2025+ILCOR科学治疗建议共识：急救

Table 1. Definition of First Aid (FA 7001)

|First aid domains for evidence evaluation and treatment recommendations|Examples of characteristics| |---|---| |First aid recipient|Age,sex,gender,health status,capacity to provide consent| |First aid provider|Knowledge,training/education, prepared-ness,familiarity,duty to respond,professional scope,capability| |Treatment|Invasiveness,skill required,technology,effacy and effectiveness,cost| |Setting and environmental|Low or high resource,safety,cultural norms and values,urban or remote settings|

help guideline authors and first aid providers under-stand how to adapt evidence-based guidelines to various emergency situations-from low-resource and remote settings to urban incidents-and across different provider skill levels-from untrained bystanders to health care pro-fessionals. In our future work, we will combine clear rec-ommendations with practical examples, which will help practitioners to better understand both the applications and limitations of first aid evidence, including when to seek additional help. Since 2024, we have also started applying an equity lens on our CoSTRs; included studies will be screened regarding content in PROGRESS Plus, ${ }^{5}$ and an equity statement will be found in every CoSTR.

The following topics are addressed in this FA Task Force CoSTR chapter. In addition, an overview of changes made in treatment recommendations since 2020 is provided in Supplemental Material Table S1 in the supplement.

GENERAL PRINCIPLES

• Pulse oximetry(FA 7010, ScopRev 2023)

● Use of supplemental oxygen(FA 7030, FA 519, FA 1549, FA 1649, ScopRev 2023, ScopRev 2024)

● Recovery position (FA 7040, FA 517, SysRev 2022)

# FIRST AID FOR MEDICAL EMERGENCIES

● Recognition of anaphylaxis(FA 7110, FA 513,ScopRev 2023, EvUp 2025)

● Second dose of epinephrine (FA 7111, FA 500,ScopRev 2021, EvUp 2025)

• Removal of foreign-body airway obstruction (FA 7113, Basic Life Support [BLS] 368, EvUp 2025)

● Potential harms from bronchodilator administration(FA 7122, ScopRev 2023)

● Early aspirin for chest pain (FA 7140, FA586, EvUp 2025)

● Methods of glucose administration for hypoglyce-mia (FA 7161, FA 1585, EvUp 2025)

● Dietary sugar treatment for hypoglycemia(FA 7162,FA 795, EvUp 2025)

● Recognition of stroke (FA 7170, FA 801, EvUp 2025)

● Recognition of sepsis(FA 7180, ScopRev 2024)

•Interventions administered by lay providers for the treatment of postpartum hemorrhage(FA 7337,ScopRev 2025)

•Manual uterine massage for postpartum hemor-hage(FA 7336, SysRev 2025)

● Use of naloxone during resuscitation for suspected opioid-associated emergencies(FA 7442,BLS 811,EvUp 2025)

• Prevention of syncope with counter-pressure maneuvers (FA 7550 FA 798,EvUp 2025)

● Unintentional injury from CPR (FA 7670, BLS 353, SysRev 2025)

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FIRST AID FOR TRAUMA EMERGENCIES

• Spinal motion restriction(FA 7311,FA 772,ScopRev 2025 including the topic Spinal injury manual stabi-lization FA 7312, FA 1547)

● Cryotherapy for epistaxis(FA 7151, ScopRev 2021)

• Manual pressure and pressure devices for bleeding(FA 7331, FA 530, SysRev 2021, EvUp 2025)

● Type of tourniquets alone or in combinations with other methods of achieving hemostasis (FA 7333,FA 768, SysRev 2021, EvUp 2025)

● Types of pediatric aturniquets (FA 7333, FA 768, SysRev 2021)

● Hemostatic dressing (FA 7334,FA 769 EvUp 2025)

● Duration of cooling for burns(FA 7371, FA 770,SysRev 2021)

● Dental avulsion (FA 7361, FA794, EvUp 2025)

● Compression wrap for closed extremity joint injuries(FA 7381, FA 511, EvUp 2025)

● Preservation of traumatic, completely amputated or auulsed body parts (FA 7391, ScopRev 2025)

FIRST AID FOR ENVIRONMENTAL EMERGENCIES

● Exertion-related dehydration and rehydration(FA 7241, FA 584, SysRev 2021)

● Tick removal(FA 7231, SysRev 2021)

● Treatment of jellyfish stings(FA 7211, SysRev 2025)

Readers are encouraged to monitor the ILCOR website3 to provide feedback on planned SysRevs and to provide comments when additional draft reviews are posted.

GENERAL PRINCIPLES

Use of Pulse Oximetry (FA 7010, ScopRev 2023)

Pulse oximetry has been used for monitoring of hospital-ized patients at risk of hypoxemia as well as, more recent-ly, for home use during the COVID-19 pandemic. The FA Task Force considered it timely to undertake a ScopRev6 in 2022 to identify evidence relating to the use of pulse oximetry as a component of first aid assessment of acute symptoms associated with illness or injury. Details of this review can be found in the 2023 CoSTR summary.6

Population, Intervention, Comparator, Outcome, and Time Frame

● Population: Adults and children in out-of-hospital or home settings with an acute illness or injury

● Intervention: Use of pulse oximetry in addition to standard first aid assessment

● Comparator: Standard first aid assessment without the use of pulse oximetry

• Outcome: Any clinical outcome

• Time frame: All years up to November 16, 2022

Good Practice Statements (2023)

First aid providers who use pulse oximeters for the as-sessment of acute illness or injuries should be proficient in their use and understand their limitations, including equipment factors, environmental considerations, and patient-specific factors that may produce inaccurate and unreliable readings (good practice statement).

The use of a pulse oximeter for first aid assessment should not supersede or replace physical assessment(good practice statement).

Use of Supplemental Oxygen in the First Aid Setting(FA 7030, FA 519, FA 1549, FA 1649,ScopRev 2023, ScopRev 2024)

In the first aid setting, oxygen use has been described for loss of consciousness, diving emergencies, carbon monox-ide poisoning, and during cardiac arrest. A 2015 CoSTR ${ }^{7}$ and a 2023 ScopRev ${ }^{6}$ identified evidence of potential harm with oxygen use in acute exacerbations of chronic obstruc-tive pulmonary disease. A 2024 ScopRev ${ }^{8}$ expanded the search dates and inclusion criteria. Details of this review can be found in the 2024 CoSTR summary. ${ }^{9}$

Population, Intervention, Comparator, Outcome, and Time Frame

● Population: Adults and children who exhibit symp-toms or signs of shortness of breath, difficulty breathing or hypoxia outside of a hospital

• Intervention: Administration of oxygen by a first aid provider

● Comparator: No administration of oxygen

● Outcome: Functional outcome at discharge, 30 days, 60 days, 180 days, or 1 year, survival only at discharge, 30 days, 60 days, 180 days, or 1 year,length of hospital stay, resolution of symptoms or signs, patient comfort, therapeutic endpoints (eg,oxygenation, ventilation)

● Time frame: All years to December 2,2023

In 2023, the following good practice statement was for-mulated based on a limited search (FA 1549): "If first aid providers, trained to use oxygen, are administering supplemental oxygen to a person with known chronic ob-structive pulmonary disease, they should titrate the sup-plemental oxygen to maintain an oxygen saturation by pulse oximetry between 88% and 92%" The intent of the 2024 ScopRev was to look more broadly at the question of first aid oxygen use for adults and children with short-ness of breath, difficulty breathing, or hypoxia. No direct evidence was identified to suggest for or against first aid oxygen administration in this general population, and this remains a knowledge gap. However, the ScopRev yielded indirect evidence of harm with high-flow- or

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high-concentration-supplemental oxygen in patients with chronic obstructive pulmonary disease in the emergency medical services setting. Based on this 2024 ScopRev,the good practice statement was slightly changed.

Good Practice Statement (2024)

When a first aid provider trained in oxygen use admin-isters oxygen to a person with acute difficulty breathing is who confirms that they have chronic obstructive pulmo-nary disease, it is suggested that pulse oximetry be used,and that oxygen be titrated to maintain an oxygen satura-tion between 88% and 92% (good practice statement).

Although high-flow oxygen should in general be avoided in patients with chronic obstructive pulmonary disease with difficulty breathing in the out-of-hospital setting, high-flow oxygen should not be withheld in the presence of life-threatening hypoxia(oxygen saturation<88%)(good practice statement).

The Recovery Position for Maintenance of Adequate Ventilation and the Prevention of Cardiac Arrest(FA 7040, FA 517, SysRev 2022)

The use of a recovery position for persons with a re-duced level of responsiveness has been taught in first aid courses for decades, primarily as a means to reduce the risk of aspiration of gastric contents. The original PICOST wording from a 2015 SysRev ${ }^{10}$ sought to com-pare a lateral, side-lying recovery position with a supine position in adults who are breathing and unresponsive in an out-of-hospital setting. The revised PICOST word-ing now clarifies the population of interest as adults and children with a reduced level of responsiveness of non-traumatic etiology and who do not require resuscative interventions. A ScopRev was last done in 2020, and this SysRev ${ }^{11}$ was undertaken with involvement of content experts from the FA and BLS Task Forces and included in the 2022 CoSTR summary. ${ }^{12}$

Population, Intervention, Comparator, Outcome,Study Designs, and Time Frame

● Population: Adults and children in the first aid set-ting who have a reduced level of responsiveness of nontraumatic etiology and do not require resuscita-tive interventions

● Intervention: Specific positioning (recovery position-ing [ie, various semiprone, lateral recumbent, side-lying, or three-quarters prone positions of the body])

● Comparator: Supine or other position

● Outcome:

- Critical: Survival, incidence of cardiac arrest,delayed detection of apnea and cardiac arrest

- Important: Need for airway management, inci-dence of aspiration, hypoxia, likelihood of cervi-cal spine injury, complications(venous occlusion,arterial insufficiency, arm discomfort/pain, dis-comfort/pain, aspiration pneumonia)

● Study designs: In addition to the standard criteria,case reports published in letter form were included.ScopRevs and SysRevs were included for discus-sion and to assure no primary papers were missed,but data were not extracted from these reviews.

● Time frame: All years to November 17,2021

Treatment Recommendations (2022)

When providing first said to a person with a decreased level of responsiveness of nontraumatic etiology and who does not require immediate resuscitative interven-tions, we suggest the use of the recovery position (weak recommendation, very low-certainty evidence).

When the recovery position is used, monitoring should continue for signs of airway occlusion, inadequate or agonal breathing, and unresponsiveness (good practice statement).

If body position, including the recovery position, is a factor impairing the first aid provider's ability to deter-mine the presence or absence of signs of life, the person should be immediately positioned supine and reassessed (good practice statement).

Persons found in positions associated with aspiration and positional asphyxia such as facedown, prone, or in neck and torso flexion positions should be repositioned supine for reassessment (good practice statement).

Recognition of Anaphylaxis (FA 7110, ScopRev 2023, EvUp 2025)

Population, Intervention, Comparator, Outcome,Study Design, and Time Frame

● Population: Adults and children experiencing anaphylaxis

● Intervention: Description of any specific symptoms to the first aid provider

● Comparator: Absence of any specific description

● Outcome: Anaphylaxis recognition (Critical)

● Study designs: In addition to the usual criteria, it was anticipated that there would be insufficient studies from which to draw a conclusion, so the minimum number of cases for a case series to be included was reduced from the default of 5 to 1 by the team.

● Time frame: October 28, 2023, to July 3, 2024

Summary of Evidence

Since the last ScopRev ${ }^{13}$ in 2022, we identified 734 unique articles, of which 4 articles ${ }^{6,14-16}$ were relevant.During the process to screen full text articles, it was noted that several studies reported an increase in knowl-edge of how to recognize anaphylaxis after educational interventions, viewing videos, health application (app) use,and coaching. Currently, there is insufficient evidence to justify conducting a SysRev on this topic. However,the available evidence suggests that a future SysRev on educational approaches for training lay providers to ef-fectively care for affected individuals is warranted.

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Treatment Recommendation (2010)

First aid providers should not be expected to recognize the signs and symptoms of anaphylaxis without repeated episodes of training and encounters with persons with anaphylaxis (good practice statement).

Second Dose of Epinephrine for Anaphylaxis(FA 7111, FA 500, ScopRev 2021, EvUp 2025)

Population, Intervention, Comparator, Outcome, and Time Frame

● Population: Adults and children experiencing severe anaphylaxis requiring the use of epinephrine

● Intervention: Administration of a second dose of epinephrine

● Comparator: Administration of only one dose

● Outcome: Resolution of symptoms, adverse effects,complications

● Time frame: January 3,2021,to October 2,2024

Summary of Evidence

Since the last ScopRev ${ }^{17}$ published in 2021, one study ${ }^{18}$examining methods of administration was identified.There was insufficient literature to impact the previ-ous treatment recommendations. Updated SysRev or ScopRev is not recommended at this time.

Treatment Recommendations (2015)

We suggest a second dose of epinephrine be administered by autoinjector to adults and children with severe anaphy-laxis whose symptoms are not relieved by an initial dose(weak recommendation, very low-certainty evidence).

Removal of Foreign-Body Airway Obstruction(FA 7113, BLS 368, EvUp 2025)

This topic was moved from the BLS Task Force to FA Task Force in 2023 because of its relevance to first aid providers. A SysRev was last done in 2020 by BLS.19

Population, Intervention, Comparator, Outcome,Study Design, and Time Frame

● Population: Adults and children with foreign body airway obstruction in any setting

● Intervention: Interventions to remove foreign body airway obstruction, such as finger sweep, back slaps, abdominal thrusts, chest thrusts, and suction-based airway clearance devices

● Comparator: No action

● Outcome: Any clinical outcome

● Study designs: In addition to the standard crite-ria, case reports of injuries or complications were also eligible. Unpublished studies (eg, conference abstracts, trial protocols), animal studies, manikin studies and cadaver studies were excluded.

● Time frame: August 2019 through September 20,2024

Summary of Evidence

This EvUp identified 17 new publications ${ }^{20-36}$ since the previous SysRev ${ }^{20}$ in 2019. The evidence suggests that regardless of which treatment is provided first, it is com-mon for more than one intervention to be required for relief of a foreign body airway obstruction. One study suggests that back blows are more effective than chest or abdominal thrusts. ${ }^{29}$ Airway clearance devices are increasing in prevalence. Currently, there are no treat-ment recommendations regarding these devices. An up-dated SysRev is warranted. After discussion, clarification regarding age range was added to one of the existing treatment recommendations.

Treatment Recommendation (BLS 2020)

We suggest that back slaps are used initially in patients with a foreign body airway obstruction and an ineffective cough(weak recommendation, very low-certainty evidence).

We suggest that abdominal thrusts are used in adults and children(over 1 year of age) with a foreign body airway obstruction and an ineffective cough where back slaps are ineffective (weak recommendation, very low-certainty evidence).

We suggest that rescuers consider the manual extrac-tion of visible items in the mouth (weak recommendation,very low-certainty evidence).

We suggest against the use of blind finger sweeps in patients with a foreign body airway obstruction (weak recommendation, very low-certainty evidence).

We suggest that appropriately skilled individuals con-sider the use of Magill forceps to remove foreign body airway obstruction in OHCA patients with a foreign body airway obstruction (weak recommendation, very low-certainty evidence).

We suggest that chest thrusts are used in uncon-scious patients with a foreign body airway obstruction(weak recommendation, very low-certainty evidence).

We suggest that bystanders undertake interventions to support foreign body airway obstruction removal as soon as possible after recognition (weak recommenda-tion, very low-certainty evidence).

Potential Harms From Bronchodilator Administration (FA 7122, ScopRev 2023)

Persons with asthma exacerbations benefit from adminis-tration of bronchodilators. However, it is unknown wheth-er first aid providers can appropriately identify asthma exacerbations, and it is unknown whether bronchodila-tors could result in harm if administered to individuals with undifferentiated respiratory symptoms. Details of this review can be found in the 2023 CoSTR summary.6

Population, Intervention, Comparator, Outcome, and Time Frame

● Population: Adults and children in any setting with acute undifferentiated respiratory problems

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● Intervention: Administration of any type of inhaled bronchodilator (eg, $\beta$ -agonists, anticholinergics)

● Comparator: No administration of an inhaled bronchodilator

● Outcomes: Survival, dysrhythmia, cardiac isch-emia, hypokalemia, need for emergency depart-ment treatment, need for hospitalization, and time to treatment

● Time frame: All years to November 2,2022

Treatment Recommendation (2015, Unchanged)

When an individual with asthma is experiencing dif-ficulty breathing, we suggest that trained first aid providers assist the individual with administration of a bronchodilator(eg, $\beta$-agonists, anticholinergics)

Early Aspirin for Chest Pain (FA 7140, FA 586,EvUp 2025)

Population, Intervention, Comparator, Outcome,Study Designs, and Time Frame

● Population: Adults who experience nontraumatic chest pain

● Intervention: Early or first aid administration of aspirin

● Comparator: Later or in-hospital administration of aspirin

● Outcome: Any outcome

● Time frame: October 1, 2019, to September 30,2024

Summary of Evidence

Since the last SysRev$^{37}$ completed for 2019, 98 articles were screened, and none were relevant for the topic. Of note, one study$^{38}$ described increased risk of bleeding in chest pain patients administered aspirin or clopidogrel(or both) and finally diagnosed as type A aortic dissec-tion necessitating surgical intervention. A new review is currently not warranted.

Treatment Recommendation (2019)

For adults with nontraumatic chest pain, we suggest the early administration of aspirin as a first aid inter-vention compared with late, in-hospital, administration of aspirin(weak recommendation, very low-certainty evidence).

Methods of Glucose Administration for Hypoglycemia(FA 7161, FA 1585, EvUp 2025)

Population, Intervention, Comparator, Outcome, and Time Frame

● Population: Adults and children in any setting(in-hospital or out-of-hospital) with(suspected)hypoglycemia

● Intervention: Administration of glucose by any route appropriate for use by first aid providers

● Comparator: Administration of glucose by another route appropriate for first aid providers

● Outcomes: Resolution of symptoms; time to resolu-tion of symptoms; blood or plasma glucose concen-tration at 20 minutes; resolution of hypoglycemia;time to resolution of hypoglycemia; any adverse event; administration delay

• Time frame: September 13, 2021, to October 18,2024

Summary of Evidence

Since the last SysRev39 in 2021, no relevant new studies were identified. An updated SysRev is not warranted.

Treatment Recommendations (2021)

We recommend the use of oral glucose(swallowed) for individuals with suspected hypoglycemia who are con-scious and able to swallow(strong recommendation,very low-certainty evidence).

We suggest against buccal glucose administration compared with oral glucose administration for individu-als with suspected hypoglycemia who are conscious and able to swallow (weak recommendation, very low-cer-tainty evidence).

If oral glucose (for example, tablet) is not immedi-ately available, we suggest a combined oral plus bac-cal glucose (for example, glucose gel) administration for individuals with suspected hypoglycemia who are conscious and able to swallow (weak recommenda-tion, very low-certainty evidence).

We suggest the use of sublingual glucose adminis-tration for suspected hypoglycemia for children who may be uncooperative with the oral (swallowed) glucose administration route (weak recommendation, very low-certainty evidence).

Dietary Sugar Treatment for Hypoglycemia (FA 7162, FA 795, EvUp 2025)

Population, Intervention, Comparator, Outcome, and Time Frame

● Population: Adults and children with symptomatic hypoglycemia

● Intervention: Administration of dietary forms of sugar

● Comparator: Standard dose (15-20 g) of glucose tablets

• Outcomes: Time to resolution of symptoms, compli-cations, blood glucose level after treatment, hypo-glycemia(defined as the persistence of symptoms(yes/no) or recurrence of symptomatic hypoglyce-mia for more than 15 minutes after treatment), hos-pital length of stay

● Time frame: January 1,2020,to December 8,2024

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Summary of Evidence

Since the last SysRev ${ }^{40}$ in 2017, we identified 3 relevant studies. One RCT ${ }^{41}$ with 3 arms in children with diabetes type 1 aged 12 to 16 years trekking for 5 days found no difference between any of the 3 arms: 0.3 g glucose prep-aration/kg, sugar fondant candies, and fruit juice. A narra-tive review ${ }^{42}$ explored the optimal dose of carbohydrates in nonsevere hypoglycemia; their conclusion was that most recover after 15 to 20 g, but individual strategies based on body weight or type of insulin delivery system might be relevant in future guidelines. One trial ${ }^{43}$ showed that oral intake of carbohydrates in patients with type 1 diabetes could be beneficial earlier, that is, at higher blood glucose levels than traditional cutoffs to avoid hypoglycemia. This might be relevant from a first aid perspective but is out of the scope for the current PICO(population, intervention,comparator, outcome). Based on these studies, additional reviews (systematic or scoping review) on this specific or similar topics are not recommended at this time.

Treatment Recommendations (2015, Unchanged)

We recommend that first aid providers administer glu-cose tablets for treatment of symptomatic hypoglycemia in conscious adults and children (strong recommenda-tion, low-certainty evidence).

We suggest that if glucose tablets are not available,various forms of dietary sugars such as small candies,singular cubes, jelly beans, or orange juice can be used to treat symptomatic hypoglycemia in conscious adults and children(weak recommendation, very low-certainty evidence).

There is insufficient evidence to make a recommenda-tion on the use of whole milk, cornstarch hydrolysate, and glucose solution, or glucose gels as compared with glucose tablets for the treatment of symptomatic hypoglycemia.

Recognition of Stroke (FA 7170, FA 801, EvUp 2025)

Population, Intervention, Comparator, Outcome,Study Design, and Time Frame

• Population: Adults with suspected acute stroke

● Intervention: Use of a rapid stroke scoring system or scale

● Comparator: Basic first aid assessment without the use of a stroke scale

• Outcomes:

- Critical: Time to treatment(eg, symptom onset to hospital/emergency department or hospi-tal admission)

-Important: Recognition of stroke, high sensitiv-ity and high specificity considered beneficial for diagnosis study, discharge with favorable neuro-logic status(increase considered beneficial), sur-vival with favorable neurologic outcome(increase considered beneficial), increased public/layer-son recognition of stroke signs

• Study designs: In addition to standard criteria,because it was anticipated that there would be insufficient studies from which to draw a conclusion,the minimum number of cases for a case series to be included was reduced from the default of 5 to 1.

● Time frame: May 26,2020,to June 31,2024

Summary of Evidence

Since the last SysRev ${ }^{44}$ in 2020, we did not identify any relevant articles. An update of the SysRev is not currently indicated.

Treatment Recommendations (2020)

We recommend that first aid providers use stroke as-sessment scales/tools for adults with suspected acute stroke(strong recommendation, low-certainty evidence).

For first aid, we suggest the use of the Face, Arms,Speech, Time tool; Melbourne Ambulance Stroke Scale;Cincinnati Prephospital Stroke Scale; or Los Angeles Pre-hospital Stroke Screen for stroke assessment(weak rec-ommendation, low-certainty evidence).

