Deadly Reaction (Allergic Reactions That Kill)

It was about ‪3:00am (some 17 yrs ago) and I was asleep on the uncomfortable cot at my ambulance resting quarters. It had been a long day of calls and we had taken advantage of the short reprieve to get a little rest. We were woken by that all too familiar buzzing of pagers and alarms letting us know that our rest was over. We quickly jumped into the now very cold ambulance rubbing our hands together. Our breath visible in the cold. My partner got the ambulance moving as I read the call aloud still feeling that adrenaline rush of being awoken from a dead sleep. The call was for a man suffering from a swollen cheek. When we arrived on scene we found the man as described, cheek swollen but alert and in no obvious distress. We began the usual investigative questioning searching for a reason for his current state of a puffy cheek. We were told he had been suffering from an infection and was at the hospital earlier that day because his other cheek was swollen. They treated him at the hospital and the swelling went down and he was sent home with antibiotics and was told he had some sort of infection. We assumed that this infection was probably the cause of his current swelling. We took his vital signs. Everything was normal. No other signs of swelling. He was breathing normally and his oxygen level was 100%. We put him on oxygen anyway just as a precaution. We repeatedly asked him if he was having any trouble breathing and he would always shake his head no. We informed him that we would be taking him to the hospital just to be on the safe side and loaded him up onto the gurney. I remember looking him in the eye, putting my hand on his and telling him that if he had any trouble breathing to put his hand up and let us know. He gave me a thumbs up and out the door we went, loading him into the ambulance. The hospital was pretty close, maybe 10 minutes away. I was driving. It should have been a quick and easy call but it would end completely differently.  What happened next was a dramatic change in his presentation, literally within minutes. He went from being alert and breathing with no trouble to serious respiratory distress. I remember looking behind me at the sudden chaos and panic as my partner began trying to get an airway in him, calling his name. I remember driving as fast as I could, lights on and siren blaring as I spoke to the hospital on the intercom. I remember saying, "starting CPR". We rolled the gurney into the emergency room pounding on his chest and pushing breathes that would not go in with a bag mask. In the first bay of the ER, we all flew around the room as the Doctor on duty tried repeatedly to get a tube down the man's throat with no luck and eventually slicing his throat in a last ditch effort to get air. Everything was tried including repeated medications but it was already to late. The man died right there in the ER. This was the same man who no less then 10 minutes before smiled at me with a thumbs up sign. So what happened and how did it happen so quick? This man did have an infection, but he also suffered an allergic reaction to the antibiotics given to him. A reaction so severe that it took him from talking to dead within 20 minutes. He did not know he was allergic and neither did we. As with any ambulance call where the outcome is bad, we beat ourselves up questioning what could have been done differently. I still think of this man sometimes. 

This was not my only experience with the unpredictability of severe allergic reactions (Anaphylaxis). I had seen my mother suffer from them and I too have had my own trips in the ambulance for this very reason. I carry my epinephrine with me at all times and wear an alert bracelet as well. I know that horrible feeling of impending doom all too well; when you feel like your ability to breathe is about to be taken away.

Anaphylactic Reactions are nothing to joke about. They can be deadly and they do kill people. Below are 10 tips I have to help others to stay informed on this serious topic. Also, we offer Anaphylactic reaction information and epinephrine injector training as part of all of our CPR and First Aid course options. We also offer this training free of charge at our facility as well. Please visit our website for more information or feel free to contact us. (‪www.lifefirsttrainingcenter.com)

1. If you've had a severe allergic reaction in the past, make sure you always carry an epinephrine injecting device with you at all times.

2. There are a variety of different epinephrine injection devices on the market and there are options available to help cover the cost of these injectors as well. We encourage you to discuss all options with your physician. For more information please contact our training center. 

3. If you or someone you know has had a severe allergic reaction in the past, make sure that friends and family know how to use their epinephrine injecting device. Injector trainers usually come with the device but may also be requested from the manufacturer. We also provide this training through our training center free of charge.

4. Keep your epinephrine injector at room temperature and out of the heat. Keep an eye out for the expiration date. Replace your device when expiring. Also keep your medical history, allergies and prescription medication information easily accessible in case of an emergency. We do supply both allergy and medical information wallet cards free of charge through our training center.

