Emergency Lifesaver Course Objectives of First Aid Preserve Life ・ Prevent Worsening ・ Pain Relief Necessity of First Aid Importance of the first 5 minutes Necessity of independent aiders - the courage to help In saving others, society saves us Casualty (person injured or taken ill) Responder （passer-by)

Tokyo Ambulance Call-outs in 2001 606,695 calls (up 5.4％) One every 52 seconds. 204 teams responding to 3,018 calls each. 1 in 20 citizens used service. Average response time at scene 5-6min.

The Chain of Survival Early Access Early CPR Quick Emergency Measures Calmly and quickly call 119 and explain the situation Early CPR Perform CPR or other first aid as necessary until ambulance arrives Quick Emergency Measures Ambulance team provides further expert care Early Medical Care Professional care at medical institution

Is Resuscitation Possible? １００ １ ２ ３ ７５ Breathing Stops Major Bleeding Heart Stops Death rate ５０ ２５ ０ ２ ３ ５ １０ １５ ３０ １hour 30s １min time ① 50% die within 3min after circulatory arrest ② 50% die within 10min after pulmonary arrest ③ 50% die within 30min of major bleeding * Average ambulance arrival time is 6min from call

Preserve airway First Aid Emergency Aid Stop bleeding Other Aid If unconscious If not breathing Artificially ventilate If no heartbeat Chest compressions If airway blocked Remove obstruction If bleeding heavily Stop bleeding Make comfortable. Treat fractures, wounds, injuries, burns, drowning. Transportation. Other Aid

Age Divisions for First Aid Treatment Life Saving CPR（observation, airway, breathing, circulation) Bleeding Age Divisions 　　Adult　　 8 years or over 　　Child　　 Between 1 and 8 years 　　Infant　　 Between 1 month and 1 year 　　Newborn Less than 1 month old

Observation and First Aid Heavy bleeding? 　Stop bleeding Impaired consciousness? 　Preserve airway Breathing absent or impaired? 　Ventilate No signs of circulation? 　CPR Is casualty breathing? Watch response Signs of circulation When ventilating Any coughing? Give two breaths Any movement?

Signs of Circulation: Checking the Pulse Adults, children 　（carotid artery） Infants, newborns 　（brachial or femoral artery）

(breathing, coughing, movement) If breathing still insufficient ①Conscious? No Yes ②Get help ④Breathing? Insufficient ③Open airway Sufficient ④Breathing? Sufficient Put in recovery position and observe ⑤Ventilate (2 times) Yes ⑥Circulation signs? (breathing, coughing, movement) If breathing still insufficient continue ventilating (one breath every 5 seconds) ⑦⑧ CPR (15 compressions: 2 breaths) for 4 cycles Yes If breathing recovers or casualty protests, stop ventilating ⑥Circulation signs? ⑧ Continue CPR (15 compressions: 2 breaths)

Observation: Consciousness Call “Are you alright? Can you hear me?” into casualty’s ear while tapping their shoulder. See if they can talk or respond. If no response, get progressively louder/harder (no more than 3 times!) 　　　　　　　　　　　　　　　　　　　　　　　 Judge whether casualty is conscious or unconscious Do not move or slide the casualty For infant/newborn casualty, scrape the sole of the foot Can you hear me?

Choose someone and request their help. Get Help Choose someone and request their help. Please call 119 for an ambulance

The Airway The airway is the path taken by air through the mouth and nose to the lungs. 　（Consciousness problems/ not breathing/ airway obstruction）

Opening the Airway 　Lift the chin forwards with the index and middle fingers of one hand while pressing the forehead backwards with the heel of the other hand. Do not put pressure on the soft parts of the chin or throat. Do not do this if there is a risk of a neck injury.

Opening the Airway (2): neck injuries Grasp the jawbone with both hands and gently ease upwards, applying pressure with all 4 fingers on both sides.

