Part 11: Pediatric Basic Life Support F or best survival and quality of life, pediatric basic life support(BLS) should be part of a community effort that includes prevention, basic CPR, prompt access to the emer- gency medical services(EMS) system, and prompt pediatric advanced life support (PALS). These 4 links form the American Heart Association(AHA) pediatric Chain of Sur- ival(Figure 1). The first 3 links constitute pediatric BLS Rapid and effective bystander CPR is associated with Figure 1. Pediatric Chain of Survival successful return of spontaneous circulation and neurologi- cally intact survival in children. ,2 The greatest impact occurs nhtsa. gov. Look for the Comprehensive Child Passenger in respiratory arrest, in which neurologically intact survival Safety Information rates of >70% are possible, 4-6 and in ventricular fibrillation Adolescent drivers are responsible for a disproportionate CVF), in which survival rates of 30% have been documented. 7 number of motor vehicle-related injuries; the risk is highest in the first 2 years of driving. Driving with teen passengers But only 2% to 10% of all children who develop out-of- and driving at night dramatically increase the risk. Additional hospital cardiac arrest survive, and most are neurologically devastated. 7-13 Part of the disparity is that bystander CPR is risks include not wearing a seat belt, drinking and drivin provided for less than half of the victims of out-of-hospital speeding, and aggressive driving arrest & 11, 14 Some studies show that survival and neurolo Pedestrian Injuries outcome can be improved with prompt CPR.6, 15-17 Pedestrian injuries account for a third of motor vehicle related injuries. Adequate supervision of children in the street Prevention of Cardiopulmonary Arrest is important because injuries typically occur when a child major causes of death in infants and children are darts out mid-block, dashes across intersections, or gets off espiratory failure, sudden infant death syndrome(SIDS), bus. 22 sepsis, neurologic diseases, and injuries. 8 Bicycle Injuries Injuries Bicycle crashes are responsible for approximately 200 000 Injuries, the leading cause of death in children and young Injuries and nearly 150 deaths per year in children and adults. cause more childhood deaths than all other cause adolescents. 2 Head injuries are a major cause of bicycle combined. s Many injuries are preventable. The most com- related morbidity and mortality. It is estimated that bicycle mon fatal childhood injuries amenable to prevention are helmets can reduce the severity of head injuries by >80%0.24 motor vehicle passenger injuries, pedestrian injuries, bicycle burns injuries, drowning, burns, and firearm injuries. 9 Approximately 80% of fire-related and burn-related deaths Motor Vehicle Injuries result from house fires and smoke inhalation 25.26 Smoke Motor vehicle-related injuries account for nearly half of all detectors are the most effective way to prevent deaths and pediatric deaths in the United States. 8 Contributing factors injuries; 70% of deaths occur in homes without functioning include failure to use proper passenger restraints, inexpert- smoke alarms. 27 nced adolescent drivers and alcohol Firearm Injuries Appropriate restraints include properly installed, rear- The United States has the highest firearm-related injury rate facing infant seats for infants <20 pounds(<9 kg)and <I of any industrialized nation-more than twice that of any year of age, child restraints for children I to 4 years of age, other country. 28 The highest number of deaths is in adoles and booster seats with seat belts for children 4 to 7 years of cents and young adults, but firearm injuries are more likely to age 0 The lifesaving benefit of air bags for older children and be fatal in young children. 29 The presence of a gun in the adults far outweighs their risk. Most pediatric air bag-related home is associated with an increased likelihood of adoles- fatalities occur when children <12 years of age are in the cent30, 31 and adult suicides or homicides. 32 Although overall vehicle's front seat or are improperly restrained for their age firearm-related deaths declined from 1995 to 2002. firearm For additional information consult the website of the National homicide remains the leading cause of death among African- HighwayTrafficsaFetyAdministration(nhtsa):http://amEricanadolescentsandyoungadultsI8 Sudden Infant Death Syndrome (Circulation. 2005: 112: IV-156-1V-166) SIDS is"the sudden death of an infant under I year of age, o 2005 American Heart Association which remains unexplained after a thorough case investiga This special supplement to Circulation is freely available at http://www.circulationaha.org tion, including performance of a complete autopsy, tion of the death scene, and review of the clinical history. "3 DOI: 10.1161/CIRCULATIONAHA. 105.166572 The peak incidence of SIDs occurs in infants 2 to 4 months ofPart 11: Pediatric Basic Life Support For best survival and quality of life, pediatric basic life support (BLS) should be part of a community effort that includes prevention, basic CPR, prompt access to the emer￾gency medical services (EMS) system, and prompt pediatric advanced life support (PALS). These 4 links form the American Heart Association (AHA) pediatric Chain of Sur￾vival (Figure 1). The first 3 links constitute pediatric BLS. Rapid and effective bystander CPR is associated with successful return of spontaneous circulation and neurologi￾cally intact survival in children.1,2 The greatest impact occurs in respiratory arrest,3 in which neurologically intact survival rates of
