30 degrees, and making sure their shoulders are flat to

2244-741: The BC Ambulance Service on July 4, 1974. BCAS is managed by British Columbia Emergency Health Services (BCEHS), which is under the jurisdiction of the Provincial Health Services Authority (PHSA). The operating budget for BCEHS in 2023 was $ 766 million. There are 183 ambulance stations in British Columbia, including the transfer fleet. As of 2024, the BCAS employs 5040 part-time and full-time paramedics and dispatchers. Dispatch centres are located in Kamloops, Vancouver, and Victoria. The Emergency Medical Assistants Licensing Board

2310-585: The Emergency Medical Assistants Licensing Board (EMALB), an independent government regulatory agency, under one of six categories: Paramedics from other provinces and countries who request to be licensed in British Columbia will need to apply to the EMALB for equivalency. All paramedics employed by BC Ambulance are required to obtain a Class 4 driver's licence. Paramedics in BC do not work under

2376-691: The Emergency Medical Assistants Licensing Board (EMALB). EMA FRs are licensed to provide scene and patient assessments, perform cardiopulmonary resuscitation , insert and maintain airway devices (both oropharyngeal and nasopharyngeal), utilize suction devices, bag-valve-mask devices, and automatic and semi-automatic defibrillators, manage wounds (not requiring tissue puncture or indentation) and fractures, immobilize fractures, and lift/load and extricate/evacuate patients. EMA FRs may be endorsed to perform spinal motion restriction and emergency childbirth , utilize pulse oximeters, CO-oximeters, and glucometers, perform non-invasive blood pressure measurement, and administer

2442-601: The ability to initiate critical patient bypasses to specialized centres with certain patient presentations and initiate alternate transport destinations to alleviate pressures and patient transport to emergency departments. Some of these include: Emergency Medical Assistant First Responders (EMA FRs) are licensed Emergency Medical Assistants in British Columbia; however, they are not employed by BCAS. Most EMA FRs work as fire fighters/fire rescue. Upon completion of an approved EMA FR training program in British Columbia (ranging from 55 to 84 hours), students may apply for licensing with

2508-573: The bystander is trained and is willing to do so. As per the AHA, the beat of the Bee Gees song " Stayin' Alive " provides an ideal rhythm in terms of beats per minute to use for hands-only CPR, which is 104 beats-per-minute. One can also hum Queen 's " Another One Bites the Dust ", which is 110 beats-per-minute and contains a repeating drum pattern. For those in cardiac arrest due to non-heart related causes and in people less than 20 years of age, standard CPR

2574-404: The case of babies. Water and metals transmit the electric current. This depends on the amount of water, but it is convenient to avoid starting the defibrillation on a floor with puddles, and to dry the wet areas of the patient before (fast, even with any cloth, if that could be enough). It is not necessary to remove the patient's jewels or piercings, but it should be avoided placing the patches of

2640-436: The chest and the other on the back (no matter which of them). There are several devices for improving CPR, but only defibrillators (as of 2010) have been found better than standard CPR for an out-of-hospital cardiac arrest. When a defibrillator has been used, it should remain attached to the patient until emergency services arrive. Timing devices can feature a metronome (an item carried by many ambulance crews) to assist

2706-571: The chest to rise up, and increases the pressure into the thoracic cavity. If the victim is a baby, the rescuer would compress the chest with only 2 fingers and would make the ventilations using their own mouth to cover the baby's mouth and nose at the same time. The recommended compression-to-ventilation ratio, for all victims of any age, is 30:2 (a cycle that alternates continually 30 rhythmic chest compressions series and 2 rescue breaths series). Victims of drowning receive an initial series of 2 rescue breaths before that cycle begins. As an exception for

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2772-474: The compressions to the child's constitution), and with babies the rescuer must use only two fingers. There exist some plastic shields and respirators that can be used in the rescue breaths between the mouths of the rescuer and the victim, with the purposes of sealing a better vacuum and avoiding infections. In some cases, the problem is one of the failures in the rhythm of the heart (ventricular fibrillation and ventricular tachycardia) that can be corrected with

2838-494: The coordination of Link and Referral Unit responses provincially. They also support crews on the street by answering the provincial Low Acuity Line. Link and Referral Units are specialized primary care paramedic units that assess and transport low acuity patients in place of an emergency ambulance. The LARUs in service are directed to the most appropriate calls by the Low Acuity Patient Navigator and are supported by

2904-476: The correct shocks if they are needed. The time in which a cardiopulmonary resuscitation can still work is not clear, and it depends on many factors. Many official guides recommend continuing a cardiopulmonary resuscitation until emergency medical services arrive (for trying to keep the patient alive, at least). The same guides also indicate asking for any emergency defibrillator (AED) near, to try an automatic defibrillation as soon as possible before considering that

