american red cross when help can’t wait emergency response copyright © 2000 by the american...

American Red Cross

When Help Can’t Wait

Emergency Response

Copyright © 2000 by the American National Red CrossAll rights reserved

EMERGENCY RESPONSETRAINING

American Red Cross


Emergency Response


Emergency Response Training Instructors Books Facilities Certificates upon completion Schedule Tests Participation Hands-on training Physical requirements

TM2

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Emergency Response


Chapter 1The First Responder

Components of the EMS system Roles and responsibilities of the First

Responder Medical Oversight Statutes and regulations

American Red Cross


Emergency Response


Links in the Chain of Survival

TM1

1. Citizen Response

2. Early activation of EMS

3. First Responder Care

4. Advanced Out-of-Hospital Care

5. Hospital Care

6. Rehabilitation

Pg 5-11

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Emergency Response


First Responders Fire fighters Law enforcement personnel Lifeguards Ski patrollers Industrial response team Athletic trainers Disaster team members First aid station attendants

TM2 Pg 12-14

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Emergency Response


VideoThe First Responder

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Emergency Response


First Responder Characteristics Maintains caring and professional attitude Controls fears Presents professional appearance Maintains skills and knowledge Stays healthy Recognizes and keeps victim’s needs as

priority

TM3 Pg 12-13

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Emergency Response


Primary Responsibilities of First Responders

Ensure safety of self and others Gain access to victim Identify life-threatening conditions Summon more advanced medical personnel

when necessary Provide care Assist more advanced medical personnel

TM 4Pg 13-14

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Emergency Response


Secondary Responsibilities ofFirst Responders

Summon additional help. Control and direct bystanders. Keep records. Reassure others at scene.

TM 5Pg 13-14

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Emergency Response


Medical Oversight Includes medical director Direct medical control Indirect medical control

protocols standing orders

TM 6Pg 14

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Emergency Response


Chapter 2First Responder Well-Being

Recognizing Stress Emotional Reactions Scene Safety Protective Equipment

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Emergency Response


Emotional Aspects of Emergency Care

Stressful Situations Death and Dying The Grieving Process Helping the Victim and the Family

Pg 18-20

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Emergency Response


Stress ManagementWarning Signs of Stress

Irritability Inability to concentrate Difficulty sleeping/nightmares Anxiety Guilt Loss of interest in work

Managing Stress Healthy physical and mental habits Diet Balance of work, recreation, family and health Seek professional help if necessary

TM 7Pg 20

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Emergency Response


Critical Incident Stress Strong emotional reaction that interferes

with ability to function Can build-up over days, weeks, months or

years May require counseling See Pages 442-443

TM 8Pg 20-22

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Emergency Response


CIS Management Pre-incident stress education On-scene peer support Critical Incident Stress Debriefing (CISD) Critical Incident Stress Defusing Family support Know when to Access CISD

Pg 21

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Emergency Response


The Emergency Scene Scene Safety Personal Safety Safety of Others Be aware of special emergency situations

Hazardous Materials Motor Vehicle Crashes

Pg 22-25

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Emergency Response


At the Scene, Evaluate - Location Problems Dangers Number of victims Behavior of victims/bystanders Need for additional assistance

TM 9Pg 22-25

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Emergency Response


Evaluate the scene

CT 3Pg 23

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Emergency Response


Ensure Your Safety By- Evaluating potential dangers. Wearing proper gear. Doing what you are trained to do. Summoning additional resources.

TM 10Pg 23

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Emergency Response


Possible Dangers at an Emergency Scene

Unstable structures or vehicles

Natural disasters Multiple victims Hostile situations Suicide Hostage situations

TM 11

Crime Traffic Fire Electricity Water/ice Hazardous materials

Pg 29-33

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Emergency Response


EnrichmentSpecific Emotional Crisis

Suicide Assault

Sexual Assault Physical Assault

Crisis Intervention Dealing with Emergency Situations at the

Scene

Pg 26-29

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Emergency Response


Chapter 3Disease Transmission

How the immune system works How diseases are transmitted Conditions required for disease

transmission Body Substance Isolation Exposure control and documentation OSHA requirements

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Emergency Response


VideoPreventing Disease Transmission

Part I

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Emergency Response


OSHA Regulations Occupational Safety and Health

Administration regulations regarding “blood borne pathogens” Apply to employers whose employees, as a

result of job requirements, have potential exposure to blood borne pathogens.

Provide safeguards to reduce disease transmission

Pg 45-46

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Emergency Response


Potentially Infectious Body Fluids Semen Vaginal Secretions Cerebrospinal fluid Synovial fluid Pleural fluid Pericardial fluid Amniotic fluid Peritoneal fluid

Pg 36-37

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How Infections OccurDisease-causing Agents

Viruses (Hepatitis, measles, mumps, meningitis, colds, HIV, herpes)

Bacteria (Tetanus, meningitis, tuberculosis, diphtheria, food poisoning)

Fungi (Athlete’s foot, ringworm) Protozoa (Malaria, dysentery) Rickettsia (Typhus, Rocky Mountain spotted

fever)

Pg 37-38

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The Body’s Defenses Immune system (antibodies)

Acquired immunity Specific immunity by Immunization

Understanding how diseases spread Taking precautions (BSI)

Pg 38-39

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Conditions Necessary for Disease Transmission

Pathogen present

TM 12Pg 39

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Emergency Response



Pathogen present

TM 12

Sufficient Quantity

Pg 39

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Emergency Response



Pathogen present

TM 12

Sufficient Quantity

Susceptibility to the disease

Pg 39

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Emergency Response



Pathogen present

TM 12

Transmission Site

Susceptibility to the disease

Sufficient Quantity

Pg 39

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How Pathogens Enter the Body

TM 13

Direct

Pg 40

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TM 13

Direct Indirect

Pg 40

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TM 13

Direct Indirect

Airborne

Pg 40

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Emergency Response



TM 13

Direct Indirect

Airborne Vector

Pg 40

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Emergency Response



Part II

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Emergency Response


Diseases that Cause Concern Herpes Simplex Meningitis Tuberculosis (TB) Hepatitis HIV

Pg 41-44

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Emergency Response


Meningitis• The bacteria are spread

through the exchange of respiratory and throat secretions (i.e., coughing, kissing)

Tuberculosis (TB)• TB is spread from

person to person through the air.

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Emergency Response


Viral Meningitisthrough direct contact with respiratory

secretions (saliva, sputum, or nasal mucus) of an infected person. By shaking hands with an infected person or touching something they have handled, and then rubbing your own nose, mouth or eyes. The virus can also be found in the stool of persons who are infected.

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Emergency Response



Part III

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Emergency Response


Exposure Control Plan Exposure determination Schedules and methods for implementing

OSHA standard Procedures for evaluation exposures Immunizations

TM 14Pg 44-51

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Emergency Response


Standard Precautions (BSI) to Prevent Disease Transmission

Protective equipment Personal hygiene practice Engineering controls Work practice controls

TM 15Pg 49-51

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Emergency Response


If an exposure occurs …

Wash any area of contact Document the situation. Most employers

have protocols for reporting infectious disease exposure

Notify your superior and any necessary medical personnel immediately.

Pg 51-52

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Emergency Response


VideoRemoving Gloves

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Emergency Response


Practice SessionWorkbook Page 21

Removing Gloves

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Emergency Response


Chapter 4Legal and Ethical Issues

First Responder responsibilities Victim’s rights Special populations (Enrichment)

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Emergency Response


Legal Considerations Scope of PracticeScope of Practice Standard of CareStandard of Care Duty to ActDuty to Act CompetenceCompetence ConsentConsent

Expressed (Informed)Expressed (Informed) ImpliedImplied

Advance DirectivesAdvance Directives/DNR Orders …./DNR Orders ….

TM 16Pg 56-62

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• Refusal of CareRefusal of Care•BatteryBattery•AbandonmentAbandonment•NegligenceNegligence•Good Samaritan LawsGood Samaritan Laws•ConfidentialityConfidentiality•Evidence PreservationEvidence Preservation•DocumentationDocumentation

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Emergency Response


Obtain Consent Before Providing Care

Identify yourself State level of training Explain what you observe Explain what you plan to do

TM 17Pg 57

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Four Components of Negligence Duty Breach of Duty Cause Damage

TM 18Pg 60

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EnrichmentSpecial Populations

The Elderly Victim Victims with Physical or Mental

Disabilities Visually Impaired Hearing Impaired Physically Disabled Developmentally Disabled

Pg 63-67

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Chapter 5Human Body Systems

Describe the various body systems and how they interact.

Anatomical terms (Enrichment)

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Emergency Response


Major Body Systems Respiratory Circulatory Nervous Musculoskeletal Integumentary (skin)

TM 19

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VideoHuman Body Systems

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Emergency Response


The Body Systems

Cells performing a common function form tissues. Different tissues work together to form organs.

CT 5Pg 70

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The Circulatory System

CT 9Pg 72-74

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The Nervous System

Images courtesy of theEMTB Anatomy Review

Pg 74-76

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The Muscular System

CT 11Pg 76-79

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Muscle Groups

CT 12Pg 78

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The Skeletal System

CT 13Pg 79

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The Integumentary System

Pg 79-80

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EnrichmentAnatomical Terms (positions)

Anatomical Position is face forward with palms front

Medial/Lateral Proximal/Distal Anterior/Posterior Superior/Inferior Right/Left refer to victims right/left

Pg 81-83

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EnrichmentAnatomical Terms (cavities)

Cranial Spinal Thoracic Abdominal Pelvic

CT 16Pg 83-85

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EnrichmentThe Digestive System


Pg 84-87

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EnrichmentThe Endocrine System


Pg 87

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EnrichmentThe Genitourinary System


Pg 87-88

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Interrelationships of Body Systems

Body systems work together to maintain a healthy state

Systems do not work independently. Injury or disease is rarely restricted to one system

Significant injury or illness may result in shock The more systems involved the more serious the

emergency Basic care may be all that is needed until more

advanced care is available.

Pg 89

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Chapter 6Lifting and Moving

Body mechanics Safety Precautions Emergency and non-emergency moves Special equipment

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VideoLifting and Moving

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Emergency Response


Safety Precautions when Moving a Victim

Consider the following: The distance the victim must be moved Dangerous conditions at the scene The size of the victim Your physical ability Whether others can help you The victim’s condition Any aids to transport at the scene

TM 20Pg 92

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Emergency Response


Basic Guidelines for Moving a Victim

Only move a victim you can safely handle Bend at knees and hips Lift with your legs, not your back Take short steps Move forward when possible Look where you are walking Protect victim’s head, neck and back Communicate clearly and frequently with your partner, the

victim, and other EMS providers Tell the victim what is expected of them

TM 20Pg 92

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Emergency Response


Emergency Moves General Considerations

Only perform an Emergency Move when - the victim is in immediate danger access must be gained to another victim

with life-threatening conditions the victim must be moved to provide proper

care

Pg 92-93

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Emergency Response


MovesEmergency Moves

TM 21

Non-urgent MovesWalking AssistFire fighter’s carryPack-strap carryTwo-Person Seat CarryClothes DragBlanket DragShoulder DragFoot Drag

Direct liftExtremity liftDirect carryDraw sheet method

Pg 93-98

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Practice SessionWorkbook Pages 45-50

Walking Assist (One or Two Rescuers) Fire Fighter’s Carry Pack-Strap Carry Two-person Seat Carry Clothes Drag Direct Carry

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Emergency Response


As you approach a scene ...

