2020 International 

first aid Guidelines

Structure of the guidelines

Throughout the Guidelines significant effort was made to link the recommendations to first aid education. Each topic now includes considerably more information to support programme designers in developing learners to be confident and skilled in providing first aid. Prominence is given to education as the way to build their ability and confidence – so much so that education is now recognised in the title of the Guidelines. Specific additions to the Guidelines include the key action and education considerations for each topic.

Each topic in the Guidelines includes:

• Key action
• Introduction
• Guidelines and good practice points
• Chain of survival behaviours
• Education considerations
• Scientific foundation
• References

Scientific foundation

Education

Recommendations in the Guidelines emerged from the 2020 ILCOR scientific review, evidence summaries by CEBaP, independent scientific review of questions, and from additional expert opinion.
For the education review, two research questions formed the basis of search strategies:

1. In laypeople (population), following first aid programmes, which learning modalities (intervention) compared to another learning modality or no training (comparison) will impact patient, learner and/or societal outcomes (outcome)?
2. What are the factors influencing implementation (outcome) of a first aid training (intervention) to different target groups (elderly, disabled, workplace, children etc…) (population)?

Search strategies for each question were developed to maximise qualitative and quantitative sources of evidence for review and were run through PubMed and EBSCO (ERIC; CINAHL; Global Health; PsycARTICLES; SPORTDiscus) databases. Two lead researchers scanned 2749 articles for research question 1; and 2043 articles for research question 2. They compiled lists of abstracts for possible inclusion into sets according to learning modalities and first aid topics.

 Table 1: Criteria for inclusion or exclusion of studies

Education reviewers with practical and academic expertise were invited to participate by reviewing papers identified from the literature search and other papers found by hand searches. Papers were scrutinised for quality using a standard quantitative evidence review template, and a qualitative review checklist developed in collaboration with CEBaP. Where evidence did not exist, educational experts in first aid across the Movement provided advice on good practices.

First aid topics

In each topic, a summary of the scientific foundation is provided. The following evidence sources were included:

• Up-to-date evidence summaries by CEBaP (updated in 2019 or 2020); all summaries are available via registration to the CEBaP First Aid Evidence Summary Database.
• Systematic reviews conducted by ILCOR; we refer to the ILCOR Consensus on Science with Treatment Recommendations publication or to separately published ILCOR systematic reviews in the reference list of the topics.
• Other relevant systematic reviews identified by the topic contributor.

The findings of these existing evidence sources are summarised under the sub-heading Systematic reviews. The overall quality of the evidence (“certainty of evidence”) was taken over from the original evidence sources. In addition, a sub-heading Non-systematic reviews is provided for many topics. The paragraph contains additional expert opinion or findings based on individual studies or other sources of information. These sources of information were gathered in a non-systematic way.

Guidelines

To go from the scientific foundation to creating specific guidelines, the quality of the evidence, benefits, harms, risks, preferences and contexts were all taken into account.

• All first aid topic guidelines are based on the systematic review sources.
• Education and context topic guidelines are based on scrutiny of available evidence found.

All guidelines are classified as either ** (strong) or * (weak) recommendation:

• For a strong recommendation, the evidence of benefits strongly outweighs the evidence of harms.
• For a weak recommendation, the evidence related to benefits is either weak or the studies conducted were at a small scale. There was either no or weak evidence of harm that was outweighed by proof of benefit or appreciable uncertainty exists about the magnitude of benefits and risks.

Good practice points 

Where no clear evidence was available or missing but clinical practice or expert opinion is available, good practice points were formulated based on the experience of Red Cross Red Crescent National Societies or based on the non-systematic review sources, provided in the scientific foundation.

Table 2: An overview of the types of guidelines and implications for practice.                                                                      

Chain of survival behaviours 

Each topic is considered through the domains of the Chain of survival behaviours. These domains represent the most effective ways to prevent, recognise or treat an illness or injury, based on the scientific foundation and guidelines. They are provided as instructions. However, they will need adapting to different contexts.

For example, if first aid providers in certain contexts are unlikely to have a particular piece of first aid equipment (such as clean water), an alternative should be used. Educators should stress the importance of learners applying all the first aid steps which are possible to reduce pain and suffering and further harm, even when it is not possible to apply all the steps in a particular context or situation.

