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Advanced First Aid, Remote Care,
CPR, and AED
Presented by
Colorado First Aid
www.cofirstaid.org
Revised 5/10/2017
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This presentation contains copyright protected materials. Public web posting and/or reproduction is
not allowed without permission.
Suggested changes and improvements may be sent to Colorado First Aid, Inc. ([email protected])
These materials may not be modified without permission.
www.cofirstaid.org
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Welcome
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Introductions
Class schedule
Breaks
Facility
Lunch
Wireless Access
Purpose of Class
About the book and how to use it
About the slides and content
Cell Phones on Stun, Please !
Take a bio-break whenever.
Take a coffee/water break whenever.
Please ask questions anytime.
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About the Pictures
These slides have pictures of real injuries and illness.
If you feel uncomfortable look away until the next slide.
If you need a break please take one!
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Practice Effectively
There are several skill practice sessions during this class.
Repetition is the key component for successful long term retention of physical skills. During
practice times we recommend you complete the skills more than once.
Some skills are individual practice, others are group activities, so consider working with different
partners.
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Take Care Of Yourself
Stay healthy – if you have physical limitations please adjust your performance accordingly.
Lift properly – don’t attempt any lift that you are not comfortable with.
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Your Packet
Layperson CPR Protocols
First Aid Response Flowchart
Current ECC and First Aid Updates
Professional vs. Layperson CPR
Over The Counter Medications
A Comprehensive Remote First Aid Kit
Classification of Burns
Classification of Frostbite
Anatomy Information
START Triage Chart
Stay Kit / Go Kit
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Updates
Disclaimer…
This training is not intended as a substitute for professional medical advice. Don't use this
information to diagnose or develop a treatment plan for a health problem or disease without
consulting a qualified health care provider. If you're in a life-threatening or significant medical
situation seek assistance immediately.
This class is for “first” aid !
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Always The Basics
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Breathing & Beating
Bleeding
Manage Shock
TBC (Teddy Bear Care)
Get ‘Em Outta There
Volunteer First Aid Has Limits
EMS Response Time
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First Aid Changes In
Remote Response Areas
• Urban-based first aid courses assume that EMS will arrive within 30 minutes after calling. This is
“Rapid Response”.
• If you are 30+ minutes away from EMS access there are options to give additional care and
make advanced decisions about rescue or movement. This is care in a “Remote Response”
area...which includes the back country.
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What is “Advanced” First Aid ?
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Techniques from introductory level first aid classes will still work. First Aid is First Aid!
Advanced providers have additional knowledge to make higher level decisions.
Higher performance standard for techniques, bandages and splints.
“Professional” level CPR techniques in this class includes airways, oxygen, BVM.
Emphasis on longer term care capability.
Safety and prevention of injury – the first aid volunteer should also be an effective safety
advocate!
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Why Advanced Training?
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Involved with activities that have a higher risk of injury
Remote area activities
Responsibility for group activities
Responsibility for minors
Sheer curiosity
Smart preparedness
Remote vs. Wilderness First Aid
• First aid is first aid…anywhere! The outdoor environment requires you to carry additional items in
your kit and have an emergency plan…we will cover some additional material for that situation.
• Wilderness care means some additional ways to handle rescue and transport…we will cover some
additional material for that situation.
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Use Appropriate First Aid
For The Situation
Consider the difference between:
…a car accident with injuries
…heart attack at the office
…day picnic at a mountain park
…hiking up a 14’er
…backpacking several hours from a trailhead
…extended canoe trip away from civilization
…extreme snowstorm strands everyone at home
…wide area disaster and you are in it
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Adjust Your First Aid For Your Role And Response Time
Examples:
• In a facility with on site EMS only minutes away – have victim self-hold their cut forearm, monitor,
and probably just wait
• In the street or at home with ambulance 15 minutes to arrival – someone initially hold the cut,
and possibly do a quick cleaning and apply a bandage
• You are driving the victim to a clinic (where there will be an unknown wait time) – someone
initially hold the cut, do a good cleaning, apply a bandage that will stay on for a longer time
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How Remote Are You?
• At the extreme end of remote care is “village medicine”. We are presenting rapid and remote
techniques…not village medicine!
• You should chose the correct response to illness and injury based on how “remote” you are!
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More Info For Remote Care
Two useful publications:
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“Wilderness” First Aid Training
• Remote care protocols (+30 minutes EMS response) in an outdoor setting.
• Remember: A wilderness course teaches whatever the sponsoring agency directs.
• The levels of first aid and the amount of wilderness topics is variable…and so is the cost…not
often connected! Caveat Emptor!
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• Judge a “wilderness” first aid course by the level of first aid skills and the content. Some are not
at the advanced level.
Volunteer First Aid
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• Professional medical ratings (EMT, Paramedic, Nurse) have established and written state
protocols to guide (and limit) their actions.
• Volunteer first aid providers (CPR, standard first aid, advanced first aid) have no state protocols.
Follow your training and the accepted techniques for conventional first aid.
• You can receive guidance (and some limitations) from written policy documents at your
workplace or acting inside a group…even as a volunteer.
Modules
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1 Preparing to Act
2 Acting in an Emergency
3 The Human Body
4 Assessing the Victim
5 CPR
6 AED - Automated External Defibrillator
7 Airway Obstructions
A Advanced Resuscitation Techniques
8 Controlling Bleeding
9 Shock
10 Wounds and Soft Tissue Injuries
Part 2
11 Burns
12 Serious Injuries
2 13 Chest, Abdominal, and Pelvic Injuries
First Aid Kits
14 Bone, Joint, and Muscle Injuries
15 Extremity Injuries and Splinting
16 Sudden Illness
17 Poisoning
18 Substance Misuse and Abuse
19 Bites and Stings
20 Cold and Heat Emergencies
21 Behavioral Emergencies*
22 Pregnancy and Childbirth*
23 Remote and Wilderness First Aid
24 Rescuing and Moving Victims
25 Are You Prepared?*
26 Moving Forward
Modules
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1 Preparing to Act
2 Acting in an Emergency
3 The Human Body
4 Assessing the Victim
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5 CPR
6 AED - Automated External Defibrillator
7 Airway Obstructions
A Advanced Resuscitation Techniques
8 Controlling Bleeding
9 Shock
10 Wounds and Soft Tissue Injuries
Part 2
11 Burns
12 Serious Injuries
2 13 Chest, Abdominal, and Pelvic Injuries
-- First Aid Kits
14 Bone, Joint, and Muscle Injuries
15 Extremity Injuries and Splinting
16 Sudden Illness
17 Poisoning
18 Substance Misuse and Abuse
19 Bites and Stings
20 Cold and Heat Emergencies
21 Behavioral Emergencies
22 Pregnancy and Childbirth
23 Remote and Wilderness First Aid
24 Triage, Rescue, and Moving Victims
25 Are You Prepared?
26 Moving Forward
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Preparing to Act
Lesson 1
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Reality Check
Let’s watch a real situation. After the video let’s discuss…
What would you have done differently?
What went right? What didn’t?
What was the role for you?
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First Aid Training is Important
• Injury and sudden illness can happen to anyone at any time
• Injury and sudden illness require immediate attention…life or well being can depend on first aid
• Most of the US population has minimal or no first aid training
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What is First Aid?
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Initial help given to a victim of injury or sudden illness
Help given before victim sees healthcare provider or Emergency Medical Services
Help given by friend, family member, co-worker, employee, or bystander
Help is provided sometimes using minimal or no first aid equipment
Challenges For
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First Aid Volunteers
• Unless the volunteer is involved with an activity that exposes them to frequent accidents or
injuries, the typical volunteer will only need to use first aid infrequently
• Specific trauma and illness often benefit from specific techniques, so the effective first aid
provider should remember the full scope of first aid skills
• Some first aid techniques will update periodically, so refresher training is a good idea
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The Primary Goals of First Aid
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Keep victim alive
Prevent victim’s condition from getting worse
Help promote early recovery
Ensure victim receives appropriate medical care
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125,000+ in US die annually from unintentional injuries
About 39 million visits are made to emergency departments annually due of injuries
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Before The Incident…
Have you considered these issues?
• Worry about not doing right thing
• Thinking someone else would provide better care
• Physical limitations
• Being around serious injury or illness
• Upset by sight of blood or injury
• Concern about catching a disease
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Be Prepared
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Be a safety officer
Know first aid
Review and refresh periodically
Be confident
Have a first aid kit
Have a way to call EMS, especially in remote locations
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When To Call EMS
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Victim may have life-threatening condition
Victim is unresponsive
Victim’s condition may become life threatening
Moving victim could make condition worse
Whenever you feel you should!
When You Call EMS…
Identify yourself with your level of medical training, plus a brief description of why you are calling,
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and your location. Then wait to give information as you are asked.
Give the EMS operator time to ask questions. Keep your voice calm, slow, and speak clearly. Use
short sentences.
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Calling 911
• If using bystanders to call for help: Point to someone specifically and direct them to call 911
• If you have someone call for you make sure they tell you what 911 said
• Do not assume bystanders will call without direction…do not assume EMS was called if you are
not the first at the scene
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911 Is A Resource
• Use the 911 dispatcher for medical help and advice as appropriate
• The are a few cell phone apps that can assist with some first aid skills
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Terms You Should Know
Good Samaritan Laws
Duty To Act
Consent
Refusal of Care
Negligence
Standard of Care
Abandonment
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Good Samaritan Laws
They protect you…
• When acting in an emergency, voluntarily and without compensation
• When acting as a reasonable, prudent person with the same training would act
• When performing first aid as trained
Some type of Good Samaritan laws are in every state
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Be Smart
• Act as you are trained to act
• Get a victim’s consent before giving first aid
• Do not move a victim unnecessarily
• Call for professional help
• Keep giving care until help arrives
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“Duty To Act”
Must You Give First Aid?
• Usually you are not required to act (as a bystander)
• You may feel an ethical or moral obligation to care
• Legal obligations to care:
– If you start first aid, you must continue
– If first aid is included in your job
– If you are responsible for a minor
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Consent
• Consent is “expressed” or “implied”
• Consent is a requirement to give care
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• Consent supports “good samaritan” legal protections
• Consent establishes a relationship with the victim
• Obtain consent in a manner appropriate to the situation
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“Expressed” Consent
• Responsive victim must give consent
• If appropriate, tell person your training
• Always tell what you are doing to help
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“Implied” Consent
• Unresponsive victim assumed to give consent (“Implied Consent”)
• Consent is also implied for child needing first aid if parent/guardian is not present
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Refusal of Care
• A “competent” adult has the right to refuse care
• A victim may be considered “incompetent” because of intoxication, influence of drug, altered
mental status from injury…so you usually have implied consent in these cases…be careful! This is
a grey area!
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Refusal of Care
• If ill or injured victim refuses care you should still call EMS…they have options that first aid
volunteers do not have.
• Keep talking to the victim but do not argue.
• Try to have a witness to the refusal of your care.
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Standard of Care
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This is your expected level of first aid performance.
It is how others with your same training would perform first aid in a similar situation
Maintain your skills after your training!
Use common sense!
Standard of Care
• Use the techniques in which you are trained, have experience, and are competent with.
• Operating outside of your scope can hurt the victim and/or make you or your employer liable.
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Negligence
You may be considered negligent if…
• You have a duty to act, and you breach that duty
and/or…
• Your actions, or inactions, were outside your standard of care, resulting in further harm
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Examples of Negligence
• Moving a victim clearly unnecessarily/improperly
• Doing something counter to your training and skills
• Failing to give first aid as you have been trained
Note: Improper movement is the most likely cause of additional harm!
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Abandonment
• Once you start…don’t stop
• Stay with victim until help arrives
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• If you leave and injury/illness becomes worse this is “abandonment”. There may be legal
implications!
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Confidentiality
• Only give private information about victim to healthcare professionals
• Only discuss the incident with others provided details of patient identity, care and health
information are safeguarded
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You can stop giving first aid if you are:
• Exhausted and unable to continue
• In imminent danger
• Are properly relieved
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Question 1
1. Which of the following is one of the primary goals of first aid?
A. Providing comprehensive medical care
B. Preventing the victim's condition from getting worse
C. Reassuring the victim and providing comfort
D. Determining the cause of the victim's illness or injury
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Question 2
If a victim is unresponsive you may assume that they want you to provide first aid. This is known as:
A. Expressed consent
B. Implied consent
C. Informed consent
D. Involuntary consent
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Acting in an Emergency
Lesson 2
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VIDEO
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Take into account:
• Mechanism of Injury (MOI)
• Nature of injury or illness
• Severity of injury or illness
• Presence of other injuries or illness
• Scene of emergency
• The victim
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Key Principles For Emergencies
• Check the scene for safety before entering…maintain awareness
• Respond to all emergencies safely and effectively
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• Take steps to prevent disease transmission
• Take care of yourself
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Take It Easy!
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Walk…don’t run.
Keep voice level, even, calm, and clear.
Manage bystanders and responders to prevent excitement and panic.
Rushing the treatment leads to poor first aid and missing key signs and/or symptoms…slow
down!
• Doing tasks too quickly usually slows down task completion and may reduce safety or the
effectiveness of the first aid.
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Preventing Disease Transmission
• There is always a risk of disease transmission from a victim
• Taking steps to prevent infection reduces the risk
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Process Of Transmission
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Someone or something has infection, then…
Infectious pathogen leaves infected body, then…
Infectious pathogen reaches another by air, direct, or indirect contact, then…
Second person develops infection.
Basic Hygiene
• Hand washing, cleaning, careful food preparation, and sanitation are always recommended.
• Once an illness is identified it is prudent to increase basic hygiene steps to help decrease cross
contamination.
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Bloodborne Disease
• Caused by either bacteria or viruses transmitted via blood and other body fluids
• Life threatening bloodborne infections
– HIV
– Hepatitis B
– Hepatitis C
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HIV
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HIV is a virus that causes AIDS
AIDS is considered fatal
There are people who are infected who don’t know they are
Transmitted through body fluids
There is no vaccine
Hepatitis B (HBV)
• Viral infectious disease
• Transmitted through body fluids – usually blood is most likely vector for infection (can be other
body fluids)
• May cause liver damage or cancer
• The CDC estimates that up to 1.4 million people in the United States have chronic HBV
• There is a vaccine for HBV
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Hepatitis C (HCV)
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Good Habits
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Use medical gloves
If gloves are not available you can improvise (plastic bags, kitchen gloves, etc…)
Wash your hands before and after giving first aid if possible
Cover cuts or scrapes on your skin and wash them gently
Good Habits
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Viral infectious disease
Transmitted by blood vector (other fluids possible)
Can cause liver disease or cancer
3.2 million people in the United States have chronic HCV
There is no universal vaccine
Treatment is available for specific strains of HCV
Avoid touching your mouth, nose or eyes when giving first aid
Avoid being cut or stuck
Constantly manage blood and body fluids
Dispose of contaminated material appropriately and promptly
What To Do
If you are exposed to blood or body fluid:
• Wash immediately with soap and water
• Involve your health care provider if appropriate after a suspected exposure
• At work you should report any incident to your supervisor
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Effective Hand Washing
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Do not wash around food preparation areas
Wash any skin with soap and water as soon after exposure as possible
Be gentle with scabs or sores
Merely wetting hands is not sufficient…soap, scrub, and rub
If hand sanitizer is used then wash with soap and water as soon as possible
Airborne Disease
• Tuberculosis (TB) is an airborne risk
• Healthcare workers will use precautions when caring for people known or suspected to have the
active strain of TB
• First aiders usually don’t need special precautions against airborne disease, but, work to side of
victim so you are not in the direct line of the “sneeze zone”
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Universal Precautions
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Use personal protective equipment (PPE)
If no gloves are available try to improvise
Keep barrier between body fluids and yourself
Wash your hands after giving first aid
Cover any cuts or scrapes on skin
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Gloves
• Remove and dispose of contaminated gloves properly
• Handle sharp objects carefully
• Be alert for signs and symptoms of latex allergy (you and the victim)
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Initial Steps For Emergencies
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Common Steps For Most Emergencies
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Recognize the emergency.
Check the scene for safety.
Check the person.
Call 9-1-1 or the local emergency number if necessary.
Obtain consent and provide care.
Have the person seek medical attention when needed.
Check the Scene
• Be prepared for multiple victims
• Look for clues about what happened and what first aid may be needed
• Look for bystanders who can help
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Hazards for the Responder
1 • Smoke, flames
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Spilled chemicals, fumes
Downed electrical wires
Risk of explosion
Building collapse
Roadside dangers
High-speed traffic
Deep water, ice
Potential personal violence
When EMS Arrives
• Continue CPR until told to stop
• Identify yourself and your level of training
• Provide a brief summary of what you found, what you were told, and what you did. Keep it short
as EMS needs to get to your patient.
• EMS might ask you to assist with care or will take over completely.
• Afterwards: Wash hands, clean equipment, and clean the scene if appropriate
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Question 3
While driving in a remote area you encounter another a car that has crashed into a tree. There are
two unresponsive victims in the car. What should you do?
A. Call 911 and depart scene.
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B. Tell the victims to get out of the car
C. Tell the victims to stay in the car.
D. Call 911 and, if you feel it can be done safely, gain entry into the vehicle and begin first aid
procedures.
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Question 4
For blood borne hazards for the volunteer first aider no vaccine is currently available for:
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Hepatitis C (only)
Hepatitis B and C (only)
Hepatitis C and HIV
Tuberculosis
Question 5
_____ are the most important form of personal protective equipment for the volunteer.
A. Gloves
B. Proper vaccines
C. Face masks
D. Soap and water
E. Baseball bats
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The Human Body
Lesson 3
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The Human Body
• All parts work together to sustain life and allow activity
• Injury or illness impairs these functions
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Body Systems
• Organs have one or more specific functions
• The organs that work together for a specific function are called a body system
• A basic understanding of body systems can help you make more informed first aid decisions
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Body Systems
1  Respiratory system
 Cardiovascular system
 Nervous system
 Musculoskeletal system
 Integumentary system
[in-teg-yuh-men-tuh-ree]
2  Gastrointestinal system
 Endocrine system
 Urinary system
 Reproductive system
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4 Cavities of the Body
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Respiratory System
Cardiovascular System
• Heart
• Blood
• Blood vessels
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Nervous System
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Musculoskeletal System
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Bones
Muscles
Ligaments
Tendons
Bones
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Brain
Spinal cord
Sensory receptors
Nerves
Provide body shape and support
Protect vital organs
Produce blood cells
Store calcium
Act as levers to allow joint movement
Muscles
• Skeletal muscles attach to bones and allow movement
• Produce body heat
• Perform pumping action of heart and work of breathing
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Integumentary System
[in-teg-yuh-men-tuh-ree]
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Skin
Nails
Hair
Sweat glands
Oil glands
Gastrointestinal System
• Digests food and extracts nutrients
• Organs are more easily injured by traumatic forces
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Lymphatic System
• Helps defend against disease
• Part of immune system
• Maintains fluid balance
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Endocrine System
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• Includes glands that produce hormones
• Injury or illness can cause hormone release that can help, or cause other issues
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Urinary System
• Blood transports wastes to kidneys
• Kidneys filter wastes and produce urine
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Reproductive System
1 Male
Produces and transports sperm
2 Female
Produces eggs
Supports and nurtures fetus in uterus
Childbirth
Lactation
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Question 6
Which cavity of the body contains the heart and lungs?
A. Abdominal cavity
B. Cranial cavity
C. Pelvic cavity
D. Thoracic cavity
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Question 7
Which cavity of the body contains the stomach and intestines?
A. Abdominal cavity
B. Cranial cavity
C. Pelvic cavity
D. Thoracic cavity
E. Dental cavity
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Question 8
Which cavity of the body contains the bladder and reproductive organs?
A. Abdominal cavity
B. Cranial cavity
C. Pelvic cavity
D. Thoracic cavity
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Assessing the Victim
Lesson 4
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VIDEO
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The Assessment Sequence
1. Is the scene safe?
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2.
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Initial assessment
CPR or rescue breathing if needed – stop bleeding if needed
Treat and/or secondary assessment (if appropriate)
Monitor the victim for any changes
Unresponsiveness
• Unresponsiveness can be a sign of a life-threatening problem
• In most cases call EMS and have AED moved nearby in case victim stops breathing/beating
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Unresponsiveness
What are 3 situations for which you might not call EMS immediately regarding unresponsiveness?
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Do You Check for Pulse ?
• Advanced level first aid includes judging the pulse for speed, regularity, strength
• Radial Pulse best for conscious victims
• As an advanced responder you should check the pulse during initial assessment…if there is a
pulse and no breathing then do rescue breathing only (and check for pulse every 2 minutes)
• Feel for 10 seconds max
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Carotid Pulse
• Use for unconscious victim, or, victim with very weak pulse.
• Find Adam’s apple and slide fingertips toward you and down to groove at side of neck
• Feel for 10 seconds max
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Untrained Bystanders
• Uncertified bystanders may begin CPR if they witness a collapse, or will start first aid based on
their experience level.
• If you take over care begin with your regular assessment and apply your level of CPR training.
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The Initial Assessment
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Check for Severe Bleeding
• Severe bleeding is life threatening
• Control with direct pressure
• CPR is always the priority. You can use additional responders or bystanders to control bleeding
so CPR can proceed.
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Provide Care
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If a pulse and breathing is found quickly care for any threats to life
If no life-threatening conditions are found move on to secondary assessment (if appropriate)
Position breathing unresponsive victim in modified recovery position
Remote Care: Take additional steps to keep the patient warm and dry
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VIDEO
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The Recovery Position
• Helps keep airway open
• Allows fluid to drain from mouth
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• Prevents fluid aspiration
• Continue to monitor breathing
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How to Move a Supine Victim to the Recovery Position
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Left Side Is Better
• Vomiting is less likely with the recovery positions with the victim lying on the left side.
• Use right side if injuries won’t allow turning the victim on the left side.
• A conscious victim who is nauseous will also benefit from the recovery position.
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The Secondary Assessment
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The Secondary Assessment
• The secondary assessment provides additional information necessary for care
• Includes verbal history (if victim is responsive) and the physical examination
• Sometimes victims are unwilling to disclose a symptom or are unaware of additional problems …
assess!
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Get the Victim’s History
• Important! You may discover critical information before a victim becomes unresponsive!
• Ask bystanders what happened
• Consider the mechanism of injury
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SAMPLE History
S
Signs and symptoms
A
Allergies
MMedications
P
Previous problems (medical)
L
Last food or drink
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Events leading up to the illness or injury
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Unresponsive Victim
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Ask family or bystanders what happened
Check the scene for clues
Consider environmental effects
Consider victim’s age
Secondary Assessment
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• The secondary assessment is tailored to the situation, environment, and EMS response.
• In many rapid response situations the secondary assessment is not done, or, may be limited to
the suspected injury site.
• The secondary assessment becomes more detailed when EMS response is delayed, there is a
need to check the whole body, or you are doing a specific assessment (such as spinal injury)
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Secondary Assessment
• Done if appropriate
• Examine for:
Pain
Bleeding or other wounds
Swelling or deformity
Skin color, temperature, condition
Abnormal sensation or movement
• Use your entire palm and fingers for the physical assessment
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DOTS: What to look for
D
O
T
S
Deformities
Open injuries
Tenderness (pain)
Swelling
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Secondary Assessment
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Removing Personal Items
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Clothing Removal
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Remove if needed to examine injured area
Protect victim’s privacy
Manage exposure to cold and heat
Prevent movement of injured area…cut clothing if necessary
Wilderness: Take extra steps to keep the victim warm and dry.
Patient Privacy
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Sometimes you need to remove personal items or clothing to assess and/or treat the victim.
Put personal items in the victim’s pocket (not yours).
Keep clothing and personal property with the victim.
Small items placed on the ground usually get stepped on.
Respect patient privacy
Tell them what you are doing
Female victims – Do not assess chest area unless there is an injury there
All victims – Do not assess groin area and buttocks unless there is an injury there
Remove/access/cut only what you have to
Outside: You can use bystanders standing in a ring around victim, facing outwards, if needed
Pediatric Assessment
• Use simple questions, simple vocabulary
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• Involve parents or guardians (if they are value added!)
• If needed, perform secondary examination from toe to head
• Be prepared for misunderstandings (both ways)
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Monitor the Victim
• Continue to talk to the victim even after initial care is completed
• Periodic monitoring can detect if a condition worsens
• Check breathing and airway every 5 minutes if victim is unconscious (rapid response area)
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Question 9
For an apparently unconscious victim confirm initial responsiveness by:
A. Using a sternum rub
B. Pinching the earlobe
C. Talking to them
D. Tapping the victim's shoulder and asking, "Are you okay?
E. Pouring a cold drink on their head
155
Question 10
What is the meaning of the "S" in the SAMPLE history format?
A. Does the victim take any prescribed drugs or over-the-counter products?
B. Has the victim ever experienced anything like this before?
C. What can you observe about the victim? How does the victim say he or she feels?
D. When did the victim first begin to experience the problem?
156
Question 11
Which should almost always be considered an emergency with immediate EMS call:
A. fever
B. unresponsiveness
C. being thirsty
D. being dizzy
157
Question 12
You can assume that the heart is beating if:
A. the skin is warm
B. the victim is breathing
C. the skin is not blue
D. the eyes are open
158
159
Cardiopulmonary
Resuscitation (CPR)
Lesson 5
160
19
161
Reality Check
• 1,250,000+ heart attacks occur annually, leading to 130,000+ deaths
• Studies confirm only 1 out of 5 US heart attack victims received CPR before the ambulance
arrived (when bystanders/family were present)
162
What is BLS? - Basic Life Support
163
We Use BLS…
164
CPR Is Not Just For
Heart Attack
1 Heart attack
Drowning
Suffocation
Stroke
Allergic reaction
2 Diabetic emergency
Prolonged seizures
Drug overdose
Electric shock
Major trauma
165
CPR Saves Lives !
• CPR and defibrillation within 3-5 minutes of collapse can save over 50% of cardiac victims
• CPR and AED is more effective than CPR only
• CPR helps keep victim alive until EMS or AED arrives
166
Cardiac Chain of Survival
1.
2.
3.
4.
5.
167
Early recognition and EMS
Early CPR
Early defibrillation (with AED)
Early access to advanced care
Follow up care
Protocol Age Groups
Infant: Birth to 1 year old
Child: Age 1 to the onset of puberty
Adult: Adolescents and older
168
AED Use is Important
• Use of an automated external defibrillator (AED) could restore a more normal heart rhythm
• Even with a pulse send for AED if appropriate
• Early use is critical if no pulse is found
169
CPR
170
CPR Protocols
20
The order for CPR was updated to
C-A-B (Compressions – Airway – Breathing).
This is based on medical research that shows CPR is more effective if compressions are done first and
promptly.