Observe Breathing Place your ear above the casualty’s mouth and nose. Look along the chest and abdomen. If she is breathing you will hear and feel the breath on your face and see movement. Observe for no more than 10 seconds to judge whether or not casualty is breathing. Count “1 2 3 4 5 6” “No breathing” “Ventilate”

The Recovery Position For the casualty who is breathing sufficiently but is not fully conscious. Use the casualty’s own hand under their jaw to keep the airway open.

Artificial Ventilation Keeping the airway open, pinch the nostrils so that air cannot escape through the nose but is forced into the lungs. Mouth-to- -Mouth -Nose -Mouth & nose -Mask -Tracheostomy etc.

Breathe for the Casualty Open your mouth wide, take a deep breath, and seal your lips around the casualty’s mouth. Blow into the lungs, looking along the chest until you see the chest rise slightly. Blow about 10cc per kg of casualty’s weight. (e.g. 500-800cc) Problems: Open airway? Nostrils? Seal? Airway obstructions?

Remove your mouth and watch the chest fall Pros and cons of Mouth-to-Mouth Ventilation Requires no special tools Can be done by one person, even a child Easy to see if it’s working Risk of infection Risk of secondary poisoning May feel unpleasant

Preventing Infection A non-return valve resuscitation mask can be used. If you’re worried about infection you can perform chest compressions only.

Ventilating when circulation signs are present １ ２ １ ２ １ ２ ３ ４ ５ ６ ７ ８ ９ １０ １ Breathe gently for two seconds Breathe gently for two seconds Breathe gently for two seconds “No breathing” Ventilate Ventilate Ventilate Check signs for no more than ten seconds. Look for autonomous breathing, coughing or movement. Breathing may still be insufficient. “Circulation Signs present”

Mouth-to-mouth-and-nose Breathing: Age groups Frequency Amount Duration Method Adult Every 5 sec. 500-800cc （10cc/kg） 2 sec. Mouth-to-mouth Child Every 3 sec. Until chest rises gently. 1 - 1.5 sec. Infant Mouth-to-nose Mouth-to-mouth-and-nose Newborn Every 1 - 2 sec. 1 sec.

Chest Compressions: Correct Hand Position The heart is located within the ribcage, slightly to left of centre. An incorrect hand position will make compressions less effective, and break the casualty’s ribs. Heart Hand position

Hand position: lower half of the sternum (breastbone) For adults and children, the first hand should be placed on the sternum one finger-space from the lower end. Hand position Sternum One finger-space Lower limit for compression Xiphoid process

Finding the correct hand position Trace the underside of the ribs with your index and middle fingers. ribs

Place the middle finger in the sternal notch, and the index finger on the sternum Using two fingers, trace the underside of the ribs to the notch where the sides join in the middle. Leaving your middle finger in the notch, rest the index finger next to it on top of the sternum. Index finger on the sternum Middle finger in the notch

Now rest the heel of the other hand on the sternum next to the extended index finger. This is the correct hand position for compressions.

Cardiac Compressions - Essential Points ①　Sit level with the casualty’s chest ②　Correct hand position, with the heel of the hand ③　Lock your elbows ④　Position your shoulders over the chest ⑤　Using your body weight, compress straight down towards the ground Adult casualty: Compress 3.5〜5cm Rhythm of 100 per min.

Compression technique Avoiding pressure on the casualty’s ribs, compress only the narrow sternum. This maximises the safety and effectiveness of the compressions. Use this part (the heel of the hand) to compress the chest

Compress Vertically With elbows straight, push straight down. Release pressure promptly. Take care not to lose your position.

