BASIC LIFE SUPPORT

TRAINING
Legal Basis in the Conduct of
BLS Training
• RA 10871 “Basic Life Support Training in Schools Act”
• AO 155 s, 2004, Section VI Implementing Guidelines “BLS
Training is mandatory to all health workers”
• AO 2018-0001 “BLS as a minimum competency requirement
for Type I and Type II Ambulance Service Providers”
• Department Memo (DM) 2005-0056 “BLS is mandatory to
DOH Employees”
• DM 2020-0290 “Interim Consensus Guidelines on Basic Life
Support During COVID-19 Pandemic”
• DM 2021-0134 “Updated Consensus Guidelines on Basic Life
Support based on the 2020 Guidelines for CPR”
PRINCIPLES OF EMERGENCY
CARE
• PLANNING
– Emergency plans should be established based on
anticipated needs and available resources
• PROVISION OF LOGISTICS
– The emergency response begins with the
preparation of equipment and personnel before any
emergency occurs.
• Remember the INITIAL RESPONSE as follows:
– Ask for Help
– Intervene
– Do not do further harm
• INSTRUCTION to BY-STANDER
– Proper information and instruction to a bystander/s
would provide organized first aid care.
EMERGENCY ACTION
PRINCIPLES
1. SURVEY THE SCENE
– Once you recognized that an
emergency has occurred and decide
to act, you must make sure that the
scene of the emergency is safe for
you, the victim/s and the bystander/s
1.1 Elements of SURVEY THE
SCENE
a. Scene safety
b. Mechanism of injury or nature of illness
c. Take standard precautions. Wear
protective PPE.
d. Determine the number of patients
e. Consider additional/specialized
resources
1.2 Take time to survey the scene
and answer these questions:
a. Is the scene safe?
b. What happened? Nature of Incident
c. How many people are injured?
d. Are there bystanders who can help?
e. Then identify yourself as a trained first
aider.
2. ACTIVATE MEDICAL
ASSISTANCE
• In some emergencies, you will
need to call for specific medical
advise before administering first
aid. But in some situations, you will
need to attend to the victim first.
2.1 Call First and CPR First
– Both trained and untrained
bystanders should be instructed to
activate medical assistance as
soon as they have determined that
an adult victim requires
emergency care.
 CALL FIRST CPR FIRST
• Adults and adolescents • Adults and adolescents with likely
• Witnessed collapse of children asphyxia arrest (e.g. drowning)
and infants • Unwitnessed collapse of children
and infants

• If you are alone with no mobile • Give 5 cycles (2 minutes) of CPR

phone, leave the victim to activate • Leave the victim to activate
emergency response system and emergency response system and
get AED/emergency equipment get the AED.
before beginning CPR. • Return to the child or infant and
• Otherwise, send someone and resume CPR; use the AED as
begin CPR immediately; use the soon as it is available.
AED as soon as it is available.
2.2 Use of social media to summon rescuers
2.3 Use mobile phone in activation of emergency
medical services (EMS)
2.4 Information to be remembered in activating medical
assistance:
• What happened?
• Location?
• Number of injured persons?
• Extent of injury and first aid given?
• The telephone number from where you are calling?
• PERSON who activated medical assistance must
identify him/herself and drop the phone last.
3. DO A PRIMARY ASSESSMENT
OF THE VICTIM
• In every emergency situation, you
must first find out if there are
conditions that are of immediate
threat to the victim’s life.
 ABC
Remember!
Check for Checking for
Responsiveness Open the
breathing and Airway
circulation shall be
done
simultaneously in
no more than 10
seconds

Check for circulation (pulse)*

* For HCP only Check for breathing (Look for
rise and fall of the chest
IN COVID-19
PANDEMIC:
ABC
Remember! Open the Airway during FBAO
Checking for management only, otherwise,
breathing and cover the victim’s mouth and
Check for Responsiveness nose with cloth or mask
circulation shall be
done simultaneously
in no more than 10
seconds

