This bulletin is intended to provide clarity and direction for both instruction and evaluation.<\/span><\/span>\u00a0<\/span><\/p>\nCurrent references in our training resources include: <\/span><\/span>CSP Patrollers Manual 2022 Revision 2<\/span><\/span><\/em> (AFA 6-97)<\/span>\u00a0<\/span>and CSP eLearning courses on Moodle, module eAFA127B (<\/span>S<\/span>lide 6) found in both <\/span>the <\/span>AFA 2024 New Recruit and AFA Requalification courses.\u00a0<\/span><\/span>\u00a0<\/span> <\/span><\/p>\nThe <\/span><\/span>Patroller Manual 2022 Revision 2<\/span><\/span><\/em> reflects changes based on the ILCOR (International Liaison Committee on Resuscitation) 2020 revisions<\/span>,<\/span> and also<\/span> the <\/span><\/span>First Aid, Resuscitation, and Educational Guidelines 2020 Clinical and Educational Updates for Canada<\/span><\/span><\/em>, prepared by the Canadian Red Cross<\/span> (CRC)<\/span>. <\/span>The <\/span>CSP reviews and revises protocols based on <\/span>these evidence<\/span> based<\/span>–<\/span>finding<\/span>s.<\/span><\/span>\u00a0<\/span><\/p>\nThe excerpt from the Patroller<\/span> Manual is copied below<\/span>,<\/span> with the <\/span>two sections requiring clarification bolded. <\/span>The two topics are <\/span>identified<\/span>, and instructional and evaluation direction <\/span>is <\/span>provided here.<\/span><\/span>\u00a0<\/span><\/p>\n1. The Patroller Manual and module eAFA127B states: <\/span><\/span>Abdominal thrusts, back blows, and chest thrusts should be applied in quick succession until the object has been cleared from the airway or the patient becomes unresponsive.<\/span><\/span>\u00a0<\/span><\/strong><\/em><\/span><\/p>\nThis has often been interpreted to mean all three techniques are to be used in succession. In other words, <\/span>five<\/span> abdominal thrusts; <\/span>five<\/span> back blows; <\/span>five<\/span> chest thrusts, with the three <\/span>techniques <\/span>being repeated in sequence.<\/span><\/span>\u00a0<\/span><\/p>\nResearch evidence has <\/span>demonstrated<\/span> that each of the techniques <\/span>is<\/span> equally effective. Treatment protocols may differ, however, the CSP and CRC in Canada <\/span>provide<\/span> treatment guidance as follows:<\/span><\/span>\u00a0<\/span><\/p>\nIf the patient is suffering from complete choking as <\/span>determined<\/span> by the following signs:<\/span><\/span>\u00a0<\/span><\/strong><\/em><\/p>\n\n- \n
\n- Inability to speak, breathe or cough.\u00a0<\/span><\/i><\/b>\u00a0<\/span><\/li>\n
- Absence of chest movement or air exchange.\u00a0<\/span><\/i><\/b>\u00a0<\/span><\/li>\n
- Increased cyanosis.\u00a0<\/span><\/i><\/b><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n
Treat the choking adult or child alternating between any two of the three techniques described in the manual or module until the object has been cleared from the airway or the patient becomes unresponsive<\/span>.\u00a0\u00a0<\/span><\/span>\u00a0<\/span><\/strong><\/em><\/p>\nThere is no evidence to <\/span>indicate<\/span> one technique is best to start with. If no success is being achieved, then the third technique may be <\/span>utilized<\/span>. For <\/span>instance<\/span> if the sequence being used is: <\/span>five<\/span> back blows; <\/span>five<\/span> abdominal thrusts, repeated with no success, the sequence may be changed to include <\/span>five<\/span> chest thrusts replacing <\/span>a technique<\/span>, or in addition to the other techniques<\/span>,<\/span> to achieve success.\u00a0<\/span><\/span>\u00a0<\/span><\/strong><\/em><\/p>\nThe desired outcome is to expel the object and clear the airway<\/span>.<\/span><\/span>\u00a0<\/span><\/strong><\/em><\/p>\n2. The Patroller Manual and module eAFA127B states: <\/span><\/span>There is not enough evidence to suggest a different approach for an obese or pregnant person who is choking.<\/span><\/span>\u00a0<\/span><\/strong><\/em><\/span><\/p>\nThis statement has been interpreted to include using the abdominal thrust technique. Evidence<\/span>–<\/span>based recommendations continue to <\/span>advise<\/span> the <\/span>use of chest thrusts for pregnant women<\/span> or where the patroller cannot get their arms around the <\/span>patient\u2019s <\/span>stomach. In these instances<\/span>,<\/span> provide<\/span> instructional guidance as follows:<\/span><\/span>\u00a0<\/span><\/p>\nIf the patient is a pregnant woman or a person where the patroller cannot reach around the stomach, use <\/span>five<\/span> back blows and <\/span>five<\/span> chest thrusts in sequence, continuing until <\/span><\/span>the object has been cleared from the airway or the patient becomes unresponsive<\/span>.\u00a0\u00a0<\/span><\/span><\/strong><\/em>\u00a0<\/span><\/p>\nThe clarification provided in this bulletin will be shared by instructors at face<\/span>–<\/span>to<\/span>–<\/span>face sessions in 2024. The manual and eLearning module will not be revised <\/span>this year.\u00a0<\/span><\/span>\u00a0<\/span><\/p>\nDuring evaluation<\/span>,<\/span> if a requalifying patroller <\/span>demonstrates<\/span> all three techniques in <\/span>sequence, or<\/span> indicates abdominal thrusts may be used with pregnant women or obese individuals, the patroller will not be penalized. The patroller will receive the clarification provided here by the evaluator<\/span> who will confirm their understanding.\u00a0<\/span><\/span>\u00a0<\/span><\/p>\n
\nManual Reference: CSP Patrollers Manual 2022 Revision 2 (AFA 6-97)<\/strong><\/span><\/h3>\nComplete choking <\/span><\/span><\/span><\/strong><\/p>\nSigns of complete choking:\u00a0<\/span><\/span>\u00a0<\/span><\/span><\/strong><\/p>\nDetermine if the patient is suffering from complete choking by looking for the following signs:\u00a0<\/span>\u00a0<\/span><\/p>\n\n- inability to speak, breathe or cough\u00a0<\/span><\/li>\n
- absence of chest movement or air exchange\u00a0<\/span><\/li>\n
- increased cyanosis\u00a0<\/span><\/li>\n<\/ul>\n
The inability to produce any sound <\/span>
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