1. Diver First Responder (DFR) Module D: Diving Emergencies 3 Emergency Care DFR JAN 2011: MODULE D: EMERG CARE

2. DFR Course ModuleTitleContent APHECC CFR CourseBasic Life Support & AED BDiving Emergencies 1Barotrauma CDiving Emergencies 2Non-Pressure Related Emergencies DDiving Emergencies 3Emergency Care EOxygen TreatmentTheory and Practice 2 DFR JAN 2011: MODULE D: EMERG CARE

3. In Module D: we will Cover Emergency CareEmergency Care –Initial Patient Assessment –Recognise the signs & symptoms of Shock –Describe & demonstrate care for Shock –Recognise the 3 types of bleeding –How to care for bleeding –Dealing with other emergencies –Hypothermia 3 DFR JAN 2011: MODULE D: EMERG CARE

4. Common Terminology TermDefinition IndicationUses for a medication / drug Contra-indicationCircumstances where a medication should not be given Medical EmergencyAcute injury or illness that poses an immediate risk to a person's life or long term health SymptomWhat the patient experiences SignWhat the care-giver sees 4 DFR JAN 2011: MODULE D: EMERG CARE

5. Four Causes of Sudden Death (Ref. PHECC CFR DVD) 1.Respiratory Arrest* 2.Cardiac Arrest* 3.Bleeding 4.Shock * CFR Course 5 DFR JAN 2011: MODULE D: EMERG CARE

6. Initial Patient Assessment Review of CFR Initial Assessment ….Review of CFR Initial Assessment …. Is it safe to approach the patient ?Is it safe to approach the patient ? Check Airway – Head Tilt/Chin LiftCheck Airway – Head Tilt/Chin Lift Check Breathing – Look, Listen & FeelCheck Breathing – Look, Listen & Feel Check Circulation – Look for signs of bleedingCheck Circulation – Look for signs of bleeding 6 DFR JAN 2011: MODULE D: EMERG CARE

7. Shock

8. Shock – Failure of the Circulatory System Pump Failure (heart)Pump Failure (heart) Fluid Loss (blood)Fluid Loss (blood) Pipe Failure (blood vessels)Pipe Failure (blood vessels) Permanent damage if untreatedPermanent damage if untreated Present with every sudden injury or illnessPresent with every sudden injury or illness Treat for Shock EarlyTreat for Shock Early 8 DFR JAN 2011: MODULE D: EMERG CARE

9. Signs and Symptoms of Shock Pale, Cold & Clammy SkinPale, Cold & Clammy Skin Rapid BreathingRapid Breathing Nausea & VomitingNausea & Vomiting Altered Mental StatusAltered Mental Status UnresponsiveUnresponsive 9 DFR JAN 2011: MODULE D: EMERG CARE

10. Treatment for Shock Reassure patientReassure patient If possible treat injuriesIf possible treat injuries If possible, lay patient downIf possible, lay patient down If appropriate / comfortable - raise legsIf appropriate / comfortable - raise legs Keep patient warmKeep patient warm Administer O2, Monitor A-B-CAdminister O2, Monitor A-B-C Alert EMSAlert EMS 10 DFR JAN 2011: MODULE D: EMERG CARE

11. SHOCK: SUMMARY CausesCauses –Pump Failure / fluid loss Signs and SymptomsSigns and Symptoms –Pale, Cold & Clammy Skin / Rapid Breathing –Nausea & Vomiting / Altered Mental Status TreatmentTreatment –Treat early to prevent long term damage –Lay patient down / raise legs / keep warm –Administer O2, Monitor A,B,C, / Alert EMS 11 DFR JAN 2011: MODULE D: EMERG CARE

12. 12 DFR JAN 2011: MODULE D: EMERG CARE

13. Bleeding

14. Bleeding - 3 Types Capillary (oozing) Capillary (oozing) Venous (flowing) Venous (flowing) Arterial (spurting) Arterial (spurting) 14 DFR JAN 2011: MODULE D: EMERG CARE

15. Self Protection Always wear gloves when dealing with: Blood Body fluids 15 DFR JAN 2011: MODULE D: EMERG CARE

16. Treatment of Bleeding ReassureReassure Make comfortableMake comfortable Expose and examine woundExpose and examine wound Cover with dressingCover with dressing Apply direct pressureApply direct pressure Elevate area bleedingElevate area bleeding Secure dressing with bandageSecure dressing with bandage 16 DFR JAN 2011: MODULE D: EMERG CARE

17. Treatment of Bleeding Treat for ShockTreat for Shock Monitor ABC / Administer 100% oxygenMonitor ABC / Administer 100% oxygen Alert Emergency Medical Services (EMS)Alert Emergency Medical Services (EMS) If blood soaks through the first dressing:If blood soaks through the first dressing: place new dressing over the existing one 17 DFR JAN 2011: MODULE D: EMERG CARE

18. 18 DFR JAN 2011: MODULE D: EMERG CARE

19. Wounds that need Special Attention Embedded objects (impaled) Embedded objects (impaled) Amputations Amputations DFR JAN 2011: MODULE D: EMERG CARE

20. Treatment of Embedded (impaled) Objects Expose areaExpose area Control bleeding around the objectControl bleeding around the object Stabilise the objectStabilise the object Do not remove the objectDo not remove the object Monitor ABC / Administer 100% oxygenMonitor ABC / Administer 100% oxygen Alert Emergency Medical Services (EMS)Alert Emergency Medical Services (EMS) 20 DFR JAN 2011: MODULE D: EMERG CARE