For first aid, we suggest the use of stroke assess-ment scales/tools that include blood glucose measure-ment when available, such as the Melbourne Ambulance Stroke Scale or Los Angeles Prehospital Stroke Screen,to increase specificity of stroke recognition (weak rec-ommendation, low-certainty evidence).

For first aid, we suggest the use of the Face, Arms,Speech, and Time tool or Cincinnati Prehospital Stroke Stroke scale stroke assessment when blood glucose mea-surement is unavailable (weak recommendation, low-certainty evidence).

Recognition of Sepsis (FA 7180, ScopRev 2024)

A significant proportion of preventable deaths worldwide are caused by sepsis, and early detection and treatment is beneficial. No review was undertaken until 2024, when the task force prioritized a ScopRev on the recognition and awareness of sepsis by first aid providers evaluating adults with an acute illness. The completed ScopRev45 and CoSTR can be found in the 2024 CoSTR summary. ${ }^{8}$

Population, Intervention, Comparator, Outcome,Study Design, and Time Frame

● Population: Adults who are being evaluated by a first aid provider for an acute illness

● Intervention: The presence of any specific signs or symptoms (ie, pale, blue, or mottled skin, lips,tongue, gums, or nails; nonblanching rash; difficulty breathing or rapid respiratory rates; rigors/shiver-ing; lack of urination in a day; muscle pain; confu-sion; or slurred speech)

● Comparator: Fever (≥38 ℃[≥100.4°F]) with signs of infection

● Outcomes: Recognition of a seriously ill person requiring hospitalization or evaluation by a physician for sepsis and increased awareness of sepsis

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● Study designs: In addition to the standard crite-ria, gray literature, social media posts, non-peer-reviewed studies, unpublished studies, conference abstracts, and trial protocols were eligible for inclusion.

● Time frame: All years to December 2,2023

Good Practice Statement (2024)

Those providing first aid should consider an infection in any person who presents with an acute illness, and if the illness is associated with any abnormal signs or symp-toms, they should urgently seek further medical evalua-tion (good practice statement).

Interventions Administered by Lay Providers for the Treatment of Postpartum Hemorrhage(FA 7337, ScopRev 2025)

Rationale for Review

Postpartum hemorrhage is the leading cause of ma-ternal mortality and morbidity worldwide, particularly in low-income countries with limited resources.46 Early recognition and prompt treatment have the ability to prevent many deaths and long term health challeng-es.47 The FA Task Force performed a ScopRev to exam-ine interventions for treating postpartum hemorrhage by lay providers, a topic that had not been reviewed by ILCOR before. The full report of the ScopRev can be found online.49

Population, Intervention, Comparator, Outcome,Study Designs, and Time Frame

● Population: First aid or emergency care adminis-tered by a lay provider to anyone experiencing post-partum hemorrhage

● Intervention: Interventions that are classified as emergency care include those that fall within the following 2 categories:

- Physical interventions: Examples of physical inter-ventions administered by a lay provider include external uterine massage, bimanual compression,aortic compression, antishock garment, manual removal of placenta, or manual removal of clots.

- Medications/Pharmaceuticals: Examples of medical interventions administered by a lay pro-vider include iron supplementation, prostaglandin E1/misoprostol, or any other drug that may be accessible without intervention from a medical professional.

● Excluded interventions include those that require hospital/clinic support through medical profes-sionals such as a blood transfusion, or any invasive surgical intervention such as curetage, uterine or pelvic artery ligation, uterine tamponade, or hysterectomy.

● Comparator: No intervention

● Outcomes: Any clinical outcome

● Study designs: In addition to standard criteria, gray literature including social media, non-peer-reviewed studies, unpublished studies, case reports, confer-ence abstracts and trial protocols were eligible for inclusion.

● Time frame: All years to October 22, 2024

Summary of Evidence

Sixteen articles were included in this ScopRev, includ-ing 1 opinion article, ${ }^{50}$ 2 observational training or perfor-mance assessment articles, ${ }^{51,52}$ 5 qualitative studies, ${ }^{53-57}$3 cross-sectional studies, ${ }^{58-60}$ 2 guidelines, ${ }^{61,62}$ 2 non-RCTs, ${ }^{63,64}$ and 1 RCT. ${ }^{49}$ Interventions in these studies were primarily implemented by traditional birth atten-dants or similar persons with minimal formal training.

Three drugs were discussed: misoprostol, oxytocin,and ergotamine. All medications were administered orally,rectally, or intramuscularly and were therefore consid-ered compatible with first aid practices. Misoprostol was administered rectally or orally in doses ranging from 400 to 1000 mcg.60-65 Evidence on misoprostol came from the RCT,65 both non-RCTs,63,64 a cross-sectional study,60 and both guidelines.61,62 Oxytocin was discussed in both guidelines61,62 and 1 cross-sectional study58 in the con-text of a Unject autoinjector, which keeps the medication cool and enables lay administration.58,61,62 Ergotamine/ergometrine was kept and used in lay settings56,58 and was further recommended for intramuscular delivery of low-resource settings in both guidelines.61,62

Controlled cord traction was not recommended for use by unskilled birth attendants in both guidelines. ${ }^{61,62}$In lower-resource settings, some unskilled providers applied it in the absence of skilled birth attendants. ${ }^{54}$

The use of uterine balloon tamponade was found to be effective and simple to use by community providers in 1 qualitative study.65 A novel intrauterine tamponade device developed for administration by people with mini-mal training increased usability.51

The use of a compression lower body suit, so-called nonpeumatic antishock garment, which forces blood back to the vital organs, was highlighted by one guide-line and one opinion article.50,61 These garments are con-ventionally used only in health care facilities but were described as having high potential for application by lay providers. Herbal medicines commonly used by traditional birth attendants were also addressed in several qualita-tive and cross-sectional studies and guidelines53,54,56-59 but discouraged based on harms or lack of benefit.56

Task Force Insights

Most birth attendants globally are untrained or trained to a level that would align with a first aid provider outside of the birthing or obstetrical domain. ${ }^{67}$ Determining the difference between preventing and treating postpartum hemorrhage can be difficult, especially when interven-tions used for prevention and treatment are often the same (eg, manual external uterine massage, oxytocin).

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Most studies were qualitative and retrospective in na-ture, leading to an increased risk of bias and overall low certainty of evidence. Only 1 RCT65 was performed and evaluated only the efficacy of misoprostol.65

Although we excluded studies on conventional uterine balloon tamponade, we included studies on innovative devices useable by nonskilled providers.

This ScopRev triggered a SysRev on manual uterine massage(FA 7336), which is included below.

Task Force Knowledge Gaps

● The effect of first aid interventions for postpartum hemorrhage on long-term outcomes

● Most studies were qualitative and retrospective in nature, leading to an increased risk of bias and overall low certainty of evidence.

Manual Uterine Massage for Postpartum Hemorrhage(FA 7336, SysRev 2025)

Rationale for Review

The FA Task Force undertook a SysRev on this topic be-cause many international guidelines and other knowledge syntheses recommend external uterine massageus for the pre-vention and management of postpartum hemorrhage.4768-74 Postpartum hemorrhage is a major cause of global morbidity and mortality, particularly in lower-resource settings where most birth attendants have limited professional health edu-cation and may be considered lay or first aid providers.67 Manual external uterine massageus is a simple and safe phys-ical maneuver similar to other manual maneuvers taught to first aid providers and may reduce morbidity and mortality.This SysRev was registered in Prospective Register of Sys-tematic Reviews (PROSPERO) (CRD42024572048).The full CoSTR can be found online. ${ }^{75}$

Population, Intervention, Comparator, Outcome, and Time Frame

● Population: Those experiencing postpartum hemorrhage

● Intervention: Manual external uterine massage immunated administered by a lay provider

● Comparator: Any other first aid intervention to treat postpartum hemorrhaging, or no intervention

• Outcomes:

- Critical: Maternal survival, blood loss

-Important: Future fertility, surgical intervention,organ dysfunction, pain, and blood transfusion

● Time frame: All years to March 22,2024

Consensus on Science

We identified a single RCT ${}^{76}$ including 127 women who had recently given birth in Kenya and were advised to perform self-massage cue and by an alarm every 15 min-utes for the first 120 minutes after birth. The study re-ported better compliance with an alarm every 15 minutes but a non-statistically significant difference in the impor-

tant outcomes of blood loss and blood transfusion (weak recommendation, very low-certainty evidence).

Treatment Recommendation (2025)

We suggest external uterine massage, including self-massage, in the immediate postpartum period in com-parison with no intervention to prevent postpartum hemorrhage, which can lead to maternal death (weak recommendation, very low-certainty evidence).

Justification and Evidence-to-Decision Framework Highlights

The complete evidence-to-decision table is provided in Appendix A.

External uterine massage is a ubiquitous standard for professional birth attendants and first responders for the prevention and management of postpartum hemor-rhage.68,73,74,77 External uterine massage is a simple and safe physical maneuver, equivalent to other physical interventions routinely taught to first aid providers (eg,moving a patient, splinting an injured limb, applying direct pressure or a tournament to a bleeding wound).

Postpartum hemorrhage is a major source of global morbidity and mortality, especially in settings with lim-ited or no access to professional health care providers.Therefore, recommendations that limit external uterine massage to health care professionals would potentially compound health inequities. Although the identified study did not demonstrate a statistically significant reduction in blood loss or blood transfusion, it did demonstrate that external uterine massage can be taught to lay providers.

Task Force Knowledge Gaps

● The importance of the pressure and firmness of the uterine massage for the effectiveness of the intervention; the included study could not measure or regulate the strength or firmness of the uterine massage by study participants and did not describe if or how this was controlled or taught.

● More studies examining massage by lay providers,such as traditional birth attendants, are needed.

● Whether manual uterine massage affects maternal outcome beyond 120 minutes

Use of Naloxone During Resuscitation for Suspected Opioid-Associated Emergencies(FA 7442,BLS 811,EvUp 2025)

Population, Intervention, Comparator, Outcome, and Time Frame

● Population: Adults and children with suspected opioid-associated cardiac or respiratory arrest in the prehospital setting

● Intervention: Bystander naloxone administration(intramuscular or intranasal), in addition to standard CPR

● Comparator: Standard CPR only

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• Outcomes: Any clinical outcome

● Time frame: July 2019 to December 12,2023

Summary of Evidence

This PICO question was transferred from the BLS Task Force to the FA Task Force after 2020. Since the last SysRev in 2020, 356 new titles were screened.No new evidence was identified, and an update to the SysRev is not indicated. The current ILCOR practice is to use good practice statements in place of treat-ment recommendations for cases in which there is in-sufficient evidence for a treatment recommendation,but the task force thinks guidance is warranted. The previous treatment recommendation based on expert consensus from 2020 has therefore been changed to a good practice statement.

Good Practice Statement (2020)

We suggest CPR be started without delay in any uncon-scious person not breathing normally and that naloxone be used by lay rescuers in suspected opioid-related re-spiratory or circulatory arrest (good practice statement).

Prevention of Syncope With Counter-Pressure Maneuvers (FA 7550, FA 798, EvUp 2025)

Population, Intervention, Comparator, Outcome, and Time Frame

● Population: Adults and children with signs and symptoms of faintness or presyncope of suspected vasojave argothostic origin

● Intervention: Interventions such as counter-pressure maneuvers, body positioning, hydration, or other

● Comparator: No intervention or any other intervention

● Outcomes: Avoiding or preventing syncope or transient loss of consciousness, resolution of symptoms or symptoms response, hemodynamic status(including systolic and diastolic blood pres-sure, change in heart rate, cardiac output, stroke volume, or blood flow velocity), recurrences of presyncope or syncope, time to resolution of symptoms, adverse events, admission to hospital,quality of life

● Time frame: December 2, 2021, to December 2,2023

Summary of Evidence

Since the 2019 CoSTR summary, ${}^{78,79}$ 2 SysRev ${}^{80,81}$ were identified on the use of physical counter-pressure ma-neuvers for the prevention of syncope. Additionally, 1 RCT82 was found assessing counter-pressure maneu-vers during dental extraction in patients with a history of dental anxiety and previous syncope. The SysRevs and single RCT support the conclusions of the 2019 SysRev and CoSTR. ${}^{78,79,83}$ An updated SysRev is not indicated at this time.

Treatment Recommendation (2019)

We recommend the use of any type of physical counter-pressure maneuver by individuals with acute symptoms of presyncope due to vasovagal or orthostatic causes in the first aid setting (strong recommendation, low-certainty and very low-certainty evidence).

We suggest that lower body physical counter-pressure maneuvers are preferable to upper body and abdominal physical counter-pressure maneuvers (weak recommen-dation, very low-certainity evidence).

Unintentional Injury From Laypersons Providing Chest Compressions to Patients Who Are Not in Cardiac Arrest (FA 7670, BLS 353, SysRev 2025)

Rationale for Review

Delivery of high-quality chest compressions is a key step in the Chain of Survival for patients in cardiac ar-rest. Immediate CPR initiated by laypersons is associ-ated with improved outcomes. However, there may be a reluctance among laypersons to initiate CPR for fear of causing unintentional injuries. Since the last review ${ }^{84}$ in 2020, the topic has been moved from the ILCOR BLS Task Force to FA Task Force, prompting a new SysRev ${ }^{85}$ focusing on layperson rescuers. The term harm was changed to unintentional injury. The SysRev was registered before initiation (PROSPERO Registra-tion CRD42023476764). The complete CoSTR can be found online. ${ }^{86}$

Population, Intervention, Comparator, Outcome, and Time Frame

● Population: Adults and children outside of a hospital who are not in cardiac arrest

● Intervention: Provision of chest compressions by laypersons

● Comparator: No use of chest compressions

• Outcomes: Survival with favorable neurological out-come at discharge, 30 days, 60 days, 180 days, or 1 year; unintentional physical injury(previously harm)(eg, rib fracture, bleeding); risk of unintentional injury(eg, aspiration, rhabdomyolysis)

● Time frame: All years to September 17,2024

Consensus on Science

Since the last SysRev,1 new study87 was identified. In the total of 5 studies,87-91 including 1031 patients not in cardiac arrest who received CPR, 7 (0.7%) experienced unintentional physical injury. Additionally, 2 (0.2%) pa-tients had a risk of unintentional injuries and a further 24(2%) had symptoms such as chest pain or discomfort.No deaths caused by CPR were reported, but 61 (6%)patients died before being discharged from the hospital.The included studies were too heterogeneous to perform a meta-analysis.

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Prior Treatment Recommendations(2020)

We recommend that laypersons initiate CPR for pre-sumed cardiac arrest without concerns of harm to pa-tients not in cardiac arrest(strong recommendation, very low-certainty evidence).

Treatment Recommendations (2025)

We recommend that laypersons initiate CPR for pre-sumed cardiac arrest without concerns of causing un-intentional injury(strong recommendation, low-certainty evidence).

We recommend that other rescuers(eg, trained bystanders, health care professionals, and those with a duty to respond) initiate CPR for presumed cardiac arrest without concerns of causing unintentional injury to persons not in cardiac arrest (good practice statement).

Justification and Evidence-to-Decision Framework Highlights

The complete evidence-to-decision table is provided in Appendix A.

In making this discordant recommendation, the FA Task Force placed a higher value on the potential survival ben-efits of CPR initiated by laypersons for patients in cardiac arrest and a lower value on the low risk of injury in patients not in cardiac arrest. The intention of this recommenda-tion is to strongly encourage and support laypersons who are willing to initiate CPR in any setting when they believe someone has suffered a cardiac arrest.

The included studies focused on laypersons and not on other persons, such as health care professionals or those with a duty to respond, but the task force believes that the benefit of starting CPR outweighs the harm and used the indirect evidence to make a good practice statement.

The incidence of chest wall bone fractures was sub-stantially lower than the incidence reported after CPR in patients who were in cardiac arrest. This could be because of the shorter duration of CPR (most often <5 minutes) ${ }^{85}$ initiated by laypersons and stopped by professional res-cuers. However, the possibility of underreporting due to nonsystematic diagnostic studies cannot be excluded.

The task force discussed how the use of a structured equity assessment, such as the PROGRESS Plus tool, ${ }^{5}$ might increase equity-focused reporting. The proportion of men and women were roughly equal in the included studies. However, in 3 studies, the layperson often had some kind of relationship with the patient, as either a fam-ily member or personnel at a nursing home. Both types of relationships might be accompanied by fear of causing an injury, and still they most likely would be more willing to cause an unintentional injury if it comes with survival.

Task Force Knowledge Gaps

● More studies are needed with robust methodology to identify unintentional injuries and provide follow-up after hospital discharge.

● The incidence and pattern of injuries from CPR given to children not in cardiac arrest.

● Few aspects of equity were reported in studies.

Spinal Motion Restriction for Possible Traumatic Cervical Spinal Injury (FA 7311, FA 7312,FA 1547, ScopRev 2025)

Rationale for Review

In many countries, spinal motion restriction protocols are used by emergency medical service professionals, but similar guidance for first aid providers continues to be debated. There is ongoing controversy around the use of cervical collars and other devices by both trained emer-gency medical service providers and lay first aid provid-ers and concern regarding the evidence of harm from cervical collars, as well as the risk of secondary spinal cord injury after the initial trauma. Manual stabilization of spinal injury(FA 7312, FA 1547) was included in this new PICO.This ScopRev92 encompasses literature published in the last 25 years, including previous work done by the 2015 FA Task Force.37,93 The full report of the ScopRev can be found online.

Population, Intervention, Comparator, Outcome, and Time Frame

● Population: Adults and children with possible trau-matic cervical spinal injury

● Intervention: Cervical spinal motion restriction per-formed by a trained first aid provider

● Comparator: No cervical spinal motion restriction, or another type of cervical spinal motion restriction

● Outcome: Any clinical outcome

● Time frame: January 1,1999,to July 31,2024

Summary of Evidence

We included 66 studies, including 22 RCTs,94-115 19 non-RCTs,116-134 8 cohort studies,135-142 3 interrupted time series,143-145 7 case series,146-152 and 7 retrospec-tive chart reviews.153-159 Out of a total of 46 experimental studies,36(78%) were performed in live human volun-teers,94-99,101-103,105-116,119-124,126,128-130,133,134,144,145,150,152 and 5 primarily used human cadaver mod-els117,118,127,131,132 to assess range of cervical motion and adverse effects of spinal motion restriction. The 20 observational studies 135-143,146-149,153-159 mainly investi-gated the risk of secondary spinal injury, functional out-comes, and adverse effects of spinal motion restriction in trauma patients.

Evidence for the effectiveness of spinal motion restriction compared with no spinal motion restric-tion was provided in 46 studies, 94,97,99-101,105,107-111,114-118,120,121,123-125,127,130,131,133,135,136,138,139,143-157,159 $\overline{\text { (n=35) comparing cervical collar use with no cervical}}$ collar use with no cervical collar use. Together, these studies indicated that cervical collars decrease the range of cervical motion but lead to

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impaired respiratory and swallowing function as well as increased intracranial pressure.

Twenty-nine studies94,97-100,102-104,106-113,115,117,120,121,123,126,128,131-134,140,146 compared multiple types of spinal motion restriction. Four studies compared soft foam with rigid collars,117,120,131,146 suggesting that the use of soft foam collars allows significantly more cervical motion117,120,131 but is not associated with an increased risk of secondary spinal injury.146 One study106 showed no significant dif-ferences in range of cervical motion between improvised(eg, a folded fleece jacket) and commercially available collars. Five studies98,99,103,108,113 showed that in com-parison with 2-piece rigid collars, one-piece rigid collars result in greater restriction of cervical motion and cause significantly lower increases in jugular venous pressure but create higher interface pressures.

The effectiveness of spinal motion restriction meth-ods or devices during simulated extrication from vehicles was assessed in 4 studies.95,96,122,129 These suggested that collar application in combination with unassisted self-extrication, whereby a person is asked to leave the vehicle themselves without further instructions, creates the least range of cervical motion.

Finally, 5 studies ${ }^{135,137,141,142,158}$ found no significant difference in the incidence of spinal cord injuries or functional outcomes of trauma patients before and after the implementation of spinal motion restriction protocols.

Task Force Insights

Most of the evidence comes from experimental stud-ies in healthy young adult volunteers or human cadav-ers. Therefore, the findings may not be generalizable to adults and children with possible traumatic cervical spine injury. Also, 40% of all included studies were conducted in the United States.

Only 2 studies ${ }^{106,120}$ looked at improvised devices for spinal motion restriction, which may be particularly useful for first aid in low-resource settings. In contrast,many experimental studies included direct comparisons of multiple commercially available cervical collars. There was marked heterogeneity across studies in the different brands or specific features of cervical collars, including in their design (1-piece or 2-piece) and structure (rigid,semirigid, soft,improvised).

The task force recognizes that trained first aid provid-ers in selected circumstances(eg, ski patrols and life-guards) might be capable of using cervical collars but concluded that formal data synthesis and determination of the certainty of the vast evidence base is required to confidently withdraw the existing treatment recommen-dation or to formulate any further treatment recommen-dation or good practice statement. A future systematic review of protocol-based selective spinal motion restric-tion may provide additional evidence for a good practice statement.

This ScopRev provides a comprehensive overview of the available evidence and may serve as a basis for future SysRevs on one or more narrowly defined PICO questions, which will be discussed in the upcoming year within the task force. Currently, the 2015 treatment rec-ommendation remains unchanged.

Treatment Recommendation (2015)

We suggest against the use of cervical collars by first aid providers (weak recommendation, very low-certainty evidence).

Task Force Knowledge Gaps

● The potential benefits and harms of spinal motion restriction in conscious or unconscious persons,performed by untrained or trained first aid providers to performed by untrained or trained first aid providers tings(eg, a folded fleece jacket as an improvised collar, a folded towel wrapped around the neck and crossed around the chest)

tings(eg, a folded fleece jacket as an improvised collar, a folded towel wrapped around the neck and crossed around the chest)

● Whether selective spinal immobilization by trained first aid providers using a protocol results in benefi-cial or harmful clinical outcomes

Cryotherapy for Epistaxis(FA 7151, ScopRev 2021)

Cryotherapy, or cooling, has been suggested to shrink nasal mucosa and cause vasoconstriction as a method to aid hemostasis. For 2021, the FA Task Force prioritized the topic for a ScopRev to identify the scientific evidence behind such recommendations for the use of cryotherapy for epistaxis. Details of this ScopRev ${}^{160}$ can be found in the 2021 CoSTR summary. ${ }^{161}$

Population, Intervention, Comparator, Outcome,Study Design, and Time Frame

● Population: Adults and children receiving first aid for acute epistaxis

• Intervention: Cryotherapy alone or cryotherapy with nose pinching

● Comparator: Nosie pinching alone

● Outcome: Time to hemostasis control (minutes),hemostasis (yes/no), reduction of nasal blood vol-ume (volume), reduction of pain, need for follow-up care (yes/no), adverse events (yes/no), recovery time (days/min), reduction of swelling (volume)

● Study designs: In addition to the standard criteria,gray literature was available for inclusion. Further,we examined ILCOR's 8 member councils' and their subcouncils' websites.

● Time frame: All years to January 14,2021; a gray literature search was conducted December 28,2020

There was insufficient evidence to support a good prac-tice statement.