2970-413: The defibrillator are considered urgent when the problem has a cardiac origin). Defibrillation The standard defibrillation device, prepared for a fast use out of the medical centres, is the automated external defibrillator (AED), a portable machine of small size (similar to a briefcase) that can be used by any user with no previous training. That machine produces recorded voice instructions that guide to

3036-441: The defibrillator directly on top of them. The patches with electrodes are put on the positions that appear at the right. In very small bodies: children between 1 and 8 years, and, in general, similar bodies up to 25 kg approximately, it is recommended the use of children's size patches with reduced electric doses. If that is not possible, sizes and doses for adults would be used, and, if the patches were too big, one would be placed on

3102-445: The difficulty people have in accurately assessing the presence or absence of a pulse, CPR guidelines recommend that lay persons should not be instructed to check the pulse, while giving healthcare professionals the option to check a pulse. In those with cardiac arrest due to trauma , CPR is considered futile but still recommended. Correcting the underlying cause such as a tension pneumothorax or pericardial tamponade may help. CPR

3168-467: The electric shock of a defibrillator . So, if a victim is suffering a cardiac arrest, it is important that someone asks for a defibrillator nearby, to try with it a defibrillation process when the victim is already unconscious. The common model of defibrillator (the AED) is an automatic portable machine that guides to the user with recorded voice instructions along the process, and analyzes the victim, and applies

3234-508: The essential role of prehospital care in stroke management. Selected ACPs are able to administer TNKase (if endorsed and authorized) after consultation with a transport advisor as part of the Collaborative Heart Attack Management Program (CHAMP) Protocol for ST-Elevation Myocardial Infarction Pre-hospital Reperfusion. If this trial is successful, it can be extended to other areas of the province. Paramedics have

3300-594: The field. They provide valuable information regarding not only what paramedics should do for patients under certain circumstances, but also the decision of when, and if, that care is appropriate is dependent on their ability to decide the best course of action for the patient. Many paramedics seek additional training to achieve licence endorsements, which authorize them to perform medical interventions/treatments outside of their normal scope of practice. The two most common licence endorsements are for EMRs to utilize narcotic antagonists (otherwise known as Narcan or Naloxone) and

3366-637: The five highest-paid employees (each a physician) in the public health sector listed in annual reviews by the Vancouver Sun newspaper. David Byres has been president and CEO since February 2021, when Benoit Morin stepped down following a review into allegations of misspending. Morin had taken the role in February 2020 after the retirement of his predecessor, Carl Roy, who served as the executive leader of PHSA from January 2014 – February 2020. The organization’s first president and CEO, Lynda Cranston, resigned after

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3432-773: The following medications: EMA FRs may also be endorsed to assist a patient with the administration of a medication. Emergency Medical Responders (EMRs) are licensed to "administer basic life-saving emergency medical care". Upon completion of an approved EMR training program in British Columbia (~100 hours), students may apply for licensing with the Emergency Medical Assistants Licensing Board (EMALB). EMRs are licensed to provide all Emergency Medical Assistant First Responder (EMA FR) designated services (and endorsements), in addition to occupational first aid, transportation, and soft tissue injury management. EMRs may be further endorsed to maintain intravenous lines (without medications or blood products), perform chest auscultations, and administer

3498-1539: The following medications: EMR is the lowest level of care employed by BCAS, and most EMRs work at rural ambulance stations on part-time shifts. Further training is required (e.g. in primary care paramedicine) before transferring to a BCAS station in a larger population centre. Primary Care Paramedics (PCPs) are licensed to administer more advanced care. PCP is the most common level of care in BCAS. Primary care paramedic programs take between 9 weeks and 8 months to complete and issue program certificates. Unlike EMA FR or EMR education, PCP programs consist of multiple courses in each program and most programs are offered full time or at night. In addition to all services provided by EMRs, PCPs are licensed to administer extraglottic airway devices, medication administration through IV , oral (PO), subcutaneous , sublingual , intramuscular , inhalation, and nebulization routes. PCPs can receive endorsements for IV initiation, administration of IV crystalloids , endotracheal tube intubation , ECG acquisition, administration of non-invasive positive airway pressure ventilation devices, and administration of anti-emetics, anti-nauseants, and vitamins through IV, oral, SL, SC, inhalation, or nebulization routes. Community Paramedics (CPs) provide non-emergency and scheduled care to patients, often referred to colloquially as "clients," (although CP services are covered by provincial health insurance and come at little to no cost), as part of an integrated healthcare team, usually coordinated with