Volunteers at this level of training will no longer have to check for a pulse or Look-Listen-Feel for
breathing.
Advanced first aid volunteers should check pulse and breathing is confirmed.
171
CPR Protocol
For Volunteer Responders
1. Check responsiveness – Are you OK?
2. If unresponsive: Quickly assess breathing by looking at the victim…DO NOT open Airway yet by
tilting head…DO NOT Look-Listen-Feel. Advanced first aid folks will also check for a pulse at this
step while checking breathing.
3. If there was no breathing (or if they are gasping) call EMS and send for a nearby AED.
4. Give 30 compressions.
5. Open airway with head tilt-chin lift and then give two breaths.
6. Continue CPR…30 compressions and 2 breaths
172
CPR Technique
173
CPR Compression Depth
174
Use the Heel of the Palm
• Pull the fingers back to expose the heel portion of your palm
• Position the heel of the palm between the nipples…don’t center your whole hand
175
Push on the Lower Half of Breastbone
• Use the heel of palm between the nipples.
• We no longer feel the ribs to find the Xiphoid process, then measure two finger widths up, and
position palm above that.
176
Why CPR Works
• The heart compresses between the breastbone (sternum) and the spine.
• Between compressions the natural elasticity of the heart returns it to original size.
• Heart valves will still work during external compressions.
177
CPR Needs a Hard Surface
• CPR must be done on a hard surface for the compressions to be effective.
• Victim must be moved to the floor before starting compressions.
• Infants should receive compressions on a firm table or held.
178
Use Correct Body Position
• Lock elbows and position yourself directly over the victim…use your body weight to help with
compressions.
179
Push on the Right Spot
• Push between the nipples on the lower half of the breastbone
• As responder becomes fatigued a common mistake is to push on the wrong spot
• Find the correct position each time you start a compression cycle
21
180
Breaking Stuff
• Older victims have a greater chance that CPR compressions will break connective tissue or bone
near the breastbone.
• If you hear/feel this you should continue CPR. Verify that your compression depth is correct.
• CPR is the priority – skeletal damage can be treated later.
•
181
Clothing Removal
•
•
•
•
•
182
CPR can be done through one layer of clothing or on a bare chest.
It may be necessary to open or remove the shirt to find the nipples.
Remove clothing the way it was put on, or cut away what you need to.
AED pads must be attached to a bare chest in the correction locations.
Insure arms are kept to the side of the torso.
Opening the Airway
• Tilting the head lifts the tongue off the back of the throat
• Many unconscious victims on their back will have a partially or fully obstructed airway unless the
head is tilted
183
Do Proper Rescue Breathing
• For any age group…adult, child, infant: only breathe until the chest rises.
• Do not over-breathe!
• Over-breathing can put air in the stomach and lead to vomiting.
184
Why Rescue Breaths Work
• Standard air contains about 21% oxygen
• A typical exhalation contains 17-19% oxygen, which is enough for another person to use
185
Disease Transmission Facts
• If there is no vomit or blood present then direct mouth to mouth contact has a near zero chance
of bloodborne disease transmission.
• Expect almost every victim will eventually bring up some stomach contents during CPR.
• Thankfully, if used properly, barrier devices reduce the chance of bloodborne disease
transmission to effectively zero, even with blood or vomit in the mouth.
186
Mouth-To-Mouth Technique
• Keep the airway open by maintaining the head tilt
• Pinch the nose to keep air from escaping
• Lift away from the mouth between breaths
187
Use a Barrier Device
188
Face Shield Technique
• Instructions on the face shield will show which side is up
• Pinch the victim’s nose through the shield
189
Pocket Mask Technique
190
It May Not Be Choking
• Some people breathe through hole in lower neck
22
• The opening is called a “stoma”
191
Stoma? Do Mouth-to-Throat
• Cup your hand over victim’s nose and mouth
• Seal your mouth over stoma
• Give rescue breaths as usual
192
CPR Sequence
193
Responsiveness
•
•
•
•
194
Tap the victim on the shoulder
Speak to the victim
A victim who speaks to you, moves purposefully, or responds to stimuli is responsive
Not breathing? No pulse? Call EMS and send for the AED
Compressions First
If not breathing/beating start with compressions.
Use bystanders to help with CPR if available.
195
CPR Technique
Find correct hand position on the lower half of breastbone midway between nipples
Give 30 compressions
196
197
198
199
Choking Protocol for CPR
(Unconscious Victim)
• When the first breath does not go in you assume you didn’t tilt correctly…re-tilt and try again.
• When second breath does not go in use choking protocol with CPR.
• Continue compressions and breaths…but look in mouth for obstruction before attempting first
breath.
• If you see the object lift it out, otherwise attempt two breaths, with re-tilts, and continue
compressions.
200
“Hands Only” CPR
FOR UNTRAINED RESPONDERS:
If the untrained responder sees someone unconscious and not breathing then they are to push on
the chest as best as they can…studies verify that untrained responders can still give effective CPR
201
Compression Only CPR
For Trained Responders
• There are times when you will choose to give compressions only (no breaths)…this is OK.
• If you cannot or will not give rescue breaths you should still give chest compressions…this gives
the victim a much better chance than doing nothing.
• Let’s discuss these situations on the next slide…
202
Discussion:
Can you identify some situations where you would choose to do compressions only CPR? (Victim is
23
an adult in a rapid response area).
203
Dentures
• Dentures are usually left in place during rescue breaths and CPR
• Remove them if they become loose, or they make it difficult to deliver a breath, or they fall back
in mouth and block airway
204
CPR
for Child
Ages 1 to puberty onset
205
206
207
208
209
210
211
212
Discussion:
What are the differences between adult and child CPR?
213
Prepare for CPR
Move furniture if directed.
Obtain a CPR practice dummy, knee board, shirt, pocket mask, and training face shield.
Make sure you can see the screen.
Put the shirt on the dummy (don’t button it).
214
FOR THE VIDEO
Instructions:
• Please use shirts and face shields/pocket masks for all practice activities (gloves are not needed).
• Start with face shields, switch to pocket mask when directed in the video
• Put shirt on the dummy – don’t button
• CPR Dummy lungs may not be installed (so the chest won’t inflate when you breathe).
215
VIDEO
216
2+ Person CPR
• A more realistic scenario: Initial responder will bring in second helper by having them do
compressions while the primary responder continues with rescue breathing
• As responders become fatigued they switch roles
• Switch with minimal interruption
• Use additional responders if available
217
2-person CPR Practice
• Partner up…two responders per practice dummy.
• Designate one responder as the primary.
• Use your face shields (sharing the CPR dummy)
24
• Exercise starts with primary responder only…instructor will announce when additional responder
“arrives”.
• Introduce yourselves like a real situation and have the bystander take over
compressions…primary responder continues breaths.
• Switch roles when tired…keep CPR going without interruption.
218
How Did You Do?
Take a moment to discuss with your partner what worked and what you would do differently next
time.
219
2-person CPR – 2nd Practice
We will switch roles and do the activity again.
220
Rescue Breathing
• Professional Rescuer trained responders should check the pulse along with breathing.
• If the victim is beating, but not breathing, you may provide rescue breathing (without
compressions)
• Adult: 1 breath every 6 seconds
• Child: 1 breath every 4 seconds
• Infant: 1 breath every 3 seconds
• Check the pulse every two minutes
Practice rescue breathing
221
Recovery
• Return furniture to class configuration.
• Return CPR dummy, knee pad, shirt.
• Keep face shield and pocket mask.
222
Professional vs. Layperson CPR
• Anyone trained in professional level CPR will use a combination of layperson and professional
techniques when away from a medical facility.
• Professional level CPR providers will likely have to work with untrained or layperson level CPR
helpers.
223
CPR
For
Infants
Ages 0-1
224
Infant CPR
• Follow the same procedures/order as adult CPR. It keeps you in familiar order and is reassuring
to parents and bystanders who are watching.
– “Baby, Are You OK?” (tap shoulders or feet)
– Not breathing? 911, AED,
begin CPR
225
226
227
25
228
229
230
Discussion:
What are the differences between adult and infant CPR?
231
Question 13
The best CPR option for trained volunteer responders in the field is:
A.
B.
C.
D.
232
Hands only CPR (no breaths)
CPR with compressions and breaths
Either full CPR or breaths only
Breaths only if a barrier device is available
Question 14
During CPR by volunteer responders:
A. Don’t exceed 100 compressions/min
B. Use different rates for two person CPR
C. Rates are different with a barrier device
D. Maintain prompt and continuous CPR
233
Question 15
When using a pocket mask to deliver rescue breaths, it is important to:
A. Cover the mouth only
B. Keep the airway open
C. Make sure some air can escape from around the seal
D. Turn the valve to the two-way position
234
Question 16
Pediatric CPR techniques are very similar to adult CPR for children over:
A. 16
B. 12
C. 8
D. 1
235
Question 17
When giving rescue breaths to an infant or a very small child, put your mouth over the victim's:
A.
B.
C.
D.
236
Nose
Nose and mouth
Mouth
Throat
Question 18
For an adult, you have determined that the victim is not breathing normally, and given 30
26
compressions. What is your next step?
A. Give 2 breaths
B. Give 30 chest compressions at rate of 100 compressions per minute
C. Head-tilt chin-lift to open the airway
D. Send for the AED
237
Question 19
In an adult, the correct depth for chest compressions is:
A. 2 to 3 inches
B. 2 inches
C. ½ the distance
D. 2 to 2.4 inches
238
Question 20
In an unresponsive infant you cannot get breaths into the infant because of an airway obstruction,
you should:
A. Provide alternating back slaps and breaths
B. Perform infant CPR, looking for the airway obstruction before attempting breaths
C. Use a finger to sweep the back of the mouth for the obstruction
D. Do compressions only
239
240
AED
Lesson 6
241
VIDEO
242
Automated External Defibrillator
243
Automated External Defibrillator (AED)
• Victims in fibrillation need a defibrillator to restore normal heart rhythm
• The AED is automatic and will not shock unless a “shockable” rhythm is detected
• The AED may restore a normal heartbeat if used in time
244
Why AEDs Work
• The heart’s electrical system keeps chambers of the heart synchronized and working together
• During a heart attack or other heart problems, this rhythmic electrical system may be disrupted,
resulting in an abnormal rhythm, such a fibrillation, or stoppage
• For some fibrillations the AED shock may restore a regular heart rhythm – by “defibrillation”.
245
Access to AEDs
• Available in many workplaces, public gathering places, and other facilities
• Trained first aid volunteers may use an AED
• State laws differ if you want to purchase your own for home or organization
246
Colorado and AEDs
• Colorado AED law updated in 2009
27
• Organizations, businesses, and individuals may own an AED without a doctor’s supervision
• There is a recommendation to have written policy (keep it simple) and 30 day inspections
(logged)
• Check out Colorado law for details: SENATE BILL 09-010
247
Time Is Important
• AEDs are easy and simple to use but must be used right away
• Once the victim enters fibrillation…every minute without an AED reduces survival rate by 10%
• Deploy it immediately
248
Using an AED
• Whenever a victim suddenly collapses or is found unresponsive consider possibility of cardiac
arrest
• Send someone to get an AED immediately
• It is better to have it right away and not need it, than to need it and have to wait for it
249
Leave It ON
• The first step is to turn the unit on, then following the instructions to attach the pads
• Leave the unit attached and leave it on, regardless of it the unit delivers a shock, or not
• The AED will tell you to stop CPR every two minutes to re-analyze, and possibly deliver a shock
250
Do not put cell phone or 2-way devices on or next to the AED due to the possibility of interference
251
The Two Questions
• AEDs from different manufacturers are different colors, buttons in different spots, batteries
different, etc… However, they all work the same way.
• Before using an AED you must ask yourself these two questions:
1. Are the pads pre-connected or not?
2. Are the pads interchangeable or not?
252
#1: Are The Pads Pre-Connected?
• Some models have AED pads pre-connected…put the pads on the patient.
• Other models have the pads and wires all inside the foil pouch.
You will apply the pads to the patient first…then plug them in!
253
#2: Are The Pads Interchangeable?
• Newer models have interchangeable pads…they work from both positions.
• Other models have pads that must be in a specific position. Follow the diagrams on the pads.
254
Insure Correct AED
Pad Placement
• Follow diagrams on AED pads for correct placement
• Adult placement is on the chest
• Pediatric/infant is on the front and back
255
AED Can Be Used On Infants
• Use adults pads on adults – do not use pediatric pads (not powerful enough)
• Use pediatric pads on children – if not available use adult pads on children
• Use pediatric pads on infants and place front and back – if not available use adults pads on
28
infants and place front and back
256
Changing To Pediatric With
Pre-Connected AEDs
• The unit should be off if you have to change to pediatric pads.
• If the AED is the pre-connected type you may have to also locate a latch, lever, or lock on the
plug in order to release the pad connection.
•
257
Pediatric AED “Keys”
• Some newer model AEDs provide a “key” or “card” which is inserted into the unit to reduce the
power to pediatric levels. Only one type of pad comes with this type of unit.
•
258
Dry or Non-Conductive
Surface Necessary
• Don’t use an AED when the victim is wet or lying on a wet surface.
• Don’t use an AED on a metal grate, electrostatic discharge pad (ESD area), or other
industrial/conductive surface.
• Don’t use an AED outside in the rain.
259
AED and Trauma
• Cardiac arrest in severely injured victim usually caused by traumatic injury…not a heart rhythm
problem
• Professional responders may be under medical direction to not deploy defibrillation when the
heart has stopped due to trauma.
• The volunteer responder should deploy an AED as long as you don’t have significant chest
trauma…and don’t delay CPR.
260
Victim with Internal Pacemaker or Defibrillator
• May appear as a bulge beneath the victim’s skin
• Do not place AED pad over this area…place it several inches away, or, use alternate placement
(switch both pads to other side)
261
Victims With Medication Patch
If the victim has medication patch or paste on chest, remove it and wipe the area before applying
AED pads.
Careful – use gloves or barrier to protect your skin from touching the medicine !
262
Furry People
• If the victim has so much chest hair that the pads won’t make it to the skin then shave away
patches for the AED pads.
• This is not common – only heavily hairy folks need this extra step – AED pads will work through
normal body fur.
•
263
Jewelry
• Move jewelry out of the way (from the area between the pads)
• Short choker necklaces are not a concern as they are not between the pads
• Do not tear out nipple rings … we will fix the burn later!
29
264
265
• Every 2 minutes the AED will prompt you to stop CPR for another analysis cycle
• Continue CPR until victim moves or professional rescuers arrive and take over
• If victim recovers put victim in recovery position (with pads in place) and continue to monitor
breathing
• Leave unit on
266
AED Accessories
AEDs should be packed with accessories!
• Spare pads (adult and pediatric)
• Spare AED battery
• Medical scissors
• Disposable razors
• Pocket mask and/or face shields
• Gloves
• Aspirin
267
AED Maintenance
•
•
•
•
268
Easy!
Once installed only a periodic check of the “OK” indication is needed
When turned on AEDs have audible error messages to help you identify problems
If you get a low battery prompt change the battery before continuing
AED Solo Response
• If you have to respond without others perform about two minutes of CPR before applying the
AED.
• With multiple helpers don’t delay AED deployment as long as some CPR has been done.
269
VIDEO
270
AED Practice
271
Question 21
AED pads:
A. Only monitor the heart's electrical activity
B. Only deliver an electric shock to the heart
C. Both monitor the heart's electrical activity and deliver an electric shock to the heart
D. Neither monitor the heart's electrical activity nor deliver an electric shock to the heart
272
Question 22
It is important to place AED electrodes correctly on the victim's chest. Some are not
interchangeable - others are universal. Follow the diagrams on the pads.
A. True
B. False
273
Question 23
30
If the AED advises that no shock is indicated, this means the victim's heart is working normally and
you can stop CPR.
A. True
B. False
274
Question 24
If a non-breathing victim has a medication patch on his or her chest, you should remove the patch
before applying AED pads.
A. True
B. False
275
276
Airway Obstructions
Lesson 7
277
VIDEO
278
Choking Emergencies
• 4000+ die from choking each year
• Adults over 65 are more than twice as likely to die as younger people from choking
279
Common Choking Risks
•
•
•
•
•
280
Trying to swallow large pieces of food that haven’t been chewed sufficiently
Eating too quickly
Eating while engaged in other activities
Alcohol/drugs effects
Loose dentures
Choking
• Choking has two categories, partial obstruction or full obstruction
• Ask victim if they are choking – do NOT initially ask if they are OK
• If victim can’t answer or indicates affirmative – obtain consent and begin choking care
281
General Choking Care
(Responsive Adult or Child)
282
Mild Choking
•
•
•
•
•
•
•
283
Victim is coughing forcefully
Victim is getting some air
Wheezing or high pitched sounds with breath
Encourage coughing
Do not back slap
Be prepared for victim to go unconscious
Severe Choking
• Victim getting little air or none
• Victim may look frantic and be clutching at throat
31
• Victim may have pale or bluish coloring around mouth and nail beds
• Victim cannot speak
• Apply Heimlich Maneuver (abdominal thrusts) – don’t forget to obtain consent!
284
Example:
Choking Care Responsive Adult or Child
(The Heimlich Maneuver)
285
Heimlich Maneuver
286
287
288
289
290
291
Responsive to Unresponsive
• If airway obstruction is not cleared the victim will become unresponsive
• Quickly and safely lower victim to floor and move to supine position…prevent injury from falls
• Give CPR with choking protocol…check for object in mouth each time you open it to give 2
rescue breaths
292
Conscious Infant Choking
Apply five back blows
Turn infant (sandwich technique)
Look in mouth for obstruction – remove if seen
Apply five CPR compressions
Look in mouth for obstruction – remove if seen
Turn infant (sandwich technique)
Continue until obstruction is cleared or infant becomes unconscious
293
294
Advanced Resuscitation Techniques
Appendix A
295
Professional CPR
for the Volunteer
• Both professional and layperson trained CPR volunteers will use layperson CPR protocols for
initial contact outside of medical facilities.
• A few professional CPR techniques are most appropriate for a medical facility and medical
professionals. We will present them here with the expectation the CPR volunteer won’t use them
in the field.
• Many professional CPR techniques are useful to the volunteer and can enhance your CPR
effectiveness, especially in remote response areas.
296
Why Professional Rescuer CPR?
• Adds advanced BLS protocols
32
• Adds additional techniques
• Use of specialized equipment
– Suction devices
– Bag-valve-mask units (BVM)
– Supplemental oxygen
– Airway adjuncts (NPA and OPA)
297
Call First vs. Call Fast
(alone + contact is 2 minutes away)
Call First for…
…any unresponsive adult.
…witnessed child/infant collapse who is not beating/breathing. you are alone, and contact is less
than 2 minutes away.
Call Fast (give 2 minutes of CPR before leaving to call) for…
…any infant or child with unwitnessed collapse who is unresponsive and not beating/breathing.
…any adult in cardiac arrest due to airway obstruction (choking).
298
Alternative to Head Tilt Chin Lift - The Jaw Thrust
• Less likely to cause additional injury to victim with spinal/neck injury
• May be useful if victim is wearing cervical collar
• Lift jaw upward using both hands
299
Pulse Check
• Health care and professional rescuers should check for pulse in unresponsive victim who is not
breathing normally before beginning CPR
• About 10 seconds to feel for pulse during an initial assessment
• Unless pulse is clearly found, start CPR with chest compressions immediately
• If obvious pulse is found with no breathing then begin ventilations immediately
300
Different Pulse Locations
•
•
•
•
301
Carotid Pulse
•
•
•
•
302
Should use carotid [“kuh-rot-id”] pulse on neck for adult
Can use carotid with small child (and femoral for professionals)
Can use radial pulse for adults and children
Should use brachial pulse for infant
Keep airway open
Find Adam’s apple and slide fingertips toward you and down to groove at side of neck
Press gently
Feel for pulse for no more than 10 seconds
Radial Pulse
• Put index and middle fingers on artery in line below thumb
• Press gently
• Feel for no more than 10 seconds if initial assessment
303
Brachial Location
For Infants
33
•
•
•
•
304
Femoral Pulse
(In Medical Facility)
•
•
•
•
305
Keep airway open
Put index and middle fingers about midway between shoulder and elbow on inside of arm
Press gently against bone
Feel for no more than 10 seconds
Keep airway open
Put three middle fingers at crease of upper leg at midline
Press against bone
Not generally used by volunteers
Rescue Breathing
• Victim may not be breathing adequately but still have a heartbeat
• If you confirm a pulse in a non-breathing victim, you may give rescue breaths but not chest
compressions
• Give breaths every six seconds (adult) or every four seconds (child) or three seconds (infant)
• Check pulse every two minutes
306
Inadequate Breathing
(In Medical Facility)
•
•
•
•
307
Professional CPR Ratio for Infants and Children
•
•
•
•
308
If adult breathing is less than 10 per minute and unconscious begin rescue breaths only
Use same airway technique as in CPR
Give one breath every three to five seconds
Check pulse every two minutes
For infant and child victims the professional’s ratio is 15:2.
Use this ratio with 2-person CPR and bag valve mask (BVM).
Breaths and compressions are asynchronous.
Usually, this is done in a medical facility (use layperson ratio for street use)
Bradycardia in Infant/Child
(In Medical Facility)
• Bradycardia is pulse < 60 and heart is not getting enough oxygen.
• If infant/child pulse is less than 60 beats/minute AND infant/child has signs of poor perfusion
then provide CPR using 15:2 ratio.
309
Using Pocket Masks
• Seal mask well while maintaining open airway
• How you hold mask depends on:
– Your position by victim
– Method to open airway
– Whether you have one or two hands to seal mask
310
Position at Victim’s Side
• With thumb and index finger seal top and sides of mask to victim’s head
• Put thumb of second hand on lower edge of mask
• Put remaining fingers of second hand under jaw to lift chin
34
• Press mask down firmly to make seal as you lift chin
311
Position at Top of Victim’s Head: Using Head Tilt – Chin Lift
• Put thumbs on both sides of mask
• Put remaining fingers of both hands under angles of victim’s jaw
• As you tilt head back, press mask down firmly to make seal as you lift chin
312
Position at Top of Victim’s Head: Jaw Thrust
• Without tilting head back, position thumbs on mask with fingers under angles of jaw
• Lift jaw as you press down with thumbs to seal mask, without tilting head back
313
Suction Devices
• Used to clear blood, vomit, other substances from victim’s airway
• Be familiar with the equipment you have
•
314
Suctioning The Airway
•
•
•
•
•
•
Confirm suction device is working
Determine maximum depth of insertion
Turn victim’s head to side and open mouth
Sweep out solids and larger amounts of fluid with finger
Start Suction
Insert catheter tip into mouth, move tip as you withdraw it. Finger marks max depth of insertion.
Maintain suction as you withdraw
•
•
315
Suctioning An Infant
With Small Bulb
•
•
•
•
316
Hold infant in position for suctioning
Head lower than body
Turned to one side
Suction mouth first! Then nostrils
Bag Valve Mask
Appendix A
317
Bag-Valve-Mask
• BVM units are more effective for providing ventilations
• Victim receives air from atmosphere (21% oxygen) rather than exhaled air (17-19% oxygen)
318
Components of BVM Unit
319
Using BVM: Sealing Mask
•
•
•
•
320
Open airway and position mask on victim’s face
If alone, hold mask in one hand and squeeze bag with other
Use C-clamp technique
If there is a second rescuer, hold mask with both hands
Using BVM: Giving Ventilations
(Multiple Sizes in Medical Facility)
35
•
•
•
•
•
•
•
321
Using BVM: Giving Ventilations
•
•
•
•
322
Rescue breaths delivered by squeezing bag – do not squeeze full bag completely !
Squeeze 1 L bag about ½ to ⅔ of volume
Squeeze 2 L bag about ⅓ of volume
Squeeze bag over 1 second (and watch victim’s chest rise as in mouth-to-mouth)
Give ventilation every 5 seconds in adult
Give ventilation every 3-5 seconds in infant or child
Monitor effectiveness of ventilations
Feel for resistance when squeezing bag
If air escapes around mask, reposition mask and fingers
If problems occur, use alternate technique
Using BVM: You Can Use Supplemental Oxygen
• Use supplemental oxygen with BVM if available
• Attach oxygen reservoir bag to valve on bag and oxygen tubing
• Use BVM same way as on regular air
323
Using BVM: Mask and Bag Size
(Multiple Sizes In Medical Facility)
• Choose correct size for victim if multiple sizes available….medical care facilities have different size
BVMs
– 500 mL for newborns
– 750 mL for infants/small children
– 1200 mL for large children/adolescents
– 1600 mL for adults
• If right size not available then adjust to give right amount of air (chest rise)
• In the field you may only have the adult size - apply upside down to fit children better
324
Example:
BVM: Rescue Breathing with BVM
325
Assemble BVM and position and seal mask over victim’s mouth
326
Squeeze bag to provide ventilations.
Recheck pulse every 2 minutes.
If no signs of circulation, call for AED and start CPR.
327
Supplemental Oxygen
328
Supplemental Oxygen
• Used when there are signs of poor perfusion, shock, or significant trauma
• Victims with serious medical conditions may benefit from additional oxygenation
• COPD victims should not be given 100% oxygen for long term (8+ hours)
329
Supplemental Oxygen: Equipment
36
•
•
•
•
•
330
Safety Around Oxygen
•
•
•
•
•
331
Pressurized cylinder
Pressure regulator
Flow meter
Oxygen tubing
Oxygen delivery device
No smoking or open flame near oxygen source
Never use grease, oil, or adhesive tape on equipment
Don’t expose oxygen cylinder to high temperature (120+ degrees)
Don’t drop cylinder or let it fall against another object
Don’t use a non-oxygen regulator on a medical oxygen cylinder
Oxygen Administration
• Do not interrupt CPR or critical first aid to deploy supplemental oxygen
• Once oxygen is started continue to monitor oxygen flow rate, tank pressure, and victim’s
condition
332
When do I use oxygen?
In the pre-hospital environment: High flow oxygen is recommended for use in resuscitation, major
trauma, anaphylaxis, major hemorrhage, shock, active convulsions and hypothermia.
333
Oxygen Setup and Use
334
Not Too Tight !
You only need to push the oxygen tube on to the nipple on the regulator so that it stays on.
If you keep pushing you won’t be able to get it off unless you cut it off!
335
Volunteer
Flow Rates
• Set flow meter at correct initial rate for the delivery device:
– 4 LPM for nasal cannula
– 10 LPM for all others
• For a non-rebreather mask: Hold your finger over valve disk to inflate rebreather bag before
putting on victim.