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Manual Pressure and Pressure Devices for Bleeding(FA 7331,FA 530, SysRev 2021,EvUp 2025)

Population, Intervention, Comparator, Outcome, and Time Frame

● Population: Adults and children with severe, life-threatening external bleeding from an extremity

● Intervention: Direct pressure to the wound with a compression dressing, compression bandage, com-pression device, wound clamp, application of a junc-tional pressure, proximal manual pressure

• Comparator: Direct manual pressure

• Outcomes:

- Critical: Mortality due to bleeding; cessation of bleeding, achieving hemostasis; time to achieving hemostasis

-Important: Mortality from any cause; decrease in bleeding; complications/adverse effects(eg, wound infection, limb loss, rebleeding, pain related to an intervention)

● Time frame: November 22,2019, to July 2,2024

Summary of Evidence

Since the 2021 SysRev,162 7 studies163-169 were identified on the use of pressure devices or pressure points compared with direct manual pressure. While findings in these studies suggest some potential benefits for the use of pressure points or pressure devices in some settings, the results are confounded by the indirect nature of the evidence and po-tential bias. Given these limitations, a ScopRev or SysRev is not warranted at this time. Future ScopRev or SysRev should clarify the definitions of devices for manual pres-sure versus limb tourniquets. After discussion, wording was added to the existing 2021 treatment recommendations to clarify that the recommendation for direct manual pressure is specific to bleeding from an extremity.

Treatment Recommendation (2021)

We recommend that first aid providers use direct manual compression compared with the use of external com-pression devises or pressure dressings/bandages for se-vere life-threatening external bleeding from an extremity(strong recommendation, very low-certainty evidence).

We recommend against the use of pressure points compared with the use of direct pressure by first aid providers for severe, life-threatening external bleeding(strong recommendation, very low-certainty evidence).

Type of Tourniquets Alone or in Combinations With Other Methods of Achieving Hemostasis(FA 7333, FA 768, SysRev 2021, EvUp 2025)

The original PICO was a mega-PICO with several sub-PICOrs. ${ }^{162}$ The EvUp below focused on one of the sub-PICO s.

Population, Intervention, Comparator, Outcome, and Time Frame

● Population: Adults of children with severe, life-threatening external bleeding from an extremity

● Intervention: Improvised tourniquets, direct manual pressure or direct pressure to the wound with a compression dressing, compression bandage or compression device, hemostatic dressings

● Comparator: Manufactured tourniquets

• Outcomes:

- Critical: Mortality due to bleeding; cessation of bleeding or achieving hemostasis; time to achiev-ing hemostasis

-Important: Mortality from any cause, decrease in bleeding, complications/adverse effects(eg,wound infection, limb loss,rebleeding, pain related to an intervention)

● Time frame: November 22,2019,to June 29,2024

Summary of Evidence

Since the last SysRev162 in 2021, 29 articles170-198 were identified regarding the use of tourniquets for life-threatening extremity bleeding. The data support the use of tourniquets compared with no use of a tourniquet for life-threatening extremity hemorrhage. Studies demon-strate reduced in-hospital mortality and a lower incidence of shock when tourniquets are used. Evidence supports the use of commercial tourniquets compared with im-provised tourniquets because commercial tourniquets achieve better arterial occlusion and are simpler to apply.Therefore, based on this EvUp, a SysRev on tourniquet use in children was undertaken and is included here.

Treatment Recommendation (2020)

We suggest that first aid providers use a tourniquet in comparison with direct manual pressure alone for severe,life-threatening external bleeding that is amenable to the low-certainty evidence).

We suggest that first aid providers use a tourni-quet rather than a hemostatic dressing for severe, life-threatening external bleeding that is amenable to the use of a tourniquet (weak recommendation, very low-certainty evidence).

Types of Pediatric Tourniquets (FA 7333, FA 768,SysRev,2021 CoSTR Summary)

A SysRev of the use of tourniquets in the children(<19 years of age) was conducted for the 2021 CoSTR sum-mary.${}^{161}$

Population, Intervention, Comparator, Outcome,Study Designs, and Time Frame

● Population: Children(<19 years of age) with severe,life-threatening bleeding from an extremity wound

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● Intervention: Commercial elastic wrap tourniquet or commercial ratcheting tourniquet

● Comparator: Commercial windlass rod-type tourniquet

● Outcome: Mortality, control of bleeding (includ-ing surrogate outcome of obliteration of Doppler pulses), blood loss, shock/hypotension, and adverse events

• Study designs: In addition to standard criteria, mod-eling studies, studies of tourniquets applied solely to maintain a bloodless surgical field, and those relat-ing only to education were excluded.

● Time frame: All years to October 1,2020

Treatment Recommendations (2021)

We suggest the use of a manufactured windlass tour-niquet for the management of life-threatening extremity bleeding in children (weak recommendation, very low-certainty evidence).

We are unable to recommend for or against the use of other tourniquet types in children because of lack of evidence.

For infants and children with extremities that are too small to allow the snug application of a tourniquet before activating the circumferential tightening mechanism, we recommend the use of direct manual pressure with or without the application of a hemostatic trauma dressing(good practice statement).

Hemostatic Dressing (FA 7334, FA 769, EvUp 2025)

Population, Intervention, Comparator, Outcome, and Time Frame

● Population: Adults and children with severe, life-threatening external bleeding

● Intervention: Hemostatic dressings with or without direct pressure (manual or pressure to the wound with a compression dressing, compression ban-dage, or compression device)

● Comparator: Direct manual pressure or direct pres-sure to the wound with a compression dressing,compression bandage, or compression device

● Outcomes:

- Critical: Mortality due to bleeding; cessation of bleeding, achieving hemostasis; time to achieving hemostasis

-Important: Mortality from any cause; decrease in bleeding; complications/adverse effects(eg, wound infection, limb loss, rebleeding, pain related to an intervention)

● Time frame: November 1,2019, to November 2024

Summary of Evidence

Since the 2020 SysRev,5 articles199-203 were identified regarding the use of hemostatic dressings for the con-trol of life-threatening bleeding. While much of the data

<EndOfPara>continue to be indirect, data continue to suggest that hemostatic dressings decrease the duration of bleeding and improve survival when compared with conventional gauze used to stop life-threatening bleeding. There con-tinues to be a low reported rate of side effects. The new studies identified support the existing recommendations.Therefore, based on this EvUp, no additional ScopRev or SysRev is warranted.

Treatment Recommendations (2020)

We suggest that first aid providers use a hemostatic dressing with direct pressure as opposed to direct pressure alone for severe, life-threatening external bleeding (weak recommendation, very low-certainty evidence).

For the treatment of severe, life-threatening external bleeding by first aid providers, due to very limited data and very low confidence in effect estimates, we are unable to recommend the use of any one specific type of hemostatic dressing compared with another.

Duration of Cooling With Water for Thermal Burns(FA 7371, FA 770 SysRev 2021)

This topic was prioritized by the ILCOR FA Task Force because of a lack of international consensus about the optimal duration for cooling of thermal burns with run-ning water in the first aid setting and because of newly identified relevant studies since the topic was last re-viewed in 2015. A SysRev ${ }^{204}$ was undertaken on behalf of the FA and Pediatric Task Forces and was included in the 2021 CoSTR summary. ${ }^{161}$

Population, Intervention, Comparator, Outcome, and Time Frame

● Population: Adults and children in first aid settings with a thermal burn

• Intervention: Active cooling using running water for 20 minutes or more as an immediate first aid intervention

● Comparator: Active cooling using running water for any other duration as an immediate first aid intervention

● Outcome: Size of burn, defined as percentage of total body surface area at any reported time point;depth of burn, defined as any degree of deep partial or full thickness burn depth; pain, defined as any measurement of pain or administration of pain relief medications; adverse outcomes, defined as any adverse outcome, including hypothermia; wound healing, defined as time to re-epithelization in days;and complications within 24 hours, defined as organ dysfunction, ICU care, infections(within 7 days),bleeding, and rhabdomyolysis as well as the need for surgical procedures such as skin grafting, fasci-otomy, or escharotomy

● Time frame: All years to February 10,2021

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Treatment Recommendations (2021)

We recommend the immediate active cooling of thermal burns using running water as a first aid intervention for adults and children (strong recommendation, very low-certainty evidence).

Because no difference in outcomes could be dem-onstrated with the different cooling durations studied, a specific duration of cooling cannot be recommended.

Young children with thermal burns being actively cooled with running water should be monitored for signs and/or symptoms of excessive body cooling (good prac-tice statement).

Dental Avulsion(FA 7361, FA 794, EvUp 2025)

Population, Intervention, Comparator, Outcome, and Time Frame

● Population: Adults and children in any setting(in-hospital or out-of-hospital) with an avulsed perma-nent tooth

● Intervention: Any storage media, container, or technique

● Comparator: Storage in whole milk or the patient's saliva

• Outcomes:

- Critical: Success of replantation and tooth sur-vival or viability

-Important: Color of the tooth, infection rate, mal-function(eating, speech) and pain

● Time frame:July 1,2019,and updated to December 2,2023

Summary of Evidence

Since the last SysRev205 in 2020, 3 studies ${ }^{206-208}$ were identified regarding the use of a storage medium, con-tainer, or technique for an avulsed permanent tooth. The evidence suggests that storage in a cooler tempera-ture favored viability of periodontal ligament fibroblasts for all storage media, except for Hanks' Balanced Salt Solution (a buffered salt solution). Propolis (a natural product made by bees by mixing resin, wax, and oils),cow's milk, and almond milk can be alternative storage mediums. Based on this EvUp, an updated SysRev is not warranted.

Treatment Recommendation (2020)

We suggest the use of Hanks' Balanced Salt Solution,propolis(0.04-2.5 mg per mL 0.4% ethanol), oral rehy-dration salt solutions including Riccetal(oral rehydration salt solutions containing sodium chloride, glucose, potas-sium chloride,citrate(or extruded rice)), or cling film com-pared with any form of cow's milk for temporary storage of an avulsed tooth that cannot be immediately replanted(weak recommendation, very low-certainty evidence). If none of the above choices are available, we suggest the use of cow's milk, any percent fat or form, compared with tap water, buttermilk, castor oil, turmeric extract, or saline

(sodium chloride) for temporary storage of an avulsed tooth(weak recommendation, very low-certainty evi-dence).

There is insufficient evidence to recommend for or against temporary storage of an avulsed tooth in saliva compared with alternative solutions.

There is insufficient evidence to recommend for or against temporary storage of an avulsed tooth in probi-otic media, epigallocatechen-3-gallate,Dentosafe box,or egg white compared with cow's milk.

Compression Wrap for Closed Extremity Joint Injuries (FA 7381,FA 511, EvUp 2025)

Population, Intervention, Comparator, Outcome, and Time Frame

● Population: Adults in the prehospital setting with a closed extremity joint injury

● Intervention: Compression wrap, elastic wrap

● Comparator: No compression wrap or elastic wrap

• Outcomes:

- Critical: Reduction of pain and reduction of swelling/edema

-Important: Recovery time, range of motion,adverse effects

● Time frame:January 1,2020,to September 30,2024

Summary of Evidence

Since the SysRev ${ }^{209}$ in 2020, no new studies were identi-fied.

Treatment Recommendations (2019)

We suggest either application of a compression bandage or no application of a compression bandage for adults with an acute closed ankle joint injury(weak recommen-dation, very low-certainty evidence).

Due to a lack of identified evidence, we are unable to recommend for or against use of a compression bandage for closed joint injuries on other joints besides the ankle.

Preservation of Traumatic, Completely Amputated or Avulsed Body Parts (FA 7391,ScopRev 2025)

Rationale for Review

Complete amputation of extremities or digits is a physi-cally and emotionally traumatic experience that can lead to long-term disability and disfigurement. Globally,the incidence and prevalence of traumatic amputations reached 11.37 million and 552.45 million respectively in 2019. Nonfreezing cold storage of an ischemic ampu-tated limb or digit is essential to improve the potential for successful replantation and revascularization, par-ticularly when transport times are prolonged. Only 35%of patients with traumatic amputations present to the emergency department with properly preserved ampu-tated body parts, making it difficult for surgeons to offer

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replantation when it would otherwise be an option.$^{210-211}$ The full report of this ScopRev can be found online.$^{211a}$

Population, Intervention, Comparator, Outcome,Study Designs, and Time Frame

● Population: Adults and children with a traumatic complete amputation or a complete avulsion of an external body part(eg, digit, hand, arm) or soft tis-sue in the out-of-hospital setting

- Excluded: Adults and children with a partial amputation or avulsion, an internal avulsion, or a surgical amputation

● Intervention: Any approach to preservation of the amputated body part or avulsed tissue for possible replantation/attachment

● Comparator: Another approach to preservation of the amputated body part or avulsed tissue for pos-sible replantation/attachment

● Outcomes: Any clinical outcome; the task force further specified a priori the critical outcome of attempted and successful replantation of ampu-tated body parts or reattachment of avulsed tissue.

● Study designs: In addition to standard criteria, the gray literature search included relevant guidelines from ILCOR-member organizations.

● Time frame: All years to April 17,2024

Summary of Evidence

This review^{212} identified 37 studies from 23 countries with various study designs: 23 case reports, ${}^{213-235}$ case series, ${}^{236,237}$ 2 experimental studies using animal mod-els, ${}^{238,239}$ 1 prospective observational study, ${}^{240}$ 6 retro-spective observational studies, ${}^{210,241-245}$ and 3 SysRevs with meta-analyses. ${}^{246-248}$

All studies included human subjects except for the 2 experimental studies. The experimental studies assessed replantation success following storage of amputated parts for between 21 and 24 hours at room temperature, 4℃ and minus 5°C. Case reports ${}^{213-235}$ and series described varying degrees of successful replantation with revas-cularization of completely amputated or avulsed body parts that, before hospital arrival, were cooled by differ-ent means or stored without cooling. Total ischemic time between amputation and replationation rangeded from 2 hours to 15 days. Successful replantation was reported in nearly all case reports and series with amputations involv-ing body parts without skeletal muscle (eg, digits) and in those cases with longer ischemic times when the part(s)were preserved with cold storage. ${ }^{215,219,228,234}$ Unsuccessful replantations were described in cases of prolonged(eg, up to 30 hours) ischemia without cooling or cleaning/soaking the part in water for 2 hours. The process described for cooling varied widely but often involved wrapping the part in moist gauze, placing it in a plastic bag and then placing the bag in another container with ice or an ice-water mix.A complete overview of characteristics and key findings from the case reports and series is presented in Table 2.

The observational studies assessed factors poten-tially associated with successful replantation and func-tional recovery, including the method of preservation of the amputated part prior to hospital arrival and the total ischemic time. Three cohort studies ${}^{240,243,244}$ reported an association between cold preservation for up to 6 hours and successful replantation of major upper extremity,although replantation of upper extremities was reported in a fourth study ${}^{245}$ to be successful after 7 to 13 hours without cold preservation but with limited functional out-comes. A complete overview of experimental and obser-vational studies with key findings is presented in Table 3.

Three SysRevs with meta-analysis(Table 4) assessed clinical outcomes for amputated parts preserved with cooling compared with no cooling of tissue, but in most cases failed to describe the actual method of cooling or other factors such as cold or warm ischemia times.$^{246-248}$

Care for amputated body parts was found in guide-lines from St. John Ambulance and from several National Societies of the International Federation of Red Cross and Red Crescent.249-251 The guidelines249-251 describe wrapping the amputated part in moist gauze and plac-ing it in a watertight container, which is then placed in another larger container with ice or a mixture of ice and water.

Task Force Insights

Following a traumatic amputation or avulsion, the pri-rity is to care for the patient, including control of life-threatening bleeding. However, care of the amputated or avulsed part is sometimes overlooked or delayed. Our ScopRev found that in 9 out of 23 case reports, there was a delay in retrieving the amputated part due to the part being lost, intentionally discarded, or intentionally withheld in a hostage situation(Table 2).

More distal amputated parts(such as digits) without skeletal muscle appear to tolerate longer periods of isch-emia without cold preservation(eg, up to 12 hours) while cold preservation appears to extend the tolerable isch-emic time before successful replantation to 24 or more hours. Observational studies of major upper extrem-ity amputations note successful replantation and func-tion when cold preservation techniques were used, with extension of time to replantation to 12 hours versus 6 hours without cold preservation.

Guidelines identified provide a reasonable approach to providing cold but nonfreezing storage of amputated or avulsed body parts. Wrapping the part in gauze or cloth is intended to prevent freezing of the tissue. Moistening the cloth with saline or water is intended to prevent des-iccation of exposed tissues. Some guidelines also sug-gest labeling the container holding the body part with the name of the person, time of injury, and time the ampu-tated part was placed in cold storage.

Most evidence identified in this review appears to support the prehospital cold storage of amputated or avulised body parts, when feasible, especially when

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Table 2.Preservation of Traumatically Amputated/Avulsed Parts Characteristics of Case Reports and Series

|First author, year, country|Population|Preservation technique|Main findings for patient outcomes| |---|---|---|---| |Akyurek,213 2020, United States|72-year-old female, equestrian accident, scalp avulsion|Avulsed scalp left under snow for 4 hours be- fore being located|Uncomplicated/complete survival of replanted scalp, normal appearance at 4 years| |Borenstein,214 1990, Israel|2 female teenagers with complete avul- sion of the scalp and 3/4 ears|Case 1:Scalp with 2 auricles wrapped in wet gauze, placed in a plastic bag surrounded by ice; hospital arrival 2 hours postinjury Case 2: Total avulsion of scalp and left auricle; preservation technique not described|Case 1:95% of the scalp and left auricle survived; new hair growth, eyebrow movement at 3-months post-op Case 2: Partial survival of scalp, some grafting required; no survival of replanted ears| |Braga-Silva,215 2016, Brazil|55-year-old female, amputation of distal ring finger from knife|Patient presented without amputated part; finger located later, placed in sealed jar, refrigerated at 4°C for 15 days|Survival of cold-preserved replanted finger despite 15-day delay; good function, cosmesis and 2-point discrimination at 8-year follow-up| |deLagausie,216 2008, France|4-year-old male, amputated penis|Placed in container with ice without direct contact, 6 hours|Successful replantation of penis after cold ischemic time 6 hours; normal function at 8-year follow-up| |Dvofak,217|38-year-old male, avuls ear|Ear wrapped in moistened gaze and stored on dry ice, arrived frozen/rigid|Successful replantation despite frozen avulsed/amputated ear; cosmetic changes and cold intolerance on long-term follow-up| |Elsahy,235 1974, Canada|14-year-old male, avulsed left nasal ala from dog bite|Tissue lost for 2 hours; at hospital, immersed in saline, refrigerated at 7°C for 2 hours|Successful grafting 4 hours after injury following 2 hours warm ischemia and 2 hours cold ischemia; normal skin color at 7 months| |Facio,218 2015, Brazil|30-year-old male, amputated penis|No cooling of amputated part for initial 5 hours, then stored 1 hour in a clean plastic container with saline and ice cubes|Successful replantation of transplanted penis after 5 hours warm ischemia; erectile function, urinary pattern, cosmesis ac- ceptable at 2-year follow-up| |Fernandez- Palacios,219 2009, Spain|28-year-old male, hand amputation at sea|Hand stored in a plastic bag on ice inside an isothermal box; prolonged transport time due to remote(cean) location|Successful replantation at 13 hours postinjury; posttransplant infection; recovery at 3 weeks| |Firdaus,220 2017, Malaysia|8-year-old male, above elbow amputation from motorcycle accident|"A witness immediately buys an ice bag from shop nearby and the amputated part was well preserved"|Successful replantation of cold-preserved arm; good circula-tion in the immediate post-op period; no further follow-up described| |Firdaus,220 2017, Malaysia|27-year-old female, hostage, bilateral ear helix amputations|Both ears unpreserved for 2 hours, then wrapped in moist gauze, placed in sterile plastic bag, kept in a bucket filled with ice/water then refrigerated 3 hours|Failed replantation after 2 hours warm ischemia, 52 hours cold ischemia; successful salvage procedure with reattachment of ears, reconstruction and free flap; good cosmesis at 12 months| |Gunasagaran,222 2022, Malaysia|42-year-old female, left thumb amputation from machete|Amputted thumb found on side of road(unknown time interval after injury), placed in plastic bag with ice; on arrival 2 hours later, ice had melted, thumb immersed in ice water; thumb then wrapped in moist gauze, stored in "ice box"|Successful replantation despite 2 hours storage directly on ice followed by ice water; no frostbite or maceration of the ampu-tated thumb observed after storage on ice/in ice water; good motion/function of thumb at follow-up| |Henry,223 2020, UK|34-year-old male, amputated penis|No preservation for 15 hours, then put on ice/ transported with patient|Survival of penile transplant despite 15 hours warm ischemia time; debridement and skin graft needed at 2 months, normal function at 6 weeks| |Kyrmizakis,224 2006, Greece|47-year-old male and 20-year-old male, amputated ears|For both cases, auricles placed in plastic bag with saline, surrounded by ice, transported with patient|Case 1: Successful replantation after 4 hours cold ischemia time as composite graft but required revision at 3 months; no complications at 6 months except 10% decrease in size Case 2: Successful replantation after 3 hours of cold ischemia time, composite graft, revision at 3 months| |Li,225 2020, China|3-year-old male, right leg amputation at knee level by sword|No specific care of the amputated leg before hospital arrival (warm ischemia time: 2 hours); leg then wrapped in saline-soaked gauze, placed in a plastic bag with ice for 400 km transfer to hospital(cold ischemia time< 6 hours)|Successful replantation of leg after 2 hours of warm ischemia time, <6 hours cold ischemia; partial motor and sensory func-tions 6 months after surgery; during follow-ups, the patient underwent sustained rehabilitation and recovered well| |Liang,228 2004, China|30-yr-old male, left ear amputation by knife|Auricle retrieved 5 hours postamputation; at hospital auricle cleaned and "preserved in ice" for 5 hours|Successful replantation 10 hours after complete amputation of auricle; warm ischemia time 5 hours, 5 hours cold ischemia time in-hospital; 1-year follow-up showed color, contour, tem- perature similar to right ear|

$$\text{(Continued)}$$

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Table 2. Continued

|First author, year, country|Population|Preservation technique|Main findings for patient outcomes| |---|---|---|---| |Makki,227 2020, Denmark|Case 1:43-year-old male, amputation of upper lip by human bite Case 2:30-year- old male, upper lip amputated in bicycle-motor vehicle collision|Avulsed lips both wrapped in saline-soaked gauze and placed on ice in a bag|At the 8-day follow-up, both patients had 100\% healed cleft lip and flap survival; at the 12-month follow-up, case 1 had a cos-metically acceptable result with full movement in the upper lip| |May,228 1981, United States|28-year-old male, amputation of 4 fingers of the left hand from a paper cutting machine|Digits placed in plastic bag surrounded by iced saline (unclear if cooling occurred before arrival at hospital; patient presented with amputated parts soon after injury)|Because of the time required to replant all digits, a cold isch-emia time of up to 28 hours was recorded for the final digit; all digits survived replantation; the case suggests that the margin of safety in digit replantation may be greater than previously thought| |Musa,229 2016,Nigeria|15-year-old male, avulsion of penis from a grinding machine, with scrotal laceration and devialized tissues|Initially resuscitation at local hospital; amputated penis wrapped in gauge at hospital and sent with patient to higher level of care, arrived 30 hours postinjury; no cooling of amputated tissue|Patient presented 30 hours after injury with the penis mumimm -fied, precluding replantation| |Salem,230 2009,Egypt|23-year-old male, penile amputation|Amputated penis kept dry in plastic bag, double bagged in ice and slush for 2 hours|Successful replantation after 2 hours cold ischemia, 5 hours warm (intraoperative) ischemia| |Selm,231 2018, Turkey|11-year-old male, amputation of right testicle from bicycle|Testicle found in muddy water, cleaned with soap/water, placed in jar of water for 2 hours before arrival at ER|No testicular replantation attempted due to storage in water and condition of testicle| |Szlosser,232 2015, Poland|82-year-old male, transmetacarpal amputation of 4 fingers by circular saw|Amputated fingers "cooled" and "stored appropriately" 3 hours prior to arrival at hospital|2/4 amputated fingers were replanted, 4 hours warm isch-emia (operative) time; at 8 months, minimal movement of fin- gers; however, because the thumb was uninjured, hand grasp was preserved, and patient was satisfied with the result; age alone should not be an absolute contraindication to finger replantation| |Usui, 233 1979, Japan|14-year-old male, distal one third leg amputation from a mower|Cooling of the amputated part in ice water; 5-hour transportation time to the hospital|Successful replantation, 5 hours cold ischemia time; at 4-year follow-up, no joint contracture or deformity; child able to walk and run as fast as other children his age; success was attributed to the patient's youth, ideal conditions for nerve repair, and the prearrival preservation of the amputated part in ice water| |Wei,234 1988, Taiwan|24-year-old female, amputations of 8 fingers by a paper cutting machine|Prearival: All 8 digits wrapped in normal saline- soaked gauze and preserved in an ice bag; 76- hour transportation time to the hospital|All replations were successful following 76-hour transport time with cold preservation and total cold ischemia times of 84, 86, and 94 hours for the left thumb, right thumb and left index finger; at 8 months post-op, the patient was able to per-form most routine household tasks| |Berger,236 1977, Austria|33 patients with 27 complete amputations, 41 incomplete ampu- tations|Prearival method of preservation or cooling not described except for 4 cases described as "improper first aid contributing to failed replant procedure," including: - Liquid-filled glass (1) - Floating in ice water (1) - No cooling (2)|Functional replantation not achieved in 9 of 11 cases; warm ischemia time of more than 8 hours felt responsible for failure of replantation in 2 cases; review did not clearly describe the specific prearvalial method of preservation or cooling technique other than for 4 cases; cold ischemia times of up to 12 hours and a warm ischemia time of up to 6 hours considered the limit for replantation, although consideration of injury mechanism and storage technique were both necessary for exclusion of replantation| |O'Brien,237|8 patients, complete amputation of total 14 digits|The amputated fingers were "cooled in ice" (n=3),"cooled by ice in a plastic bag" (n=4), and not reported (n=1)|Of 14 digital amputations, 11 survived replantation (83%), with ischemia times of 7 to 14 hours; for preservation methods linked to replantation failures due to complications, one was "cooled in ice," one not reported|

