tijn Van de Velde ∗, Paul Broos, Marc Van Bouwelen, Rudy De Win,n Sermon, Johann Verduyckt, Andre Van Tichelen, Door Lauwaert,arbara Vantroyen, Christina Tobback, Patrick Van den Steene,armite Villere, Carlos Urkia Mieres, Gabor Gobl, Susanne Schunder,oenraad Monsieurs, Joost Bierens, Pascal Cassan, Enrico Davoli,arc Sabbe, Grace Lo, Maaike De Vries, Bert Aertgeerts,
n behalf of the European First Aid Manual project by the Belgian Redross-Flanders
raining Department, Belgian Red Cross-Flanders, Motstraat 40, 2800 Mechelen, Belgium
eceived 26 August 2006; received in revised form 20 October 2006; accepted 20 October 2006
SummaryAim: Our objectives were to determine the most effective, safe, and feasible firstaid (FA) techniques and procedures, and to formulate valid recommendations fortraining. We focussed on emergencies involving few casualties, where emergencymedical services or healthcare professionals are not immediately present at thescene, but are available within a short space of time. Due to time and resourceconstraints, we limited ourselves to safety, emergency removal, psychosocial FA,traumatology, and poisoning. Cardiopulmonary resuscitation (CPR) was not included
Please cite this article in press as: Van de Velde S, et al., European first aid guidelines, Resuscitation (2006),doi:10.1016/j.resuscitation.2006.10.023
because guidelines are already available from the European Resuscitation Council(ERC). The FA guidelines are intended to provide guidance to authors of FA handbooksand those responsible for FA programmes. These guidelines, together with the ERCresuscitation guidelines, will be integrated into a European FA Reference Guide anda European FA Manual.
� A Spanish translated version of the summary of this article appears as Appendix in the final online version at . . .�� Guidelines are not a substitute for the caregiver’s own judgment of a specific medical or health condition. Casualties shouldonsult a qualified health-care professional for advice about a specific condition. The authors disclaim any liability to any party forny damages arising out of the use or non-use of this material and any information contained therein, and all warranties, expressedr implied.∗ Corresponding author. Tel.: +32 15 44 34 76.
These guidelines provide systematically developed recommendations and justifica-tions for the procedures and techniques that should be included in FA manuals and
vier
mbtocena
grtthtc
ttTfEaoguraEM
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TtGuidelines Network (SIGN).6 This is a recognisedreference for the development of guidelines.7
Every year, thousands of people experience orwitness medical emergencies. When emergenciesoccur, family members, friends, colleagues, orbystanders often provide spontaneous help.1—3
Citizens can take safety precautions and helpothers until professional help arrives. First aid(FA) training is essential in preparing the gen-eral public for an initial response to suchsituations.
To improve the outcome of the casualty, firstaiders must be taught correctly; they must be giventraining in the right things. Incorrect training canresult in inadequate, even harmful, interventions.The procedures and techniques taught to the publicvary between European countries, but these dif-ferences cannot always be justified. Recently, theAmerican Heart Association published guidelinesfor resuscitation and FA,4 the European guide-lines that were published at the same time onlycovered resuscitation.5 European FA guidelines,which incorporate research and expert opinion sys-tematically and transparently, therefore are muchneeded.
Belgian Red Cross-Flanders initiated a project todetermine the most effective, safe, and feasibleFA techniques and procedures, and to formulatevalid recommendations. This project received sup-port from the European Commission. The guidelinescover emergencies involving few casualties, whereemergency medical services (EMS) or healthcareprofessionals are not present at the scene imme-diately, but are available within a short space oftime. Due to time and resource constraints, welimited ourselves to safety, emergency removal,psychosocial FA, traumatology, and poisoning. Car-diopulmonary resuscitation (CPR) is not included,because guidelines5 are already available from the
Please cite this article in press as: Van de Velde S, et aldoi:10.1016/j.resuscitation.2006.10.023
European Resuscitation Council (ERC).We define FA as ‘immediate help provided to a
sick or injured person’. FA consists of proceduresand techniques, requiring minimal or no equip-
G
WG
Ireland Ltd.
ent, that can be taught to the general public inasic FA courses. FA is not only concerned with thereatment of physical injury but also with providingther initial care to the individual, including psy-hosocial FA—–assistance given to people sufferingmotional distress caused by experiencing or wit-essing a stressful event. A first aider is defined aslayperson trained in FA.These guidelines have been designed to provide
uidance to authors of FA handbooks and thoseesponsible for FA programmes. They are intendedo be a blueprint for local training programmes ando increase the usefulness, quality, impact, andarmonisation of training. This will improve bothhe quality of FA provided and the outcome for theasualty.
