Chest Truama and CPR. To Do, Or Not To Do?

This week Roy answers a question that came all the way from France where a student asked a great question about how to perform CPR if a person has had major trauma to their chest after a motor vehicle accident. You know, starting CPR on a victim can be a difficult decision to make in any normal situation, then add the complication of internal or external truama and without guidance,  it may be a temptation to avoid providing CPR all together. On this episode of RoyOnRescue, Roy Shaw, EMT-Paramedic and Trainer sheds some light on why it’s okay to perform CPR on a person with a chest injury  or on someone who has recently had thoracic surgery and what to consider while providing this life saving skill.


Be sure to keep the questions coming and send them to:

How Do I Know If It’s A Fracture or A Sprain?

Hello Again,

A great question came in about how to tell if an injury is a fracture or a sprain or strain. This is a great question. In some cases it’s very easy to tell that a fracture is present. Like… bone sticking out of the skin! But if it’s not and there isn’t any deformity, it can be tricky. Check out this video blog for a more in-depth look on how to tell if the injury is something that needs medical attention or if it’s minor and can be managed right at home.

To read a bit more about the specifics, feel free to browse this link.
Fractures Vs. Sprains and Strains

Best Wishes,


Isn’t “Not Breathing Normally” Still Breathing? Maybe Not.

ConfusedHello Everyone,

I had a great comment come through the student comment section this week and thought it might help others if I shared my response.

So, the student asked,
” Some questions on your test seemed to give incomplete or misleading information, in my opinion. Such as the one referring to a man who is unresponsive and not breathing normally. The answer to pass was to give them 30 chest compressions yet if someone is not breathing NORMALLY it leads me to believe that they are breathing and the first thing I would want to do is try and figure out why the breathing is not normal. Not give them chest compressions. Have I checked for a heartbeat? I wouldn’t give chest compressions unless I couldn’t detect a pulse.” Student

Here was my response. I hope it helps.

Dear “Student”,

There were a couple of changes in this 2010 ECC/ILCOR and American Heart Association release from the guidelines of 2005. One was that if the person is unresponsive and not breathing “normally” we begin chest compressions. Pretty aggressive I know but this is what the guidelines suggest as best practice. Secondly, basic first aid providers no longer check for pulses in the unresponsive victim. Now, when a lay-rescuer comes upon a person who is unconscious, not breathing or not breathing “normally”, they are to activate EMS(call 911) and begin chest compressions at a rate of at least 100 per minute and at least 2 inches deep. This is to continue for 30 compressions only interrupted long enough to give two full breaths after the head tilt chin lift and then back to the chest compressions. The rescuer is not to stop this process unless the patient begins to respond and become conscious, begins breathing normally again, an AED is available, or if EMS arrives and takes over. CPR is to be provided fast and hard with as few interruptions as possible. So there you have it as stated by the new and latest ECC/ILCOR guidelines.

Now, for my subjective slant on the whole deal. I say, don’t feel bad if you’re a little frustrated. As a licensed paramedic, instructor trainer for CPR, First Aid, ACLS and PALS, it still a bit hard for me to watch the latest recommendations and guidelines put forth by the International Liaison Committee On Resuscitation”. It was hard to watch them throw the proverbial “baby out with the bath water” if you will. I for one believe that people can learn how to perform effective and more advanced assessment if given the correct learning mechanisms by which to learn and retain the information in order to use it well during a real rescue situation. I believe that people are more than capable of providing optimal CPR and First Aid which would include pulse checks. I think that there can be times, though maybe rare, where checking for pulses would be helpful in determining the correct next steps especially when dealing with patients suffering from low blood sugar, or a hard hit to the head which temporarily knocks them unconscious and they stop breathing for some time. I also wonder about the person who has been in cardiac arrest for some time. The person is certainly permanently dead and any resuscitation efforts will not change the patients status because they’ve been dead for more than half an hour or longer. Does the rescuer still perform CPR and Rescue Breathing because the person is not moving, not breathing or not breathing normally? Very difficult for me to believe that a rescuer would have to perform CPR on a person with rigor mortis while waiting for the EMS providers to arrive and confirm time of death.

