5.4 First Aid, CPR, and Emergency Preparedness

First Aid, Emergency Preparedness & CPR

Health and physical educators are frequently the first trained responders during medical emergencies in school settings. Mastery of evidence-based cardiopulmonary resuscitation (CPR), automated external defibrillator (AED) operation, first aid, and emergency action plans (EAPs) is essential for student safety and professional compliance.

Cardiopulmonary Resuscitation (CPR) & AED Protocols

CPR protocols established by the American Heart Association (AHA) and American Red Cross emphasize high-quality chest compressions to maintain coronary and cerebral perfusion during cardiac arrest. Responders must follow the C-A-B sequence (Compressions, Airway, Breathing) for all cardiac arrest victims.

Primary Resuscitation Steps (Adult & Pediatric)

1. Check Scene Safety: Ensure the environment is safe for the responder and victim.
2. Check Responsiveness & Breathing: Tap shoulders and shout, "Are you okay?" Simultaneously scan the chest for breathing (or gasping) for at least 5 but no more than 10 seconds.
3. Activate Emergency Response & Retrieve AED: Call 911 (or direct a specific bystander to call 911 and get an AED).
4. Check Carotid/Brachial Pulse: Check for a pulse for no more than 10 seconds (Carotid for adult/child; Brachial for infant).
5. Initiate High-Quality CPR: If no pulse or breathing, immediately begin chest compressions.

High-Quality CPR Parameters

• Rate: 100 to 120 compressions per minute for all age groups.
• Chest Recoil: Allow complete chest recoil after each compression to permit heart refill; do not lean on the chest.
• Minimize Interruptions: Keep interruptions in compressions to less than 10 seconds.
• Depth and Hand Placement:
  • Adult: Depth of 2.0 to 2.4 inches (5–6 cm) using two hands on the lower half of the sternum.
  • Child (Age 1 to Puberty): Depth of about 2 inches (5 cm) using one or two hands on the lower half of the sternum.
  • Infant (< 1 Year): Depth of about 1.5 inches (4 cm) using the heel of one hand or the two-thumb encircling technique just below the nipple line (the 2025 AHA guidelines eliminated the two-finger technique).
• Compression-to-Ventilation Ratios:
  • Adult (1 or 2 Rescuers): 30:2
  • Child & Infant (Single Rescuer): 30:2
  • Child & Infant (Two Healthcare Rescuers): 15:2

Automated External Defibrillator (AED) Usage

An AED analyzes cardiac rhythms (identifying shockable rhythms: Ventricular Fibrillation [VF] and Pulseless Ventricular Tachycardia [VT]) and delivers an electrical shock to reset the heart's natural pacemaker.

• Step 1: Turn on the AED immediately upon arrival.
• Step 2: Apply adhesive pads to victim's bare chest (Upper right chest below collarbone, lower left side of chest). For infants/children, use pediatric pads; if unavailable, use adult pads ensuring they do not touch (place one on center chest, one on upper back).
• Step 3: Stand clear while the AED analyzes the rhythm ("Clear the victim!").
• Step 4: If a shock is advised, ensure no one is touching the victim, shout "CLEAR!", and press the shock button.
• Step 5: Immediately resume CPR starting with chest compressions.

CPR & Resuscitation Comparison Table

Choking Relief (Foreign Body Airway Obstruction)

Airway obstruction prevents ventilation and rapidly leads to cardiac arrest if uncorrected.

Responsive Adult or Child

• If the person is coughing forcefully, encourage them to keep coughing.
• If the victim cannot speak, cough, or breathe (clutching throat—universal choking sign):
  • Stand behind the victim, wrap arms around their waist.
  • Make a fist with one hand, place thumb side against the abdomen slightly above the navel and well below the xiphoid process.
  • Grasp fist with other hand and deliver quick, upward abdominal thrusts (Heimlich maneuver) until object is dislodged or victim becomes unresponsive. (Red Cross guidelines support alternating 5 back blows and 5 abdominal thrusts).

Responsive Infant (< 1 Year)

• Kneel or sit, hold infant face down along forearm supported by your thigh, head lower than chest.
• Deliver 5 firm back slaps between shoulder blades using the heel of your hand.
• Turn infant face up, supporting head and neck.
• Deliver 5 quick chest thrusts along lower sternum using the heel of one hand.
• Repeat cycle of 5 back slaps and 5 chest thrusts until object dislodges or infant becomes unresponsive.

Unresponsive Choking Victim (Any Age)

• Gently lower victim to the floor.
• Activate 911.
• Begin chest compressions immediately (do not check pulse).
• Each time the airway is opened to give rescue breaths, look inside the mouth. If a foreign object is seen, perform a finger sweep to remove it. Never perform a blind finger sweep as it may push objects deeper.

First Aid Interventions for Common School Emergencies

Severe Hemorrhage & Bleeding

1. Direct Pressure: Apply firm, direct pressure over the wound using sterile gauze or clean cloth.
2. Pressure Dressing: Wrap bandage firmly around dressing to maintain constant pressure.
3. Tourniquet: If life-threatening arterial bleeding from an extremity continues despite direct pressure, apply a commercial tourniquet 2 to 3 inches above the wound (not over a joint). Tighten until bleeding stops and record application time.

Thermal, Chemical, and Electrical Burns

• Thermal Burns: Cool immediately with cool, running water for 10 to 20 minutes. Cover loosely with sterile, non-adherent dressing. Do NOT use ice, ice water, butter, or ointments.
• Chemical Burns: Dry chemicals should be brushed off skin before flushing. Flush affected area with large amounts of running water for at least 20 minutes. Remove contaminated clothing.
• Electrical Burns: Ensure power source is disconnected before touching victim. Monitor for cardiac arrest (AED ready) and internal tissue damage.

Musculoskeletal Injuries (Fractures, Sprains, Strains)

Utilize the R.I.C.E. protocol:

• Rest: Stop activity and immobilize injured area.
• Ice: Apply cold pack wrapped in towel for 15-20 minutes every 1-2 hours.
• Compression: Apply elastic bandage snugly from distal to proximal to reduce swelling (check circulation).
• Elevation: Elevate injured limb above heart level if no fracture is suspected.
• Splinting: If fracture is suspected, immobilize the joint above and below the fracture site in the position found.

Heat-Related Illnesses

• Heat Cramps: Involuntary muscle spasms; move to cool area, stretch muscle, provide water/electrolyte solution.
• Heat Exhaustion: Pale/flushed skin, profuse sweating, dizziness, nausea, headache, normal mental status. Move to shade, remove heavy clothing, apply cool damp cloths, sip cool liquids.
• Heat Stroke (Medical Emergency): Failure of body thermoregulation. High body temperature (>104°F / 40°C), altered mental status (confusion, agitation, seizures, unconsciousness), hot dry or sweaty skin. Immediately call 911 and initiate rapid cooling (cold water immersion / ice bath up to neck) before EMS transport.

Anaphylaxis

Severe allergic reaction causing airway constriction, facial swelling, hives, and low blood pressure.

• Administer Epinephrine Auto-Injector (EpiPen) into the outer mid-thigh (can inject through clothing). Hold in place for 3 seconds, then massage area.
• Call 911 immediately. A second dose may be administered after 5-10 minutes if symptoms persist.