What I Saw At The 6th National First Aid Conference (Part 1)
Invited by my dad’s friends to Jiuhua Resort & Convention Center in Beijing, I had the opportunity to participate in China’s 6th National First Aid Conference and 8th National First Aid Skills Competition. Initially, I wasn’t the most enthusiastic person to walk into the room; I simply wanted to enjoy my weekend like any teenager would, balancing studying with relaxing. But I soon changed my mind entirely, as I became deeply fascinated and inspired by the insights I gained at this event. That is why I would like to share my experiences and thoughts in this two-part series, and I hope you enjoy it.
But before we get into that, chances are you aren’t familiar with this event, which is understandable as its intended audience is primarily first aid personnel and medical professionals from cities across China. It’s organized by the Emergency Center Branch of the China Hospital Association and hosted by the Beijing Emergency Medical Center, with this year’s event divided into two related but distinct sections.
The National First Aid Conference
Personally, I learned the most from the conference, especially from their ‘workshops’. These seminars took place in branch venues, typically consisted of 30 or 40 attendees, and invited one or two specialists to explain a subject related to first aid. For me, the workshops were very technical and challenging to understand, though my impression is somewhat biased, given my exceptionally unprofessional and inexperienced background in first aid. But as time progressed and I listened intently, I not only understood most of what they were talking about, but was also able to strike up conversations with the specialists. Among the many workshops that I attended, there were two that interested me the most.
BLS and ACLS
Prior to attending, my understanding of first aid was largely limited to basic CPR. CPR, short for cardiopulmonary resuscitation, is an emergency procedure involving continuous chest compressions that is used when someone is not breathing or is experiencing cardiac arrest. Coupled with the usage of rescue breaths, CPR can be used as a temporary measure until trained medical help can arrive. But what protocols do experts actually use? That is where this advanced training course on BLS (basic life support) and ACLS (advanced cardiovascular life support) comes in – it teaches the professional guidelines utilized by first aid teams in practice. Although BLS and ACLS are characterized as different levels of first aid and medical care, I’m going to cover them as one subject, considering they are closely related topics.
Before the medical team can start saving a patient, they have to predetermine roles that will involve specific responsibilities. An ideal ACLS team would include six members: the team leader (organizes team efforts and makes decisions), compressor (performs high-quality CPR compression continuously), airway manager (ensures airways are open and oxygen is flowing properly), defibrillator operator (operates the defibrillator as well as analyzes indicators such as heart rhythms), medication administrator (administers drugs when needed), and timekeeper (also records key details throughout). However, since a typical ambulance crew only consists of 2 to 3 people, oftentimes, first responders have to operate with fewer resources, and the ideal ACLS team can only be formed within hospital emergency rooms or when multiple ambulances are on the scene. Besides the sophisticated division of labour, good coordination between members of the team is just as crucial. The following are 8 steps to team dynamics during resuscitation, as stated by the American Heart Association: clear roles and responsibilities, knowing one’s limitations, clear messages, closed-loop communication, knowledge sharing, constructive intervention, mutual respect, re-evaluation, and summarizing. Although these internal guidelines may seem easy to follow and commonsense knowledge, these steps are essential to ensuring productive team communication.
In the actual first aid process, personnel must be aware of several additional recommended practices. Because ACLS is used to treat life-threatening cardiovascular emergencies such as cardiac arrest, the patient’s breathing and pulse must first be checked to determine whether ACLS is appropriate.
Presuming ACLS is necessary, the medical team has to prepare various equipment. One of the most crucial pieces of equipment is the defibrillator, an advanced machine that delivers an electric shock to reset the heart’s natural pacemaker if needed (essential in the ACLS process). Here, I should point out a key difference between the two major types of defibrillators, manual and automated. Newer Automated External Defibrillators (AEDs) feature adhesive pads and clear voice and audio instructions to the user. The pads can tell the machine the patient’s vitals, and deliver a shock automatically when necessary. Although AEDs are designed to be relatively easy to use even for non-professional laymen, advanced paramedics are still trained to utilize manual ones. This is because manual defibrillators can offer more controlled, calculated intervention, as the paramedic is the person who is analyzing the patient’s vitals and making the decision whether to conduct the shock.
While additional equipment, like the defibrillator, is being prepared by other personnel, the compressor has to start conducting CPR immediately. It is recommended to do CPR at 100 to 120 compressions per minute, and the depth should be within the range of 5 to 6 centimeters. Typically, the number of compressions to the number of rescue breaths should be on a ratio of 30:2. In ACLS, the airway manager often uses a specialized device known as the bag-valve-mask (BVM) in place of traditional mouth-to-mouth resuscitation (according to newer guidelines that aim to minimize disease transmission).
As soon as the defibrillator is prepared for usage, it should be charged and used after a pulse check. Usually, the first shock should be charged at 120 to 200 joules. If the patient still hadn’t resumed consciousness after the first shock, the timekeeper starts a two-minute countdown, and continuous CPR and usage of the BVM are resumed.
Provided that the timer is approaching the two-minute mark and the patient still hasn’t been revived, then the defibrillator operator should pre-charge the machine. After another brief pulse check by the airway manager, the second shock should be delivered, perhaps at a higher shock level if needed. This cycle continues for as long as medically necessary, and the team leader coordinates additional efforts such as epinephrine injections throughout. Typically, resuscitation efforts can persist for 30 minutes or more, depending on the patient’s circumstances, until terminated, which means continuous CPR can last for quite a while. That is why it is often good practice for the compressor and the airway manager to change roles during resuscitation, so that high-quality CPR can be maintained. If more personnel are available, an additional person can help secure the BVM’s airtight seal around the patient’s face to ensure airflow is maximized.
If needed, normal 30:2 CPR can be replaced by asynchronous ventilation, though it requires an advanced airway such as an endotracheal tube (a planted airway tube running through the patient’s mouth or nose into their trachea). This procedure enables continuous, uninterrupted compression, and one breath is provided every six seconds. Although this procedure increases blood flow to the brain and other vital organs, it also intensifies the risks of hyperventilation, where the body expels more carbon dioxide than it produces.
After the specialist had guided us through the process, a 6-person ACLS team was assembled from the audience to perform a 10-minute drill with real equipment and a manikin. This was honestly the part I most enjoyed, as I was able to see the process unfold, albeit not as coordinated as real-life paramedics would be. A fun fact I noticed during the live demonstration was that team members confirmed they were clear by stretching out their arms – like kids pretending to fly as airplanes.
Conclusion
And that is all on the Advanced Cardiovascular Life Support workshop. In the next article, I’m going to share what I learned at another workshop, as well as what I saw at the National First Aid Skills Competition. Thank you for reading. Please consider liking and subscribing, and don’t forget to come back next week for Part 2.