336
Oxygen Delivery Devices
337
Oxygen Delivery Devices
Different delivery devices provide different percentages of oxygen
• Nasal Cannula
• Resuscitation mask (Pocket Mask)
• Non-rebreathing mask
• Rebreathing mask (not commonly used anymore)
• Bag-Valve-Mask
338
Nasal Cannula
• Use with breathing victims who do not require high concentration of oxygen
• Use starting flow rate of 4 LPM
• Oxygen concentration depends on flow rate
37
• 1 to 6 LPM can deliver 24% to 50% O2
339
Pocket Mask
• Some have oxygen port to connect oxygen tubing
• Starting flow rate is 10 LPM
• Provides 30% to 60% oxygen with flow rate of 10 LPM
340
Non-Rebreather Mask
•
•
•
•
341
Use with breathing victim
80% to 95% oxygen with bag inflated
Starting flow rate is 10 LPM
Remote response area technique (only): Adjust flow rate lower to keep reservoir from collapsing
completely when victim inhales
Bag-Valve-Mask (BVM)
•
•
•
•
Delivers oxygen through tube or reservoir
Starting flow rate is 10 LPM
Up to 100% oxygen
Can also use with breathing victim if no other mask available
342
Remove any protective seal. If necessary: open main valve briefly to blow out contaminants.
Attach regulator with flow rate at zero and tighten
343
Open main cylinder valve
Check pressure
Attach delivery device, push straight with slight twist, don’t bend, not too tight
344
Removing the Regulator
•
•
•
•
•
•
Remove oxygen delivery device from victim
Turn flow rate to zero
Remove oxygen delivery device from regulator
Turn off main valve
Open flow rate until meter reads zero
Loosen regulator knob and remove regulator
345
Airway Adjuncts
346
Airway Adjuncts
• Airway adjuncts prevent obstruction by tongue more easily than holding head position alone
• Supplemental oxygen can be given through mask or BVM with airway in place
• For the volunteer responder, they are generally used in remote response areas.
347
Oral Airways (OPA)
Oral Pharyngeal Airway
•
•
•
•
Use only with unresponsive victim (no gag reflex)
For use with BVM or pocket mask
Can be breathing or not
Available in variety of sizes
38
• Victim can be suctioned with airway in place
348
OPA Sizing
• Proper placement is essential
• Periodically reassess to confirm airway remains in proper position
349
OPA Insertion
350
• Choose correct size.
351
Insert with tip pointing toward roof of mouth.
For small children you insert with the tip pointed down.
352
• When tip reaches back of mouth and you feel resistance, rotate airway 180 degrees.
353
Continue to insert until flange rests on lips. To remove just pull out (no twist).
354
Nasal Airways (NPA)
Nasal Pharyngeal Airway
•
•
•
•
355
Use with responsive victim
Use with unresponsive victim with gag reflex
Use with unresponsive victim with mouth or jaw trauma in lieu of an OPA
Do not use if there is facial trauma or suspected skull fracture
Nasal Airways
Pro
• Less likely to cause gagging and vomiting than oral airways
• Easier to insert
Con
• Difficult to suction
• You should still maintain a partial head tilt
• Need lubricant to insert
356
NPA Insertion
357
Choose correct size.
358
Lubricate airway.
359
Insert into nostril with bevel toward septum. Try the right nostril first, as this is often a slightly
larger diameter.
360
Insert straight back, sliding along floor of nostril. Insert until flange rests against nose. To remove
39
pull out.
361
NPA Or OPA ?
• Volunteers can use a quirk of the human nervous system to help with the decision to use NPA or
OPA. This is better than arbitrarily putting an OPA in someone with an active gag reflex!
• Lightly tapping the center for forehead and/or touching the eyelashes could result in a blink
reflex. Blinking means the gag reflex is probably active, so select NPA as the preferred airway.
362
363
Two-Rescuer CPR
•
•
•
•
364
Minimizes time between rescue breaths and compressions
CPR becomes more effective and consistent
Helpers cab be used to set up AED
Reduces rescuer fatigue
Two-Rescuer CPR: Infants
• Uses different hand position
• Place thumbs of both hands on sternum while fingers encircle chest
• Compress breastbone with both thumbs while squeezing chest with fingers
365
Special Resuscitation Situations
•
•
•
•
•
366
Trauma
•
•
•
•
367
Trauma
Hypothermia
Near-drowning
Electric shock
Pregnancy
Do not assume victim has only trauma
Treat trauma victim like any other
If in cardiac arrest, call first (rather than call fast)
If possible spinal injury
– Hold head in line with body if necessary to turn victim
– Use jaw thrust to open airway
Trauma
• There may be blood or fluid blocking airway so turn victim or suction mouth
• Local protocols may include not using AED in severe trauma…if AED not used, give CPR while
waiting for advanced help
368
Hypothermia
•
•
•
•
•
•
369
Victim’s breathing may be very slow or may have stopped
Victim’s heart may be beating very slowly or may be in arrest
Skin may be cold and pale; victim may appear dead
Take extra time to check breathing and pulse (up to 30-45 seconds)
Do not start compressions if there is evidence of beating…even if slow
Do not start breaths if there is evidence of breathing…even if slow
Hypothermia
40
• Follow local protocol for AED use
– Typically one shock given while victim cold
– AED can be used again when body warmed to 86-90°F
• Do not delay or stop resuscitation to warm victim, but prevent further heat loss
• Be gentle when handling victim
370
Near-Drowning
•
•
•
•
•
Begin rescue breaths as soon as possible (even before removing victim from water)
Remove victim from water before beginning CPR
Consider possible spinal injury
Call fast (give two minutes of rescue breathing or CPR first)
If victim is not breathing normally, first open airway and give two rescue breaths; then quickly
check for pulse
• If victim has pulse but is still not breathing normally, continue with rescue breathing
• If victim does not have a pulse, give CPR immediately, beginning with chest compressions
371
Near-Drowning
• Do not take any special actions to try to remove water from victim
• If victim is not breathing and your rescue breaths do not make chest rise, open airway again and
try to give two breaths; if your breaths still do not go in, give chest compressions for airway
obstruction.
• If supplemental oxygen available and you are trained, administer oxygen
• Use AED as usual (dry victim on dry surface)
•
372
Electric Shock
• May cause breathing to stop and cardiac arrest
• With lightning strike, assume possible spinal injury
• When safe to approach victim, check for responsiveness and normal breathing and provide BLS
as needed
373
Electric Shock
• Often causes ventricular fibrillation
– AED may return heart to more normal rhythm
• If alone, first shout or call for help and for an AED to be brought, and then give CPR
374
Pregnancy
• Give woman in late stages of pregnancy with airway obstruction chest thrusts instead of
abdominal thrusts
– Give thrusts from behind a responsive victim
– Give thrusts as in CPR with unresponsive victim
– Give chest compressions slightly higher on sternum
• When possible, position injured pregnant woman (more than 20 weeks pregnant), who is
breathing normally, on her left side rather than flat on back
– Reduces pressure on vena cava
–
375
Question 25
A first aid provider should "call fast" (rather than "call first") if an adult is seen to collapse suddenly.
41
A. True
B. False
376
Question 26
With oxygen connected to either device, using a bag-valve-mask unit is better than rescue
breathing with a pocket mask because the BVM allows more oxygen to reach a victim's lungs.
A. True
B. False
377
Question 27
Oxygen regulator O-rings should be lubricated periodically with a light oil to keep them from
drying out.
A. True
B. False
378
379
Controlling Bleeding
Lesson 8
380
Hemorrhage
• Bleeding can be external or internal
• Can be minor or life threatening
• Most external bleeding can be controlled with direct pressure for 5+ minutes
381
Washing Wounds
• Old protocols were to flush all wounds for 5+ minutes…this is now only for human and animal
bites, and significant avulsions
• Cleaning wounds should be appropriate to the type of wound, the size (area), and the rate of
blood loss
• Soap and water is the preferred solution for field and emergency first aid
• With significant blood flow don’t delay direct pressure
382
Effects of Blood Loss
• Body can compensate for smaller quantities of blood loss
• Severe blood loss (greater than 30%) results in lack of oxygen and shock
• In infants and children, severe bleeding becomes critical more quickly
383
Effects of Blood Loss
384
The Body Can Control Bleeding
•
•
•
•
•
Vascular spasm constricts blood vessel
Platelets form platelet plug
Clotting seals leak in the blood vessel
These mechanisms may not be enough to stop severe bleeding
A bandage slows the flow and allows clotting to begin
42
385
Types of External Bleeding
386
Types of External Bleeding
• The type of bleeding does not change the care provided by a volunteer.
• Volume of bleeding, regardless of type, determines severity with regards to volume of blood loss.
• Any spurting (arterial bleeding) is traumatic for the patient, contaminates the environment, and
can be a stressor for the volunteer provider.
387
Controlling External Bleeding
•
•
•
•
•
388
Stopping bleeding is the top priority
Apply direct pressure
Press directly on wound
Sterile dressing and gloved hands preferred
Elevation may help reduce bleeding (raise above level of heart), but, is not considered a primary
method
Pressure Bandages
• Used to apply direct pressure and support coagulation
• Keeps external contamination and bacteria out of the wound
• Caution: Make sure the bandage doesn’t prevent circulation…adjust tightness as needed
389
Quick Application Tourniquet
• It is no longer “tourniquet last”...it is “tourniquet first for severe hemorrhage”.
• Commercial models are more effective, easier to apply, and do less tissue damage than
expedients.
• Gradually tighten until hemorrhage stops.
• If used to gain time to apply a pressure dressing it should be used no longer than 30 minutes.
• For amputation/near amputation leave the tourniquet on.
• Mark application time on the tourniquet.
390
When To Use A Tourniquet
•
•
•
•
•
•
391
When direct pressure is not stopping the bleeding
There are multiple injuries where bleeding cannot receive direct pressure immediately
CPR in progress prevents immediate use of direct pressure
There are not enough responders to provide CPR along with direct pressure
A mass causality situation
The wound cannot be accessed with direct pressure until the victim is moved or rescued
Improvised Tourniquet
• Improvised tourniquets are more difficult to apply than commercial types and may do more
tissue damage, but they are still effective
• Keep folds 2+ inches wide if possible
• Follow the same application rules as QAT
• Mark skin with “T” and time of application
392
Hemostatic Agents
• Use is now recommended for all levels of first aid.
• Use in conjunction with direct pressure.
• Use for very large wounds or significant bleeding.
43
• Use dressing type (not agent).
• You can insert the hemostatic gauze pad in a puncture.
393
Internal Bleeding
• Any bleeding within body when blood does not escape
• Can be life threatening
• Consider the mechanism of injury
394
First Aid For Internal Bleeding In The Abdomen
•
•
•
•
395
First Aid For Simple Bruises
•
•
•
396
Have victim lie on back
Use shock position if appropriate
Be prepared for vomiting.
Keep victim from becoming chilled or overheated.
Check for signs and symptoms of fracture or sprain.
Use cold pack on area.
Extremities: Consider compression wrap and/or elevation, if appropriate.
Question 28
If you encounter bright red blood that is spurting, this probably indicates:
A. An injured artery
B. An injured vein
C. Injured capillaries
D. Injured alveoli
“It’s only a flesh wound.”
397
Question 29
You are providing first aid to a victim with an apparent bruise on the leg. What is your first step in
caring for the bruise?
A. Check for signs and symptoms of a fracture or sprain
B. Elevate the leg
C. Put ice or a cold pack on the area
D. Wrap the area with an elastic bandage
398
Question 30
After applying a pressure bandage to an arm or leg, you should periodically check the victim's
fingers and toes for signs of good circulation.
A. True
B. False
399
400
Shock
Lesson 9
44
401
What is Shock ?
Circulatory shock is a serious, life-threatening medical condition defined as an inadequate
perfusion of tissues which is insufficient to meet cellular metabolic needs.
402
Why?
Interruption of normal oxygenation can lead to shock.
Some circulatory failures…
• Heart does not pump effectively
• Blood volume is not sufficient to fill blood vessels
• Blood vessels are not intact (bleeding) and/or not functioning properly
403
Shock Is Urgent
•
•
•
•
404
Shock will usually continue to develop unless treated
It can appear gradually or quickly
It can begin immediately or by delayed
You will need EMS
Shock Has Many Causes
1 • Severe bleeding
•
•
•
•
•
•
2 •
•
•
•
405
Types of Shock
•
•
•
•
406
Severe burns
Heart failure
Heart attack
Head or spinal injuries
Allergic reactions
Toxemia
Dehydration
Electrocution
Serious infection
Extreme emotional reactions
Hypovolemic Shock when blood volume drops*
Cardiogenic Shock with diminished heart function*
Neurogenic Shock with nervous system problems*
Anaphylactic Shock from whole body allergic reaction
* A type of “circulatory shock”
Development of Shock
• Assume any victim with serious injury is at risk for shock
• Victim ultimately becomes unresponsive
• Not all victims experience multiple signs and symptoms of shock
407
Shock Signs and Symptoms
1 • Anxiety/confusion
•
•
•
2 •
Dizziness
Pale/bluish skin
Cold/clammy skin
Rapid, shallow breathing
45
• Nausea/vomiting
• Thirst
• Changing levels of responsiveness
408
First Aid and Shock:
Do Critical Care First
• Validate normal breathing and control severe bleeding.
• Care for life-threatening injuries first.
409
Treat for Shock
•
•
•
Place victim in supine position and raise legs 12 inches.
Loosen any tight clothing.
Raise under the calves, not the heels. The knees should not be hyperextended backwards.
410
Maintain Body Temperature
411
Shock in Children
• Blood loss in infants/children may quickly lead to shock
• Early shock may be less obvious but child’s condition rapidly declines
• Treatment is same as for adults
412
Anaphylaxis
•
•
•
•
413
Anaphylaxis is a severe allergic reaction
Also called anaphylactic shock
Life-threatening emergency because airway can swell
You need EMS
Common Causes of Anaphylaxis
Sensitivity to:
• Allergens
• Certain drugs
• Certain foods
• Insect stings and bites
414
Development of Anaphylaxis
• Signs and symptoms may begin within seconds to minutes
• The faster symptoms happen - the more serious the reaction may be
• Be vigilant for signs and symptoms of any airway issue…we must have EMS help if the airway is
compromised
415
If Anaphylaxis Suspected
•
•
•
•
SAMPLE – ask about allergies, food intake, and bites/stings.
Remember: This could be a first reaction even if the victim reports no history.
Suspect allergic reaction based on situation and victim’s signs and symptoms.
Benadryl recommended (this is OK for first aid use). Liquid is better than pills…pulverize nonchewable pills.
• Provide the appropriate Benadryl dose as shown on the container…do not exceed the max dose.
416
Urgent-Rx: “Allergy Attack”
•
It is a credit card sized foil pouch for wallet, purse, AED, or first aid kits
46
• This is an adult does of Benadryl that is pulverized and flavored
• Available from several outlets and online
• Current sources listed on vendor’s website:
www.urgentrx.com
417
Emergency Epinephrine Kit
•
•
•
•
•
418
May be prescribed to those with known severe allergies
The medication delays the effects of the whole body allergic attack
Ask a victim about it…help victim use it
Don’t share…this is a prescription item
It is not a replacement for Benadryl.
First Aid for Anaphylaxis Attack
•
•
•
•
•
•
Call EMS
Help victim use their epinephrine kit + Benadryl
Help victim sit in position of easiest breathing
Monitor!
Give basic life support if needed
419
How to Use An Epi Injector
420
Hydration and Allergies
• Rapid response area: Provide no fluids
• Remote response area: Provide sips of water if the victim is conscious and can tolerate it (does
not vomit)
421
Question 31
Which type of shock occurs as a result of severe bleeding?
A. Anaphylactic shock
B. Cardiogenic shock
C. Hypovolemic shock
D. Neurogenic shock
422
Question 32
Which type of shock occurs as a result of an allergic reaction?
A. Anaphylactic shock
B. Cardiogenic shock
C. Hypovolemic shock
D. Neurogenic shock
423
Question 33
What is the primary first aid technique in caring for a victim with the signs and symptom of
circulatory shock?
A. Call EMS.
B. Have the victim lie on his or her back and raise the legs about 8 to 12 inches.
47
C. Put the victim in the recovery position.
D. Try to maintain the victim's normal body temperature.
424
425
Wounds and Soft Tissue Injuries
Lesson 10
426
Bleeding Control
• The most effective method to stop bleeding is direct pressure.
• Elevation is not a primary method to stop bleeding.
427
Add Layers
• If the first bandage does not stop the bleeding then add additional layers.
• Try not to remove the first layer as this will disturb blood clots already formed.
428
EMS Recommended For…
• Deep punctures
• Gaping wounds
• Uncontrolled bleeding
• Any deep or large wound
• Significant wound on face, armpit,
body folds, feet, hands, groin
• Infected wound
• Or…If you feel you should !
429
Wound Care Is Important
• Soap and water is more effective than water
• Water only cleaning is better than nothing (unless bleeding severely)
• Remote care: Cleaning plus bandage is important, while less aggressive cleaning or quick
bandages could be more appropriate for rapid response area
430
Wounds
• Different types of wounds require different techniques
• Any wound has a risk of infection
• Goals of wound care: Prevent infection and protect wound so it can heal
431
Significant Bleeding
Is A Priority
Do not attempt to clean a wound that is bleeding severely – controlling bleeding is the priority.
432
Use Appropriate Techniques
• Select the appropriate steps from the wound care options listed on the next slide, based on the
type of the wound, the size of the wound, the location on the body, the environment, if EMS is
called, and first aid supplies available.
• Many wounds don’t need comprehensive treatment, a few will need everything.
433
Steps of Wound Care
434
48
Do not use alcohol, hydrogen
peroxide, bedadine, or iodine on wounds
Don’t remove
clothing stuck to wound if
this will cause significant
bleeding (rapid response)
Don’t breathe on the
wound
Don’t remove debris if this will
cause significant bleeding (rapid response)
435
Infection
436
Signs And Symptoms Of Infection
•
•
•
•
437
Antibiotic Ointment
•
•
•
•
•
438
Wound area is red, swollen, and/or warm
There could be a pain, pus, fever, and/or red streaks at or near wound
Infections can spread slowly or quickly
Amputation or loss of life are possible outcomes if infection is not treated
Use antibiotic ointment on abrasions or shallow wounds
Don’t pack ointment into punctures or deeper wounds
Use triple antibiotic type unless there is a known allergy
If there are signs that wound is infected see a healthcare provider
US triple antibiotic contains neomycin, bacitracin and polymyxin-B (all are the same)
Topical Antibiotic
• Soap and water remains the best way to clean a wound and prevent infection.
• Victims which are about access medical care should not have topical antibiotic, since it will be
immediately removed.
• If there are signs of progressive infection always access EMS.
• For minor wounds and in remote areas use topical antibiotic within 4 hours for 2 or 3 days (5
max), even if signs improve.
439
Types of Open Wounds
Abrasions
440
Abrasions
•
•
•
•
•
•
•
441
Can involve larger areas
Higher risk of infections compared to other types of wounds
Antibiotic ointment may be appropriate
Can be a difficult to clean
Non-adherent bandage may be better than roller gauze for deeper abrasions
Daily bandage change important
Types of Open Wounds
Lacerations – The tissue is cut or torn
49
442
Lacerations
•
•
•
•
•
Unless bleeding is severe, clean both the surface and the inner part of the wound.
Use direct pressure techniques and bandages that will press tissue gaps back together.
Do not use antibiotic ointment.
For larger wounds assess for damage to connective tissues, bone, and nerves.
443
444
Punctures
•
•
•
•
Unless bleeding is severe, squeeze the wound to let blood clean the wound from inside.
Only small and shallow objects can be removed (splinters, cactus needles, paper staples).
Do not apply antibiotic ointment.
For deeper wounds assess for internal bleeding, or damage to organs, connective tissues,
muscles, bone, and nerves.
•
445
446
Avulsions
• Be gentle when cleaning internal tissues, often a water flush is enough. Avoid putting soap on
internal tissues.
• Do not use antibiotic ointment.
• Put tissues back in place before bandaging.
• Monitor to insure bandages are not cutting off circulation to an extremity.
• Initiate transport to EMS quickly.
447
Dressings and Bandages
448
Types of Bandages
•
•
•
•
•
•
•
•
449
Adhesive compresses (Band-Aids)
Adhesive tape
Cohesive bandage
Roller gauze
Non-adhering bandage
Triangular bandage
Combine/trauma bandage
Improvised bandage
Use The Right Bandage
• Roller Gauze – Acts as a bandage and compress, easiest on extremities and places where you can
wrap around and tie. (Multi-ply type sometimes called “Kerlix”)
• Triangular Bandage – Can be used as a bandage, splint tie, head bandage, general tie
Gauze pads can be used in combination with other dressings.
450
Use The Right Bandage
• Cohesive Bandage – Can be used to hold bandage in place, reduce swelling, stays on even in wet
50
conditions
• Non-Adherent Bandage – Burns and some open wounds (abrasions)
•
•
Gauze pads can be used in combination with other dressings.
451
Wound Closures
(Steri Strips, Butterflies)
• Stop bleeding and clean wound first
• Apply
• Back up with roller gauze, elastic bandage, tape, or self-adherent bandage
452
Not Too Tight !
453
Liquid Bandage
•
•
•
•
454
Occlusive Dressing
•
•
455
For small cuts with bleeding stopped
Clean the wound before using a liquid bandage
Will wear off in about a day
It is an antiseptic, but it is not an anesthetic or an antibiotic
Some wounds are candidates to use an occlusive (airtight) dressing, such as for larger abrasions,
chest penetrations, and second or third degree burns.
Occlusive dressings can be improvised from many things, such as Mylar rescue blankets, plastic
bags, cut up gloves, or airtight bandage wrappers.
Bandage Techniques
• There are many ways to bandage – many more than shown in this training – the effectiveness of
the bandage is the primary consideration.
• Use the cleanest materials available – but in remote/wilderness care situations or when you don’t
have access to a first aid kit just about anything can be used to improvise a bandage.
•
456
Roller Gauze
457
Roller Gauze
458
Roller Gauze
459
Roller Gauze
460
• Cohesive bandage is not a good absorbent, so use a gauze pad or other bandage to stop the
bleeding.
• Use cohesive wrapping to hold a bandage in place, reduce swelling, or provide a cover.
461
Demonstration
Applying Roller Gauze
Applying Cohesive Bandage
462
463
Multi-Ply Roller Gauze
51
(Kerlix)
464
Multi-Ply Roller Gauze
465
Multi-Ply Roller Gauze
466
Multi-Ply Roller Gauze
467
Multi-Ply Roller Gauze
468
• Triangular bandages can also be a dressing.
469
Demonstration
Applying Multi-Ply Roller Gauze
Applying a Triangular Bandage
470
Bandage Skill Practice
Please put on gloves for the bandage practice sessions.
471
472
Special Wounds
473
Puncture Wound
•
•
•
•
474
Impaled Objects
•
•
•
•
475
Greater risk of infection
Germs may not be flushed out
Remove small objects or dirt (not impaled object)
If the object has fallen out, gently press on wound edges to promote bleeding (flushes out
wound)
Removing an object could cause more injury and bleeding
Leave it in place and dress wound around it
Control bleeding by applying direct pressure at sides of object
If it falls out don’t put it back in!
Fishhook Removal
• Attempt only if a minor puncture or in a remote area
• A medical facility has better aids and ability to flush wound
476
Avulsion
•
•
•
•
477
Irrigation of five minutes+ will reduce infection risk (if bleeding permits)
Move skin or tissue into normal position
Control bleeding and provide wound care
If avulsed body part completely separated care for it as an amputation
Amputation
• Control bleeding and care for wound first, then recover and care for amputated part
478
Preserve The Tissue
• Wrap severed part in dry, sterile dressing or clean cloth (do not scrub…gentle rinse only)
• Place part in plastic bag, seal it
52
• Place sealed bag in another bag/container with ice
• Part should not touch ice directly
• Keep body part(s) and the victim together
479
Genital Injuries
• Provide privacy for victim
• Use direct pressure for external bleeding
• Seek medical care for severe or continuing bleeding, significant pain, discoloration/swelling,
continuing pain, or indicators of abuse
480
Genital Injuries
• If appropriate support with towel between legs
• For vaginal bleeding press sanitary pad or clean folded towel to area
481
Head and Face Wounds
• Consider possible neck or spinal injury
• Do not move victim’s head while giving first aid
482
First Aid: Scalp Wound Without Suspected Skull Fracture
•
•
•
483
Replace any skin flaps and cover wound with sterile dressing
Expect bleeding
Put roller or triangular bandage around victim’s head to secure dressing
Eye Injuries
• Three categories of injury: soft tissue around the eye, surface of the eye, or damage to the eye
structure (such as punctures)
• If the eye is bleeding or leaking fluid activate EMS
• For external tissue injury you can use a cool pack for up to 20 minutes…do not put pressure on
the eye
• Do not remove contact lenses in most cases
•
484
First Aid For Eye Penetration
•
•
•
•
•
485
Do not remove the object
Leave contact lenses in
Stabilize with dressings or bulky cloth (paper cup for large object)
Cover both eyes
Access EMS quickly
Removal Of Dirt/Small Particle In The Eye
Priority of options:
1. Encourage victim to blink to flush out object with tears
2. Have victim grab upper eyelash and pull upper eyelid out and over lower lashes – it may brush
object out
3. Flush eye with saline or water to rinse out object
4. Use clean gauze, tissue, cotton applicator to brush out object
486
First Aid: Chemical
In The Eye
• Gently rinse the eye with water or saline for 20 to 30 minutes or until EMS arrives.
53
• Have victim hold head with affected eye lower so water doesn’t flow into unaffected eye
• Remove contacts (with chemical contamination of the eye)
487
Ear Injuries
•
•
•
•
488
First Aid: Ear Injuries
•
•
•
489
Bleeding or cerebrospinal fluid from the ear can be a sign of serious head injury
Do not use direct pressure to stop fluid coming out of ear
Remove foreign object only if easily seen and accessible
For an insect in the ear gently pour lukewarm water into ear to float it out
If blood looks watery evaluate for broken eardrum, or more severe head injury (Cerebral/Spinal
Fluid ).
Help victim sit up, tilt head towards affected ear.
Cover ear with loose sterile dressing (do not apply pressure).
Nosebleed
• Nose trauma can cause heavy bleeding
• Usually controlled by victim leaning forward and pinching nostrils closed
• Position unresponsive victim on one side with head turned while you pinch nostrils closed
490
Nosebleed
• Common nosebleeds are usually from blood vessels in the front of the nose
• Significant bleeding that runs from back of nose down throat needs medical attention
• If a foreign object is visible and easily grasped with tweezers…remove it
491
First Aid for Nosebleeds
1.
2.
3.
4.
5.
492
Nosebleeds: Next Step
•
•
•
•
493
Tilt head forward.
Pinch nostrils together for 10 minutes.
After 10 minutes release pressure slowly.
Pinch nostrils closed for 10 more minutes if bleeding continues.
