The 2015 AHA and American Red Cross Guidelines Update for First Aid reaffirms the goals of first aid: to reduce morbidity and mortality by alleviating suffering, preventing further illness or injury, and promoting recovery. The scope of first aid has been expanded. First aid can be initiated by anyone, in any situation, and includes self-care.
2015 (New): The use of a stroke assessment system by first aid providers is recommended. Compared with stroke assessment systems that do not require glucose measurement, assessment systems that include glucose measurement have similar sensitivity but higher specificity for recognition of stroke. The Face, Arm, Speech, Time (FAST) or Cincinnati Prehospital Stroke Scale (CPSS) stroke assessment systems are the simplest of these tools for use by first aid providers, with high sensitivity for the identification of stroke.
Why: Evidence shows that the early recognition of stroke with the use of a stroke assessment system decreases the interval between the time of stroke onset and arrival at a hospital and definitive treatment. In 1 study, more than 94% of lay providers trained in a stroke assessment system were able to recognize signs and symptoms of a stroke, and this ability persisted at 3 months after training.1,2
2015 (New): For diabetics with mild symptomatic hypoglycemia who are able to follow commands and swallow safely, the use of oral glucose in the form of glucose tablets provides more rapid clinical relief compared with other forms of sugar found in common dietary products. Glucose tablets, if available, should be used to resolve hypoglycemia in these individuals. If glucose tablets are not available, other specifically evaluated forms of foods and liquids containing sugars such as sucrose, fructose, and oligosaccharides can be effective alternatives for reversal of mild symptomatic hypoglycemia.
Why: Hypoglycemia is a condition that first aid providers commonly encounter. Early treatment of mild hypoglycemia may prevent progression to severe hypoglycemia. Severe hypoglycemia can result in loss of consciousness or seizures and typically requires management by EMS.
2015 (New): A first aid provider caring for an individual with an open chest wound may leave the wound open. If a dressing and direct pressure are required to stop bleeding, care must be taken to ensure that a blood-saturated dressing does not inadvertently become occlusive.
Why: The improper use of an occlusive dressing or device for open chest wounds may lead to development of an unrecognized life-threatening tension pneumothorax. There are no human studies comparing the application of an occlusive dressing or device to a nonocclusive dressing or device, and only a single animal study showed benefit to use of a nonocclusive device. As a result of the lack of evidence for use of an occlusive device, and considering the risk of unrecognized tension pneumothorax, the application of an occlusive dressing or device by first aid providers for individuals with an open chest wound is not recommended.
2015 (New): An HCP should evaluate any person with a head injury that has resulted in a change in level of consciousness, progressive development of signs or symptoms of concussion, or other causes for concern to the first aid provider. The evaluation should occur as soon as possible.
Why: First aid providers often encounter individuals with minor head injury and possible concussion (mild traumatic brain injury). The myriad of signs and symptoms of concussion can make recognition of this injury a challenge. In addition, the long-term consequences of unrecognized concussion can be significant. Although a simple validated single-stage concussion scoring system could possibly help first aid providers with the recognition of concussion, no such assessment system has been identified. Sport concussion assessment tools used by healthcare professionals that require a 2-stage assessment (before competition and after concussion) are not appropriate as a single assessment tool for first aid providers.
2015 (Updated): First aid providers may be unable to reimplant an avulsed tooth due to lack of protective medical gloves, training and skill, or fear of causing pain. When immediate reimplantation is not possible, it may be beneficial to temporarily store an avulsed tooth in a solution shown to prolong viability of dental cells (compared with saliva). Solutions with demonstrated efficacy at prolonging dental cell viability from 30 to 120 minutes include Hank’s Balanced Salt Solution (containing calcium, potassium chloride and phosphate, magnesium chloride and sulfate, sodium chloride, sodium bicarbonate, sodium phosphate dibasic, and glucose), propolis, egg white, coconut water, Ricetral, or whole milk.
2010 (Old): Place the tooth in milk—or clean water if milk is not available.
