BLS Training for Lay People - when to get help?

The resuscitation council offers this advice:

We (Resuscitation council [UK]) receive a number of enquiries from trainers teaching lay people in basic life support about whether the "one minute CPR exceptions" should be taught. The guidelines state a single rescuer will have to decide whether co start resuscitation or go for help first. If the likely cause of unconsciousness is trauma, drowning, choking, drug or alcohol intoxication or if the victim is a child, the rescuer should perform resuscitation for about one minute before going for help.

The majority of cases of sudden cardiac arrest in adults are due to ventricular fibrillation, and the Resuscitation Council (UK) therefore teaches that the emergency medical services should be called as soon as a victim is found not to be breathing. If, however, the primary cause of unconsciousness is respiratory arrest, there is potential benefit in performing some CPR before leaving the victim, since restoration of breathing or prevention of cardiac arrest may result. For this reason, a list of the most likely causes of respiratory arrest is included in the guidelines.

Skill acquisition and retention in resuscitation training has been increasingly recognised as a problem, particularly for lay persons when BLS courses are, of necessity, short. Where possible, the Guidelines have been simplified to aid learning, but a balance has to be struck between ensuring that course participants remember the basic management of cardiac arrest, and teaching additional procedures for less common situations.

The BLS/AED Subcommittee of the Resuscitation Council (UK) accepts the established concept that it may be beneficial to give some resuscitation before leaving to obtain help for the victim of primary respiratory arrest. It recognises, however, that this applies to relatively few cases of cardiopulmonary collapse and only when the rescuer is on his or her own. The potential advantages of including these exceptions in BLS training are outweighed by the well-proven disadvantage of having to teach additional steps in the BLS sequence.

For these reasons, the Subcommittee recommends that the list of exceptions should not be taught on adult basic life support courses. It is recognised, however, that trainers will at times have to respond to specific training needs. The exceptions should be included in courses for specific target groups, such as paediatric life support and lifeguard training.

Dr Tony Handley