Emergency Preparedness and First Aid

1. 43 Emergency Preparedness and First Aid

2. Learning Outcomes 43.1 Discuss the importance of first aid during a medical emergency. 43.2 Describe the purpose of the emergency medical services (EMS) system and explain how to contact it. 43.3 List items found on a crash cart or first-aid tray. 43.4 List general guidelines to follow in emergencies.

3. Learning Outcomes (cont.) 43.5 Compare various degrees of burns and their treatments. 43.6 Demonstrate how to help a choking victim. 43.7 Demonstrate cardiopulmonary resuscitation (CPR). 43.8 Demonstrate four ways to control bleeding. 43.9 List the symptoms of heart attack, shock, and stroke.

4. Learning Outcomes (cont.) 43.10 Explain how to calm a patient who is under extreme stress. 43.11 Discuss ways to educate patients about ways to prevent and respond to emergencies. 43.12 Describe your role in responding to natural disasters and those caused by humans.

5. Emergencies Acute illnesses Acute injuries Phone calls from patients with urgent problems Disasters Introduction The medical assistant must be prepared to determine the urgency of and handle any emergencies that arise

6. Understanding Medical Emergencies • Any situation in which a person becomes ill or sustains an injury requiring immediate care • Prompt action may prevent disability or death • Can occur within or outside the health-care setting

7. Quick response using first aid is vital First aid can Save a life Reduce pain Prevent further injury Reduce risk of permanent disability Increase the chance of early recovery Patient education First aid Proper way to respond in an emergency Understanding Medical Emergencies

8. Apply Your Knowledge Why is it important to perform first aid in a medical emergency? • ANSWER: First aid can: • Save a life  Prevent further injury • Reduce pain Reduce risk of permanent disability • Increase the chance of early recovery Good Job!

9. Establish roles Post emergency telephone numbers EMS if different than 911 Fire Police Poison control Crash cart – rolling cart with emergency supplies and equipment Women’s shelter Rape hotline Drug and alcohol center Preparing the Office for Emergencies

10. Preparing the Office (cont.) • Provide information to EMS • Your name and location • Nature of the emergency • Number of people needing help • Condition of the injured or ill patient(s) • Summary of the first aid already given • Directions to your location Do not hang up until the dispatcher gives you permission to do so.

11. Preparing the Office (cont.) • Emergency and first-aid supplies • Crash cart/tray • Basic drugs, supplies, and equipment for medical emergencies • First-aid kit for minor injuries and ailments • Must be routinely checked and restocked

12. Urgency of condition Focused exam Document Guidelines for Handling Emergencies • A medical emergency requires certain steps • Medical assistant provides only first aid • Patient emergencies • Assess the situation • PPE • Assess patient • Six steps to initial assessment • General impression • Level of responsiveness • Assess ABCs ABCs

13. Handling Emergencies (cont.) • Telephone emergencies • Triaging • Classification of injuries according to severity, urgency of treatment, and place for treatment • Follow office protocols • General guidelines • Stay calm • Reassure the patient • Act confidently in an organized manner

14. Handling Emergencies (cont.) • Personal protection • Take precautions to reduce chance of exposure during an emergency • Follow Standard Precautions • Keep personal protective equipment in first-aid kit at home and work

15. Handling Emergencies (cont.) • Documentation • Assessment • Treatment given • Patient response • If patient transported, location of facility • Date, time • Signature, credentials

16. Apply Your Knowledge What are the steps of the initial assessment of a patient in an emergency? Correct! • ANSWER: The steps of the initial assessment are: • Form a general impression of the patient • Determine the patient’s level of responsiveness • Assess ABCs • Determine the urgency of condition • Perform a focused exam (head to toe); vital signs; skin color • Document findings/report to physician or EMT

17. Accidental Injuries • Injuries requiring emergency treatment • Bites and stings • Burns • Choking • Ear and eye traumas • Falls and fractures • Head injuries

18. Animal bites Bruise, tear, or puncture Cleanse wound, apply ointment and dry, sterile dressing Insect stings Remove stinger, if present Wash area, apply ice Snake bites Poisonous bite will need antivenin Immobilize and position below heart Spider bites Refer patient to physician Wash area, apply ice, and keep below heart level Bites and Stings