5. If you or someone you care about has suffered a severe allergic reaction in the past, make sure to be a strong advocate/detective. Keep an eye out for possible situations where the individual may come into contact with what their allergic reaction was to. Do not be afraid to speak up. For example, if you are allergic to latex make sure to mention this to all dental and medical providers and be aware that sometimes restaurants staff use latex gloves when handling food. If you're allergic to a certain food product, make sure you mention it to your waiter at every restaurant even if you're not ordering something that has that product in it. 

6. You may not know that you're allergic to something if this is your first reaction. If somebody has a severe allergic reaction, it is possible that there may not be an epinephrine injecting device available. If this is the case, please make sure to call 911 immediately if you notice signs of a possible Anaphylactic reaction. Also, try your best to keep the person as calm as possible. Be prepared to start CPR if needed. Signs of a possible Anaphylactic reaction include swelling and/tingling around the face, mouth, tongue, lips or inside the throat. A rash may be present but that is not always the case. If someone complains of these symptoms, especially if it's shortly after eating food, taking medication or being stung by an insect, assume it is it possible allergic reaction and call 911 immediately. 

7. Get informed on the current laws in your state regarding the use of epinephrine injectors in schools and businesses. In the state of California, schools and even some businesses are now able to keep epinephrine injectors on site to be used on anyone who shows symptoms of a severe allergic reaction.

8. If you work in the medical field or another industry where you may come in contact with possible life-threatening Allergy triggers such as latex, please take these allergies seriously. If a patient tells you they're allergic to latex gloves, make sure there are no latex gloves anywhere around them. Do not touch them with gloves even for a second. If a patient tells you they are allergic to latex or it is in their file and you use gloves on them anyway, you can be held liable and you're putting that person's life at risk. Educate the other staff in your facility in regards to the serious nature of Anaphylactic reactions as well.  

9. Take a First Aid and CPR training course every two years so you are prepared when an emergency such as a severe allergic reaction occurs. Please see our website for upcoming course dates and times.  

10. Educate others. There are still far too many people in this world who know nothing about Anaphylactic reactions and just how serious they can be. Now that you have this information, please share it with others. The more people that are educated on Anaphylactic emergencies, the more lives will be saved. 

In honor of Invisible Illness Week, Here are some tips for family and friends of someone living with a chronic illness. By K.Harney (CEO LFTC)

1.  Don't limit us but respect our limitations:  Just because somebody is suffering from chronic illness, that does not authorize the people around them to try and "Captain" their lives for them. People with disabilities should be allowed to have the same hopes and dreams as everyone else and given a fair opportunity to achieve. Sure, sometimes those achievements may be more difficult to attain.  There will be some things that they may not be able to do. However, it does not mean it is fair to say they should not try.  Let's face it, all of us, sick or healthy have limitations.   It should be up to us as individuals to figure out what those are. In that same regard, when limitations are revealed they should be respected. If you know someone who is chronically ill and they tell you they cannot do something or be somewhere because of their illness, try to be understanding of that. They know their bodies better than you and if they tell you that something is going to be difficult for them, believe them.  Know that they are not trying to let you down, they are just trying to take care of themselves. They should not be made to feel guilty for that. 

2.  Learn about our disease(s): One of the very best ways to show support is to become educated about the illness. Learning about the symptoms and treatments will show that you care and you want to be there to support.  You will also be surprised how this opens the door to conversation and connection.  One of the best ways to show support to someone fighting a chronic illness is to become informed on exactly what they are fighting.  You will likely be surprised to learn about what they are going through since people with chronic illness rarely share their challenges to the extent that they are suffering.

3.  Focus on being supportive, not trying to fix us: I have 5 autoimmune diseases.  They are not curable.  Yes, there may be treatments or even lifestyle changes that can improve certain illnesses but please don't ever assume that you know how to fix someone with chronic illness.  Just because drinking some nutritional shakes cured your gout, does not mean it will stop my spine from fusing. Just because your nasal polyp disappeared after you prayed to God does not mean God can heal my brain lesions. Do not assume that it must be caused by what I am eating when you don't even know what I eat! (I eat very healthy, organic, avoiding hormones and gmo's, etc by the way). Being sick is not our fault.  It is not a punishment. Avoid comments that start with, " You should". Stay away from comments that come from a place of judgment and instead try comments that come from a place of compassion. 