Together with the resuscitation guidelines ofhe ERC, these guidelines will be bundled intohe European Reference Guide for FA Instruction.his Reference Guide should be a helpful toolor the dissemination of the guidelines throughouturope. To implement the new guidelines simplynd efficiently across Europe, we produced EFAMr European FA Manual. EFAM collates all the newuidelines for first aid and resuscitation into onenique tool to update teaching material. It offerseady-to-use digital texts and high quality photos ofll the latest techniques. The Reference Guide andFAM can be requested from the European First Aidanual website http://www.efam.be.
ethodology
he guideline development process was based onhe methodology of the Scottish Intercollegiate
ARTICLE IN PRESSESUS-3163; No. of Pages 12
S. Van de Velde et al.
Methods: To create these guidelines we used an evidence-based guideline develop-ment process, based on the methodology of the Scottish Intercollegiate GuidelinesNetwork (SIGN).Results: The recommendations cover FA for bleeding, wounds, burns, spinal and headtrauma, musculoskeletal trauma, and poisoning, as well as safety and psychosocial FA.Conclusions: Where good evidence was available, we were able to turn science intopractice. Where evidence was lacking, the recommendations were consensus-based.
., European first aid guidelines, Resuscitation (2006),
uideline Development Group
hen composing the Guideline Developmentroup, we ensured participation from all relevant
ey groups and disciplines. The group consisted ofuropean specialists in anaesthesiology, cardiology,raumatology, emergency medicine, disaster man-gement, psychosocial care, medical education,nd FA training. The director of the Belgian branchf the Cochrane Collaboration, i.e. the Belgianentre for Evidence-Based Medicine (CEBAM), gavedvice on methodology. The experts who conductedhe systematic literature review participated inraining in evidence-based medicine.
iterature search and data sources
he objective of the search was to find all rele-ant studies using sensitive search strategies. Annitial search was performed for guidelines and sys-ematic reviews (SR) in the Cochrane Database ofystematic Reviews, the Guidelines Internationaletwork database, the Health Evidence Network,he National Guideline Clearinghouse, the Nationallectronic Library for Health Guidelines Finder, andubmed. A subsequent search for other studies wasarried out using Pubmed, Embase, and the Webf Science. Where eligible guidelines or SRs wereound, the subsequent search focussed on stud-es published thereafter, up to December 2005.and searching and checking the reference listsf selected studies enabled the inclusion of stud-es that were not retrieved in the initial search.he detailed search strategy is available uponequest.
election of studies
nclusion and exclusion criteria were defined beforehe selection procedure. There were no languageestrictions or limits on study design. Studies wereelected from the titles and abstracts of all theetrieved references. Full texts were then screenednd irrelevant studies were excluded.
uality assessment
ll the selected studies were evaluated for method-logical quality using checklists. We used theGREE instrument8 from the AGREE Collaborationor assessing guidelines, and the SIGN checklist foreviewing SRs, randomised controlled trials (RCT),nd cohort and case—control studies. We developeddditional checklists for other study designs.
Please cite this article in press as: Van de Velde S, et aldoi:10.1016/j.resuscitation.2006.10.023
ata extraction
he data from valid studies were tabulated in evi-ence tables and summarized by level of evidence.vidence statements and recommendations were
lcap
PRESS3
ormulated at a conference held in Riga, Latvia,n February 2006. If no relevant research evidenceas found, recommendations were based on a con-
ensus of what was considered good practice. Forach recommended FA technique or procedure, wessessed the effectiveness, safety, and feasibil-ty. In accordance with the SIGN grading system6
Figure 1), our recommendations are graded fromto D. These grades match the strength of the
upporting evidence, ranging from LOE 1 to 4.here evidence was unavailable, the recommen-
ation is based on a consensus of the Guidelineevelopment Group as to what constitutes goodractice.
alidation
xternal reviewers, including medical specialists,xperts in psychosocial care, training managers,nd trainers, made an initial assessment of eachuideline statement. They gave feedback on scope,uality, clarity, and usefulness. The Guidelineevelopment Group then considered the responses.n independent expert committee, following theEBAM external validation procedure, officially val-
dated the final guidelines.
vidence
able 1 shows the number of studies identified,ncluded, and excluded. In total we selected8 studies to support our recommendations. Themerican FA guidelines4 were included under mul-iple topics, thus explaining why ‘total included’ inable 1 amounts to 93 rather than 88.