Repeat for up to thirty minutes
High altitude or winter environment have very dry air…a possible cause of nosebleeds.
Acceptable next step for first aiders is to pack the nostril with gauze saturated with Vaseline,
“Ayr”, first aid gel, etc…
Make sure bleeding is not coming from higher up in the sinus…this is a serious condition
requiring medical attention.
After a few hours gently remove the gauze pack.
Cheek Injuries
• Treat the external wound with general care
• Any facial wound calls for further investigation for trauma to underlying tissues
• If bleeding inside mouth position unresponsive victim with head turned to side so blood will run
out
494
Mouth Injuries
• May cause bleeding anywhere in mouth…assess carefully
• Control bleeding with direct pressure
• Ensure airway open and blood can drain from mouth
54
• For loose tooth make pad from rolled gauze and have victim bite down gently to keep tooth in
place and see a dentist
495
Knocked Out Tooth
• Have victim sit with head tilted forward
• To control bleeding place rolled gauze pad in tooth socket
• Have victim bite down gently for 20+ minutes
496
Knocked Out Tooth
(Adult Tooth)
• Save tooth…it may be re-implanted if victim sees dentist quickly
• Touch only tooth’s crown, lightly rinse if dirty
• Place in commercial save-a-tooth (Hanks balanced salt solution), Propolis, egg white, coconut
water, Ricetral, or whole milk
• Alternative: Put tooth in bag with victim’s saliva…do not place tooth back in socket
497
Bleeding in Mouth
•
•
•
•
498
Do not excessively rinse as that may delay clotting
Do not let victim swallow blood as this can cause vomiting
Control the bleeding, and tell the victim not to drink anything warm for several hours
Seek medical attention if bleeding is severe or does not stop
Blisters
• Treat as a soft tissue injury with higher potential for infection
• Prevent by protecting feet with socks, right size shoes, protecting hot spots where socks rub with
moleskin or bandage
• Take preventive action at first sign of friction…before the blister forms if possible
499
First Aid: Blisters
•
•
•
•
•
500
Wash blister and surrounding area with soap and water. Rinse and dry.
Cover open blister with bandage and antibiotic ointment - change dressing and clean
frequently
Protect large hot spot from friction - cut hole in layers of gauze or use moleskin.
Lance blisters if close to top layer of skin – leave deep blisters alone and prevent further friction
Remove dead skin (white tissue).
Question 34
What should you do if blood seeps through a dressing on a wound?
A. Apply a new dressing on top of the soaked dressing and continue to apply pressure.
B. Apply occlusive (airtight) layer on top of the dressing.
C. Remove the soaked dressing and apply a new dressing.
D. Rinse the wound clean with tap water for at least 5 minutes and re-bandage.
501
Question 35
What is the poorest choice of bandage to use if you want to control bleeding?
A. Adhesive tape
B. Elastic bandage
55
C. Roller bandage
D. Triangular bandage
502
Question 36
You need to apply a roller bandage to a victim's forearm. What is your first step?
A. Anchor the start of the bandage.
B. Continue with overlapping figure-eight turns.
C. Fasten the end of the bandage.
D. Turn the bandage diagonally across top of foot and around ankle.
E. Have several large people sit on the victim
503
504
505
Part 1 Conclusion
Please turn in pre-tests.
Homework: Please complete the advanced first aid equipment exercise and bring with you
tomorrow.
Homework: Please look over all handouts.
Class will start promptly.
506
End of Part 1
507
Copyright
This presentation contains copyright protected materials. Public web posting and/or reproduction is
not allowed without permission.
Suggested changes and improvements may be sent to Colorado First Aid, Inc. ([email protected])
These materials may not be modified without permission.
www.cofirstaid.org
56
Advanced First Aid, Remote Care,
CPR, and AED
1
2
This presentation contains copyright protected materials. Public web posting and/or reproduction is
not allowed without permission.
Suggested changes and improvements may be sent to Colorado First Aid, Inc. ([email protected])
These materials may not be modified without permission.
www.cofirstaid.org
Modules (Part 2)
3
1
1 Preparing to Act
2 Acting in an Emergency
3 The Human Body
4 Assessing the Victim
5 CPR
6 AED - Automated External Defibrillator
7 Airway Obstructions
A Advanced Resuscitation Techniques
8 Controlling Bleeding
9 Shock
10 Wounds and Soft Tissue Injuries
Part 2
11 Burns
12 Serious Injuries
2 13 Chest, Abdominal, and Pelvic Injuries
-- First Aid Kits
14 Bone, Joint, and Muscle Injuries
15 Extremity Injuries and Splinting
16 Sudden Illness
17 Poisoning
18 Substance Misuse and Abuse
19 Bites and Stings
20 Cold and Heat Emergencies
21 Behavioral Emergencies*
22 Pregnancy and Childbirth*
23 Remote and Wilderness First Aid
24 Triage, Rescue, and Moving Victims
25 Are You Prepared?*
26 Moving Forward
Modules
4
1
1 Preparing to Act
2 Acting in an Emergency
3 The Human Body
1
4 Assessing the Victim
5 CPR
6 AED - Automated External Defibrillator
7 Airway Obstructions
A Advanced Resuscitation Techniques
8 Controlling Bleeding
9 Shock
10 Wounds and Soft Tissue Injuries
Part 2
11 Burns
12 Serious Injuries
2 13 Chest, Abdominal, and Pelvic Injuries
-- First Aid Kits
14 Bone, Joint, and Muscle Injuries
15 Extremity Injuries and Splinting
16 Sudden Illness
17 Poisoning
18 Substance Misuse and Abuse
19 Bites and Stings
20 Cold and Heat Emergencies
21 Behavioral Emergencies
22 Pregnancy and Childbirth
23 Remote and Wilderness First Aid
24 Triage, Rescue, and Moving Victims
25 Are You Prepared?
26 Moving Forward
5
Scenario & Practice
Advanced First Aid
6
Preparation
• Divide into groups
• Pick one volunteer to act as victim and have them go to the presenter’s table
• The scenario will be presented on the next slide
• Move to your group’s area when directed.
• With the scenario information, please discuss with your group how you will handle this situation
• What you see is what you have…don’t make stuff up, please!
The scenario begins when your victim
arrives in your area
7
The Scenario
• This is in an office area, an administrative part of the building, with modular cubicles. The
number of folks present is your group.
• You are on the first floor. Ambulance response is about 15+ minutes. There are phones
available.
• One of your co-workers is reaching underneath their desk. There is a jagged edge of metal
2
exposed and the person cut their forearm. The cut is about two inches long, ¼ + inch deep in
the middle, and bleeding.
• Use whatever materials are available in this classroom. Talk to the victim as you would in a real
situation.
8
The Scenario
• This is in an office area, an administrative part of the building, with modular cubicles. The
number of folks present is your group.
• You are on the first floor. Ambulance response is about 15+ minutes. There are phones
available.
• One of your co-workers is reaching underneath their desk. There is a jagged edge of metal
exposed and the person cut their forearm. The cut is about two inches long, ¼ inch deep in the
middle, and bleeding.
• Use whatever materials are available in this classroom. Talk to the victim as you would in a real
situation.
• Company policy only allows for ambulance or sending an employee home by themselves.
9
10
It’s Your Turn !
How Did You Do?
•
•
•
•
11
Return to your group area and discuss.
What went well? What would you do differently next time?
Pick a spokesperson who will present a summary of your discussion.
After a few minutes we will return to the classroom and present your group’s discussion.
Discussion
Please tell us what you would do differently next time.
No need to tell us what happened or what went well, please!
12
Issues
Consent? 911 called?
SAMPLE? Wrote it down?
Gloves?
Used first aid supplies?
Shock treated?
Resources mostly on CPR?
CPR techniques?
Communication? Teamwork?
Second 911 call?
AED attempted?
Face shield or pocket mask used? BVM?
13
Conducting Effective
First Aid Practices
•
•
•
•
Practice first aid in groups periodically.
Focus on one or two key skills per practice.
You don’t need extensive moulage or equipment. Keep it simple.
Never allow participants to perform a skill incorrectly…correct skills immediately so only proper
skills are practiced (and observed by everyone else).
3
• Don’t allow first aid training to be performed as a “game”. Instill the value that first aid is serious
and it needs to be done right.
• Use all age groups present so adults and youth understand this is not a game…first aid is a
partnership of all responders who are present.
• Use EMS professionals and first aid instructors to help present “pop quiz” and practice.
14
15
Temperature Measurement
16
Temperature?
Victim temperatures can be useful if you are in a remote area or you need information regarding
the need for further care.
High temperatures can indicate:
- Fever from illness
- Fever from infection
Low temperatures can indicate:
- The severity of hypothermia
17
How Far Do I Go?
Oral temperatures are easy to take. It is a useful capability for the advanced first aid volunteer in
remote areas.
Rectal temperatures are always the most accurate for significant hypothermia. It might be an
option if you are in an extreme remote location and EMS is delayed. You need a glass or probe
type for rectal temperatures.
Otherwise, oral temperatures should be adequate for almost all first aid applications.
18
What Should You Carry?
• Rapid response first aid kits don’t really need a thermometer.
• Remote response first aid kits should have the plus an inexpensive probe type. For extended
remote support a glass thermometer or strip type (oral) thermometer can also be included.
19
Which Kind?
• Glass thermometers fell into disuse in the US because of the mercury ban. They are now sold (in
US) with a non-mercury fluid.
• Inexpensive digital probes can be 1+ degrees off…not as accurate, even if covers are not used.
But, they are easy to use.
• Tympanic thermometers and forehead strips do not accurately represent core body temperature
in the outdoors.
• Disposable oral strips are somewhat accurate, but, can be neutralized if stored in high heat too
long
20
Glass Thermometers
Glass thermometers have advantages for field use:
• No batteries to get cold or old
• No liquid crystal display you can’t read if very cold
• Glass thermometers have highest accuracy
Disadvantages of glass thermometers:
• Can burst if left in high heat too long
• Need training to use and read correctly
4
• Need a hard case to prevent breakage
• They are not stocked everywhere – harder to find
21
Glass Thermometers
Fever Thermometer
• Must be shaken down before use
• Keeps highest temperature after removal
• Made as Oral or Rectal type
• Measures 94 – 108 degrees
• Leave in for 3-5 minutes
Oral vs. Rectal Type?
• Rectal has a blunt, shorter, stronger tip
• Field Tip: Carry Rectal type fever thermometers in field kits…they resist bursting if they overheat
much better than the Oral type. They can be used orally!
22
Normal Human Temperature
Some folks do run slightly higher or lower…ask them what is normal for them!
• Oral – 98.6°F
• Axial (armpit) – 97.6°F (1 degree lower)
• Rectal – 99.6°F (1 degree higher)
23
Reading A Disposable Strip Thermometer
• The temperature is the warmest dot that changes color
• Read immediately since dots will revert to original color as the strip cools
24
Reading a Glass Thermometer
•
•
•
•
•
•
25
Hold by stem end
3-5 minutes oral and rectal…7-8 minutes axial
Rotate to see fluid in shaft and numbers (some have longer tick at 98.6 degrees)
Each tick mark is .2 degrees
Be as accurate as possible…to nearest .1 degrees
Clean before and after use
Reading A Glass Thermometer
Several thermometers are available for practice. Please read them and put the answer on your
answer sheet (find the three lines at the bottom)
Do not touch the bulb end or shake. The temperate has been pre-set!
26
27
Burns
Lesson 11
28
Fires and Burns
• 3900 deaths every year
• 500,000 injuries lead to emergency department visit
• Most occur in the home
5
• Most can be prevented
29
Functions of Skin
•
•
•
•
Protection from pathogens
Fluid retention
Temperature regulation
Sensation
Burns interfere with these functions.
30
What Does A Burn Do?
•
•
•
•
•
•
•
31
Fire Evacuation (Buildings)
•
•
•
•
•
•
32
May damage different layers of skin
Burns into dermis allow pathogens to enter skin
Cause fluid loss
Severe burns are likely to cause shock
Aftermath of severe burns can cause loss of body heat and increased risk of hypothermia
Damage to nerve endings causes pain
Pain may be missing if nerve endings are destroyed
Evacuation is the top priority
Do not use elevator
Feel doors before opening them
Stay near floor if air is smoky
Use appropriate extinguishers only if fire is small
If you cannot escape then stuff door cracks and vents, and call for help
Fire Rescues
• The best choice is for fire responders to perform fire rescues
• If you have to remove victims do so quickly at minimal risk to yourself
• Let others know if you are attempting a rescue or are doing area checks
33
Put Out The Fire
•
•
•
•
•
34
Stop, drop, and roll
Use water on any flames
Cool the burned area
Remove burned clothing
Remove jewelry
Three Categories Of Burns
Thermal
Chemical
Electrical
35
Classification Of Burns
36
First Aid For Thermal Burns
• Remove from heat and cool the area
• Protect the burned area from additional trauma and pathogens
6
• Provide supportive care
• Seek medical attention (if needed)
37
When To Seek Medical Care
•
•
•
•
•
•
•
38
Any 3rd-degree burn bigger than a quarter
Any 2nd-degree burn of more than 10% of body in adult (more than 5% in child or older adult)
2nd- or 3rd- degree burn on face, armpit, genitals, or hands or feet
Circumferential burns
Burns around nose, mouth, groin, armpit
Victims with chronic health disorders
If you feel you should
Assessing Burn Size and Severity
The “Rule of Nines”
Multiples of 9 help you remember percentages to estimate surface area of burns.
The victim’s palm size is about 1%.
39
40
Preventing Sunburn
•
•
•
•
•
41
First Aid: First-Degree Burns
•
•
•
•
•
42
Stop the burning.
Cool burned area.
Remove constricting items.
Protect burned area from friction.
Long term: Provide moisturizing cream/lotion
First Aid: Second-Degree Burns
•
•
•
•
•
43
Keep infants out of direct sunlight
Use sunscreen
Wear brimmed hat and protective clothing
Limit sun exposure
Be aware of reflective surfaces (water, snow, light surfaces)
Stop the burning.
Cool burned area.
For large burns call EMS.
Remove constricting items.
Apply loose nonstick dressing over area.
First Aid: Third-Degree Burns
•
•
•
•
•
Stop the burning.
Cool surrounding areas.
Remove constricting items.
Call EMS.
Prevent shock.
7
• Apply nonstick dressing or burn dressings.
44
Smoke Inhalation
• Airway could swell and make breathing difficult
• Damage to alveoli may affect ability to receive oxygen
• Symptoms may not be obvious for up to 48 hours after exposure
45
First Aid: Smoke Inhalation
•
•
•
46
Chemical Burns
•
•
•
•
47
Move victim to avoid additional contamination, fumes, and to support treatment
Brush off any dry contaminates
Remove constricting items and jewelry
Wash area gently with running water for at least 30 minutes
First Aid: Chemical in the Eyes
•
•
•
•
49
Strong chemicals can burn skin on contact
Sometimes burns develop slowly
Acids, alkalis, liquids and solids can cause burns
Flush substance from skin with water as soon as possible
First Aid: Chemical Burns
•
•
•
•
•
•
48
Move victim to fresh air.
Help victim into position for easy breathing.
Administer oxygen if available.
Have victim remove contact lens.
Flush eye immediately with water for at least 20 minutes.
Tilt victim’s head so water runs away from other eye.
Further care and evaluation in a medical facility is usually appropriate.
Electrical Burns
• Occur when body contacts electricity
• There can also be thermal burns
• Typical injuries occur with faulty appliances or power cords or appliance in contact with water
50
Injuries from Electricity
•
•
•
•
51
External injuries can include entrance and/or exit wounds
Internal injures are caused by electricity flowing through body tissues
Heart rhythm irregularities possible
Cardiac arrest possible
First Aid: Electrical Burns
•
•
•
•
•
Do not touch victim until it is safe
Turn off electricity (if possible)
Give BLS to unresponsive victim
Care for burn
Manage shock
8
•
52
Have AED ready
Question 37
A mild sunburn is an example of a:
A. First-degree burn
B. Second-degree burn
C. Third-degree burn
D. Fourth-degree burn
53
Question 38
Which type of burn damages the dermis, is very painful, and often results in blisters?
A. Third-degree burn
B. Second-degree burn
C. First-degree burn
D. Fourth-degree burn
54
Question 39
You encounter an unresponsive victim who appears to have been electrocuted by a household
appliance. What should be your first step of care?
A. Call EMS
B. Give BLS
C. Treat any burns
D. Unplug the appliance
E. Grab the victim firmly with wet hands
55
56
Serious Injuries
Lesson 12
57
Head and Spinal Injuries
•
•
•
•
58
Can be difficult to assess…they can be minor up to life threatening
Damage can be to the brain, spinal cord, and/or the surrounding tissues
Injuries that cause unresponsiveness or loss of sensation are more likely to be serious
Be prepared for a neck or spine injury when treating any serious injury or trauma
Spinal Injury
• In a rapid response area: If victim is responsive their signs and symptoms may be enough to
suspect a spinal injury
• If victim may have a spinal injury do not move victim unless necessary (rapid response area)
59
Spinal Injury Statistics
•
•
•
•
Motor vehicle crashes are the leading cause of head and spinal injuries in people < 65
Falls are the leading cause of head and spinal injuries in people over 65
Sports and recreation cause about 18% of spinal injuries
About 11,000 people have spinal injury each year
9
• Over 200,000 people live with disability resulting from spinal injury
60
Spinal Injury
Signs and Symptoms
•
•
•
•
•
•
61
Lump or deformity in head, neck, or back
Changing levels of responsiveness
Drowsiness
Confusion
Dizziness
Unequal pupils
Suspected Neck Injury
62
63
Spinal Motion Restriction
64
Mechanism of Spinal Injuries
• Fracture of neck or back can be serious due to possible damage to spinal cord
• Extent of nerve damage depend on nature and location of injury
• Movement of head or neck could damage the spinal cord
65
The Spinal Injury Assessment
66
Spinal Injury
Secondary Assessment
•
•
•
•
•
•
•
•
•
67
Check the head (including underneath)
Check neck for deformity, swelling, pain
Feel along spine for deformity, pain, swelling
Check sensation in feet
Ask victim to point toes
Ask victim to push against your hands with feet
Check sensation in hands
Ask victim to make fists and curl them in
Ask victim to squeeze your hands
First Aid: Spinal Injuries
•
•
•
•
Use appropriate assessment
Stabilize victim’s head and neck in position found
Monitor victim’s breathing.
Prevent victim’s head movement and manage other first aid issues
68
Head and Brain Injuries
69
Brain Injuries
•
•
•
•
Can be associated with a skull fracture, no outward signs of a blunt trauma
Wide range of signs and symptoms
Signs and symptoms may seem mild but may progress to become life threatening
Be alert for an additional spinal injury
10
70
Brain Injury Signs and Symptoms
Seek medical attention if there is:
• Nausea and vomiting
• Severe or persistent headache
• Changing levels of responsiveness
• Lack of coordination, movement problems
• Problems with vision or speech
• Seizures
(up to 1-2 days after incident)
71
Skull Fracture
• Skull fracture could allow external pressure to reach the brain
• Check for possible skull fracture before applying direct pressure to a bleeding scalp
• Use appropriate bandages if you have to control bleeding around a skull fracture
72
First Aid: Brain Injuries
• For a head injury allow the victim to lie down, keeping head and shoulders raised
• Keep victim still and warm
• Support head and neck if you suspect there is also neck or spinal injury
73
Concussion
• Concussion is a brain injury resulting in temporary impairment of brain functions
• There may or may not be outward signs of trauma
• Victim may have been “knocked out” and regained consciousness quickly
74
Concussion Signs and Symptoms
•
•
•
•
•
•
•
•
75
First Aid: Concussion
•
•
•
•
•
•
•
76
Brief loss of responsiveness
Mild or moderate altered mental status
Unusual behavior
Headache
Dizziness
Vomiting
Nausea
Ringing in the ears
Field evaluation of seriousness is difficult
Seek medical care for suspected brain injuries or severe concussion
Keep victim still, give supportive care, monitor breathing
Wound care for any external trauma
Victim should stop activities with additional risk for head/brain trauma
Watch for symptoms for up to 48 hours
Especially watch for progressive symptoms
Suggested: A “One Minute” Rule
For Concussions
If the loss of consciousness is less than a minute
- and –
11
There are no symptoms in the first 24 hours
…you can use the option to observe the victim for symptoms for up to 2 days, instead of immediate
EMS access
If in doubt, if symptoms appear, or if you feel you should, then medical evaluation is recommended
77
Colorado Concussion Law
• Since January 2012 organized youth sports officials and/or coaches (K-12 only) must have annual
awareness training in concussions and concussion first aid.
• After suspected concussion parents must be notified and youth may not participate in activity
until cleared by medical personnel.
78
Rolling The Victim With The “Log Roll”
79
Why Perform A Log Roll ?
•
•
•
•
80
The Log Roll is for temporary access to the back area
You may need to get access to the back to stop bleeding or assess injury
You may need to get padding (for warmth) under the victim to keep them warm
The victim is vomiting
Log Roll: Start With Spinal Motion Restriction
81
82
83
84
85
Question 40
You have detected signs and symptoms of a possible neck or head injury:
A. Movement of the head or neck could make the injury worse.
B. There is little chance that the victim's condition will improve.
C. The victim can be moved by hand with little concern for causing additional damage.
D. The victim's head must be tilted back to be in line with the body.
86
Question 41
You need to perform a log roll on a victim with a spinal injury. What is the first step?
A. Hold the victim's head with your hands
B. Keep the legs, hips, back, neck, and head aligned.
C. Support the victim's head in the new side position.
D. The first aider at the victim's head directs other rescuers to roll the victim.
E. Duct tape the ankles together.
87
88
Chest, Abdominal, and Pelvic Injuries
89
Injuries to Chest, Abdomen, and Pelvis
• Can result from blunt or penetrating forces
12
• Can result from any object that breaks the skin
• Can be life threatening
• Shock can happen
90
Torso Injury
Signs and Symptoms
•
•
•
•
•
91
Sucking Chest Wound
•
•
•
•
92
Breathing problems
Severe pain
Bruising, swelling
Deformity
Coughing blood
This is an open wound in chest caused by penetrating injury
Opening lets air move in and out of chest during breathing
Can be life threatening
Do not bandage or obstruct (allow for unrestricted airflow in rapid response area)
Pneumothorax
(Collapsed Lung)
• Can be caused by trauma (tear in lung) or puncture of the lung cavity
• Air escapes from injured lung into thoracic cavity, or, air enters the thoracic cavity from a
puncture, causing collapse of lung tissue
• Results in respiratory distress and poor perfusion
93
Hemothorax
94
Impaled Object
•
•
•
•
•
95
First Aid For Rib Injury
•
•
•
•
96
Keep victim still.
Don’t pull object out
Stabilize object.
Bandage area around object.
If object falls out then adjust bandage.
Keep victim still
Apply wide area support to injured side(s)
Sling(s) and binder may help keep injured area from moving
Let victim choose position of greatest comfort (includes sitting upright)
Flail Chest
• A flail chest is a fracture of two or more ribs in two or more places
• Usually results from severe blow to chest
• Injury separates segment of chest wall from remainder of chest
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Flail Chest Can Display
“Paradoxical Movement”
• Flail segment moves in opposite direction to rest of chest wall
• The larger the flail segment, the greater the threat to respiratory function
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First Aid For Flail Chest
• Have person lie down or sit in position of easiest breathing.
• Splint the flail area the same as a broken rib.
• Position victim on injured side, if victim comfort allows.
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Abdominal Injuries
• Can be closed or open
• Can involve internal or external bleeding
• Victim needs medical care
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Closed Abdominal Injury
• Can be life threatening
• Internal organs may have ruptured
• Possibility of severe internal bleeding
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First Aid For
Closed Abdominal Injury
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Modified Recovery Position
For Abdominal Injury
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Carefully position victim on back and loosen any tight clothing.
Let the victim comfort help you select the best position.
Treat victim for shock and monitor victim’s breathing.
In rapid response areas do not give them anything food or drink, even if they are thirsty.
To reduce tension in the lower abdomen you can lie them down and raise the lower body by
placing something under the knees.
This position is to help with shock and support tissues in the lower belly.
If there are no signs of shock a conscious victim can also be seated against a wall, with the
knees bent.
Open Abdominal Wound
• Can include injury to internal organs (intestines, liver, kidneys, or stomach)
• Large wound may cause evisceration
– Abdominal organs protrude through wound
– Serious emergency
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First Aid: Open Abdominal Wound
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Lay victim on back.
Cover wound with occlusive (airtight) and moist sterile dressing.
Treat for shock.
Remote response area…very important to keep tissues warm and moist!
Pelvic Injuries
• Can cause severe internal bleeding
• Can be life threatening, cause shock, or be associated with a spinal injury
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First Aid For Pelvic Injuries
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Help victim lie on back, bend knees slightly if victim is more comfortable.
If help is delayed then immobilize legs together.
Treat for shock.
Question 42
You have determined that a victim has a likely pneumothorax, and no external penetration of the
chest is found. Your best care step should be to:
A. Place a pocket mask over the hole.
B. Cover the chest with a plastic wrap or bag to make an airtight seal.
C. Put a thin, sterile dressing over the wound, with an occlusive flap taped on three sides.
D. Position the victim lying down, inclined toward the injured side.
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Question 43
You believe that a victim may have a closed abdominal injury. What is an acceptable step you can
take (specific for this injury)?
A. Lying on their back, allow the victim to bend his or her knees slightly if this eases the pain (pad
under the knees).
B. Call EMS.
C. Carefully position the victim on his or her back and loosen any tight clothing.
D. Treat the victim for shock and monitor the victim's breathing.
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First Aid Kits
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The Quest
• There is no magic list that defines a perfect first aid kit.
• First aid kits should be customized based on:
– What are the likely injury or illness they will support?
– It the kit for personal (individual) or group use?
– What is the level of training of the expected users?
– How large (or small) should/must the kit be?
– What environment will the kit be kept in?
– What is you budget?
– Are there legal, company policy, or other restrictions?
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Discussion
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Exchange your first aid worksheet with another.
Take a few minutes to discuss and defend choices with each other
Record changes in column A.
Discuss your selections and make suggestions on your partner’s selections.
Consider Making Your Own Kit
• Most commercial kits won’t meet your needs for a personalized or group kit – we recommend
you build your own.
• Decide on hard vs. soft side container
• Put everything in ziplock bags – items stay cleaner and the outdoor kit can be used in rain/snow.
• Gloves and face shields should be packed for quick access.
• Review it periodically so you are familiar with contents and replace/restock items as necessary.
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Go Shopping & Order Smart
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Generic items have the same drugs as name brand items, and are cheaper.
Prices are not competitive! Shop around!
The best deals are usually from online sources.
Specialty items be found at surplus stores, eBay, and veterinary sources at reduced prices.
