EFR change?

[TMHeimer]

I hear somewhere that rescue breaths have been eliminated from CPR (EFR?). Can't find out googling. Anyone know?

 

[boulderjohn]

I hear somewhere that rescue breaths have been eliminated from CPR (EFR?). Can't find out googling. Anyone know?

That happened years ago. The theory was that there is enough O2 in the blood to do the job if you get it circulating. This also goes along with the belief that in an adult, if the diver is not circulating, they are also not breathing, so there is no need to check for it.

All of this goes out the window, though, with drowning. Drowning has different characteristics that make it different from other situations and bring it back to the older rules.

 

[shurite7]

I hear somewhere that rescue breaths have been eliminated from CPR (EFR?). Can't find out googling. Anyone know?

When I got my instructor rating for CPR the instructor trainer (IT) stated what boulderjohn wrote above. The IT elaborated on this calling the revision "layman's cpr" for those who get the certification, but don't really keep up on their skills. Basically it is 100 compressions per minute with no breaths. For those who are most likely to need the cpr they still conduct the breaths, especially if it is two person cpr. Another factor for the change is it is easier to remember 100 rather than the other methods, thus "encouraging people to at least attempt some form of cpr. An interesting thing about cpr is the success rate is less than 1%. If an AED is used with cpr the success rate is much much higher; I can't remember what it is, but it is quite significant.

For divers, drowning is a significant issue which has already been stated above.

 

[TMHeimer]

Thanks last 2 posts. I see what you guys say about different regarding drowning/near drowning (we all see that on TV where all of sudden the patient spits out water).
When I first took EFR in '06 you gave 2 rescue breaths first, then compressions, and 30 to 2 or 15 to 2 depending on if it's a child or adult. In '09 you still gave the 2 breaths first, but it was all either 15 or 30 to 2--the reason I was given was as mentioned--easier to remember one thing as a layman. I took it again (not with EFR) in both '11 and '14. By then ('11?) it changed to doing compressions first, then the breaths. So now, with breaths eliminated, that occurred either 4 or 7 years ago.
Gets back to a question I asked years ago--why so many changes in this era of having statistics for everything -- Was it not possible to figure out even decades ago that doing breaths at all was just not practical (except for drowning)? What information did they have 4-7 years ago that they were unable to figure out in say, 1992--or 1967?

 

[rsingler]

Part of the genesis arose with the arrival of HIV. There was an observation that lay rescuers were averse to providing mouth-to-mouth resuscitation, and barrier techniques were a new opportunity for ineffective ventilation.
So with less than effective ventilation, and interruption of CPR to provide breaths, the decision was made at a consensus level that breaths could be eliminated for lay CPR without negatively impacting an already dismal success rate. Any decreased survival from circulating less-oxygen-rich blood was felt to be offset by more effective compressions.
At ACLS level resuscitation, ventilation is provided.
As already noted above, scuba rescue is completely different. If the problem is cardiac, then the outlook is dismal due to the time to bring the victim to a hard surface for compressions. However, many scuba emergencies are near drowning, and the victim likely still has a cardiac rhythm. Rescue breaths are thus the key, and fortunately are the one thing we can provide during in-water transport. It's why Rescue class is so methodical during gear removal. The key rescue item is those breaths, not the speed with which you get the victim out of his/her gear.

Diving Doc

 

[TMHeimer]

Part of the genesis arose with the arrival of HIV. There was an observation that lay rescuers were averse to providing mouth-to-mouth resuscitation, and barrier techniques were a new opportunity for ineffective ventilation.
So with less than effective ventilation, and interruption of CPR to provide breaths, the decision was made at a consensus level that breaths could be eliminated for lay CPR without negatively impacting an already dismal success rate. Any decreased survival from circulating less-oxygen-rich blood was felt to be offset by more effective compressions.
At ACLS level resuscitation, ventilation is provided.
As already noted above, scuba rescue is completely different. If the problem is cardiac, then the outlook is dismal due to the time to bring the victim to a hard surface for compressions. However, many scuba emergencies are near drowning, and the victim likely still has a cardiac rhythm. Rescue breaths are thus the key, and fortunately are the one thing we can provide during in-water transport. It's why Rescue class is so methodical during gear removal. The key rescue item is those breaths, not the speed with which you get the victim out of his/her gear.

Diving Doc

I understand all of that and it makes sense. I do have to think though that it was a long time ago when HIV first appeared. It has also been a pretty darn long time since barrier masks became the norm (at least back in '06 when I first took EFR, if not significantly before that). I guess it just took a fair bit of time for the consensus to become "forget about the breaths" (minimum of 5 years).
So you'd have to figure that whatever data was available in either 2011 or 2014 to come to the conclusion that rescue breaths (other than water accidents) did almost nothing to make better a less than 1% success rate---was simply not available in 2006? Not like it was the computer dark ages.

 

[rsingler]

I guess it just took a fair bit of time for the consensus to become "forget about the breaths"

Yeah, I think that was a hard thing for the medical community to let go of. It drives us (anesthesiologists) crazy, but you can't argue with the data, I guess.

In any case, the take away point is: this DOESN'T apply to scuba rescue.

 

[Rred]

Yes and no. About five-six years ago the official recommendations in the US were changed. For "civilians" rescue breathing was formally dropped from CPR training, because it is more important to make sure the compressions are being done, and the "Yech!" factor and need for protective barriers is a serious impediment to care..

For *professionals*, emergency responders, paramedics, anyone in the "responder" business as a job, they are still expected to do rescue breathing, and presumably they will also have protective barrier devices available with them. (These can be had on a keychain these days.)

Legally, as a volunteer or professional, you are normally required to FOLLOW YOUR TRAINING and not exceed it. So whichever way you have been certified, follow your training. If you disagree with it, retake the course that teaches the standard you want to follow.

 

[rsingler]

Well, if any of you are taught to skip breathing during a scuba EFR course, argue with your instructor.

 

[TMHeimer]

Yes and no. About five-six years ago the official recommendations in the US were changed. For "civilians" rescue breathing was formally dropped from CPR training, because it is more important to make sure the compressions are being done, and the "Yech!" factor and need for protective barriers is a serious impediment to care..

For *professionals*, emergency responders, paramedics, anyone in the "responder" business as a job, they are still expected to do rescue breathing, and presumably they will also have protective barrier devices available with them. (These can be had on a keychain these days.)

Legally, as a volunteer or professional, you are normally required to FOLLOW YOUR TRAINING and not exceed it. So whichever way you have been certified, follow your training. If you disagree with it, retake the course that teaches the standard you want to follow.

That's interesting--"civilian" vs. "professional". CPR is pretty basic stuff--I guess I figured it would be the same, professional or not.