1. Before Providing Care and Victim Assessment
Chapter 7
Before Providing Care and Victim Assessment

2. Bloodborne Pathogens
Bacteria and viruses present in blood and body fluids that can cause disease in humans.
Bacteria and viruses MOST COMMON forms of pathogens
Found almost everywhere in our environment.

3. Bacteria vs. Viruses BACTERIA VIRUSES
Live can live outside of the body
Commonly do NOT depend on other organisms of life
Antibiotics and other medications often are used to treat the infection
VIRUSES
Depend on other organisms to live
Once viruses are in the body, they are difficult to kill
Prevention is CRITICAL

4. Hepatitis B
Liver infection caused by the hepatitis B virus.
Severe or even fatal can be in body for up to 6 months before symptoms appear.
Prevention: Hepatitis B vaccine (3 doses)
Primarily spread through direct or indirect contact with infected blood or other body fluids
Hepatitis C
Liver disease caused by the hepatitis C virus
Most common chronic bloodborne infection in US
No vaccine against hepatitis C and NO treatment available to prevent infection after exposure
Leading cause of liver transplants

5. HIV
Virus that causes acquired immunodeficiency syndrome (AIDS)
Weakens the body’s immune system
People with AIDS eventually develop life-threatening infections and can die from these infections.
Currently NO vaccine against HIV
Primarily spread through direct or indirect contact with infected blood or other body fluids

6. How Pathogens Spread
For any disease to be spread, ALL four of the following conditions must be met:
A pathogen is present
A sufficient quantity of the pathogen is present to cause disease
A person is susceptible to the pathogen
The pathogen passes through the correct entry site (eyes, mouth other mucous membranes; non-intact skin or skin pierced by needle sticks, human bites, cuts, abrasions and other means)
Think of these four conditions as pieces of a puzzle all must be in place for picture to be complete

7. How infections occur
Entry Site
Susceptible
Quantity
Present

8. Direct Contact
Occurs when infected blood or body fluid from one person enters another person’s body at a correct entry site.
Example: *Infected blood splashing in the eye
*Directly touching the body fluids of an infected person and that infected blood or other body fluid enters the body through a correct entry site

9. Indirect Contact
Occurs when a person touches an object that contains the blood or other body fluid of an infected person and matter enters the body through a correct entry site.
Example: *Soiled dressings: when a person picks up blood-soaked bandages with bare hands and the pathogens enter through a break in the skin on the hand.
*Equipment and work surfaces that are contaminated

10. Droplet Transmission
Occurs when a person inhales droplets from an infected person’s cough or sneeze
Example: Flu

11. Vector-Borne Transmission
Occurs when the body’s skin is penetrated by an infectious source, such as an animal or insect bite or sting
Example: *Malaria
*West Nile Virus

12. Risk of Transmission Very low but should be very cautious
Neddlestick or cut exposure
30% chance if unvaccinated person for Hep B (depending on several factors)
Risk of hep c is about 2%
Risk of HIV infected blood less than 1%

13. OSHA Occupational Safety and Health Administration
OSHA Occupational Safety and Health Administration
  “issue regulations about on-the-job exposure to bloodborne pathogens”
Exposure Control Plan  Written program outlining the protective measures that employers will take to eliminate or minimize employee exposure incidents.

14. Standard Precautions Personal protective equipment (PPE)
Good hand hygiene
Engineering controls
Work practice controls
Proper equipment cleaning
Spill clean-up procedures

15. Personal protective equipment (PPE)
Breathing barriers
Non-latex disposable gloves
Gowns
Masks
Shields
Protective eyewear
Guidelines for using PPE to prevent infection:
Avoid contact w blood and other body fluids
Use CPR breathing barriers when giving ventilations
Wear disposable gloves when providing care
**All lifeguards should consider ALL body fluids and substances as INFECTIOUS and precautions can be taken through the use of PPE
Do not use gloves that are discolored torn or punctured
Cover any cuts, scrapes or sores and remove jewelry (rings)
Avoid handling items (pens, combs or radios when wearing gloves
Change gloves before providing care to a different victim.
To put on wet gloves, fill gloves with water and place your hand inside the glove.