File your finds for future re-orders.
Order gauze pads in quantity (“semi-sterile”, “surgical sponges”) and repackage into zip-lock
baggies.
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Bone, Joint, and Muscle Injuries
Lesson 14
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VIDEO
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Musculoskeletal Injuries
• Fractures
• Dislocations
• Sprains
It is not necessary to know the exact nature of a musculoskeletal injury to provide first aid
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Fracture Signs And Symptoms
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Most Victims are Symmetrical
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General Guidelines
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During assessment you can compare an injured arm or leg to opposite side
Look for pain when touched
Abnormal sensation (numbness, tingling)
Inability to move area
Difference in temperature
Swelling is not an indicator of severity
Deformity is a sign of dislocation or fracture
Skin discoloration can resemble bruising
Pale, bluish skin color and cool skin may indicate lack of blood flow to area
Remove (or check under) victim’s clothes as appropriate
Do not assume less painful injuries are minor
Do not ask victim to move injured area if it causes pain
Lack of sensation may be a symptom of nerve damage
Musculoskeletal Injuries:
Use “RICE”
R
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= Rest
= Ice (cold pack)
= Compression
= Elevation
Rest
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• Any movement can cause further injury, pain, swelling
• Have victim remain still until medical help arrives
• Use a splint to immobilize area if EMS response is delayed or victim must be moved
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Ice (Cold Pack)
• Cold reduces swelling, lessens pain, and minimizes bruising
• Use ice plus water for better cooling rather than ice only
• Objective is twenty minutes on, with short term goal of ten minutes per patient comfort. Less
cold for full period is better than too cold for a short time
• Improvised cold packs: cloth pad soaked in cold water in a plastic bag
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What about heat packs?
• Generally, heat is not used for 48+ hours
• Heat is only applied when most of the swelling is gone
• Exercise, stretching and massage can be part of long-term care for minor connective tissue
injuries
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Compression
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Provides comfort and support
May help prevent internal bleeding and swelling
Use elastic roller bandage or cohesive bandage
Wrap bandage over injured area or over cold pack
Check circulation in fingers and toes
Can be used during the first 48 hours (insure it is not too tight)
Elevation
• Helps prevent swelling
• Helps control internal or external bleeding
• Splint fracture first and elevate it only if moving limb does not cause pain
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When Is Medical Care Recommended?
1 • Signs and symptoms of significant fracture or dislocation
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Fractures
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Severe pain
Numbness
Angulation
Injured joint cannot move
Redness or red streaks from injured area
When you feel that it is appropriate
Bone can be completely broken, partially broken, or only cracked
Closed fracture – skin not broken
Open fracture – open wound at site
Bleeding can be severe with fracture of large bones and surrounding tissue or organs may be
damaged
First Aid: Fractures
• Treat open wounds first
• Immobilize injured area from the joints above and below the break
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• Bone edges can cause damage to surrounding tissue if not immobilized
• In remote response areas splinting is usually appropriate
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Sprains
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First Aid: Sprains
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Immobilize area
Apply RICE.
Use of a soft splint or elastic wrap is best to immobilize a sprained ankle, wrist, or knee
Dislocations from Trauma
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Usually caused by joint overextension
Results in swelling, pain, bruising, or inability to use joint
It is difficult to tell a severe sprain from a fracture
Call EMS immediately if peripheral circulation is compromised
Could be accompanied by fractures or other serious injuries
Pain, swelling, bruising occur
Significant tissue displacement can damage nerves or cause serious bleeding
Treat as a fracture…do not attempt to reset dislocation
Joint Injuries: Dislocation From Routine Activities
• One or more bones moved out of normal position in joint
• Usually involves weakness or tearing of ligaments and joint structures
• Some victims are predisposed to dislocations
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First Aid: Dislocation From Routine Activities
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Strains
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Tearing of muscle, tendon, or both
Usually caused be a muscle that is stretched too far
Causes pain, swelling, and sometimes inability to use muscle
Can be prevented by avoiding overexertion, good body mechanics, sports safety
First Aid: Strains
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Have victim sit and relax…the joint may go back in once the muscles relax
Do not pull, twist, or apply pressure
If joint goes back in do not continue physical activities – rest for 24 hours
There are some different options for remote response areas
After four to six hours: Possible need for surgery to fix dislocation
Apply RICE
Immobilize or splint if appropriate
Keep cold pack on area for 20 minutes on, then 30 minutes off
Access EMS if there is severe pain or significant loss of mobility
Contusions
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A bruising of muscle, usually from a blunt trauma or a crushing force
Can cause pain, swelling, and discoloration
May persist up to several weeks – slow to heal.
Access EMS if there is severe pain or significant loss of mobility
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First Aid: Contusion
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Apply RICE
Do not massage muscle
Keep cold pack on area for 20 minutes, then at least 30 minutes off
Access EMS if there is severe pain or significant loss of mobility
Muscle Cramps
• A tightening of a muscle usually because of no warmup activity, repetitive use, cold temperature,
overexertion, low calcium, high sodium (salt)
• This is different from heat cramps (dehydration with low sodium or potassium)
• Also, may have no apparent cause
• May last a few seconds to minutes
• Can be prevented with warm up exercises and stretches
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First Aid: Muscle Cramps
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Stop the activity
Gently stretch out muscle
Massage muscle after active cramping stops
Victim may then warm up, stretch, and return to activity
Remove Jewelry
• Jewelry can compromise circulation if extremity swells
• Remove jewelry before swelling occurs
• To remove ring: Soak finger in cold water, wrap in cold pack, use elastic wrap, and/or use
slippery solution like dishwashing soap
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Summary
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Swelling is common with fractures
Control bleeding before splinting
Splints usually not used in rapid response areas
Check peripheral circulation before and after splinting
Let victim comfort be a guide to your splinting methods
Immobilize above and below the break…don’t forget about movement that would disturb the
fracture
• Pad, pad, pad…especially with improvised splints
• Monitor tension on splint ties if there is swelling
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Question 44
For fractures and dislocations a splint may not be necessary if you are in a rapid response area.
A. True
B. False
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Question 45
The tearing of a muscle or a tendon is known as a:
A. Contusion
B. Cramp
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C. Fracture
D. Strain
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Extremity Injuries and Splinting
Lesson 15
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Why Do We Splint?
• Prevent further injury
• Reduce pain
• Minimize bleeding and swelling
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Types of Splints
• Rigid splints
• Soft splints
• Anatomic splints
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Commercial Splints
There are many choices
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SAM Splints
• Easy to carry, lightweight, versatile
• Can be used to make a cervical collar
• Shape before you apply to the victim
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Securing Splints
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Guidelines for Splinting
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Triangular bandages are the top choice for splinting ties in the field
Otherwise, use other bandages, strips of cloth, Velcro straps, whatever works.
Use bow knots
Do not use non-medical tape directly on skin as it can cut off circulation
Dress any open wound first
Effective splinting should reduce discomfort
If you have to splint in a rapid response area do so in the position found
Immobilize entire area
Splint joints above and below injury
Place padding between skin and splint
Let’s Look At Some Different Splints and Slings
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Arm Sling With Binder
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Shoulder Injury
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Hip (Pelvic) Injury
• Can be a fracture, dislocation, or both
• One sign of fractured pelvis is a foot turned outwards while victim is supine
• Do not move victim unless necessary
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• Pad between legs and bandage together (unless this causes more pain)
• Treat victim for shock but do not elevate legs
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Pelvic/Upper Leg Fracture
• For a pelvic or upper leg break the whole length of the body is splinted, from ankle to armpit.
Padding is very important!
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Lower Leg Fracture
• Rigid splint applied the same as for knee injury
• Leg should not bend even if injury is below knee
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Ankle Injury
Soft or rigid splints
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Applying An Elastic Bandage
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Options
• The metal clips that are included with the elastic bandage only work a few times
• If you don’t have the clips try first aid tape
• Suggestion: Stock your kit with elastic bandages with Velcro closures
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Splinting a Lower Leg Fracture
(With Anatomic Splint)
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Immobilize The Feet
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Alternative Lower Leg Splint
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Passing Splint Ties
Under The Victim
• “Pass through” points are at the neck, lumbar area, knees and ankles.
• Pass through splint ties and then slide back and forth until tie is in the right position. This will
minimize movement of the injured area.
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Question 46
An arm sling is used even if the fracture is not on the arm, such as a collarbone fracture or broken
rib.
A. True
B. False
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Question 47
An injured limb should always be straightened out before you apply a splint.
A. True
B. False
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Question 48
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For larger bones, splint on both sides if possible.
A. True
B. False
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During Skill Practice…
 Tie snugly with bow knots.
 Use commercial and improvised splints.
 Padding is always important.
 Do a full body splint.
 Triangular bandages are best for splints, elastic bandage is best for joints.
 Please keep practicing during the skill session!
 Try splints, slings, and elastic joint wrapping.
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Sudden Illness
Lesson 16
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Sudden Illness
• Illness can occur suddenly or gradually
• They may be a life threatening emergencies
• Knowledge of a victim’s specific illness is not needed to provide effective first aid
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Signs and Symptoms Often Are Non-Specific
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General Care for Illness
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Call EMS if appropriate
Help victim rest and avoid getting chilled or overheated
Reassure victim
EMS Called: Do not give victim anything to eat or drink (in rapid response area)
Watch for changes
Colds / Flu / Sore Throats
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Person feels ill, dizzy, confused or weak
Skin color changes - Flushed or pale
Sweating
Breathing changes
Nausea, vomiting
In rapid response areas use general principles for illness care
Take steps to minimize infection vectors
In case of severe issues then EMS or transport to a medical facility is the next step
In outdoor (remote) settings the stay/go decisions should consider the environment, physical
activity, and travel issues
Vomiting or Diarrhea
• Seek medical care for unexplained or persistent GI distress
• Vomiting and Diarrhea will cause dehydration
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• Clear fluids are recommended for rehydration
• Do not rehydrate with coffee, energy drinks, or alcohol
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Constipation
• Dehydration can cause constipation
• Victims who choose not to void can give themselves constipation
• Severe constipation can be a medical emergency, and oral rehydration may not be able to
resolve the problem
• A commercial enema kit can help resolve most situations, however, transport to a medical facility
would be the next step if this does not resolve the problem
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Asthma
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VIDEO
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Asthma
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Asthmatics may carry and inhaler and/or medication
A severe attack can be fatal
Call EMS for first attacks
Help victim use their inhaler/medication
Help victim into position of easiest breathing
Bronchodilator Inhaler
• Relaxes muscles of airway
• Used during asthma attack
• Delivered by inhaler in measured dose
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Stroke
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VIDEO
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Stroke
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Stroke is an interruption of blood flow to part of the brain
Kills nerve cells and affects brain function
Victims need medical help immediately to decrease chance of permanent damage
More common in older adults, but can happen at any age
700,000+ people have strokes annually the US
Stroke - Time is Critical
• Call EMS immediately and tell dispatcher this is a possible stroke.
• Notify EMS what time symptoms started…this is important (helps determine further treatment
options)
• Drugs can minimize brain tissue damage but only if administered quickly
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Stroke
Signs and symptoms can appear gradually or quickly:
• Numbness (one side)
• Weakness (one side)
• Forgetfulness or confusion
• Sudden headache
• Coordination problems
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Use FAST To Assess
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4.
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Speech issues
Partial loss of memory
Can’t hold arm up
Loss of consciousness
Is their face weak on one side? (Face)
Is there a weakness in the arm(s)? (Arms)
Are there problems talking? (Speech) Please say “You can’t teach and old dog new tricks.”
Get help immediately. (Time)
When Did It Start?
• Ask the victim when they started to have symptoms or problems.
• Ask bystanders and family when they first observed signs or problems.
• Pass this information to EMS, as it may change how the victim is treated (based upon when the
stroke started).
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First Aid: Stroke
Call EMS.
Monitor victim and be prepared to give BLS.
Have victim lie on back with head and shoulders slightly raised.
Turn victim’s head if necessary (drooling)
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Transient Ischemic Attack (TIA)
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Temporary interruption to blood flow in brain - “Ministroke” or “Street Stroke”
May be precursor to stroke – victim should see their doctor - even if symptoms go away
Produces signs and symptoms similar to stroke – but they improve within an hour or less
Call EMS, even if they seem to recover
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Diabetes
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VIDEO
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Diabetes
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Condition where blood sugar levels not regulated properly
Over 20 million people in U.S. have diabetes (this is 2012 data…the number is increasing)
5 million+ haven’t been diagnosed
Chronic and incurable
Types of Diabetes
Type I (insulin-dependent or juvenile-onset) diabetes - body does not produce enough or any
insulin, person must receive insulin
Type 2 (non-insulin-dependent or adult-onset) diabetes - body cells do not use insulin well
With either type blood glucose (sugar) levels may be too high or too low
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Facts About Diabetes
• Kills about 70,000 people each year
• Contributes to 210,000 deaths annually from other related causes - Contributes to heart disease,
stroke, blindness, kidney disease, nervous system damage, and foot infections leading to
amputation
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Facts About Diabetes
• Increasing number of children and adolescents developing Type 2 diabetes due to obesity, diet,
and lack of exercise
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Management of Diabetes
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Diet
Exercise
Weight control
Control of:
– Glucose levels
– Blood pressure
– Cholesterol levels
• Preventive care for eyes, kidneys, feet
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Preventing Diabetic Emergencies
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Carefully monitor blood glucose levels
Control diet
Exercise
Regular schedule for injections
Use medications
“Controlled” blood sugar level is 70-150+ for diabetics
Initial diagnosis is morning fasting blood sugar > 125
High or Low Sugars?
1 Hypoglycemia
• Diabetic takes too much insulin
• Diabetic doesn’t eat enough of right foods
• Uses blood sugar too fast due to exercise, illness, or emotional stress
2 Hyperglycemia
• Diabetic takes too little insulin
• Diabetic eats too much of wrong foods
• Does not use blood sugar with activity (insulin resistant)
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High or Low Sugars?
1 Hypoglycemia
• Sudden dizziness
• Shakiness
• Mood change
• Headache
• Confusion
• Pale skin
• Sweating
• Hunger
2 Hyperglycemia
• Frequent urination
• Drowsiness
• Dry mouth
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First Aid: Low Blood Sugar
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Thirst
Deep rapid breathing
Nausea/vomiting
Fruity smelling breath
Confirm victim has diabetes.
Give victim 5 glucose tablets. This is the primary choice.
Alternatives to tablets: ½ cup fruit juice, 1-2 sugar packets, 5-6 pieces hard candy
Give more sugar after 15 minutes if victim still feels ill.
Call EMS if appropriate.
First Aid: High Blood Sugar
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Confirm diabetes.
Have victim follow healthcare provider’s instructions for hyperglycemia.
If you cannot judge if victim has high or low blood sugar – give sugar.
Call EMS if victim goes unresponsive or continues to have significant signs and symptoms.
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Heart Attack
208
VIDEO
209
Heart Attack
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Heart Attack
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Cased by a reduced blood flow to the heart muscle, usually from a blockage.
Medical emergency that often leads to cardiac arrest
Can occur at any age
Usually caused by atherosclerosis, a disease that clogged the arteries, eventually causing
blockages (clots)
Facts About Heart Attack
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500,000+ people in U.S. die annually
Many could have been saved by first aid and medical treatment
More likely in those with family history
One-fifth of victims do not have chest pain
Victims may deny they are having a heart attack
212
Some Common Heart Attack Symptoms
213
Characteristics of Heart Attack
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Can vary from vague chest discomfort to crushing pain with or without other symptoms
May have no signs and symptoms before suddenly collapsing
May have milder symptoms that come and go before heart attack occurs
Consider possibility of heart attack with wide range of symptoms. Don’t expect a clearly defined
situation
Look For Attitude Changes
• The process of heart muscle in trouble includes the release of a specific enzyme into the
bloodstream
• Medical facilities will test for this enzyme to confirm a cardiac problem
26
• Other changes in the body will effect the way the victim thinks…they can become angry, irritable,
stupid, anxious, or uncooperative
215
Women: Heart Attack Symptoms
• For women chest pain or discomfort is the most common symptom
• Women are more likely to have shortness of breath, jaw or back pain, nausea and vomiting
216
Aspirin For Heart Attack
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Aspirin is a blood thinner to help slow down clot formation
Remember “1-2-4”: 1 adult aspirin, 2 children aspirin, 4 baby aspirin (81mg)…all are adult dose
of aspirin
Best choice is “chewable”
Crush non-chewable type to a powder
Only if needed, a small sip of water is to clear the mouth…no food
Urgent-Rx: “Aspirin-to-Go”
• It is a credit card sized foil pouch for wallet, purse, AED, or first aid kits
• Aspirin is adult dose, pulverized, and flavored
• Available from several outlets and online
• Current sources listed on vendor’s website:
www.urgentrx.com
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Angina (Chest Pain)
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Angina is chest pain caused by heart disease, sometimes after activity or exertion
Chest pain should last only few minutes after taking medication
People with angina usually carry medication
If pain persists after ten+ minutes after medicating call 911 and treat as a possible heart attack
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COPD
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Chronic Obstructive Pulmonary Disease (COPD)
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Includes emphysema and chronic bronchitis
More than 12 million people in U.S. have COPD
124,000 deaths/year
May cause respiratory distress and breathing emergencies
Chronic Obstructive Pulmonary Disease (COPD)
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Make sure EMS knows this is a COPD victim
Give first aid for respiratory distress as needed
Don’t give high flow oxygen for more than 8-12 hours…they can stop breathing
Help victim with prescribed medication
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Hyperventilation
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Hyperventilation
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Fast, deep breathing
Can be caused by anxiety, physical activity, or stress
Victim might be anxious
May lead to fainting, which will restore normal respirations
Usually doesn’t last long…if it does then look for other signs and symptoms of illness
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First Aid: Hyperventilation
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Make sure there is no other cause of breathing difficulty that requires care.
Reassure victim. Ask victim to breathe slowly. No breathing into bags!
Call EMS if victim’s breathing doesn’t return to normal within a few minutes.
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Fainting
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Fainting
• Caused by temporary reduced blood flow to brain, or a reduced blood pressure in the brain.
• Hot weather, fright, emotional shock, lack of food, standing with knees locked, suddenly standing
• Usually not sign of serious problem unless it occurs often or person does not recover quickly
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First Aid: Fainting
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Victim should recover quickly, especially if they are sitting or lying down.
If victim remains weak or dizzy put them in the shock position.
Watch for possible injuries from falling.
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Seizures
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Prevention of Seizures
• First time seizures can rarely be prevented
• Medications can prevent seizures in diagnosed victims, but, some seizures to happen despite
treatment
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Some Causes of Seizures
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Epilepsy
High fever (infants, young children)
Head injuries
Low blood sugar
Poisoning / Overdose / Drugs
Electric shock
Toxemia (during pregnancy)
Brain tumor/disorder
Facts About Epilepsy
• Affects 2.5 million people in U.S.
• About 181,000 new cases each year
• Males slightly more likely to develop epilepsy than females
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Facts About Epilepsy
• In 70% of new cases cause not apparent
• 70% enter remission
• 75% of people who are seizure-free on medication after 2 to 5 years can withdraw from
medication
• 10% of new cases may still have seizures despite optimal medical management
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Epilepsy Seizures
• Generalized tonic/clonic seizure - convulsions or grand mal seizure, person loses consciousness,
falls, is stiff (tonic), then experiences jerking of muscles (clonic)
• Febrile seizures - caused by high fever in infants/young children
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Epilepsy Seizures
• Complex partial seizure - victim seems dazed, may mumble or wander
• Absence seizure - victim seems to stare blankly into space, doesn’t respond to others
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First Aid For Seizures
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Prevent injury.
Cushion head on hard surface.
No bite stick!
No holding down!
Loosen constricting clothing.
Turn person to one side if vomiting.
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Altered Mental Status
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Altered Mental Status
Illness or injury can cause any victim to become:
• Confused
• Disoriented
• Combative
• Drowsy
• Partially or wholly unresponsive
• Not all patients are pleasant people before they were hurt ! Pain and sickness can make them
more unpleasant !
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There Are Physical Causes ForAltered Mental Status
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First Aid: Altered Mental Status
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Seizures
Stroke
Head injury
Poisoning, drug use, overdose
High fever
Diabetic emergencies
Lowered blood oxygen
Heart attack
Determine cause (if possible)
Establish rapport (if possible)
SAMPLE
Give first aid
Stay safe!
Question 49
Which medication is for asthmatics?
A.
B.
C.
D.
An EpiPen®
An inhaler (such as Albuterol)
Glucose tablets
Nitroglycerin
29
241
Question 50
Chest pain is present in every heart attack.
A. True
B. False
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243
Poisoning
Lesson 17
244
Poisoning
• There are 2 million poisoning incidents every year resulting in 20,000 deaths
• Each year 60,000+ kids receive emergency care due to misuse of medications, accidental or
intentional
245
Poison
• Can enter body by any path:
– Swallowed
– Injected
– Inhaled
– Absorbed
• Almost anything can be poisonous in doses larger than intended
246
Poison Control Centers
• The PCC provides information and treatment advice for all kinds of poisonings
• Can be reached at 800-222-1222 (this will redirect to your regional center)
• You can call EMS and ask for poison control
• Will have the most accurate information
American Assn of Poison Control Centers (aapcc.org)
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Swallowed Poisons
•
•
•
•
•
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Most cases of poisoning involve swallowed substances
Effects can be rapid or delayed
Have conscious victim sit, remain still, or lie down
Victim may be nauseated, unresponsive, or confused and disoriented
Initial challenge is the recognition of a poisoning
Preferred Treatment
• Generally, we don’t induce vomiting for most poisoning.
• The victim is given activated charcoal, the poison is absorbed, and medications are administered
to move it through the system quickly.
• Not for field/first aid use. You don’t have the drugs to speed the plumbing up!
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Call Poison Control Or 911?
• Call Poison Control for poison treatment guidance, otherwise
Call 911 if victim is:
– Vomiting
– Unresponsive
30
– Changed mentation
250
Assess the Situation
• Look for containers nearby or clue of substance or product use
• Ask others at scene what happened
• Try to find out how much person may have swallowed and how long ago
251
Signs and Symptoms:
Swallowed Poisons
•
•
•
•
•
•
•
•
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Care for Swallowed Poisons
•
•
•
•
•
•
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Unresponsive victim - call EMS
Check for normal breathing, provide CPR if needed
Put breathing, unresponsive victim in recovery position
Call PCC for a responsive victim who can think clearly and is not vomiting
Determine what was swallowed, when, and how much.
For an unresponsive victim, dizziness, abdominal pain, vomiting – call EMS and give BLS if
needed.
Inhaled Poisons
•
•
•
•
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May look and feel ill
Abdominal pain
Nausea, vomiting, diarrhea
Altered mental status, unresponsive
Burns, stains, or odors around mouth
Dilated or constricted pupils
Abnormal breathing
May be appropriate to use compression only CPR (avoid cross contamination)
Use the right equipment
Maintain heating appliances
Use detectors
Evacuate immediately if airborne poison suspected
Carbon Monoxide
• Invisible, odorless, and tasteless
• May be present from exhaust, faulty furnace, kerosene heater, industrial equipment, fireplace,
wood stove, fire
• Exposure to large amounts can be lethal
• Exposure to small amounts may cause gradual poisoning
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First Aid: Carbon Monoxide (CO)
•
•
•
•
256
Move the victim to fresh air.
Notify EMS of possible CO victim.
Monitor the victim and give care as needed.
Oxygen if available.
Poison Ivy, Oak, Sumac
• Contact with resin causes allergic contact dermatitis in about half of population
• If you have made contact wash area with soap and water
31
• Rash appears within few hours up to two days
257
Poison Ivy
258
Poison Oak
259
Poison Sumac
260
Guidelines for Poison Ivy, Oak, and Sumac
•
•
•
•
•
261
Wash area thoroughly with soap and water
For severe reactions or swelling of face, victim needs medical attention
Treat itching with calamine lotion, topical hydrocortisone cream and oral antihistamine
Change clothing and shoes, wash pets
Regular washing will remove the oils
First Aid: Poison Ivy, Oak, and Sumac
• Wash area with soap and water as soon as possible after contact.
• Seek medical attention if severe reaction or swelling on face or genitals.
• Treat itching.
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Do not burn these poisonous plants to get rid of them because smoke also spreads the poisonous
substance.
263
Question 51
The preferred treatment for a swallowed poison is to induce vomiting.
A. True
B. False
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Question 52
What is the first step in caring for a victim who has been exposed to poison ivy, oak, or sumac?
A. Apply hydrocortisone cream.
B. Encourage the victim to take an oral antihistamine.
C. Seek medical attention.
D. Wash the affected area thoroughly with soap and water.
E. Put their clothing in the campfire.
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266
Substance Misuse and Abuse
Lesson 18
32
267
Drug Abuse
•
•
•
•
268
It is not necessary to know type of drug to care for victim
Observe scene for drug paraphernalia, wrappers, containers, and drugs
Call Poison Control Center or EMS
Ensure the scene is safe before entering
Drug Overdose Trends
•
•
•
•
There is a significant national increase in opioid, heroin, cocaine, and methamphetamine use
Heroin, Phentenoyl, and Benadryl overdose events are increasing
Teen use of drugs is increasing (includes marijuana)
Hospitalizations for THC overdose (from food and oil) are increasing in Colorado
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270
Narcan
• Narcan (Naloxone) counteracts negative effects of opiates on the brain, which can interfere with
heart action and respiration
• It is now considered part of standard first aid, to be administered whenever opiate drug overdose
is suspected
• June 2016: Colorado reclassified Narcan as over the counter.
• In cases of opiate overdose have the victim supine, insert in nostril, and apply. The nasal spray
version is one time use.
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First Aid For Drug Abuse/Overdose
•
•
•
•
•
•
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Call EMS for serious signs and symptoms or Poison Control Center for known substance.
Withdraw if scene is unsafe.
Put an unresponsive victim in the recovery position and monitor for breathing/vomiting.
Try to keep an awake victim alert and talking.
Keep victim from harming self or others.
Ask questions about substance used, how much, and when it was taken.
Medication Overdose
• Overdose can result from accidentally taking too much of prescription or OTC medication
• May be impossible to know if signs and symptoms caused by drug or other injury or illness
• Try to determine what drug was taken
273
First Aid: Medication Overdose
•
•
•
•
•
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Put unresponsive victim in recovery position. Give BLS if needed. Call EMS.
If scene not safe call EMS.
Try to find out what drug was taken.
Call poison control center if symptoms and not life-threatening and substance is known.
If victim vomits save a sample (put wipes in plastic bag).