We included 23 guidelines, 5 SRs, 2 RCTs,cohort study, 14 case reports or series, 2
ross-sectional surveys, and 41 miscellaneousanuscripts (narrative reviews, letters, comments,
tc.). Five guidelines contained specific recom-endations for FA.4,9—12 The other guidelines were
or use by healthcare professionals, but extrapola-ion to FA recommendations was possible. Twelveuidelines4,10,12—21 used systematic and transpar-nt methods for integrating research evidence,wo guidelines9,11 were based on expert con-ensus, and for nine guidelines22—30 we couldot retrace what method was used. Eight guide-ines included grades of recommendation. Whenppropriate guidelines or SRs were found, weocussed the subsequent search on later pub-
., European first aid guidelines, Resuscitation (2006),
ications, up to December 2005. This was thease for psychosocial FA, wounds, burns, spinalnd head trauma, musculoskeletal trauma, andoisoning.
two on fire,39,40 and seven on electricalaccidents.40—46 Except for one cross-sectionalsurvey on fire safety (LOE 339), all the selectedstudies on safety measures are expert opiniondocuments (LOE 4). As to road accidents, there isdebate among specialists whether parking the carbefore or after the accident is important.
Please cite this article in press as: Van de Velde S, et aldoi:10.1016/j.resuscitation.2006.10.023
Recommendations (Grade D)
General principlesAlways make personal safety your first priority.Check the situation and identify any potential dan-
tm
t
ding system.6
er. Only approach the scene if it is safe forou to do so. If possible, try to ensure safetyor the casualty and bystanders. If it is unsafeor you to approach the casualty, alert the emer-ency services and wait at a safe distance for theirrrival.
oad accidentlways act according to local laws.
When approaching a road accident, reduce speednd avoid sudden braking. Park your car in aafe place, off the road or at the side of theoad. Wear high visibility clothing. Use warn-ng signs (e.g. warning triangle) to alert passing
., European first aid guidelines, Resuscitation (2006),
raffic. Do not run across busy travel lanes onotorways.Identify any downed electrical cables and ensure
Please cite this article in press as: Van de Velde S, et aldoi:10.1016/j.resuscitation.2006.10.023
ARTICLE INRESUS-3163; No. of Pages 12
European first aid guidelines
Tabl
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PRESS5
Prevent fire by switching off the ignition of vehi-les involved in the accident, and ensuring thatobody smokes. Be aware of the danger of airbags.f possible, apply the handbrake to stabilise theehicles involved.
ire at homery to warn everybody at risk without putting your-elf at risk. Do not enter a burning house. Moveway from the area to a safe distance. If you aren a burning building, leave the area immediatelynd help other people to leave, provided you cano this safely.
lectrical accident at homeonsider electrical devices and cables as ‘live’ntil proven to be disconnected. Do not touch aasualty connected to a power source. Remem-er that liquids or objects in contact with theasualty can potentially conduct electricity. Switchff the current. If it is not possible to dis-onnect the power, stand on insulating materialnd push the power source away using non-onductive material. If this is not feasible, waitor the fire brigade or specialised personnel torrive.
mergency removal of the casualty
indings
hree expert opinion manuscripts are included onmergency removal of the casualty (LOE 44,23,47).here is no evidence on which technique of movingcasualty is best.
ecommendations (Grade D)
s a general rule, do not move a casualty fromhe scene of the accident. Only move a casualtyf he or she is in uncontrollable danger, and ift is safe for you to do so. In that case movehe casualty to the nearest place of safety. Tryo shield the casualty from cold or heat, but onlyove a casualty if he or she has been exposed
o cold for a long time. Explain to a consciousasualty what you are going to do and ask foris or her cooperation. Use a technique thats safe for you and the casualty, is easily and
., European first aid guidelines, Resuscitation (2006),
uickly applied, without the need for special equip-ent. If possible, support the neck and avoid
wisting the head, neck, and body during the pro-edure.
