Circulation. 2020;142:e287–e303. DOI: 10.1161/CIR.0000000000000900 October 27, 2020 1 *This article represents the author’s opinions and does not represent the offcial policy or position of the Uniformed Services University, Defense Department, or US government. Key Words: AHA Scientifc Statements ◼ bleeding ◼ chest pain ◼ dental avulsion ◼ heatstroke ◼ hypoglycemia ◼ stroke ◼ tourniquet Jeffrey L. Pellegrino, PhD, MPH, Co-Chair Nathan P. Charlton, MD, Co-Chair Jestin N. Carlson, MD, MS Gustavo E. Flores, MD, NRP Craig A. Goolsby, MD, MEd* Amber V. Hoover, RN, MSN Amy Kule, MD David J. Magid, MD, MPH Aaron M. Orkin, MD, MSc, MPH Eunice M. Singletary, MD Tammy M. Slater, DNP, MS, ACNP-BC Janel M. Swain, BSc, BEd, ACP © 2020 American Heart Association, Inc, and The American National Red Cross. AHA/RED CROSS GUIDELINE FOCUSED UPDATE 2020 American Heart Association and American Red Cross Focused Update for First Aid Circulation https://www.ahajournals.org/journal/circ TOP TAKE-HOME MESSAGES 1. First aid providers can use the signs of weakness in the face (eg, droop), arm, or grip on one side of the body, or speech disturbance to identify individu- als with a possible stroke and should activate emergency services when this occurs. 2. After activating emergency services, frst aid providers may encourage alert adults experiencing nontraumatic chest pain to chew and swallow 162 to 324 mg of aspirin. This recommendation applies to all adults except for indi- viduals who have an aspirin allergy or individuals who have been advised by a healthcare provider not to take aspirin. 3. Alert adults and children with suspected hypoglycemia should be given glu- cose to swallow. If symptoms worsen or do not resolve within 10 minutes, emergency services should be activated. 4. Tourniquets should be used as soon as available for the treatment of life- threatening extremity bleeding or bleeding that cannot be controlled with direct pressure. 5. Direct manual pressure, with the use of a hemostatic dressing if available, should be used for the treatment of injuries with life-threatening bleeding not amenable to the use of a tourniquet, or for extremity bleeding until a tourniquet is available. 6. Immediate replantation of an avulsed tooth is best, but if this is not an option, transporting the tooth in a solution like Hanks’ Balanced Salt Solution or in plastic wrap to a dental provider increases chances of tooth survival. Tap water should not be used as a transport medium. 7. For people experiencing exertional hyperthermia or heatstroke, cold-water, whole-body immersion is the most effective technique for rapidly reducing core temperature and should be initiated as soon as possible and continued until a temperature of less than 39°C (102.2°F) is reached or resolution of signs and symptoms of heatstroke occurs. If cold-water, whole-body immer- sion is not available, other forms of cooling, such as commercially prepared ice packs, cold showers, and fanning, may be reasonable. PREAMBLE First aid, or the initial care provided for an acute illness or injury, has the goals of preserving life, alleviating suffering, preventing further illness or injury, and pro- moting recovery. First aid can be initiated by anyone in any situation and includes self-care. General characteristics of the provision of frst aid, at any level of train- ing, include recognizing, assessing, and prioritizing the need for frst aid; provid- ing care using appropriate competencies; and recognizing limitations and seeking Downloaded from http://ahajournals.org by on October 21, 2020