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2021 ILCOR Summary Statement – CPR and First-Aid Guidelines for EFR Courses

In November 2021, the International Liaison Committee on Resuscitation (ILCOR) published its regular findings and treatment recommendations for international cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) science.

These published findings and recommendations from ILCOR can sometimes impact training standards for Emergency First Response® courses, particularly as methods and current best practices for lay-person first-aid and CPR skills evolve. However, ILCOR’s most recent findings indicate no changes to CPR procedures are necessary in EFR® courses.

The 2021 findings provide mostly re-emphasis statements, or indicate relatively small changes to the way CPR and first-aid skills are conducted by lay people. This is a testament to the success of CPR training in modern times.

Below are key points taken from the latest ILCOR Consensus as they may relate to EFR programs. Please update your Emergency First Response courses as necessary to reflect the following information:


Firm Surface for CPR:

It is most effective to perform chest compressions on a firm surface when possible.

CPR Feedback Devices:

Not required, but can benefit learning once initial skill foundations have been learned.
Where possible, you may consider the use of feedback devices during CPR training that provide feedback on one or more or the following elements: compression rate, depth, release and hand position.
If feedback devices are not available, tonal guidance can be used – e.g., music or metronome – during training to improve compression rate.

Suspected Opioid Overdose

Resuscitation care for suspected opioid associated emergencies:

Suggest that CPR be started without delay in any unconscious person not breathing normally.
Naloxone may be used by lay rescuers in suspected opioid-related respiratory or circulatory arrest.

Opioid overdose first-aid education:

Where possible, and if trained to do so, offer opioid overdose response education with or without naloxone distribution, to persons at risk for opioid overdose in any setting.

Foreign Body Airway Obstructions (choking response):

Choking adults, children and infants:

Back blows are suggested for use initially in adults and children with a foreign body airway obstruction (FBAO).
Abdominal thrusts are suggested for use in adults and children when back blows are ineffective.
Chest thrusts should be used in unconscious adults and children.
Consider the manual extraction of visible items in the mouth, only. Do not use blind finger sweeps.


Tick Removal:

Use of sanctioned chemicals, heat or ice is preferred over mechanical methods for the removal of ticks. If unavailable, use tweezers or other specialized commercial tick removal devices (according to manufacturer’s directions) to remove a tick, rather than removing by hand.

Pediatric tourniquets:

Suggest the use of a commercially available windlass-style tourniquet for life-threatening extremity bleeding in children. For infants and children with extremities that are too small to allow for the snug application of a tourniquet, direct manual pressure with or without a hemostatic trauma dressing should be applied.

Pressure immobilization bandaging for venomous snakebites:

Properly performed pressure immobilization of extremities should be considered in first aid after snake envenomation.

Second dose of epinephrine for anaphylaxis:

A second dose of epinephrine may be administered to adults and children with severe anaphylaxis whose symptoms are not relieved by an initial dose.

Dehydration from exertion:

Use any readily available rehydration drink or water for treating exertion-related dehydration in the first-aid setting.


For more detailed references, please review the full 2021 ILCOR Consensus for CPR and ECC. You can view the ILCOR document in the journal Circulation published by the AHA HERE as well as in the journal of Resuscitation published by the ERC HERE.

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