1.4.3.1: First Aid and Cardiopulmonary Resuscitation Training for Staff

All staff members involved in providing direct care to children should complete and document training in pediatric first aid and cardiopulmonary resuscitation (CPR). Courses in pediatric first aid and CPR should be taught in person by instructor-led demonstrations and practiced to ensure the technique could be performed in an emergency. Early care and education programs should follow training renewal cycles recommended by the providing organization (eg, American Heart Association [AHA]).

At least one staff member trained in pediatric first aid and CPR should be in attendance at all times when a child whose special care plan indicates an increased risk of cardiac arrest or complications due to cardiac disease is in attendance.¹ Children with special health care needs who have compromised airways may need to be accompanied to child care by nurses who are able to respond to airway problems (eg, the child who has a tracheostomy and needs suctioning).

While the use of automated external defibrillators (AEDs) on children is rare, early care and education programs should consider having an AED on the premises for potential use on both adults and children. Pediatric pads should be used for children younger than 8 years old.² Trainings should be inclusive to children in care, staff and other adults present in early care and education programs.

Records of successful completion of training and renewal cycles in pediatric first aid and pediatric CPR should be maintained in the employee personnel files on site.

RATIONALE

 

The 2018 update to the AHA “Guidelines for CPR and Emergency Cardiovascular Care” section on pediatric basic life support includes recommendations for hands-only CPR chest compressions. These recommendations include chest compression rates of 100 to 120 compressions/min for infants and children.³

Early care and education programs with staff trained in pediatric first aid and CPR can mitigate the consequences of injury and reduce the potential for death from life-threatening conditions and emergencies. Furthermore, knowledge of pediatric first aid and CPR includes addressing a blocked airway (choking) as well as rescue breathing. Repetitive training, coupled with the confidence to use these skills, are critically important to the outcome of an emergency.

Documentation of current certification of satisfactory completion of pediatric first aid and demonstration of pediatric CPR skills in the facility assists in implementing and monitoring for proof of compliance.

 

COMMENTS

 

Additional Resources:

First aid and CPR courses from the American Red Cross can be found here: https://www.redcross.org/take-a-class/babysitting/babysitting-child-care-preparation/child-care-licensing.

First aid and CPR courses from the AHA can be found here: https://cpr.heart.org/AHAECC/CPRAndECC/FindACourse/UCM_473162_CPR-First-Aid-Training-Classes-American-Heart-Association.jsp.

The American Academy of Pediatrics pediatric course in first aid can be found here: https://www.pedfactsonline.com.

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

1.4.3.2 Topics Covered in Pediatric First Aid Training
1.4.3.3 Cardiopulmonary Resuscitation Training for Swimming and Water Play
9.4.1.2 Maintenance of Records
9.4.3.3 Training Record
10.6.1.1 Regulatory Agency Provision of Caregiver/Teacher and Consumer Training and Support Services
10.6.1.2 Provision of Training to Facilities by Health Agencies

REFERENCES

1. Marino BS, Tabbutt S, MacLaren G, et al; American Heart Association Congenital Cardiac Defects Committee of the Council on Cardiovascular Disease in the Young; Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Cardiovascular Surgery and Anesthesia; and Emergency Cardiovascular Care Committee. Cardiopulmonary resuscitation in infants and children with cardiac disease: a scientific statement from the American Heart Association. Circulation. 2018;137(22):e691–e782

2. American Academy of Pediatrics. Using an AED. Healthy Children. https://www.healthychildren.org/English/health-issues/injuries-emergencies/Pages/Using-an-AED.aspx Updated May 09, 2018. Accessed April 25, 2019.

3. American Heart Association. Part 11: pediatric basic life support and cardiopulmonary resuscitation quality. https://eccguidelines.heart.org/
   index.php/circulation/cpr-ecc-guidelines-2/part-11-pediatric-basic-life-support-and-cardiopulmonary-resuscitation-quality. Updated 2017. Accessed December 20, 2018

NOTES

Content in the STANDARD was modified on 05/17/2019.

1.4.3.2: Topics Covered in Pediatric First Aid Training

To ensure the health and safety of children in an early care and education setting, staff should be able to respond to common injuries and life-threatening emergencies. Staff trained in pediatric first aid should be in attendance at all times. Pediatric first aid training is necessary to gain skills that allow caregivers/teachers to respond to emergencies and nonemergencies.¹ First aid training should present a variety of topics, including accessing emergency medical services (EMS), accessing poison control centers, safety at the scene of an incident, and isolation of bodily substances (standard precautions). Procedures for parental notification and records of communications with EMS should be established.

