EMS News - AHA 2025 Guideline Updates

The American Heart Association (AHA) has released its 2025 updates to the Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) guidelines, introducing several important changes for both healthcare professionals and everyday responders. 

These evidence-based guidelines outline best practices that improve survival from cardiac arrest and other life-threatening cardiovascular emergencies.

A Quick Note for EMS Providers

These updates aim to streamline care, reduce variability in the field, and improve the chain of survival across diverse patient populations. 

Many of the changes emphasize consistency, simplified decision-making, and the continued integration of lay rescuers into time-critical care. 

At the same time, these updates are written to be accessible to the general public, who play a vital role in early recognition and CPR.

The 2025 release builds on the 2020 guidelines, refining previous recommendations and adding new guidance in areas that had not been previously addressed. 

Image from Circulation - AHA / ASA Journals

Below is a summary of several take-home messages and key updates that EMS Providers - and the public - should be aware of:

• Unified Chain of Survival: A single model now applies to all cardiac arrests, regardless of patient age or location, providing a consistent framework for recognizing emergencies and delivering timely interventions.

• Systems of Care: Greater focus on community preparedness, telecommunicator CPR (e.g., 911 Dispatchers), early warning systems, and health equity. 

• Remain in Place: It is recommended that resuscitation should be conducted where the patient is found, as long as high-quality cardiopulmonary resuscitation (CPR) can be administered safely and effectively.

• Position and Location of CPR: Quality chest compressions are improved by optimizing the rescuer’s hand placement, body mechanics (i.e., posture), and the patient’s position. When possible, CPR should be performed on a firm surface to maximize compression effectiveness. 

• Bariatric Patients: CPR for adult cardiac arrest patients with obesity should be provided by using the same techniques as for the average weight patient.

• Pediatric CPR: The two-thumb encircled or one-hand compression techniques are favored on the the two-finger method.

• Mechanical CPR: The routine use of mechanical CPR devices is not recommended for adults in cardiac arrest. However, mCPR may be considered in specific settings where the delivery of high-quality manual compressions may be challenging or dangerous.

• Assisted Ventilations: It is still considered reasonable for both professional rescuers and lay responders to give breaths - when they are willing and able to do so with an appropriate barrier device - to improve oxygenation during cardiopulmonary resuscitation at a ratio. of 30:2 for adults.

• Choking Response: the updated sequence begins with 5 back blows, followed by 5 abdominal thrusts for all patients (e.g., adults & pediatrics), and continuing to alternate until the object is removed or the person becomes unresponsive.

• Opioid Overdose Response: The guidelines reinforce the importance of rapid naloxone administration and recommends supporting public access to opioid emergency response kits. The BLS algorithm explicitly shows where naloxone fits for suspected opioid overdose during respiratory and cardiac arrest.

Additional updates covering resuscitation education, systems of care, and post-cardiac arrest management are provided in the Highlights of the 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

Image from Circulation - AHA / ASA Journals

Why These Changes Matter

Cardiac arrest remains a leading cause of sudden death. Even small improvements in CPR technique or response consistency can dramatically impact survival. The 2025 updates aim to:

• Improve clarity during high-stress emergencies
• Increase bystander willingness to act
• Standardize care across EMS, hospitals, and the community
• Enhance oxygenation and compression effectiveness
• Support faster opioid overdose interventions

For EMS providers, these recommendations reinforce strong fundamentals, situational awareness, and the life-saving importance of early naloxone access.

What You Can Do Next

Whether you are an EMS professional or a member of the public, you play a vital role in improving survival from cardiac arrest. Here are a few ways to stay prepared:

• Review the full AHA 2025 guideline highlights
• Refresh your CPR, AED, or First Aid training
• Make sure your workplace or community organization has access to naloxone and CPR equipment
• Share these updates with colleagues, friends, or family

Understanding MARCH - The Relevance of Respiratory Assessment

Image retrieved from tccc.org.ua

From the MARCH Mnemonic Series – Tactical Trauma Care for EMS Providers

After controlling massive hemorrhage and ensuring a patent airway, the next priority in the MARCH sequence is Respiration. 

