Temporary measures for First Aid and Cardiopulmonary Resuscitation (CPR)
A number of temporary measures currently apply to first aid interventions, in order to minimise the risk of coronavirus infection among EROs and to minimise any harm to casualties. This advice applies for a limited period of time.
Be aware that this advice may be revised. The most recent information will always be available through the NIBHV website. The ERO may not provide first aid in a number of cases.
When is the ERO not allowed to provide first aid?
EROs may not provide first aid if:
- They have tested positive to COVID-19 (this applies for as long as the Municipal Health Service (GGD)/ National Institute for Public Health and the Environment (RIVM) judges them to be contagious).
- They feel ill, or someone in their family is ill.
- They are not at work as a result of following the RIVM guidelines – they may also not provide first aid in their free time.
- They are in a high-risk group. Please visit the RIVM website to find out when someone is considered to be in a high-risk group.
Once an employee has recovered, they can return to work and resume their ERO duties.
Adjustments to first aid interventions
- A maximum of two emergency workers (including fire brigade/police) may assist a casualty. Others must keep at a minimum distance of 1.5 metres.
- EROs must wear protective nitrile gloves while providing first aid, to protect themselves and the casualty. Do not use vinyl gloves as these do not provide protection against microorganisms.
- In each situation, EROs assess whether it is necessary to approach to within 1.5 metres of the casualty. If not, they provide help at a distance by giving the casualty instructions for helping themselves. Call 112 if necessary. If it is necessary to come within 1.5 metres of the casualty, EROs should restrict themselves to providing emergency first aid.
After a first aid intervention
Directly after a first aid intervention, EROs should disinfect their hands and wrists in the workplace or at the ambulance or other emergency vehicle present.
EROs who suffer from complaints that might indicate COVID-19 infection in the days/weeks after providing CPR can have themselves tested.
Inform EROs about their liability – if they do not perform a particular action, they will not be held liable.
Temporary adaptation of CPR guidelines
During the COVID-19 pandemic, adapted guidelines will apply to actual cardiopulmonary resuscitation (CPR) in practice. Please inform EROs about this.
The Dutch Resuscitation Council (NRR), in consultation with Ambulancezorg Nederland (AZN), the Nederlandse Vereniging van Medische Managers Ambulancezorg (NVMMA), the National Institute for Public Health and the Environment and HartslagNu, has revised the advice for temporary adaptation of CPR guidelines from 10 April 2020. In the opinion of the experts in these organisations, it is responsible and therefore important to return to previous CPR practices.
Back to normal guidelines
With respect to CPR provided by EROs, the advice given starting on 22 June is to carry it out in accordance with the normal guidelines, including rescue breaths, unless the emergency service dispatcher indicates otherwise.
The following points for attention apply to all instances of CPR.
- Ask the emergency service dispatcher whether it is necessary to deviate from the normal guidelines.
- If possible, follow the hygiene and other measures recommended by the government.
- In all cases, minimise the number of EROs involved in the actual provision of CPR. A maximum of two EROs may perform CPR on the casualty, and others must stay at a distance of at least 1.5 metres.
- After performing CPR, wash your hands and wrists with water and soap, and if that is not available, use alcohol-based hand sanitiser which you may be able to obtain from an attending ambulance or other emergency vehicle.
- EROs who suffer from complaints that might indicate COVID-19 infection in the days/weeks after providing CPR can have themselves tested.
Rescue breaths: yes or no?
Rescue breathing is an important part of CPR. As was the case before the coronavirus outbreak, EROs may choose not to give rescue breaths if they are unable or unwilling to do so. Naturally, the reverse also applies. EROs may choose to give rescue breaths even if advised not to, and should respect each other’s choice in this regard.
When to still use the COVID-19 guidelines for performing CPR
From now on, the recommendation is to perform CPR in accordance with normal guidelines, including rescue breaths, unless the emergency service dispatcher advises you to follow the COVID-19 guidelines for CPR.
If the dispatcher recommends that you follow the COVID-19 guidelines, CPR should be performed as follows:
- Assess the breathing by only looking at the chest. Do not open the airway and do not come close to the casualty’s head to feel and listen for breathing;
- If the breathing is abnormal and you decide to perform CPR, cover the casualty’s mouth and nose with a cloth, garment or face mask without moving their head;
- Start continuous chest compressions, and do not give mouth-to-mouth/mask rescue breaths;
- Use the AED as soon as it arrives;
- Then resume continuous chest compressions without rescue breaths.
If the ERO uses a cloth or their own garment to cover the casualty, then they are advised to wash the cloth or garment with a regular laundry detergent before using it again.
Personal protective equipment
Ambulance personnel come into much more frequent contact with patients than EROs, bystanders and citizen responders. This means that they run a greater risk of becoming infected. This group therefore makes more frequent use of personal protective equipment (PPE), also for health and safety reasons. This is not only for their own protection but also for the protection of other emergency workers and patients. Some or all of the emergency workers may therefore wear some form of personal protective equipment.
Recommendation on performing CPR on children up to puberty
The normal guidelines apply for children up to puberty. The advice not to give rescue breaths only applies to children who have tested positive to COVID-19 and are still contagious. However, anyone is still free to give rescue breaths should they decide to do so.
Recommendation on performing CPR on children from puberty onwards
Children from puberty onwards are subject to the same guidelines as for adults, including the adapted COVID-19 guidelines. However, anyone is still free to give rescue breaths should they decide to do so.