21. Control BleedingControl Bleeding Treat for Shock earlyTreat for Shock early Recover amputated part & place in plastic bag or wrap in gauze, keep coolRecover amputated part & place in plastic bag or wrap in gauze, keep cool –Avoid direct contact with ice –Keep with patient Monitor ABC / Administer 100% oxygenMonitor ABC / Administer 100% oxygen Alert Emergency Medical Services (EMS)Alert Emergency Medical Services (EMS) Treatment of Amputations 21 DFR JAN 2011: MODULE D: EMERG CARE

22. Dressings and Bandages Functions of DressingsFunctions of Dressings –Control bleeding / Prevent infection –Protect wound / Absorb blood Function of BandagesFunction of Bandages –Hold dressing in place –Apply pressure to control bleeding –Prevent or reduce swelling –Support and stabilise an extremity or joint Dressings maybe packaged with ‘conforming’ bandage attachedDressings maybe packaged with ‘conforming’ bandage attached 22 DFR JAN 2011: MODULE D: EMERG CARE

23. Signs that bandage is too tight Blue tinge found on finger/toenailsBlue tinge found on finger/toenails Blue or pale skin colourBlue or pale skin colour Tingling/Pins & Needles or loss of sensationTingling/Pins & Needles or loss of sensation Cold hands / feetCold hands / feet Ensure patient is comfortable with bandage (not too tight/loose )Ensure patient is comfortable with bandage (not too tight/loose ) 23 DFR JAN 2011: MODULE D: EMERG CARE

24. 24 DFR JAN 2011: MODULE D: EMERG CARE

25. Hypothermia

26. Cold, Wet, Wind, Fatigue = Hypothermia 26 Survival expectancy related to water temperature without Insulation Time in water(hours) Water temp (°C) DFR JAN 2011: MODULE D: EMERG CARE

27. Hypothermia (revision) 27 DFR JAN 2011: MODULE D: EMERG CARE Body core temperature drops below 37°C Water has 25 times greater heat conduction than air Water requires 1,000 times more energy to heat than air Any dive, regardless of location, can lower diver’s core body temperature

28. Hypothermia (revision) 28 DFR JAN 2011: MODULE D: EMERG CARE Signs and Symptoms Increased secretion of urine Goose pimples Vasoconstriction Metabolism increased Shivering

29. Hypothermia (revision) 29 DFR JAN 2011: MODULE D: EMERG CARE Clinical Features 36.5°C Blue pallor, numbness 36°C Violent shivering 35°C Confusion, uncontrollable shivering 34°C Clumsy, loss of co-ordination 33°C Shivering ceases / loss of movement 32°C Victim appears drunk or drugged 30°C Loss of Consciousness 28°C Heartbeat /breathing stops.. death

30. Hypothermia (revision) 30 DFR JAN 2011: MODULE D: EMERG CARE Treatment Remove from cold water / dress in dry clothing Keep victim in “Huddle” position Re-warm with survival bag / body heat Warm drinks, e.g. Soup / no alcohol Monitor A-B-C, Administer 100% oxygen Alert EMS

31. 31 DFR JAN 2011: MODULE D: EMERG CARE

32. Dealing with any other Sudden Injury or Illness DFR JAN 2011: MODULE D: EMERG CARE

33. Sudden Injury or Illness: Treatment Avoid moving patient unnecessarilyAvoid moving patient unnecessarily Let patient sit/lie in comfortable positionLet patient sit/lie in comfortable position Treat for ShockTreat for Shock Monitor ABC / Administer 100% oxygenMonitor ABC / Administer 100% oxygen Alert EMSAlert EMS 33 DFR JAN 2011: MODULE D: EMERG CARE

34. Module D: Diving Emergencies 3 Has coveredHas covered –Different types of bleeding –How to care for bleeding –Signs and symptoms of Shock –How to care for a patient in Shock –Signs & symptoms fro Hypothermia –How to treat Hypothermia –How to deal with other emergencies 34 DFR JAN 2011: MODULE D: EMERG CARE

35. 35 DFR JAN 2011: MODULE D: EMERG CARE

36. PRACTICAL SKILLS 36 DFR JAN 2011: MODULE D: EMERG CARE

37. Bleeding: Scenario While preparing shot-line, a diver in the boat has cut his/her lower arm with a diving knife Diver is pale, cold, clammy sweat and feels weak, the bleeding is flowing from the right lower arm? Show what you would do ….. 37 DFR JAN 2011: MODULE D: EMERG CARE

38. Bleeding: Practical Session Gloves on Make patient comfortable Expose and examine wound Apply direct pressure Elevate area if possible Secure dressing with bandage Check patient is comfortable with bandage Treat for Shock/ABC/ Administer Oxygen Contact EMS 38 DFR JAN 2011: MODULE D: EMERG CARE

39. Shock: Scenario A diver stands on the pontoon to watch out for dive bubbles – slips and falls heavily against bottle rack States that he’s OK – but a few minutes later he begins to show signs of shock. You suspect that he has sustained internal injuries from his fall ….. 39 DFR JAN 2011: MODULE D: EMERG CARE

40. Shock: Practical Session Reassure patient If possible treat injuries Depending on nature of injuries, consider treating the patient lying down with legs raised Keep patient warm Monitor A-B-C / Administer 100% oxygen Alert EMS 40 DFR JAN 2011: MODULE D: EMERG CARE

41. 41 DFR JAN 2011: MODULE D: EMERG CARE