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Table 3.Preservation of Traumatically Amputated/Avulsed Parts-Characteristics of Experimental and Observational Studies

|Author, year, country|Population|Preservation technique|Main findings for preservation technique|Other outcomes| |---|---|---|---|---| |Hayhurst,238 1974, Aus-tralia|10 Macaque monkeys with surgically ampu- tated index fingers, replanted at 24 hours|1.5 hours of warm ischemia during amputation proce- dure; fingers then wrapped in saline-moistened surgical sponge, kept at -4°C for ~21 hours; finger allowed to return to room temperature for up to 2.5 hours for re- plantation|Preservation for 21 hours at 4°C did not produce enough damage to preclude a reasonable chance of survival in digital replantation|The first 3 amputated fingers had com- plete necrosis; 1 subject died unexpected edly with normal appearing replanted finger;1 finger had bleeding and necro- sis felt due to anticoagulant overdosage or trauma; the final 5 finger replants were successful with survival of replants at up to 35 days| |VanGiesen,239 1983, United States|40 amputated rabbit ears replanted at 24 hours|1. Room air storage and replanted within 1 hour (control) 2. Immersed in lactated Ringer's at 4°C(24 hours) 3. Nonimmersed,ear wrapped in lactated Ring-er's moistened sponge at 4°C(24 hours) 4. Immersed in normal saline at 4°C(24 hours) 5. Nonimmersed,ear wrapped in saline moist- ened sponge at 4°C(24 hours) 6. Immersed in lactated Ringer's and wrapped in a sponge at room tempera- ture (24 hours) 7. Frozen,nonimmersed, wrapped in lactated Ring- er's moistened sponge at 0° to -5°C(24 hours) 8. Nonimmersed wrapped in lactated Ringer's moist- ened sponge for 2 hours at room temperature and 4°C for 22 hours|1.5/5 replants survived 2.5/5 replants survived 3.5/5 replants survived 4.5/5 replants survived 5.4/5 replants survived 6.0/5 replants survived 7.0/5 replants survived 8.4/5 replants survived|All replants failed to survive after 24 hours of storage at room temperature or at minus 5°C; 2 other failures were recorded: 1 stored at 4°C wrapped in a moistened normal saline surgical sponge, and 1 stored 2 hours at room temperature followed by 22 hours of storage at 4°C; no difference was shown when the amputated part was stored in either lactated Ringer's or nor- mal saline solution at 4°C The author suggests that the best meth- od for preservation would be to wrap the amputated part in saline-moistened gauze and place this packet in a plastic bag to be floated in an iced saline solu- tion. No difference among conventional methods of storage were noted if the amputated part is not frozen or allowed to become normothermic for more than 2 hours.| |Li,242 2008, China|211 patients(117 male and 94 female, mean age 26.2 years [range, 1-67 years]) with 211 complete fingertip am-putations undergoing replantation surgery|1. Dry storage at room tem- perature(n=84 digits) 2. Dry storage at 2-6℃ (n=106 digits) 3. Immersed in saline or ethanol(n=21 digits)|Compared with immersion in saline or ethanol, dry storage at room temperature was associated with increased survival rates in a nonstatistically significant man- ner(aOR,0.314;95% Cl,0.041-2.399; P=0264); compared with immersion in saline or ethanol, dry storage at 2-6 °C was significantly associated with increased survival(aOR,0.028;95% Cl,0.003-0.270;P=0.002); no statistical difference between room- and low- temperature(2-6°C) preservation, sug- gesting that the amputated fingertip could withstand longer warm ischemia time|Binary logistic regression analysis for predictor of digit survival found that injury mechanism, platelet count, preser- vation of amputated part before admis- sion, vein grafting, and smoking after the operation were independent prognostic variables that influence the survival of the replanted fingertip| |Chen,241 2017, China|896 amputated fingers (average patient age, 22.0±3.8 years)|1. Freeze-dried (n=536) 2. Room temperature/dry (n=273) 3. Soaking liquid (n=87) Specifics of how and when preservation performed not described|1. 518(60.9%) survived versus 18 (40.0%) did not survive 2.257(30.2%) survived versus 16 (35.6%) did not survive 3. 76(8.9%) survived versus 11 (24.4%) did not survive|851/896(94.98%) of amputated fingers were successfully replanted; univariate analysis showed successful replantation correlated with ischemic time, etiology of injury, age, plane of severed finders, ways of preservation, artery reconstruction, platelet level and incidence of vascular crisis(P<0.05)|

(Continued)

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Table 3. Continued

|Author, year, country|Population|Preservation technique|Main findings for preservation technique|Other outcomes| |---|---|---|---|---| |Okumus, ${}^{243}$ 2020,Turkey|14 patients(14 male; mean age, 29.6 years; age range 11-45 years) with work- related amputations of an upper extremity|All amputated parts but one arrived at hospital "in prop-erly prepared cold ischemic conditions"; one without cooling had "appropriate" warm ischemic time|Replantation of amputated extremity in 11/14 cases (withheld in multilevel crush);“recommended ischemia times for reliable success with replantation are 12 hours of warm and 24 hours of cold ischemia for digits, and 6 hours of warm and 12 hours of cold ischemia for major replants; the amputated part should be wrapped in a saline-moistened gauze sponge and placed in a plastic bag; the plastic bag should be sealed and placed on ice; the amputated part should not be placed directly on ice"|Overall satisfaction, recovery of active motion of digits and thumb opposition, wrist and elbow joints, recovery of sensitivity in the median and ulnar nerve distribution, and ability of the surviving hand or forearm to perform daily work were all judged satisfactory in hand replantations; some distal ulnar nerve motor function problems reported in 3 cases with replantation at the elbow| |Tark,244 1989, Korea|261 replantations of amputated digits and hands in 153 patients; 176 were complete amputations|"Hypothermic" preservation (no description given of how "hypothermic preservation" was accomplished, and if performed before arrival to a hospital)|Survival of replantated amputated parts was assessed based on a warm or cold ischemia time of ≤12 or ≥13 hours; there was no significant relationship between survival of the replant and length of isch-emic time in the cold ischemia amputated parts group; success rate of replantation within 12 hours of warm ischemia was higher than that after 13 hours of warm ischemia|140 of 176 (80%) complete amputa- tions were successfully replanted; clean-cut proximal level amputations and hypothermic-preserved amputation parts had the highest survival rate; a higher survival rate seen with repair of both digital arteries and 2 veins rather than only 1| |The Hoang, ${}^{245}$ 2009, Vietnam|10 male patients with complete forearm amputations, ages 14 months-42 years|None of the amputated arms were "properly preserved"|Ischemia times ranged from 7 to 13 hours; 1 illustrating case described the amputated arm wrapped in a towel, transported with the patient 3 hours to the hospital; no prehospital storage/ preservation of the amputated part was performed, beyond one case in which the arm was wrapped in a towel|All patients arrived at the hospital within 2-8 hours postinjury; none of the ampu-tated parts were properly stored; overall survival of replanted limbs was 100%; functional outcomes of replanted fore- arms at 20 months rated from"excel- lent" to“fair” in 70% of patients| |Sinatro, ${}^{210}$ 2022, United States|91 patients with trau- matic amputation and documented modality of preservation seen at a single tertiary center|Prearrival"proper preserva- tion" assessed, defined as "wrapping the part in saline soaked gauze inside a wa- tertight bag and placing it on ice"|Most patients(60/91,65.9%) arrived most with proper preservation of their amputated parts; of 74 patients trans- ported by EMS, only 35.1% had proper preservation of their amputated part; only 25.5% of patients presenting from home had proper preservation of their amputated part(s)|Replantation was attempted at a sig-nificantly lower rate(n=14, 23.3%) in patients with improperly preserved parts than in those with properly preserved parts(n=18, 58.1%)(P=0.001)| |Waikakul, ${}^{240}$ 1998, Thailand|186 patients(137 male,39 female; age range, 19-38 years) with upper limb amputations: 24 am-putations at the palm, 75 at the wrist, 50 at the forearm, and 28 through the upper arm and 9 disarticulations at the elbow|"Good preservation" defined as "cooling" without further description|Prearival preservation by cooling of the amputated part showed a significant effect on the outcome and was a better predictor than ischemic time|There were 167 successful replantations and 16 failed replantations; of 102 ampu- tated extremities that were cooled, 3 re- plantations failed; 99 were successful; for amputated parts with“poor” preservation, 13 replantations failed, and 68 were suc- cessful(P<0.05, X2 8.14); total ischemic time, sex and age did not affect results; the type and severity of injury were also good predictors of successful replantation and functional outcome at 2 years|

aOR indicates adjusted odds ratio.

transport of the part to a replantation center may be delayed or take up to 6 hours. A SysRev of this topic is planned.

Good Practice Statements(2025)

Success in replantation is time dependent; complete-ly amputated and avulsed external body parts such as fingers, hands, arms, and legs should be retrieved and transported as soon as possible, preferably to the same health care facility as the injured person(good practice statement).

Replantation outcomes may be improved by cooling without freezing the amputated or avulsed part as soon as possible and throughout transportation to a health care facility. If feasible, this can be accomplished by wrapping the part in a moist clean cloth or gauze and sealing it in a watertight bag or container prior to cooling(good practice statement).

Task Force Knowledge Gaps

● The optimal techniques for the provision of cold storage for an amputated or avulsed body part in

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the first aid/out-of-hospital setting, including cool-ers and freezer packs,instant cold packs,cool water,battery-powered coolers,and their association with successful replantation

● Systematic collection and reporting of data on the methods of prehospital preservation by first aid provid-ers and prehospital professionals specifically should be performed by both clinicians and researchers.

Exertion-Related Dehydration and Rehydration(FA 7241, FA 584, SysRev 2021)

During prolonged exercise, sweat losses generally ex-ceed fluid intake, and even low levels of dehydration can lead to impaired physical and cognitive performance. In such situations, it is of utmost importance to promote postexercise drinking to restore fluid balance,252 yet there is no clear endorsement regarding the specific type of rehydrating fluid. Therefore, a SysRev253,254 was under-taken on behalf of the FA Task Force and was included in the 2021 CoSTR summary.161

Population, Intervention, Comparator, Outcome, and Time Frame

● Population: Adults and children with exertion-related dehydration

● Intervention: Drinking oral carbohydrate-electrolyte or alternative rehydrating liquids

● Comparator: Drinking water

● Outcomes: Volume/hydration status(measured as cumulative urine volume, net fluid balance, hemato-crit, hemoglobin, plasma volume change), vital signs(measured as heart rate), development of hypona-tremia(measured as serum sodium concentration,serum/plasma osmolarity), need for advanced medi-cal care, and patient satisfaction(measured as thirst performance, perceived intensity of stomach fullness,nausea, stomach upset, abdominal discomfort)

● Time frame: All years to February 21,2021

Treatment Recommendations (2021)

We recommend the use of any readily available rehydra-tion drink or water for treating exertion-related dehydra-tion in the first aid setting (good practice statement).

We suggest rehydration for exertion-related dehy-dration with a 4% to 9% carbohydrate-electrolyte drink.Alternative rehydration options include 0% to 3.9%carbohydrate-electrolyte drinks, water, coconut water, or skim or low-fat cow's milk(weak recommendation, very low-certainty evidence).

There is insufficient evidence to recommend for or against rehydration with beer(0%-5% alcohol).

METHODS OF TICK REMOVAL(FA 7231 SYSREV 2021)

This topic was prioritized by the FA Task Force because of a lack of international consensus in guidelines for re-

<EndOfPara>moval of an attached tick in the first aid setting and a lack of prior SysRevs of this topic by ILCOR. This CoSTR was created with the adoption process255 by using a recent SysRev. Details of this review can be found in the 2021 CoSTR summary. ${ }^{161}$

Population, Intervention, Comparator, Outcome, and Time Frame

● Population: Individuals in the first aid setting with a tick attached to the skin

● Intervention: Any tick-removal method, including heat, chemical, commercial tick removal apparatus,or tweezers/forceps

● Comparator: Any other method of tick removal

● Outcome: Transmission of disease, removal of (parts of) the tick, damaged or broken-off mouth parts

● Time frame: 2017 (date of the adoloped SysRev) to February 14,2021

Treatment Recommendations (2021)

We recommend against the use of chemicals, heat, or ice in comparison with mechanical methods for the removal of a tick (strong recommendation, very low-certainty evi-dence).

We suggest either pulling with tweezers or using com-mercial devices according to the manufacturer's instruc-tions to remove a tick rather than removal by hand(weak recommendation, very low-certainty evidence).

Treatment of Jellyfish Stings(FA 7211, SysRev 2025)

Rationale for Review

This topic was prioritized by the FA Task Force based on the morbidity that jellyfish stings cause through-out the world. Jelly fish envenomation is common in coastal areas. While most jellyfish stings have local-ized effects only, stings by some species of jellyfish can cause systemic illness or death. In 2023, an updated Cochrane SysRev256 on interventions for the treatment of jelly fish stings was published, and an ILCOR sys-tematic reviewer was a member of the author team.That Cochrane review included randomized controlled trials only, and because of the very low certainty of the evidence, the authors concluded that the effectiveness of the treatments evaluated was uncertain. The FA Task Force undertook this review, ${ }^{257}$ including random-ized and nonrandomized research, to identify a broader range of evidence and help in the formulation of treat-ment recommendations. The full CoSTR can be found online. ${ }^{258}$

Population, Intervention, Comparator, Outcome,Study Design, and Time Frame

● Population: Adults and children with a suspected jellyfish sting

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Table 4. FA7391 Preservation of Traumatic Amputated/Avulsed Body Parts. Systematic Review Characteristics and Findings

|Author, year, country|Population|Intervention|Comparison|Primary outcome|Findings for cold preservation|Other factors assessed| |---|---|---|---|---|---|---| |Shaterian,248 2018, Unit- ed States|2 studies with 6000 digit amputation and replantation cases Note: One of the 2 stud- ies was excluded from this scoping review as it did not provide any description of how prehospital cooling was accomplished or time interval between injury, cooling and replantation.|"Cold" preservation was provided in this review of how or when cooling of the amputated part oc- curred or long how cooling took place.|"Warm" or room temperature preservation|Replant survival|The method of preservation was not statistically associated with replant survival (OR, 0.94;P>0.05).|Meta-analysis showed the number of venous anastomosis(0 versus 1 versus 2), the number of arterial anastomosis(0 versus 1 versus 2), and mechanism of injury (sharp ver- sus blunt cut versus avulsion versus crush) to influence replant survival(P<0.05). No significant association between survival and age, sex,zone of injury,dit number,tobacco use, ischemia time, method of preserva- tion, and use of vein graft.| |Ma,247 2016,China|22 observational studies with 2641 patients(aged 1-75 years) with 4678 amputated digits in total; studies con- ducted in Brazil,China,Yugo slavia,Korea,United States, Japan,Singapore,Italy,and India|Cold ("ice") preser- vation|Compression bandage|Survival of replanted digit|Meta-analysis of survival rates sug- gested that cold preservation is as- associated with better replantation survival rates than emitter gency compression (OR,4.89;95% CI,2.14-11.20; P=0.0002).|Sex and ischemia time had no signif- icant influence on the survival rate of amputation replantation(P>0.05).| |Huawei,245,2015,China|3 studies included in meta-analysis of preservation tech- nique and survival rate, total of 979 patients with 1755 amputated digits (no refer- ences provided in the review)|Storage in an ice bag|No storage in an ice bag|Survival rate of replanted fingers|Cold storage improves the sur- vival rate; specific methods used to cool the amputated part in the included studies were not detailed.|Amputated digits stored in low temperature more likely to survive than that in common temperature (OR,4.89;95% CI,2.14-11.20; P=0.0002)|

OR indicates odds ratio.

● Intervention: Any pain-reducing or harm-minimizing technique(or combination of techniques) appropri-ate for first aid, such as vinegar, seawater, topical anesthetics,met tenderizer, cold packs, urine, wet sand rubs, aloe, other commercial topical products(eg, Sting No More), or pressure bandaging with immobilization

● Comparator: Heat or cold treatment in any form appropriate for first aid(hot/cold water, hot rocks,hot packs, cold packs) or no treatment

● Outcomes: Pain reduction(yes/no or amount), time to pain reduction, survival, need for hospitalization,adverse effects/complications(hypothermia, burns,worsening of pain, anaphylaxis,Irukandji syndrome)

● Study designs: In addition to the standard criteria,unpublished scientific abstracts were eligible for inclusion.

● Time frame: All years to October 1,2024

Consensus on Science

The 2023 Cochrane SysRev256 included 9 studies259-266 that were RCTs and quasi-RCTs. The current task force SysRev included the Cochrane data and identified 5 additional nonrandomized studies.267-271 Evidence from

all studies was of very low certainty and heterogenous,therefore no meta-analysis was possible. In the 2023 Cochrane SysRev,interventions were characterized into hot or cold treatments, topical treatments, and parenteral treatments. The overall evidence for all outcomes was of very low certainty and data were conflicting on the efficacy of heat and cold therapy. The RCT data sug-gested that heat(eg, hot water) may reduce pain when compared with cold after stings from Physalia. However,heat may not be superior to cold in reducing pain for the jellyfish Carybdea alata and Chironex flecker. Further, the RCT data did not find a significant difference in outcomes between different topical treatments(ie, application of seawater, fresh water, sting aid, Adolph's meat tenderizer,isopropyl alcohol, heated water, acetic acid, lidocaine, or sodium bicarbonate). The Cochrane authors concluded that because of the very low certainty of evidence, the effectiveness of any of the treatments evaluated in the review was uncertain. The Cochrane SysRev included a patient who sustained a first-degree burn following appli-cation of 10% ammonia.256 The Cochrane SysRev did not report any cases of increasing pain or redness of skin af-ter treatment with vinegar(5% acetic acid). This current task force SysRev identified 5 additional nonrandomized

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Table 5. Jellyfish Stings(FA 7211). Included Studies for the Critical Outcome Pain Relief and Adverse Effects/Complications

|Outcome|Study, year|Finding|| |---|---|---|---| |Pain reduction (relief): critical|McGee,268 2023|Heat may reduce pain when compared to cold following stings from Physalia(at 1 hour RR 2.66,95% CI 1.71-4.15; at 6 hours RR 2.25,95% CI 1.42-3.56; at the end of treatment RR 1.63,95% CI 0.81-3.27). However, heat may not reduce pain for the Carybdea alata and Chironex fleckeri(at 1 hour RR 1.16,95% CI 0.71-1.89; at 6 hours RR 1.66,95% CI 0.56-4.94; pain at the end of treatment RR 3.54,95% CI 0.82-15.31). Topical application of seawater,fresh water, sting aid,Adolph's meat tenderzer,isopropyl alcohol, heated water, acetic acid, lidocaine, or sodium bicarbonate resulted in no significant difference in overall improvement between the different treatments.|| |Pain reduction (relief): critical|Lopez,267 2000|Hot water demonstrated a benefit in pain reduction as participants receiving hot water immersion (110°F) had a relative risk of 1.600 (95% CI, 0.9354-2.7367) for pain relief compared to those with ice pack therapy.|| |Pain reduction (relief): critical|Knudsen,268 2016|Following treatment, VAS regarding pain for hot water immersion was 0.5 and for topical lidocaine 5% was 1.3 at 30 minutes (P<0.05).|| |Pain reduction (relief): critical|Yoshimoto,269 2002|An odds ratio of 11.5 (95% CI,1.007-131.28) was found regarding pain relief for heat therapy (hot shower, hot pack, hot wet compress) application versus parenteral analgesics. An odds ratio of 22.0 (95% CI, 1.40-378.90) was obtained for pain relief in heat application versus parenteral benzodiazepines.|| |Pain reduction (relief): critical|Birsa,270 2010|Application of lidocaine concentrations of 10% and 15% produced immediate relief; 4% and 5% solutions pro-duced relief after approximately 1 minute, while 1,2, and 3% solutions required 10-20 minutes provide noticeable relief. Benzocaine provided some relief but took 10 or more minutes.|| |Pyo,271 2016|Sea salt water and 10% lidocaine provided pain relief and less erythema in Nemopilema nomurai stings. Pain and erythema were increased by treatment with topical application of 4% acetic acid, ethanol(70%) and isopropanol compared with sea salt water. In Carybdea mora stings, seawater and 10% lidocaine reduced pain and erythema. Ethanol(70%) and isopropanol increased pain and erythema compared with sea salt water.||| |Adverse effects/ complications: important|McGee,268 2023|Ammonia treatment resulted in a first-degree burn in 1 participant.|| |Adverse effects/ complications: important|Birsa,270 2010|Areas of redness were observed after treatment with benzocaine. More areas of skin redness were observed after treatment 5% acetic acid, or ethanol(70%) than in control (no treatment).|| |Adverse effects/ complications: important|Pyo,271 2016|Erythema developed with 4% acetic acid, ethanol(70%) and isopropanol following sting by Nemopilema nomurai. Erythema developed with ethanol(70%) and isopropanol following by Carybdea mura tentacles.||

RR indicates relative risk; and VAS, visual analog scale.

studies that reported the critical outcome of pain reduc-tion. Details of study findings are provided in Table 5.