Check for circulation (pulse)*

* For HCP only Check for breathing (Look for rise
and fall of the chest
4. DO A SECONDARY
ASSESSMENT OF THE VICTIM
• It is a systematic method of
gathering additional
information about the injuries
or conditions that may need
care
4.1 Interview the victim
– S – signs and symptoms
– A – allergies
– M – medications
– P – past
– L – last meal taken
– E – events prior to injury
• 4.2 Check Vital Signs
– Every 15 minutes for stable condition
and every 5 minutes if unstable
• 4.3 Head to toe examination
– Rescuers should look for other signs
of injuries in a quick manner from the
head to toe and apply necessary first
aid measures to the injury seen
• Head to toe assessment:
– D – deformity
– C – contusion
– A – Abrasion
– P – puncture
– B – burn/bleeding
– T – tenderness
– L – Lacerations
– S – Swelling
5. REFERRAL OF THE VICTIM FOR
FURTHER EVALUATION AND
MANAGEMENT
• Refer patient for further evaluation and management
(if necessary, depending on patient’s condition) to
advance medical team/ physician/ health facility
• Endorse:
– Initial Assessment – NOI, TOI, POI
– Procedures performed/management
– Latest status – from red to yellow/green tag
INTRODUCTION
TO BASIC LIFE
SUPPORT
Chari V. Rivo
THREE KIND OF LIFE SUPPORT
1. Basic Life Support (BLS)
• A set of emergency procedures that consists
of recognizing respiratory or cardiac arrest
and the proper application of Cardio-
pulmonary Resuscitation (CPR) with or
without Automated External Defibrillator
(AED) of foreign body airway obstruction
management (FBAOM) and rescue breathing
(RB) or to maintain life until victim recovers
or advanced life support is available
2. Advanced Cardiac Life Support
(ACLS)
• A set of clinical interventions for the urgent
treatment of cardiac arrest and other life
threatening emergencies, as well as the
knowledge and skilla to deploy those
interventions
3. Prolonged Life Support (PLS)
• For post resuscitative and long
term resuscitation with the use of
adjunctive equipment such as
ventilator, cardiac monitor, pulse
oximeter, etc.
BODY SYSTEM
• The Circulatory System
– It delivers oxygen and nutrients to the body’s
tissues and removes waste products. It
consists of the heart, blood vessels, and
blood
• The Respiratory System
– It delivers oxygen to the body, as well as
removes carbon dioxide from the body.
– The passage of air into and out of the lungs is
called VENTILATION
– Breathing in or inhalation is called INSPIRATION
– Breathing out or exhalation is called
EXPIRATION
– The actual exchange of oxygen in the alveoli as
well as the tissues of the body is called
RESPIRATION
Breathing and Circulation
• Air that enters the lungs contains about 21%
oxygen and only a trace of carbon dioxide.
Air that is exhaled from the lungs contains
about 16% oxygen and 4% carbon dioxide.
• The right side of the heart pumps blood to
the lungs, where blood picks up oxygen and
releases carbon dioxide.
• The oxygenated blood returns to the left side
of the heart, where it is pumped to the
tissues of the body
Breathing and Circulation
• In the body tissues, blood releases oxygen
and takes up carbon dioxide after which it
flows back to the right side of the heart.
• All body tissues require oxygen, but the brain
requires more than any other tissue.
3. The Nervous System
• It is composed of the brain, spinal cord, and
nerves. It has two major functions –
communication and control. It lets a person
be aware of and react to the environment. It
coordinates the body’s responses to stimuli
and keeps body systems working together.
• Clinical Death
– Within 1 minute – cardiac irritability
– 1-4 minutes – brain damage not likely
– 4-6 minutes – brain damage possible
• Biological Death
– 6-10 minutes – brain damage very likely
– More than 10 minutes – irreversible brain
damage
CARDIOPULMONARY
RESUSCITATION
(CPR)
Chari V. Rivo
CPR
• Is a series of assessments and interventions
using techniques and maneuvers made to
bring victims of cardiac and respiratory arrest
back to life.
• CARDIAC ARREST
– Is the condition in which circulation ceases
and vital organs are deprived of oxygen.
Three Conditions of Cardiac Arrest
• Cardiovascular Collapse
– The heart is still beating but its action is so weak
that blood is not being circulated through the
vascular system to the brain and body tissues
• Ventricular Fibrillation
– Occurs when the individual fascicles of the heart
beat independently rather than in coordinated,
synchronized manner that produces rhythmic
heart beat
• Cardiac Standstill
– It means that the heart has stopped beating
WHEN TO START CPR
• If you see a victim who is:
– Unconscious/unresponsive
– Not breathing or has no normal
breathing
– No definite pulse

