The American Heart Association (AHA) and American Red Cross released comprehensive updated guidelines for first aid, marking the first major revision since 2010. The guidelines, published in Circulation, provided 179 recommendations covering medical, traumatic, environmental, and toxicological emergencies.

The guidelines presented changes to several first aid practices. The recommendations included stopping routine spinal immobilization for trauma patients and discontinuing the use of pressure points for bleeding control. The guidelines also addressed opioid overdose response.

None of the 179 recommendations received Level A evidence support. Thirteen recommendations were supported by Level B randomized evidence, while 23 were backed by Level B nonrandomized evidence. The majority relied on Level C evidence, with 65 recommendations based on limited data and 78 on expert opinion.

The changes included:

• Removal of rigid cervical collars and spine boards from routine first aid practice
• Immediate cooling for thermal burns with clean running water
• Opioid overdose response combining naloxone administration with CPR
• Bleeding control emphasizing direct pressure over pressure points
• Chemical exposure protocols, including specific eye irrigation procedures

The guidelines utilized a "modular knowledge chunks" format, organizing recommendations into sections for specific conditions or scenarios. Each module included recommendations with corresponding levels of evidence.

Environmental emergency sections covered hypothermia, frostbite, and heat-related illnesses. The guidelines specified rewarming techniques and temperature ranges for cold-related injuries.

Toxicological emergency protocols addressed chemical exposures, snake bites, and marine envenomations. The guidelines detailed rapid decontamination for chemical exposures.

The writing committee identified knowledge gaps in pediatric first aid and care delivery in low-resource settings. They noted the need for research on technology integration, including mobile phones and wearables.

Matthew J. Douma, MN, RN, co-chair, reported that existing research primarily included male and White subjects from North America and Western Europe.

The guidelines specified criteria for emergency medical services activation and provided instructions for interim care pending professional medical attention.

Implementation guidance included recommendations for first aid education and training. The guidelines advocated for universal access to first aid education.

The document resulted from collaboration between emergency medicine, pediatrics, toxicology, and critical care specialists. The writing committee underwent conflict-of-interest screening, and recommendations received peer review before publication.

Conflict of interest disclosures can be found in the guidelines.