4. Be aware that looks can be deceiving:  Although we may feel like the walking dead, we don't necessarily look that way.  Do not assume we don't struggle because we don't struggle out in the open.  I can do most of what everyone else can do, it is just 10 times harder.  I love the water and doing just about any water activity that I am capable of. I love to snorkel, swim, kayak, and go river rafting.  There are some activities that I just can't do.   I am ok with that.  Keep in mind that just because you see someone with chronic illness partaking in the activities of life, it does not mean they are not truly sick.  Doing the activities I love is vital to keeping me going for many reasons, both physical and mental. However, that does not mean those activities come easy for me.  Quite the opposite actually. I may have to make adjustments and alterations you are unaware of.   I will also pay with extreme fatigue and pain for days after a particularly active day.  When you have a disease(s) that is there to stay, you have to learn how to evolve to get through life. When you see me smiling and laughing, that does not automatically mean I feel fine. I want to share in life's joys just like someone who's healthy. Just because someone is not in a wheelchair or not on crutches does not mean it's easy for them to get around. Just because you see them moving around, it doesn't mean they are not in pain. You may not know that for those social gatherings or busy days at work they may have to take pain pills just so they can function. Perhaps the next day they may be so sick that they will be couch ridden recuperating. When you deal with something every day of your life, you don't bother mentioning it everyday.  You evolve to a new normal but that doesn't mean it does not effect you. 

5.  Remember our reality is different than yours:  Understanding chronic illness is like most things in this world in that if you have not experienced it yourself, it can be very difficult to understand.  For example, somebody who deals with chronic migraines has a much different experience than someone who gets an occasional headache. Someone who has a little trouble sleeping here and there has a much different experience than someone who suffers from true insomnia. Everyone will suffer from pain, fatigue and other ill feeling symptoms during different times in their lives.  That is just part of life. However, the levels of such symptoms can vary immensely from person to person. Do not ever assume the pain that you may have felt is equivalent to what someone else feels. Also, people handle the symptoms in different ways. Just because someone does not complain about their symptoms does not mean their pain is less.

6. Small gestures make big impressions:  There are a lot of online communities for people suffering from chronic illness. By far the number one topic discussed over and over is the feelings of loneliness, judgement and abandonment that people experience from others and how horrible that can feel. When someone is going through a difficult time, that is when they need the people around them the most. Coincidentally, in many situations that is when the people around them flee. There are a lot of theories that go around the chronic illness community about why this is.  I could write a whole page on that. Regardless of the reason, what I would say to people who know someone who has a chronic illness is simply stay connected. A small gesture that may only take you a few minutes of your time, can have a big impact on somebody suffering from chronic illness. This could be something like sending a card, texting a supportive message or funny picture, inviting them over to watch a movie or asking if you could bring a movie and dinner to them.  Keep in mind that when somebody is feeling particularly ill, they may not be up to housecleaning and therefore may not want people over. On the other hand sometimes if you're feeling ill, it is easier to stay at home in your pajamas then having to go to someone else's place. My best advice would be to offer both options and let the person with a chronic illness choose what works best for them without any guilt/pressure added.  Offering to accompany someone suffering from chronic illness to an upcoming appointment is a very thoughtful way to show support. If you know that they're having surgery or some sort of treatment that's going to make it harder for them to get around for a while, offering to bring food or help out in other ways is very kind. If they have young children, an offer to babysit or pick kids up from school may be a good way to show support. 

7.  Check in: One thing you learn pretty early on in the chronic illness fight is that many times people around you don't really want to hear about it.  After all when someone says, "hi, how are you doing", they are probably hoping you will just say, "fine". When someone answers with, " not great.  I have been pretty sick lately", people don't always know how to respond and may even respond with a comment that is taken as insensitive or uncaring. For this reason, people with chronic illness may keep their pain both physically and mentally to themselves adding to the isolation of living with chronic illness.  Taking the time to send a quick text that says, "Thinking of you or how are you feeling this week?", can mean a lot. If you know that somebody has an important medical test or surgery coming up, take a moment to jot down a reminder in your phone so you can check on them that day and see how it went or give them positive wishes beforehand.  Also, remember that most chronic illnesses are not going to just go away so continue to check in overtime, reminding them that you have not forgotten that they may be struggling.

8.  Only offer support that you know you can give:  I have mentioned several ways to show support above.  When offering support try to think of something specific that may be helpful that you know you could and would really do.  Do not make offers that you don't really mean. I think a lot of times people offer "empty support" in an attempt to make themselves feel like they are being supportive.  It is really easy to say, "let me know if you need anything" but ask yourself, what do you really mean by that? Of course everyone is busy with things going on in their own lives and people with chronic illness really do understand that. Remember that even the smallest, simplest gesture can mean a lot though.