In these studies, heat therapy provided benefit compared with ice pack therapy. Topical lidocaine also appeared beneficial compared with parenteral analge-sics and benzodiazepines.267-269 The use of seawater and topical lidocaine also provided pain relief and reduced erythema compared with no treatment.270,271 Faster pain relief and fewer areas of redness on skin were achieved with higher concentrations of topical lidocaine compared with benzocaine.270 In contrast, pain was increased by treatment with acetic acid, ethanol, or isopropanol com-pared with controls using sea salt water.271

Treatment Recommendations(2025)

Following a jellyfish sting, we recommend rinsing the area of the sting with seawater(strong recommendation,very low-certainty evidence).

For non-life-threatening jellyfish envenomation,we suggest the use of heated water(40-45℃[104-113°F](immersion, irrigation or shower) or hot pack application compared with application of a cold pack, topical lidocaine, benzocaine, acetic acid, Adolph's meat tenderizer, sting aid, or sodium bicarbonate to relieve pain from a jellyfish sting(weak recommendation,very low-certainty evidence).

We recommend against the use of topical 10% ammo-nia,isopropanol, or ethanol for the treatment of jellyfish stings(weak recommendation, low-certainty evidence).

Justification and Evidence-to-Decision Framework Highlights

The complete evidence-to-decision table is provided in Appendix A.

In making these recommendations, the FA Task Force considered the following:

Seawater should be available at the setting where envenomation occurs and requires no additional cost.Seawater should preferentially be used to wash the area to remove remaining tentacles or nematocysts that are stuck to the skin.

While hot water appears to demonstrate a bene-fit in the non-RCTs compared with other treatments,access to hot water may not be feasible in many parts of the world. Hot water may also lead to skin burns if the temperature is too hot. In some locations, solar-heated water bags and instant hot packs are available at beach lifeguard stations for treatment of jellyfish stings. Fresh water may activate nematocysts remain-ing on the skin,272 therefore, it is preferred to rinse the area of the sting with seawater prior to application of hot fresh water.

The included studies used a water temperature range of 40°C to 45°C(104-113°F); 1 study used hot packs that were reported to be 43°C(109°F),and 1 study used a“hot shower” without reporting the water temperature. It may be most practical to use water as warm as the person can safely and comfort-ably tolerate.

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In the Cochrane SysRev,256 1 study showed that etha-nol resulted in increased pain following jellyfish stings compared with seawater while 2 other studies reported less reduction in pain with ethanol and isopropyl alcohol compared with seawater.

The efficacy of first aid treatment may depend on the species of jellyfish causing the envenomation and the benefit of heat therapy was evaluated in stings due to Physalia, Cyanea capillata, and Marine cnidaria. However,in many instances, it is not feasible for lay first aid provid-ers to know the type of jellyfish, resulting in the enven-oming before beginning.

Task Force Knowledge Gaps

● Whether the effect of jellyfish sting treatments dif-fers by species of jellyfish

● The effect of different jellyfish sting treatments on survival or need for hospitalization

Topics Not Included in the 2025 Review

The following topics have not been reviewed by a SysRev or ScopRev since 2020.

General Principles

● Optimal position for shock(FA 7131, FA 520, EvUp 20201)

First Aid for Medical Emergencies

● Supplemental oxygen for stroke(FA 7031, SysRev 20201)

● Bronchodilators for acute asthma exacerbation(FA 7121,FA 534, EvUp 202212)

● Oral dilution with milk or water for poisoning with caustic substance ingestion (FA 7421, FA 537,EvUp 2022^{12})

First Aid for Trauma Emergencies

● Thermal injury dressing (FA 7251, FA 1545,ScopRev 20201)

● Open chest wound dressings (FA 7321, FA 525,EvUp 202212)

● Foreign body in eye (FA 7351, FA 1544, EvUp 2015273)

● Single-stage scoring systems for concussion (FA 7341, FA 799, EvUp 2022^{12})

First Aid for Environmental Emergencies

● Pressure immobilization following snake bite (FA 7221, EvUp 2021161)

● Heatstroke cooling(FA 7242,FA 1548,SysRev 2020,^{274} EvUp 2022^{12})

ARTICLE INFORMATION

The American Heart Association requests that this document be cited as follows:Djarv T, Douma MJ, Carlson JN, Singletary EM, Berry DC, Bradley RN, Cassan P,Chang W-T, Charlton NP,Cimposu D,Goolsby CA,Lim SH,Pek JH,Klaassen B,Kule A, Laermans J, Macneil F, Martinez-Meijas A, Meyran D, Okubo M, Orkin AM,Raitt J, Shahhaed H, Subic AM, Thilakasiri K, Williamson F; on behalf of the ILCOR First Aid Task Force Collaborators. First aid: 2025 International Liaison Committee on Resuscitation Consensus on Science With Treatment Recommendations. Circu-lation.2025;152(suppl 1):S250-S282. doi: 10.1161/CIR.0000000000001358

This article has been copied published in Resuscitation. Published by Elsevier Ire-land Ltd. All rights reserved.

Acknowledgments

The Writing Group acknowledges True Thommesen for her advice as a content expert on the topic of postpartum hemorrhage and Jaylen I. Wright for his as-sistance with editing supplemental materials and providing administrative support throughout the manuscript preparation process.

Collaborators

The authors thank the following individuals(the First Aid Task Force Collabora-tors) for their contributions: Verne Borra, Domhnall O'Dochartaigh, Jonathan L. Ep-stein, Gustavo E. Flores, Grete Heitmann, Teruko Kishibe,Ella MacKenzie, Peter T. Morley,Gene Yong-Kwang Ong,Tina L. Palmieri,Christopher Picard,Jessica Rogers, Tetsuya Sakamoto, Wlem Stassen, Lloyd Visser, Michelle Welsford

Disclosures

Writing Group Disclosures

|Writing Group Member|Employment|Research Grant|Other Research Support|Speakers Bureau/ Honoraria|Expert Witness|Ownership Interest|Consultant/ Advisory Board|Other| |---|---|---|---|---|---|---|---|---| |Therese Djarrv|Karolinska Institutet and Karolinska University Hospital(Sweden)|None|None|None|None|None|None|None| |Matthew J. Douma|Alberta Health Services University of Alberta (Canada)|None|None|None|None|None|None|None| |David C. Berry|Saginaw Valley State University|None|None|None|None|None|None|None| |Richard N. Bradley|Texas A&M University School of Medicine|None|None|None|None|None|None|None| |Jestin N. Carlson|Allegheny Health Net- work|None|None|None|None|None|None|None| |Pascal Cassan|International Federation of Red Cross and Red Crescent National Soci-eties(Switzerland)|None|None|None|None|None|None|None|

(Continued)

Djarv et al

$$\text{First Aid: 2025 CoSTR}$$

Writing Group Disclosures Continued

|Writing Group Disclosures Continued||||||||| |---|---|---|---|---|---|---|---|---| |Writing Group Member|Employment|Research Grant|Other Research Support|Speakers Bureau/ Honoraria|Expert Witness|Ownership Interest|Consultant/ Advisory Board|Other| |Wei-Tien Chang|National Taiwan Universi- ty Hospital and College of Medicine(Taiwan)|None|None|None|None|None|None|None| |Nathan P. Chartlon|University of Virginia|None|None|None|None|None|None|None| |Diana Cimpoesu|Harbor-UCLA Medical Center|None|None|None|None|None|None|None| |Craig A. Goolsby|Harbor-UCLA Medical Center|None|None|None|None|None|None|None| |Barry Klaassen|Ninewells Hospital and Medical School(United Kingdom)|Emergency Medicine- Malawi Proj- ectt;member ERC First Aid Writing Group*|None|None|None|None|Honorary Consultant in Emergency Medicine*; Chief Medical Adviser British Red Crosset; co- Author First Aid Manual 11th Edition StJohn/St Andrew/BRC*; Con- sultant for Superhero First Aid Manual*|British Red Crosst; DK/Penguin Ran- dom House pub- lisher*| |Amy Kule|Loyola University Medi-cal Center|None|None|None|None|None|None|None| |Jorien Laermans|Belgian Red Cross-Flanders(Belgium)|None|None|None|None|None|None|Belgian Red Cross- Flanders; ILCOR First Aid Task Force*;Cochrane First Aid*;Co- chrane Acute and Emergency Care*| |Swee Han Lim|Singapore General Hos- pital(Singapore)|None|None|None|None|None|None|None| |Finlay Macneil|Australian and New Zealand Committee on Resuscitation(Australia and New Zealand)|None|None|None|None|None|None|None| |Abel Martinez-Meyjas|Hospital Universitari de Terrassa,CST.(Spain)|None|None|None|None|None|None|None| |Daniel Meyran|French Red Cross (France)|None|None|None|None|None|None|None| |Masashi Okubo|University of Pittsburgh|NIHt|None|None|None|None|None|None| |Aaron M. Orkin|University of Toronto (Canada)|None|None|None|None|None|None|None| |Jen Heng Pek|Sengkang General Hos- pital,Singapore(China)|None|None|None|None|None|None|None| |James Raitt|Thames Valley Air Ambu-lance(United Kingdom)|None|None|None|None|None|None|None| |Heba Sha-haed|University of Toronto (Canada)|None|None|None|None|None|None|None| |Eunice M. Singletary|University of Virginia|None|None|None|None|None|None|None| |Anna Maria Subic|University of Toronto (Canada)|None|None|None|None|None|None|None| |Kaushila Thilakasiri|Ministry of Health(Sri Lanka)|None|None|None|None|None|None|None| |Frances Wil-iamson|Royal Brisbane and Wom- en's Hospital(Australia)|None|None|None|None|None|None|None|

This table represents the relationships of writing group members that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Questionnaire, which all members of the writing group are required to complete and submit. A relationship is considered to be"significant" if(a) the person receives$5000 or more during any 12-month period, or 5% or more of the person's gross income; or(b) the person owns 5% or more of the voting stock or share of the entity, or owns$5000 or more of the fair market value of the entity. A relationship is considered to be"modest" if it is less than"significant" under the preceding definition.*Modest.

*Modest.

tSignificant.

DJarv et al

First Aid:2025 CoSTR

Reviewer Disclosures

|Reviewer|Employment|Research Grant|Other Research Support|Speakers Bureau/ Honoraria|Expert Witness|Ownership Interest|Consultant/Advisory Board|Other| |---|---|---|---|---|---|---|---|---| |Elizabeth Hewett Brumberg|UPMC Children's Hospital of Pittsburgh Division of Pediatric Emergency Medicine|None|None|None|None|American Red Crosst|None|American Red Crosst| |Matthew J. Levy|Johns Hopkins University School of Medicine Emergency Medicine|None|None|Stryker Medical Education|None|None|None|None| |Jeffrey L. Pellegrino|University of Akron Emergency Management/ Homeland Security|None|None|None|None|None|International Journal of First Aid Education*; In- ternational Red Cross/ Red Crescent*; Ameri- can Red Cross*|None| |Samuel Robert Seitz|University of Pittsburgh|None|None|None|None|None|American Red Cross*|None|

This table represents the relationships of reviewers that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Ques-tionnaire, which all reviewers are required to complete and submit. A relationship is considered to be“significant” if(a) the person receives$5000 or more during any 12-month period, or 5% or more of the person's gross income; or(b) the person owns 5% or more of the voting stock or share of the entity, or owns$5000 or more of the fair market value of the entity. A relationship is considered to be“modest” if it is less than“significant” under the preceding definition.

*Modest.

t+Significant.

REFERENCES

1. Singlelet EM, Zideman DA, Bendall JC, Berry DA, Borra V, Carlson JN,Cassan P, Chang WT, Charlton NP, Djvar T, et al; on behalf of the First Aid Science Collaborators.2020 International Consensus on First Aid Science With Treatment Recommendations. Resuscitation. 2020;156:A240-A282. doi:10.1016/j.resuscitation.2020.09.016

2.Singletary EM,Zideman DA,Bendall JC,Berry DA,Corra V,Carlson JN,Cassan P,Chang WT,Charlton NP,Djar T,et al; on behalf of the First Aid Science Collaborators.2020 International Consensus on First Aid Science With Treatment Recommendations. Resuscitation.2020;156:A240-A282.doi:10.1016/j.resuscitation.2020.09.016

3.The International Liaison Committee on Resuscitation. Accessed November 21,2024.https://costic/licord.org/document

4.Morley PT, Berg KM, Billion JE, Nolan JP, Montgomery WH, Attkins DL, Bray JE,Carlson JN, de Caen AR, Djar T, et al. Methodology and conflict of interest management: 2025 International Liaison Committee on Resusclucta-tion Consensus on Science With Treatment Recommendations. Circulation.2025;152(S33)-ppl 1):S23-S33. doi:10.1161/CIR/0000000000001366

5.OnEllal J, Shib J, Welch V, Pottley M, Pottley K, Clarke M, Evans T,Pardo Pardo J, Waters E, White H, et al. Applying an equity to interven-tions: using PROGRESS ensures consideration of socially stratifying fac-tors to illuminate inequities in health. J Clin Epidemiol. 2014;67:56-64. doi: 10.1016/j'clinepi.2013.08.005

6. Berg KM, Bray JE, Ng KC, Liley HG, Grifert R, Carlson, Norie PT, Drennan IR, Smyth Mry, Schofield BR, et al; on behalf of the Collabora-tors.2023 International Consensus on cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommenda-tions: summary from the Basic Life Support; Advanced Life Support; Pe-diatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation, Experiments and Team; and First Aid Task Forces. Circulation, 2023;148:e187-e280. doi:10.1161/CIR0000000000000000000000000000000000000000000000000000000000000000000

7. Singleary EM, Zideman DA, De Buck ED, Chang WT, Jensen JL, Swain JM, Woodin JA, Blanchard HE, Perragino L, Jcinal, et al: behalf of the First Aid Chapter Collaborators. Part 9: first aid. 2015 International Consensus on First Aid Science With Treatment Recommendations. Circula-2015;132S269-S311. doi:10.1161/CIR00000000000278

8.Greif R,Bray JE,Darryn IR,Liley HG,Hg NC,Cheng A,Douma MJ,Solechfield BR,Smyth M,et al.2024 International Consensus on CarloDiumal Resuscitation and Emergic Cardiovascular Care Science With Treatment Recommendations: summary from the Basic Life Support; Edu-cation,Implementation, and Teams; and First Aid Task Forces. Circulation,2024;150E580-Eg878: doi:10.101161/CIR0000000000001288

9.Greif R,J E B,Djarv T,I RD,H GL,Ng KC,Cheng A,M JD,B RS,Smyth M,et al.2024 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommen-dations: summary from the Basic Life Support; Advanced Life Support; Pe-diatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forcees. Resuscitation. 2024; 205:110414: doi:10.1016/iresuscitation.2024.110414.

10. Singletary EM, Zideman DA, De Buck ED, Chang WT, Jensen JL, Swain JM, Woodin JA, Blanchard IE, Herrington RA, Pellegrino JL, et al; on behalf of the First Aid Collaborators. Part 9: first aid: 2015 International Consensus on First Aid Science With Treatment Recommendations. Circula-dion 2015;132:S269-S311.10. doi: 10.1161/CIR.000000000000000278

11.Douma MJ,Handley AJ,MacKenzie E,Raitt J,Orkin A,Berry D,Bendall J,O'Docharta D, Picard C, Carlson JN, et al. The recovery posi-tion for maintenance of adequate ventilation and the prevention of car-diac arrest: A systematic review. Resuscus Plus. 2022;10:100236. doi:10.1016/j.respuil.2022;100236

12.Wyckoff MH,Greif R,Prley PT, Ng KC, Olasveengen TM, Singletary EM,Soar J, Cheng A, Drrenan IR, Liley HG, et al; on behalf of the Collabora-tors.2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommenda-tions: summary from the Basic Life Support; Advanced Life Support; Pe-diatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Resuscitation. 2022;181:208-288. doi:10.1016/j.resuscitation.2022.10.005

13. Meyran C, Cassan P, Nengeth M, Singletary E, Raitt J, Djarv T, Carlson JN.The ability of first aid providers to recognize anaphylaxis: a scoping review.Cureus:2023;15e41547. doi: 10.7759/cureus.41547

14.Yildirim A,Haney MO.Effects of training on teachers'food allergy and anaphylaxis management self-efficacy levels. Allergol Immunopathol(Madr).2023:515-168:163: doi:10.15586/aeiv15i14.849

15. Rahman E, Elliott SA, Scott SD, Hartling L. Children at risk of anaphylaxis:a mixed-studies systematic review of parents' experiences and information needs. PEC. Innov.2022;10018.10:10.1016/j.pecin.2022.100018

16.Gudichsen JH, Baekal EA, Jessen FB, Lassen AT, Bindslev-Jensen C,Mortg MT, Gelleksen S. Anaphylaxis: first clinical presentation, subsequent referral practise, and suspected elicitor-an observational study. Intem Emerg Med.2024;19:2047-2056. doi:10.1007/s11739-024-03589-5

17.Carlsson J.Nook S.Diay T,Woodin JA,Singleary E,Zideman DA.Second dose of epinephrine for anaphylaxis in the first aid setting: a scoping review.Cureus:2020;12:e11401.doi:10.7759/cureus.11401

18.Casale TB, Ellis AK, Nowak-Wegrzyn A, Kaliner M, Lowenthal R,Tanimoto S. Pharmacokinetics/pharmacodynamics of epinephrine af-ter single and repeat administration of neffy, EpiPen, and manual

Djarv et al

First Aid: 2025 CoSTR

intramuscular injection. J. Allergy Clin Immunol. 2023;152:1587-1596. doi:10.1016/j.jaci.2023.08.007

19.Olasvengen TM, Mancini ME, Perkins GD, Avis S, Brooks S, Castren M,Chung SP. Consine J. Couper K, Erquist G, Erait et al; on behalf of the Adult Basic Life Support Collaborators. Adult Basic Life Support: 2020 Interna-tional Consensus on Cardiopulmonary Resuscitation and Emergency Car-vodovascular Care Science With Treatment Recommendations. Circulation 2020;142:S41-S91.doi: 10.1161/CIR.00000000000000892

20. Couper K, Abu Hassan, A ohri V, Patterson E, Tang HT, Bingham R,Olasveenvens. Preliminary $D_{\text {G}}$ :on behalf of the International Liaison Com-mittee on Resuscitation Basic and Paediatric Life Support Task Force Collaborators. Removal of foreign body airabstruction: a system-atic review of interventions. Resuscitation. 2020;156:174-181. doi: 10.1016/j.resuscitation.2020.09.007

21. Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 3: adult basic life support. The American Heart Association in collaboration with the International Liaison Com-mittee on Resuscitation. Circulation: 2001/1028/ supp122-158. doi:10.1161/circ.102supp.11-12

22. Pellegino JL,Charlton NP,Carlson JN, Flores GE, Goolsby CA, Hoover AV,Kule A, Magid DJ, Orkin AM, Sienglet AM, et al. 2020 American Heart As-sociation and American Red Cross Focused Update for First Aid. Circulation.2020;142e287-e9303.d:101.1161/CIR00000000000000900

23. ANZCOR. Airway. Accessed March 12, 2025. https://www.anzcor.org/home/basic-life-support/guideline-4-airway/

24. Olsvevensne JM, Semeraro F, Ristagno G, Casten M, Handley A, Kuzovl A, Monsieurs KG, Raffay V, Smyth M, Soar J, et al. European Resuscitation Council Guidelines 2021: basic life support. Resuscitation. 2021;161:98-114. doi: 10.1016/j.resuscitation-2021.2020.009

25. International Federation of Red Cross and Red Crescent; International First Aid Resuscitation and Education Guidelines 2020. Global First Add Refer centre.ence Centre.2020. Accessed March 12,2025.https://www.globalfirstaid-centre.org/resource/international-first-aid-resuscitation-and-eduction-guidelines-2020-2/

26. Banderhii BG, Palmer Hill S. Evaluation of DeChoker, an airway clearance device (ACD) used in adult choking emergencies within the adult care home sector: a mixed methods case study. Front Public Health. 2020;5841855. doi:10.3389/fpubh2020.541885

27. Costable NJ, Costable JM, Rabin G. The use of LifeVac, a novel airway clearance device, in the assistance of choking victims aged five and under-Results of a retrospective 10-year observational study. J Pediatr Crit Care 2024;11:93-98. doi:10.4103/pjccpp.3,24

28. Dunne CL, Viguers K, Osman S, Queirouga SC, Zsplman D, Peden AE,A 2-year prospective evaluation of airway clearance devices in for-eign body airway obstructions. Resuscus 2023;2016:100496. doi:10.1016/j.resplu.2023.100496.

29. Dunne CL, Cirone J, Blanchard IE, Holrod-Lyduc J, Wilson Ta, Sauro K, McRae AD. Evaluation of basic life support interventions for foreign body airway obstructions: A population-based cohort study. Resuscitation 2024:2011:10258. doi:10.1016/j.resuscitation.2024.110258

30. Gal LL, Pugliesi P, Peterman D. Resuscitation of choking with victims a pediatric population using a novel portable non-powered suction device: Real-world data.Pedalty Ther.2020;10:5-10.1393/42874/216-0656.20.30171

31. Norii I, Tgarashi Y, Braude D, Sklar DP. Airway foreign body removal by a home vacuum cleaner: Findings of a multi-center registry in Japan. Resuscitation.tation:2001;1629:109-101.doi:10.1016/j.cussitation.2021.02.006

32. Norii I, Igarashi Y, Yoshino Y, Nakao, S Yang M, Albright, D Skar L,Drancall C. The effects of bystander interventions for foreign body airway obstruction on survival and neurological outcomes: Find-ings of the MOCHI registry. Resuscitation. 2024;199:110198. doi: 10.1016/j.resuscitation.2024;1191198.