Effective breathing is critical for oxygen delivery and carbon dioxide removal. When trauma impairs the chest wall or lungs, hypoxia and shock can develop rapidly - even when the airway is clear.

In tactical or prehospital settings, respiratory compromise is often caused by thoracic injury, such as a gunshot, stab wound, or blast trauma. 

These injuries can lead to life-threatening conditions like tension pneumothorax or open chest wounds, both of which are preventable causes of death when identified and treated early.

This article - the third in a five-part series - will focus on that next critical step: 

R – Respiration

Respiration refers to the body’s ability to move air into and out of the lungs and to exchange gases at the alveolar level. 

Any disruption - mechanical, anatomical, or physiological - can cause hypoxia and threaten survival. 

The responder’s task is to rapidly assess, seal, decompress, and support breathing as needed.

Image retrieved from tccc.org.ua

Principles of Respiratory Management

1. Assess the Casualty’s Breathing

Begin by evaluating rate, depth, and effort of respirations. Look, listen, and feel for:

• Asymmetrical chest rise or movement

• Difficulty speaking, gasping, or labored breathing

• Cyanosis around lips or fingertips

• Tracheal deviation, jugular venous distention, or subcutaneous emphysema

• Penetrating trauma to the chest or upper abdomen

If you’re operating in a tactical environment, conduct this assessment as efficiently as safety allows—rapid but systematic.

2. Expose and Inspect for Chest Injuries

Visually inspect the anterior, lateral, and posterior thorax for entry and exit wounds, contusions, or deformities. In low-light or confined spaces, gloved hands may detect what the eyes can’t.

• Sucking chest wounds (open pneumothorax) occur when air enters the pleural space through a chest wall defect.

• These must be sealed immediately with a vented or occlusive chest seal to prevent the progression to tension pneumothorax.

Modern products like the HyFin® Vent Chest Seal or FoxSeal™ are designed for field reliability and are standard in most tactical trauma kits.

Image retrieved from tccc.org.ua

3. Manage a Tension Pneumothorax

A tension pneumothorax occurs when air becomes trapped in the pleural space and cannot escape, collapsing the lung and compressing the heart and great vessels.
Signs may include:

• Severe respiratory distress

• Decreased or absent breath sounds on one side

• Hypotension and tachycardia

• Tracheal deviation (a late sign)

Image retrieved from tccc.org.ua

Intervention:

If tension pneumothorax is suspected and equipment/training allow, perform needle decompression:

• Use a 14-gauge, 3.25-inch (8.25 cm) needle or catheter.

• Insert into the 5th intercostal space, anterior axillary line (or 2nd intercostal space, midclavicular line if indicated).

• Listen for escaping air and observe for improvement in breathing and perfusion.

Always reassess, if symptoms recur, repeat decompression or prepare for chest tube insertion at higher care levels.

Image retrieved from tccc.org.ua

4. Support Oxygenation and Ventilation

If available and appropriate, administer supplemental oxygen to maintain SpO₂ above 94%. 

For inadequate respirations, assist with bag-valve-mask (BVM) ventilation while maintaining airway alignment. In prolonged field care, consider monitoring SpO₂ and ETCO₂, if resources allow, to guide ongoing management.

5. Continue Monitoring and Reassessment

The chest is dynamic, bleeding, air leakage, or mechanical disruption can recur with movement or time. Reassess chest rise, breath sounds, and patient condition frequently during evacuation.

Key Takeaway for EMS and Tactical Providers

Thoracic trauma demands vigilance. While hemorrhage and airway compromise often draw attention first, unrecognized respiratory failure can kill just as quickly. The tactical provider must be proficient in identifying chest injuries, applying chest seals, and performing needle decompression when indicated.

In short: find the holes, seal the leaks, relieve the pressure, and keep the oxygen moving.

Coming Up Next: Part Four – Circulation

Once bleeding is controlled, the airway is secure, and breathing is restored, it’s time to assess circulation—the body’s ability to perfuse vital organs. 

In Part Four of our MARCH series, we’ll explore recognition and management of shock, fluid resuscitation strategies, and maintaining perfusion in both field and tactical environments.

Because after oxygen, the mission is to keep it flowing where it matters most.