The recommendations below are based on a con-sensus of the Guideline Development Group as towhat constitutes good practice.
Recommendations (Grade D)
Introduce yourself and explain what you are goingto do. This will increase the casualty’s confidencein you. Evaluate the casualty’s condition. If help isneeded, alert the EMS or local emergency responsesystem, the Poison Control Centre (PCC) or otherhealthcare professionals as appropriate. Remem-ber that 112 is the recognised emergency telephonenumber in all countries of the European Union.Always refer to healthcare professionals or socialservices if you have any suspicion of non-accidentalinjury.
Psychosocial first aid
Findings
The focus of the literature tends to be onthe first weeks after an incident has occurred.Three guidelines on acute and post traumaticstress disorder,13,14,22 one systematic review ondebriefing,48 and seven expert opinion scripts49—55
were selected. Single session debriefing or activelyexploring emotions should not be done (LOE1+,14,48 LOE 413,22,49,53); this has proven tobe ineffective and potentially harmful. Singlesession debriefing is a psychological techniquefor a structured conversation about emotionaland cognitive experiences. Laypersons provid-ing initial psychosocial support need continuoustraining and assistance (LOE 451,54). Taking careof basic needs is part of psychosocial FA, butfood or drink should not be given because thiscomplicates professional care if anaesthesia isrequired.
Recommendations (Grade D)
Approach the casualty in a non-judgmental way. Lis-ten empathetically to the casualty, be supportive,and offer practical assistance. Do not give food or
Please cite this article in press as: Van de Velde S, et aldoi:10.1016/j.resuscitation.2006.10.023
drink to a sick or injured casualty, unless advisedotherwise by professional healthcare providers.Explain carefully to the casualty what has happenedand what is going to happen.
o(an
PRESSS. Van de Velde et al.
nfection control
indings
e included three guidelines related to infectionontrol.11,15,30 Cross-infection between first aidernd casualty must be avoided. Hand hygiene, bysing liquid soap and water, is an effective methodf preventing cross-infection (LOE 1+,15 LOE 430).he risk of cross-infection can be reduced by using aarrier (e.g. gloves) between the first aider and thelood or body fluids of the casualty (LOE 411,15,30).areful handling and disposal of glass, needles, orther sharp objects that might cut, graze, or pricks essential in preventing infection (LOE 415,30).
ecommendations (Grades B and D)
henever possible, wash your hands with liquidoap and water before and after giving FA (B). Useisposable gloves if they are available (D); if not,plastic bag may be used instead (D). Handle and
ispose of sharp objects safely (D). If needles areresent as a result of recreational drug use, thenhey should be identified and left to professionalso handle (D).
leeding
indings
ne guideline,4 2 SRs on control of arte-ial puncture56 and on femoral vessel injuriesn warfare,57 2 RCTs on control of arterialuncture,58,59 11 case reports or series,60—70 and4 expert opinion scripts71—84 were selected.he effectiveness of controlling external bleedinghrough applying direct pressure or a compres-ion bandage to the site of bleeding is proveny high level of evidence (LOE 1+,4,56,58,59
OE 3,61,62,65,67,68 LOE 44,71—78,80—83). There isnsufficient evidence about the effectiveness ofndirect pressure on pressure points and eleva-ion (LOE 44,72,74—76,80—82). Because of the possibleomplications, the use of a tourniquet is con-raindicated for laypersons (LOE 360,63—66,68—70,OE 44,57,72,75,76,79,80,82,84).
ecommendations (Grades B and D)
o control external bleeding, apply direct pressure
., European first aid guidelines, Resuscitation (2006),
r a compression bandage to the site of bleedingB). If bleeding continues, apply more pressure orn additional bandage without removing the origi-al dressing (D). Maintain pressure on the site of the
ound until the EMS arrives (D). Do not use indirectressure on pressure points and elevation, and doot use a tourniquet to control bleeding (D).