19. Thermal Hot liquids, steam, flame, etc. Water, wet cloth, or blanket Chemical Remove chemical Wash with cool water for 15 minutes Cover with dry, sterile dressing Electrical Entry and exit sites Tissue damage along current’s pathway Burns

20. Categories Minor Moderate Major Burns (cont.) • Classifications of burns • Severity determined by • Depth and extent of burn area • Source of burn • Age of patient • Body area burned • Other illness/injuries

21. Burns (cont.) • Classifications of burns • By depth • Superficial • Partial-thickness • Full-thickness • Estimation of extent of a burn using rule of nines

22. Choking • Foreign object or food blocks the trachea or windpipe • Universal sign • Hand up to throat with a fearful look Medical assistants should know first aid for choking adult, child, or infant!

23. Ear trauma Lacerations, cuts Severed ear – wrap ear and transport with patient Eye trauma Falls, blows to eye, puncture, foreign objects Care depends on severity Falls Have patient examined before moving Stabilize neck if injury suspected Minor falls, notify the physician; document Accidental Injuries (cont.)

24. Fracture – break in the bone Dislocation– displacement of a bone end from the joint Sprain– partial tearing of ligaments Strain – muscle injury occurring from overexertion Treatment Immobilize Ice Monitor patient Fractures and Dislocations

25. Head Injuries • Concussion – jarring injury of the brain • Patient may lose consciousness, have temporary loss of vision, pallor, listlessness, memory loss, or vomiting • Severe head injuries – contusions, fractures, and intracranial bleeding • May require immediate hospitalization and/or CPR • Scalphematoma and laceration – blood under the skin or break in the skin • Control swelling with ice • Control bleeding with direct pressure

26. Hemorrhaging • Heavy or uncontrollable bleeding • Internal – keep patient warm, quiet, and calm, and get medical help • External • Use direct pressure, apply additional dressing as needed • Elevate body part, put pressure on nearestpressure point between wound and heart

27. Multiple Injuries • Often the result of automobile accident or fall • Assess ABCs, perform CPR if needed • Only perform first aid after ABCs ensured • Treat most life-threatening injuries first • Notify EMS/physician

28. Poisoning • Substance that produces harmful effects if it enters the body • Majority of accidental poisonings happen in children under age 5 • Post poison control center number • Patient education – prevention

29. Inhaled poisons Get to fresh air Loosen clothing Check ABCs Poisoning (cont.) • Ingested poisons • Only induce vomiting if directed • Position patient on left side • Send poison container with patient • Absorbed poisons • Remove contaminated clothing • Wash skin, alcohol, rinse

30. Hypothermia Body temperature below 95º Move patient inside, cover with blankets, give warm liquids Frostbite Ice crystals form between tissue cells Warm with clothing or other body part Heat stroke Prolonged exposure to high temperatures and humidity Move to cool place, cool with whatever is available Sunburn Soak in cool water, cold compresses Weather-Related Injuries

31. Amputations Elevate extremity Transport body part with patient Punctures Clean, dress Tetanus toxoid immunization Open Wounds • Skin or mucous membrane is damaged • Incisions and lacerations • Control bleeding • Clean and dress wound • Abrasion • Wash with soap and water • Remove debris, dressing if needed

32. Closed Wounds • Injury occurring inside the body without breaking the skin • Caused by blunt trauma • Contusions– bruises • Cold compresses • Color changes are normal

33. Apply Your Knowledge Yeah! What is the universal sign of choking? ANSWER:The patient holds his hand to his throat and looks afraid. A patient arrives at the clinic with severe hemorrhaging from the left thigh. What steps should you take to control the bleeding? • ANSWER: The steps are: • Apply direct pressure with sterile gauze • Add additional dressing as necessary • Elevate the leg • Apply pressure to the left femoral artery

34. Abdominal pain – a variety of causes Asthma – spasmodic narrowing of bronchi Dehydration – lack of adequate water in the body Diarrhea – can result in dehydration and electrolyte imbalance Common Illnesses

35. Fainting (syncope) – partial or complete loss of consciousness Fever – usually indicates infection Hyperventilation – breathing too rapidly and too deeply Nosebleed – epistaxis Tachycardia – heart rate greater than 100 bpm Vomiting – can result in dehydration and electrolyte imbalance Common Illnesses (cont.)