 Responders need to generally assume that all victims

have infectious diseases so that safety protocols must be
completely observed at all times
When NOT to start CPR
• All victims of cardiac arrest should receive CPR unless:
– Patient has a valid DNAR order
– Patient has signs of irreversible death (Rigor
mortis, decapitation, dependent lividity)
– No physiological benefit can be expected
because the vital functions have deteriorated as
in septic shock or cardiogenic shock
– Confirmed gestation of < 23 weeks or birth
weight <400 g, anencephaly
– Attempts to perform CPR would place the
rescuer at risk of physical injury
When to STOP CPR
• S. SPONTANEOUS signs of circulation are restored
• T. TURNED over to medical services or properly
trained and authorized personnel
• O. OPERATOR is exhausted and cannot continue
CPR
• P. PHYSICIAN assumes responsibility (declares
death, takes over, etc)
• S. SCENE becomes unsafe (such as traffic,
impending or ongoing violence, gun fires, etc.)
• S. SIGNED waiver to stop CPR
COMPRESSION ONLY-CPR
• If a person cannot perform mouth-to-
mouth ventilation for an adult victim,
chest compression only-CPR should be
provided rather than not attempting
CPR.
• Chest compression only-CPR is recommended
only in the following circumstances:
– When a rescuer is unwilling or unable to perform
mouth-to-mouth rescue breathing, or
– For use in dispatcher-assisted CPR instructions
where the simplicity of this modified technique
allow unstrained bystanders to rapidly intervene
C-A-B Compression-Airway-Breathing
• Early CPR improves the likelihood of survival
• Chest compressions are the foundations of
CPR
• Compressions create blood flow by
increasing intra-thoracic pressure and
directly compresses the heart; generate
blood flow and oxygen delivery to the
myocardium and brain
CAB: Compression
• Circulation represents a heart that is actively
pumping blood, most often recognized by the
presence of a pulse in the neck
• Assume there is no CIRCULATION if the ff
exists: (1) unresponsive, (2) not breathing,
(3) not moving, (4) poor skin color
• Return of Spontaneous Circulation (ROSC) –
sign of life
 ADULTS & CHILDREN (age 1 INFANTS (age
ADOLESCENTS to puberty) less than 1 year,
excluding
newborns)

COMPRESSION 100-12- per minute

RATE

COMPRESSION Atleast 2 inches (5 At least 1/3 Antero-Posterior (AP)

DEPTH cm) but should not Diameter of the chest
exceed 2.4 inches
(6cm)
About 2 inches About 1.5 inches (4
(5cm) cm)
ADULT CPR
• Kneel facing the victim’s chest
• Place the heel of on hand on the center of
the chest
• Place the heel of the second hand on top of
the first so that the hands are overlapped and
parallel
• 30:2 (compression: ventilation)
Child CPR
• Lower half of the sternum, between nipples
• One hand only/two hand for big children
• 30:2 for single rescuer, 15:2 for 2 man
rescuer (optional for HCP)
Infant CPR
• Just below the nipple line
• Two fingers, flexing at the wrist (lone rescuer)
• 2 thumb-encircling hands technique
CAB: Open AIRWAY
• This must be done to ensure an open
passage for spontaneous breathing or mouth
to mouth during CPR
• Head-Tilt-Chin-Lift (HTCL) Maneuver
– Tilt the head back with your one hand and lift
up the chin with your other hand
• Jaw-Thrust Maneuver
– a technique that can be done by atleast two
highly trained BLS providers (if suspected
with cervical trauma)
 REMEMBER!!!
• In COVID-19 Pandemic, opening the victim’s
mouth without protection for the responder is not
advisable (maintaining airway is still a MUST
during CAB)

• Cover the victim’s mouth and nose with cloth or

mask before performing chest compression.
CAB: BREATHING
• Maintain an open airway
• Pinch nose shut (if mouth to mouth RB is
preferred)
• Open your mouth wide, take a normal breath, and
make a tight seal around outside a victim’s mouth
• Give 2 full breaths (1 sec each breath)
• Observe chest rise
• 30:2 (compressions to ventilation ratio)
• 5 cycles for 2 minutes
In Pandemec:
• Single rescuer:
– Avoid direct mouth to mouth
– Use pocket mask if RB is needed
– Hands-only CPR
• Two Rescuers
– Compressions with ventilations via BVM
– Give 2 ventilations via tight sealed BVM with 1
sec each ventilation
BLS Sequence
1. Wear PPE
2. Verify the scene
3. Introduce Yourself
4. Check for responsiveness
5. Activate EMS
6. Recognition of Cardiac Arrest
7. Perform High Quality CPR
High Quality CPR
1. Correct compression site
2. Adequate compression rate (100-120/min)
3. Adequate compression depth
4. Chest recoil completed after each
compression
5. Minimize interruptions to less than 10 sec in
between chest compressions
6. Avoidance of excessive ventilation
Primary CPR Procedures
• Continue CPR until:
– AED arrives and starts to analyze
– EMS providers take over the care of the victim
• Reassess victim every 2 minutes
• Rescuers may switch roles (for two-man
rescuers)
• If patient becomes conscious, place patient
in RECOVERY POSITION
DONT’S in External Chest Compression
• Jerker
• Massager
• Bender
• Rocker
• Bouncer
• Double Crosser