Why: Dental avulsion can result in permanent loss of a tooth. The dental community agrees that immediate reimplantation of the avulsed tooth affords the greatest chance of tooth survival, but it may not be an option. In the event of delayed reimplantation, temporary storage of an avulsed tooth in an appropriate solution may improve chances of tooth survival.
2015 (New): Education and training in first aid can be useful to improve morbidity and mortality from injury and illness, and we recommend that it be universally available.
Why: Evidence shows that education in first aid can increase survival rates, improve recognition of acute illness, and aid symptom resolution.
2015 (Updated): The recommended recovery position has changed from supine to a lateral side-lying position for patients without suspected spine, hip, or pelvis injury. There is little evidence to suggest that any alternative recovery position is of greater benefit for an individual who is unresponsive and breathing normally.
2010 (Old): If the victim is facedown and is unresponsive, turn the victim faceup. If the victim has difficulty breathing because of copious secretions or vomiting, or if you are alone and have to leave an unresponsive victim to get help, place the victim in a modified HAINES recovery position.
Why: Studies showing some improvement to respiratory indices when the victim is in a lateral position compared with a supine position has led to a change in the recommendation for patients without suspected spine, hip, or pelvis injury. The HAINES position is no longer recommended, due to the paucity and very low quality of evidence to support this position.
2015 (Updated): There is no evidence supporting the routine administration of supplementary oxygen by first aid providers. Supplementary oxygen may be of benefit in only a few specific situations such as decompression injury and when administered by providers with training in its use.
2010 (Old): There is no evidence for or against the routine use of oxygen as a first aid measure for victims experiencing shortness of breath or chest pain. Oxygen may be beneficial for first aid in divers with a decompression injury.
Why: Evidence shows a benefit from use of oxygen for decompression sickness by first aid providers who have taken a diving first aid oxygen course. Limited evidence also shows supplementary oxygen to be effective for relief of dyspnea in advanced lung cancer patients with dyspnea and associated hypoxemia but not for similar patients without hypoxemia. Although no evidence was identified to support the use of oxygen, when patients exposed to carbon monoxide are breathing spontaneously, it might be reasonable to provide oxygen while waiting for advanced medical care.
2015 (Updated): While waiting for EMS to arrive, the first aid provider may encourage a person with chest pain to chew 1 adult or 2 low-dose aspirins if the signs and symptoms suggest that the person is having a myocardial infarction, and if the person has no allergy or other contraindication to aspirin. If a person has chest pain that does not suggest a cardiac source, or if the first aid provider is uncertain of the cause of chest pain or uncomfortable with administration of aspirin, then the first aid provider should not encourage the person to take aspirin and the decision to administer aspirin can be deferred to an EMS provider.
2010 (Old): While waiting for EMS to arrive, the first aid provider may encourage the victim to chew and swallow 1 adult (non–enteric-coated) or 2 low-dose “baby” aspirins if the patient has no allergy to aspirin or other contraindication to aspirin, such as evidence of a stroke or recent bleeding.
Why: The administration of aspirin significantly decreases mortality due to myocardial infarction, but there is no evidence to support the use of aspirin for undifferentiated chest pain. A reduction in mortality is also found when “early” administration of aspirin (ie, in the first few hours after onset of symptoms from myocardial infarction) is compared with “later” (ie, after hospital arrival) administration of aspirin for chest pain due to acute myocardial infarction. It remains unclear, however, whether first aid providers can recognize the signs and symptoms of myocardial infarction, and it is possible that use of aspirin for noncardiac causes of chest pain could cause harm. Although the dose and form of aspirin used for chest pain was not specifically reviewed by the ILCOR First Aid Task Force, the bioavailability of enteric-coated aspirin is similar to non–enteric-coated when chewed and swallowed.2 Thus, there is no longer the restriction to use non–enteric-coated aspirin, as long as the aspirin is chewed before swallowing.
2015 (Updated): When a person with anaphylaxis does not respond to an initial dose of epinephrine, and arrival of advanced care will exceed 5 to 10 minutes, a repeat dose may be considered.