33. McKinney MJ, Deede J, Markowitz B. Use of a novel portable non-powered suction device in patients with oropharyngeal dysphagia durchoing emergency. Front Med (Lausame). 2021:8747274.34.10.3389/fmedr.2021.742734.

34.Wolthers SA, Holgersen MG, Jensen JT, Andersen MP, Blomberg SNF,Mikelsen S, Christensen H, JCEN, JW. Foreign body airway ob-struction resulting in out-of-hospital cardiac arrest in Denmark - Inci-dence, survival and interventions. Resuscitation. 2024;198:110171. doi:10.1016/j.resuscitation.2024;110.12171

35. Wang C, Wang ZZ, TB. Blunt myocardial injury and gastro-intestinal hemorrhage following Heinich maneuver: A case report and literature review. World J Emerg Med. 2022;13:248-250. doi:10.5847/jewmj.1920-8642.2022.038

36. Pawlukiewicz AJ, Merrill D, Griffiths SA, Frantz G, Bridwell RE. Choles-terol embolization and arterial occlusion from the Heimlich maneuver. Am J Emerg Med.2021;43:290.e1-290.e3.doi:10.1016/j.ajem.2020.09.079

37. Djan T, Swan JM, Chang WT, Zideman DA, Singletary E. Early or first aid administration versus later or in-hospital administration of aspirin for non-traumatic adult chest pain: a systematic review. Cureus. 2020;12:e6862.doi:10.7759/cureus 6862

38. Jiang X, Khan F, Shi E, Faran Q, Xian Z, Zhang H, Gu T. Outcomes of preop-erative antipletate therapy in patients with acute type A aortic dissection.J Card Surg.2022;37:53-61. doi:10.111/jocs.16080

39. De Buck E, Borra V, Carlson JN, Zideman DA, Singletary EM, Djarv T. First aid glucose administration routes for symptomatic hypo-glycaemia. Cochrane Database Syst Rev. 2019;4:CD013283. doi: 10.10102/14651858CD.13283.pub2

40. Carlson JN. Schunder-Tatberz S, Neilson CJ, Hood N. Dietary sugars ver-sus glucose tablets for first-aid treatment of symptomatic hypoglycaemia in awake patients with diabetes: a systematic review and meta-analysis. Emerg Med.J 2017;34:100-106. doi: 10.1136/emmered-2015-205637

41. Fumanelli J, Franceschi R, Bonani M, Orrash M, Cauvin V. Treat-ment of hypoglycemia during prolonged physical activity in adolescents with type 1 diabetes mellitus. Acta Biomed. 2020;91:e2020103. doi: 10.23750/abm.v91i4.8437

42. Urbanova J,Fier B. Tamriwall A, Brozova K, Malinovska J, Chandel A, Brozov J. Optimal carbohydrate dose for treatment of nonsevere hypoglycemia in insulin-treated patients with diabetes: a narrative review. Can J Diabetes 2022:46743-749.e4.d. doi:10.1016/j.jcjd.2022.03.011

43. Cheng R, Taleb N, Wu Z, Bouchard D, Parent V, Lalanne-Mistrih ML,Boudreau V, Messier V, Lacombe MJ, Grou C, et al. Managing impending nonsevere hypogycemia with oral carbohydrates in type 1 diabetes: the REVERS trial. Diabetes Care.2024;47:476-482. doi: 10.2337/dc23-1328

44. Meyran I, Cassan P; Avau B, Singletary E, Zideman DA. Stroke Recogni-tion for first aid providers: a systematic review and meta-analysis. Cureus.2020;12:e13186. doi:10.7759/cureus.11386

45.Kule A, Stassen W. Flores Ge,Djarv T, Singletary E. Recognition and aware-ness of sepsis by first-aid providers in adults with suspected infection: a scoping review. Cureus.2024;16:e61612. doi: 10.7759/cureus.61612

46. World Health Organisation recommendations for the prevention and treat-ment of postpart homear hemorrhage. 2012. Accessed August 15,2025.https://www.ncbi.nlm.nih.gov/books/NBK131942/

47. Likfe,SAThe NA, Morgans AK, Hartmann Ke, Young JL, Carlson-Bremer D,Schorn M, Surawicz T, Andrews J. In: Management of Postpartum Hemor-hrage Rockville (MD): Agency for Healthcare Research and Quality(US);2015 Apr. Report No.: 15-80EHC03-EF.MPID: 26020092.

48. Deleted in proof.

49. Shahed H.S.A,Carson J.NU,Douma M,Djarv T,Kule A,Hofmeyer GJ,Kishibe T,Aronsson A,Heitmann G,Thomasmen T,et al; on behalf of the Interna-tional Liaison Committee on Resuscitation First Aid Task Force. Interven-tions administered by lay providers for the treatment of post-partum hemor-hage: a scoping review. Published October 28,2024. Updated November 3,2024.Accessed December 4,2024.https://costrilororg/doc/document/fa-7337-interventions-inderated-by-layer providers-for-the-treatment-of-partum-hemor-hage: a scoping-review-fa-7337-ftscr

50.Rodgers C. Low-tech first aid for obstetric hemorrhage. Midwifery Today Int 2012;Milano 2012;103:56-57.

51. Candiori S, Dozio N, Ousouli K, Graziosi S, Zanini AA, Costantino ML,De Gaofano F, Improving maternal safety: Usability and performance as-sessment of a new medical device for the treatment of postpartum haemor-hage. Appl/Ergon.2024;117:104223.doi:10.1016/j.apergo.2023.104223

52.Andreatta P.,Perosky J.,Johnson TRB. Two-provider technique for bimanual uterine compression to control postpartum hemorrhage.J Midwifery Women's Health.2012:5771-375. doi:10.1111/j.1542-2011.2011.00152.x

53.Collins L, M mari K, Mulla any LC, Gruber CW, Favero R. An exploration of village-level uterotonic practices in Fenerive-Est, Madagascar. BMC Preg-rancy Chikbirth:2016;16:89.69. doi:10.1186/s12884-016-0858-3

54. Hose I, Durham J. Phengshavan A, Sychareun V, Vongxay V, Xaysompho D,Rickart K. Perceptions and management of postpartum haemorrhage among remote communities in Lao PDR. Rural Remote Health. 2020;20:5436. doi:10.22605/RRH5436

55.Nelson BD,Stiklosa H,Ahn R,Eckardt MJ,Walton EK,Burke TF,Use of uterine balloon tamponade for control of postpartum hemorrhage by community-based health providers in South Sudan. Int J Gynaecol Obstet.2013:1227-32: doi:10.1016/j.ijgo.2013.02.017

56.Onongse O, Okello ES, Rembe F. Excessive bleeding is a normal cleans-ing process: a qualitative study of postpartum haemorrhage among

$\text{Djar}\,\text{v}\,\text{et al}$

First Aid: 2025 CoSTR

ural Uganda women. BMC Pregnancy Childbirth. 2016;16:2111. doi:10.1186/s12884-016-1014-9

57. FobOK KN, Kovane GP, Minnie CS. Management of the third stage of la-bour by Bachos dothir traditional birth attendants. Health SA 2024:29:372: doi:10.4102/hsagv.y29012372.

58. Brauer MD,Anton J,George PM, Kunter L, Wacker J. Handling postpartum haemorrhage-obstetrics between tradition and modernity in post-war Sierra Leone.Trop Doct.2015;45:105-113.doi:10.1177/0049475514557579

59. Nabataniz A, Walusansa A, Nangobi J, Natassa D. Understanding maternal Ethnomical Folkore in Central Gupta; a cross-sectional study of herbal remedies for managing Postpartum hemorrhage, inducing uteramine contrac-tions and abortion in Najembe subcounty, Bulkwe district. BMC Women Health.2024;24:349. doi:10.1186/s12905-024-03205-w

60 Prata N, Mbaruku G, Grossman A, Holston M, Hsieh K. Community-based availability of misopropi: is safe? Af J Repod Health; 2009;13:117-128.

61. Lalonde A; International Federation of Gynecology and Obstetstraticneterial Federation of G,Obstetrics. Prevention and treatment of postpartum hemorigh inage low-resource settings. Int J Gynaecol Obstet 2012;117:108-118. doi: 10.1016/j.jigo.2012.03.001

62. Nyusula E, D.S. The community approach to prevention and manage-ment of postpartum haemorrhage(PPH): review. Obstet Gynaecol Forum.2010;20:98-10.104;4143/gj.20359331

63. Mary M.Jafarey S, Dabash R,Kamal I, Rabbanai A, Abbas D, Durocher J,Tan YL, Winikoff B. The safety and feasibility of a family first aid approach for the management of postpartum hemorrhage in home births: a pre-post intervention study in rural. Matem Child Health J. 2021;25:118-126. doi: 10.1007/s10995-020-03047-6

Prata N. Mbaruku G. Campbell P. Motts, M. Vahidania F. Controlling post-partum hemorrhage after home births in Tanzania. Int J Gynaecol Obstet 2005;90:51-55. doi:10.1016/j.jijgo.2005.0307

65 Abbas, D Fehan J, DiAop O, Drischer J, Byrne M, Zeuberi N, Ahmed H Zalwraven G, Winkoff B. Using misoprost to treat postpart hemorrhage in home delivers attended by traditional birth attends. Int J Gynacool Obstet. Obstet 2019;144:290-296. doi:10.1002/jigo.12756

66.Deleted in proof.

67. Bazirete O,N M,UwinaMC,UmukoyeI A, Mariynin E Factors affecting the prevention of postpartum hemorrhage in low-and-middle income countries:a scop review of the literature. J Nurs Educ Pract. 2020;11:66-77. doi:10.5430/njep.11n1p66

68. Saccone G, Caissutti C, Ciarduli A, Abdel-Aleem H, Hofmey GJ,Berghella V. Uterine massage as part of active management of the third stage of labour for preventing postpart haemorrhage during vaginal deliv-ery: a systematic review and meta-analysis of randomised trials. BJOG 2018;15:2787-781; doi:10.1111/1471:0581492394

69. Escobar MF, Nassar AH, Theron G, Barnea ER, Nicholson W, Ramasauskaite D,Lloyd I, Chandraharan E, Miller S, Burke T, erot, et al. behalf of the FIGO Safe Motherhood and Newborn Health Committee. FIGO recommendations on the management of postpartum hemorrhage 2022. Int J Gynaecol Ob-stet.2021;157:3-50. doi:10.1002/jigo.11416

70. Gioleka S, Riskitaki, I. Gakilonioidis, M., nanopoulos, A. Tentas I,10.1076/OG/100000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000

71. Hofmeyr GJ,Abel-Aleem H, Abdel-Aleem MA. Uterine massage for preventing postpartum haemorrhage. Cochrane Database Syst Rx et al.2013;2013:C006431.001:10.1002/1465185.CD006431.00

72. Prata N, Bell S, Weidert K. Prevention of postpart hemorrhage in low-resource settings: current perspectives.Int J Women Health.2013;5:737-752. doi: 10.2147/JWSH.S51661

73. Tuncalou P, Souza J.Plgumezologia M, World Health Organization. New WHO recommendations on prevention and treatment of postpartum hemorrhage: What Int J Gynaecol Obstet.2013;123:254-256. doi:10.1016/j.jigoo.2013.06.024

74. Weeks A. The prevention and treatment of postpartum haemorrhage: what do we know, and where do we go to next? BJ/OG.2015;122:202-210. doi:10.1111/1471-0528.13098

Anna Marisa Subc S,Carlson J,Douma M,Djarv K,Tule A,Justus Hofmery G,Kishibe T,Aronsson A,Heitmann G,Thommones T,et al; on behalf of the International Lison Committee on Resuscitation First Aid Task Force. Layor provider administration of manual external uterine usage for the preven-tion or treatment of post-partum hemorrhage. Published October 18,2024.Updated November 3,2024.Accessed March 12,2025.https://costulir.org/document/ja-7336-manual-uterine-usage-administered-by-play-providers-for-the-prevention- or-treatment-of-partum-hemor-hage-a-systematic-review

76. Ngichage SK, Gatinu BW,Nyangore MA,Karuga R,Wanyonyi SZ,Kiarie JN.Remister systems for stefine usage in the prevention of postpartum blood loss. East Afr Med J. 2012;89:128:133.

77. Hofmeyi GJ,Gulmezoglu A,Novikova N, Lawrie TA, Postpartum misopros-tol for preventing material mortality and morbidity. Cochrane Database Syst Rev.2013;2013:CDC008982. doi:10.1002/14651858.CD008982.pub2

78. Soar J, Maconochie l, Wyckoff MH, Olasveengen TM, Singletary EM, Greif R, Aickin R, Bhanji F, Donnino MW, Mancini ME, et al. 2019 International Consensus on Cardioplumary Resuscitation and Emergency Cardio-vascular Care Science With Treatment Recommendations. Resuscitation.2019;145:95-150. doi:10.1016/j.resuscitation.2019.10.016

79. Soar J, Maconchioie I, Wyckoff MH, Olasveengen TM, Singletary EM,Greif Greif R, Aickin R, Bhanji F, Donnino MW, Mancini ME, et al. 2019 Inter-national Consensus on Cardiopulmonary Resuscitation and Emergency Cardio-ardivocular Care Science With Treatment Recommendations: sum-mary from the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation. 2019;140:e826-e880. doi:10.1161/CIR.0000000000000000734

80. Williams EL, Khan FM, Caydonve V. Counter pressure maneuvers for syn-cope prevention: a semi-systematic review and meta-analysis. Front Cardio-vasc Med.2022;9:1016420. doi: 10.3389/fcvm.2022.1016420

81. Dockx K,Avau B,De Buck E,Vranckx P,Vanderekorphve P.Physical manoeu-vers as a preventive intervention to manage vasovagul syncope: a systematic review.PLoS One.2019;14:e0212012.doi:10.1371/journal.pone.0212012

82.James Antony Hagati M Sr,Sakthi S Jr, Nathiya B Sr, Duraiiraj D Sr,Thennanar Ar Jr. Effectiveness of leg raise and leg fold maneuver ver to prevent syncope during extraction of teeth: a pilot study. Cureus.2023;15:e34848.d.10:7759/cureus.34488

83. Jensen JL, Ohshimo S, Cassan P, Meyran D, Greene J, Ng KC, Singletary E,Zideman D, First A; Pediatric Task Forces of the International Liaison Com-mittee or R. Immediate interventions for presyncope as vovasag or ortho-static origin: a systematic review. Prehosp Emerg Care.2020;24:64-76. doi:10.1080/1090/1327.2019.6105431

84.Savarsdottir H, Olasveen GEN TM, Mancini MB, Avis S, Brooks S, Castren M,Chung S, Considine J, Kudenchuk P, Perkins G, et al; on behalf of the Inter-national License Committee on Resuscitation Basic Life Support Task Force.Harm from CPR to victims not in cardiac arrest: consensus on science with treatment recommendations. Published December 28, 2019. Accessed June 1,2025.https://costril.licor.org/document/harm-from-cpr-to-victims-not-in-cardiac-arest-frts-costr-1

85. Williamson F, Heng PJ, Okubo M, Mejias AM, Chang WT, Douma M, Carlson J, Raitt J, Dart J. Dev T does delivering chest compressions to patients who are not in cardiac arrest cause unintentional injury? A systematic review. Resusc plus:2024:100828.doi:10.1016/j.resplu.2024.100828

86.Williamson O,Heng J,Chang MM,Carlson D,Djarv R. Unintentional injury by laypersons chest compressions to patients who are not in cardiac arrest: A systematic review. Accessed March 12,2025.https://costril.org/docu-ment/unintentional-injury-by-laypersons-chest-compressions-to-patients-who are-noin-in-cardiac-arest-fr-sert-fa-76707-ft-sr.2024.

87.Ng JYX,Sim ZJ,Siddiigui FJ,Shahidah N,Leong BS,Tiah L,Ng YY,Blewer A, Arulanandam S, Lim S, et al. Incidence, characteristics and complica-tions of dispatcher-assisted cardiopulmonary resuscitation initiated in patients not in cardiac arrest. Resuscitation. 2022;170:266-273. doi:10.1016/j.resuscitation.2021.09.022

88. White L, Rogers J, Bloomingdale, F Mahrenbruch C, Culley L, Subido C,Eisenberg M, Rea T. Displancher-assisted cardiopulmonary resuscitation:risks for patients not in cardiac cardiac arrest. Circulation. 2010;121:91-97. doi:10.1161/CIRCULATIONAHA.109.872366

89.Tanaka Y,Nishi T, Takase K,Yoshita Y,Wato Y,Taniguchi J,Hamada Y,Inaba H.Survey of a protocol to increase appropriate implementation of dispatcher-as-isted cardiopulmonary resuscitation for out-of-hospital cardiac arrest. Circula-tion 2014;129:1751-1760. doi:10.1161/CIRCULATIONAHA.113.004409

90.Moriawick,Y.Sugami Y,Matahara Y,Iwashita M,Kosuge T,Harunari N,Arataa S, Suzuki N. Complications of bystander cardiopulmonary resuscitation for unconscious patients without cardiopulmonary arrest. J Emerg Trauma Shock;2012:53-6. doi:10.4103/0974-2700.93094

91. Haley KB, Lerner EB, Pirallo RG, Croft H, Johnson A, Uihlein M. The fre-quency and consequences of cardiopulmonary resuscitation performed by bystanders on patients who are not in cardiac arrest. Prehosp Emerg Care.2011;15:282-287. doi:10.3109/10903127:2010.541981

292. Laermans JS, Eunice M, Macneil F, Williamson F, D'aes T, Cimpoesu ed,DC, D) De Buck E, Spinal motion restriction for possible traumatic cervical spine injury: a scoping review. Cureus. 2025;17:e84393. doi:10.1175/cureus.84399

Djarv et al

First Aid: 2025 CoSTR

93. Zideman DA, De Buck ED, Singletary EM, Cassan P, Chalkias AF,Evans TR, Hafner CM, Handley AJ, Meyran D, Schunder-Tazzer SB,et al. European Resuscitation Council Guidelines for Resuscitation 2015. Section 9. First aid. Resuscitation 2015;95:278-287: doi:10.1016/j.resuscitation.2015.07.031

94. Ala A, Vahdati SS, Maroufi P, Hafezan S, Ansari N, Ghabousian A.Philadelphia versus Miami M-Jical cervical's impact on pulmonary function-Am J Emerg Med.2021;43:59-619. doi:10.1016/j.ajem.2021.10.0143

95. Engsberg JR,Standeven JW,Shurtleff TL,Eggars JL,Shafer JS,Naunheim RS,Cervical spine during excitation.J Emerg Med 2014;34:122-127. doi:10.1016/j.jeemmered.2012.02.082

6. Gabrieli A, Nardello F, Geronogzo M, Marchetti P, Liberto A, Arcozzi D,Polati E, Cesari P, Zampar P. Cervical spine motion during vehicle extrica-tion of healthy volunteers. Phoemp Emerg Care. 2020;24:712-720. doi:10.1080/10903127Z2019.1669298

97. Gavin TM,Carandang G,Havey R,Flanagan P,Ghanayem A,Patwardhan AG. Biomechanical analysis of cervical orthoses in flexion and extension: a comparison of cervical collars and cervical thoracic orthoses. J. AholiRes Dev.2003;40:527-537. doi: 10.1081/jr2003.11.0527

98. James CY,Riemann BL, Munkasy BA, Joyner AB. Comparison of cervical spine motion during application among 4 rigid immobilization collars. J Ath/Train.2004;39:138-145.

99. Karasson S, Reynsson K, Sigwalson K, Sigurdsson GH. Evaluation of clinical efficacy and safety of cervical trauma collars: differ-ences in immobilization, effect on jugular venous pressure and pa-tient comfort. Scand J. Trauma Resusc Emerg Med. 2014;22:37: doi:10.1186/1757-7241-22-37

100.Kim JG,Bang SH,Kang GH,Jang YS,Kim W,Choi HY,Kim GM.Compari-son of the efficacy of three cervical collars in restricting cervical range of motion: a randomized study. Hong Kong J Emerg Med.2020;27:24-29. doi:10.1177/1024907918809499.

101. Malson M, Smereka J, Ahuja S, Sarpak L, Ruttey K, Ladryt J, LRj. Ef-fect of 5 different cervical collars on optic vureth sand rheometer: a randomized crossover trial. Medicine (Bulmt) 2020:99:91740. doi:10.1019/MD.000000000000000000

10. Ladny M., Smereka J, Sarpak L, Ladny R, JAssment of the cervi-cal collar application impact on the conditions of intubation and the feel-ings of patients- pilot study. Disaster Emerg Med J. 2018;3:1-4. doi:10.5603/demj.2018.0001

103. Leenen JPL, Ham HW, Leenen LPH. Indentation marks, skin tempera-ture and comfort of two cervical collars: a single-blinded randomized con-trrolled in healthy volunteers. Int Emerg Nurs.2020:51:00878. doi:10.1016/j.jen2020.10878

104. Mahshidfar B, Mofidi M, Yari AR, Mehrosshor S. Long backboard versus vacuum mattress split to immobilize while spine in trauma victims in the field: a randomized clinical trial. Prehosp Disaster Med.2013;28:462-465.doi:10.1017/S1049023X13008637

105. Maissan, KMetalares R. Volltes B, Hoops SE, den Hartog D., Stolker RJ.Increase in intracranial pressure by application of a rigid cervical collar: a pilot study in healthy volunteers. Eur J Emerg Med 2018;28:e24:58. doi:10.1016/WEJ.0000000000000490

106. Porter A. Difrancesca S, Slack, Sudehke L, McLintosh SE. Impro-vised vs standard cervical collar to restrict spine movement in the back-country environment. Wildess Environ Med.2019;30:412-416. doi:10.1016/j.wem.2019.07.002

107. Rahmatalsai S, DeShaw J, Silley J, Denning J, Gennissen C. Comparing the efficacy of methods for immobilizing the cervical spine. Spine (Pha 1976).2019;44:32-40. doi:10.1097/RBS0000000000002749

108.Russell L.J.Dodd T,Kendall D,Lazburn A,Leggett A,Payton-Haines,Siang L,Filingeri D,Worsley PR.A bioengineering investigation of cervical collar collar design and fit Implications on skin health. Cli: Biomechanics(Bristo).Avon,2024;112:10617.18:doi:1016/j.jclinomech.2024.106178

109.Szarpak L, Ladny M, Pyda S, Madziala M, Bielski K, Pusleck M, Smereka J.Comparison of two cervical collars on the intracranial pressure measured indirectly based on the thickness of the optic nerve sheath. Preliminary data.Post N Med.2018;31:68-71. doi:10.25121/pnm.2018.31.2.68

10. TeuschER, AN Rindflabes HC, Youdast JS. Brown J. Dopson, L. Down 11 Miers AG, Basford JR, Cullinane DC, Stevens SR, Pankratz VS, et al.Range-of-motion restriction and cranialiac tissue-interface pres-sure from four cervical collars. J Trauma 2007;63:1120-1126. doi:10.1097/TA,0b013e3180487d0f

111.Techer AN,Rindflappen B,Youdas JW,Yanstrom RW.Jacobson TM,Douglas LL,Miers AG,Austin CM,Delgado AM,ZINS SM,et al. Comparison of cer-vical range-of-motion restriction and cranialfacial tissue-interface pressure

with 2 adjustable and 2 standard cervical collars. Spine(Phila Pa 1976).2016:41:E304-E312.doi: 10.1097/BRS.0000000000001252

112. Totten VY, Sugarman DB. Respiratory effects of spinal immobilization. Pre-hospern Care 1999;3:347-352. doi:10.1080/10903129908958967

113. Worsley PR, Stanger N, Dorrell AK, Bader DL. Investigating the ef-fects of cervical collar design and fit on the biomechanical and bio-marker reaction at the skin. Med Devices(Auck). 2018;11:87-94. doi:10.2147/MDERS14941

114. Yard J, Richman PB, Leeson B, Leeson K, Youngblood G, Guardiola J,Miller M. The influence of cervical collar immobilization on optic nerve sheath diameter. J Emerg Trauma Shock. 2019;12:141-144. doi:10.4103/JETSJETS,80_18

115. Zhang S, Wortley M, Clowers K, Krusenklaus JH. Evaluation of efficacy and 3D kinematic characteristics of cervical orthoses. Clin Biomechanics(Bristol,Avon)2005;2020:264-269. doi: 10.1016/j.cliniomech.2004.09.015

116. Ay D,Aktas C,Yesilyurt S, Sarikaya S,Cetin A, Ozdogan ES.Effects of spinal immobilization devices on pulmonary function in healthy volunteer individu-als. Ulus Trama Acid Cernah Derg.2011;17:103-107.