70% are possible,4–6 and in ventricular fibrillation (VF), in which survival rates of 30% have been documented.7 But only 2% to 10% of all children who develop out-of￾hospital cardiac arrest survive, and most are neurologically devastated.7–13 Part of the disparity is that bystander CPR is provided for less than half of the victims of out-of-hospital arrest.8,11,14 Some studies show that survival and neurologic outcome can be improved with prompt CPR.6,15–17 Prevention of Cardiopulmonary Arrest The major causes of death in infants and children are respiratory failure, sudden infant death syndrome (SIDS), sepsis, neurologic diseases, and injuries.18 Injuries Injuries, the leading cause of death in children and young adults, cause more childhood deaths than all other causes combined.18 Many injuries are preventable. The most com￾mon fatal childhood injuries amenable to prevention are motor vehicle passenger injuries, pedestrian injuries, bicycle injuries, drowning, burns, and firearm injuries.19 Motor Vehicle Injuries Motor vehicle–related injuries account for nearly half of all pediatric deaths in the United States.18 Contributing factors include failure to use proper passenger restraints, inexperi￾enced adolescent drivers, and alcohol. Appropriate restraints include properly installed, rear￾facing infant seats for infants 20 pounds (9 kg) and 1 year of age, child restraints for children 1 to 4 years of age, and booster seats with seat belts for children 4 to 7 years of age.20 The lifesaving benefit of air bags for older children and adults far outweighs their risk. Most pediatric air bag–related fatalities occur when children 12 years of age are in the vehicle’s front seat or are improperly restrained for their age. For additional information consult the website of the National Highway Traffic Safety Administration (NHTSA): http:// nhtsa.gov. Look for the Comprehensive Child Passenger Safety Information. Adolescent drivers are responsible for a disproportionate number of motor vehicle–related injuries; the risk is highest in the first 2 years of driving. Driving with teen passengers and driving at night dramatically increase the risk. Additional risks include not wearing a seat belt, drinking and driving, speeding, and aggressive driving.21 Pedestrian Injuries Pedestrian injuries account for a third of motor vehicle￾related injuries. Adequate supervision of children in the street is important because injuries typically occur when a child darts out mid-block, dashes across intersections, or gets off a bus.22 Bicycle Injuries Bicycle crashes are responsible for approximately 200 000 injuries and nearly 150 deaths per year in children and adolescents.23 Head injuries are a major cause of bicycle￾related morbidity and mortality. It is estimated that bicycle helmets can reduce the severity of head injuries by
80%.24 Burns Approximately 80% of fire-related and burn-related deaths result from house fires and smoke inhalation.25,26 Smoke detectors are the most effective way to prevent deaths and injuries; 70% of deaths occur in homes without functioning smoke alarms.27 Firearm Injuries The United States has the highest firearm-related injury rate of any industrialized nation—more than twice that of any other country.28 The highest number of deaths is in adoles￾cents and young adults, but firearm injuries are more likely to be fatal in young children.29 The presence of a gun in the home is associated with an increased likelihood of adoles￾cent30,31 and adult suicides or homicides.32 Although overall firearm-related deaths declined from 1995 to 2002, firearm homicide remains the leading cause of death among African￾American adolescents and young adults.18 Sudden Infant Death Syndrome SIDS is “the sudden death of an infant under 1 year of age, which remains unexplained after a thorough case investiga￾tion, including performance of a complete autopsy, examina￾tion of the death scene, and review of the clinical history.”33 The peak incidence of SIDs occurs in infants 2 to 4 months of (Circulation. 2005;112:IV-156-IV-166.) © 2005 American Heart Association. This special supplement to Circulation is freely available at http://www.circulationaha.org DOI: 10.1161/CIRCULATIONAHA.105.166572 Figure 1. Pediatric Chain of Survival. IV-156