CT 17

… have a plan in mind.

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Emergency Response


Scenario 1

TM 22

Emotional Aspects of Emergency Medical Care:Death of a Child

You are summoned to respond to a call for injuries from a fall. You arrive to find a child lying motionless on the ground. He has fallen from a third story window. Two women are standing by the fallen child. One woman rushes to you and starts to tell you it happened 10 minutes ago. The child’s mother is kneeling next to her child, crying and screaming. It appears the child is dead. As you try to get close to the child to perform an initial assessment, the mother refuses to let you near, screaming at you to stay away. How do you respond?

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Emergency Response


Scenario 2

TM 23

Unconscious Victim, Bleeding:Possible Crime Scene

A vehicle has struck a pedestrian. The victim is lying motionless in the street, bleeding from a wound on the thigh. Bystanders are surrounding the car, claiming the driver had started to drive away. The driver is still in the car. He is shouting out the window and looks extremely upset. How do you respond?

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Emergency Response


Scenario 3

TM 24

Conscious Victim:Dangerous Scene

You and another rescuer are searching for a missing hiker. At the bottom of a dry gully, you find the victim who has an injured leg resulting from a fall. He is in severe pain and unable to walk. The sides of the gully are very steep. You can see a rapidly approaching storm and realize that it is going to rain very shortly and the gully will flood. How do you respond?

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Emergency Response


Scenario 4

TM 25

Legal and Ethical Issues

You arrive at a scene where a man is lying on the sidewalk. He has one leg that appears to be bleeding, but not profusely. He is very pale, in pain and is breathing heavily. He is conscious and able to speak. When you approach him, he waves you off and yells at you to go away. When you explain who you are and that you are trained and want to help him, he says he doesn’t want any help. His friends will take care of him. How do you respond?

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Emergency Response


Chapter 7Assessment

Components of a scene size-up Initial Assessment

CABC Physical Exam SAMPLE history On-going assessment Common mechanisms of injury Taking vital signs

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Emergency Response


Assessment - Scene Size-Up Scene safety Mechanism of injury/nature of illness Number of victims Resources needed

TM 26Pg 106

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VideoPerforming an Initial Assessment

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Emergency Response


Assessment - Initial Assessment Form a general impression Assess level of consciousness Assess airway Assess breathing Assess circulation (pulse, severe bleeding,

and skin characteristics)

TM 27Pg 109-116

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Emergency Response


Levels of Consciousness - AVPU

TM 28

Level Characteristic Victim Behavior

Alert

Verbal

Painful

Unresponsive

Is able to respond to you

Only responds to verbal commandsOnly responds to a painful stimulusDoes not respond

Pg 110

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Emergency Response


Airway Assessment May need to position the head and neck to

open the airway Tongue can sometimes block the airway To open airway-

For illness use head-tilt/chin-lift For injury use jaw-thrust without head-tilt

(protects neck and back) Inspect for obvious obstructions

Pg 111

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Emergency Response


Breathing Assessment Look, listen and feel Determine rate and quality of breathing,

note any abnormal sounds of distress If not breathing provide rescue breathing

Pg 112

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Emergency Response


Circulation Assessment Check pulse rate and quality Check skin color, temperature and moisture Check for severe bleeding Record victim’s age, gender, chief

complaint, LOC and status of airway, breathing and circulation. Note the time.

Pg 113

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Emergency Response


Signs of Circulation Breathing Coughing Any type of body movement Pulse

Pg 113

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Circulation Assessment

CT 18Pg 114

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Other Indications of Circulation Skin Color – pale, ashen or flushed Skin Temperature – hot or cold Skin Moisture – moist or dry (Pale or bluish skin that feels cool and moist

indicates poor blood flow. Persons with darker skin will appear ashen.)

Capillary refill – normal or slow. Use for infants and children. Less than 2 seconds unless cold temperature.

Pg 114-116

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Emergency Response


VideoPerforming a Physical Exam and

SAMPLE History

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Emergency Response


Assessment - Physical Exam Gather information about problem Identify signs and symptoms Check victim from head to toe Look and palpate (feel) for signs of

injury - (DOTS)

TM 29Pg 116-119

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Deformity Open injuries Tenderness Swelling

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Emergency Response


Assessment - SAMPLE History

Signs and symptomsAllergiesMedicationsPertinent past historyLast oral intakeEvents leading up to injury or illness

TM 30Pg 120

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Emergency Response


Ongoing Assessment Repeat and record vital signs

-every 5 minutes for serious problem (unstable) -every 15 minutes for non-serious problem

Pg 120

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Emergency Response



Performing an Initial Assessment Performing a Physical Exam and SAMPLE

History

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When to Summon More Advanced Medical Personnel

Unconscious or altered LOC Breathing problems Persistent chest or abdominal pain or pressure No pulse Severe bleeding Vomiting or passing blood Suspected poisoning Seizures, severe headache or slurred speech Suspected or obvious injuries to head or spine Painful, swollen or deformed areas(when in doubt, summon the help)

Pg 121-122

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Emergency Response


VideoMeasuring Blood Pressure

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Emergency Response


Measuring Blood Pressure

TM 31

Systolic Pressure

Diastolic Pressure

Palpation

Auscultation

Reflects pressure in arteries when heart is working/contractingReflects pressure in arteries when heart is resting/refilling

Measures only the Systolic pressure by feeling for the radial pulse. Record as palpated (eg. BP120p). Announce as “BP <pressure> by palpation”Measures both Systolic and Diastolic pressures by listening for the pulse with a stethoscope. Record as <systolic>/<diastolic> (eg. BP 120/80). Announce as “BP <systolic> over <diastolic>”.

Pg 123-126

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VideoBlood Pressure Practice

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Emergency Response



Blood Pressure Measurement (Palpation) Blood Pressure Measurement

(Auscultation)

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Chapter 8Breathing Emergencies

The Breathing Process Respiratory Distress

Illness causing respiratory distress Respiratory Arrest Airway Obstruction

Anatomical Mechanical

Care for choking victims

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Emergency Response


Respiratory System Review


The body requires a constant supply of oxygen. Various illnesses and accidents can cause breathing emergencies.

Pg 136

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Emergency Response


AsthmaFacts Narrows air passagesTriggered by- Allergic reaction to pollen/food/a drug/insect

stings Emotional stress/physical activitySigns and symptoms Struggling to breathe Wheezing when exhaling

TM 32Pg 137

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Emergency Response


EmphysemaFacts Lungs lose ability to exchange carbon dioxide and

oxygen effectivelyCaused by- Smoking: usually develops over many yearsSigns and symptoms Shortness of breath Possible coughing, cyanosis, or high fever Advanced cases: Restlessness, confusion,

weakness

TM 33Pg 138

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Emergency Response


HyperventilationFacts Rapid breathing upsets body’s balance of oxygen and

carbon dioxideTriggered by- Fear/anxiety Injury to head/ severe bleeding/ illness Asthma ExerciseSigns and symptoms Shallow, rapid breathing Dizziness Numbness in fingers/toes

TM 34Pg 138

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Emergency Response


Anaphylaxis(Severe Allergic Reaction)

Facts Swelling of air passages restricts breathingTriggered by- Food/ insect stings/ a drugSigns and symptoms Skin rash Tightness in chest/throat Swelling of face/ neck/ tongue

TM 35Pg 138

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Emergency Response


Care for Respiratory Distress Have victim rest in comfortable position Keep victim from getting chilled or

overheated Reduce heat; add moisture If authorized, help victim take any

medications Summon more advanced medical personnel Monitor vital signs

TM 36Pg 139

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Emergency Response


Key Points of Respiratory Arrest Life threatening Commonly caused by illness, injury or

choking Often preceded by respiratory distress Body systems will progressively fail

TM 37Pg 139-140

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Emergency Response


Rescue Breathing Follow BSI precautions - use a barrier

Pg 140-141

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Emergency Response


Rescue Breathing Check LOC If unconscious, open the airway and check

for breathing If not breathing, give two breaths Check for signs of circulation If circulation is present, continue with

rescue breathing Check for circulation every minute

Pg 141

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Emergency Response


VideoFace Shields/Barriers

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Emergency Response


Rescue BreathingSpecial considerations

Vomiting Mouth-to-nose breathing Mouth-to-stoma breathing Victims with dentures Suspected injury to the spine

Pg 141-144

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Emergency Response


Airway ObstructionPartial Victim can still move air to and from lungs; can

cough, speak, breatheComplete Victim is unable to speak, breathe, cough; no air

movement

TM 40Pg 146-147

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Chapter 9Breathing Devices

Suctioning Airways

Oral Nasal

Barrier Shields Resuscitation Masks Oxygen (Enrichment section)

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Emergency Response


VideoSuctioning

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Emergency Response


Steps for Suctioning Turn head to side or roll body if head, neck,

or back injury suspected Open victim’s mouth Remove large pieces of matter Measure distance of insertion Insert suction device into back of mouth Suction for no more than 15 seconds at a

time

TM 41Pg 164

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Emergency Response


Practice SessionWorkbook Pages 101

Suctioning

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Emergency Response


VideoAirway Insertion

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Emergency Response


Airway Adjuncts Two types of airways: Oral(oropharyngeal)

and nasal (nasopharyngeal) Available in various sizes Oral airways are only used on unresponsive

victims Nasal airways may be used on victims who

are responsive but need assistance keeping the tongue from obstructing the airway

Pg 165-166

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Emergency Response


Inserting an Oral Airway Select airway of proper size Open victim’s mouth Insert airway with curved end along roof of

mouth Advance airway gently until resistance is

felt Rotate airway 1/2 turn Flange should rest on lips

TM 42Pg 166

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Emergency Response


Inserting an Oral Airway

CT 20

Insert and advance Rotate

Pg 167

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Emergency Response


Inserting a Nasal Airway Select airway of proper size Lubricate nasal airway Insert nasal airway into right nostril with

bevel toward middle of nose Advance airway gently, until flange rests on

nose

TM 43Pg 166

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Emergency Response


Inserting a Nasal Airway

Pg 168

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Emergency Response



Inserting an Oral Airway Inserting a Nasal Airway

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Emergency Response


VideoUsing a Resuscitation Mask

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Emergency Response


Criteria for a Resuscitation Mask Transparent, pliable One-way valve 15mm or 22mm coupling assembly Able to deliver supplemental oxygen Able to withstand extreme temperatures Easily assembled and used