117. Bednar DA. Effectancy of therapeutic immobilization of the unstable subaxial cer-vical spine of the elderly patient: investigation in a cadaver model. Can J Surg.2004;47:251-256.

118.Ben-Galim,P. Dreielang N, Mattox KL, Reitman CA, Kalantar SB, Hipp JA.Extrication collars can result in abnormal separation between vertebrae in the presence of a dissociative injury. J Trauma. 2010;69:447-450. doi: 10.1097/TA0.0b013e3181be785a

119. Chi CH,Wu F,GTsai SH,Wang CH,Stern SA.Effect of hair and clothing on neck immobilization using a cervical collar. Am J Emerg Med.2005;23:386-390. doi: 10.1016/j.ajem.2005.02.006

102. Eisner ZL, Delaney PG, Pine H, Yeh K, Aleem IS, Raghavendran K, Widder P. Evaluating a novel, low-cost technique for cervical-spine immobilization for application in resource-limited LIMCs: a non-inferiority trial. Spinal Cord. 2022;60:726-732. doi:10.1038/s41393-022-00764-3

121. Evans NR, Hooper G, Edwards R, Whalling G, Sparkes V, Holt C, Ahuja S. A 3D motion analysis study comparing the effectiveness of cervical spine orthoses at restricting spinal motion through physiological ranges. Eur Spine J.2013;22:S10-S15. doi: 10.1007/s00586-012-2641-01

122. Henéndex H. Gldimo Martín R, Serrano Martínez F, Alonso Ibánez L, Carazo Diaz C, Prieto Merino D, Sánchez-Arévalo Morato S, Dixon M, Pardo Rios M, Juggera Rodriguez L. Self-extraction with and with-out a cervical collar: a biomechanical simulation study. Emergias.2019;31:36-38.

123.Holla M.Value of a rigid collar in addition to head blocks: a proof of principle study. Emerg Med.J 2012;29:104-107. doi:10.1136/emj.2010.092973

124. Hudson MAJ,Ehsanullahi J, Lee A, Macpherson N, O'Gilvie A, Shrestha A,Tangsak K, Morgan C, Pock E, Koizia LJ, et al. In healthy volunteers the Miami-J® cervical collar causes swallow dysfunction. This may increase the risk of aspiration; of particular potential consequence in older peo-ple with neck injury. Interdisciplinary Neurosurg. 2023;33:101788. doi:10.1016/j.injat.2023.101788

125. Hunt K,Hallworth S,Smith M.The effects of rigid collar placement on intra-cranial and cerebral perfusion pressures. Anaesthesia.2001;56:511-513.doi:10.1046/j.1365-2044.2001.02053.x

126. Kreel JM, McCoy M, Sparo TJ, Fisher GL, Stoy WA, Hostler DP. Com-parison of the Ferno Scopt Stretcher with the long backboard for spinal immobilization. Prehosp Emerg Care. 2006;10:46-51. doi:10.1080/1090312005600366375

127. Liao S, Schneider N, Huttlin P, Grutzner PA, Weilbacher F, Matschke S,opp E, Kreinest M. Motion and dural sac compression in the upper cervical spine during the application of a cervical collar in case of unstable cranio-cervical junction-A study in two new cadaveric trauma models. PLoS One.2018:13e01952.15 doi:10.1371/journal.pone.0195215

128.McGrath T.,Murphy C. Comparison of a SAM splint-molded cervical collar with a Philadelphia cervical collar. Wilderness Environ Med. 2009;20:166-168. doi:10.1580/08-WEME-BR-220R1.1

129.Nutbeam T,Fenwick R,May B,Stassen W,Smith JE, Wallis L,Dayson M,Shippen J. The role of cervical collars and verbal instructions in minimising spinal movement during self-extrication following a motor vehicle collision- a biomechanical study using healthy volunteers. Scand J Trauma Resusc Emerg Med.2021;29:108.3 doi:10.1186/s13049-021-00919-w

10. Krpyce R, McDonald P. Nrel hospital spinal immobilization:effect of effort on ki-nematics of voluntary head-neck motion assessed using accelerometry. Pre-hospon Disaster Med 2016;31:36-42. doi: 10.1017/S1049023X1500552X

131.Richter D, Lattla LL, Miline EL, Varkarakis GM, Biedermann L, Ekkernkamp A,Ostermann. PA The stabilizing effects of different orthoses in the intact and

$\text{Djarv et al}$

First Aid: 2025 CoSTR

unstable upper cervical spine: a cadaver study. J Trauma. 2001;50:848-854. doi: 10.1097/00005373-200105000-00012

132. Roebke AJ, Bates, N. Jurenovich K, Yu E, Karnes J, Khan S, Kman N,Groth A. Martin KD. Cervical spinal immobilization: a head-to-head com-parison of a one-step spray-on foam splens versus structural aluminum malleable splint immobilization. Mil Med. 2023;188:e2987-e2991. doi:10.1093/milmed/adis08/

133. Schneider AM, Hipp JA, Nguyen L, Reitman CA. Reduction in head and intervertebral motion provided by 7 contemporary cervical or thoses in 45 individuals. Spine (Phila Pa 1976). 2007;32:E1-E.6: doi:10.1097/01.brs.0002551019.24917.44

10.114. Zuzun DD, Jung MK, Weerts J, Minzberg M, Gritzner PA, Haske D, Kreimest M. Remaining cervical spine movement under different im-mobilization techniques. Prehosp Disaster Med.2020;35:382-387. doi:10.1017/S1049023X2000059X

135. Castro-Marin G, Baither JB,Rice AD,RN, RCBi, V. Vossbrink A, Bobrow B.J. Prehospital protocols reducing long spinal board use are not associ-ated with a change in incidence of spinal cord injury. Presheng Emerg Care 2020;24:401-410. doi:10.1080/109031272019.145923

136. Chen HA, Hsu ST, Shin SD, Jamuddin S, SFon, DN, Hong KJ, Tanaka H,Sun JT,Chang WC; PATOS Clinical Research Network. A multicenter cohort study on the association between prehens immobilization and functional outcome of patients following spinal injury in Asia. Sc: Rapp 2022;12:3492.10. doi:10.3084/s15948-022-07481-0

137. Cemency BM, Natalz Pia, Innes J, Guinaro S, Welch J, Haghdel A, Noyes E,Jordan J, Lindstrom H, Amerer EB. A change from a spinal immobilization to a spinal motion restriction protocol was not associated with an increase in disabling spinal cord injuries. Prehosp Disaster Med.2021;36:708-712.doi:10.107/51409230011871

138. Jung E, Ro YS, Ryu HH, Shin SD. Impact of cervical spine immobili-zation on clinical outcomes in traumatic brain injury patients accord-ing to prehospital mean arterial pressure: a multinational and multi-center observational study. Medicine (Baltim). 2023;102:e32849. doi:10.1097/MD000000000003849

139. Leonard JC, Jao J, Delfeic Potential adverse effects of spinal im-mobilization in children. Preshop Emerg Care. 2012;16:5135-518. doi:103109/103912720128.689925

140.McDonald N, Kriellaarsa D, Weldon E, Pryce R. Head-neck motion in preshos-tilla trauma substral under spinal motion restriction: a pilot study. Presheng Emerg Care.2021;25:117-124. doi:10.1080/109312072201727591

141. Mitra B, Bernard S, Yankoff C, Somesh A, Stewart C, Koolstra, Calarito,C. Nehre Z, Fitzgerald MC, Cameron PA, Change from semi-rigid to soft collars for prehospital management of trauma patients: an obser-vational study.J Am Coll Emer Physicians Open 2024;5:e132936. doi:101002/em2:133293.

142. van de Breevaart OJ, van der Waarden N, Schoonhoven L, Ham WHW,Schep NWL. Patient outcomes before and after implementation of a selec-tive pre-hospital spinal immobilization protocol a comparative cohort pilot study in a level 2 trauma center. Int Emerg Nurs. 2023;70:101345. doi:10.1016/j.ienj.2023.101345.

13. Colak T, Celik K. The association between cervical collar and intracranial pressure measured by the optic nerve sheath diameter in trauma patients refered to the emergency department. Sigma Visea: 2020;16:89-95. doi:10.22514/sv.2020.16.0012

144. Kroeker J, Keith J, Carruthers H, Hanna C, Qureshi N, Calic M, Kaye M,Solow M, CoeyJ, Sulaman S. Investigating the time-lapsed effects of rigid cervical collars on the dimensions of the internal jugular vein. Clin Anat 2019;32:196-200. doi:10.1002/ca/23264

145. Woster CM, Zwank MD, Pasquarella JR, WernerKa, S. Anderson JP,Greupner JT, Motalib S. Placement of a cervical collar increases the optic nerve sheath diameter in healthy adults: Am J Emerg Med. 2018;86:3430-4430.10.1016/j.ajem.2017.08.051

146. Asha SE, Curtis K, Healy G, Neuhaus L,Tzannes A, Wright K. Neurologic outcomes following the introduction of a policy for using soft cervical collars in suspected traumatic cervical spine injury: 10.1111/11/2024. doi:10.1016/j.jemari.2018.051

147. Bruston, Lichols M. Loo S, Evans T. Bendal, JC) Davis, K'UK: The ESCAPE-Evaluation Steering Committee. Evaluating soft collars in pre-hospital crai spine immobilisation: A cohort study on neurological outcomes, patient comfort and paramedic perspectives. Emerg Med Australas. 2024;36:862:867. doi:10.1111/1742-6723.14464

148. Ham WH, Schoonhoven L., Schurums MJ, Leenen LP. Pressure ulcers,indentation marks and pain from cervical spine immobilization with extrinsic tion collars and headblocks: An observational study. Injury, 2016;47:1924-1931. doi:10.1016/j.injury2016.03032

149. Kolb JC, Summers R, Galli RL. Cervical collar-induced changes in intracranial pressure. Am J Emerg Med. 1999;17:135-137. doi:10.1016/s0735-6757(99)90044-x

150. March JA, Ausband SC, Brown LH.Changes in physical examination caused by use of spinal immobilization. Prehosp Emerg Care.2002;6:421-424. doi:10.1080/10903120290938067

1.Mubos RJ,Stoley MA,Fuller J. Effect of cervical hard collar on intra-cranial pressure after head injury. ANZ J Surg. 2002;72:389-391. doi:10.1046/j.1445-2197.2002.02462.x

15.Stone MB,�Tubrido CM,Curan R.The effect of rigid cervical collars on in-ternal jugular vein dimensions. Acad Emerg Med.2010;17:100-102. doi:10.1111/11573/1597212.2009.00624.x

153. Jao S, Wang Z, Mukhi A, Chaudhary N, Martin J, Yuan V, Laskowski R, Huang E, Voswinkel J, Singer AJ, et al. Radiographic cervical spine injury patterns in admitted blur trauma patients with and without prehospital spi-nation restriction. Trauma Surg Acute Care Open.2023;8:e001092. doi:10.1136/saco-2023-001092

154. Lee SJ, Jan L, Liu CY,Tzeng IS, Chien DS, Hou YT, Lin PC, Chen YL,Wu MY, Yang GT. A Ten-Year Retrospective Cohort Study on Neck Collar Immobilization in Trauma Patients with Head and Neck Injuries. Medicina(Kaunas).2023;59:1974. doi:10.3390/medicina59111974

155. Lin HL, Lee WC, Chen CW, Lin TY, Cheng YC,Yeh YS, Lin YK, Kuo LC.Neck collar led in treatment of victims of urban motorcycle accidents:over or underprediction? Am J Emerg Med. 2011;29:1028-1033. doi: 10.1016/j.ajem.2010.06.003

156.Nitras A, Heimer SD, Drake RM, Reyes J, Morriss M, Haan JM. Pre-hospi-tal spinal immobilization:neurological outcomes for spinal motion restric-tion versus spinal immobilization. Kans J Med. 2022;15:119-122. doi:10.1716/j.kmol.vol.156213

157. Oosterwold JT, Sagel DCo, van Grunsven PM, Holla M, de Man-van Ginkel J.Berben S. The characteristics and pre-hospital management of blunt trauma patients with suspected spinal column injuries: a retrospective observational study. Eur J Trauma Emerg Surg. 2017;43:513-524. doi:10.1007/s000860-016-0688-z

158. Stroh G, Braude D. Can an out-of-hospital cervical spine clearance protocol identify all patients with injuries? An argument for selective immobilization.Ann Emerg Med.2001;37:609-615. doi:10.1067/mem.2001.114409

159.Yazici MM, Yavasi O.E. Effect of a cervical collar on optic nerve sheath di-ameter in trauma patients. World J Emerg Med. 2024;15:126-130. doi:10.5847/jwijm.1920-8642.2024.023

160. Berry,Carlson JN,Singleletary E,Zideman DA,Ring J. Use of Cryotherapy for Managing Epistakis in the First Aid Setting: A Scoping Review. Cureus.2021;13:e832.108:7759/cureus.14832

16.Wyickoff MH, Singlety EM, Soar J, Olasveeneng TM, Greif R, Liley HG,Zideman D, Bhanj F, Anderson LW, Avis SR, et al; on behalf of the CO-VID-19 Working Group.2021 International Consensus on Cardiopulmonary Resuscitation and Emergence Cardiovascular Care Science With Treatment Recommendations: summary from the Basic Life Support; Advanced Life Support; Neonatal Life Support; Education, Implementation, and Teams;First Aid Task Forces; and the COVID-19 Working Group. Resuscitation.2021;169:229-311. doi:10.1016/j.resuscitation.2021.10.040

162. Charlton NP,Swain JM,Brozek JL,Ludwikowska M, Singletary E,Zideman D,Epstein J,Darz A,Bak A,Karam S,et al.Control of Severe,Life-Threatening Ex-ternal blaining the Outf-Hospital Setting: A Systematic Review. Prehosp Emerg Care.2021;25:2357-267. doi:10.1080/10903127.2020.1743801

163.Furness A,Abey P,Kemp-Smith K, Bruce K, Lamond D, Taylor N, Jones P,Smelling RJ. Comparison of surf livesaver pressure point control and a com-mercial arterial tiquurtering for major lower limb haemorrhage: A randomised controlled crossover pilot trial. Emerg Med Australas.2023;35:1038-1040.doi:10.1111/1742-6723.14307

146.McKee JL, McKee IA, Ball CG,Tan E, Moloff A, McBeth P, LaPorta A,Bennett B, Filip s, Teichner C, et al. The iClamp in the treatment of pre-hospital craniomiaflaxial injury: a case series study. J Inj Violence Res.2019:11-29-34.doi:10.5249/jiv.v11i.917

16.McKee JL, McKee IA, Bolucin MD, Filips DF, Atkinson J, Ball CG, McBeth PB, Kirkpatrick MA.W A Randomized Controlled Trial using iTClamp,Direct Pressure, and Balloon Catheter Tamponade to Control Neck Hemorrhage in a Perfused Human Cadaver model. J Emerg Med. 2019;56:363-370. doi:10.1016/j.ijememander.2018.12.008

16. Mikpy R.,Gialvari R.,Gelikas S,Levy S,Ahmor A,Glassberg E,Shapira S,Benov A,Avital G. Human Pressure Points Technique for Massive Hemor-hage Contro-A Prospective Human Volunteer Study. Prehosp Emerg Care.2023;27:586-591. doi:10.1080/10903127.2022.2122644

167. Stuart SM,Bohan ML,Friedrich EE.Speed,Skill Retention, and End User Perceptions of Ilamp Application by Navy Corpsen on a Manikin

Djarv et al

First Aid: 2025 CoSTR

Model of Femoral Hemorrhage. Mr. Med 2023;188:e2496-e2501. doi:10.1093/milmed/usac355

168. Taylor NB, Lamond DW. Stopping Haemorrhage by Application of Rope tourniquet or inaugural Compression (SHARC) study. Emerg Medical Australas 2021;33:803-807. doi:10.1111/1147-6273.13736

169.Thompson P,Glassberg E,Alon Y,Bjerkigv CK,Eliassen HS,Radisomlensky L,Strandzen G, Talmy T, Almogoy. The effectiveness of the manual pres-sure points technique for hemorrhage control-The2022 THOR pre-conference meeting experience. Transfusion. 2023;63:S222-S229. doi:10.1111/tfr.17350

170.Barala Furelos R, Schmidt A, Mantela Guronb J, Aranda Garcia S,Otero-Agra M, Dti to NOliva E. Silva Oartis Iziss S. Fermar-Mendez F. Aquas Feasticities of Limb Applications of Tourniquets (AFLAT) during a lifeguard water rescue: a simulation pilot study. Prehosp Disaster Med 2024;29:53:58-8. doi:10.1017/S8140293X24000050

171. Beaven A, Ballard S, Mellon E, Briard R, Parker PJ. The Combat Applica-tion Tourniquet versus the Tactical Mechanical Tourniquet, J Spec Oper Med.2018;18:18:78. doi:10.55490/PR623/6N48

122. Bedri H, Ayoub H, Engelbart JM, Lilienthal G, Mael Cke, Skeete DA. Tourni-quet application for bleeding control in a rural trauma system: outcomes and implications for prehospital providers. Phesorg Emerg Care 2022;26:246-254. doi: 10.1080/10903127.2020.1868635

173. Carius BM, Tapia AD, Uhsan, Johnson SA, Cuenca CM, Lyabry RS,Schauer SG. STAT vs. CAT: A pilot comparison after a video demonstration. Am J Emerg Med.2021;47:305-306. doi:10.1016/j.ajem.2021.01.017

107. Covey,DGtentos CE. Field uarniques in a austenire military envi-ronment: A prospective case series. Injury. 2022;53:3240-3247. doi: 10.1016/j.injury:2022.07.044

157 Cremonini C, Néen D, Remasset P, Ricpinni A, Minmet A, Canamar CP,Benjemi ER, Demetriades D, Inaba K. Evaluation of the efficacy of com-mercial and noncommunitary tropqins for extremity hemorrhage control in a perfused cadaver model. J Trauma Acute Care Surg. 2021;90:522-526. doi: 10.1097/TA/00000000000003033

167.EB Asthatyl A, Kahl E, Methot F, Ledou-Hutchinson L, Frang, JM. Homer T. Vournet application by schoolchildren a randomized crossover study of three commercially available models. J Trauma Acute Care Surg.2021;90:566-6672; doi:10.1097/TA.00000000000003055

177.Ellis J., Morrow M M, Belau, A. Sztajkrycer LS, Wood JN, Kummer T, Serztajkyer MCD. The efficacy of novel commercial tourniquet designs for extremity hemorrhage control: implications for spontaneous re-sponder every day carry. Prehospon Disaster Med. 2020;35:276-280. doi:10.1017/S049023X200004X5

178. Gabbitas RL, Carius BM. Smart Tactical Application Tourniquet versus Combat Application Tourniquet: comparing layperson applications for arte-rial occlusion after a video demonstration. Cureus.2023:15e42615. doi:10.7759/cureus.42615

179. Gobsyly C, Dacyan-Faucher N, Schuler K, Lee A, Shah A, Cannon J,Kothera C. Blood vessel occlusion by the Laperson Audiovisual Assist Tourniquet (LAVA TO) compared to the Combat Application Tourniquet randomized controlled trial. West J. Emerg Med. 2023;24:566-571. doi:10.5811:westemf.15974.