9.  Some comments can be hurtful. Be thoughtful in what you say:  Many times comments are not being made to be hurtful but we interpret them that way. The most infamous comment is, " you don't look sick". I think those saying that probably mean it as a compliment actually but many people with chronic illness feel that comment means you don't believe they are sick and it invalidates the agony they go through. Some other comments I have heard include:

1.  Your too young to have that much wrong with you 

2.  Why would you want to put your body through that

3.  You have that, oh yikes that's bad

Those are just a couple examples. There have been many more. 

The one that will forever stand out for me though was," How long do they think your gonna live. Your disease is fatal.  You know that right?"  I was at a dentist apt when the dentist said this to me. I was in shock when he said it. All I wanted to do was tell him off and leave but it was right in the middle of a procedure so I politely explained that my disease was not  necessarily fatal.  The symptoms can be but I planned to be around a very long time. I got through the apt, cried on the way home and of course never went back to that dentist again. 

10. Forgive our bad days: Being in chronic pain, especially with little sleep, would make anyone cranky.  If we seem a little on edge some days please be understanding. I am very lucky that I have someone in my life that truly is there in sickness and in health and in good and bad. For the most part you will find me smiling but there are some days where I have just had enough and that's okay. Also remember that laughter is the best medicine.  There is not a day that goes by that I do not laugh.  My SO and kids make me laugh all the time and it really does keep me going.

Choking...It was just another day

It is a day like any other.  You wake up and begin to get ready for work like you do each day without ever knowing this day would be different .  You are listening to your favorite morning radio show as you get ready to conquer another day.  As you take a bite of your bagel something you hear on the radio makes you laugh.  When you laugh a piece of the bagel goes onto the back of your throat.  As you feel it hit the back of your throat there is a moment of instant panic as your ability to draw in a air disappears.  Your heart begins to race as you desperately try to cough but can't.  You are choking.

Of all of the many lifesaving techniques we teach at Life First Training Center, relief of a foreign body airway obstruction (relief of choking) is one of the most common emergencies that our students will come across in their own lives.  Almost everyone will choke or be present when someone else chokes at least one time in their life.  It is vital that everyone knows what to do when a choking emergency occurs.  

At each of our CPR classes, we hand out a paper where students can tell us how they have used their CPR or First Aid training in a real life situation.  We have received countless stories from students on how the training has impacted their lives.  What we hear about most frequently however are stories about choking.  It seems like almost everyone has at least one choking story.  Do you have one?  I know for myself, I have many.  As the owner of Life First Training Center, I have always had an interest in health and safety since childhood.  This may come from the fact that my own sister died as an infant from drowning.  I took my first CPR class when I was only about 11 years old as part of a junior life-guarding program.  Back then the CPR training consisted of training on  one full size Annie manikin for everyone.  We would take turns by wiping her mouth each time with an alcohol pad and going around in a circle practicing as the instructor lectured.  Wow have times changed.  Training of course is much more involved and polished now, including video instruction, advanced manikins, cleaner practices, etc.    I went on to take many CPR classes and became an instructor when I was around 20 yrs old.  I won't say how old I am now but let's just say, it's been awhile since that first class when I was 11. 

I remember choking myself 3 different times as a child.  Well, the first time I actually do not remember because I was a toddler but my mother had told me a story of how I choked on an orange, which she was able to pull from my throat.  I do remember choking again when I was only around 5 yrs old.  I choked on a potato chip.  I can actually remember that feeling of what it was like to feel the chip stuck in my throat.  I also remember my brother carrying me as I was crying after the incident because my throat hurt so bad.  The 3rd time I choked as a child was actually a rather ironic story because I choked on a jaw breaker candy.  What makes that story ironic is that my mother never let me have jawbreakers.  I remember asking her if I could get one out of the candy machine at the grocery story on many occasions and she would always say no because I could choke.  That was back when you could actually use a penny to buy something.  You could buy a gumball for a penny back then.  Finding a penny on the street was cool back then.  Now, not so exciting to see one glimmering on the ground.  I was probably around 10 when the 3rd choking incident happened.  I was at a softball game and one of my team members offered me a jaw breaker.  I remember hesitating to accept because I knew my mom did not want me to have it but I thought, "hey she will never know".  I took the jawbreaker and at some point sure enough it went to the back of my throat and I began to choke.  I remember being absolutely terrified.  When it happened there were no adults around and I could not get it to come back up to my mouth.  In an act of complete desperation and total panic of needing to breathe, I swallowed it.  The jaw breaker hurt so bad as it slowly slid down my throat.  Such a terrible feeling.  As it reached the end of my throat, I actually felt it get stuck again.  By absolute crazy luck, it got stuck in a way the 2nd time where I could get a little bit of air so I was able to breathe.  Eventually it dissolved a little more which was enough to get it down completely.  What I know now that I didn't then is how incredibly lucky I was that day.  If it had completely blocked my airway when I swallowed it down, I would definitely have stopped breathing and because of how far down it had gone, attempts to relieve it would most likely have been unsuccessful. 