Further Reading:

American College of Surgeons Committee on Trauma. (2022) Advanced Trauma Life Support (10th Ed). Chicago, IL: American College of Surgeons.

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, MA: Pearson Education

Butler, F. K. (2017) Tactical Combat Casualty Care: Beginnings. Wilderness & Environmental Medicine 28 (2S): S12-S17. 

Retrieved from https://pubmed.ncbi.nlm.nih.gov/28284483/ on October 8, 2025

Butler, F. K., Bennett, B., & Wedmore, C. I. (2017) Tactical Combat Casualty Care and Wilderness Medicine: Advancing Trauma Care in Austere Environments. Emergency Medicine Clinics of North America 35 (2): 391-407. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28411934/ on October 8, 2025

Committee on Tactical Combat Casualty Care (2023) Tactical Combat Casualty Care (TCCC) Guidelines for Medical Personnel. Defense Health Agency, Joint Trauma System. Retrieved from https://jts.health.mil on October 8. 2025

National Association of Emergency Medical Technicians NAEMT (2020) TECC: Tactical Emergency Casualty Care Course Book (2nd Ed). Burlington, MA: Jones & Bartlett Learning

National Association of Emergency Medical Technicians NAEMT (2023) Tactical Emergency Casualty Care (TECC) Guidelines. NAEMT Education Division

National Association of Emergency Medical Technicians NAEMT (2025) PHTLS: Prehospital Trauma Life Support, Military Edition eBook (10th Ed). Burlington, MA: Jones & Bartlett Learning 

EMS Education - Are You BLS Certified?

Are you a pre-hospital, in-healthcare or care facility professional, then it is likely you are required to maintain certification in Basic Life Support (BLS) through the American Heart Association (AHA). 

However, BLS certification is not just a regulatory requirement to remain in good standing with  an employer, it is a critical asset and an occupational necessity that ensures you can perform your job effectively.

Why is BLS Certification Important?

The knowledge and skills associated with being BLS certified means you are prepared to respond to life-threatening emergencies involving cardiac arrest, respiratory failure, and choking incidents across adult to infant populations.

Also, beyond enhancing your professional skills, BLS certification empowers you to be a valuable resource for your family, community, and the patients you serve.

What Does an AHA BLS Course Cover?

The American Heart Association BLS course covers a wide range of life-saving techniques, including:

• Cardiopulmonary Resuscitation (CPR)
• Safe & Effective Automated External Defibrillator (AED) use.
• Bag-Valve Mask (BVM) Ventilations
• Choking & Airway Obstruction Management
• Rescue Breathing
• And much more!

Who Needs BLS Certification?

All healthcare providers in patient-facing roles - whether in a hospital or pre-hospital setting - are required to hold a valid BLS certification card. 

This includes:

• Emergency Medical Technicians (EMTs)
• Paramedics 
• Registered Nurses (RNs)
• Certified Nursing Assistants (CNAs)
• Medical Doctors (MDs)
• Firefighters & Law Enforcement Officers (LEOs)

Who Should I Train With?

Choosing the right BLS certification course is essential to gaining the confidence and skills needed to respond to life-threatening emergencies. Look for a program that offers small class sizes to maximize hands-on learning and individualized instruction.

Experienced instructors with real-world expertise can provide valuable insights, ensuring that every student leaves feeling fully competent in their abilities.

Investing in quality training means staying certified, staying prepared, and continuing to make a difference in the lives of those you serve.

Conclusion

BLS certification is more than just a credential - it is a vital skill set that can mean the difference between life and death in critical situations.

Whether you are an EMT, nurse, physician, or first responder, staying up to date with your BLS training ensures you are always prepared to act swiftly and effectively when every second counts.

By maintaining your AHA BLS certification, you contribute to a safer workplace, enhance patient outcomes, and reinforce your commitment to providing quality care.

If your certification is nearing expiration or you have yet to obtain it, consider enrolling in a BLS course today. Your knowledge and readiness could save a life.

Recommended CPR Training Providers: 

Bethesda, Wales, UK: Active First Aid

Rawlins, Wyoming, USA: Brian Eveleth, DTAC LLC

Littleton, Colorado, USA: Colorado Cardiac CPR

International: Crossing Latitudes