36. Apply Your Knowledge ANSWER: Matching: ___ Syncope A. Nosebleed ___ Pulse > 100 bpm B. Fainting ___ Spasmodic narrowing of bronchi C. Dehydration ___ Dehydration and electrolyte imbalance D. Tachycardia ___ Epistaxis E. Diarrhea/vomiting ___ Rapid and deep breathing F. Asthma ___ Lack of adequate water G. Hyperventilation Bravo! B D F E A G C

37. Less Common Illnesses • Anaphylaxis • Severe, life-threatening allergic reaction • Check ABC’s, perform CPR if needed • Bacterial meningitis – usually a complication of another bacterial infection • Diabetic emergencies • Insulin shock – severe hypoglycemia • Diabetic coma – severe hyperglycemia

38. Gallbladder attack – inflammation of the gallbladder due to obstruction of cystic duct Heart attack Myocardial infarction Chest pain – cardinal symptom Cardiac arrest – ventricular fibrillation Hematemesis – vomiting blood Obstetric emergencies – office protocols Respiratory arrest May follow distress Assess ABCs, perform CPR, if needed Less Common Illnesses (cont.)

39. Seizures Convulsions Patient safety a priority Shock Life-threatening state related to failure of the cardiovascular system Hypovolemic shock Septic shock Stroke – cerebrovascular accident due to impaired blood supply to brain Toxic shock syndrome – acute bacterial infection originating in the uterus Viral encephalitis – inflammation of the brain due to a virus Less Common Illnesses (cont.)

40. Provides ventilation and circulation for an arrest victim Assess responsiveness, call EMS (911) Assess ABCs If available, connect patient to the automated external defibrillator (AED) Start CPR CPR

41. Apply Your Knowledge ANSWER: Matching: ___ Hypo- or hyperglycemia A. Stroke ___ Myocardial infarction B. Diabetic emergencies ___ Vomiting blood C. Seizures ___ Impaired blood supply to brain D. Hematemesis ___ Convulsions E. Shock ___ May be hypovolemic or septic F. Heart attack B SUPER! F D A C E

42. Alcohol, spousal, child, and elder abuse Report per state law Provide information on community resources Overdose on drugs Requires emergency care Call EMS Violent behavior Office protocols Document Common Psychosocial Emergencies

43. Suicide Allow patient to verbalize Report suspicions to physician Always take patient seriously Rape Provide privacy Contact authorities and local rape hotline Follow protocol for chain of custody of specimens Common Psychosocial Emergencies (cont.)

44. Apply Your Knowledge Mrs. Jamison tells you that she is very tired of being ill and often thinks of “ending it all.” She then laughs and says she was just kidding. What is/are your responsibilities in this matter? ANSWER: You should allow her to talk about her feelings and despite the fact that she said she was “just kidding” you should take her seriously. The physician should be told of her comments. You may be asked to provide her with information on community services available. You should document her comments and your actions. Fantastic!

45. People react differently to emergency situations Detect stress Behavior different from normal Unable to focus or follow directions Keep victims and family calm Challenges Non-English speaking Visual impairments Hearing impairments The Patient Under Stress

46. Educating the Patient • How to prevent and handle medical emergencies • Encourage patients and families to learn first aid and CPR • Provide first-aid kit checklist • How to access EMS and to keep emergency numbers by the phone • How to childproof homes • Provide appropriate, easy-to-read handouts

47. differently Apply Your Knowledge True or False: ___ All people react the same during an emergency. ___ Patients should be encouraged to learn CPR and first aid. ___ Challenges to dealing with patients during an emergency include visual and hearing impairments and English- speaking people. ___ Patients should be instructed on how to prevent emergencies. ___ It is not important to keep the victim of an emergency calm. ANSWER: F T F T F non- Very Good!

48. Disasters • Be familiar with standard protocols for responding to disasters • Participate in fire or other disaster drills to familiarize yourself with emergency procedures • Triage –victims are tagged to classify the victim • Emergent – needing immediate care • Urgent – needing care within several hours • Nonurgent –needing care when time is not critical, or dead

49. Disasters (cont.) • Evacuation plans – maps of facility with escape routes • Shelter-in-place plans –interior room with few/no windows • Plans • Communication during and after emergency • Training in procedures and employee roles • Means of alerting employees

50. Weather-related Community command post Accept assignments appropriate to abilities Document carefully Office fires Activate alarm system Fire extinguisher Turn off oxygen Close windows and doors Evacuate Disasters (cont.)