Pediatric first aid training in the early care and education setting should include instruction on recognizing and responding to:

• Abrasions and lacerations
• Airway management, both blocked airway and rescue breathing for infants and children, with return demonstration by the learner (pediatric cardiopulmonary resuscitation [CPR])
• Allergic reactions, including information about when epinephrine may be required
• Asthmatic reactions, including information about when rescue inhalers should be used
• Bites, including insect, animal, and human
• Bleeding, including nosebleeds
• Burns
• Cold-related injuries, including frostbite
• Dental and mouth injuries/trauma
• Drowning
• Electric shock
• Eye injuries
• Fainting
• Head injuries, including shaken baby syndrome/abusive head trauma
• Heat-related injuries, including heat exhaustion/heatstroke
• Illness-related emergencies (eg, stiff neck; inexplicable confusion; sudden onset of blood-red or purple rash; severe pain; temperature above 101°F [38.3°C] taken orally, above 102°F [38.9°C] taken rectally, or 100°F [37.8°C] or higher taken axillary [armpit] or measured by an equivalent method; looking/acting severely ill)
• Loss of consciousness
• Musculoskeletal injuries (eg, sprains, fractures)
• Poisoning, including swallowed, skin or eye contact, and inhaled
• Puncture wounds, including splinters
• Seizure care
• Shock

In addition, first aid training should include

• Managing first aid interventions for children with special health care needs
• Addressing the needs of all children in the group when managing emergencies in a child care setting
• Moving/positioning injured/ill persons

RATIONALE

First aid training provides instruction for simple, commonsense procedures that are intended to keep a child’s medical condition from becoming worse. Training in first aid is not intended to replace proper medical treatment; instead, it is for providing initial aid until EMS, medical professionals, or parents/guardians assume responsibility of the child’s medical care.^1(p3)

First aid for children in the early care and education setting requires a more child-specific approach than standard adult-oriented first aid offers. A staff member trained in pediatric first aid, including pediatric CPR, coupled with a facility that has been designed or modified to ensure the safety of children can reduce the potential for death and disability. Knowledge of pediatric first aid, including the ability to demonstrate pediatric CPR skills, and the confidence to use these skills are critically important to the outcome of an emergency.²

Small family child care home caregivers/teachers often work alone and are solely responsible for the health and safety of children in care. Caregivers/teachers in these settings, who participate in pediatric first aid trainings, are better equipped on how to properly manage the supervision of other children during a medical emergency.

COMMENTS

Additional Resources:

First aid information can be obtained from:

• American Academy of Pediatrics (https://www.pedfactsonline.com)
• American Heart Association (https://www.heart.org)
• American Red Cross (https://www.redcross.org/take-a-class/first-aid)

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

1.4.3.1 First Aid and Cardiopulmonary Resuscitation Training for Staff
1.4.3.3 Cardiopulmonary Resuscitation Training for Swimming and Water Play
3.4.3.1 Medical Emergency Procedures
3.6.1.3 Guidelines for Taking Children’s Temperatures
5.6.0.1 First Aid and Emergency Supplies
9.4.3.3 Training Record

REFERENCES

1. American Academy of Pediatrics, National Association of School Nurses. PedFACTs: Pediatric First Aid for Caregivers and Teachers. 2nd ed. Burlington, MA: Jones & Bartlett Learning; 2012

2. Scott JP, Baptist LL, Berens RJ. Pediatric resuscitation: outcome effects of location, intervention, and duration. Adv Anesth. 2015;2015:1–9 https://doi.org/10.1155/2015/517863

NOTES

Content in the STANDARD was modified on 5/17/2019.

1.4.3.3: Cardiopulmonary Resuscitation Training for Swimming and Water Play

Early care and education programs with a swimming pool on-site or that participate in swimming or water play activities should have, at minimum, one staff member with current documentation of successful completion of training in pediatric cardiopulmonary resuscitation (CPR). Pediatric CPR–certified staff should be counted in the child to staff ratio for all swimming and water play activities.

This documentation should require the successful completion of training in the following areas:

1. Basic water safety
2. Proper use of swimming pool rescue equipment
3. Emergency procedures
4. Pediatric CPR according to the criteria of the American Red Cross or the American Heart Association

 

For small family child care homes, the person trained in water safety and CPR should be the caregiver/teacher. Written verification of successful completion of CPR and lifesaving training, water safety instructions, and emergency procedures should be kept on file and reviewed and updated annually.

RATIONALE

Drowning can occur very quickly, quietly, and anywhere water is available, such as play areas, bathtubs, swimming pools, and buckets.¹ Children can drown in as little as 2 inches of water, making supervision critical. Active, persistent supervision by a nearby adult is believed to be the most effective drowning prevention strategy for children.² The brain can only survive for several minutes without oxygen. Trained staff members who are able to provide CPR in a timely manner can significantly prevent or offset possible brain damage from drowning.³ The interruption of breathing, as well as possible cardiac arrest, makes prolonged immersion time and drowning an urgent, life-threatening emergency.³

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

1.1.1.5 Ratios and Supervision for Swimming, Wading, and Water Play
2.2.0.4 Supervision Near Bodies of Water
2.2.0.5 Behavior Around a Pool
6.3.1.7 Pool Safety Rules
6.4.1.1 Pool Toys
9.4.3.3 Training Record

REFERENCES

1. Centers for Disease Control and Prevention. Unintentional drowning: get the facts. https://www.cdc.gov/homeandrecreationalsafety/water-safety/waterinjuries-factsheet.html. Updated April 28, 2016. Accessed December 20, 2018

2. Franklin RC, Pearn JH, Peden AE. Drowning fatalities in childhood: the role of pre-existing medical conditions. Arch Dis Child. 2017;102(10):888–893

3. American Academy of Pediatrics, National Association of School Nurses. PedFACTs: Pediatric First Aid for Caregivers and Teachers. 2nd ed. Burlington, MA: Jones & Bartlett Learning; 2012

NOTES

Content in the STANDARD was modified on 5/17/2019.