THC / Cannabis
• Death from smoking THC is practically impossible
• Can be smoked, swallowed (oil), inhaled (including E-cigarettes), or ingested through beverages
and food items
• Foods and oil will not display the “burning rope” odor of THC via smoking
•
33
275
THC / Cannabis Signs and Symptoms
Signs and Symptoms:
– Increased heart rate
– Increased blood pressure
– Increased rate of breathing
– Red eyes
– Dry mouth
– Increased appetite, or "the munchies"
– Slowed reaction time
276
First Aid For THC Overdose
• High levels of THC can cause a condition of deep unconsciousness, but heart rate, breathing rate,
and BP can be high, or sometimes very low
• Maintain airway, monitor for vomiting, and call EMS
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Be safe!
You may not be able to reason with someone using drugs.
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279
Alcohol Effects
•
•
•
•
280
Alcohol Overdose
•
•
•
281
Good news: In “almost all” cases the body detects too much alcohol and vomits it out
First Aid for Alcohol Overdose
•
•
•
•
283
Are there signs of other injuries or illness?
Stay with person and protect from injury
Do not let person lie down on back, use the recovery position if possible
Good News – Bad News
•
282
Excessive consumption can lead to a medical emergency
Alcohol is a respiratory depressant
Vomiting is a risk
The gag reflex is limited
Recovery position is recommended
Monitor for vomiting or airway obstruction
Call EMS if appropriate
Irregular breathing is a serious sign – immediate EMS access is the next step
Drinking Games
•
•
•
•
Drinking games cause the victim to consume too much too fast
Stomach can only absorb alcohol at fixed rate
Drinking too much too fast can put a potentially life threatening amount of alcohol in the
stomach…they vomit or they can pass out and die
The more alcohol consumed means a more serious situation
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34
Intoxication can make some folks hostile or violent
Stay safe !
285
Question 53
What is the first step in caring for an unresponsive breathing victim who has overdosed on his or
her medication?
A. Call EMS.
B. Call the Poison Control Center.
C. Put the breathing victim in the recovery position and verify an open airway.
D. Try to find out what drug the victim took.
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Question 54
A drug overdose is a type of poisoning and the first aid steps for a drug overdose are similar to
those for poisoning.
A. True
B. False
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288
Bites and Stings
Lesson 19
289
Bites and Stings
•
•
•
•
290
Millions of people every year are bitten or stung
Most are not medical emergencies
Treat for bleeding, wound care, and infection
If victim is allergic it can be a medical emergency
Animal Bites
• More than 4 million people bitten by animals (primarily dogs) each year
• More than 300,000 animal bites require emergency department treatment
• Serious because of bleeding and risk of infection
291
Animal Bites
• The majority of animal bites involve smaller children
• 65% of children less than 4 years also have an injury to the head or neck
292
Rabies
• The bite of any mammal can transmit rabies if the biter is infected
• Rabies can be fatal unless vaccination is administered
• Wild animal bite or bite from unknown dog/cat should be reported to public health
department/animal control
293
First Aid: Animal Bites
•
•
Clean wound with soap and water.
Gentle water irrigation over the wound for 5+ minutes will significantly reduce risk of infection
and rabies crossover
35
•
•
•
294
First Aid for Human Bites
•
•
•
•
•
295
Control bleeding.
Cover wound with sterile dressing and bandage.
Emergency department needed for deeper punctures or avulsed tissue.
Clean wound with soap and water. Irrigate for at least 5 minutes to reduce the risk of infection
Prompt gentle water irrigation for 5+ minutes greatly reduces crossover of infection
Control bleeding
Cover wound with sterile dressing and bandage
Victim should see healthcare provider or go to emergency department for further cleaning and
evaluation
Snakebites
Poisonous snakes include:
Rattlesnakes
Copperheads
Water moccasins (cottonmouths)
Coral snakes
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Snakebites
•
•
•
•
•
297
Avoid Risk
•
•
•
•
298
7000 to 10,000 snakebites occur annually in the US
Rattlesnakes are the most common bites in the US
Alcohol use commonly involved (the human!)
Those who live or work in areas of venomous snakes should take preventative steps
Treat an unknown bite as poisonous if you aren’t sure
Stay away from areas known to have snakes
If you see a snake reverse direction, retrace steps
Stay away from underbrush areas, fallen trees or other areas where snakes may live
Do not capture or harass a snake
Preventing Snakebites
•
•
•
•
•
Be cautious during peak activity times
Keep hands and feet out of crevices in rocks, wood piles, deep grass
Carry a flashlight and wear shoes or boots after dark
Don’t handle a venomous snake…even if “dead”
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First Aid for Snakebite
300
Black Widow Spider
• The female black widow possesses a venom 15 times more potent than rattlesnake venom. The
bite is like a pin prick…causes pain within a few minutes.
• The pain spreads rapidly. Chills, vomiting, difficult respiration, profuse perspiration, delirium,
partial paralysis, violent abdominal cramps and spasms may occur within a few hours.
• The victim usually recovers in 2 to 5 days
• About 5% of all black widow attacks are fatal. The black widow, usually bites only when it is
disturbed or defending the nest.
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301
Brown Recluse Spider
• Deaths from brown recluse spiders have been reported only in children younger than seven
years.
• Hide during the day in clothes, shoes, boxes and other out of the way places. Bites are most
likely to occur through unintentional contact.
• Rare in Colorado (unless imported) as their habitat is south and southeast US.
• Adult Brown Recluse Spiders are yellowish-tan to dark brown. There is a dark brown or black
violin or fiddle on its back with the violin's "neck" pointing toward the rear of its body. A few
Colorado spiders are easy to mistake for a recluse spider.
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First Aid: Spider Bites
•
•
•
•
303
If victim has difficulty breathing – call EMS.
Keep bite area below level of heart.
Wash area with soap and water.
Put cold pack on bite.
Tick Bites
• Ticks are not poisonous, but can transmit diseases: Rocky Mountain Spotted Fever or Lyme
disease
• If not detected they may remain for days
• Medical treatment is not needed, but watch for signs of disease transmission or subsequent
infection
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Rocky Mountain Spotted Fever
• Typical symptoms include: fever, headache, abdominal pain, vomiting, and muscle pain. A rash
may also develop in 80%-90% of victims.
• It can be fatal if not treated in the first few days of symptoms.
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Rocky Mountain Spotted Fever
306
Lyme’s Disease
• Partial rash, or bull’s eye rash, around tick bite site 3 to 30 days later, full ring in about 10% of
victims, rash of some kind in 80% of victims
• Seek medical attention if there is a red splotchy rash with flu-like symptoms, water in the knee(s),
fatigue, or joint pain after a known/suspected tick bite
• Trend is 8-12 cases in Colorado per year, but, there are probably more, due to Lyme’s being
diagnosed as some other illness.
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Tick Removal
• Remove tick by grasping close to skin with tweezers, pull gently…sometimes tick will let
go…twist a little when pulling…if head comes off then go back and pull it out too.
• Wash area with soap and water.
• Seek medical attention if rash appears or flu-like symptoms.
308
Mosquitoes
Carry bloodborne disease such as:
• West Nile Virus – In humans, flulike symptoms develop 3-14 days after the bite of an infected
mosquito.
• Eastern Equine Encephalitis (EEE) - In humans, flulike symptoms develop 4-10 days after the bite
37
of an infected mosquito.
• Zika Virus (now in US)
309
EEE Distribution
310
EEE Symptoms
•
•
•
•
•
•
•
•
•
Fatigue
Fever
Headache
Nausea
Restlessness or irritability
Difficulty walking or unstableness
Confusion, impaired judgment, or an altered mental state
Seizures
Complications can cause coma within a week
311
West Nile Virus Distribution
312
West Nile Virus Symptoms
•
•
•
•
•
•
•
313
Fever
Headache
Tiredness
Body aches
Occasionally with a skin rash (on the trunk of the body)
Occasionally swollen lymph glands
May last for days, sometimes weeks
Zika Signs And Symptoms
• Many people infected with Zika virus won’t have symptoms (80%) or will only have mild
symptoms (a few days to a week).
• A blood or urine test can confirm Zika.
• Pregnant women at special risk.
• There is no specific medicine for Zika.
• Symptoms:
– Fever
– Rash
– Joint pain
– Conjunctivitis
– Muscle pain
– Headache
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Insect Stings
•
•
•
•
315
Most are not poisonous but some can cause anaphylaxis
About 50 people/year die from allergic reactions to insect stings
Venomous insects include honeybees, bumble bees, hornets, wasps, yellow jackets, fire ants
Someone allergic may carry prescribed EpiPen®
Bee Sting
• Remove stinger from skin.
38
•
•
•
•
316
Call EMS if there is known allergy or symptoms of whole body reaction.
Wash area with soap and water.
Put cold pack on area.
Monitor victim for 30 minutes for signs or symptoms of anaphylaxis
Scorpion
Stings
• In US a small yellow species has venom considered a more significant hazard to humans (a few
species of the Bark Scorpion). Deaths in the US are rare.
• All species of scorpions will inject some venom.
• It is similar to a bee sting with local reactions.
• Cold pack, anti-itch cream (Cortisone), Benadryl orally, and Tylenol for pain.
• Evacuate if anaphylaxis.
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Question 55
Which of the following can be transmitted by mammal (animal) bites?
A. Lyme disease
B. Rocky Mountain spotted fever
C. Rabies
D. West Nile virus
318
Question 56
Which of the following can be transmitted by mosquito bites?
A. Lyme disease
B. Mountain spotted fever
C. Rabies
D. West Nile virus
319
Question 57
Most snakebites occur because the victim accidently disturbed, deliberately handled, or harassed
the snake.
A. True
B. False
320
Question 58
One recommended way to remove an embedded tick is by covering it with petroleum jelly.
A. True
B. False
321
322
Cold and Heat Emergencies
Lesson 20
323
Heat and Cold Emergencies
• Cold and heat emergencies are the body’s core temperature being out of normal range…high or
39
low
• Heat/cold emergencies may begin gradually but can develop into life-threatening emergencies
• It is better to recognize and treat before it becomes a true emergency
324
Body Temperature
• The body maintains a relatively constant internal temperature
• Body uses multiple mechanisms to create or lose heat
• Mechanisms cannot maintain constant temperature when exposed to temperature extremes for
extended period
325
Risk Factors For
Heat/Cold Injuries
1 • Younger children
•
•
•
•
•
•
•
2 •
•
•
•
326
Elderly
Injuries
Chronic health problems
Mental impairment
Dehydration
Too little body fat
Fatigue
Too much body fat
Activity in extreme environments
Medications and drugs (including alcohol)
Environmental variables (water immersion, wind chill, humidity)
How the Body Stays Warm
• Metabolic processes - Most body heat produced this way
• Contraction of muscle tissue – Most variable (includes shivering)
• Vasoconstriction - Less radiation of heat away from skin
•
327
How the Body Stays Cool
• Vasodilation
– More warm blood to surface of skin to be radiated away
– This is the primary heat loss method
• Sweating
– Evaporation from skin surface cools body
328
Cold Emergencies
• Frostbite
• Hypothermia
329
Frostbite
330
First Degree Frostbite
• This is called frostnip and only affects the surface of the skin.
• On the onset, there is itching and pain, and then the skin develops white, red, and yellow patches
and becomes numb.
• The area affected by frostnip can have long term damage, even though only the skin's top layers
40
are affected.
• Long-term insensitivity to both heat and cold can sometimes happen after suffering from frost
nip.
331
First Degree Frostbite
(Frostnip)
332
Second Degree Frostbite
• If freezing continues, the skin may freeze and harden, but the deep tissues are not affected and
remain soft and normal.
• Second-degree injury usually blisters 1–2 days after becoming frozen. The blisters may become
hard and blackened, but usually appear worse than they are.
• Most of the injuries heal in one month, but the area may become permanently insensitive to both
heat and cold.
333
Second Degree Frostbite
(Superficial Frostbite)
334
Third Degree Frostbite
(Severe or Deep Frostbite)
• If the area freezes further, deep frostbite occurs. The muscles, tendons, blood vessels, and nerves
all freeze. The skin is hard, feels waxy, and use of the area is lost temporarily, and in severe cases,
permanently.
• The deep frostbite results in areas of purplish blisters which turn black and which are generally
blood-filled.
• Nerve damage in the area can result in a loss of feeling. This extreme frostbite may result in
fingers and toes being amputated if the area becomes infected with gangrene. If the frostbite has
proceeded untreated, they may fall off.
• The extent of the damage may take several months to assess, and this can delay surgery to
remove the dead tissue
335
Third Degree Frostbite
336
Re-warming
Frostbite
Re-warm frostbite by immersing area in warm water (maximum of 104 degrees) for 20 to 45
minutes.
Do this only if there is no risk of refreezing. Refreezing can cause significant additional tissue
damage.
337
Hypothermia
338
Hypothermia
•
•
•
•
339
Occurs when body cannot make heat as fast as it loses it.
Body core temperature is less than normal.
May occur gradually or quickly, and is progressive.
700+ people die each year from hypothermia in U.S.
Facts About Hypothermia
• Occurs more easily in elderly or ill people, or young children
• Those under influence of drugs or alcohol are more at risk
41
• Immersion in cold water cools 30 times faster than in cool air
• Victims in cold water are more likely to die from hypothermia than drowning
•
340
Stages of Hypothermia
These are core temperatures.
341
Stages of Hypothermia
Mild (Stage 1)
• Symptoms may be vague, such as shivering, hypertension, and possible blood sugar issues. Core
temperature is 90°-95°F. Aggressive rewarming should be started in the field.
Moderate (Stage 2)
• Lethargy, full body uncontrollable shivering, or, reduced shivering (lower core temp),
coordination difficulties, stumbling, confusion, pale or blue skin. Core temperature is 90°-83°F.
Aggressive rewarming should be started in the field and EMS should be activated.
Severe (Stage 3+)
• Lower heart rate, no shivering, lower respiration, low blood pressure, difficulty speaking,
confusion, poor coordination, irrational behavior, eventually coma and death. Core temperature
below 83°F. Begin modified rewarming and activate EMS.
342
Mild Hypothermia
•
•
•
•
•
•
343
First Aid For Mild To Moderate Hypothermia
•
•
•
•
•
•
344
Shivering
Numbness
Lethargy
Poor coordination
Slurred speech
Infants may have bright red skin and little energy
Remove the victim from the cold environment
Dry the victim off, replacing wet clothing
Shelter the victim
Use dry head cover to prevent heat loss
For unresponsive victim check for breathing and provide CPR if needed.
Current guidance: Immersion in warm water (max 104° F) up to neck encouraged for mild to
moderate hypothermia
Prevent Re-Injury
• Prevent a repeat cold injury
• You must change one or more of these causes:
– Environment (get them out of the cold)
– Activity (change the activity that led to the cold injury)
– Clothing (additional/different clothing, head covering, gloves, or other footgear is needed)
345
CPR and Hypothermia
• Victims in cardiac arrest after immersion in cold water, especially children, have been resuscitated
after a long time underwater (due to the mammalian dive reflex)
346
Re-Warming With Immersion
42
• For mild to moderate hypothermia re-warm with immersion (if available)…water temperature is a
maximum of 104°F (hot tub temperature).
• Monitor victim for level of consciousness and airway.
347
Severe Hypothermia
• Do not try to evacuate if hypothermia is severe…you need help quickly.
• Begin modified re-warming efforts as soon as possible.
348
Hypothermia
Modified Re-Warming
• Heating pads or hot water bottles beside neck, armpits, groin…no immersion.
• Remove/replace all wet clothing.
• Alternative: Put victim between two dressed responders in pre-warmed sleeping bag(s). Monitor
warmers for hypothermia. No naked helpers and victims in the bag!
349
Paradoxical Undressing
20-50 % of severe hypothermia deaths are associated with paradoxical undressing. This typically
occurs during moderate to severe hypothermia. The person becomes disoriented, confused, and
possibly combative. They may begin discarding their clothing, which, in turn, increases the rate of
heat loss.
350
Terminal Burrowing
A self-protective behavior known as terminal burrowing, or “hide-and-die syndrome”, occurs in the
final stages of severe hypothermia. The victim will enter small, enclosed spaces, such as
underneath logs, between rocks, under beds or in closets. It is often associated with paradoxical
undressing.
351
Severe Hypothermia and CPR
•
•
•
•
Victim may appear to be dead with skin cold/blue, signs of breathing very faint, unresponsive
Internal temperature could be less than 85° F
CPR can lead to life-threatening dysrhythmia if heartbeat is present
Assess victim carefully…victim may be breathing only once every 30 seconds or so…check pulse
for 1 minute+
• Re-warm victim and provide CPR if needed
• Resuscitation may occur even after significant time in cold water
•
352
Heat Injury
353
Heat Emergencies
• Usually occurs during hot weather…but can also occur in any setting
• 400+ deaths/year
• Heatstroke can start with milder symptoms or can happen suddenly
354
Categories of Heat Illness
• Heat exhaustion - Develops when body becomes hot and dehydrated
• Heatstroke - If untreated, can cause death
355
Heat Exhaustion
• Heavy sweating may lead to dehydration and depletion of salt and electrolytes if person doesn’t
drink enough fluids
43
• Unrelieved, can lead to heatstroke
356
Heat Exhaustion
Signs And Symptoms
•
•
•
•
•
•
•
•
357
First Aid For Heat Exhaustion
•
•
•
•
•
358
Call EMS
Move victim to cool place
Remove outer clothing
Cool victim as a priority
Additional Issue: Heat Rash
•
•
•
•
361
Life-threatening emergency
More common during hot, summer periods
May develop slowly or more rapidly with strenuous activity
Victim may be dehydrated and not sweating or may be sweating heavily
Brain temperature exceeds 107° F
First Aid: Heatstroke
•
•
•
•
360
Move victim from heat to rest in cool place
Loosen or remove clothing
Give sports drink or water
Raise legs 8-12 inches.
Cool victim
Heatstroke
•
•
•
•
•
359
Significant sweating
White/clammy skin
Dizziness / weakness
Thirst
Lethargic / fatigued
Dry mouth
Cramping
Caused by sweat trapped against skin
Can be red, bumpy, or both
Treat with washing, clean clothes, reduce pressure on rash, especially while sweating
Can lead to infection if not cared for
Additional Issue: Heat Syncope
• High core temperature can cause lower blood pressure when stopping after activity, resulting in
fainting
• Treat with fluids, snacks, cool the victim, and avoid strenuous activity
• Use shock position if victim does not quickly recover
362
Question 59
What is the first step in caring for a victim with frostbitten fingers?
A. Move the victim to a warm environment.
44
B. Put dry gauze or fluffy cloth between the fingers.
C. Remove any tight clothing or jewelry around the affected area.
D. Seek medical attention immediately.
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Question 60
What is the first step in caring for a victim with heat exhaustion?
A. Give a sports drink or water to drink.
B. Loosen or remove unnecessary clothing.
C. Move the victim from the heat to rest in a cool place.
D. Raise the legs 8 to 12 inches.
364
Question 61
Not drinking enough fluid can make one more susceptible to heat emergencies.
A. True
B. False
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366
Behavioral Emergencies
Lesson 21
367
Behavioral Emergencies
•
•
•
•
368
Process of giving first aid can be complicated by victim’s behavior
Injuries or illnesses can cause altered mental status or emotional responses
Victims could have emotional problems before the event that will influence their behavior
Abuse and rape are behavioral situations plus physical care
Victim Responses to
Injury and Illness
• Normal reactions can include fear, anxiety, change in thinking, and anger
• Normal physical reactions can cause trembling, shakiness, nausea, fast heartbeat and breathing,
perspiration
• Victims with preexisting problems or mental illness are more likely to have severe
reactions…overreaction, panic, wild behavior, incoherent speech, argumentative, withdrawn, or
violent
369
Altered Behavior Can Have Physical Causes
1 • Respiratory emergencies
•
•
•
•
•
2 •
•
•
•
Cardiac emergencies
Poisoning
Head injuries
Seizures
Diabetic emergencies
Stroke
High fever
Substance abuse
Drug overdose
45
• Heat/cold emergencies
370
Don’t Judge
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•
•
•
371
Do not judge victim’s behavior too quickly…assess the situation
If it is unsafe – stay at a safe distance until help arrives
Victim can transition to extreme anxiety and panic, so watch for warning signs
May need to calm victim to prevent further injury
Your Role Is Initial Care
• Don’t diagnose. Reassure the victim that they are being cared for. Specific questions about their
condition or outcome will need to be answered at a medical facility after examination and tests.
• Don’t give opinions on anything, including their conduct, fault, or non-medical issues.
372
Reassure and Calm Victim
•
•
•
•
•
373
Reassure and Calm Victims
•
•
•
•
374
Remain calm and patient
Follow guidelines for calming and reassuring victim…often panic will subside in few minutes
Victim may need more time to calm down and may suddenly experience renewed anxiety
Be empathetic and gentle
Allow victims to talk about their feelings
Depression
•
•
•
•
•
•
•
376
Ask victim for their name and use it
Involve friends or family members (if value added!)
Let victim tell you what he or she thinks is wrong
Use eye contact and communicate at eye level (if possible)
Actions For Victim With Anxiety
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•
•
•
375
Tell victim who you are
Say you are there to help
Don’t be judgmental
Do not assume victim is intoxicated or on drugs
Reassure victim that help is on the way
Frequent feelings of sadness
Loss of energy
Feelings of hopelessness or worthlessness
Difficulty concentrating
Difficulty making decisions
Physical symptoms
Thoughts of death or suicide
Actions for Depression
•
•
•
•
•
Encourage victim to talk
Acknowledge that person seems sad and ask why
Show victim you care
Don’t be dismissive or judgmental
Help make person comfortable
46
•
•
•
•
377
Suicide
•
•
•
•
378
Talking about suicide
Comments about hopelessness or worthlessness
Taking risks that could cause death
Loss of interest in past activities
Suddenly and unexpectedly seeming calm or happy after being sad
Actions for Victim
Who May be Suicidal
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•
•
•
•
•
380
30,000+ people commit suicide each year
Third leading cause of death for those 15 to 24 years old
Eighth leading cause of death for adult men
Drug overdose and firearms are the most common methods
Suicide Warning Signs
•
•
•
•
•
379
Allow person to cry and work through emotion
Listen sympathetically to complaints but do not offer false reassurances
Talk about available resources
Be alert to possibility of suicide
Take person seriously
Listen to what he or she is saying
Ask what person is planning to do
Talk calmly and be supportive
Do not argue
Take suicide threats seriously
It Can Happen:
Violent Behavior
Watch for the danger signs!
Don’t become so involved with treatment that you miss the clues.
Your safety is always #1!
381
Actions With a Violent Victim
•
•
•
•
•
Encourage calm, speak calmly, ask, don’t order, say what you are doing
Do not enter an unsafe scene
Notify EMS of the situation
Do not attempt to restrain the person
Monitor violent situation from safe location and wait for help to arrive, if appropriate
382
Abuse
383
Abuse
•
•
•
•
384
Intentional inflicting of injury or pain on someone under abuser’s power
Victims include children, spouses, elderly parents
Adjust care based on victim’s emotional status
Be open to special issues in any care situation
Abuse
47
•
•
•
•
•
385
Many individual and cultural factors contribute
Tension, anger, frustration can grow into act of violence
Some never develop ways to manage stress or control feelings
Often occurs in cycle of regret and promises followed by more abuse
Many abusers were abused themselves
Prevention of Abuse
• Difficult to predict who may become an abuser or to prevent first act of abuse
• Repeated abuse may be prevented by abuse control programs
• Prevention begins with recognizing and acknowledging it and making resources available for
abuser and victim
386
Child Abuse
• Every week there are more than 50,000 reports of suspected child abuse or neglect
• Every year more than 800,000 children found to be victims, 20% physically abused, 10% sexually
abused
• Average of 3 children die each day from abuse or neglect…infants account for half of these
deaths
387
Characteristics of Child Abuse
• Any child of any age, race or ethnicity may be abused
• Boys and girls equally vulnerable
• Girls are 4 times more likely to experience sexual abuse
388
Characteristics of Child Abuse
• Mothers acting alone responsible for 50% of cases of neglect and about 1/3 of cases of physical
abuse
• Fathers acting alone responsible for 25% of cases of sexual abuse
• In 80% of cases of sexual abuse, abuser is known by child
•
389
Physical Abuse
• Physical injuries are considered abuse despite caregiver’s intent
• Shaken baby syndrome is abuse
390
Clues of Sexual Abuse: Child
•
•
•
•
•
•
•
•
•
Difficulty walking or sitting
Suddenly refuses to change clothes
Reports nightmares or bed-wetting
Sudden change in appetite
Bizarre, sophisticated, or unusual sexual knowledge
Pregnancy or venereal disease
Runs away from home
Reports sexual abuse
Seems afraid of particular person or being alone with that person
391
Signs of Sexual Abuse: Caregiver
392
Reporting Child Abuse
• If you suspect abuse or neglect, report it to authorities (Police or Child protective services)
48
• Your report will help protect child and get help for family
• Your report is confidential and may be anonymous
• You may be legally required to report it
•
393
Care For Possibly Abused Child
•
•
•
•
394
Do not confront abuser
Do not ask direct questions about abuse
Provide first aid as usual
Document what was said and observed, not opinions
Domestic Abuse
• 31% of women report physical or sexual abuse by husband or boyfriend at some point
• Up to 4 million women physically abused by husbands or live-in partners each year
• 76% of women reporting abuse or rape are victimized by known person
395
Domestic Abuse
• Reports of female high school students with reports of occurrence of inappropriate physical or
sexual contact from dating.
• Women 5 to 8 times more likely to be victimized, but it happens to men too.