Aside from my stories of choking myself, I have been present many times when others have choked.  I have many stories of choking but I will just share a couple.  In my late teens I worked in a childcare center.  One day when I was at work, the children were eating goldfish crackers for snack.  These children were only about 1-1.5 yrs old and they were all sitting in those clip onto the table baby chairs.  The assistant director of the center was standing at the doorway speaking to me when we both noticed one of the babies turning blue in the chair.  I grabbed the baby out of the chair and flipped him over and gave several back blows and out came the cracker.  As I held the crying baby I remember looking up at the assistant director.  We both had looks of shock over what had just happened and I remember her saying, "wow, good job.  You just saved his life."  Many years later I was working at Stanford's Children's Hospital when an infant choked.  I was working in the Pediatric Oncology unit that day and myself and another nurse were standing over the bed of a very sick baby who was only a few months old and hooked up to every machine in the book.  We were doing vital signs and checking the monitors and such when suddenly the baby turned blue.   The monitors began to alarm as her oxygen and respiratory rate plummeted.  We both looked at each other with fear in our faces.  The other nurse began to frantically get the suction machine going.  I remember grabbing the baby, tubes and all and flipping her over to give back blows.  A chunk of mucous flew out of her mouth.  Instantly her color returned and numbers went up on the monitor.  I have also used my training on choking with both of my own children and in several other situations, as well.

Of course not all stories have a happy ending.  One story that I have shared with students is one that involved a 12 yr old boy who choked.  That story sticks out in my head because it really does remind you how these things can happen when you least expect them to.  In my younger years I worked on an ambulance.  This story was of a young boy who was at his grandparents house after school.  He choked on a burrito and  stopped breathing.  His heart stopped as well.  Though his heart was able to be re-started, his breathing did not return

and he was put on life support at the hospital.  He died several days later in the hospital.  I can still see his face.  I remember looking at him and thinking how just hours before he was at school playing with the kids like every other day.  When I would share that story at classes, I of course never shared his name or any personal details but I knew the story helped students to connect with the importance of the training.  A few years after the incident occurred, I was teaching a class.  After the class, a women came up to me and said, "I know the boy you were taking about".  It turned out she was a family friend.  We both teared up as we spoke about him.  She thanked me for sharing his story because she knew it would help to save others.

I think choking is one of those things that most people do not think will happen to them, until one day it does.  When we teach to children we put a large emphasis on choking prevention.  We tell them such things as to take small bites, chew their food up before swallowing, don't make people laugh with food in their mouth, don't lay down or run around with things in your mouth, keep chokable items out of the reach of children, etc, etc.  One of our young students ended up using the training he learned to save the school librarian when she choked on an apple in front of him.  Without a doubt this is training that everyone should have.  Having the knowledge of something as simple as back blows on a infant or abdominal thrusts on an older child/adult can really save a life.  Even if your job does not require this training, consider taking a course for your own knowledge.  Our courses are very reasonably priced.  Our instructors are supportive and encouraging.  Consider taking out a few hours to make it to an upcoming class.  Please encourage others to learn CPR and First Aid, as well.  I hope that you never have a choking story occur in your future but in case you do, I hope you are prepared.  

