1. BASIC FIRST AID BSI/Standard precautions Emergency Response Bleeding/Shock/Soft Tissue Bone, Joint & Muscle Injuries Trauma Burns Sudden Illness Heat and Cold

2. Standard Precautions & BSI Guidelines from CDC should be followed to prevent bloodborne pathogen infection Guidelines from CDC should be followed to prevent bloodborne pathogen infection ALL bodily fluids should be treated as infectious!!!!! ALL bodily fluids should be treated as infectious!!!!! To prevent infection  Cover all cuts, scrapes, hangnails, rashes, etc. Wash hands/disinfect any exposed area after a spill Use gloves ALWAYS and eye protection, gown and/or mask if appropriate

3. Head-to-toe Exam 1. 1. Introduce self and ask for permission to give care. Responsive adult must give “consent” to treat 2. 2. Follow SAMPLE Signs and symptoms Check level of responsiveness What is complaint? Check Respiration Allergies Ask victim about allergies to food or medicine. Medications Is the victim taking any medications or other drugs? Pre-Existing Medical History Look for medical alert bracelets etc… Ask victim about medical conditions leading to this. Last Meal Ask victim when they ate last and what did they eat? Events What events led up to illness or injury? 3. 3. Proceed with Head-to-toe assessment Look for obvious injuries to head, neck, chest, abdomen and extremities. Check pulse Check skin condition Check Eyes

4. Head-to-toe Exam During your head to toe survey you should be looking for: Deformity Deformity Open injuries Open injuries Tenderness Tenderness Swelling Swelling

5. You come on to scene…. Check scene safety while putting on BSI gear. This is always your FIRST step! Check scene safety while putting on BSI gear. This is always your FIRST step! If scene safety global overview of mechanism of injury and patient, if you have the slightest suspicion a fall could have happened utilize full C-spine precautions. Including using jaw thurst to assess ABC’s If scene safety global overview of mechanism of injury and patient, if you have the slightest suspicion a fall could have happened utilize full C-spine precautions. Including using jaw thurst to assess ABC’s IF VICTIM IS UNRESPONSIVE CALL EMS IF VICTIM IS UNRESPONSIVE CALL EMS Treat as required, “implied consent” Treat as required, “implied consent” Assess ABC’s if adequate; move to head-to-toe exam, SAMPLE Assess ABC’s if adequate; move to head-to-toe exam, SAMPLE Pink, warm, and dry  GOOD Pink, warm, and dry  GOOD Cool, pale, moist  BAD Cool, pale, moist  BAD

6. Head, neck, & spinal care Signs and Symptoms Signs and Symptoms Change in Level of Consciousness Change in Level of Consciousness Difficulty breathing Difficulty breathing Unequal pupils Unequal pupils Headache Headache Vomiting Vomiting ANY TRAUMATIC INJURY OR FALL FROM PERSONS HEIGHT OR HIGHER C-SPINE PRECAUTIONS SHOULD BE APPLIED!!! √ABCs –Use Jaw Thrust Stabilize head and neck – Move body as one unit!

7. Positioning the Patient To properly assess and provide care, patient should be lying on back (if conscious and verbal position of comfort may be appropriate) To properly assess and provide care, patient should be lying on back (if conscious and verbal position of comfort may be appropriate) Only move patient to provide necessary care or avoid imminent danger Only move patient to provide necessary care or avoid imminent danger Patient should be moved if: Patient should be moved if: Unconscious and lying face down Unconscious and lying face down Patient is breathing but unconscious Patient is breathing but unconscious If you have to leave an unconscious breathing victim unattended If you have to leave an unconscious breathing victim unattended Vomiting patient Vomiting patient Imminent danger Imminent danger

8. Log Roll/Recovery position If alone: 1. Kneel down at waistline of patient. 2. Attempt to roll the patient as a single unit. 3. Grasp the patient’s opposite shoulder and hip and roll the patient towards you. As soon as movement begins, remove your hand from the patients shoulder and support his head and neck until the patient is flat on back If you have assistance: One person should stabilize head and neck as the other responder rolls the patients’ body.

9. HAINES – High Arm IN Endangered Spine position Use this position WHENEVER you come upon an injured person Use this position WHENEVER you come upon an injured person Preferable to traditional recovery position because there is less head and neck movement Preferable to traditional recovery position because there is less head and neck movement

10. Bleeding Injuries 1. Capillary bleeding – Slow bleeding, body usually can control on own. 2. Venous bleeding – Deep cut that opens veins. Blood will appear dark red. Control this bleeding. Sutures may be needed. 3. Arterial bleeding – The most serious. Blood may spurt out from wound. Blood will appear bright red. Control this bleeding. Death may result.