396
Common Clues: Victims of Domestic Violence
•
•
•
•
•
•
•
397
Signs of Domestic Violence
•
•
•
•
398
Love their partner – they just want abuse to stop
Afraid of partner
Feel guilty and blame themselves
Often have low self-esteem
Isolated from family and friends
Emotionally or financially dependent on partner
Do not know their rights or that help is available
Victim unusually fearful
Victim’s account of injury inconsistent or unlikely
Victim uneasy in presence of partner
Victim’s partner aggressively blames woman for being injured
Guidelines For Suspected Domestic Violence Situations
•
•
•
•
•
•
Provide first aid as usual
Call EMS for significant injuries and report any suspicions
Ensure privacy when providing care
Do not directly confront victim with suspicions
Try to involve friend or family member
If victim communicates abuse to you, you can tell victim domestic violence is against the law and
help is available
• If you see physical abuse occurring or the threat of violence, call EMS
399
Elder Abuse
• Physical, emotional, or financial abuse or neglect inflicted on someone over age 60
• 500,000 reports in US annually
49
• Abuser is family member in 90% of cases
• The older the person the greater the risk
• The more person needs help with daily activities the greater the risk
400
Signs and Symptoms: Elder Physical Abuse
•
•
•
•
•
401
Signs and Symptoms: Elder Physical Abuse
•
•
•
•
402
Bruises, black eyes, welts, lacerations, rope marks
Bone fractures, skull fractures
Open wounds or injuries in various stages of healing
Strains, dislocations, internal injury/bleeding
Broken eyeglasses, signs of being punished or restrained
Medication overdose or under-utilization of prescribed drug
Report of being hit, slapped, kicked, or mistreated
Sudden change in behavior
Caregiver’s refusal to allow visitors to see elder alone
Signs and Symptoms: Elder Emotional Abuse
• Emotional upset or agitation
• Extreme withdrawal, lack of communication and responsiveness
• Report of verbal or emotional abuse
403
Signs and Symptoms: Elder Neglect
•
•
•
•
•
404
Signs and Symptoms:
Elder Self-Neglect
•
•
•
•
•
•
405
Dehydration, malnutrition, untreated bedsores, poor personal hygiene
Unsafe living conditions
Unsanitary living conditions
Inappropriate/inadequate clothing
Lack of necessary medical aids
Inadequate housing/homeless
Care For Victim of Elder Abuse
•
•
•
•
406
Dehydration, malnutrition, untreated bedsores, poor personal hygiene
Untreated health problems
Unsafe living conditions
Unsanitary living conditions
Report of neglect
All states have specific elder abuse laws
Report suspected abuse to adult protective service agency
Information is confidential
State agency will investigate and provide services
Sexual Assault and Rape
•
•
•
•
Over 4000 pregnancies result from attacks each year
7 of 8 rape victims are female
3% of men are victims
44% of victims are less than 18 years old
50
• 15% less than 12 years old
Care For Victim of Rape or Sexual Assault
407
•
•
•
•
•
•
•
•
Be sensitive to psychological trauma
Call EMS
Ensure privacy for victim
Try to involve friend or family member
First aider of same sex may be better
Provide first aid as needed, stay with victim till help arrives
Preserve evidence
Ask victim not to urinate, bathe, or wash any area pending arrival of police (evidence issues)
Question 62
408
One action you should take to calm and reassure the victim of an injury or sudden illness is to
always tell him or her that everything will be okay.
A. True
B. False
Question 63
409
If the victim of an injury or sudden illness seems irrational or delusional, one option is to pretend
that you agree with his or her false beliefs, if this will enhance calm.
A. True
B. False
Question 64
410
If someone may be suicidal, you should remove any weapons, drugs, or medications that might be
used in a suicide attempt (if it is safe for you to do so).
A. True
B. False
411
Pregnancy and Childbirth
412
Lesson 22
Pregnancy and Childbirth
413
•
•
•
•
Childbirth is normal, natural process
Pregnancy usually lasts 40 weeks
Usually occurs without problems or complications
It is possible, though unlikely, that problems may occur that will require first aid
Supporting Pregnancy
414
1
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•
•
Regular prenatal care
Follow healthcare provider’s instructions
Healthy diet with normal weight gain
Minimize caffeine
51
2 •
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•
415
Terms
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•
•
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•
416
No smoking
No drugs
No drinking
30 minutes exercise a day
Rest
Prevent injury
Embryo – term used for first 8 weeks after implantation
Fetus – term used thereafter
Uterus – where the baby develops
Cord – attaches baby to placenta
Placenta – attaches cord to mother
Physiology of Pregnancy
• Embryo develops inside amniotic sac which contains amniotic fluid
• Embryo attached to placenta
• By 8 weeks, embryo has developed all major organ systems
417
Stages of Pregnancy
• First trimester
– Few visible changes
– HR increases by about 8 beats/min
– Nausea, breast tenderness
418
Stages of Pregnancy
• Second trimester
– Fetus grows to 12 inches
– Abdomen gradually swells
– At 18 to 20 weeks may feel fetus moving
419
Stages of Pregnancy
• Third trimester
– Fetus grows rapidly
– By week 36 weighs 6 ½ lbs and fully formed
– Uterus is high on abdomen and presses on lungs causing shortness of breath
– May experience backache, heartburn, constipation, frequent urination
420
Labor and Delivery
• Begins with “Show” or “Bloody Show” when mucous plug from cervix released…can occur up to
10 days before contractions begin
• Occurs in 3 stages starting with contractions
421
First Stage
• Amniotic sac ruptures before or during first stage…the “water breaks”
• Uterine contractions begin and eventually push infant’s head into cervix
– 10 to 15 minutes apart initially
52
– 2-3 minutes apart shortly before birth
• May last few hours to a day
422
Second Stage
•
•
•
•
•
•
•
423
Typically lasts 1 – 2 hours, but can be much longer
Cervix fully dilated
Contractions powerful and painful
Infant’s head presses on floor of pelvis – urge to push down
Vagina stretches open
Head emerges (crowning)
Rest of body pushed out
Third Stage
• Placenta separates from uterus and delivered usually within 30 min of birth
• Uterus contracts and seals off blood vessels
424
The Cord
• Immediate response area: tie off or clamp cord 6-12 inches from baby…don’t cut.
• Delayed response area: tie off cord 6-12 inches from baby, tie again 2 more inches out, and cut
cord between clamps (you will need sharp implement)
425
Childbirth
• Remember it is a natural process
• Woman may be fearful or distressed
• Remain calm
426
Is Delivery Imminent?
•
•
•
•
Contractions less than 5 min apart and last 45 – 60 seconds
If this is not the first child events can move quickly
Amniotic sac ruptured
Some mothers may have urge to have bowel movement…this is due to pregnancy and pressure
on bowel
• Crowning just before delivery
427
Assisting During Labor
•
•
•
•
•
•
•
428
Ensure plan for transport
Help woman rest between contractions
Provide comfort measures
Do not let mother bathe during delivery
Write down contraction intervals and length
Help remind woman to control breathing
Continue to provide reassurance
Good Things To Do
•
•
•
•
•
You may flick baby’s feet to stimulate breathing…if breathing does not begin start CPR
Suction mouth and nose if you can
Wipe off baby, place in towel, and let mother hold the baby on tummy
Massage lower tummy after placenta is delivered
Encourage mother to begin breast feeding (causes changes in mother to reduce uterus and stop
53
bleeding)
429
Items Useful for Delivery
•
•
•
•
•
•
•
430
Items Needed for Delivery
•
•
•
•
•
•
431
Clean blanket/coverlet
Several pillows
Plastic sheet, or stack of newspapers
Clean towels and washcloths
Sanitary napkins or pads of clean cloth
Medical exam gloves
Plastic bags
Clean water
Empty bowl(s) or tubs
Clean handkerchief, clamp, or item to tie off cord
Clean soft towels, sheets, or blankets
Bulb syringe
If help may be delayed: Sterile scissors or razor blade to cut cord
First Aid:
Assisting with Delivery
432
433
434
435
436
437
Care of Mother After Delivery
•
•
•
•
•
•
438
Wrap up placenta and cord for transport to hospital
Support and comfort
Ensure mother and infant are warm
Give water to drink to mother
Wipe mother’s face with cool water
Ensure she and infant see healthcare provider
Care of Newborn
•
•
•
•
•
Assure newborn breathing well
Dry, but do not wash newborn
Ensure newborn stays wrapped, including head, to stay warm
Support head if newborn must be moved
Continue to check breathing
439
Childbirth Problems
440
Breech Birth
• Occurs when buttocks or feet appear in birth canal
• Umbilical cord squeezed and blood flow may stop
54
• If infant’s head becomes lodged in birth canal and it tries to breathe, it may suffocate
441
Breech Birth
• Medical attention urgently needed
• Move woman to kneeling position with head and chest down
442
Breech Birth
• Support body as it emerges, do not try to pull head out
• If head does not emerge soon, create breathing space for infant
• Check infant immediately and give CPR if needed
–
443
Limb Presentation
•
•
•
•
444
Rarely, arm or leg may emerge first
Emergency requiring immediate medical assistance
Put woman in knee-chest position
Do not try to pull infant out or push arm or leg back in
Prolapsed Cord
• Segment of cord protrudes through birth canal before childbirth
• Cord will be compressed as infant moves through canal
445
Prolapsed Cord
• Put woman in knee-chest position to reduce pressure on cord
• Do not try to push cord back inside mother
• When infant begins to emerge insert hand into birth canal and try to separate cord and
presenting part while allowing birth to continue
• Check infant immediately and give CPR if needed
446
Umbilical Cord Around Neck
• Umbilical cord may be around neck when infant emerges
• Slip it over head or shoulder to allow infant to emerge without strangling on cord
447
Cord Around Neck
• If it is too tight and you cannot release head, it is a life-threatening emergency
• Tie off cord in two places and cut cord between the two points…delivery should then proceed
without the obstruction.
448
Bleeding After Delivery
• Bleeding normally occurs with childbirth and delivery of placenta
– Usually stops after placenta delivered
• Use sanitary pads or clean folded cloths to absorb blood
• To help stop bleeding, massage the abdomen
449
Review Question
If a pregnant woman is bleeding from her vagina, pack the vagina with sterile dressings.
A. True
B. False
450
Review Question
55
To help the baby start breathing you should:
A. Gently flick the bottom of the feet
B. Spank the baby
C. Start CPR
D. Gently shake the baby
451
Review Question
Most emergency childbirths will occur without incident as a natural function.
A. True
B. False
452
453
Remote & Wilderness
Protocols
Lesson 23
454
Remote Care: Pick The Right Level
• Use remote protocols if EMS is more than 30 minutes away
• Pick the appropriate actions…some remote techniques are not appropriate in all
situations…others can be used in almost all situations
• Balance the need for advanced techniques vs. the risk
455
Any Area Can Be Remote Response
456
Considerations For The Wilderness Area
•
•
•
•
•
•
•
•
•
C-A-B + bleeding/shock control may not be enough when care is delayed
Environment may determine how care is provided (heat, cold, weather)…and limit options
Transport decisions critical
Call for help or treat in place decisions critical
Equipment is limited…improvise!
Helicopter evacuation, if available, more likely
Initial responders may be a different group from the rescue response
There may be communications challenges to call EMS
Know pre-existing conditions and medications for group.
457
Preparation Is Key For Remote Area First Aid
458
Good Things To Do In Remote Areas
•
•
•
•
•
459
When EMS is Remote: Use remote protocols!
Improvise! Improvise! Improvise!
Leadership is a key factor of successful wilderness care
Be able to request help via multiple methods
Insure safety and comfort of the entire group (including survival considerations)
Leadership Is Critical
• Assess situation plus the victim’s needs
56
•
•
•
•
•
Have a plan for first aid, rescue, obtaining medical care, and taking care of the group
Delegate responsibilities – use helpers
Involve the group to participate in useful ways
Continually reassess situation – modify your plan if the situation changes
Always maintain focus on the primary goal…getting the victim to medical care
460
Disasters Change The Rules
461
First Aid Kits Are Different
• Have the appropriate items and quantities.
• Consider trauma plus illness plus comfort items.
• Everyone should have their own personal medications.
462
Survival Essentials
Water
Food
Warmth / Fire
Shelter
Survival techniques and equipment are specific to the area and the season.
Survival techniques are not included in this presentation.
463
Sheltering The Victim
• Protect your victim from the environment - you may need to create an emergency shelter
• Have items to construct a seasonal expedient shelter
464
465
Wilderness Care Decisions
In The Remote Area
466
Three Key Questions For
Wilderness Medicine
1. Should I call for help? (“Care or Call”?)
2. Do I wait for help or move the victim? (“Stay or Go”?)
3. Is it safe? (Location, environment, group)
467
Evacuation of Victim
• It is almost always better to wait for help than try to evacuate a seriously injured non-mobile
victim yourself
• Moving victim with limited resources is often not the right choice
• Evacuation decision has five considerations:
1. When is help expected?
2. What is victim’s condition and mobility?
3. How many responders are available?
4. What is the environment?
5. How effective is the first aid?
468
Consider Psychological Issues
• The outdoor environment adds stress of weather, temperature extremes, shortage of food or
water
57
• Members of party may show different behaviors because of the new environment
• Mental preparedness and leadership skills important to be ready to act effectively
• Emergencies can stress the group
469
Self-Transport
Is this a smart option for your situation ?
Are you sure?
470
Sending Someone For Help
• If it is not possible to call for help then someone may need to go for help
• An important decision – including who will go – at least two should be in the group going for
help
• Those who go for help must be able to accomplish this task – so you must choose how is capable
471
The Go For Help Team
•
•
•
•
•
•
•
•
472
Physically able to get to their destination
Have sufficient clothing and equipment
Clear idea of where you are, where they are, and how to get there…and back!
Able to survive if they get into trouble
They have a plan for how to call for help
Communication expectations with you (if possible)
Know what they will do when the call is made
Have discussed backup plans…just in case
Leaving A Victim Alone
Consider this option only if:
• You are alone, and…
• You cannot call for help, and…
• Unlikely that anyone will pass by, and…
• Medical condition warrants it
473
Leaving A Victim Alone
•
•
•
•
Prepare victim as well as possible before leaving
Shelter, food, water
Leave note with victim explaining when you anticipate returning
With 2 or more responders don’t leave a victim alone
474
Leaving A Victim Alone
475
Emergency Communications
In The Remote Area
476
Calling For Help
•
•
•
•
477
Communication failure is the most common cause to limit wilderness medical outcomes
Plan in advance and have appropriate equipment
Three of anything is considered a distress signal (whistle, fires, lights, horn, etc…)
Always know where you are
Position Description
• Can you describe your position accurately (without a working cell phone)?
58
• Do you know the name of the road or trail you are on? How far have you travelled on it?
Campsite name?
• Do you carry a map for backwoods or trail travel? Can you use it?
•
•
•
478
Cell Phones
•
•
•
•
•
479
Communications Alternatives
•
•
•
•
•
480
Know how to respond to animal attacks in your area
Know animal behaviors that could signal an attack
Treat bites as trauma plus flush gently with water for 5+ minutes if bleeding allows
Insure the area is safe to provide care (animal has departed)
Mountain Lion
•
•
•
•
•
•
482
Satellite phones connect calls from anywhere in the world…can be rented easily on the internet
SPOT Satellite Personal Tracker
Amateur (“Ham”) Radio
Satellite texting devices for cell phones
Satellite phone in vehicles
Animal Attacks
•
•
•
•
481
Protect from environment
Save the charge and/or have an external power pack for emergency use
Get to higher ground to find a cell phone signal
Text messages may still work in area of weak signal when voice connection does not work
Will your cell phone show your location coordinates? Do you know how to access coordinates?
Do you need to load an “app”?
Stop and stand tall. Do not run. Try to appear larger than the cougar.
Never take your eyes off the animal or turn your back.
Do not crouch down or try to hide.
If the animal displays aggressive behavior, shout, wave your arms, throw rocks.
If the cougar attacks, stay on your feet.
If you go down you can sustain much worse injury or death. Fight back violently.
Black Bear
• Do not run because that could trigger an attack response.
• Keep all your movements slow and deliberate.
• Do not approach the animal. Pick up small children and pets so they will not be perceived as
prey.
• If the animal is at a distance make loud noises.
• Wave your arms above your head to appear larger.
• Leave an escape route open so the bear won’t feel cornered and forced to fight its way out of the
situation.
• If attacked concentrate on striking the eyes and nose.
483
Elk/Deer
• Do not turn your back or run from the animal, as they almost always charge from behind.
59
• Facing the animal, raise your arms and your jacket, to make yourself appear larger. Climb a tree
if available.
• If you are knocked down, curl up in a fetal position to protect your head, neck and organs. You
might be thumped a few times, and then it is likely the animal will leave.
• If the animal has antlers, put trees or boulders between you and the animal.
484
Wolf or Coyote
• Social animals that generally will avoid man.
• Don’t run, because that might trigger an attack. Yell at the animal to make it back off.
• If you’re surrounded by a pack it is time to fight back violently. These are carnivores and you are
on the menu.
• Do not lose your footing. Once you go down, a pack will rush in and rip you apart.
• If you are surrounded and are in a group, position yourselves back to back, facing the animals.
Use anything to fend off the attack.
485
Assessing Unresponsiveness
486
AVPU
• The AVPU scale can be useful in remote situations as it can track the level of unresponsiveness
over time.
• AVPU is not usually used in rapid response situations by first aid volunteers.
•
487
AVPU
• Alert - This patient will have spontaneously open eyes, will respond to voice (although may be
confused) and will have bodily motor function.
• Voice - the patient makes some kind of response when you talk to them, which could be in any
of the three component measures of Eyes, Voice or Motion
• Pain - the patient makes a response on any of the three component measures when pain
stimulus is used on them.
• Unresponsive - the patient does not give any Eye, Voice or Motor response to voice or pain.
488
Wound Care
In The Remote Area
489
Wilderness Wound Care
•
•
•
•
490
Antibiotic Ointment
•
•
•
•
491
Direct pressure is still the preferred technique to control bleeding in remote areas
Use soap and water to clean the wound – flush if appropriate
Use cleanest water and materials available
Add an extra layer over bandages to protect the dressing
Soap and water is more important for cleaning wounds than just using antibiotic ointment
For extended trips use antibiotic if appropriate and continue use for 2-3 days (not one time use)
Antibiotic ointment can also act as a barrier for future contamination (with bandage)
Twice daily dressing changes are appropriate in remote care settings
Water
• Soap and water, or just water, is the preferred way to clean wounds in the outdoors
• Victim (and you) must have water to survive
60
• Use the cleanest available…even if from natural sources
492
Saline
• Wound wash, eye wash, and contact lens saline solution are effectively the same solution
• It is a near-sterile solution for washing, flushing, cleaning
• Don’t “improvise” homemade salty water…use cleanest plain water available if you don’t have
medical saline
493
Larger Wounds
• If you are several days from medical care large wounds may need different long term bandaging
• Stop immediate bleeding with direct pressure and pressure bandages
• After 1 – 2 days, if there is fluid buildup or discharge from deep wounds (including punctures),
then pack wound “open” with wet gauze inside and dry gauze outside, allowing wound to drain
• Access to EMS is a priority in these cases
494
Remote Tourniquet Protocol
• Use of tourniquets in remote areas is different than rapid response deployment
• With initial bleeding controlled, attempt to shift to direct pressure bandage, if possible, so you
can discontinue tourniquet use
• Loss of limb due to time using a tourniquet is highly variable, but, the longer tourniquet is used
the more likely limb loss will happen
• Do not loosen/tighten tourniquet periodically (this is old guidance)
495
Altitude Issues
In The Remote Area
496
Normal High Altitude Effects
•
•
•
•
•
•
•
497
Headache
Fatigue or Physical Exhaustion
Disturbed Sleep
Nausea and/or Vomiting
Digestive Disorders
Agitation
Vertigo
Altitude Sickness
• High Altitude Syndrome (HAS)
• Brought on with three to five thousand feet or more of altitude gain, usually above 5000 feet
498
Acclimatization Take Time
As you acclimatize:
• You breathe faster and deeper.
• You experience shortness of breath with exertion.
• You will exhibit a different breathing pattern as you sleep.
• You will awaken more frequently at night.
• The body's hematocrit level will increase (more red blood cells are produced)…helps the transport
of oxygen to the body tissues.
• Increased urination is normal.
499
Oxygen and Water
61
• Medical oxygen is for poor perfusion
• Oxygen may make a victim with HAS feel better, but, does not “cure” altitude sickness. Once
oxygen is discontinued symptoms will return.
• Symptoms of high altitude sickness may look like dehydration. Evaluate hydration by judging
urination.
• Don’t hyper hydrate the victim. This is not a “cure”, and can be serious.
500
Acute Mountain Sickness
• AMS is a severe version of HAS, where the victim has difficulty performing routine tasks
• Acute mountain sickness (AMS) includes headache, dizziness, fatigue, shortness of breath,
nausea, lack of appetite, general malaise
• As AMS worsens there will be shortness of breath at rest, decreasing mental status, and inability
to walk
• Treatment is to descend to lower altitude
• For extended activities treat the symptoms and do not allow victim to gain altitude
501
High Altitude Pulmonary Edema (HAPE)
• HAPE symptoms start gradually within the first 2-4 days at altitude.
• Symptoms: Shortness of breath, tightness in chest, significant fatigue and weakness, persistent
coughing, confusion, irrational behavior
• Treatment: Activate EMS and descend to lower altitude and administer oxygen
502
High Altitude Cerebral Edema (HACE)
• HACE is an extension of AMS, often subsequent to HAPE
• Rare in Colorado, usually only happens higher than 13,000 feet.
• Symptoms: Disorientation, lethargy/fatigue, nausea, headache, loss of coordination, memory loss,
possible hallucinations, psychotic confusion, coma.
• Transition from AMS to HACE can be fuzzy.
• Treatment: Descend to lower altitude and administer oxygen.
503
Pulse Oximeter
•
•
•
•
504
Measures pulse and percentage of oxygen saturation in the blood
Inexpensive (shop smart)
Can help with a judgment regarding poor perfusion
Remember that percentage of oxygen profusion will read lower at altitude…90% at 10,000 feet is
a normal perfusion level
Pulse Oximeter
• At sea level, typical saturation values are 97 to 99 percent in healthy people. At 5,000 feet it can
be 95 percent and at around 10,000 feet it may be 90 percent. Above 10,000 feet there is a larger
change rate and oxygen saturation can drop to 80 percent or below.
• For field first aid volunteers up to 10,000 feet: Below 90 percent start oxygen and treatment for
high altitude sickness…descend.
505
Burns and Lightning
In The Remote Area
506
Burns
• A conscious victim who is alert should be given water or clear fluids if tolerated
62
• Burn prevention is important in remote areas since access to medical care is delayed
• Include victim’s level of discomfort and pain as a criteria for evacuation
• For extended care twice daily cleaning/flushing and bandage change is appropriate
507
Lightning Strikes
• Two thirds of direct lightning strike victims may survive
• Immediate CPR critical
• Continue CPR past 30 minutes
508
Lightning Fatalities
Colorado ranks high for lightning fatalities
509
Lightning Injury Prevention
•
•
•
•
•
510
Avoid Lightning Strikes
•
•
•
•
•
511
Seek shelter if you hear thunder soon after lightning strike
Get out of water immediately or off boat
Try not to be tallest object
Stay away from metal objects
Closed motor vehicle safer than being in open
Possibilities
•
•
•
•
•
512
Stay indoors during storm
If caught in open, crouch, squat, or sit with feet together, stay 15 feet away from others
Stay away from doors and windows
Do not use electrical appliances (even indoors)
The only thing predictable about lightning is unpredictability!
Direct strike - can be fatal
Contact injury - when the person was touching an object that was struck
Side splash - when current jumped from a nearby object to the victim
Ground strike - current passing from a strike through the ground into a nearby victim.
Blast injuries - hearing damage or blunt trauma by being thrown to the ground.
Care For Lightning Strikes
•
•
•
•
•
Thermal burns: Treat as any other 1st/2nd/3rd degree burn
There may be an entrance wound, exit wound, both, or neither
There could be cardiac issues
There could be trauma from muscle contractions
There could be trauma from flying debris
513
Head, Neck, and Spinal Injury
In The Remote Area
514
Spinal Injuries
• May be difficult to keep spine immobilized in a remote care situation
• Self-evacuation is usually your last choice
• In remote response areas gently move victim to the normal anatomic position with head straight
and eyes forward
• Assess for the specific location of the spinal injury
63
515
Is It A Spinal Injury ?
In a remote situation you can assess to rule out a spinal injury if:
1. Victim is alert, sober, cooperative
2. There is no neck or back tenderness when you press with fingers along spine
3. There are no other injuries that may distract from feeling pain or tenderness of spinal injury
4. Normal function in all 4 limbs
516
Concussion
•
•
•
•
517
A victim with a mild concussion may be able to continue a remote activity
Watch for symptoms in the first 24-48 hours
Monitor victim closely – wake and check every few hours when sleeping in first 24 hours
Emergency evacuation is recommended if the initial loss of consciousness is more than a minute,
or, there are other concussion symptoms
The One Minute Rule for Concussions
If the loss of consciousness is less than a minute
- and –
There are no symptoms in the first 24 hours…
…you can use the option to observe the victim for symptoms for up to 2 days, without immediate
EMS access
• If in doubt, if symptoms appear, or if you feel you should, then medical evaluation is
recommended
518
Traumatic Brain Injury
(TBI)
• For a suspected closed head injury put victim in a reverse shock position (supine with head and
shoulders slightly raised
• Frequently monitor for changes and open airway
• Give fluids if EMS is several hours away
• Give no aspirin, caffeine, or energy drinks
519
Musculoskeletal Injuries
In The Remote Area
520
Musculoskeletal Injuries
• Splinting fractures is probably the best option due to the time needed to access EMS
• Splinting materials may need to be improvised
• Padding and patient comfort are important as the splint may be improvised and worn for an
extended time
• Monitor swelling frequently and adjust splint tightness as needed
521
Improvised Splinting
Use any materials, natural or man-made, that will provide stability to the fracture
522
Sprains and Strains
• Use of elastic bandages can permit mobility for minor injury to ankles, wrists, and knees
• Assessment of pain, motion, tenderness, and change over time will determine the treatment plan
• Anticipate swelling during sleep periods with cohesive wrap (or loose elastic bandage) to control
64
swelling
523
Femur Fracture
•
•
•
•
A commercial traction splint may be the best splint for femur fractures
The commercial models are a better than an improvised splint
Pulls bones back to normal position and protects soft tissues
Make sure responders know how to deploy the splint before using it on the victim
524
Is Traction Necessary?
525
Pelvic Splint
• Use commercial splints or improvise with triangular bandages or a sheet
• Can be used if response is delayed or transport is required
526
Heat Injuries
In The Remote Area
527
Heat Emergencies
• Prevent heat emergencies…much better than having to treat them!
• For heat exhaustion or heatstroke – cool victim as soon as possible
• If victim alert and not vomiting – give fluid a little at a time
528
Heat Emergencies
• Victim of heat exhaustion may be able to travel after cooling and resting. Caution: walking in
heat can renew the problem
• Heat injury recovery takes time (dehydration and fatigue)
• Cool heatstroke victim fast and evacuate if possible
529
Eye Injuries
In The Remote Area
530
Snow Blindness
•
•
•
•
•
•
531
Burn caused by intense sunlight reflected from snow, water, and light surfaces
Prevent with UV eye protection
Eyes first are sensitive, headache may develop, eventually vision lost
Bandage eye(s) to prevent further exposure
Cold compresses may relieve pain
Recovery usually within 12 – 18 hours
Eye Infections
• Many eye infections are contagious – take precautions to limit spread to others or the other eye
• Little can be done in a field environment or by EMS – consider transport to a treatment facility
• Have victim frequently wash face and hands and don’t touch/rub the eyes
532
Contact Lens Overwear
•
•
•
•
•
•
Usually caused by not performing scheduled lens removal or cleaning
For minor discomfort and irritation issue can probably be handled in the field
Flood the eye with saline until victim can easily remove the lens or lenses
Have victim not use contacts until inflammation is gone
If infected then transport to treatment facility
65
533
Air Evacuation
In The Remote Area
534
More Than An Ambulance
• Air evacuation means fast transport to a trauma center with advanced medicine, specialized
doctors, and surgical options.