ounds
indings
hree guidelines on wound management4,12,20 andne SR on water for wound cleansing85 wereelected. Irrigating wounds with water reducesnfection rates and improves healing rate (LOE+85). Irrigation should be continued until thereppears to be no foreign matter left in the woundLOE 44). Swabbing the wound can damage theound tissue (LOE 420). There is debate amongst
esearchers as to whether the potential toxicffects of antiseptics and antibacterials on tis-ue may delay the healing of wounds; therefore,t present, use of antiseptics and antibacterialshould be undertaken with caution (LOE 412,20).ound dressings are necessary to protect theound (LOE 420). Tetanus immunisation is needed
or all wounds.12 Many people do not know theirxact immunisation status. One guideline includedriteria for referral to healthcare professionals.12
ecommendations (Grades B and D)
fter controlling bleeding, irrigate wounds withlean, running, cold, tap water if available (B); ifot, use any source of drinkable water (B). Irri-ate directly on the wound and continue until thereppears to be no foreign matter left in the woundD). Do not swab a wound (D). After cleaning aound, cover it with sterile gauze if available (B);
f not, use a clean dry cloth (D). Advise the casu-lty to seek medical advice to determine his/heretanus immunisation status (D).
Do not remove an object that is embedded in aound (D). Instead, try to immobilise it (D), thenover the wound with sterile gauze if available, orclean dry cloth (D).Referral to healthcare professionals is indicated
f (D):
an object is embedded in the wound;there is uncontrollable bleeding;an abrasion is larger than half the width of thepalm of the casualty;bone, muscle, or other subcutaneous tissue is
Please cite this article in press as: Van de Velde S, et aldoi:10.1016/j.resuscitation.2006.10.023
exposed;a wound involves the face, eyes, or genital area;a wound cannot be cleaned properly;a wound is caused by a bite.
ciii
PRESS7
ry to control bleeding until professional help is atand.
urns
indings
e included six guidelines,4,9,10,16,17,24 two caseeports or series,86,87 one cross-sectional survey,88
nd two expert opinion scripts89,90 on burns man-gement. Burns should be cooled as soon asossible with tap-water (LOE 2++,4 LOE 3,86—88 LOE9,16,24,90). For some types of chemical burns, rins-ng with water is potentially harmful (LOE 49).he incidence of such burns, in a non-occupationaletting, is low. This recommendation should, there-ore, apply to both types of burn to allow uniformnd simple guidelines for first aiders. The evidenceor the optimum length of time a burn should beooled is inconclusive (LOE 387,88, LOE 44,9,16,89).hen cooling, hypothermia in the casualty must
e prevented (LOE 3,86—88 LOE 44,9,89). Clothingnd jewellery can be removed, if they are notdhering to the skin (LOE 3,86,88 LOE 49,24,89,90).ntact burn blisters should not be opened (LOE 3,4
OE 490). Antibiotic creams should not be used asA.10 Wet wound dressings can protect the burnLOE 3,88 LOE 49,10,24,89,90). Tetanus immunisations needed for burns.10,16 Many people do not knowheir exact immunisation status. Four guidelinesLOE 410,16,17,24) included criteria for referral toealthcare professionals. The extent of a burnan be assessed with the Rule of Nines, the Lundnd Browder chart, or with the palm of the casu-lty’s hand (LOE 410,16). The palm and fingers ofhe casualty’s hand is approximately 1% of theirotal body surface area. There is no consensusn the research on the best method. The Rule ofines should not be used for children under 16ears old. Using the casualty’s hand is a feasibleethod for estimating the size of a burn at the
cene.
ecommendations (Grades B and D)
ool burns as soon as possible with tap-water (B).ontinue cooling for 15—20 min or until pain relief ischieved or until professional help arrives (D). Pre-ent hypothermia in the casualty by avoiding usef very cold water for cooling, protecting casual-ies from the wind, and using blankets to keep the
., European first aid guidelines, Resuscitation (2006),
asualty warm (D). Remove clothing and jewelleryf they are not adhering to the skin (D). After cool-ng, apply wet wound dressings (D). Do not openntact burn blisters (D). Advise the casualty to seek
medical advice to determine his/her tetanus immu-nisation status (D).