TM 44Pg 168

American Red Cross


Emergency Response


Using a Resuscitation Mask Tilt head back Lift jaw Open mouth

TM 45Pg 169

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Emergency Response



Using a Resuscitation Mask

American Red Cross


Emergency Response


VideoOxygen Delivery

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Emergency Response


Supplemental Oxygen Delivery System Components

Oxygen cylinder Pressure regulator with flowmeter Delivery device

TM 46Pg 173-179

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Emergency Response


Oxygen Delivery Devices

TM 47

Common OxygenDevice Flow Rate Concentration Function

Nasal 1-4 lpm 24-36% Breathing victims onlycannula

Resuscitation 6+ lpm 35-55% Breathing andnonbreathing victims

Bag-valve- 10+ lpm 90+% Breathing andmask nonbreathing victims

Nonrebreather- 15 lpm 90+% Breathing victims onlymask

Pg 177

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Emergency Response


Precautions During Oxygen Delivery

Do not operate around flames/ sparks Do not stand cylinder upright Do not use grease/ oil/ petroleum products

to lubricate Check oxygen flow before placing delivery

device on victim

TM 48Pg 179

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Oxygen Delivery

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Chapter 10Cardiac Emergencies

Heart Attack Cardiac Arrest CPR for Adults Cardiac Emergencies in Infants and Children CPR in Infants and Children Two-Rescuer CPR Preventing Cardiovascular Disease AED s

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Emergency Response


The Heart Right atrium - receives

blood from body Left atrium - receives

blood from lungs Right ventricle - pumps

blood to lungs Left ventricle - pumps

blood to body

TM 49Pg 190

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Emergency Response


VideoRecognizing a Heart Attack

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Emergency Response


The Heart Attack Heart muscle does not get enough oxygen

through coronary arteries and dies Depending upon which heart muscle and

how much is affected, a heart attack may range from undetected to sudden cardiac death

Usually caused by Cardiovascular disease

Pg 192

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Emergency Response


Signs and Symptoms of Heart Attack

Persistent chest pain or discomfort Breathing difficulty Changes in pulse rate Pale, bluish, or moist skin Nausea, vomiting Sweating General ill appearance

TM 50Pg 192-193

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Emergency Response


Care for Heart Attack Stop victim’s activity Have victim rest in a comfortable position Summon more advanced medical personnel Be calm and reassuring Monitor breathing and pulse, look for

changes in victim’s appearance or behavior. Administer supplemental oxygen if it is

available and you are trained

TM 51Pg 194

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Emergency Response


Controllable Risk Factors forCardiovascular Disease

Smoking Diet high in fat High blood pressure Obesity Lack of regular exercise

TM 52Pg 209-211

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Emergency Response


Cardiac Arrest Cardiovascular disease is most common

cause but also caused by drowning, suffocation, drugs, injuries, loss of blood, electrocution or stroke

CPR will delay death Defibrillation might restart heart rhythm

Pg 209-211

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Emergency Response


Time Without Breathing Until Brain Damage Occurs

Pg 198

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Emergency Response


When to Stop CPR Another trained rescuer takes over You are too exhausted to continue Victim’s heart starts beating Scene becomes unsafe A defibrillator is available with trained user

present You are presented with a valid DNR order Advanced medical personnel order you to

discontinue

TM 53Pg 202

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Emergency Response


Ways to Prevent Cardiac Emergencies in Children

Prevent injuries leading to cardiac emergencies Proper medical care Recognize early signs of respiratory emergency

Agitation Drowsiness Change in skin color Increased difficulty breathing Increased heart and breathing rates

TM 54Pg 202

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Emergency Response


Special Resuscitation Situations Near drowning

Must seek follow-up care Electrocution

Insure personal safety Serious burns can occur along the entire path

from the entry to the exit sites. Identify both if possible.

Lightening strike Can cause severe burns and fractures, including

the spine.

From CPR-PR

American Red Cross


Emergency Response


Special Resuscitation Situations Traumatic injury

Survival rate is poor, transport ASAP. Always suspect head/neck injury

Hypothermia Pulse is hard to find, check for 45 seconds Transport ASAP Warm slowly, handle gently

From CPR-PR

American Red Cross


Emergency Response


Special Resuscitation Situations Difficult locations

Only move if unsafe or impractical to do CPR When transporting up or down stairs, perform

CPR for one minute on the landings, try not to interrupt CPR for more than 30 seconds

From CPR-PR

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Emergency Response



CT 17


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Emergency Response


Scenario 5

TM 55

Conscious Person,Difficulty Breathing

At work, you are summoned to assist a fellow worker who is ill. As you arrive, you notice the person lying on the ground, having obvious difficulty breathing. How do you respond?

American Red Cross


Emergency Response


Scenario 6

TM 56

Conscious Person,Breathing, with Severe Bleeding

While hiking, a man strays from the path in search of more challenging terrain. The man loses his footing on loose rocks and slides approximately 15 feet down the rocky slope. When you arrive, you notice that he is bleeding badly from a deep wound on the lower leg. You notice that he appears pale, cool, and is sweating. He tells you he is feeling dizzy, nauseated, and thirsty. How do you respond?

American Red Cross


Emergency Response


Scenario 7

TM 57

Unconscious Person,Breathing

A frantic neighbor is knocking at your door. She says that she cannot wake her sleeping roommate. She remembers that her roommate took some pills about two hours ago, but she is not sure what they were or where her roommate keeps them. You enter and see a woman lying face up on the couch, not moving. She has vomited. How do you respond?

American Red Cross


Emergency Response


Scenario 8

TM 58

Unconscious Person,Not Breathing, Has Pulse

It’s early morning, and you are the lifeguard at a local pool. The pool is almost deserted. Only two people were swimming, but now they are finished and have gone to the locker rooms. It is time to lock up the pool, and you proceed to the locker rooms. You are startled to see a body lying motionless on the damp floor next to a row of lockers. You recognize the older woman who had been swimming laps earlier. How do you respond?

American Red Cross


Emergency Response


Scenario 9

TM 59

Unconscious Person,Not Breathing, No Pulse

In the early morning, you respond to a call dispatched as a “heart attack.” You find an elderly man lying motionless on the floor. His wife tells you that he had been feeling ill for several hours and had vomited. She says that he emerged from the bathroom clutching his chest and in apparent pain, and suddenly collapsed on the floor. How do you respond?

American Red Cross


Emergency Response


Scenario 10

TM 60

Unconscious Person,Breathing, With Severe Bleeding

You witness a bicyclist struck by a car. The bicyclist is thrown from the bike, striking her head. The driver of the vehicle gets out to help. As you approach, you see the bicyclist lying on her side, twitching. Blood is spurting from her thigh onto the pavement. You want to help. How do you respond?

American Red Cross


Emergency Response


Chapter 11Bleeding and Shock

Blood and Blood Vessels When Bleeding Occurs

External Internal

Shock (Hypoperfusion)

American Red Cross


Emergency Response


Blood Components Plasma

Liquid. Carries nutrients and waste products White Blood Cells

Disease fighting component. Aids in producing antibodies needed to fight infection

Red Blood Cells Transport Oxygen and Carbon Dioxide

Platelets Essential to the clotting process

Pg 222

American Red Cross


Emergency Response


Major Functions of Blood Protects against disease Maintains constant body temperature Transports oxygen, nutrients and wastes

TM 61Pg 222

American Red Cross


Emergency Response


Blood Vessels Arteries -

Systemic Arteries carry oxygen-rich blood from the heart to the rest of the body

Pulmonary arteries carry oxygen-poor blood from the heart to the lungs

Capillaries - Deliver oxygen and nutrients and remove waste products from the cells

Veins - Systemic Veins carry waste products from the cells to the

heart Pulmonary Veins carry oxygen-rich blood from the lungs to

the heart for delivery to the body

Pg 222-223

American Red Cross


Emergency Response


When Bleeding Occurs Brain, Heart and Lungs attempt to compensate for

blood loss to maintain flow to vital organs Platelets collect to clot the blood, white blood

cells try to attack infections, body produces more red blood cells

Fluid is reabsorbed from the kidneys, lungs and intestines to maintain needed volume

Pg 223

American Red Cross


Emergency Response


Bleeding Bleeding may be internal or external. Whichever

the case, uncontrolled bleeding is a life-threatening emergency

Pg 223-229

American Red Cross


Emergency Response


Recognizing External Bleeding Visible blood Bleeding is serious when -

Blood is spurting from a wound Blood fails to clot after all measures have been taken

Arterial bleeding is bright red and oxygen rich. May spurt and be harder to control

Venous bleeding is dark and flows at a steady rate Capillary blood is dark red and “oozes”. Usually

clots spontaneously

Pg 223-226

American Red Cross


Emergency Response


Care for External Bleeding Direct pressure Elevation Pressure bandageIf necessary- Use pressure points Summon more advanced medical personnel

TM 62Pg 226-227

American Red Cross


Emergency Response


Practice Session

Bleeding control Direct pressure Elevation Pressure bandage Pressure points

American Red Cross


Emergency Response


Recognizing Internal Bleeding Discoloration of the skin Soft tissues are tender, swollen or firm Anxiety or restlessness Rapid, weak pulse Rapid breathing Skin feels cool or moist or looks pale, ashen or bluish Nausea and vomiting Excessive thirst Declining level of consciousness (LOC) Drop in blood pressure

Pg 228

American Red Cross


Emergency Response


Care for Internal BleedingIf minor injury- Apply ice or cold packIf serious injury Summon more advanced medical personnel Do no further harm Monitor ABCs and vital signs Have victim rest in a comfortable position Keep victim from getting chilled or over heated Reassure victim Provide care for other conditions Administer Oxygen if it is available and you are trained

to do so

TM 63Pg 229

American Red Cross


Emergency Response


When the Body is Healthy …Three conditions are necessary to maintain

adequate blood flow – The heart must be working well An adequate amount of blood must be

circulating in the body The blood vessels must be intact and able to

adjust blood flow

Pg 229

American Red Cross


Emergency Response


Shock The circulatory system fails to provide

oxygen-rich blood to all body parts Several types of shock - Anaphylactic,

Cardiogenic, Hemorrhagic, Metabolic, Neurogenic, Psychogenic, Respiratory, Septic

Three phases of shock - Compensated Decompensated Terminal

Care is the same in all cases

Pg 230-231

American Red Cross


Emergency Response


Shock

Pg 231

American Red Cross


Emergency Response


Signs and Symptoms of Shock Restlessness/irritability Rapid/weak pulse Rapid breathing Pale, ashen or bluish/cool/moist skin Excessive thirst Nausea and vomiting Drowsiness/loss of consciousness

TM 64Pg 232

American Red Cross


Emergency Response


Stages of Shock

American Red Cross


Emergency Response


Compensated Shock:

Pulse fast - Bounding Breathing rate increases Superficial blood vessels constrict Blood pressure maintained Increased diastolic Body sweats capillary refilling prolonged (2-4 seconds) Anxious

TM 65Pg 232

American Red Cross


Emergency Response


Decompensated Shock:• LOC deteriorates

• Tachycardia

• Tachypnea and shallow

• Decreased systolic pressure

• Decreased diastolic pressure

• weak and thready pulse

• Blue/pale skin

American Red Cross


Emergency Response


Terminal Shock:• Very low blood pressure

• dilation of peripheral blood vessels

• Unconscious

• death

American Red Cross


Emergency Response


American Red Cross


Emergency Response


Care for Shock Do no harm Monitor ABCs Help victim rest in a position of comfort Keep victim from getting chilled or

overheated Reassure the victim Provide care for specific conditions

Pg 232-233

American Red Cross


Emergency Response


Further Care for Shock Control any external bleeding as soon as

possible Elevate the legs about 12 inches if you do

not suspect head, neck or back injuries or injuries to the hips or legs

Administer Oxygen if available Give nothing to eat or drink Call advanced medical assistance

Pg 233

American Red Cross


Emergency Response


Chapter 12Specific Injuries

Soft Tissue Injuries Closed Open

Burns Chest Injuries Injuries to the Abdomen

American Red Cross


Emergency Response


VideoInjuries

American Red Cross


Emergency Response


The Structure of the SkinThe epidermis provides a barrier to bacteria and other organisms that can cause infections and helps regulate the body’s temperature

The dermis contains structures of the nerves, the sweat and oil glands and the blood vessels

CT 29Pg 238

American Red Cross


Emergency Response


Wounds Closed Open

Types Abrasion Laceration Avulsion Puncture Impaled Object Infection

TM 66Pg 239-243

American Red Cross


Emergency Response


Wounds Closed

CT 29Pg 239

American Red Cross


Emergency Response


Wounds Abrasion

CT 30Pg 240

American Red Cross


Emergency Response


Wounds Laceration

CT 30Pg 241

American Red Cross


Emergency Response


Wounds Avulsion

CT 31Pg 241

American Red Cross


Emergency Response


Wounds Puncture

CT 31Pg 242

American Red Cross


Emergency Response


Wounds Impaled Object

CT 31Pg 243

American Red Cross


Emergency Response


Wounds Infection

CT 32Pg 249

American Red Cross


Emergency Response


Dressings Dressings absorb blood and must be sterile.

Commonly 2” or 4” square Universal dressings cover very large

wounds Occlusive dressings do not allow air to pass

Pg 243

American Red Cross


Emergency Response


Bandages Wrap or cover any part of the body to hold

dressings in place Adhesive bandages are small pads of nonstick

gauze and a strip of adhesive tape Bandage compresses can be tied in place Roller bandages are self adhering and are used to

cover dressings Elastic bandage keeps pressure on a body part but

must be used with caution Triangular bandages are used as slings

Pg 244-246

American Red Cross


Emergency Response


Applying a Roller Bandage Elevate injured part Secure end of bandage Completely cover dressings Don’t cover fingers or toes Apply additional dressings if necessary

TM 70Pg 244

American Red Cross


Emergency Response


Care for closed injuries Direct pressure Elevation Cold

Do not apply ice directly to the skin

Pg 247

American Red Cross


Emergency Response


Care for severe open injuries Don’t waste time washing the wound Control the bleeding Control with direct pressure Summon more advanced medical care Use pressure points as necessary Wash hands after completing care

Pg 247-248

American Red Cross


Emergency Response


Pressure Point Location

Pg 227

American Red Cross


Emergency Response


VideoControlling External Bleeding

American Red Cross


Emergency Response


Types of Burns Depth

Superficial Partial-thickness Full-thickness

Source Thermal Chemical Electrical Radiation

TM 67Pg 249-250

American Red Cross


Emergency Response



Superficial Red and dry and usually painful Often cause swelling in the burn area Generally heal in a few days without scarring

CT 33Pg 250

American Red Cross


Emergency Response



Partial-thickness Red and wet and may have blisters that may open and weep

clear fluid Are usually painful Often cause swelling in the burn area Generally heal in 3-4 weeks May result in scarring

CT 34Pg 250-251

American Red Cross


Emergency Response



Full-thickness Appear brown or charred (black) with tissues underneath

sometimes appearing white May either be extremely painful or relatively painless if the

burn destroyed the nerve ending Take longer to heal Usually result in scarring

CT 35Pg 251-252

American Red Cross


Emergency Response


American Red Cross


Emergency Response


Critical Burns Burns causing breathing difficulty Burns covering more than one body part Burns on the head, neck, hands, feet or

genitals Any partial- or full-thickness burns to

children or the elderly Burns from chemicals, explosions or

electricity

TM 68Pg 252

American Red Cross


Emergency Response


The “Rule of Nines” Used to estimate the percentage of the body

affected by a burn Head = 9% Front of trunk = 18% Back of trunk = 18% Arm = 9% Leg = 18% Groin = 1%

Pg 253

American Red Cross


Emergency Response


Care for Burns Cool burned area with cool water Cover burned area with dry dressings Minimize shock by keeping victim from

getting chilled or overheated If caused by a chemical have the victim

remove any contaminated clothes If an eye is burned by a chemical flush the

eye for at least 20 minutes

TM 69Pg 252-255

American Red Cross


Emergency Response


Care for Electrical Burns Make sure the scene is safe Turn off electrical current before

approaching the victim During the physical exam, look for all entry

and exit wounds. All tissue between these areas may be affected

Pg 256

American Red Cross


Emergency Response


VideoBandaging

American Red Cross


Emergency Response



Care for a Major Open Wound (Forearm) Care for a Major Open Wound (Leg) Care for a Wound with an Embedded

Object

American Red Cross


Emergency Response


Signs and Symptomsof Chest Injury

Difficulty breathing Severe pain Obvious deformity Discoloration of skin Coughing up blood

TM 71Pg 258-259

American Red Cross


Emergency Response


Types of Chest Injuries Rib Fractures

Flail Chest

CT 36Pg 259

American Red Cross


Emergency Response


Types of Chest Injuries Puncture Injuries

CT 37Pg 260

American Red Cross


Emergency Response


Types of Chest Injuries Sucking Chest Wound

CT 38Pg 261

American Red Cross


Emergency Response


Care for Serious Chest Injury Summon more advanced medical personnel Position victim to aid breathing If ribs are broken, bind arm to injured side Cover sucking chest wound Administer oxygen Monitor breathing and pulse

TM 72Pg 259-260

American Red Cross


Emergency Response


Practice Session(Not in the workbook)

Chest Injury

American Red Cross


Emergency Response


Signs and Symptomsof Abdominal Injury

Nausea and vomiting Pale or ashen, moist skin Thirst Pain, tenderness or rigid abdomen Weakness Organs protruding from the abdomen

Pg 261-262

American Red Cross


Emergency Response


Abdominal Organs

CT 39

American Red Cross


Emergency Response


Care for Serious Abdominal InjuryOpen Wound

Do not put pressure on protruding organs or try to put them back inside

Position victim on back Remove clothing around wound Cover loosely with moist, clean dressing Cover dressing with plastic wrap Cover with folder towel to maintain warmth Administer oxygen

TM 73Pg 262

American Red Cross


Emergency Response


Closed Wound Position victim on back Bend knees slightly Administer oxygen if available Minimize shock Summon more advanced medical personnel

American Red Cross


Emergency Response


Signs and Symptomsof Pelvic Injury

Same as for abdominal injury with the addition of loss of sensation or movement in the legs, which sometimes occurs

Pg 261-264

American Red Cross


Emergency Response


Care for Serious Pelvic Injury Summon more advanced medical personnel Minimize movement Control bleeding Administer oxygen if available Minimize shock

TM 74Pg 261-264

American Red Cross


Emergency Response


Care for Open Wound to Genitalia

Cover with sterile dressing Control bleeding Do not put anything into the vagina

American Red Cross


Emergency Response


Embedded Objects Do not remove objects in the eye, ear or

nose Remove objects from the cheek Remove objects from the chest if it will

interfere with chest compressions

Pg 263

American Red Cross


Emergency Response


Amputations Wrap the part in a sterile dressing Wrap the dressing in plastic Pack in ice to cool, not freeze. Transport

with the victim.

Pg 263

American Red Cross


Emergency Response


Chapter 13Muscle and Bone Injuries

Musculoskeletal System Review Injuries to Bones and Joints Immobilization The Skeletal system Types of Musculoskeletal injuries Caring for specific injuries

American Red Cross


Emergency Response


Musculoskeletal System Review


Muscles attach to bones with tendons

Joints are held together by ligaments

Pg 277

American Red Cross


Emergency Response


Musculoskeletal System ReviewBones are different shapes and sizes

Pg 287

American Red Cross


Emergency Response


Musculoskeletal System ReviewBones can fracture or separate in various ways

Crack

Broken Through

Chip

Separation

Pg 289

American Red Cross


Emergency Response


Common Signs and Symptomsof Musculoskeletal Injury

Pain Swelling Deformity Discoloration Bone protruding from wound Inability to use affected part Grating bones Snapping or popping sound Cause of injury, such as fall from a height

TM 75Pg 278-279

American Red Cross


Emergency Response


VideoImmobilizing Muscle and Bone

Injuries

American Red Cross


Emergency Response


Care for Muscle and Bone Injury Rest Ice Elevation ImmobilizationOr Rest Ice Compression Elevation

TM 76Pg 280

American Red Cross


Emergency Response


Immobilization - Types of Splints Soft Rigid Anatomic Traction Air splints- precautions Vacuum

Pg 281

American Red Cross


Emergency Response


VideoSplinting

American Red Cross


Emergency Response


Emergency Care for Muscle and Bone Injuries -

Take BSI precautions Control life-threatening injuries Allow victim to rest in comfortable position Apply cold to reduce pain and swelling Support area above and below injury Cover open wounds with sterile dressing Do not reposition protruding bones

TM 77Pg 279-283

American Red Cross


Emergency Response


Types of Muscle and Bone Injuries

Fracture Dislocation Sprain Strain

Pg 288-289

American Red Cross


Emergency Response


Caring for Specific Injuries to Bones and Muscles

Upper Extremity injuries Shoulder -

The clavicle is the most frequently injured, typically from a fall

Great force is required to break the scapula. Suspect other injuries is this occurs

Splint in position. Use a pillow or rolled blanket to fill any gaps between the arm and chest

Pg 290-292

American Red Cross


Emergency Response



Upper Extremity injuries Upper Arm

the humerus is the longest bone in the arm and can be broken at any point

Injury may be very painful and may have considerable deformity

Control external bleeding and immobilize the upper arm from the shoulder to elbow

Sling and bind to the chest

Pg 295-296

American Red Cross


Emergency Response



Upper Extremity injuries Elbow

Injuries are made worse by movement Immobilize from the shoulder to the wrist in the

position found Splint and secure to the body If the elbow is bent, splint diagonally across the

inside of the arm

Pg 296

American Red Cross


Emergency Response



Upper Extremity injuries Forearm, Wrist and Hand

Apply a pressure bandage in a figure-eight Place a roll of gauze in the hand Put the arm in a sling and secure to the chest If fingers are broken, splint to an adjacent finger

Pg 297-299

American Red Cross


Emergency Response



Lower Extremity injuries Thigh

Many femur fractures involve the upper end of the bone and are called hip fractures

A leg with a broken femur may appear shorter than the other leg and be turned outward

Femur fractures can cause serious internal bleeding which may result in life-threatening shock. A traction splint may be used for mid-shaft fractures

Pg 299-302

American Red Cross


Emergency Response



Lower Extremity injuries Lower Leg

Open fractures are common. With some fractures of the fibula the victim may still be able to walk

Immobilize using a rigid splint or anatomical splint

Pg 299-302

American Red Cross


Emergency Response



Lower Extremity injuries Knee

Very vulnerable to injury. Sprains, fractures and dislocations are especially common with athletic injuries

Violent force may fracture the kneecap If the knee can be straightened, splint as with any

other leg injury. If bent, splint in the position found

Pg 303-304

American Red Cross


Emergency Response



Lower Extremity injuries Ankle and Foot injuries

It can be difficult to distinguish between minor and severe foot and ankle injuries. Treat as if they were serious

Victims of a fall may injure the foot or ankle as well as other parts of the body, such as the back. Do a full physical survey

Pg 304

American Red Cross


Emergency Response



Applying a Rigid Splint Applying a Sling and Binder Applying an Anatomic Splint Applying a Soft Splint Applying a Traction Splint

American Red Cross


Emergency Response


Chapter 14Head, Neck and Back Injuries

Recognizing Serious Head, Neck and Back Injuries

Injury Situations Care for these injuries Immobilizing the victim Preventing Head, Neck and back injuries

American Red Cross


Emergency Response


Head, Neck and Back Injury Although a small percentage of injuries

they account for over half of the fatalities Nearly 80,000 victims are permanently

disabled each year in the U.S. Prompt care can prevent some injuries from

becoming more serious Bleeding in the skull can occur rapidly or

slowly over a period of days

Pg 313

American Red Cross


Emergency Response


Head, Neck and Back Injury

Injuries to the skull can cause bleeding inside the skull or brain which can result in severe pain, headaches or changes in level of consciousness

Pg 313-314

American Red Cross


Emergency Response


Head, Neck and Back InjuryThe spine consists of individual vertebrae which protect the spinal cord while allowing flexibility. The disks are separated by compressible disks and individual nerves or nerve bundles exit between the vertebrae.

Pg 314-315

American Red Cross


Emergency Response


When to Suspect a Head, Neck or Back Injury

Any fall greater than victim’s height Any motor vehicle collision A person found unconscious for unknown reasons Any injury that penetrates the head or trunk A motor vehicle crash involving a driver or

passengers not wearing safety belts Any person thrown from a motor vehicle Any injury in which a victim’s helmet is broken

TM 78Pg 314

American Red Cross


Emergency Response


Signs and Symptoms of SeriousHead, Neck or Back Injuries

Change in level of consciousness Severe pain/pressure in head/neck/back Tingling/loss of sensation/movement in

extremities Unusual lumps/depression on head/spine Blood/fluids in the ears/nose…….

TM 79Pg 314-317

American Red Cross


Emergency Response


Profuse external bleeding of head/neck/back

Seizures Impaired breathing/vision Nausea/vomiting Persistent headache Loss of balance Bruising of head: around eyes/back of head

American Red Cross


Emergency Response


Assessing a victim with aHead, Neck or Back Injury

Responsive victim Ask about the mechanism of injury Ask the victim-

Does your head, neck or back hurt? What happened? Where does it hurt? Can you move your hands and feet? Can you feel me touching your fingers Can you feel me touching your toes?

Pg 317

American Red Cross


Emergency Response


Unresponsive victim Look for the mechanism of injury Maintain airway and breathing Stabilize the head, neck and back manually

in the position the victim is found

American Red Cross


Emergency Response


VideoImmobilizing Head, Neck

and Back Injuries

American Red Cross


Emergency Response


Care for Head, Neck and Back Injuries

Minimize Movement In-line stabilization unless contra-indicated

Maintain an open airway Complete physical assessment and on-going

assessment Control external bleeding Keep victim from getting chilled or

overheated

Pg 317-319

American Red Cross


Emergency Response


Additional Care for Head, Neck and Back Injuries

Head injury may include a concussion, which is a temporary impairment of the brain function

Never place pressure on the eyeball. For an embedded object, stabilize with a paper cup

For a nosebleed, pinch the nostril and have the person lean forward

For teeth knocked out, control the bleeding and save the teeth. They can be replanted

Pg 319-325

American Red Cross


Emergency Response



Bandaging an Eye with an Embedded Object

Pg 322

American Red Cross


Emergency Response


American Red Cross


Emergency Response


When Not to UseIn-line Stabilization

When victim’s head is severely angled When victim complains of pain, pressure or

muscle spasms on initial head movement When rescuer feels resistance when

attempting to move head

TM 80Pg 317

American Red Cross


Emergency Response


Specific Injuries Concussion Scalp Cheek Injury Nose Injury Eye Injury Ear Injury Mouth, Jaw and Neck Injury

Pg 319-324

American Red Cross


Emergency Response


Immobilizing the Victim Hold in-line stabilization Apply a cervical collar Secure the body to a backboard Secure the head (last!)

Note: Only remove helmets if they interfere with breathing or breathing assistance. ER will want helmet with the victim

Pg 326-328

American Red Cross


Emergency Response


Ways to Prevent Head, Neck and Back Injuries -

Wear safety belts Wear helmets and protective eyewear Safeguard against falls Take safety precautions in sports and recreation Avoid improper drug use Inspect equipment Think and talk safety

TM 81Pg 334-336

American Red Cross


Emergency Response



Immobilizing a Head, Neck or Back Injury

American Red Cross


Emergency Response


Chapter 15Medical and Behavioral Emergencies

Medical Emergencies Altered Mental Status Seizures Stroke Diabetic Emergency Heat and Cold Exposure

Behavioral Emergencies

American Red Cross


Emergency Response


General Signs and Symptomsof Medical Emergencies

American Red Cross


Emergency Response


General Signs and Symptomsof Medical Emergencies

Change in level of consciousness Headache/lightheaded/dizzy/weak Nausea/vomiting Change in breathing, pulse, or skin temperature, color or moisture

TM 82Pg 341-342

American Red Cross


Emergency Response


VideoMedical Emergencies

American Red Cross


Emergency Response


Altered Mental StatusCan Result From -

Fever Infection Poisoning, including substance abuse or misuse High or low blood sugar or insulin reactions Head injury Any condition that results in decreased blood flow

to the brain Conditions resulting from mental, emotional, or

behavioral disorders

TM 83Pg 341

American Red Cross


Emergency Response


Altered Mental Status A person who faints has experienced an altered

level of consciousness. The brain was deprived of its normal flow of blood

Fainting usually resolves itself when the blood flow is restored

Fainting by itself does not usually harm the victim but injury may occur from falling

Fainting does have an underlying cause that should be explored

Pg 341

American Red Cross


Emergency Response


Care for a Victim of an Altered Level of Consciousness Do initial assessment, physical exam,

and SAMPLE history as needed Elevate legs Do ongoing assessment Check airway; …….

TM 84Pg 342

American Red Cross


Emergency Response


put unconscious victims in recovery position

Loosen any restrictive clothing Do not give victim anything to eat Have suction equipment available Summon more advanced medical

personnel Reassure victim

American Red Cross


Emergency Response


Causes of Seizures Fever Infection Chronic medical conditions Poisoning Low blood sugar Head injury Any condition causing decreased Level Of

Consciousness (LOC) Pregnancy complications

TM 85Pg 342

American Red Cross


Emergency Response


Seizure Indications The chronic form of seizure is known as epilepsy Before a seizure, the victim may experience a

warning called an aura. This is an unusual sensation or feeling such as a visual hallucination; strange sound, taste or smell; or an urgent need to get to safety

Seizures may range from mild blackouts that appear to be daydreaming to sudden uncontrolled muscular contractions lasting several minutes

Pg 342-343

American Red Cross


Emergency Response


To Care for a Seizure Victim - Summon more advanced medical personnel Do not try to stop seizure or restrain victim Protect victim from injury Protect victim’s modesty Manage airway by rolling victim onto his or her

side Remove nearby objects and protect victim’s head Do not place anything between teeth When seizure is over, do physical exam and care

for any injuries found

TM 86Pg 343

American Red Cross


Emergency Response


For a Seizure Victim, Call if - The seizure lasts more than a few minutes The victim has repeated seizures The victim appears to be injured You are uncertain about the cause of the seizure The victim is pregnant The victim is a known diabetic The victim is an infant or child The seizure takes place in water The victim fails to regain consciousness after the

seizure

Pg 343

American Red Cross


Emergency Response


Those at Greatest Riskfor Heat-related Illness

Young children and the elderly Those involved in strenuous activity in a

hot environment Those with pre-existing health problems Those using illicit drugs or medications Those who have had a heat-related illness in

the past

TM 89Pg 343-346

American Red Cross


Emergency Response


Signs and Symptomsof Heat-related Illness

Headache Cool, moist, pale or ashen skin (early stages) Dry, red, hot skin (later stages) Nausea Exhaustion Progressive loss of consciousness Rapid, weak pulse (later stages) Rapid, shallow breathing (later stages) High body temperature (later stages)

TM 90Pg 347-348

American Red Cross


Emergency Response


Care for Heat Exposure Remove victim from hot environment Give small amounts of cool water to conscious

victim Have victim lie down in a cool or shady area

and elevate legs if possible Loosen or remove clothing Apply cool, wet towels or cold packs to wrists,

armpits, groin and legs Fan victim

TM 91Pg 348

American Red Cross


Emergency Response


Scenario 11

TM 92

Heat Emergency

You are involved with a fire-fighting training exercise involving a burning structure. It has been a really hot day, with temperatures in the 90s. You and others have been wearing you heavy turnout gear for hours. Suddenly, someone collapses. You notice that her skin is hot, flushed and wet. Her pulse is very fast. How do you respond?

American Red Cross


Emergency Response


Factors Affecting Normal Body Temperature

Air temperature Humidity Wind Clothing Intensity of activity Body’s ability to adapt (physical fitness

level)

TM 93Pg 348

American Red Cross


Emergency Response


Those at Greatest Risk for Cold Exposure

Young children and elderly Those without adequate equipment,

clothing or training for cold environment Those with health problems Those using illicit drugs, medications or

alcohol

TM 94Pg 345-346

American Red Cross


Emergency Response


Signs and Symptomsof Hypothermia

Cool skin Shivering Numbness Decreasing level of consciousness (LOC) Poor coordination Difficulty speaking Rigid posture

TM 95Pg 348-350

American Red Cross


Emergency Response


Care for Hypothermia Summon more advanced medical personnel Reassure victim Handle victim gently Remove victim from cold environment Have victim stop all activity and rest Remove wet clothing Place victim in dry blankets or clothing and wrap

in plastic if available Protect from any further heat loss

TM 96Pg 348-349

American Red Cross


Emergency Response


FrostbiteSuperficial frostbite Most common form of frostbite Skin is frozen, underlying tissues are not Involves loss of feeling and sensation Person feels tingling sensation when rewarmedDeep frostbite Skin is white and waxy Skin is firm when palpated Swelling and blisters may be present When rewarmed, skin appears red with areas of

purple and blue

TM 97Pg 349

American Red Cross


Emergency Response


Care for Localized Cold Injury Handle the affected area gently Remove wet clothing and any jewelry from the

affected area Cover the affected area with dry dressings and

bandage loosely Do not rub the area or break any blisters Do not re-expose the injury to cold Do not apply heat

Pg 349

American Red Cross


Emergency Response


To Prevent Overexposure Emergencies

Do not work in the hottest or coldest part of the day

Take frequent breaks Replenish body with food and fluids Reduce work intensity Wear clothing appropriate for task and

environment

TM 98Pg 350

American Red Cross


Emergency Response


Behavioral EmergenciesA behavioral emergency is a situation in which a

person exhibits abnormal behavior that is unacceptable or intolerable. Common causes for the behavior alteration include -

Pg 350-351

American Red Cross


Emergency Response


Situational stress Illness or injury resulting in lack of oxygen

or low blood sugar Substance abuse Mental illness, including crises involving

panic, agitation, self destructive behavior, and/or violence.

American Red Cross


Emergency Response


Actions Indicating a Behavioral Emergency

Threatening posture Possessing a weapon(s) Threatening harm to others or self Being verbally abusive Speaking in a nonsensical manner Withdrawing deeply Hallucinating

TM 99Pg 351

American Red Cross


Emergency Response


To Calm a Victim of a Behavioral Emergency -

Assume non-threatening posture Acknowledge that victim appears upset Get in front of victim and at eye level Avoid unnecessary contact Do not threaten, challenge or argue with victim Involve others that victim trusts Encourage victim to discuss whatever is troubling

him/her

TM 100Pg 351-352

American Red Cross


Emergency Response


Diabetic Emergencies

Too much Sugar Too much Insulin

Pg 354-359

American Red Cross


Emergency Response


Hyperglycemia Too much sugar and too little insulin in the

blood stream Without insulin the body cells can not

convert the available sugar into energy Without sugar the body breaks down other

food sources The result can be a diabetic coma

Pg 354-359

American Red Cross


Emergency Response


Causes of Hyperglycemia• Eating too much food relative to the amount

of insulin injected • Missing an insulin injection • Blockage in insulin pump tubing • Disconnected insulin pump infusion set • Illness or stress hyperglycemia caused by insufficient insulin

can lead to diabetic ketoacidosis.

American Red Cross


Emergency Response


Symptoms of Hyperglycemia

• Frequent urination

• Frequent thirst

• Blurry vision

• Dry mouth

• Fatigue

American Red Cross


Emergency Response


Hypoglycemia Adequate insulin Too little sugar Sugar is used rapidly Also called insulin reaction

TM 87Pg 355

American Red Cross


Emergency Response


Signs and Symptoms of Diabetic Emergencies

Change in level of consciousness (LOC) Rapid breathing and pulse Feeling and looking ill

TM 88Pg 359

American Red Cross


Emergency Response


Signs and Symptoms of Hyperglycemia

• Frequent urination

• Frequent thirst

• Blurry vision

• Dry mouth

• Fatigue

American Red Cross


Emergency Response


Signs and Symptoms of Hypoglycemia

• Grouchiness

• Shakiness

• Sweating

• Fast heart rate

• Pale skin

• Dizziness

• Yawning….

American Red Cross


Emergency Response


• Confusion

• Poor coordination

• Inability to cooperate

• Slurred speech

Severe

• Unconsciousness

• Convulsions …

American Red Cross


Emergency Response


Care for Diabetic Emergencies

If conscious, ask victim about medical conditions

Do a SAMPLE history. (Important to know when medication and food were last taken)

If conscious and able to swallow, give sugar in some liquid form

If no improvement in 5 minutes, summon advanced medical personnel

Pg 359

American Red Cross


Emergency Response


For Hyperglycemia

• Drink lots of water

American Red Cross


Emergency Response


EnrichmentStroke

Called a Cerebrovascular Accident (CVA) Caused by a disruption of blood flow to a

part of the brain Can be caused by a blood clot lodging in an

artery or a ruptured artery A Transient Ischemic Attack (TIA) is a

short-term stroke

Pg 359-360

American Red Cross


Emergency Response


EnrichmentStroke

Pg 360

American Red Cross


Emergency Response


EnrichmentSigns and Symptoms of a Stroke Ill appearance Changes in LOC Sudden weakness and numbness in face,

arm or leg, usually on one side Difficulty speaking or understanding speech Pupils of unequal size, blurred vision Headache, confusion, change in mood

Pg 360

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Emergency Response


EnrichmentCare for a Stroke Victim

Care for life-threatening conditions Summon advanced medical help Comfort and reassure victim Administer Oxygen if available Nothing to eat or drink Prompt medical attention is critical Do NOT give aspirin

Pg 360-362

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Emergency Response


Chapter 16Poisoning

How Poisons Enter the Body Care for Poisoning

Inhaled Poisons Ingested Poisons Absorbed Poisons Injected Poisons

Anaphylaxis Substance Abuse

American Red Cross


Emergency Response


How Poisons Enter the Body

TM 101

Ingestion

Injection

Inhalation

Absorption

Pg 367

American Red Cross


Emergency Response


Clues of Poisoning Odors Flames or smoke Containers that are open or out of place Plants partially eaten or disturbed

TM 102Pg 367

American Red Cross


Emergency Response


Signs and Symptomsof Poisoning

Nausea or vomiting Chest or abdominal pain Breathing difficulty Altered consciousness Seizures Burns sometimes found on or around the

mouth

Pg 368

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Emergency Response


Poisoning Severity The type and amount of poison How and when it entered the body Victim’s size, weight and age

TM 103Pg 369

American Red Cross


Emergency Response


General Principle forPoisoning Emergencies

Conduct scene size-up Remove victim from source of poison Conduct initial assessment Conduct physical exam and SAMPLE history Summon more advanced medical personnel Contact PCC (as per local protocols) 1-800-222-1222 Do not give anything to eat or drink

TM 104Pg 369

American Red Cross


Emergency Response


When NOT to Induce Vomitingfor Ingested Poisons

Victim is unconscious Victim is having a seizure Victim is pregnant Victim has ingested corrosive substance or

petroleum product Victim is known to have heart disease

TM 105Pg 371-372

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Emergency Response


Care forInhaled Poisons

Conduct scene size-up, toxic fumes may be colorless, odorless and tasteless.

Remove victim from source of poison if possible

Administer Oxygen Care for life-threatening conditions Call for advanced medical personnel

Pg 370-371

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Emergency Response


Care forAbsorbed Poisons

Brush off dry chemicals using gloved hand or cloth. Keep out of eyes and eyes of victim and bystanders

Flush area with large amounts of cool running water, remove jewelry if necessary

Summon advanced medical personnel

Pg 372-374

American Red Cross


Emergency Response


Care forInjected Poisons

Remove stinger, scrape it away with a card or knife

Wash the site, cover it and apply cold to reduce the pain and swelling

Monitor for anaphylaxis Specific care depends on source. Know the

local risks

Pg 374

American Red Cross


Emergency Response


Care forTick bites

Rocky Mountain spotted fever is a serious tick-borne disease. Another is Lyme disease

Deer ticks are difficult to see. They can attach themselves without your knowledge

If you find an embedded tick, pull it off with a fine-tipped tweezers and seek treatment

Pg 374-378

American Red Cross


Emergency Response


Deer Tick

American Red Cross


Emergency Response


Female deer tick with dime for size comparison.

American Red Cross


Emergency Response


Care forSpider and Scorpion bites

In the United States the two spiders to be careful of are the Black Widow and the Brown Recluse

Spiders prefer dark places where they are seldom disturbed. Bites occur usually on the hands or arms

Antivenin is available for the black widow. Those bit by the Brown Recluse should seek medical treatment

Pg 378-380

American Red Cross


Emergency Response


Black Widow

American Red Cross


Emergency Response


Brown Recluse

American Red Cross


Emergency Response


Guidelines forInitial Snakebite Care

Take victim to medical care immediately Wash wound if possible Immobilize affected part Minimize victim’s movement Keep affected part lower than heart Summon more advanced medical personnel Consider using a commercial suction kit if advanced

medical care is more than 30 minutes away.

TM 106Pg 380-381

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Emergency Response


Guidelines forInitial Snakebite Care

DO NOT apply ice DO NOT cut the wound DO NOT apply a tourniquet DO NOT use electric shock

Pg 380-381

American Red Cross


Emergency Response


Guidelines forMarine Life Injuries

Some marine life such as jellyfish can inflict painful injuries Care for injuries from jellyfish, sea anemone and Portuguese

man-of-war by soaking the injured part in vinegar. If the sting was from a sting ray, sea urchin or spiny fish soak

the affected area for 30 minutes in non-scalding hot water Summon advanced medical personnel if the victim has a

history of allergic reactions to marine life stings, is stung on the face or neck or develops any severe problems such as difficulty breathing.

Pg 381

American Red Cross


Emergency Response


Guidelines forAnimal Bites

The most serious result is from a wild animal with rabies Rabies is fatal if not treated. Anyone bitten must get

medical attention Get the victim away from the animal safely Get a description of the animal and the area in which it

was last seen. Do not try to restrain or capture the animal For minor wounds, wash with soap and water. For serious

bleeding control the bleeding and summon more advanced medical personnel

Local laws may require a report to be filed

Pg 382

American Red Cross


Emergency Response


Human Bites May be highly contaminated with bacteria Require professional medical care

immediately Need to be washed with soap and water Can bleed if severe; control severe bleeding

TM 107Pg 383

American Red Cross


Emergency Response


Substance Abuse Can be intentional or unintentional Drug use can lead to dependency and

addiction Unavailability can lead to withdrawal Drugs can be stimulants, Hallucinogens,

Depressants, Narcotics, Inhalants, Cannabis products, steroids or OTC (Over The Counter) medications

TM 108Pg 384-388

American Red Cross


Emergency Response


Stimulants Stimulants affect the central nervous system

by increasing physical and mental activity They produce temporary feelings of

alertness and prevent fatigue Stimulants can be ingested as pills, but

some can be absorbed or inhaled Cocaine and Crack are the most publicized

and powerful stimulants

Pg 388

American Red Cross


Emergency Response


Hallucinogens Hallucinogens have physical effects similar

to stimulants. They are classified differently because of the other mind-altering effects including - Panic, paranoid delusions, vivid hallucinations,

profound depression, tension and anxiety The most widely used are LSD,

mushrooms, PCP and mescaline, ecstasyketamine

Pg 389

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Emergency Response


Depressants Depressants decrease physical and mental activity

and are commonly used for medical purposes Common depressants are alcohol, barbiturates,

benzodiazepines, narcotics and inhalants Depressants will -

Relieve anxiety Alter consciousness Promote sleep Depress respiration Relieve pain Relax muscles Impair coordination and judgement

Pg 390

American Red Cross


Emergency Response


Narcotics Narcotics work on the central nervous

system to reduce pain. All are illegal without a prescription. Some are not prescribed at all.