3564-500: The ground. If this is not effective, healthcare professionals should consider emergency resuscitative hysterotomy . Evidence generally supports family being present during CPR. This includes in CPR for children. Interposed abdominal compressions may be beneficial in the hospital environment. There is no evidence of benefit pre-hospital or in children. Cooling during CPR is being studied as currently results are unclear whether or not it improves outcomes. Internal cardiac massage

3630-435: The lack of heart beats. But the ventilations could be omitted for untrained rescuers aiding adults who suffer a cardiac arrest (if it is not an asphyxial cardiac arrest, as by drowning, which needs ventilations). The patient's head is commonly tilted back (a head-tilt and chin-lift position) for improving the air flow if ventilations can be used. However, in the case of babies, the head is left straight, looking forward, which

3696-472: The license of a physician as they do in other provinces/jurisdictions. They hold their own licenses under the authority of the EMALB. Paramedic practitioners practicing in BC do not use protocols, instead, they utilize BCEHS Treatment Guidelines (TGs). TGs are the medical resource documents that guide paramedic practice in the province. TGs are a combination of best practice and evidence-based medicine designed to better equip paramedics to make informed decisions in

3762-465: The neonatal/pediatric intensive care unit as well as the high risk labour and delivery areas of the hospital. Tertiary level critical care is delivered by the team to the bedside at any location in the province. They respond as an equally qualified team of two and sometimes take a physician with them for critically ill patients. When dispatched on street calls, these are targeted response ambulances that often assist or intervene when necessary, but can hand

3828-467: The normal compression-to-ventilation ratio of 30:2, if at least two trained rescuers are present and the victim is a child, the preferred ratio is 15:2. Equally, in newborns, the ratio is 30:2 if one rescuer is present, and 15:2 if two rescuers are present (according to the AHA 2015 Guidelines). In an advanced airway treatment, such as an endotracheal tube or laryngeal mask airway , the artificial ventilation should occur without pauses in compressions at

3894-429: The normal heart function of the victim. The common model of defibrillator out of an hospital is the automated external defibrillator (AED), a portable device that is especially easy to use because it produces recorded voice instructions. Defibrillation is only indicated for some arrhythmias (abnormal heart beatings), specifically ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT) . Defibrillation

3960-425: The organization and by the medical directors to provide clinical, safety, and operational advice to paramedics. The pre-hospital environment poses many clinical challenges to practising paramedics. When faced with these challenges it may be appropriate to seek clarity with an appropriate senior clinician. Paramedics at all license levels can call CliniCall to speak with a paramedic specialist who will be either an ACP or

4026-463: The patient has died. A normal cardiopulmonary resuscitation has a recommended order named 'CAB': first 'Chest' (chest compressions), followed by 'Airway' (attempt to open the airway by performing a head tilt and a chin lift), and 'Breathing' (rescue breaths). As of 2010, the Resuscitation Council (UK) was still recommending an 'ABC' order, with the 'C' standing for 'Circulation' (check for

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4092-423: The priority for the drowned and most of the already collapsed children). As another possible variation, if a rescuer is completely alone and without a phone near, and is aiding to any other victim (not a victim of drowning, nor an already unconscious child), the rescuer would go to call by phone first. After the call, the rescuer would get a nearby defibrillator and use it, or continue the CPR (the phone call and

4158-670: The subject's mouth or nose ( mouth-to-mouth resuscitation ) or using a device that pushes air into the subject's lungs ( mechanical ventilation ). Current recommendations place emphasis on early and high-quality chest compressions over artificial ventilation; a simplified CPR method involving only chest compressions is recommended for untrained rescuers. With children, however, 2015 American Heart Association guidelines indicate that doing only compressions may actually result in worse outcomes, because such problems in children normally arise from respiratory issues rather than from cardiac ones, given their young age. Chest compression to breathing ratios

4224-438: The user along the defibrillation process. It also checks the victim's condition to automatically apply electric shocks at the correct level, if they are needed. Other models are semi-automatic and require the user to push a button before an electric shock. A defibrillator may ask for applying CPR maneuvers , so the patient would be placed lying in a face up position. Additionally, the patient's head would be tilted back, except in

4290-406: The victim. The best position for CPR maneuvers in the sequence of first aid reactions to a cardiac arrest is a question that has been long studied. As a general reference, the recommended order (according to the guidelines of many related associations as AHA and Red Cross) is: If there are multiple rescuers, these tasks can be distributed and performed simultaneously to save time. The reason

4356-411: Was emphasized. The order of interventions was changed for all age groups except newborns from airway, breathing, chest compressions (ABC) to chest compressions, airway, breathing (CAB). An exception to this recommendation is for those believed to be in a respiratory arrest (airway obstruction, drug overdose, etc.). The most important aspects of CPR are: few interruptions of chest compressions,

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