11. Bleeding Control Sequence 1. Direct Pressure – At this time a pressure bandage may be applied. 2. Elevate 3. Pressure Point Other bleedings issues  internal; penetrating object; amputation; bites

12. Pressure Bandage 1. Place Sterile dressing on wound. 2. Wrap gauze around wound site. 3. Tie knot directly over wound. 4. Check for circulation(?) below bandage. If too tight, tissue below wound will not have adequate blood flow. * If blood soaks through dressing, do not remove. Add additional layers of dressing. Re-tie.

13. Signs of Shock Shock – inadequate perfusion to the tissues Anxiety Anxiety Altered consciousness Altered consciousness Rapid pulse rate Rapid pulse rate Rapid breathing Rapid breathing Pale, cool, moist skin Pale, cool, moist skin Lackluster eyed Lackluster eyed Weak, helpless feeling Weak, helpless feeling Thirst Thirst Nausea Nausea

14. Care for Shock Keep victim lying down Keep victim lying down Try to make the victim comfortable Try to make the victim comfortable Speak reassuringly Speak reassuringly Control bleeding Control bleeding Elevate legs 10-12 inches Elevate legs 10-12 inches Cover victim to maintain core body temperature Cover victim to maintain core body temperature Do not give anything to eat or drink Do not give anything to eat or drink If victim vomits, place in recovery position If victim vomits, place in recovery position Activate EMS Activate EMS

15. Eye Injuries Eye injuries require immediate advanced medical care Eye injuries require immediate advanced medical care Penetrating object in eye – do not remove due to potential severe bleeding and eye loss. Shut and cover both eyes to reduce movement of other eye. Protect eye with padding around object. Penetrating object in eye – do not remove due to potential severe bleeding and eye loss. Shut and cover both eyes to reduce movement of other eye. Protect eye with padding around object. Chemicals in eye – flush for at least 15 minutes, seek medical treatment Chemicals in eye – flush for at least 15 minutes, seek medical treatment Cuts or blow to eye – patch both eyes, seek treatment. Cuts or blow to eye – patch both eyes, seek treatment.

16. Abdominal - Internal Organ Injuries In case of severe injury, always suspect internal damage or bleeding. Call EMS, treat for shock. In case of severe injury, always suspect internal damage or bleeding. Call EMS, treat for shock. Protrusion of organs from the abdomen – do not touch, cover with a clean, moist dressing, seek immediate medical treatment Protrusion of organs from the abdomen – do not touch, cover with a clean, moist dressing, seek immediate medical treatment

17. Burns 1 st Degree/Superficial – top layer of skin is red and dry 1 st Degree/Superficial – top layer of skin is red and dry 2 nd Degree/Partial Thickness – Top layers of skin are burned. Skin will be red and have blisters. 2 nd Degree/Partial Thickness – Top layers of skin are burned. Skin will be red and have blisters. 3 rd Degree Burn/Full Thickness – All layers of skin are destroyed as well as underlying structures. May be painless due to nerve damage. 3 rd Degree Burn/Full Thickness – All layers of skin are destroyed as well as underlying structures. May be painless due to nerve damage.

18. Burn 1 st Aid 1 st Degree 1. Cool Burned area. Immerse in cold water or apply cold cloths. 2. Cover with clean dressing. 3. Elevate above heart level. 4. Treat for shock if needed 2 st Degree 1. Cool Burned area. Immerse in cold water or apply cold cloths. 2. Cover with clean dressing. 3. Elevate above heart level. 4. Treat for shock if needed 3 st Degree 1. Call EMS immediately. Do not apply water unless burn is very small. 2. Cover with clean dressing. 3. Elevate above heart level. 4. Treat for shock!

19. Other Burn Types & Care Chemical burn Chemical burn Wash chemical with gently flow of water for 20 mins Wash chemical with gently flow of water for 20 mins Contact EMS and/or Poison Control Contact EMS and/or Poison Control Electric burn Electric burn Check ABCs Check ABCs Cover burn with sterile dressing Cover burn with sterile dressing Call EMS Call EMS Smoke inhalation Smoke inhalation Move victim to safe area Move victim to safe area Place in position of comfort usually seated Place in position of comfort usually seated Call EMS Call EMS

20. Strains and Sprains Rest – Discontinue activity. Ice – Apply a cold pack. Compress – Use an elastic or conforming wrap to hold the ice in place. Elevate – raise injury above heart level to control swelling.