But, the ECC/ILCOR recommendations were based on some evidence, though from my findings I admit not much, that more people would benefit from these simplified procedures than would suffer any ill consequence. So they made the change.

What helps me to deal with the changes when I don’t agree with them, is that the changes were made by the ILCOR group to “simplify” the procedures of CPR and to hopefully encourage more people trained or not, to get involved and hopefully make a difference in saving more lives. If this is indeed the case and we’ll know in a few years, than I guess it’s worth the bit of frustration that some of us must suffer.

I hope this helped. Please let me know if you have any further questions.

Best Wishes,


What’s Been Going On With RoyOnRescue?

Hello Everyone,

Well, it’s been crazy in the camp, but it’s all been great!   Updating all of the 2010 CPR and First Aid manuals and workbooks, creating the new ProTrainings Instructor program and expanding further into the UK market.  All very exciting.  I’m hoping to bring some new subject matter into the program and maybe even implement a RoyOnRescue live program.  All to be seen but I can tell you, your comments regarding it would be really helpful. Let me know if a live show where you could call in, chat live, email questions and interact while I’m hosting the show would be helpful, fun or just a waste of time.  Let me know what time of day and on what day would work best too.  Tuesdays -Thursdays or Fridays between 8am and 3pm EST.  Let me know what kind of topics you’d like me to cover too.  Would you like to see more interviews with victims, rescuers or both?  And regarding the video shoot today, sorry to record while cruising down the highway to my next meeting but I wanted to let everyone know where I’ve been and what’s been going on.  Time is a very expensive commodity but I didn’t want to miss another week.  P.S.  When ever you get a video capture while I’m driving, please note that safety measures are in place to ensure there is no danger while recording to me or to anyone else.

Best Wishes,


Professional Rescuers and The Good Samaritan Law

In this episode of RoyOnRescue, a newly licensed Medical First Responder asked if they might be at a higher risk when they try to help a citizen now that they are licensed.  Though this can be a scary and ever present problem in the world of professional medicine, it’s very rare for anyone to get sued or especially lose a lawsuit when it comes to helping people who have medical needs.  In this episode, Roy sheds some light on how most Good Samaritan Laws work and how any rescuer regardless of their level of training and license can help others while staying well within the guidelines of the Good Samaritan Law.

Best Wishes and a Blessed New Year From Roy and The Whole RoyOnRescue Team!

Minnesota Good Samaritan Law

RoyOnRescue Answers Question About Assessing Breathing

In this post, I answer a question from a professional who has been training lay rescuers and wants to update their students to the new 2010 suggested guidelines.

The following excerpt is taken from the original email.
Greetings from India,

“We teach first aid and CPR (to the layperson/non medical person)in New Delhi, India and are reading the new guidelines so that they can be incorporated in the new year.  I know the handbooks will be out in the first quarter but would like to start adding the 2010 guidelines sooner.
A couple of questions- your input would be appreciated.
1. Do we carry on with AVPU
2. As checking for breathing is being de-emphasized – how are first aiders to tell if breathing is present or not. From what i can figure out- look, listen feel is not to be used now.”

Merry Christmas and Happy New year.

Kind Regards,

New Delhi

The following is my response:

Hello Student,

Thank you for reaching out as I hope to be of assistance.  Regarding the new updates for 2010 and how it relates to training the lay public.

1.  Q:  “Do we carry on with AVPU?”
A:  Yes and No.  Yes in so much as we are always kind of asking ourselves, “Is this person awake? Are they Verbal? Do they respond to pain(not that we should be causing any pain)? Are they unresponsive?  But I have to say no, because we are checking to see if the person appears to be breathing or breathing normally?  This does not fit in the AVPU scale for a level of consciousness.  We must also remember that AVPU is an advanced medical training and the ECC/ILCOR recommendations do not teach lay rescuers to use AVPU anywhere in the curriculum.

2.  Q: With assessment for breathing being de-emphasized and the elimination of the “Look, Listen, and Feel” part of assessment, what is the best way to train lay rescuers to assess for breathing?
A:  This is a great question.  Under the new guidelines, assessment for breathing is performed by looking for the following:  Is the persons chest moving like in breathing?  Does the person appear to be breathing normally?   If the person is not breathing normally, and the chest is not rising and falling, the rescuer will initial emergency medical services and begin CPR starting with 30 chest compressions at least 2 inches deep and at a rate of at least 100 per minute.