2010 (Old): In unusual circumstances, when advanced medical assistance is not available, a second dose of epinephrine may be given if symptoms of anaphylaxis persist.
Why: The 2010 Guidelines recommended that first aid providers assist with or administer (the victim’s own) epinephrine to persons with symptoms of anaphylaxis. Evidence supports the need for a second dose of epinephrine for acute anaphylaxis in persons not responding to a first dose; the guidelines revision provides clarification as to the time frame for considering a second dose of epinephrine.
2015 (Updated): First aid providers may consider use of hemostatic dressings when standard bleeding control measures (with direct pressure with or without gauze or cloth dressing) are not effective for severe or life-threatening bleeding.
2010 (Old): Routine use (of hemostatic agents) in first aid cannot be recommended at this time because of significant variation in effectiveness by different agents and their potential for adverse effects, including tissue destruction with induction of a pro embolic state and potential thermal injury.
Why: The application of firm, direct pressure to a wound is still considered the primary means for control of bleeding. When direct pressure fails to control severe or life-threatening bleeding, first aid providers who have specific training in their indications and use may consider a hemostatic dressing. Newer-generation hemostatic agent-impregnated dressings have been shown to cause fewer complications and adverse effects than older hemostatic agents, and are effective in providing hemostasis in up to 90% of subjects.
2015 (Updated): With a growing body of evidence showing harm and no good evidence showing clear benefit, routine application of cervical collars by first aid providers is not recommended. A first aid provider who suspects a spinal injury should have the injured person remain as still as possible while awaiting arrival of EMS providers.
2010 (Old): First aid providers should not use immobilization devices because their benefit in first aid has not been proven and they may be harmful. Maintain spinal motion restriction by manually stabilizing the head so that motion of the head, neck, and spine is minimized.
Why: In the 2015 ILCOR systematic review of the use of cervical collars as a component of spinal motion restriction for blunt trauma, there was no evidence found to show a decrease in neurologic injury with the use of cervical collars. In fact, studies demonstrated actual or potential adverse effects such as increased intracranial pressure and airway compromise with use of a cervical collar. Proper technique for application of a cervical collar in high-risk individuals requires significant training and practice to be performed correctly. Application of cervical collars is not a first aid skill. The revision of this guideline reflects a change in recommendation class to Class III: Harm due to potential for adverse effects.
These Web-based Integrated Guidelines incorporate the relevant recommendations from 2010 and the new or updated recommendations from 2015.
The International Liaison Committee on Resuscitation (ILCOR) First Aid Task Force was formed in 2013 to review and evaluate the scientific literature on first aid in preparation for development of international first aid guidelines, including the 2015 American Heart Association (AHA) and American Red Cross Guidelines Update for First Aid. The 14 members of the task force represent 6 of the international member organizations of ILCOR. Before 2015, evidence evaluation for first aid was conducted by the International First Aid Science Advisory Board and the National First Aid Advisory Board. Although the group responsible for evidence evaluation has changed, the goals remain the same: to reduce morbidity and mortality due to emergency events by making recommendations based on an analysis of the scientific evidence.
A critical review of the scientific literature by appointed ILCOR First Aid Task Force members and evidence evaluators resulted in consensus on science statements with treatment recommendations for 22 selected questions addressing first aid interventions. These findings are presented in “Part 9: First Aid” of the 2015 ILCOR International Consensus on First Aid Science With Treatment Recommendations,3-4 and they include a list of identified knowledge gaps that may be filled through future research. The ILCOR treatment recommendations are intended for the international first aid community, with the understanding that local, state, or provincial regulatory requirements may limit the ability to implement recommended first aid interventions. The current AHA/American Red Cross First Aid guidelines are derived from this work. New topics found in the 2015 First Aid Guidelines Update include first aid education, recognition of stroke, recognition of concussion, treatment of mild symptomatic hypoglycemia, and management of open chest wounds. Other topics have been updated based on findings from the corresponding ILCOR reviews.