Compress 15 times at a rate of 100 compressions/minute. Cardiac Compressions Compressing the heart between the sternum and spine causes blood to circulate. Compress 15 times at a rate of 100 compressions/minute. heart sternum spine downstroke upstroke

How NOT to do it! Don’t push at an angle Don’t bend your elbows

Cardio-pulmonary Resuscitation(CPR) Repeat cycles of 15 compressions to two breaths (ratio 15:2) After the first four cycles, check again for signs of circulation - for no more than 10 seconds

One cycle 10 second check for signs of life 15 chest compressions 2 breaths 2 breaths “No breathing. Ventilate.” “Checking signs” “No signs of life” “Starting CPR” One cycle 15 compressions : 2 breaths

Removing Obstructions (1) Open the casualty’s mouth with the “crossed finger” technique. Cross the thumb and index finger. Place the thumb on the upper teeth, the index finger on the lower teeth, and twist to open the mouth. Don’t move the head when inspecting the mouth. Do you need to remove dentures?

Removing Obstructions (2) Turn casualty’s head to one side. Wrap your finger with a handkerchief or cloth, and wipe out any obstructions. Make sure to clean away all blood or body fluids.

Back Slaps 　Slap sharply and strongly 4 or 5 times between the casualty’s shoulder blades using the heel of your hand.

Heimlich Maneuver (Sitting) Only on conscious casualties aged > 8 years Put the ball of the thumb against the upper stomach area Put your chest against the casualty’s back. Put both arms under the casualty’s armpits. Squeeze inward and upward.

Heimlich Maneuver (Astride) With the heel of one hand on the upper stomach area, support with the other hand and push sharply upwards and inwards.

Compression from Behind With one knee raised, put open hands on the lower trunk beneath the ribs on either side of the spine. Squeeze strongly, inwards and upwards.

Breathing? Coughing? Moving? ① Conscious? No Yes ② Call for help ④ Breathing? Not enough ③ Open airway Enough ④ Breathing? Enough Recovery position (continue to monitor) ⑤ Two breaths Yes ⑥ Check signs of life　　　　　　　 Breathing? Coughing? Moving? If breathing sufficient, continue ventilations (1 every 2 to 3 sec.) ⑦⑧ Perform CPR (15:2) 　 Yes If breathing recovers or casualty objects, stop ventilations ⑥ Check signs of life ⑧ Perform CPR (15:2)

CPR for Children, Babies and Newborns Mouth-to-Mouth Two breaths. 1～1.5 seconds apart. Chest should rise gently. Mouth-to-Nose & Mouth Two breaths. Breathe for 1 sec. Baby & Newborn Child

Baby & Newborn Child Casualty Hand Position Technique Extent Rate (1-8 yrs) Lower half of sternum Heel of one hand About 1/3 depth of chest 100/minute Baby (1-12 month) One finger width below line joining the nipples Middle & ring fingers only At least 100/minute Newborn (less than 28 days) About 120/minute Baby & Newborn Child

Removing Obstructions: Baby & Child Back Slaps 　Turn over, facing downwards Support chin with fingers Slap 5 times with heel of hand Thoracic Compressions Face upward. Compress lower sternum as for CPR, 5 times. Cycle both techniques. If becomes unconscious start CPR!

Bleeding Control: Direct Pressure Consider the cleanliness, thickness and position. Apply direct pressure to the wound. Use a plastic bag or rubber gloves to avoid infection. Gauze pad bone wound

Bleeding Control: Tourniquet Position between the wound and the heart. Centered a few cm from the wound. Using a wide (at least 3cm) triangular bandage or scarf. Tighten using a stick.　　　　　　　　　　　 Release pressure every 30 mins.

1. Prepare the tourniquet. 4. Turn the stick until bleeding stops. 2. Tie loosely. Insert a pad. 5. Secure the stick so it won’t move. 3. Insert the stick. Steady the pad. 6. Record the time.

Legal Protection for First Aiders 　USA: Good Samaritan Law. If emergency aid is given with sincere spirit there will be no retribution even in the event of a mistake. JAPAN: “Regarding actions made in good faith, in the absence of malice or negligence, there shall be no civil or legal liability.” (総務庁長官官房交通安全対策室・交通事故現場における市民による応急手当促進方策委員会報告書・平６．３)