21. Dislocations and Fractures Immobilize area – Stop movement by supporting injured area (splints). (For open fractures do not try to replace exposed portion, cover with sterile dressing and splint as best you can) Activate EMS (911) Care for Shock Treat any additional secondary injuries.

22. Trauma Car accidents– hit by or thrown thrown from a car, and is conscious and complains of tingling in feet. Car accidents– hit by or thrown thrown from a car, and is conscious and complains of tingling in feet. -- OR -- Other potentially serious life-threatening events ie. falls of a height greater than their body, bicycle accidents, skiing accidents etc.. Other potentially serious life-threatening events ie. falls of a height greater than their body, bicycle accidents, skiing accidents etc.. Keep victim lying down, do not move them and apply C-spine precautions, treat for shock, activate EMS. Keep victim lying down, do not move them and apply C-spine precautions, treat for shock, activate EMS.

23. Sudden Illness -Seizure Signs & Symptoms - Mild black-out Mild black-out Severe & sudden uncontrolled muscular contractions/convulsions. Severe & sudden uncontrolled muscular contractions/convulsions. First Aid - Clear area of any objects that can harm the victim - Do not restrain victim or place anything in mouth - Cushion head with blanket, pillow, towel.. - After seizure activity subsides, place victim on side in recovery position - Activate EMS if - Uncertain of cause - Seizure lasted >2minutes or was repeated - Victim is pregnant - Victim does not regain conciousness - Seizure occurs when victim is in water - Victim is injured Seizures occur when electrical activity of the brain becomes irregular. This can be a chronic condition (epilepsy) or result from an injury, disease, fever or infection.

24. Sudden Illness -Stroke Sudden Illness -Stroke Signs & Symptoms - May be proceeded by severe headache and ill feelings May be proceeded by severe headache and ill feelings Signs similar to sudden illness/medical emergencies Signs similar to sudden illness/medical emergencies Pale flushed skin, cold sweats, dizzy, light-headed, nauseous, diarrhea, severe headache, paralysis, slurred speech, seizure, breathing difficulty, changes in conciousness Pale flushed skin, cold sweats, dizzy, light-headed, nauseous, diarrhea, severe headache, paralysis, slurred speech, seizure, breathing difficulty, changes in conciousness First Aid Call EMS Call EMS Lie victim on side Lie victim on side Do not give anything to eat or drink Do not give anything to eat or drink Reassure / comfort victim Reassure / comfort victim Monitor breathing & circulation until medical help arrives. Monitor breathing & circulation until medical help arrives. Called a ‘brain attack’, caused by a blockage of a blood vessel or hemorrhage.

25. Sudden Illness -Bites and Stings Jellyfish – Soak wound in vinegar for 30 minutes Jellyfish – Soak wound in vinegar for 30 minutes Sea Nettle – seek medical attention!! Sea Nettle – seek medical attention!! Stingray – Soak in hot water to relieve pain. Stingray – Soak in hot water to relieve pain. Catfish/Stonefish – Soak in hot water to relieve pain. Catfish/Stonefish – Soak in hot water to relieve pain. Bee stings – remove stinger with credit card or knife edge. Watch for anaphylaxis – allergic reaction. Bee stings – remove stinger with credit card or knife edge. Watch for anaphylaxis – allergic reaction.

26. Severe Allergic Reaction – Anaphylactic shock - Severe Allergic Reaction – Anaphylactic shock - Life threatening reaction of the body to a substance to which a victim is extremely allergic. Causes Insect bite or sting - Insect bite or sting - Ingested substances – foods – nuts, spices, fish, shellfish, medication Ingested substances – foods – nuts, spices, fish, shellfish, medication Inhaled substances – dust, pollen, chemicals Inhaled substances – dust, pollen, chemicals Injected substances – antitoxin, drugs such as penicillen Injected substances – antitoxin, drugs such as penicillen Absorbed substances - chemicals Absorbed substances - chemicals Signs & Symptoms - Rash, skin burning, itching, hives Rash, skin burning, itching, hives Tightness in chest & throat Tightness in chest & throat Difficulty breathing Difficulty breathing Swelling of face, neck, lips and / or tongue Swelling of face, neck, lips and / or tongue Fainting, coma, confusion, dizziness Fainting, coma, confusion, dizziness Treatment – THIS IS AN EMERGENCY! CALL EMS THIS IS AN EMERGENCY! CALL EMS EPI-PEN – Epinephrine Auto Injector. Epinephrine is a medication used to treat some allergic reactions & respiratory emergencies. The EPIPEN delivers fast, reliable first aid to potentially fatal reactions. You must be trained to administer shot. EPI-PEN – Epinephrine Auto Injector. Epinephrine is a medication used to treat some allergic reactions & respiratory emergencies. The EPIPEN delivers fast, reliable first aid to potentially fatal reactions. You must be trained to administer shot. Pull off cap, place black tip on outer thigh Pull off cap, place black tip on outer thigh Push pen against outer thigh until it activates & hold in place for 5 seconds Push pen against outer thigh until it activates & hold in place for 5 seconds Safely discard. Safely discard.

