Basic life support

What is basic life support?

Basic Life Support (BLS) is a set of procedures that aims to recover the life of a victim of cardiorespiratory arrest (CPA), until the arrival of specialized help. It is part of the chain of survival and consists of two actions:

• chest compressions (to get blood circulating)
• ventilations (to give oxygen to the lungs)

Basic life support can prevent injury to vital organs such as the brain and heart, increasing the likelihood of survival with quality of life.

The pandemic COVID-19 required an adjustment in basic life support procedures with a view to minimizing the risk of contagion. In this context, no ventilations are performed.

What is the chain of survival?

The chain of survival involves a sequence of vital attitudes to recover a victim in cardiorespiratory arrest:

• Call for help by calling 112. Identify yourself, tell the place where you are and that you have identified a person in cardiorespiratory arrest. Don't hang up until you've been told you can
• return to the victim and immediately start basic life support manoeuvres, with the necessary adaptations in the context of a pandemic by COVID-19 (see steps below)
• If you have access to a defibrillator, use it following the machine's guidelines

The chain of survival consists of four links:

1. Early warning: call 112
2. Early initiation of basic life support
3. early defibrillation
4. Early Advanced Life Support (ALS)

When should basic life support be applied?

Basic life support should be applied whenever the victim is unconscious and not breathing. To assess the victim, you must determine whether:

• Is you aware
  • Protect yourself with a surgical mask and put a mask on the victim as well. If you do not have access to masks, keep a safety distance of 2 meters from the victim
  • Call Out Loud
  • Find out what happened and if necessary call 112
• is unconscious
  • due to the risk of contagion, this assessment is now carried out only through the V (to see if the chest expands), without opening or contacting the airway. Observe the victim and search for a reaction. If you experience no breathing, call 112 immediately (or ask someone to do so) and start basic life support manoeuvres (see steps below)

Who can do basic life support maneuvers?

If you are alone, after the call for help made to 112, you should immediately start basic life support maneuvers, while waiting for the arrival of the emergency team. If there is a second resuscitator, ask them to turn on 112, and immediately start basic life support maneuvers.

Do I need a specific course?

yes. Basic life support manoeuvres require training and supervision by accredited trainers.

Where can I take a basic life support course?

Basic life support courses can be attended in schools accredited by the Portuguese Board of Resuscitation and/or the National Institute of Medical Emergency.

What are the steps to follow in basic life support maneuvers?

• Approach the victim carefully and ensure that there is no danger to yourself, the victim or others
• if you don't have a surgical mask, keep a safe distance and loudly call, "Do you feel good?"
• if you have a surgical mask with you, put it on yourself and the victim: assess the victim's state of consciousness by shaking your shoulders carefully and question the victim by asking aloud, "Do you feel okay?"
• If the victim responds:
  • Leave it in the position where you found it as long as it does not involve danger
  • Try to understand what happened and ask for help if necessary
  • Regularly reassess the victim
• If you don't answer:
  • Assess breathing, noting for breathing movements
  • Do not approach the victim's mouth and nose
• If the victim is unresponsive and does not breathe normally, call 112
• Have someone pick up a defibrillator
Ensure that a
• surgical mask or garment is placed over the victim's mouth and nose and begin continuous chest compressions, kneeling at their side with your hands overlapping and with your fingers interlaced in the middle of the victim's chest
• Press the chest at least 5 to 6 cm, causing it to drop visibly and relieve pressure at a rate of 100 to 120 compressions per minute.
• in times of pandemic by COVID-19:
  • Do not vent
  • You should wash your hands thoroughly with soap and water or disinfect your hands with alcohol gel solution as soon as possible
  • you should contact SNS 24 – 808 24 24 24 – to obtain information on your own follow-up after having been in contact with a suspected or confirmed person of COVID-19

Am I at risk when doing basic life support maneuvers?

yes. The desire to help someone can lead to ignoring the risks they may take. You should be aware of different types of risks:

• Road Accident – Take precautionary measures if rescue has to be done on a road
• Poisoning – In the case of poisoning by toxic fumes or gases, it is important to identify the product in question
• Chemicals or hazardous materials – if you detect the presence of these products, it is essential to avoid contact without proper protective measures (e.g. gloves, mask)
• disease transmission – resuscitators should take safety precautions on all victims, given that in the current pandemic COVID-19, all victims of cardiorespiratory arrest are considered suspects

Are there any associated risks in COVID-19 patients?

Evidence addressing this issue is scarce, but given that the main transmission mechanism of COVID-19 is by respiratory secretions directly from the patient or touching contaminated surfaces, and evidence suggests that chest compressions have the potential to generate aerosols, so yes, there are risks.

What are the recommendations for COVID-19 cases?

It is suggested that in the current pandemic framework:

• Resuscitation is performed only with chest compressions and defibrillation with an automatic external defibrillator with public access
• Healthcare workers wear personal protective equipment during resuscitation and procedures that may generate aerosols
• Healthcare providers should consider defibrillation before using aerosol-generating personal protective equipment in situations where the benefits may outweigh the risks

Is basic life support for adults the same for children?

yes. Basic adult life support can be used safely on the child. However, there are some differences that should be highlighted:

• It is necessary to adapt basic life support maneuvers to the size and age of the child
• For children under the age of 1 year, there are specific procedures

What are the precautions to be taken in basic life support in children?

The cause of cardiorespiratory arrest in children is mostly of respiratory origin.
In the context of a pandemic by COVID-19 manipulation of the airway (mouth and nose) increases the risk of contagion, so as in adults, ventilations are not advised. Must:

• Adapt the compressions to the size of the victim:
  • if it's a baby up to 1 year old use only 2 fingers
  • If it's a child up to 8 years old, only one hand
• return to the child, and continue basic life support manoeuvres (2 ventilations for every 30 chest compressions)

If you do not ventilate, proceed as in an adult:

• Call 112
• Put on a surgical mask or a piece of clothing to cover the child's mouth and nose
  Perform continuous chest compressions

Is there special basic life support care for pregnant women?

yes. Basic life support maneuvers in women pregnant women are a special situation because there are two victims – the mother and the fetus. The chances of survival of the fetus depend on the success of the mother's resuscitation. You should take some precautions, such as:

• Do not apply the abdominal compressions of foreign body airway clearance maneuvers in pregnant women at the end of pregnancy and replace them with chest compressions
• placing a pillow (or something equivalent) under the victim's right hip so that the uterus is shifted to the left

Should I have any specific equipment to do basic life support?

To perform basic life support maneuvers, whenever possible, it is recommended to use protective equipment, such as:

• surgical mask (for the resuscitator and victim)

Source: Portuguese Resuscitation Council