The simplification of assessment for breathing was brought by confusion of agonal respirations vs. regular gas exchanging breathing.  The hope is that if a rescuer notices that the person is not breathing normally, help will be called and initiation of CPR will not be delayed.

For those of us who worry that too many victims will receive CPR when it is not necessary and thereby suffer unnecessary injuries, one must be aware of the scientific studies that show that “only two percent of people receiving CPR suffered any injury at all from CPR when it was not needed.  But the advantages of early initiation of CPR without delay, has been shown to improve survival with minimal risk of injury but with great increase of benefit.(

Please note that all update training is available for free at:

Thank you for your email and please let me know if you need any further assistance.

Best Wishes and Merry Christmas!

Roy Shaw, EMT-Paramedic

Foods That Help Hydrate While In The Orient

A student wrote:

“My Husband and I will spend a month in Southeast Asia in January.  I am concerned that I will have issues with the hot, huumid climate.  We will only have air conditioning in the hotel and bus.  I have lightweight clothes, colling bandana, big hat, and know to drink lots of water.  Is there anything else I can do, such as eat certain foods, ie, salty snacks, boullion, etc.?”

Well this is a great question!  After a little research I’ve got great news.

It turns out that not only can you add one type of food to your diet, there are three types of food that will help you stay hydrated or rehydrate especially if you or someone you know is NOT a big drinker of water.  The following VideoBlog should help answer this question and at the bottom of this post, I’ve included the source where I found some helpful information on different foods that help you stay or get better hydrated.

I hope this helps and thanks for sending the question.

Have fun in Southern Asia and let me know how it went when you get back.

Zai Jian(Goodbye)

Tweet: @royonrescue

Foods That Hydrate

How Can A Child Do CPR?

In this episode of RoyOnRescue, Roy get’s asked the best way to have a child do CPR on a person who is larger then them.  Other than a bit of bad videography while Roy’s on the fly…I think it will help answer a question many people have about the best way that a small person can help someone in cardiac arrest.
Best Wishes,
The RoyOnRescue Team

Life and Death With Dignity…and Privacy

just received a question from a student who asked:

Dear RoyOnRescue,

“In thinking about the use of an AED, what if the person is a woman and we have to “bare the chest”.   Should we place the AED pads under the shirt, or do we have to actually bare the chest for proper use of an AED?”


This is a good question and one that is uncomfortable for some to think about.  Whenever a rescuer is working on a patient, male or female,  a rule of ethics applies.  We as rescuers should be thinking about the dignity and respect of the patients privacy and confidentiality at all times.  This includes times where we may have to “Bare” the chest of the victim in order for us to defibrillate or treat them.  We should seek to be discrete as long as we are able to get the job of rescue accomplished without delay.   If the person is able to be defibrillated without full removal of the clothing that’s great.  If the person needs to have shirt or underclothing cut or removed in order to defibrillate properly than that will need to be done.  If there are bystanders, those bystanders could turn their backs to the patient and try to make a human curtain around the patient in order to protect the patients privacy and dignity.  Think about if this is in a public workplace or location where the person is known.  They may survive if everything goes the way it should and if they do, they will probably return to this workplace.  We must make sure that as far as we can control, we protected their dignity and helped them as much as possible without complicating or slowing down the rescue process.

I hope this helps.

Best Wishes,


2010 AHA Updates From Chicago

Hi Everyone,

I’m here at the 2010 American Heart Association instructor conference hosted at the McCormick Place. It was a wonderful weekend in the “Windy City” and worked out well for Jody Marvi( Compliance and Accreditation Manager) and I to attend the new guideline roll-out for BLS, ACLS, PALS and NeoNatal Resuscitation. I’m glad to announce that in the end, I don’t see any serious issues to any of the latest guidelines for resuscitation. I was afraid there was going to be some changes that were going to cause ethical issues for end of life issues but thankfully to the best of my knowledge, this didn’t materialize for 2010. So take a peek and let me know what you think of the latest ECC/ILCOR recommendations for resuscitation.