16. in prehospital settings Gown Mask Protective Eyewear
Recommended Protective Equipment against Hep B, Hep C, and HIV transmission
in prehospital settings
Disposable Gloves
Gown
Mask
Protective Eyewear
Bleeding control with spurting blood
Yes
Bleeding control with minimal bleeding NO
Emergency childbirth
Oral/nasal suctioning; manually clearing airway No
No, unless splashing is likely
No, unless splashing is likely
Handling and cleaning contaminated equipment and clothing
No, unless soiling is likely

17. Work practice controls- things done to help reduce the risk
Good hand hygiene
Most effective measure to prevent the spread of infection
Wash hands frequently (for at least 15 seconds)
Engineering controls- objects used in the workplace that isolate or remove a hazard
Biohazard bags and labels
Personal protective equipment
Sharps disposal containers
Self-sheathing needles
Safer medical devices
Work practice controls- things done to help reduce the risk
Placing sharp items in puncture-resistant containers
Avoiding splashing, spraying, and splattering of droplets of blood
Removing and disposing of soiled clothing
Cleaning and disinfecting all equipment
Washing hands thoroughly with soap and warm water immediately
Not eating or drinking, smoking, applying cosmetics or lip balm, handling contact lenses, or touching the eyes, mouth or nose when in an area where exposure to infectious materials is possible
Isolating contaminated areas so other employees or people do not walk through and become exposed
Good idea to keep your fingernails shorter than ¼ inch and avoid wearing artificial nails
Hand sanitizer good to use if water and soap not available. If soil is visible on hands, wash them do not just use sanitizer!

18. Equipment cleaning and Spill-clean up procedures
Always clean and disinfect the equipment and surfaces used
Wear disposable gloves and other personal protective equipment when cleaning up spills
Clean up spills immediately or as soon as possible after the spill occurs
Dispose of the absorbent material used to collect the spill in a labeled biohazard container
Flood the area with fresh disinfectant solution of approximately 1 ½ cups of liquid chlorine bleach to 1 gallon of water and allow to stand for about 10 minutes
Use appropriate material to absorb the solution, and dispose of it in a labeled biohazard container
Scrub soiled boots, leather shoes, and other leather goods, such as belts, with soap, a brush and hot water. If a uniform is worn to work, was and dry it according to the manufacture's instructions.

19. If you are exposed
Clean the contaminated area thoroughly with soap and water
If you are splashed with blood or other potentially infectious material around your mouth or nose, flus the area with water.
If your eyes are involved, irrigate them with clean water, saline for 20 minutes
Report the exposure incident
Document what happened (include time date)
Seek immediate follow-up care

20. General Procedures for injury or sudden illness on land
Size up the scene
Move victim only if necessary for his or her safety
Perform a primary assessment
Obtain consent if the victim is conscious.
Summon EMS, if needed
Perform secondary assessment, if no life-threatening conditions are found.
Provide care for the conditions found.
Report, advise, and release

21. Size up the Scene:
Determine if the scene is safe for LGs, other rescuers, victim(s) and bystanders
Use your senses to check hazards (gas leak or fire, look for things explosion)
Determine what caused the injury or illness
Determine the number of injured or ill victims
Determine what additional help may be needed
Put on the appropriate PPE
Moving a victim victim on land move only: You are faced w immediate danger You need to get to other victims who have more serious injuries or illnesses It is necessary to provide appropriate care (stairs)
Moving water remove if needed care. Land provide care where found

22. Moves Non-emergency moves
Walking assist: one or two responders conscious person who simply needs assistance
Two-person seat carry: requires a second responder. Conscious person no serious injury

23. Moves Emergency moves:
Clothes drag: conscious or unconscious person suspected of having a head, neck, or spinal injury
Pack-strap carry: conscious and unconscious
Ankle drag: (foot drag) to move a person who is too large to carry or move in any other way.

24. Perform an initial assessment:
to identify any Life-threatening conditions
Checking the victim for responsiveness
A person who speaks is CONSCIOUS
Breathing and pulse
Scanning for severe bleeding

25. Continue sudden illness on land
Perform Secondary assessment
To identify additional conditions
Only do it if you know that there are no life-threatening conditions
To gather additional info about injuries or conditions that may need care
Not life-threatening but could be if not cared for

26. Summon EMS if any of the following conditions are found:
Unconsciousness or altered level of consciousness (LOC) “confusion or drowsiness”
Breathing problems (difficulty or no breathing)
Any victim recovered from underwater who may have inhaled water
Chest pain, discomfort, or pressure lasting more than a few minutes or goes away and comes back
Persistent abdominal pain or pressure
No pulse
Severe external bleeding
Vomiting blood or passing blood
Severe (critical) burns
Suspected poisoning
Seizures in the water
Seizures that last more than 5 minutes or cause injury
Suspected or obvious injuries to head, neck or spine
Stroke
Painful, swollen, deformed areas (broken bones) or open fracture
Victim's physical condition is unclear or is worsening (allergic reaction)
Seizure has repeated not slowing down, person appears injured, pregnant, cause unknown, has diabetes, fails regain consciousness, person is elderly, first seizure

27. Open the Airway and check for breathing and Pulse
No more than 10 seconds
Perform concurrently
If able to speak, airway is functioning