• The aircrew on a medical evacuation helicopter are highly trained flight nurses or paramedics
with some options, equipment, drugs, and techniques that are otherwise only found in the
emergency room.
535
Calling for Air Evacuation
•
•
•
•
•
Air evacuation is appropriate when fast access to advanced care is needed.
Anyone can call for air evacuation.
Helicopter activation will automatically alert EMS and fire.
If the LZ can be reached the local fire department will establish LZ.
No one is charged unless a victim is transported…even if the aircraft lands at your site. Don’t let
cost drive your decision for air evacuation.
536
Air Evacuation?
537
Landing Zone Safety
•
•
•
•
538
Keep landing zone (LZ) clear
Protect face and victim from flying debris
Do not approach landed helicopter until signaled to do so by the crew members
Don’t approach from uphill side (rotor clearance issue)
Tail Rotor Hazard
• The tail rotor is a significant safety hazard
• Volunteers may be recruited to keep bystanders clear of the aircraft
• Most modern helicopter do not require you to bend down under rotors if spinning…follow the
aircrew’s guidance
539
Landing Zone Protocols
• If fire responders can get to the LZ they will handle all the arrangements and preparation
• Some counties have pre-selected landing zones and will use local resources to transport victim to
helicopter
• If you are isolated you may have to set up the LZ yourself
540
Self Preparation of Landing Zone
•
•
•
•
•
100’ by 100’ (minimum) hard flat surface with minimal obstructions
Clear LZ of loose debris…very important!
Optionally mark corners of LZ (securely)
At night never shine lights at aircraft and spotlight obstructions
Give GPS coordinates if you have them, nearby major intersection, or geographical landmarks will
also work…they can see you from the air
• Identify surrounding obstructions to dispatcher
541
Important LZ Protocols
• The aircraft has advanced night vision capability…often they choose to land at night using night
vision devices
66
• Earplugs are useful…volunteers near a running aircraft work more safely and calmly when using
earplugs
• Move vehicles away from the LZ
• Don’t wave at aircraft…this could be misinterpreted as the two handed “abort landing” hand
signal
• Wait until signaled by crew to approach, or, usually they will come to you
542
Who Do I Call?
• For the volunteer the best option is to request air evacuation via 911.
• In the early stage of your response you can request a “helicopter standby”. They will go to a
higher state of readiness and start researching your location for an LZ, weather, availability, etc...
543
But …They Turned Me Down
If any air evacuation dispatch says no aircraft is available don’t bother calling another
company…they have shared that information and no one will send an aircraft. You will have to
use a ground based resource.
544
Special Situations In Remote Care Areas
545
Shock
• In remote response areas give water, clear fluid, or rehydration fluid in small drinks, frequently
but as tolerated…if victim is responsive and can swallow. (In a rapid response area a shock victim
is not to be given anything to drink).
• Keep them warm (important).
• Expedite access to EMS…all shock victims should be under medical care.
546
Splinters and Cactus Needles
• Quick removal and thorough cleaning will reduce irritation and swelling
• Splinters or cactus spines in the genitals, lips, and around the eyes are more appropriate to
remove at a medical facility
• If they are deeply embedded, next to a large blood vessel, or in nervous tissue the victim should
be transported to a medical facility
• In remote response areas monitor for subsequent infection
547
Cactus Needle Inflammation
•
•
•
•
548
Cactus needles usually have fungus on their spines, resulting in a subsequent inflammation
If large areas of the body are involved monitor for a full-body allergic reaction
The resulting inflammation can help you locate cactus needles for removal
Don’t misinterpret this as anaphylaxis
Wood Splinter Removal
Clean the area plus clean the instruments before and after use!
• Tweezers (use sharp tweezers for splinters, blunt for cactus)…pull out along entry path
• Sharp tweezers can be inserted under the top layer of skin to reach a superficial splinter or
needle
• Small superficial cut can be made to access the end of diagonal/vertical entry (scalpel works well)
549
First Aid: Sucking Chest Wound For Remote Response Area
•
•
Put thin sterile dressing over wound.
Cover dressing with plastic wrap to make air-tight seal and tape on three sides.
67
•
550
Position victim inclined toward injured side.
First Aid: Sucking Chest Wound For Remote Response Area
You can also use a commercial chest seal, allowing one way air flow (outwards).
551
Abdominal Injury
•
•
•
•
•
552
Abdominal injury is either internal or penetrating
Abdominal injury may progress to shock
Abdominal pain in lower right may be sign of appendicitis
Evacuate any open abdominal trauma
Evacuate a closed injury if there is shock, diminished consciousness, point tenderness, hard lumps
in abdomen, tightness, soft spots, vomiting blood, blood in stool, or pain
Diabetic Emergencies
• On any extended remote trip the diabetic should inform others of their condition
• Diabetics should monitor blood sugar levels and teach others the signs and symptoms of
high/low blood sugar
• Partner with the diabetic victim to decide best treatment for high and low sugar situations
553
Diabetic Emergencies
• Insulin that is frozen or allowed to heat above 85-100 degrees should be discarded.
• Some insulins are over-the-counter, so these can be shared between victims
• Discuss with the victim what happened and how to prevent a reoccurrence on an extended
activity
• For extreme symptoms, loss of consciousness, or shock…activate EMS
554
Glucometer
•
•
•
•
•
555
Anaphylactic Shock
•
•
•
•
556
Others in group should know if someone has potential severe allergic reactions
Victims should carry prescribed doses of emergency epinephrine
Be sure others know where their emergency epinephrine is and how to use it
Activate EMS if the airway swells, there is difficulty breathing, or there is loss of consciousness
Anaphylactic Shock
•
•
•
•
•
557
Inexpensive and easy to use
Verify the “calibration” number shown on the test strips is entered into the meter
Can be included in a large first aid kit for you or a diabetic victim to use
Use for a high vs. low sugar decision
Requires knowledge of blood sugar levels
Use SAMPLE to help with the decision to call EMS
Life threatening reactions can happen on a first exposure (such as stings)
The faster significant symptoms can indicate a more severe overall reaction
Benadryl should be given, even if an Epi-Pen was used
The body will break down the allergen over time, so we are trying to maintain the airway through
the most severe time of the anaphylaxis
Avalanches
• Chances of survival diminish quickly, so call for help immediately
• Begin searching…don’t wait for help
68
• Start where victim last seen and work down slope
• Use ski poles or branches to probe snow
• You may face hypothermia + obstructed airway + cardiac arrest issues + trauma
558
Snakebites
•
•
•
•
559
Assess if the snake is poisonous, or assume a poisonous snakebite if otherwise unknown
Diamond shaped head is a good way to identify pit vipers from a distance
Don’t capture the snake or bring it to the medical facility (yes…there are folks who try this)
Envenomation is variable – effects on victims are different, evaluate signs and symptoms
Snakebites
• Use lightly wrapped elastic bandage on entire limb to slow venom spread to body core
• It is extremely important to keep the victim still. Physical exertion will spread the venom faster.
This is usually a carry out
• Keep area at or below heart if possible
• Monitor fingers and toes for circulation
• Access EMS
560
CPR
If victim is far from medical care and is clearly lifeless after 30 minutes you can choose to stop
except for victims of:
• Hypothermia
• Drowning
• Lightning strike
• Poisoning
561
Oxygen and CPR
• Generally, supplemental O2 can be used with CPR, especially at altitude.
• CPR is primary, so don’t interrupt CPR for O2 administration.
562
Oxygen for COPD
• For rapid response areas use high flow oxygen.
• For remote response areas use victim’s cannula and prescribed flow rates.
• If you have a Pulse Oximeter you can increase oxygen flow to bring percentage above 90 percent.
563
Fungal Lesions
•
•
•
•
564
Fungal growth most common in dark and moist locations (feet, armpits, groin)
There are different types of fungus and anti-fungal medications
Breaks in the skin hide spores and are an opening for potential infection
Physical activity and/or hot weather can cause a flare up
First Aid: Fungal Lesions
•
•
•
•
•
•
Clean frequently with soap and water
Wear clean underwear/socks/undershirt
Keep area dry if possible – remove dead skin and debris
Use anti-fungal medication, and continue for 1-2 weeks after skin heals
If anti-fungal medication is not effective then switch to another type
Wash before touching other body parts
69
565
Nasal Airways in the Wilderness
• NPAs are more expensive than OPAs, so purchasing a full set of diameters of lengths is not a
likely option for field kits
• Field application: Carry only a few diameters in longer lengths
• Get the length adjusting type or trim to correct length after measuring
• Also, you can use two if you have them (both nostrils)
566
Extreme Techniques
567
Reduction of Fracture
•
•
•
•
568
Angulated fracture can cut off circulation below injury
Only if necessary: Attempt to straighten extremity, reduce dislocation, or apply traction
Do not straighten if this will increase uncontrolled bleeding
Do not straighten if victim will receive medical care within 30 minutes
Joint Manipulation
If necessary, joints can be manipulated to improve splinting due to the needs of field transport. Do
this only if necessary as an option of last resort.
• Movement should be slow, deliberate, and controlled
• Move only one joint at a time
• Move the joint only in a natural direction
• Support the injured area at all times
• Have patient assist with support or movement
569
Dislocation Reduction
570
Dislocation Reduction
571
Dislocation Reduction
572
Dislocation and Fracture Reduction
573
Sutures
• Use the correct bandage with direct pressure in the field to stop blood loss until evacuation to a
medical facility. Sutures are not generally recommended for the first aid volunteer.
• If sutures are not applied within a few hours after the injury then they should not be attempted
because of swelling.
• Improper stitching can cause additional tissue damage, scarring, and retard healing.
• Legally…sutures are not prohibited. Also, volunteers are usually not trained or equipped to
suture.
574
Sutures
• Emergency sutures might be used if:
– The situation is appropriate for sutures
– You have the right equipment
– You have the experience/training
– EMS is significantly delayed
– Bleeding can be controlled by direct pressure
• Use a simple chain suture or a simple interrupted suture
70
575
Staples
576
Sutures and Staples
577
Medical Adhesive
• Medical adhesive should not be the first choice for volunteers. Pressure bandages should be
adequate.
578
Super Glue
• Conventional “super glue” is not designed for use on human tissue. Some formulations can have
a thermic reaction (burns).
• It will dry out skin with long term use. If used as a treatment for cracked skin it will interfere with
healing
• About 5% of the population can become sensitized to fumes with repeated exposure, resulting in
flu-like symptoms
• Not recommended!
579
Medical Adhesive
580
Marine Emergencies
581
SCUBA Accidents
• Call EMS for:
– Breathing difficulty
– Pain in joints or extremities
– Feelings of tingling, numbness
– Paralysis
– Significant fatigue and generalized weakness
– Convulsions, coma, unresponsiveness
• Oxygen and decompression treatment may be needed
582
SCUBA Accidents
• Scuba issues include:
– Barotraumas (expansion injury)
– Decompression Sickness (DCS…nitrogen bubbles in the blood and joints
– Marine cuts, stings, and bites
– Any other conventional illness or injury
• Use oxygen for scuba issues (DCS) and advise EMS this is a scuba accident (for access to
hyperbaric chamber)
583
SCUBA Accident Symptoms
584
SCUBA Diving
Stings and Cuts
• There are some special techniques for cuts and stings from coral and marine animals…divers
should know them
• Apply standard first aid techniques.
• Take advice from divers on special solutions for washing and cleaning wounds.
585
Transport Issues and Techniques
71
586
Transport
Options
• Local rescue resources are usually the best choice.
• They have the manpower, equipment, expertise, training, and are familiar with the area.
587
Standard Voice Commands
•
•
•
•
•
•
588
Use Good Body Mechanics
•
•
•
•
•
•
589
For volunteers: “Lift on Three…One, Two, Three”
Professionals will probably just count.
Everyone uses this protocol.
For complex multi-person lifts practice first without the victim.
Always make sure everyone is ready before lifting or putting down.
Keep voice calm and deliberate.
Do not lift more than what you can lift without straining
Lift and lower with legs, not your back
Keep feet shoulder-width apart
Keep back straight and crouch down
Lift by straightening legs
Keep arms straight – weight on skeletal structure
A Trail Carry Technique
If you have enough bearers for the trail carry you can move a victim a long distance without
stopping.
This is only an option if you have a stretcher, board, backboard, or basket.
590
Trail Carry
591
Stretcher/Litter
Folding type: Watch out for pinch points!
592
Rescue Basket
• Can be solid bottom or wire mesh
• Very strong…can be used for heavy victim carry, horizontal lift, or vertical lift
• You can place a back board patient on top (and tie in, of course).
593
Backboard
A backboard can be used with or without a cervical collar.
594
Vacuum Stretcher
Very effective for a variety of injuries and victim sizes. Comes in smaller sizes for limbs, too.
Becoming more common with rescue and EMS agencies.
595
The Wheel
Used by SAR teams for back country transport
596
Scoop Stretcher
• Watch out for pinch points for both victim and responders.
• Tie/strap/tape victim to scoop for partial spine immobilization.
597
SKED
72
• Can be carried or dragged.
• Will work in confined spaces.
• Can be used for horizontal or vertical lifts.
598
Disposable Litter
• Inexpensive, lightweight, easy to carry.
• Very versatile for backwoods use.
• A few limitations:
– No back protection.
– Must pull up…not out…it can rip if used incorrectly.
– Must have a hand on every strap.
599
Reusable Fabric Litter “Megamover”
•
•
•
•
•
600
Carried by some ambulances and fire departments
Can carry heavy/obese victims
Reusable
Needs most handles used
Bulkier and more expensive than the disposable litters
Blanket Drag
Ensure blanket or tarp is heavy enough for victim and terrain !
601
Blanket Carry
Make sure the blanket or tarp is heavy enough to support the victim !
602
Sleeping Bag Carry
Make sure the bag is heavy enough to support the victim !
603
Improvised Blanket Litter
Poles must be heavy enough to support victim !
604
Chair Carry
Also effective in narrow passages or on steps.
Chair must be heavy enough to support the victim.
605
Question 65
One way to signal an emergency is to give _____ blasts of a whistle or car horn.
A. two
B. three
C. four
D. five
606
Question 66
When administering CPR in a remote area for which cause of cardiac arrest you may choose to
terminate CPR after 30 minutes of lifelessness?
A. Drowning
B. Heart Attack
C. Hypothermia
73
D. Lightning Strike
607
Question 67
If a victim is experiencing severe symptoms of Acute Mountain Sickness what is the best treatment
option?
A. Encourage the victim to take altitude sickness medication.
B. Give the victim high-carbohydrate foods.
C. Give the victim something to drink and encourage him or her to drink more fluids.
D. Move the victim to a lower altitude.
608
Question 68
The most reliable way to assess possible dehydration in a field environment is amount, color, and
frequency of urination.
A. True
B. False
609
Question 69
Remote Protocols should be used when access to medical professionals is more than:
A. 30 minutes
B. 1 hour
C. 2 hours
D. 6 hours
610
Question 70
Leadership, planning, emergency survival, and transport decisions are critical elements, in
additional to first aid skills, of a remote care first aid situation.
A. True
B. False
611
612
613
Triage, Rescue, and Moving Victims
Lesson 24
614
VIDEO
615
Multiple Victims and Triage
616
Why Triage?
• Triage procedures activate when the number of injured significantly exceeds the number of
responders.
• We must identify who needs help first, and who makes sense to take first, when
responders/transport is limited.
• Triage procedures end when all the victims are handled, or, the number of responders/transport
has significantly increased and everyone can be immediately seen.
74
• Triage implementation will change the primary assessment and subsequent actions.
617
Multiple Victims
• Decide who needs care and who can wait
• Triage systems classify victims into four categories
– 1st priority (immediate)
– 2nd priority (delayed)
– 3rd priority (minor)
– 4th priority (expectant)
618
1st Priority Triage (Immediate)
• Victims with life-threatening injuries who cannot wait for help
– Airway or breathing problems
– Severe bleeding
– Shock
– Severe burn
619
2nd Priority Triage (Delayed)
• Victims with injuries that need care soon but may be able to wait
– Burns
– Broken bones
– Other injuries that are not severely bleeding
620
3rd Priority Triage (Minor)
• Victims who can wait for some time
– Minor injuries
– Victims who can walk
621
4th Priority Triage (Expectant)
• No signs of life
or….
• Victims who probably can’t be saved
622
Sort !
• Ask who can walk and direct them to move to and area outside the primary incident scene
(Priority 3)
• Move into the incident scene: Responsiveness – “Are You OK?”
• Unresponsive – Establish Airway (tilt the head) and move on (Priority 4)
• Responsive – Spend less than a minute per victim…sort with “START” guidelines (Priority 1 and 2)
623
Triage Chart
624
START Triage Method
• Spend less than a minute with each victim.
• Primary assessment is different when triage is used.
• Acronym “RPM” helps to remember the order of assessment.
625
START Triage Short Method
START Triage - Assess, Treat
Find color, STOP, TAG, MOVE ON
75
626
Special Situations
627
Fire Scenes
• Smoke or fumes can overcome unprotected responders in a structure
• Invisible gases are a significant hazard
• Let professionals perform rescue if possible
628
When You Discover Fire
•
•
•
•
Remove everyone from area. Close doors behind you as you exit.
Call 911 and set off alarms.
Use fire extinguishers only if fire is small.
Avoid rescues in smoke/flame areas if possible…defer to fire fighters.
629
If You Are Trapped
630
Hazardous Materials
•
•
•
•
•
•
•
•
631
Call EMS and identify a HAZMAT situation.
Approach only if safe.
Treat any unknown substance as hazard until proven otherwise
Avoid spilled liquid, powders and fumes
Leave cleanup to Hazmat professionals
Stay out of area and keep bystanders away.
Outside, stay upwind of area to avoid possible fumes.
Inside, evacuate structure
Vehicle Crashes
• There are risks of passing traffic, fire, vehicle instability
• Do not remove victim unless fire or other threat likely and you can provide first aid in place
632
Accident Scenes
633
Drowning
•
•
•
•
634
Drowning and Safety
•
•
•
•
•
635
Results in more than 3000 deaths a year
Near-drowning can result in brain damage and permanent disabilities
Second leading cause of injury-related death for children ages 1 – 14 years
Small children can drown in bathtubs, buckets, or toilets
Supervise young children during aquatic activities
Teach youth how to swim
Be safe with residential pools
Alcohol use involved in over half of adolescent and adult drowning incidents
Most boating fatalities caused by drowning - Alcohol involved in 39% of cases
Safe Water Rescue
•
•
•
•
Rescue technique depends on specific situation and equipment available
Do not jump immediately into water to save victim…may be unsafe
May be appropriate to swim to victim if no other means
Reach-throw-go priority
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636
If Stranded in Cold Water
Minimize heat loss
If alone use heat escape lessening position (HELP)
637
If Stranded
in Cold Water
Two or more people can use the huddle position
638
Moving Victims
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639
Moving Victims Decision
Accident Scenes
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640
Moving injured victim may cause further injury
May have to move victim to protect from danger at scene
May have to move victim to flat surface to provide CPR
In the few cases where first aid providers have caused further injury the most likely cause is
unnecessary or improper movement
How quickly must victim be moved?
Does victim’s condition affect move?
Are others present who can help?
Is any equipment needed?
Do you have necessary physical strength?
Considerations for Carries
Consider moving victim if:
• Fire or explosion likely
• Poisonous fumes may be present
• Structure may collapse
• Victim needs to be moved into position for life-saving care
• Victim is in way of another
641
Carry Techniques
642
Shoulder Drag
643
Ankle Drag
• Unresponsive victim without suspected spinal injury - Ankle drag (works best for short distances
over smooth surface)
644
Best for a responsive victim since getting an unconscious victim in this position is difficult without
assistant. However, victim can be carried if they become unconscious in this position.
645
For a responsive victim who can walk with help
646
Fireman’s Carry
647
Two-Handed Seat Carry
• Use this with two rescuers
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648
Piggyback Carry
649
Hammock Carry
650
Hammock Carry
• Practice wrist grabs before reaching under patient
651
Hammock Carry
• Person holding head gives commands
• Strongest lifters positioned at the torso
652
Hammock Carry With Transfer to Stretcher
653
Question 71
In a mass casualty situation which triage priority would you assign to a victim with a broken arm?
A. First (immediate/red)
B. Second (delayed/yellow)
C. Third (minor/green)
D. Fourth (expectant/black)
654
Question 72
After a serious vehicle crash you should remove the victims from the vehicle as quickly as possible
because it is likely that the vehicle will catch fire.
A. True
B. False
655
Question 73
In a group carry, the command to lift is:
A. One, two, three, lift
B. Three, two, one, lift
C. Lift on Three…One, two, three
D. One, two, three, go
656
Question 74
The voice command to lift/lower is:
A. Used only by volunteers of first aid
B. Used only by volunteers and ambulance crews
C. Used only by volunteers, ambulance crews, and firefighters in the field
D. Used by everyone in the EMS system to prevent a victim from being lifted or lowered unevenly
657
Question 75
The most likely situation where a first aid volunteer will cause more harm to a victim is:
A. Doing poor CPR compressions
B. Failure to stop severe bleeding
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C. Failure to act
D. Using unnecessary or improper movement
658
659
660
Are You Prepared?
Lesson 25
661
Plan Before The Emergency
• In an emergency you have no time to plan
• Learn what to do and how to be prepared – before an emergency occurs
662
Tornado Distribution
663
Tornadoes
• If you are in your car, stop, get out, lie flat face down in low area, and cover head
• If at home go to basement, storm shelter, or room in center of house
• Move to the interior of high rise or larger buildings
664
Your Plan
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•
•
665
Household Emergency Plan
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•
666
Learn what emergencies may affect your community
Learn how you will be notified during an emergency
Know plans in place for emergencies
Information available from Homeland Security website and state and local sources
Discuss how to respond to possible emergencies with household members
Discuss what to do in power outage or personal injury
Fire: discuss escape routes from each room or floor
Update household plan as children mature
Good Things for Every House
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Know how to turn off water, gas, electricity
Post emergency contact numbers
Teach children how and when to dial EMS and how to call long distance numbers
Identify someone to call if family separated
Have an emergency (battery) radio at home
Pick 2 meeting places
– One near home
– One outside neighborhood
• Keep family records in waterproof and/or fireproof safe, or scanned into a thumb drive
667
Prepare An Emergency Go Kit And An Emergency Stay Kit
• A list of items will allow you to adjust and assemble the appropriate items quickly
• Have items ready that cannot be easily obtained in an emergency (such as survival food)
668
During Any Emergency
• Carry identification, credit cards, cash
• Copies of important documents
79
• Extra sets of house and car keys
• Tools (screwdrivers, cutters, scissors, duct tape, waterproof matches, fire extinguisher, flares,
plastic storage containers, needle and thread, pen, paper, compass, trash bags, bleach)
669
Parents: Know School Plans
• Know school procedures for emergency
• Keep contact information up-to-date, including who is authorized to pick up children at school
670
Prescriptions
• Always keep 3 – 5 days of medications on hand
• Include medications used to stabilize condition or keep condition from worsening
671
Neighbors Can Help Neighbors
• Some communities or churches have groups to prepare for emergencies
• Introduce emergency preparedness as topic in neighborhood organization, home association, or
crime watch group
672
Pets
• In evacuation do not leave pets behind
• Remember, pets are generally not permitted in public emergency shelters…they stay in car
673
Emergency Kit for Pets
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•
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674
Evacuation
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•
675
Identification tags and rabies tags (on collar)
Carrier or cage
Leash
Medications
Waste bags
Food, bottled water, bowls
If notified to evacuate, go immediately
Take emergency go kit
Lock home
Travel on specified routes if appropriate
If Directed Not to Evacuate
• Prepare depending on type of emergency
• Monitor communications for updates
• Remain ready to evacuate on short notice
676
Severe Weather
• Know what types of severe weather are likely at your location
• Understand difference between Watch and Warning
• Find appropriate shelter quickly
677
Flash Floods
• Move immediately and quickly to higher ground
• If water rises around car get out and move to higher ground
678
Don’t Cross Running Water
• Only a few inches of running water can break traction for even heavy vehicles
80
• Muddy water hides the actual depth
679
Wildfires
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•
680
Natural Disasters
•
•
•
•
681
Avoid travel around active wildfires
Monitor media for current information, including evacuation instructions
Weather can shift fires and change danger areas with little warning
Best defense is not to be there!
Know what kinds of disasters are possible in your area.
Preparations for stay/go apply to most emergencies and disaster situations.
You may have time to prepare, or, you may have little warning.
This will influence your planning and preparation
Terrorist Situations
• Most preparedness for natural disasters also applies to terrorist situations
• Fundamentals of an effective response is to keep the remain calm, stay in touch
(communications), and follow directions
682
683
Moving Forward
Lesson 26
684
Remember Your Training
Feel confident that you know what to do in an emergency
Remember key principles of first aid to act without delay
685
Act With Confidence
• It is natural to feel hesitant or unsure
• Display confidence in your abilities to provide first aid after this course
• Your victim needs you to act with confidence
686
Remember The Basics
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•
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•
Stay calm
Call EMS for serious emergencies or when in doubt
Scene safety
Act quickly
Check the victim
Do not harm
Ask others to help
687
Prevention of Injury and Illness
688
Be An Active Safety Officer
• People will do unsafe things.
• Teach safety and help others be safe.
• The best first aid is the first aid you don’t have to use.
689
Be Prepared to Act Anytime
• Accidents and injuries will happen when you least expect them. Be ready.
81
• Leadership, knowledge, and initiative will allow you to take charge, help, or even save a life.
690
Skills Update
First-aid responders may have long intervals between learning and using CPR and AED skills.
Numerous studies have shown a retention rate of 6-12 months of these critical skills.
The American Heart Association’s Emergency Cardiovascular Care Committee encourages skills
review and practice sessions at least every 6 months for CPR and AED skills.
Instructor-led retraining for life threatening emergencies should occur at least annually. Retraining
for non-life-threatening response should occur periodically.
691
The Future
• Stay current in skills and knowledge
REVIEW AND PRACTICE !
• Keep and consult texts
• Research reputable websites
• Consider additional emergency care courses
• Periodically renew through refresher course
692
Before you leave….
• There are two certificates…one for CPR and one for first aid.
• Leave forms on the tables or turn them in.
• Insure you take all your personals.
693
You Are Ready !
694
Copyright
This presentation contains copyright protected materials. Public web posting and/or reproduction is
not allowed without permission.
Suggested changes and improvements may be sent to Colorado First Aid, Inc. ([email protected])
These materials may not be modified without permission.
www.cofirstaid.org
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