FREE Training Courses (CPR, First Aid and more at our Stockton facility)

Most people take their first CPR class or First Aid class because they're required to do so for their employer or for some type of schooling that they will be starting. However, at Life First Training Center we believe that everyone should be trained in CPR and First Aid. You never know when an emergency is going to occur and it may be at home with your loved ones and not at a job. We believe that knowing how to respond in an emergency is something that everyone should know.  It is also a top priority for our company to support our community members however we can . Some ways in which we have done this have been, keeping our prices much lower than our competitors, providing flexible scheduling options, ensuring a supportive learning environment and high quality training.  As we continue to focus on supporting our valley community, we are now offering a variety of free training programs and classes as well.  Many of these trainings are related to health and safety but we also have a variety of other classes as well. We will also offer free events to connect with families in our community such as a Halloween party and Christmas party focused on children and their families  .  To learn more about our free classes, please see our website,  www.lifefirsttrainingcenter .com.  Just click on our courses button and then select free classes.


Besides our many free classes, we also offer several certification classes.  Some classes we offer include; BLS Healthcare Provider CPR certification , Basic CPR and AED certification with or without Basic First Aid, Pediatric First Aid and CPR for childcare providers and foster parents, online CPR and First Aid options, Babysitter Certification, Abuse and Abduction Prevention for Children, EMT Prep training, ACLS and PALS training for advanced medical professionals, ECG, Bloodborne Pathogens and much more.  Please see our website for further information. We hope to see you at a training course soon.

Serving such areas as Stockton, Lodi, Tracy, Modesto, Manteca, Lathrop, and the surrounding areas.

www.lifefirsttrainingcenter.com
209-951-3097 or 1-866-life1st

It is hard to believe that yet another year has passed and we are now in 2012. As time goes on and technology continues to advance, CPR and First Aid training are advancing as well.

The first city to teach and promote resuscitation was Amsterdam, located in the heart of the European Enlightenment and also a city of canals—therefore a city with many drownings – as many as 400 per year. Death from cardiac disease was still not prevalent and sudden deaths were mostly from accidents. In August 1767 a few wealthy and civic-minded citizens gathered to form the Society for Recovery of Drowned Persons. This society was the first organised effort to respond to sudden death. Within 4 years of its founding, the society in Amsterdam claimed that 150 persons were saved by their recommendations. Their techniques involved a range of methods to stimulate the body. As time went on and science progressed, techniques were improved and added greatly increasing the number of lives saved. Today millions of lives have been saved in part to CPR and/or First Aid training. The curriculum continues to be updated every 5 years allowing for the newest in science to be incorporated in training sessions. Options for taking a classroom based course of only a few hours as well as online instruction are now available. Something as simple as pushing in the center of the chest until 911 rescuers arrive really can save a life. Best of wishes to everyone in this new year. It is a great time to be alive.

American Heart Month

February is American Heart Month. Heart disease is the leading cause of death in the United States for both men and women. The month of February is dedicated to increasing awareness of heart disease and increasing knowledge about prevention. As an approved American Heart Association training center, Life First TC is passionate about educating our community on this topic. Here are a few tips to put you on the right path to a healthy heart:

1. Know the risk factors of heart disease. Identify ways that you can improve your own chances for living a healthy life-free of cardiovascular disease.

2. Know the warning signs of a heart attack so that you can recognize them quickly and get immediate medical attention.

3. See your physician for regular check-ups even when you are feeling well. If you have any history of heart disease or risk factors of heart disease, talk with your doctor about what tests you may want to do to keep an eye on your heart.

4. Learn CPR and how to use an AED and encourage everyone you know to do the same.

Life First TC will be offering a FREE CPR certification course in honor of American Heart Month. The course will be at our Stockton training center on Feb. 19th. Space is limited and pre-registration is required.

New CPR Guidelines Announced

Life First Training Center is proud to be an official American Heart Association approved Training Center. The American Heart Association is the gold standard for CPR training. One reason for this is because of their process for creating the CPR guidelines which are updated every 5 years. More than over 250 CPR and Emergency Cardiovascular Care scientific topics undergo evidence-based review by leading experts in the field of medicine. Curriculum and instructors are updated to the newest recommended findings and students are taught the most current and effective ways possible to assist in saving the lives of others. The new CPR guidelines of 2010 will among other changes, teach a revised order of initial CPR steps. The new order is C-A-B (compressions-airway and breathing) which supports the latest evidence that compressions are the most important part of CPR. For more information on these guideline changes, please visit the AHA web site at: http://www.americanheart.org/ For information on courses in the Stockton-Modesto and Tracy area, please visit our website at: http://www.lifefirsttrainingcenter.org/