28. Opening Airway
To check breathing and give ventilations, you must manually tilt the head or thrust the jaw to move the tongue away from the back of the throat
Head-tilt/chin lift: used when the rescuer is positioned at the victim’s side
Jaw-thrust maneuver (with head extension): used when the rescuer is positioned above the victim’s head
Jaw-thrust maneuver (without head extension) used when the victim is suspected of having an injury to the head, neck or spine
Victim is unciious, the tongue relases and can blcok the flow of air

29. Child, tilt the head slightly past the neutral position not as far as adult Infant, tilt head to neutral position

30. Checking for Breathing
Position your ear over the mouth and nose so that you can hear and feel air as it escapes while you look for the chest to rise and fall.
Agonal gasps, isolated or infrequent gasping (this is NOT breathing) assume he/she is not breathing

31. Checking for a pulse
If you do not find a pulse with your fingertips in the arteries near the skin, within 10 seconds do not waste time.
Adult and child: feel for carotid pulse “place two fingers in the middle of the victim’s throat and then slide them into the groove of the neck closest to you.”
Infant: feel for brachial pulse on the inside of the upper arm between elbow and shoulder
With every heartbeat, a wave of blood moves through the blood vessels. This creates a beat called a pulse!

32. Give 2 ventilations
Victims of cardiac arrest (witnessed sudden collapse), IMMEDIATELY begin CPR chest compressions.
Other situations drowning or another respiratory event, giving ventilations before beginning CPR is important because victims of hypoxia (deprived of oxygen) likely to experience respiratory emergencies.
Adults: unconscious and not breathing as a result of drowning, hypoxia or another respiratory problem, give the victim 2 ventilations before compressions.
If unconscious and no pulse begin compressions
Child or infant: unconscious and not breathing give 2 ventilations. Only skip if you witness a sudden collapse
Hypoxia (medical), a pathological condition in which the body or a region of the body is deprived of an adequate oxygen supply

33. Scan for severe Bleeding
Do a quick visual scan of the victim for severe bleeding. Head to toe scan
Additional LGs should assist by controlling the bleeding
Breathing and cardiac emergencies are the most critical conditions

34. Recovery Position
Leave the victim in a face-up position and maintain an open airway if he/she unconscious but breathing (especially suspected spinal)
High arm endangered spine (H.A.IN.E.S):keep the airway open and clear even if a spinal injury. You are alone and have to leave victim to call for help, you cannot maintain an open and clear airway because of the fluids or vomit.

35. Perform secondary assessment
Victim does NOT have any life-threatening conditions, to identify any additional problems

36. Provide Care for the Conditions Found
Always treat life-threatening situations FIRST.
Care should be continued until EMS personnel take over

37. Report, Advise, and Release
Once care is given, be sure to complete incident report forms, advise the victim on next steps and release the victim to appropriate parties.

38. One Age does NOT fit all Purpose of the skills in this manual
Anyone approx. 12 years of age or older is an ADULT
Anyone age 1 year to about 12 years is a child
An infant is anyone younger than 1 year
AED anyone 1 to 8 years of age less than 55 pounds is an child

39. Call first or care first
If alone:
Call first for : (cardiac emergencies)
Any adult or child about 12 years of age or older who is unconscious
A child or an infant who you witnessed suddenly collapse
An unconscious child or infant known to have heart problems.
Care First (proved 2 minutes of care) for: (breathing emergencies)
An unconscious child (younger than 12 years of age) who you did not see collapse
Any victim of a nonfatal drowning

40. Head tilt not as dramatic Very little to no head tilt
Adult
Child
Infant
1. Tap the victims shoulder and shout, “Are you okay.”
Tap on foot
2. If no, response (Unconscious) summons EMS
3. Check for signs of life (movement and NORMAL breathing)
a. If victim face down, roll victim onto back, while supporting head.
b. Tilt head back and lift the chin to open airway.
Look for movement and look, listen and feel for normal breathing for NO more than 10 seconds.
Head tilt not as dramatic
Very little to no head tilt
4. If no movement or breathing, give two rescue breaths with resuscitation mask. Each breath should last about 1 second and make the chest clearly rise.
5. If chest clearly rises, check for pulse, CAROTID ARTERY, for no more than 10 seconds.
a. One hand on the victim’s forehead, take other hand and place two fingers on the front of the neck. Then, slide the fingers down into the groove at the side of neck.
One hand on infant’s forehead, use other hand to find the brachial pulse on the inside of the upper arm, between the infant’s elbow and shoulder
6. Quickly scan the victim for severe bleeding.
7. Care for conditions found.
a. If there is movement, breathing, and pulse, place victim in H.A.IN.E.S. recovery position (if spinal is suspected) continue to monitor ABCs (airway, breathing, circulation)