Education considerations

Education considerations suggest how location, environment, access to resources and other local factors may influence how a topic is taught. The education considerations are informed by a combination of evidence (only if systematic review was done and then referenced) and expert opinion. Elements may include:

Additional considerations

Involvement of the International Committee of the Red Cross

The International Committee of the Red Cross (ICRC) has contributed significantly to the development of these Guidelines. This summary explains the ICRC approach to first aid and education and the ways in which ICRC staff and delegates have supported the work of the Reference Centre and the National Societies with this project.

Approach to first aid and first aid education by the ICRC

For the Red Cross and Red Crescent Movement, first aid is not simply about performing CPR, bandaging a wound or taking an injured person to a hospital. It is also about taking someone’s hand, reassuring the frightened and giving a bit of one’s self to the role. This applies to any first aid provider in any context.

Safety and security

First aid providers working with the ICRC operate in areas of armed conflict and other situations of violence.
In these contexts, first aid providers take the risk of harm from such dangers as gunfire, collapsing buildings, burning cars, unstable rubble and tear gas. This places safety and security at the centre of ICRC first aid education.

Context adaptation

From the ICRC perspective, the best way to educate people to provide first aid in armed conflict is by adapting to the context. The ICRC trains and educates different groups of people, often in very low resource settings. Education provided needs to adjust both the first aid skills and the way of teaching to the realities of providing first aid in these contexts. In ICRC first aid training we focus on each individual learners’ needs, but we also need to adapt training tools, educational methods and curriculum to the given context which can be harsh and unsupportive.

The Guidelines reflect this approach across all contexts, aiming to put the learner at the centre and adapt the education to their needs and the realities of their situation. The ICRC has contributed insight to this approach, and the content reflects challenges faced by those providing first aid education in peacetime and in war.

 A focus on trauma

Trauma as a result of violence can appear very different from that caused by accidents. Wounds sometimes have a disproportionate effect internally to what is visible externally (for example some bullet wounds) and penetrating injuries are often seen. The types of traumatic incidents can be varied, for example, minor knife wounds, breathing problems from tear gas and shrapnel injuries from explosions. War injuries can also have devastating long term effects, especially when caused by mines and other unexploded devices.

Input to the Guidelines from ICRC

These Guidelines will serve as the basis for first aid practices across the Red Cross and Red Crescent Movement including the ICRC. The focus of the Guidelines on both the evidence-based aspects of first aid and how to teach people to become a first aid provider is supported by the ICRC.

In that capacity, the ICRC has offered input into these guidelines, especially through its knowledge of safety measures during conflict, expert opinion on trauma first aid and how to adapt and contextualise best practice and training techniques. Delegates and staff have contributed to the review of the evidence for the sections on conflict and disaster contexts as well as the multiple casualty situations outlined in the general approach. They have also provided expert opinion on the Chain of survival behaviours and the education considerations for many of the first aid topics.

Specifically, the ICRC provided input on considerations that have to be made if, for various reasons, a situation does not allow full adoption of the scientific evidence provided within the guidelines. Suggestions are there to help allow first aid to be provided in very harsh and extreme conditions and under all circumstances. In general, the considerations to be considered are local requirements and security concerns, available resources, effective local practices, and access to, and the capacity of, further care.

ICRC first aid providers are trained to step forward to help the wounded in armed conflict when the most natural reflex would be to run away. Whilst their experiences are often enriching, they must also sometimes cope with despair, when – despite their best efforts, despite all their skill – the wounded and sick they tried to save do not survive. Through their commitment, their selflessness and willingness to expose themselves to possible physical and psychological harm, first aid providers demonstrate their humanity in the fullest sense of the term, and we owe them an immense debt of gratitude. The ICRC, therefore, holds an obligation to prepare first aid providers as well as possible for being skilled, able and willing to help, but also to be able to cope with the challenges of armed conflict at the same time.

A harmonised approach to education

Similar educational approaches apply to those learning in ICRC and National Societies, as well as in peace and wartime conditions. These Guidelines seek to form a common basis for that education, acknowledging the similarities as well as the differences, and allowing for adaptations according to context, but most of all, responding to the needs of the learner.

Explore the guidelines

Published: 15 February 2021