180.Goolsy B, Conson CO, Goralnick E, Pacu-Achauen, N. Schuler K, Katera S, Chahar A, Cannon J, Prytez E, The Untrained Public's Ability to Apply the Layperson Audiovisual Assist Tourniquet v a Metab Application Tour-niquet: A Randomized Controlled Trial. Trial. J Am Coll Surg. 2023;236:178-186.doi:10.1097/CSK0000000000004032

181. Harcke HT, Lawrence LL, Gripp EW, Kesckemethyl, HR Kwe, RW Murphy S6D. Adult unputour for use in school-age emergencies. Pediatrics.2019;143:8e2013447. doi: 10.1542/peds.2018-3447

182. Hashimi ZG, Hu PJ, Jansen JO, Butler FK, Kerby JD, Holcomb JB. Characteristics and outcomes of prehospital tourniquet for use in trau-mai in the United States. Preshop Emerg Care. 2023;27:31-37. doi:10.1080/109031272.2021.202583

183.Hay-David AG, Herron JT,Thurptog A, Whittle C, Moham A, Bodger O,Hodgetts J, Pallister I. A comparison of improvised and commercially available point-of-roungmenting uquins in simulated traumatic amputa-tion with catastrophic hemorrhage. M Med 2020;1851e1536-e1541. doi:10.1093/milled/asua085

184.Henry R, Matsushima K, Ghafi C, Henry R, Wuethen H, Golden AC,Bramrama IS, TMAba K. Increased use of hospitaltright unitary and patient survival: Los Angeles countywide study. J Am Coll Surg. 2021;233:233-2392.eol.10106/jjamcollusburg.2021;03.023

18. Herron J, Hayd B, David H., Hodtsq T. Junori key application times compared with a Combat Application Tourniquet in trained and un-

trained populations. BMJ Mil Health. 2021;167:142-143. doi: 10.1136/bmmj-pyurtimal:2020-001662

186. Holinga GJ, Foor JS, Van Horn SL, McGuire JE. Performance evaluation of the Solo-T and the Combat Application Tourniquet in a perfused cadaver model.J Spec Oper Med.2022;22:49-55. doi: 10.55460/24E1-MJ5S

187. Katsnelson S, Oppenheimer J, Gerrasi R, Furer A, Wagner-Avraham L,Eisenkratt A, Nachman D. Assessing the current generation of tourniquets.Mil Med.2020;185:e377-e382.doi:10.1093/milmed/usz392

188.Katzenschlager S, Schneider NRE, Weilbacher F, Weigand MA, Popp E. Evaluating time until ligation in a novel tourniquet-a crossover randomized-controlled trial. Am J Emerg Med. 2024;79:97-104. doi: 10.1016/j.ajem.2024.02.026

19.Kelly JR, Levy MJ, Reyes J, Anders J. Effectiveness of the combat applica-tion tourniquet for arterial occlusion in young children. J Trauma Care Care Surg 2009;88:644-847. doi: 10.1097/TA.0000000000002594

10.1960. Letr Schroll, R Hunt, Pduchesne J, Marr,A Schoen J, Greiffenstein P,Stuke L, Smith A. Prehospital tourniquets placed on limbs without major vas-cular injuries, has the pendulum swung tuning too far? Am Surg. 2022;88:2103-2107.1201.117/00031348221088968

191. Mikad S, Mokhtak AK, Luckhurst CM, Breen KA, Liu B, Kaafarani HMA,Velmahos G, Mendoza E, Bloemers FW, Saillant N. Implications of the national Stop the Bleec campaign: the swinging pendulum of prehospital tourniquet application in civilian limb trauma. J Trauma Care Care Surg.2021:91,352-360. doi: 10.1097/TA.0000000000003427

192.Read DJ,Wong J,Liu R,Gumm K, Anderson D. Prehospital tourniquet use in civilian extreme trauma: an Australian observational study. ANZ J Surg.2023;93:1896-1900.doi: 10.1111/ans.18492

193.Salchner H, Isser M, Banayi L, Schachner T, Wiedermann FJ, Lederer W.Arial occlusion effectiveness of space blanket-improvised turniquets for the remote setting. Wilderness Environ Med. 2023;34:269-276. doi:10.1016/j.wem.202302.0207

194.Tatebe LC, Schanslter V, Hampton D, Chang G, Hanson I, Doherty J, Issa N,Ghandour H,Kingsley S,Sewart A,et al.The tight rope act: a multicenter re-gional experience of tourniquets in acute trauma resuscitation.J Trauma Acute Care Surg.2022;92:890-896. doi: 10.1097/TA/0000000000003491

195. Thai AP,Tseng ES, Kishawi SK, Robustenine JC, Ho VP. Prehospital tour-niquet application in extremity vascular trauma: Improved functional out-comes. Surgery.2023;174:1471-1475. doi:10.1016/j.surg.2023.08.002

19. Wall PL, Buising CM, Jensen J, White A, Davis J, Renner CH. Effects of tour-niquet features on application processes. J Spec Oper Med. 2023;23:11-30. doi: 10.55460/8FFG-1Q48

197. Wellme E, Mill V, Moran C E, Evaluating vournetiquet use in Swedish prehospital care for civilian triastum trauma.Eur J Trauma Emerg Surg.2021;47:1861-1866. doi: 10.1007/s0000-01341-0

198.Schroll R,Smith A. Alabaster K, Schroeppel T, Stillman ZE, Teicher EJ, Lita E, Ferrada P, Han J, Fullerton RD, et al.AAST multicenter prospective analy-sis of prehastial tournet used for extremity trauma. J Trauma Care Care Surg.2022:99-967.40. doi:10.1097/TA.000000000003555

1993. Ghouti-Terki L, Testa A, Frérancois G, Parahya S, Oancea I, De Geyer d'Orth,Gebri R,Coupel S.(Contribution of hemostatic dressings in the hemosta-sis of arterioftus valside: 0.1097/TA.000000000003455 Nephrol Ther. 2022;18:627-633. doi: 10.1016/j.nephro.2022.04.004

200.Kabeer M, Venugopalan PP, Subhash VC. Pre-hospital Hemorrhagic Control Effectiveness of Axiostat(R) dressing versus conventional meth-d in acute hemorrhage due to trauma. Cureus. 2019;11:e5527. doi:10.7759/cureus.5527

2011.Kilb-Eben Bassot,S. Schwartz D,Zubkov A, Gal-Oz A, Gorevoy A,Romach I, Grupper A. WoundClot(R) hemostatic gauze reduces bleeding time after arterial venous tubular discannulation. Blood Purif. 2021;50:952-958. doi: 10.1159/000514934

2023.Magir W, Lubetski A, Brutman-Barazani T, Martinowitz U, Kenet G.The hemostatic efficacy of chitosan-pads in hemodialysis patients with significant bleeding tendency. J Vasc Access. 2017;18:220-224. doi:10.5301/ya/500707

2033Wastian, M Smith JE, Wright C. Catastrophic haemorrhage in military major trauma patients: a retrospective database analysis of haemostatic agents used on the battlefield.J R Army Med Corps.2019;165:405-409.doi:10.1136/jramc-2018-001031

204.Djarv T,Douma M, Palmeri T,Yranem D,Berry D,Kloeck D,Bendall J,Morrison L, Singletary M, Zideman D; Members of the International Lai-son Committee on Resuscitation First Aid Task Force who met criteria as a collaborator include: Vere Borra, Jestin N Carlson. Duration of cooling with water for thermal burns as a first aid intervention: a systematic review. Burns(2022:485:261-262. doi: 10.1016/j.burns.2021.10.007

$\text{Djarv et al}$

First Aid: 2025 CoSTR

205. De Brier N, Doren O, Borra V, Singletary EM, Zideman DA, De Buck E;on behalf of the International Liaison Committee on Resuscitation First Aid Task Force. Storage of an abuvel tooth prior to replantation: a sys-tematic review and meta-analysis. Dent Traumatol 2020;363-453-476: doi:10.1111.ettd.12564

206. Bunwanna A, Damrongrungrung T, Puangsi Siri, Kongrant N, Chailertvanitkul P. Preservation of the viability and gene expression of human periodontal ligament cells by Thai proiscol. Extract. Dent Traumatol. 2021;37:123-130.doi: 10.1111/edit.12612

207. Srepirchanone P. Boonzong U. Sricholpech M. Comparative evaluation of periodontal ligament fibroblasts stored in different types of milk: effects on viability and biosynthesis of collagen. Eur J Oral Sci. 2019;127:332-332. doi:10.111/10/eos1.12621

208. Souza BDM, Garcia LFR, Bortolzzi EA, Felipte WP, Felpipe MCS. Ef-fects of several storage media on viability and proliferation capacity of periodontal ligament cells. Eur Arch Paediat Dent. 2020;21:53-59. doi:10.1007/s40368-019-00450-8.

Borsa B, Berry N, Dezder, C. Dysinglet, A. De Buck E. Compression wrapping for acute closed extremity joint a: synthesis systematic. J. Atri17.4051/2020;55:789-800. doi: 10.4085/1062-6050-0093.20

210. Sinato H. Massand S, Ingraham J. Proper preservation of amputated parts: A multi-level shortcoming. Am J Emerg Med. 2022;52:155-158. doi:10.1016/ajem2021.12010

211. Massand S, Sinato R, Liu AT, Shen C, Ingraham J. Improper preservation of amputated of amputated parts: a pervasive problem. Plast Reconstr Surg. Open. J8020.100-101. doi:10.1097/01g.o0000702828.18941.c541.

211a. Singale EM, Laermans J, Berry D, Cassan P, Pek JH, Thilakasiri K, Djvar T; on behalf of the International Liaison Committee on Resuscitation First Ald Task Force. Preservation of traumatic complete amputated or avulsied body parts in the out-of-hospital setting Task Force Synthesis Scoping Review.2024. Accessed December 4,2024.https://costcorl.org/docu-ment/preservation-of-traumatic-complete-amputated-oravulsed-body parts-in-the-prehosal-setting-fa-7391-ft-scoping-review.

212. Singletary Ea, Lermansek J, P.Jeh KJ, Cassan P Meyer D, Berry D. Thakasiikis K, Djar T. Preservation of traumatic completely amputated or arvulsed parts in the first aid setting: a scoping review. Cureus. 2025;17:e81998.doi:10.7769/cureus.81998

213. Akyurek M, Lujan-Hernandez J. Microsurgical replacement of completely raduls signal recovered from under snow. J CraniofugS 2020;31:e479-e481. doi:10.1097/SCS/0000000000006454

214. Borenstein A, Yaffe B, Seidman DS, Turs H. Microsurgical replantation of two total uvised scalps for J. Med Sci 1990;26:442-445.

215. Braga-Silva J, Ramos RF, Marchese GM, Piccinini P, Distal phanal am-putation with delayed presentation and successful reconstruction with re-position and flap after 2 weeks. Indian J. Plast Surg. 2016;49:491-421.doi:10.4103/0970-0358.197234

216. de Lagausie P.,Jehanno P.Sixyears follow-up of a penis transplantation in a child.J Pediatr Surg.2008;43:E11-E12:10.1016/j.epidsurg:2007;10.060

217. Dofak R, Stupka I. Atypical transplantation and reconstruction of fro-zen ear: A case report. Medicine (Baltim) 2020:39e20068. doi:10.1097/MD.0000000000020008

218. Facio FN Jr, Spessoto LC, Arruda P, Paica CS, Arruda JG, Facio MF. Penile replantation after five hours of warm ischemia. Lurr Case Rep. 2015;75:99.10:1016/j.eufr.2015.01.012

219. Fernandez-Palacios J., Duque OG, Benitez R, Bolana FL, Calderin JG.Successful hand replational in a seafarar after long-distance helicopter evaporation. A case report. Int Marit Health. 2009:60-14.17.

220 Firdus M, Richard J, Al-Hakim S, Suhabal Mulattib AW. Re-plantation of arm in children: a rare case report. Malaysian Orthop J.2017;11

212. Garcia-Murray E, Adn-Rivas O, Salico-Calidazat H. Delayed, bilateral,non-microvascular ear replantation after violent amputation. Plast Recon-str Aesthet Surg.2009;62:824-829. doi:10.1016/j.bjips.2007.11.005

222.Gunassagaran J. Tan YY, Ahmad TS. Successful lower limb replanta-tion of knee-level amputation in a child: a case report. Malays Orthop J.2022;16:122-125. doi:10.5704/MOJ.2203.019

223. Henry N. Bergman H. Fongo, D. Fibbbos G. Successful penile replan-tation after complete amputation and 23 hours ischaemia time: the first in reported literatures. BMJ Case Rep. 2020;13:e234964. doi: 10.1163/bcr-2020-234966

224. Kyrmizakis DE, Karatzanis AD, Bourolias CA, Hadjouriannou JK, Velegrakis GA. NonMicrosurgical reconstruction of the auricle after traumat-ic amputation due to human bite. Head Face Med. 2006;25:45. doi:10.1186/1746-160X-2-45

225. Li X-L, Wang W, Liu F, H, Wu, Liang D-S. Successful lower limb replanta-tion of knee-level amputation in a child: a case report. J Foot Ankle Surg.2020;59:427-430. doi: 10.1053/j.jfas.2019.08.024

226. Liang Y, Li X, Gu, Li, Xiao Y, Zhang W, Li Q, Chen G, Yang H, Tan M. Suc-cessful anuric replantation via microvascular anastomosis 10 h af-ter complete avulsion. Acta Otolaryngol. 2004;124:645-648. doi:10.1080/00016480410016603

227. Maki A, Al-Hayder S, Paulsen IV, Wolthers MS. [Microsurgical replantation of traumatic pomaticed lip. Ugeskr Laeger.2020;182:V04200293.

228. May JW. Digit replantation with full survival after 28 hours of cold ischemia. Plast Reconstr. Surg. 1981;67:566. doi: 10.1097/00006534-198104000-00039

29.Musa MU,Abdulujum A, Mashi SA,Yunusa B.Traumatic penile amputation in a 15-year-old boy presenting late in northwestern Nigeria. Clin Case Rep.2016;478-788. doi:10.1002/ccr3.629

320.Salem HK,Mostafa T. Primary anastomosis of the traumatici cally amputated pernis. Andrologia.2009;41:264-267. doi:10.1111/1.1493-0272.009.009.00925.x

21. Selivm, C, Varikliog M. A. rare case report: testicular amputation. Andrology.2018;6:111-112. doi:10.1111/ andrcl.12541

928. Szlosser Z, Walaszek I, Zyluk A. Successful replantation of 2 fingers in an 82-year-old patient: a case report. Handchir Mikochrir Plast Chir.2015:47-69:68. doi: 10.1055/s-0034-1395546

23.Thus, Umi M, Minami I, Ishii S. Successful replantation of an ampu-tated leg in a child. Plast Reconstr Surg. 1979;63:613-617. doi:10.1097/00006534-197905000-00002

24.Wehl FC, Chang YL, Chen HC, Chuang CC. Three successful digi-tal replantations in a patient after 84, 86, and 94 hours of cold ischemia time. Plast Reconstr Surg. 1988;82:346-350. doi:10.1097/00006534-198808000-00026

253. Elsani R. Replational: nse of composite graft of the nasal ala: case report. Acta Chir Plast 1974;16:124-127.

236. Berger A, Meissl G, Miller S, Piza H, Piza H.[Complications and failures through negative selection in replantation of amputated extremities]. Handchirurgie.1977;9:59-62.

237.O'Brien BM, Miller GD. Digital reattachment and revascularization. J Bone Joint Surg Am. 1973:557.714-724.

238. Hayhurst JW,O'Brien BM, Ishida H, Baxter TJ. Experimental digi-tal transplantation after prolonged cooling. Hand. 1974;6:134-141. doi:10.1016/0072-968x(7490077-1

239. Van Giesenier, PJ Aeber, Aevan, Urbaniak JR. Storage of amputated parts pri-or to replariation: an experimental study with rabbit ears. J Hand Surg.1983;8:60-65. doi: 10.1016/s0363-5023(83)80055-0

240.Waakulak S, Vanadongvan W, Unnanantana A. Prognostic factors for ma-jor limb re-implantation at both immediate and long-term follow-up. J Bone Joint Surg Br. 1998;80:1024-1030. doi: 10.1302/0301-620x.80b6.8761

241. Chen J, Huang Y, Liu Z. Analysis of the factors affecting survival in digital replantation. Int J Clin Exp Med 2017;10:5445-5448.

242. Li J, Guo Z, Zhu Q, Lei W, Han Y, Li M, Wang Z. Fingertip replantation:determinants of survival. Plast Reconstr Surg. 2008;122:833-839. doi:10.1097/PRS.0b013e318180ed61

243. Okumus A, Cerko Xian R. Upper extremity replantation results in our se-ries and review of replantation indications. Ulus Travma Acil Cerrahi Derg.2020;26:123-129. doi: 10.14744/tites.2019.85787

244. Tark KC, Kim W,YE LL H, Lew JD. Replantation and revascularization of hands: clinical analysis and functional results of 261 cases. J Hand Surg Am.1988;14:17-27. doi:10.1016/0363-5023(89)90054-3

245. The Hoang, Nai LH, Li H, Staudenmaier R, Hoehnke C. Complete middle forearm amputations after avulsion injuries--microsurgical replanta-tion results in Vietnamese patients. J Trauma. 2009;66:1167-1172. doi:10.1097/DA013e318173f846

246. Yu, Li H, Bing L, Shui H, Jinle W, Yinrong Y. Nonsurgical factors of digital replantation and survival rate. Indian J Orthop. 2015;49:265-271.doi: 10.1043/0019-5413.156185

247. Ma Z,Guo F, Qi J, Xiang W, Zhang J. Effects of non-surgical factors on digital transplantation survival rate: a meta-analysis. J Hand Surg Eur Vol.2016:411-175:163. doi: 10.1177/1753193415594572

248. Shaterian A, Rajaii R, Kanack M, Evans GRD, Leis A. Predictors of digit sur-wival following replantation: quantitative review and meta-analysis. J Hand Microsurg.2018;10:66-73.3. doi:10.1055/s-0038-1626689

249. American Red Cross. Wouds and Bleeding. In: First Aid/CPR/AED Partici-part's Manual American Red Cross; 2021.

250. Indian Red Cross Society. Indian First Aid Manual St. John Ambulance As-sociation, India; 2016.

Djarv et al

First Aid:2025 CoSTR

251. International Federation of Red Cross and Red Crescent Societies. Interna-tional First Aid. Resuscitation and Education Guidelines 2020. International Federation of Red Cross and Red Crescent Societies.2020.Accessed Sep-tember 22,2024.https://www.confstratacentre.org/amputation/

252.McDermott BP, Anderson SA, Armstrong LE, Casa DJ, Cheuront SN, Cooper L, Kenney WL, O'Connor FG, Roberts W. National Athletic Training' Association Position Statement: Fluid Replace-ment for the Physically Active. J. Athl train. 2017;52:877-895. doi:10.4085/1062-6050-52.9.02

2530. Brora V, De Brier N, Berry DC, Zideman D, Singletary E, De Buck E; on be-half of the International Liaison Committee on Resuscitation First Aid Task Force.Oral/Brydium-bearing leverages for treating exercise-associated dehydra-tion: a systematic review. Part l: carbohydrate-electrolyte solutions. J Ath/Train.2023;60:34-54. doi: 10.4085/1062-6050-0682.22

254. De Bier n, Bora V, Berry D, Zideman D, Singletary E, De Buck E; on behalf of the International Liaison Committee on Resuscitation First Aid Task Force.Alytication on oral rehydration by treating exercise-associated dehydration as to carbohydrate-electrolyte drinks. AthI train. 2025:60-0582.22

255. Schunemann HJ, Wierci Woch, Broxe J, Exandia-kobaltzeta L, Mustafa RA, Manja V, Brignardello-Petersen R, Neumann I, Falavigna M, Alhazani W, et al. GRADE Evidence to Decision(EID) frameworks for adop-tion, adaptation, and de novo development of trustworthy recommenda-tions: GRADE-ADOLOPMENT. J. Clin Epidemiol. 2017;8:1011-101. doi:101016/jclinepi.2016.09.009

256.McGee RG,Webster AC,Lewis RS,Welford M.Invertions for the symp-toms and signs resulting from jellyfish gosts. Cochrane Database Syst Rev.2023;8:CD009688. doi: 10.1002/1465185.8009688.pub3

257. Pek JH, Lim SH, Ong GY, Djar T, Douma M, Welsford M, Charlton NP.First aid treatment of jellyfish sings: a systematic review. Cureus 2025;17:e84289. doi:7.1075/cureus.84289

258. Pek JN, Sweim S, Charlton NP, Ong G, Welsford M, Singletary EM,Douma MJ,Carlson J.NJ,Dary T,On behalf of the International Liaison Com-mittee on Resuscitation First Aid Task Force.Treatment of jellyfish Sings.Published 2024. Accessed April 1,2025.https://colr.licororg/document/treatment-joJellyfish-stings-fa-7211-18f-r

259. Bowra J, G M, Morgan J, Swinburn E. Randomised crossover trial compar-ing hot showers and ice packs in the treatment of Physalia envenomation.Emerg Med.2002;14:A22.

260.DeClerck MP,Bailey Y,Craig D,Lin M,Auerbach LJ,Linney O,Morrison DE,Patry W,Auerbach PS.Efficacy of topical treatments for Chrysora chinen-sis species: a human model in comparison with an in vitro model. Wilderness Environ Med.2016;27:25-38. doi: 10.1016/j.wem.2015.10.008

261. Isbister GK, Palmer DJ, Weir RL, Currie BJ. Hot water immersion v icepackers for treating the pain of Chironex fleckeri stings: a randomised controlled trial. Med J Aust.2017;206:258-261. doi:10.5694/mja16.00990

262. Loten C, Stokes B, Worsley D, Seymour JE, Jiang S, Isbister GKA. ran-domised controlled trial of hot water(45°C) immersion versus ice packs for pain relief in bluebotl tlestings. Med J Aust 2006;184:3293-333. doi:10.5694/1,1326-53772006.tb00265.x

263.McCullagh N.,Pereira P,Cullen P,Mulcahy R,Bonin R,Little M,Gray S,Seymour J. Randomised trial of magnesium in the treatment of Iru-kandji syndrome. Emerg Med Australas. 2012;24:560-565. doi: 10.1111/j.1742-6723.2012.01602.x

264.Nomura JT,Sato RL,Ahern RM,Snow JL,Kuwaye TT,Yamamoto LG.A randomized paired comparison trial of cutaneous treatments for acute jel-lyfish (Carybdea alata) stings. Am J Emerg Med. 2002;20:624-626. doi: 10.1053/ajem.2002.36710

265. Thomas SC, Scott GA, Galanis DJ, Goto RS. Box jellyfish(Carybdea alata) in Waikiki: their influx cycle plus the analgesic effect of hot and cold packs on their strings to swimmers at the beach: a randomized, placebo-controlled,clinical trial. Mathai Wedm J.2001;60:100-107.

266. Turner B,Sullivan P. Disming the bluebottle: treatment of Physalia enven-omation, Med J.Aust 1980;2:394-395.

267. Lopez A, W R, Bernstein J. A prospective study of the acute therapy of jellyfish envenomations. Clin Toxicol.2000;38:503-582.

268. Knudsen K, A. S. Hot water immersion treatment for lion's mane jellyfish stings in Scandinavia. Clin Toxicol. 2016;54:512.

269. Yoshimoto CM, Yanagihara AA. Cnidarian (coelenterate) envenomations in Hawaii M'offuring heat application. Trans R Soc Trop Med Hyg.2002;96:300-303. doi:10.1016/s0035-9203(02)90105-7

270. Birsa LM, Verity PG, Lee RF. Evaluation of the effects of various chemi-cals on discharge of and pain caused by jellyfish nematocysts. Comp Biochem Physiol C Toxicol Pharmacol 2010;151:426-430. doi:10.1016/j.chpcx.2010.01.007

271.yo MJ,Lee H,Bae SK,Heo Y,Choudhary I,Yoon WD,Kang C,Kim E.Mod-ulation of jellyfish nematocyst discharges and management of human skin stings in Pemilemonoma norurai and Carybida more. Toxicon.2016;109:26-32. doi:10.1016/j.toxicon.2015.10.019

272.Cegolon M, Heymann WC, Lange JH, Mastrangelo G. Jellyfish stings and their management: a review. Mar Drugs.2013;11:523-550. doi:10.3390/md11020523

273.Haznski MF,Nolan JP,Aidinck R,Bhanji F,Billi JE,Callaway CW,Castren M,de Caen AR,Ferrer JM,Finn JC,et al.Part 1:executive summary:2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation.2015;132:S2-39. doi:10.1161/CIR.0000000000000270

274. Douma MJ,Aves T, Allan KS, Bendall JC, Berry DC, Chang WT, Epstein J,Hood N, Singletary EM, Zideman D, et al; on behalf of the First Aid Task Force of the International Liaison Committee on Resuscitation. First aid cooling techniques for heat stroke and exertional hyperthermia: a sys-tematic review and meta-analysis. Resuscitation.2020;148:173-190. doi:10.1016/j.resuscitation.2020.01.007