ASSISTED VENTILATIONS

INFORMATION BULLETIN
August 13, 2014

It was brought to the attention of the Branch that there is still some confusion from both First Aid and NL
Instructors regarding assisted ventilations. As per the 2014 First Aid Instructor Recert FAQ document:
Are assisted ventilations for a conscious patient an evaluated item in Standard First Aid?
No. There are only two items that make mention of assisted ventilations in the Notes section of the
First Aid Award Guide (Item 23a abdominal/chest injuries and Item 24c pressure-related injuries).
The treatment of an open pneumothorax and flail chest needs to take priority over the application of
assisted ventilations. The treatment of these two injuries will often improve the patients breathing
dramatically and assisted ventilations are not required.

Clarification #1
Although assisted ventilations can be beneficial for a patient suffering from shortness of breath, the rescuer
first needs to focus on treatment of the injury where possible, not the symptoms.
For example, if the patient is suffering from an anaphylactic reaction, medication would come before
assisted ventilations. As mentioned above, the treatment of an open pneumothorax or flail chest needs to
take priority as the treatment will often improve the patients breathing dramatically (assisted ventilations
may not be required).
In situations where the patient is suffering from shortness of breath due to an inhalation injury (e.g. smoke
inhalation), tension pneumothorax, pressure-related injury or spinal cord injury (conscious but unable to
breathe guppy breathing), then assisted ventilations would be appropriate as the primary treatment.

Clarification #2
In the event that an unconscious patient is not breathing effectively, the rescuer will start CPR as per the
current ILCOR CPR guidelines. If a conscious patient requires assisted ventilations (ineffective breathing
with cyanosis), the CFAM only states that rescuer needs to explain what they are doing (CFAM page 29).
If teaching assisted ventilations (in SFA or NL), focus should be on how to communicate with the patient
as they will not want the rescuer to put anything over their face or mouth (including a pocket mask).
Describe to the patient what the pocket mask is, what it is that you plan to do (see below) and to
try to relax. The patient needs to understand that this can make them feel better.
With the patient sitting in a position of comfort, rescuers should ventilate the patient once every 5
seconds, timing the breaths with the patients inhalation whenever possible.
If present, oxygen should be hooked up to the pocket mask at a 15lpm flow.

Clarification #3
It is important that the treatment for an open pneumothorax and flail chest be taught and demonstrated
properly, or further injury/breathing difficulties can occur (CFAM page 63).
When treating an open pneumothorax, have the patient exhale, then have a bystander cover the
hole with a gloved hand. The rescuer will then seal the wound at the end of the primary survey
(with an airtight dressing leaving the bottom edge untaped so excess air can escape), thus
preventing a tension pneumothorax.
When treating a flail chest, have the patient inhale, then have a bystander stabilize the broken
segment with a gloved hand. The rescuer can bandage this injury after the secondary survey.
BC & Yukon Branch
#112 - 3989 Henning Drive Burnaby, BC V5C 6N5
Telephone: 604.299.5450 Fax: 604.299.5795
E-mail: info@lifesaving.bc.ca
Web: www.lifesaving.bc.ca