From A-B-C to C-A-B

by Tiffany Lauria

‘Look, Listen and Feel’ is a thing of the past….

After years of drilling ‘Look, Listen and Feel’ into first responders heads as step one of the basic CPR process, the American Heart Association has released their 2010 guidelines which changes the sequence of CPR steps from Airway-Breathing-Chest Compressions (ABC) to Chest Compressions-Airway-Breathing (CAB)[1] to emphasize the importance of minimizing delay in starting the chest compressions component of care. Included among the other 2010 recommendations is the total elimination of ‘Look, Listen and Feel’ from the steps. Interestingly, the AHA states that rescuers often find it difficult to open the airway and begin delivering breaths, so the change in sequence is expected to encourage more people to begin CPR immediately without hesitation.

This is actually quite a big change, considering the scope of re-training that needs to be accomplished across a spectrum of populations. From babysitters and school teachers to flight attendants and lifeguards, numerous people in varying professions will now need to be educated and certified on the 2010 changes.  Most importantly, of course, are the healthcare providers that perform this procedure, or stand ready to perform this procedure, routinely as part of their daily tasks. And don’t just think doctors and nurses, there are midwives and radiology technicians and physical therapists, etc. The list goes on.

The American Heart Association has always done a great job in reaching the public to broadcast a message of the importance of CPR training for lay people as well as healthcare workers. Everyone- moms, waitresses, bank tellers, construction workers- everyone may at one point be faced with a life or death crisis that affords them the opportunity to try and help. Still, most people today have never been educated on CPR outside of possibly a high school health class (where the thought of giving mouth-to-mouth to the dorky kid next to you was not much of an enticement to learning). The number of professions that are now requiring CPR training, and the numerous regulations regarding the presence of Automatic External Defibrillators, is an encouraging sign that the AHA is reaching the right sectors with timely information and vital instruction.

There are two steps that you and your facility should take now to prepare for the implementation of the new CPR recommendations.

Step one: Make sure your staff have heard of the changes

Believe it or not, as busy as healthcare workers are on the job, they are just as busy in their personal lives! Many of your staff may have not had a chance in the last week or two to jump online for a news fix or to read a newspaper or journal that updates on important industry topics. But, what they don’t know can hurt them and their patients, so include information on the updated regulations in your next facility newsletter or scheduled staff meeting. Also, be sure to assign department heads or managers the responsibility of informing all staff that changes have occurred and that they will need to be re-trained and certified. You may want to include information on the scientific rationale behind the new recommendations, adjusted for use by clinical, administrative or ancillary staff.

Step two: Construct your training plan to implement the new recommendations

This step is actually a staircase that encompasses-

  • Working with human resources to determine which departments and staff require certification and training and the dates when all personnel are due for training based on their past certifications (The AHA has not released guidelines or recommendations yet on whether previous certifications will be revoked early)
  • Working with your facility’s education department, local Red Cross or other corporate instructional agency to determine training options, such as on-site or off-site training, scheduling and learning materials
  • Project a reasonable budget, allowing for staff overtime and any scheduling changes that will be needed to allow staff to participate in training, and any program and material costs
  • Begin cycling all needed personnel through the selected training programs, updating their personnel files accordingly to reflect up-to-date certification. Prioritize training according to need- clinical staff, then administrative, and so on
  • It may be necessary to revise facility or practice clinical protocols or other protocols related to emergency procedures. Always keep your practice, facility and department Operating Procedures and Clinical Protocols up-to-date


How can you assist in the efforts to inform the public about the importance of CPR training while making it worthwhile to your practice? Keep current brochures from the local Red Cross or continuing education providers handy in your office and share them with patients and parents and caregivers of patients, especially caregivers of young children and older patients. During routine well exams or care appointments for chronic conditions, make it routine to ask if anyone in the household has been CPR certified and talk to them about the importance of CPR education in their personal lives. Consider reaching out to community instructors and offer them use of your waiting room or conference area for holding classes. This allows you to advertise the courses to the public, maximizing your exposure while bringing in potential patients into the practice.

The AHA has scheduled instructor training sessions for November 2010, so while instructors are gearing up to teach the new recommendations to the masses, use your time wisely and start planning now on how to best educate and train your staff in an organized and efficient way.

[1] The sequence has not changed for newborns. To review the full 2010 recommendations, visit: