February 7, 2009SFFMA First Aid – Basic

First Responder Skills

Objectives• Objectives

– 10-01.01 – The firefighter shall list (3) major roles and responsibilities of the first responder.

– 10-01.02 – The firefighter shall describe all applicable legal aspects relating to providing emergency care as a first responder.

– 10-01.03 – The firefighter, given each vital sign, shall describe its normal and abnormal states and how he would check for the sign.

– 10-01.04 – The firefighter shall identify the medical identification symbol.– 10-01.05 – The firefighter shall state the time in which brain cells will die without

oxygen.– 10-01.06 – The firefighter shall identify a primary survey for life-threatening

injuries.– 10-01.07 – The firefighter shall describe the signs of adequate and inadequate

breathing.– 10-01.08 – The firefighter shall describe variations in design of the respiratory

system for partial and total laryngectomies.– 10-01.09 – The firefighter shall describe airway care and resuscitation

procedures for the laryngectomy.– 10-01.10 – The firefighter shall demonstrate mouth-to-mouth and mouth-to-nose

resuscitation.

Objectives, cont.• Objectives

– 10-01.11 – The firefighter shall demonstrate nasal ventilation.– 10-01.12 – The firefighter shall list the signs of cardiac arrest.– 10-01.13 – The firefighter, given a diagram of the heart and its related organs,

shall identify these organs and complications if CPR is performed incorrectly.– 10-01.14 – The firefighter shall list the signs of effective CPR.– 10-01.15 – The firefighter shall demonstrate one and two person CPR.– 10-01.16 – The firefighter, given a description of a type of bleeding, shall identify

it as arterial, venous or capillary.– 10-01.17 – The firefighter shall describe why tourniquets are a last resort for

controlling external bleeding.– 10-01.18 – The firefighter shall demonstrate techniques for controlling external

bleeding.– 10-01.19 – The firefighter shall demonstrate the proper technique for prevention

and/or spread of infectious diseases and occupational exposure to bloodborne pathogens associated with emergency care.

– 10-01.20 – The firefighter shall demonstrate the use, decontamination, disinfecting, and proper disposal of personal protective equipment used for protection from infectious diseases.

Objectives, cont.• Objectives

– 10-01.21 – The firefighter shall identify major signs of, distinctions between, and initial treatment for heat cramps, heat exhaustion, and heatstroke.

– 10-01.22 – The firefighter shall identify major signs of hypothermia.– 10-01.23 – The firefighter, given a description of patients exposed to heat and

cold, shall identify the condition and describe emergency care procedures.– 10-01.24 – The firefighter shall describe the meaning of shock.– 10-01.25 – The firefighter, given a list of signs and symptoms, shall identify those

associated with shock.– 10-01.26 – The firefighter shall describe anaphylactic shock.– 10-01.27 – The firefighter shall identify the treatment for anaphylactic shock.– 10-01.28 – The firefighter shall define the functions of the skeletal system.– 10-01.29 – The firefighter shall define and identify types of fractures (fx),

dislocations and sprains.– 10-01.30 – The firefighter, given a list of symptoms, shall identify those

associated with fx and dislocations.

Objectives, cont.• Objectives

– 10-01.31 – The firefighter shall list the primary reason for splinting.– 10-01.32 – The firefighter, given descriptions of “patients” (pts) with injuries of the

skull, spine and chest, shall identify the condition and describe appropriate emergency care.

– 10-01.33 – The firefighter, given pts, shall describe appropriate emergency care for any injuries to the spine.

– 10-01.34 – The firefighter, given a specific situation, shall indicate:• A. whether or not a patient should be moved,• B. why the patient should or should not be moved, and• C. if a move is necessary, how the move should be accomplished.

– 10-01.35 – The firefighter, given descriptions of accident scenes, shall describe procedures for gaining access to patients:

• A. in closed upright vehicles• B. in closed overturned vehicles• C. pinned beneath vehicle• D. pinned inside vehicle• E. in vehicle with electrical hazards

10-01.01

Roles and Responsibilies

• Three major roles and responsibilities of the first responder are:– 1. Safety

• Personal Safety• Safety of Crew, Patient, Bystanders

– 2. Responsible Patient Care• Patient Assessment• Care Based on Assessment Findings

– 3. Transportation and Transfer of Patients• Lifting and Moving Patients Safely• Transfer of Care

10-01.02

Legal Aspects• Once you initiate care, can’t stop until a higher level of

care takes over (EMT, Paramedic, Nurse, Doctor).• Do not go outside your scope of practice

– Scope of Practice is what you have been taught. A paramedic has a larger scope of practice than an EMT-B.

– Examples of not in scope are:• Starting IV access• Administering Drugs (outside of O2 and glucose)• Intubations

• Confidentiality– Breech of confidentiality is any private info let out– Keep your mouth shut. Do not give out any records even to a

spouse without permission from the pt.– Breech is the number one law suite reason in healthcare

10-01.03

Vital Signs• Blood Pressure

– 120/80 is considered normal• Below 90 systolic is considered hypotensive• Above 120 systolic is considered hypertensive

– Pulse of 60 – 100 is considered normal• Below 60 bpm is considered Bradycardic• Above 100 bpm is considered Tachycardic

– Respiratory rate for an adult is 12 – 20 rpm• 15 – 30 rpm for a child• 25 – 50 rpm for a newborn

– SPO2• Oxygen concentration in blood, aka Pulse Oxymetry• 90 to 100 % is normal• Below 90 %, they need oxygen and/or respiratory assistance

10-01.04

Medical Identification Symbol

10-01.05

Oxygen Deprivations

• When a patient’s breathing and heartbeat stop, clinical death occurs. This condition may be reversible through CPR and other treatments. However, when the brain cells die, biological death occurs. This usually happens within 10 minutes of clinical death and it is not reversible. In fact, brain cells begin to die after 4 to 6 minutes without oxygen supplied from air being breathed in and carried to the brain by circulating blood.

10-01.06

Primary Assessment• Primary Survey:

– AVPU• Alert – A&Ox4 (Alert and Oriented x 4 – Person, Place, Date, Event)• Verbal• Pain• Unresponsive

– CC• Chief Complaint – Why the person called 911

– ABCDE• Airway• Breathing• Circulation• Disabilities

– Disabilities caused by the injury, not pre-existing conditions• Evaluate / Examine / Environment

– Evaluate – Is this pt time critical and/or need further care– Examine – Remove clothing and obstructions to assess wounds– Environment – Environmentally related conditions – cold, lightning, heat, etc.

10-01.07

Adequate Breathing• Are they talking?

– If so, they are breathing!• Signs of adequate breathing:

– = chestrise– Unlabored

• Signs of inadequate breathing:– Tripod positioning– Cyanotic (skin turning blue, usually around lips is

easily visible)– Snoring, wheezing, stridor (high pitched sound heard

on inhalation)

10-01.08

Laryngectomies• A laryngectomy is the partial or

complete removal of the larynx (voice box), usually as a treatment for cancer of the larynx.

• A tracheotomy is a surgical procedure on the neck to open a direct airway through an incision (knife cut) in the trachea (wind pipe)

• A tracheotomy generally refers to the procedure of cutting into the trachea and is an emergency procedure.

1. Vocal Cords

2. Thyroid Cartilage

3. Cricoid Cartilage

4. Tracheal Cartilage

5. Balloon Cuff

10-01.10

Mouth-to-Mouth• 1. Determine if the person is breathing,

ear over mouth, chest rise• 2. Position victim on back, log roll.• 3. Remove foreign obstacles from

mouth.• 4. If no trauma suspected, use “head-

tilt, chin-lift” method to position head and neck. If trauma is suspected, use “jaw thrust” method.

• 5. Pinch the victim’s nose and take a deep breath.

• 6. Exhale hard into victim’s mouth.• 7. Repeat.

10-01.11

Oronasal Ventilation• 1. Determine if the person is

breathing, ear over mouth, chest rise• 2. Position victim on back, log roll.• 3. Remove foreign obstacles from

mouth.• 4. If no trauma suspected, use “head-

tilt, chin-lift” method to position head and neck. If trauma is suspected, use “jaw thrust” method.

• 5. Using C-Clamp method to hold mask, exhale hard into mask. Make sure you maintain a good seal.

• 6. Repeat.

10-01.11

Oronasal Ventilation

• Causes for poor mask seal:– Facial hair– Facial trauma / deformities– No teeth– Saliva / blood / moisture

10-01.12

Signs of Cardiac Arrest• Chest pain• General discomfort in upper body

– Arm– Chest– Jaw– Neck

• SOB (shortness of breath)• Other signs might include cold sweat and N/V

(nausea & vomiting)• Most men will have chest pain and women will

tend to have the other S/S (signs & symptoms)

10-01.14

Signs of Effective CPR

• Chest rise• Feel carotid pulse during compressions

10-01.15

CPR

• One Person– 30 compressions, 2 breaths, repeat– Ideal rate for compressions is 100 bpm

• Two Person– One person compresses, the other ventilates– Compressions at a rate of 100 bpm– Ventilations

• 1 every 5 to 6 seconds • 10 to 12 a minute

10-01.16

Different Types of Bleeding• Arterial

– Bright red– Rapid– Often spurting with each

beat• Venous

– Dark red or maroon– Steady and slow flow

• Capillary– Slow even flow– “Oozing”– Easily controlled

10-01.17 & 10-01.18

Controlling Bleeding

• Direct Pressure• Elevate• Pressure Points• Tourniquets

– Tourniquets are the absolute last resort because you are cutting off blood flow to the part of the body and the tissue begins to die.

10-01.19

BSI

• Body Substance Isolation• Used to prevent and control spreading of

diseases• Just like in firefighting, uses PPE

– Gloves– Gown– Mask– Goggles

• WASH HANDS!!!!

10-01.20

Use, Decon, Disinfect, Disposal

• Use• Decontamination

– Wearing PPE, clean all instruments and reusable materials used

• Disinfect using PDI wipes, Scubbing Bubbles disinfectant, Clorox

• Dispose of contaminated items in a red biohazard bag or container on Rockwall EMS’s ambulance

10-01.21

Hyperthermia• Muscle (heat) Cramps

– An electrolyte and fluid imbalance– Give water or 50/50 Gatorade if not nauseated– The body is like concentrated KoolAid – add water

• Heat Exaustion– Headache– Tachycardia– Thirst– Major Sweating– Ex. When you cut the grass on a hot summer day and you sit down inside where it is nice

and air conditioned. You have been sitting for 30 minutes but you are still sweating profusely and your heart is going fast. This is heat exhaustion.

– Give water or 50/50 Gatorade if not nauseated• Heat Stroke

– True emergency– Body temperature will be 104 or higher– At 107 degrees, the body will only live for 45 seconds to 2 minutes– Remove from heat and remove all clothing– Dump ice on groin, neck, pelvis to cool fast– Remove ice when victim is shivering– Over 50% of pts will have a seizure that will not stop until temperature is reduced

10-01.22

Hypothermia• Body temperature is less than 95 degrees – officially

– Mild hyperthermia is 95 to 90 degrees– Moderate is 90 to 85 degrees– Severe is less than 85 degrees– If less than 82 degrees, they are dead

• S/S– Early – epi release, movement to make heat, chill bumps to hold heat– Transitional – shivering– Late – slowing pulse and resp rate, lowering BP, decreased LOC (level

of consciousness)• Treatment

– Remove wet clothing– Apply warm blankets– Turn heater on in area– Put heat packs around person, but not on person– Body heat from another individual works well

10-01.24 & 10-01.25

Shock• Shock – the inability of the body to adequately circulate blood to the body’s

cells to supply them with oxygen and nutrients. Inadequate tissue perfusion– What does this mean?

• The blood is not going to the cells to provide required nutrients• S/S

– AMS (Altered Mental Status)– Pale, cool, clammy skin– N/V– Vital signs changing

• Compensating– Pulse increases– Respirations increase to improve SPO2, but usually become labored, shallow, and irregular– Blood pressure maintains above 90 systolic

• Decompensating– Blood pressure drops below 90 systolic– This is bad

• Irreversible– Anaerobic metabolism kicks in– Body is burning sugar instead of oxygen– Lactic acid is produced– This is very bad

10-01.26 & 10-01.27

Anaphylactic Shock• A fancy title for allergic reaction• Three fazes

– Mild• Hives, local itching, runny nose, teary eyed

– Moderate• Mild S/S with breathing affected (caughing, etc)

– Severe• Moderate S/S with lowering BP

– In general, the faster the reaction to allergy, the worse the reaction

• Epinephrine, Benadryl

Anaphylactic Shock• Bee Stings / Wasps

– Remove stinger with credit card or knife. No Tweezers!– Ice for comfort

• Fire Ants– Most common insect reaction in US– Wash with soap & water

• Black Widow Spider– CNS suppressant– Abdominal spasms within about an hour– Clean with soap & water– Anti-Venom only if pt becomes unstable, can only be given once

• Scorpion– Only one kind fatal to humans in US, found in CA, AZ, & NM– No swelling, just pain– Wash with soap & water, apply ice

Anaphylactic Shock• Snake Bites

– Snakes around here• Vipers

– Cottonmouth, Copperhead, Rattlesnake– Two punctures

• Coral Snake– Chews you in soft places

– No ice on snake bites – causes enzymes to speed up and more localized damage by keeping toxin concentrated

– Do not apply constricting band or tourniquet– Do not suck out poison– De-elevate bitten area and splint area– 20% of all bites do not envenomate

• Brown Recluse– Little to no pain when bitten– Local tissue necrosis (death). Digestive toxin– White “halo” around bitten area, in 2 days to the bone– If not caught early, must cut out skin and grow new– Be supportive, apply cold compresses and sterile dressings

Brown Recluse

10-01.28 thru 10-01.31

Skeletal System• Functions

– Provides structure– Provides protection for internal organs

• Fracture (Fx)– The breaking of a bone, cartilage, or the like, or the resulting

condition• Dislocation

– Separation of two bones from their normal relationship within a joint

• Sprain– Injury in which ligaments are stretched or partially torn

• Splinting– Provide comfort to Pt– Prevent further damage

10-01.32a

Skull, Spine, Chest Injuries• Head

– Increased Intracranial Pressure• Cushings Triad

– Increased BP– Decreased pulse– Widening pulse pressure

» Systolic vs. Diastolic– Possible projectile vomiting and irregular respirations

• Treatment– Limit oral intake unless needed– Elevate head if BP is increasing to alleviate pressure– Hyperventilate to blow off CO2 to shrink blood vessels. This will reduce blood flow to the brain.