Referral to healthcare professionals is indicatedif (D):
• the casualty is a child under 5 years or an adultover 60 years;
• a burn involves face, ears, hands, feet, the gen-ital area, or joints;
• there is a circumferential burn of the limbs,torso, or neck;
• there are burns covering more than 5% of totalbody surface area in children under 16 years,or more than 10% in adults over 16 years. Thepalm and fingers of the casualty’s hand is approx-imately 1% of the total body surface area;
• there is a third-degree burn. If the deepest layerof the skin is burned, there is usually no painin the wound itself, because the nerves in thisarea have also been destroyed. The burn can lookblack, parchment-like or white and is dry. How-ever the skin around the wound, which is oftenless deeply burned, is painful;
• burns are electrical or chemical, or due to ioniz-ing radiation, or high pressure steam;
• there is an inhalation burn.
Spinal and head trauma
Findings
One guideline on head trauma,21 one cohort study91
and one case series92 on spinal trauma wereselected. Assessment of spinal or head trauma isdifficult; in children this is even more difficult. Allthree studies provide criteria for referral to health-care professionals (LOE 2++,21,91 LOE 392). Thereis no good evidence about when first aiders shouldexpect head injury in children. There is no evidencethat manual immobilisation in a non-moving victimis effective.
Recommendations (Grades B and D)
Initial evaluation of casualties who have an alteredmental state, or who are intoxicated or in greatpain is not very reliable. Alert the EMS if there isuncertainty about the nature of any injury (B).
Suspect head injury and alert the EMS if the casu-alty (B):
• is a victim of high-impact trauma such as from a
Please cite this article in press as: Van de Velde S, et aldoi:10.1016/j.resuscitation.2006.10.023
traffic accident or a fall from higher than standingheight;
• is or becomes drowsy, sleepy, agitated, or uncon-scious;
tmls
PRESSS. Van de Velde et al.
does not remember precisely what has happened;has severe and persistent headache, nauseaand vomiting, irritability, or altered behaviour,seizure;has major lesions to the head.
Suspect spinal injury and alert the EMS if theasualty (B):
is a victim of high impact trauma such as from atraffic accident, or a fall from higher than stand-ing height;is or becomes drowsy, sleepy, agitated, or uncon-scious;does not remember precisely what has happened;complains about numbness or tingling;is not complaining about serious injuries of thelower body or legs that would normally beexpected to be painful;has pain or tenderness in the neck or back.
Calm a casualty with spinal or head trauma andry to convince him/her not to move (D). Onlymmobilise the casualty if he or she is cooperativeD). If the casualty is agitated, do not immobilisehe head and neck against his/her will (D).
usculoskeletal trauma
indings
our guidelines4,18,25,26 on musculoskeletal traumand one SR93 about the use of ice in acute soft-issue injury were selected. Initial evaluation ofimb injuries is difficult. Evidence is inconclusiven the effectiveness of immediate post-injury cool-ng (LOE 1+4,18,93), and on the optimum duration ofooling (LOE 1+93). No evidence was found abouthe effectiveness of elevation and compression.voiding standing on an injured lower limb (LOE 44),r self immobilisation of an injured upper limb (LOE25,26), are often adequate and less painful thanutting the limb in a bandage or a sling.
ecommendations (Grade D)
n case of doubt about the severity, assume thatfracture has occurred and refer to healthcare
rofessionals. Do not try to reduce angulated orislocated limbs. Cool the injury with ice. Whenooling, use a barrier such as a towel between thece and the skin and do not use for a prolonged
., European first aid guidelines, Resuscitation (2006),
ime. Limit each period of cold application to aaximum of 20 min. Do not immobilise the injured
imb if medical help is available within a short timepan. Advise the casualty not to stand on an injured
ower limb. In case of upper limb injury, ask theasualty to immobilise the arm against the trunkimself/herself. If there is major bleeding at theracture site, apply direct pressure or a compres-ion bandage.
oisoning through oral ingestion
indings
ive guidelines4,19,27—29 and two expert opinioncripts94,95 were selected. Activated charcoal (LOE4,27,29,94), water, or milk (LOE 44,94) should onlye used if this is advised by a PCC or a profes-ional healthcare provider. Ipecac syrup should note used (LOE 1+,4 LOE 3,19 LOE 427,28,28,94,95). Weid not investigate whether body position has anffect on poison absorption. Future investigations needed to test the hypothesis that left lateralecubitus decreases absorption.