The some are morphine, opium, heroin and codeine. Others, like demerol and percodan are synthetic

Pg 390

American Red Cross


Emergency Response


Inhalants Produce mood-altering effects and depress

the central nervous system. Inhalants will damage the heart, lungs,

brain and liver Solvents such as acetone, toluene and

butane may be inhaled for their effects The user will appear drunk

Pg 391

American Red Cross


Emergency Response


Cannabis Products Products include marijuana, THC and

hashish Marijuana is the most widely used illicit

drug in the United States Cannabis products produce feelings of

elation, distorted perceptions of time and space and impaired judgement and motor coordination

Pg 391

American Red Cross


Emergency Response


Designer Drugs Variations of other substances, designer

drugs do not fit neatly into any of the other categories

A user will experience a variety of unpredictable and dangerous effects. Signs and symptoms range from stimulant-like effects to hallucinogenic effects and erratic mood swings

Pg 391

American Red Cross


Emergency Response


Signs and Symptomsof Substance Abuse

Stimulants - Sweating, chills, nausea, vomiting, fever, headache, dizziness, rapid pulse, rapid breathing, high blood pressure, chest pain, respiratory distress, disruption of normal heart rhythms

Hallucinogens - Sudden mood changes, claiming to see or hear things not present, acting anxious or frightened

Depressants - Drowsiness, confusion, slurred speech, slow heart and breathing rates, poor coordination

Alcohol - Unconscious, hard to arouse, vomiting violently, confused, restless, trembling and experiencing hallucinations.

Pg 394

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Emergency Response


Care for SubstanceMisuse and Abuse

Your initial care does not require you to know the substance

Care as you would for poisoning.

TM 109Pg 396

American Red Cross


Emergency Response


Preventing Substance AbuseContributing factors include – A lack of parental supervision The breakdown of the traditional family structure A wish to escape unpleasant surroundings and stressful

situations The widespread availability of substances Peer pressure and the basic need to belong Low self-esteem, including feelings of guilt or shame Media glamorization, especially of alcohol and tobacco,

promoting the idea that using substances enhances fun and popularity

A history of substance abuse in the home or community environments

Pg 396

American Red Cross


Emergency Response


Preventing Substance Misuse Read the product information and use only as

directed Ask doctor or pharmacist about the intended use

and side effects of prescription and over-the-counter medications. If taking more than one medication ask about possible interactions.

Never use another person’s prescribed medications Always keep medications in their appropriate,

marked containers Discard all out-of-date medications. Keep medications out of reach of children

Pg 397

American Red Cross


Emergency Response


Scenario 12

TM 110

Substance Abuse

A 25-year-old woman has several drinks at a party. She later says that she feels dizzy and nauseated. She goes into another room. Soon after, someone enters shouting that the woman has collapsed to the floor and is unconscious. Among the object scattered on the floor from her open purse are several containers of pills. One is marked “Valium.” How would you help the woman? In terms of providing initial care, does it matter that she may have become unconscious because of substance abuse or misuse?

American Red Cross


Emergency Response


Signs and Symptomsof Anaphylaxis

Hives Itching Rash Weakness Nausea/vomiting Dizziness Trouble breathing

TM 111Pg 383-384

American Red Cross


Emergency Response


Care for Anaphylaxis Summon more advanced medical personnel

immediately Position victim in the most comfortable

position that aids breathing Administer supplemental oxygen Have victim use anaphylaxis kit if one is

available

TM 112Pg 384

American Red Cross


Emergency Response



CT 17


American Red Cross


Emergency Response


Scenario 13

TM 113

Conscious PersonSerious Head and Back Injury

At work, you are summoned to assist another employee who has been injured in a nine-foot fall from a ladder. As you arrive, you see the person lying on the ground. She is trembling and moaning in pain. A bystander says that she landed on her back. The victim has not moved from this position. She says that she has tingling and numbness in her lower legs and feet and pain in her back. She also has a two-inch laceration on the side of her head. How do you respond?

American Red Cross


Emergency Response


Scenario 14

TM 114

Serious Extremity Injury

You are summoned to the scene of a collision between a bicyclist and skateboarder. Both were thrown to the pavement. Both were wearing helmets and other protective padding and both are conscious and in pain. The skateboarder was struck on the outside of his leg by the bike. The leg is bent, and his knee has an obvious deformity. The bicyclist was thrown over the handle bars, landing on her arms. She is bleeding from abrasions on both forearms and her wrist has an obvious deformity. How do you respond?

American Red Cross


Emergency Response


Scenario 15

TM 115

Conscious VictimLimb Injury

You are a spectator at your child’s Little League baseball game. The pitcher is struck with a line drive to the forearm and falls to the ground. The victim is crying and in pain, unable to move the limb. Swelling and deformity are present. The nearest hospital is only a few blocks away. The player’s parents are not at the game. How do you respond?

American Red Cross


Emergency Response


Scenario 16

TM 116

Medical Emergency

An elderly woman loses her balance and collapses to the floor in a supermarket. When you arrive, she is not fully conscious. Her eyes are open and the left side of her face appears to be drooping. She is making mumbling sounds but you can not tell what she is saying. She has also vomited. How do you respond?

American Red Cross


Emergency Response


Scenario 17

TM 117

Substance AbuseA dangerous ritual is about to begin - 21 drinks for the 21st birthday. A group of close friends has gathered for a special party for the “birthday boy.” Everyone knows it is a dangerous game, but because each of these friends when through it, they believe it is a rite of passage into adulthood. The activities begin and the guest of honor is soon “chugging beers” and downing shots of liquor at a rapid pace. Four hours after the drinking began you are summoned to assist the guest of honor who is vomiting violently in the bathroom. He slumps to the floor and begins violent convulsions, followed by unconsciousness. He seems to stop breathing and then takes a deep breath. How do you respond?

American Red Cross


Emergency Response


Scenario 18

TM 118

Hypothermia

You have been involved in a search for a lost six-year-old child. The search is now into its third day. The child became lost when he wandered away from his mountain campsite. He has already spent two nights in the wilderness in cold, rainy weather. When the child is discovered, he is disoriented. His clothing is wet. His face and hands are cold to the touch. He is shivering. How do you respond?

American Red Cross


Emergency Response


Chapter 17Childbirth

The Birth Process Preparing for Delivery Assisting with Delivery Caring for the Newborn and Mother Possible Complications

American Red Cross


Emergency Response


The Labor Process

TM 119

Stage One - Woman’s body prepares for childbirthPreparation Time period: From first contraction until

uterus is fully dilatedStage Two - Crowning occursDelivery of Delivery of the babythe BabyStage Three - Occurs within 30 minutes after birthDelivery of Placenta separates from the uterine wallthe Placenta and exits through the vaginaStage Four - Recovery and stabilization of motherStabilization Lasts approximately 1 hour

Uterus contracts to control bleeding

Pg 403-404

American Red Cross


Emergency Response


Assessing Labor First pregnancy? Amniotic sac ruptured? Contraction?

Are they close together? Are they strong?

Blood discharge? Urge to bear down?

TM 120Pg 404

American Red Cross


Emergency Response


Preparing for Delivery Use complete BSI protection Provide as sanitary an environment as

possible Reassure the mother STAY CALM

Pg 404

American Red Cross


Emergency Response


Assisting with Delivery Time the contractions. If less than 3

minutes apart, be prepared to help with delivery of the baby

Have bulb syringe, gauze pads and plastic bag available

Support the head, allow to emerge slowly Use a towel to catch the baby. If possible

note the time

Pg 405

American Red Cross


Emergency Response


Assisting with Delivery

American Red Cross


Emergency Response


Caring for the Newborn Open the airway Stimulate the baby if crying does not occur Keep infant warm Record first set of vital signs Evaluate the following a 1 and 5 minutes after

birth - Appearance Pulse Grimace (response to stimuli) Activity and muscle tone (not floppy or limp) Respirations

Pg 407-409

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Emergency Response


0 1 2 A ppearance Blue/Pale Body pink, hands blue Pink P ulse Absent Below 100 Above 100 G rimace None Grimace Cough, sneeze, cry A ctivity Flaccid Some Active motion R espiration Absent Weak, slow Good, crying

Assess APGAR Score at 1 and 5 minutes after birth

American Red Cross


Emergency Response


Caring for the Mother Allow mother to nurse newborn Prepare for delivery of the placenta within

30 minutes. Place in a bag or wrap in a towel for transport to the hospital

Gently clean the mother Gently massage the lower abdomen Monitor vital signs and maintain body

temperature

Pg 407-409

American Red Cross


Emergency Response


Scenario 19

TM 121

Childbirth

A car pulls into the firehouse. The driver jumps out screaming for help for his wife who is in the back seat. The woman is 35 years old and full term in her pregnancy. Her contractions are less than 2 minutes apart. She says that “the baby is coming” and she feels the need to push. Her husband tells you this will be their fourth child. How do you respond?

American Red Cross


Emergency Response


Practice Session

Childbirth

American Red Cross


Emergency Response


Possible complications Prolapsed cord

Do not allow cord to wrap around infants neck

Pg 410

American Red Cross


Emergency Response


American Red Cross


Emergency Response


Possible complications Breech birth

Be prepared to provide airway

Pg 411

American Red Cross


Emergency Response


If baby is delivering:– Do not hurry or slow delivery– Suction infant with bulb syringe (mouth,

then nose) as soon as head is delivered– If cord wrapped around neck, attempt to

unwrap the cord. If unsuccessful, double clamp and cut the cord at least 4” from baby between clamps

American Red Cross


Emergency Response


Chapter 18Infants and Children

Communicating with children Anatomical and Physiological concerns Common problems Child abuse awareness

American Red Cross


Emergency Response


Steps to Gain a Child’s Trust Approach child slowly Get to eye level Smile Ask the child’s name Talk slowly and distinctly using words the

child understands Ask simple, clear questions Reassure child

TM 122Pg 414

American Red Cross


Emergency Response


Steps to Gain a Child’s Trust Infants less than 6 months old are fairly easy to approach Infants over 6 months show “stranger anxiety”. Conduct the

assessment in the caregivers arms or lap Toddlers between 1-2 need reassurance that they will not be

separated from a parent or caregiver Preschool between 3-5 need assurance that the first responder

will not leave them. Let them inspect equipment and demonstrate on a doll or stuffed animal

School-aged children are self-conscious about their bodies. Respect their modesty

Adolescents between 13-18 behave much like adults and are more comfortable with same gender rescuers. Earn their trust by speaking to them and not the parents or caregivers

Pg 414

American Red Cross


Emergency Response


Anatomical and Physiological Concerns

Infant and children have smaller airways than adults. Airways are easily blocked by secretions and swelling.