» This is still done today even though some think it is not advised.» MCFD will not do this unless told to by REMS

– Skull Fx• “Raccoon Eyes” and “Battle Signs”• If depressed skull fx, do not apply any pressure over the fx

– Concussion• Shaking of the brain with brief loss of consciousness• Fully reversible• Brain shuts down as a safety precausion• Possible signs are vision problems, headache, event memory loss, but not long term loss

– Contusion• Vessel rupture in brain usually caused by shaking• S/S are same as concussion, but includes long term memory loss• In the field, can not distinguish the difference between concussion and contusion. Need MRI and CT scan

10-01.32b & 10-01.33

Skull, Spine, Chest Injuries• Spine

– Mechanism of Injury• MVC• Motorcycle crash• Car vs. Pedestrian• Falls from 2 to 3 times the person’s height• Hanging• Diving – compression fx• Any unresponsive person has a spinal injury unless told otherwise!

– Treatment• If spinal injury is suspected, tell Pt not to move. Do not say sit on board – we’ll cover boarding

techniques during hands on.• ABCs• Keep spine in line• Must do log roll if person is not on back• Person at the head coordinates all movement, and never lets go until head is secured to backboard• Secure Torso first, Legs second, Head last• Hands secured in straps on groin or keep arms out. DO NOT PLACE ARMS ACROSS CHEST• Use padding in voided areas

– Under shoulders and torso for pediatrics– Under head for some adults and 99% of overweight people

10-01.32c

Skull, Spine, Chest Injuries• Chest

– Impaled objects• Leave it and immobilize it in place• Do not attempt to remove

– Open Chest Wound• Known as a sucking chest wound• Air enters the chest and collapses the lungs• Use an occlusive dressing – two types

– Four sided» Tape all four sides of dressing. If needed, open when they exhale and close when they inhale.

– Three sided (I Prefer)» Tape three sides of dressing. This will create a flutter valve allowing air to exit but not to enter. Think of a

whoopee cushon.• If no dressings are available, an available sterile plug can be:

– Your gloved finger– Rib Fxs

• Can cause internal bleeding• Can cause the Pt to not inflate their lungs completely and pneumonia can develop• Monitor ABCs and position of comfort

– Flail Chest• Two or more consecutive ribs broken in 2 or more places• Creates an “island” that moves in opposite direction of the chest• Treatment:

– Limit external movement of flailed chest– Use a pillow and trauma dressing around chest

Diabetic Emergencies• Diabetes

– The body’s inability to manage is sugar level– Diabetes can cause:

• Nerves to fail• Increased pressure in retina causing blindness• Weak, thin blood vessels that can burst• Poor wound care – a pebble in the shoe can lead to a leg being cut off

• Sugar Testing– D-Stick & Glucometer– Prick skin and collect capillary blood onto test strip– 80 to 120 mg/dL is normal range

• Hypoglycemic– Sugar level is less than 80mg/dL– Also known as Insulin Shock– This is the TRUE EMERGENCY. When the brain runs out of sugar, it doesn’t function anymore.– S/S – acute onset in minutes, truly hungry, not nauseated, normal breathing, normal BP, Altered Mental Status, headache, irritable,

pale/moist skin– Ex. Taken insulin but not eaten, worked out hard and used up sugar, etc.

• Hyperglycemic– High sugar levels above 200mg/dL– Also known as Diabetic Coma– S/S – onset 12 to 24 hours, they think they’re hungry so they eat and then vomit, are nauseated, fast deep breathing, candy

breath, urinating sugar, lower BP due to sweating, urinating and rapid breathing, restless– Ex. Eating without taking insulin

• Treatment– If any question as to hyper or hypo give sugar. It will help the most serious one which is too little sugar. If it was already high, a

little more will not kill them.– If low sugar, give .5 to 1g/kg (25 to 50g) of oral glucose

Conclusion

• This concludes the required information for the SFFMA Basic Firefighter First Aid segement.

• We will continue with our Hands On portion learning the following:– C-collar– Long Board– KED– Log Roll– Accident Scene Procedures