A to E Training and Solutions teaches combined Adult and Paediatric Basic Life Support to those who work in the pre-hospital field. We agree with the Resuscitation Council UK with regard teaching Paediatric Basic Life Support.

It is important that laypeople who have been taught adult resuscitation should know they can use the same techniques on children. The guidelines have been deliberately simplified for ease of teaching and retention.

Dentists, parents, community nurses are laypeople. They should be taught the adult sequence. However, this group may also be taught the following minor modifications to make CPR even more suitable for use in children:

• Give 5 initial breaths before starting chest compression.
• If on your own, perform 1 minute CPR before going for help.
• Compress the at least one-third of its depth.
• Use two fingers for an infant under 1 year; use one or two hands for a child over
• 1 year as needed to achieve an adequate depth of compression.

How often will often depend on the individual or the environment they are working in. We suggest skills should be refreshed at least once a year and preferably more often.

It is important that resuscitation skills are refreshed regularly, particularly by those who have a duty to respond in an emergency. The principle is that skills should be maintained at an effective level at all times. Individual employers and organisations should make arrangements for retraining to be available.

There is no specific legal requirement for employers to provide defibrillators in the workplace.

However there are many documents and statements where it is guidelines for certain locations to have an AED. For example the Resuscitation Council and the General Dental Council issues guidelines in 2006 with regard to dental surgeries. http://www.resus.org.uk/pages/MEdental.php

The Health and Safety Executive’s syllabus of first aid training for offshore installations does include the use of defibrillators but this is not extended to onshore first aid. However, the Health and Safety (First-Aid) Regulations 1981 do not prevent an employer from providing defibrillators which could benefit both their employees and the public.

Questions on workplace legislation initially should be directed to the Health and Safety Executive.

There are many causes for cardiac arrest such as severe blood loss or other trauma, lack of oxygen caused by breathing difficulties and most commonly a heart attack causing an abnormal rhythm.

Cardiac arrest results in a complete loss of the mechanical function of the heart. The hearts stops beating, usually as a result of an abnormal heart rhythm called ventricular fibrillation.

Cardiac arrest often presents with the sudden collapse of the patient who has no pulse and is not breathing. Immediate resuscitation and chest compressions are needed until the arrival of the emergency services and possible defibrillation to restore the heart rhythm to normal.

This occurs when one of the coronary arteries becomes blocked by the formation of a blood clot depriving part of the heart muscle of the fuel (blood and oxygen) it needs. This usually presents with a crushing pain in the chest which may spread to both arms, (particularly the left), and up into the throat and jaw. If this does not go away, help should be sought immediately by phoning 999 for an ambulance.

A heart attack can sometimes lead to cardiac arrest, but it’s not the same thing.

People may have an abnormal heart rhythm that leaves them more at risk of ventricular fibrillation. Most commonly, however, life threatening heart rhythms such as this are the result of a severe heart attack.

There are two types of defibrillator:

• Automated external defibrillators (AEDs) – these have been introduced more recently. These semi-automatic defibrillators are small, safe, simple and lightweight with two pads that can be applied to the patient. The defibrillator guides the operator step-by-step through a programme protocol. It records and analyses the rhythm and instructs the user to deliver the shock using clear voice prompts, reinforced by displayed messages. This minimises any risk of the patient being shocked inappropriately.
• Manual defibrillators – these have been used in hospitals and emergency centres for over 30 years. These usually also included an ECG monitor and other facilities and can be used as temporary pacemakers and to revert less dangerous abnormal heart rhythms. Professional expertise is needed to interpret the heart rhythm and decide whether to change the defibrillator and deliver the shock.

Since the mid-1990s, it has been recognised that lay responders may be well placed to use these defibrillators in the community. It is essential, however, that the person operating the defibrillator has a good up-to-date knowledge of basic life support. Thorough and recent training in the use of the defibrillator and appropriate updated training sessions are useful.

At present in the UK there are no statutory requirements for the placement of defibrillators, training and retraining for potential users of automated external defibrillators (AEDs). The Department of Health is not a regulatory body in these matters.

The Resuscitation Council provides guidance on the legal status of those who attempt resuscitation and their website (see link above) provides a wealth of information and further links on this subject.