Infant’s and children’s tongues are large in relation to the jaw and can block the airway

Infants normally breathe through the nose so suctioning nasal secretions can improve problems

Injured or ill infants or children are at risk for generalized cold exposure

Pg 415-417

American Red Cross


Emergency Response


Maintaining an Airway with Children

Do not hyper-extend the head and neck to open the airway

Placing a folded towel under the shoulders will help to maintain good airway position

During suctioning, take care not to stimulate the back of the throat and activate the gag reflex

Oral airway adjuncts are not used for initial ventilation efforts. Nasal airways are not commonly used by first responders

Pg 416

American Red Cross


Emergency Response


Maintaining an Airway with Children

American Red Cross


Emergency Response


Child and Infant Assessment When you have an injured child or infant,

you have an injured family Calm the family and obtain consent Observe the child before touching. Look

for signs of life-threatening problems Whenever possible, do not separate the

child from the parent or caregiver Begin at the toes and work up

Pg 417-418

American Red Cross


Emergency Response


Signs of Partial Airway Obstruction in Infants or Children

Stridor Retraction on breathing in Good circulation causing skin to become

very pink

TM 123Pg 418

American Red Cross


Emergency Response


Signs of Complete Airway Obstruction in Infants or Children

Inability to cough, cry or speak Cyanosis Loss of consciousness Altered mental status

Pg 419

American Red Cross


Emergency Response


Signs of Respiratory Distress in Infants or Children

Infants: respiratory rate > 60 per minute Children: respiratory rate > 30/40 per minute Nasal flaring Use of neck muscles and muscles between and

below margin of the ribs to aid breathing Stridor Cyanosis Altered mental status Grunting

TM 124Pg 419

American Red Cross


Emergency Response


Signs of Respiratory Arrest in Infants or Children

Infants: respiratory rate <10 per minute Children: respiratory rate <20 per minute Limp muscle tone Unresponsiveness Slow or absent heart beat Weak or absent distal pulses Cyanosis

Pg 419

American Red Cross


Emergency Response


Other Common Problems withInfants and Children

Circulatory Failure Indicated by increased heart rate, unequal central and distal pulses,

poor skin circulation (slow capillary refill) and mental status change Illness Fever - may develop into febrile seizure Poisoning Altered Mental Status

May be caused by low blood sugar, poisoning, post seizure, infection, head trauma or decreased oxygen levels

Sudden Infant Death Syndrome (SIDS)

Pg 419

American Red Cross


Emergency Response


Signs and Symptoms of Febrile Seizure

Sudden rise in body temperature Change in level of consciousness Rhythmic jerking of head and limbs Confusion Drowsiness Crying out Becoming rigid Holding breath Upward rolling of eyes

TM 125Pg 419

American Red Cross


Emergency Response


Trauma in Children Injuries are the #1 cause of child death in

the United States. Many are from motor vehicle accidents

Use equipment of the proper size Do not move an injured child from a safety

seat unless you must to provide further care

Pg 420-422

American Red Cross


Emergency Response


Trauma in Children The head is often injured, as is the chest

cavity or abdominal cavity The most important objective is to ensure

an open airway Children have pliable ribs. There may be

significant injuries without external signs Abdominal injuries often are not obvious

Large amounts of blood may distend the abdomen and not be visible

Pg 420-422

American Red Cross


Emergency Response


Signs of Child Abuse Injury that does not fit description of cause Cigarette burns, whip marks or hand prints Fractures in children less than 2 years old Injuries in various stages of healing, especially

bruises and burns Unexplained lacerations, especially to mouth, lips

and eyes Injuries to genitalia More injuries than are typical for child of same age Repeated calls to same address

TM 126Pg 422-423

American Red Cross


Emergency Response


Signs and Symptoms of Neglect Lack of adult supervision Malnourished appearance Unsafe living conditions Untreated chronic illness Untreated soft tissue injuries

TM 127Pg 423

American Red Cross


Emergency Response


Responder Debriefing Even when uneventful, calls involving

infants and children are some of the more stress producing situations for first responders

Care for infants and children with the same principles as with adults but keep in mind the differences in developmental characteristics and anatomy

Pg 423

American Red Cross


Emergency Response



CT 17


American Red Cross


Emergency Response


Scenario 20

TM 128

Preparing for Childbirth

You are called to respond to a pregnant woman who is in labor. During your assessment you find that this is the mother’s third pregnancy and her contractions are 2 minutes apart. The baby’s head is not yet crowning, but the mother feels the urge to move her bowels. How do you respond?

American Red Cross


Emergency Response


Scenario 21

TM 129

Delivering the Baby

After you have prepared the mother and yourself for the imminent delivery of the baby, the mother tells you that she feels an urge to push. When you inspect the vaginal area, you note that the baby’s head is crowning. What should you do next?

American Red Cross


Emergency Response


Scenario 22

TM 130

Care of the Newborn

You are called to the scene of a mother who is in active labor. As you arrive on scene, the baby has just emerged from the birth canal. What steps would you take to care for the newborn?

American Red Cross


Emergency Response


Scenario 23

TM 131

Post Delivery Care of the Mother

After you have assisted with the unscheduled delivery of a newborn and ensured that the baby’s condition is normal, list the steps in the post delivery care of the mother

American Red Cross


Emergency Response


Scenario 24

TM 132

Assessment of the Child

On your way home from work, you approach your neighborhood and see a group of people gathered in the playground. As you approach the scene you hear someone say that a child fell off the jungle gym, a height of approximately 10 feet. As you get closer, you see a child of 8 years old lying on the ground, crying and you notice blood coming from a laceration on his forehead. Demonstrate how to assess the child.

American Red Cross


Emergency Response


Chapter 19EMS Support and Operations

Phases of a Response Air-Medical Considerations Multiple Casualty Incidents

Incident Command Structure Triage

Fundamentals of Rescue Operations Hazardous Materials Water Rescues

American Red Cross


Emergency Response


The EMS Response Preparation for emergency call Dispatch En route to scene Arrival at scene Transferring victim to ambulance En route to receiving facility Arrival at receiving facility En route to station Post run

TM 133Pg 428-431

American Red Cross


Emergency Response


Air Medical Considerations First responders may have to assist with air

medical transport Considerations

Victim preparation Landing zone Safety

TM 134Pg 431

American Red Cross


Emergency Response


Multiple Casualty Incidents Some emergency situations may overwhelm

local responding groups The Incident Command System approaches an

emergency in an organized manner Triage is the process of sorting victims

according to how ill or injured they are The START system is an often used triage

method. The letters stand for Simple Triage And Rapid Treatment

Pg 431-433

American Red Cross


Emergency Response


S.T.A.R.T.

Simple Triage And Rapid Treatment

American Red Cross


Emergency Response


Incident Command System (ICS) The ICS manages a group of people to

achieve a common goal ICS clearly defines who is in charge, the

scope of authority and responsibility, the goal and objectives to meet the goal

Pg 433

American Red Cross


Emergency Response


Advantages of ICS Use of common terms One big “boss” – Incident Commander Unified command structure Integrated communications system Small, easily managed units

TM 135Pg 433

American Red Cross


Emergency Response


ICS Incident Commander -

Directs the response Appoints chiefs

Operations Section Officer - Puts together plan Coordinates actions of other leaders

Planning Section Officer - Gather/analyzes information/resources Provides updates

Logistics Section Officer - Finds resources Establishes communications Coordinates crowd control Evaluates scene if necessary

TM 136Pg 434-435

American Red Cross


Emergency Response


The START System Injured are rapidly prioritized to receive

adequate care Save more lives by sacrificing some victims

who are very severely injured Classify victims as -

Immediate treatment - Red Tag Delay Care - YellowYellow Tag Minor - Green Tag Dead or non-salvageable - Black Tag

Pg 436

American Red Cross


Emergency Response


The START System

CT 58Pg 437

American Red Cross


Emergency Response


Fundamentals of Extrication First responders administer necessary care to

minimize further injury Care precedes extrication unless delayed

movement would endanger the victim or rescuer

Personal safety is the #1 priority. Wear appropriate clothing and safety equipment.

Pg 438-439

American Red Cross


Emergency Response


Gaining Access to VictimSimple Access No equipment needed Try to open each door Have victim roll down the windows Have victim unlock doorsComplex Access Use of tools and equipment

TM 137Pg 440

American Red Cross


Emergency Response


Hazardous Materials A HAZMAT is any material that can pose a

threat to the health, safety and property Dealing with HAZMAT requires special

training Primary concern is the safety of the crew,

victim(s) and bystanders Safely obtain as much information as

possible

Pg 445

American Red Cross


Emergency Response


General Procedures for HAZMAT Situations

Stay upwind and uphill from incident Be alert to wind changes Stay away from area Keep people away from the danger zone Look for clues indicating hazardous materials Never enter a HAZMAT area unless you are

trained

TM 138Pg 446

American Red Cross


Emergency Response


Scenario 25

TM 139

Gaining Access

You arrive on the scene of an automobile collision involving one vehicle that has struck a guard rail head-on. The car is still running. The driver did not have on a safety belt and struck the steering column. He is seated behind the steering wheel, conscious and complaining of chest and abdominal pain. The other passenger also was not wearing a safety belt. She is lying motionless, facedown on the floor of the vehicle. You see blood around her body. She is unconscious and not breathing. You are unsure if she has a pulse.

American Red Cross


Emergency Response


Water Rescues Throw, row ... then go Do not endanger yourself, do not attempt in-

water rescue unless trained Distressed swimmer may be too tired to get to

shore but can float and call for help Active drowning victim may thrash to get out

of the water but can’t call for help If water has entered lungs, near-drowning

victims must go to hospital

Pg 448-451

American Red Cross


Emergency Response


Throwing Assists Keep your balance Secure any line attached to device to be

thrown Throw device beyond victim Consider wind and current Once victim grasps device, pull him or her

slowly to safety

TM 140Pg 451

American Red Cross


Emergency Response



CT 17


American Red Cross


Emergency Response


VideoPutting it all Together

American Red Cross


Emergency Response


Scenario 26

TM 141

Extrication

You arrive at a scene in which a car has plunged down an embankment, landing on one side at the bottom. You can see at least two people in the car, one of whom appears to be conscious. Several bystanders have just arrived and are staring at the car. The doors appear to be undamaged, but you are unable to open them. How should you respond?

American Red Cross


Emergency Response


Scenario 27

TM 142

Multiple Casualty Incident

A small commuter airplane carrying eight people and crew has made a crash landing in a cornfield. Witnesses say the plane managed to land without burning, with no smoke visible. When you reach the scene, fire fighters and other rescue personnel have already arrived. The plane is severely damaged but is not of fire. There appear to be survivors. What should you do?

American Red Cross


Emergency Response


Scenario 28

TM 143

Multiple Casualty Incident - Triage

You are at the scene of a train derailment. Two cars have been severely damaged and you are helping with the victims. The incident commander has assigned you four victims to triage as rapidly as possible, using the START system. One of the victims is standing, leaning against a tree. He says he can walk. Another victim is lying on the ground moaning. You can see blood around her body. The third victim is lying on the ground motionless, making no sound. When you check for his pulse, you cannot find it. The fourth victim is also lying on the ground unconscious, but she has a pulse. When you open her airway, she begins to breathe. How would you proceed?

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