ecommendations (Grade D)
ontact the PCC or professional healthcareroviders and follow their instructions.
iscussion
here was limited evidence addressing FA. It wasometimes possible to extrapolate research findingsn professional healthcare to FA; the 21 guide-ines retrieved were very useful for this purpose.hen evidence was available, we were able to
urn science into practice. When evidence wasot available, our recommendations are consensus-ased. Effective and appropriate FA proceduresnd techniques have been described, and interven-ions that are contraindicated have been identified.ven though the evidence base was limited, theseuidelines provide systematically developed rec-mmendations and justifications for the proceduresnd techniques that should be included in FA man-als and training programmes.
Customary practices are not always correct. Ifesearch shows that first aid can become better,ne should not be blind to that fact. It is stronglydvised that FA manuals and programmes beeviewed in the light of these guidelines and revised
Please cite this article in press as: Van de Velde S, et aldoi:10.1016/j.resuscitation.2006.10.023
here appropriate. The European Reference Guideor FA Instruction and EFAM are handy tools topdate or develop teaching material and can beequested at the website http://www.efam.be.
vKCH
PRESS9
Until now, there has been no explicit descrip-ion of the status of research on FA. This studyllustrates the need for more research which isecessary to ensure the quality of FA provision.pecifically, research is required on how well firstiders can perform immobilisation techniques, andn the optimum duration of irrigation for burns andooling after musculoskeletal trauma.
We hope these guidelines will encourage the sci-ntific community to start new research effortsn FA. As new evidence becomes available, theseuidelines will need to be revised. A strategy muste developed to bring in wider European represen-ation and to include additional basic and advancedA topics when these guidelines are updated.
ontributors
he Belgian Red Cross-Flanders is very grateful forhe work that has been done by the participatingxperts. S. Van de Velde, (Belgian Red Cross-landers) planned, coordinated, facilitated andrafted the study report. P. Broos (University Hos-ital Gasthuisberg Leuven, Belgium) supervised thetudy and chaired the expert group. B. AertgeertsBelgian Centre for Evidence-Based Medicine) gaveethodological advice. The systematic literature
eview was done by: R. De Win (Belgian Red Cross-landers), D. Lauwaert (Academic Hospital Freeniversity Brussels, Belgium), A. Sermon (Univer-ity Hospital Gasthuisberg Leuven, Belgium), C.obback (Poison Control Centre Belgium), M. Vanouwelen (Belgian Red Cross-Flanders), P. Van denteene (Stressteam Federal Police Belgium), A. vanichelen (Saint-Marie Hospital Halle, Belgium), B.antroyen (University Hospital Gasthuisberg Leu-en, Belgium), J. Verduyckt (University Hospitalasthuisberg Leuven, Belgium). Advisors on special-
st topics were: J. Bierens (VU University Medicalentre Amsterdam, Netherlands), P. Broos, P. Cas-an (European Reference Centre for First Aidducation, France), E. Davoli (World Health Organ-sation), M. De Vries (Impact Foundation, Dutchnowledge Centre for Post-Disaster Psychosocialare), G. Gobl (Hungarian Red Cross), G. Lo (Inter-ational Federation of the Red Cross and Redrescent Societies, IFRC), C. Urkia Mieres (Spanished Cross), K. Monsieurs (European Resuscitationouncil), M. Sabbe (University Hospital Gasthuis-erg Leuven, Belgium), S. Schunder (Austrian Redross), and S. Villere (Latvian Red Cross). External
., European first aid guidelines, Resuscitation (2006),
alidators were D. Ramaekers (Belgian Health Carenowledge Centre), H. Van Brabant (Belgian Healthare Knowledge Centre) and P. Vranckx (Virga Jesseospital Hasselt, Belgium).
We are grateful to the IFRC for their permission tocite from the First recommendations on life-savingtechniques report.11 We thank A. Handley (Colch-ester, UK) for reviewing and editing the manuscript.
Funding: The European Commission funded thisstudy. The Commission did not participate in theguideline development process and is not responsi-ble for any use that may be made of the informationin this publication.
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