27. Sudden Illness -Asthma Causes - Limited air flow due to decreases in air passages from swelling or mucus Limited air flow due to decreases in air passages from swelling or mucus Signs & Symptoms - Coughing, wheezing, shortness of breath Coughing, wheezing, shortness of breath Anxiety, chest tightness, pounding heart Anxiety, chest tightness, pounding heart Difficulty breathing Difficulty breathing Bluish color to lips and face Bluish color to lips and face Treatment – Encourage victim to administer prescribed medicine, if victim is unable, administer it to them. Encourage victim to administer prescribed medicine, if victim is unable, administer it to them. Alert EMS if victim shows no improvement in 15-20 minutes Alert EMS if victim shows no improvement in 15-20 minutes There are different types of inhalers; nebulizers There are different types of inhalers; nebulizers

28. Sudden Illness - Diabetics Signs & Symptoms - If person is weak and dizzy If person is weak and dizzy Has a medical alert tag that indicates they are a diabetic. Has a medical alert tag that indicates they are a diabetic. Conscious - Give them some form of sugar, seek medical treatment * if sugar is low, signs off illness will diminish * if sugar is high, the additional sugar will not be enough to cause further damage. Signs continue to develop and advanced medical treatment necessary. Unconscious – Call EMS/Monitor breathing & circulation People with diabetes sometimes become ill due to too little or too much sugar in their blood.

29. Cold Related Emergencies Hypothermia – Hypothermia – Mild – shivering, stumbling, slurred speech. Remove from cold, put in dry cloths, seek medical attention. Mild – shivering, stumbling, slurred speech. Remove from cold, put in dry cloths, seek medical attention. Severe – body core below 90oF, no shivering, skin blue, slow pulse and respiration. Call EMS, keep victim from getting colder, do not re-warm in field, careful moving victim, check pulse CAREFULLY before determining whether CPR is necessary. Severe – body core below 90oF, no shivering, skin blue, slow pulse and respiration. Call EMS, keep victim from getting colder, do not re-warm in field, careful moving victim, check pulse CAREFULLY before determining whether CPR is necessary. Frostbite / Frozen appendages – treatment, do not re- warm body part if there is a chance that it may refreeze before seeking medical treatment. Frostbite / Frozen appendages – treatment, do not re- warm body part if there is a chance that it may refreeze before seeking medical treatment.

30. Heat Related Emergencies Heat Cramps – painful cramps, moist skin, heavy sweating. Heat Cramps – painful cramps, moist skin, heavy sweating. Move to cool place, give water or saline Move to cool place, give water or saline Heat Exhaustion – cold clammy, sweating, weak pulse, nausea, stomach cramps Heat Exhaustion – cold clammy, sweating, weak pulse, nausea, stomach cramps Move to cool place, elevate legs, apply cool packs, give water, MONITOR Move to cool place, elevate legs, apply cool packs, give water, MONITOR Heat stroke – hot dry skin, confusion, little sweating, rapid pulse. Heat stroke – hot dry skin, confusion, little sweating, rapid pulse. Move to cool place, cool victim by fanning, remove excess clothing, CALL EMS!! Move to cool place, cool victim by fanning, remove excess clothing, CALL EMS!!

31. Triage When multiple victims are present, the responder must prioritize injuries. When multiple victims are present, the responder must prioritize injuries. 1. Critical – Life threatening injuries that may be corrected. 2. Serious – Not life threatening injuries. 3. “Walking Wounded” – Victims who appear to be stable. Can be identified by announcing: “people who are able to walk, please move to a (specified) safe location 4. Fatally injured or dead – Victims who are obviously beyond help.

32. TAKE HOME MESSAGE… 1. Scene Safety 2. Standard Precautions & BSI 3. ABC’s=If traumatic mechanism of injury use C-Spine precautions 4. Quick Head-to-Toe for major bleeding including signs of internal bleeding 5. Thorough Head-to-Toe including SAMPLE and Mechanism of Injury