WCTC - Police Academy FALL 2011 FIRST RESPONDER FIRST AID AND CPR

1. WCTC - Police Academy FALL 2011 FIRST RESPONDER FIRST AID AND CPR

2. INSTRUCTORS DET. MARK GRALINSKI CITY OF BROOKFIELD PD 787-3577 DAYS SGT. MARK GARRY VILLAGE OF PEWAUKEE PD 691-5678 11P-7A SGT. STEVE LESNIEWSKI CITY OF OCONOMOWOC PD DAYS

3. REQUIRED MATERIAL AMERICAN HEART ASSOCIATION STUDENT MANUAL POCKET MASK

4. CLASS REQUIREMENTS CPR/AED Written/Practical exam 84% Final exam 70% Be prepared to discuss all material for the date assigned Proper conduct during class – Sexual/racial slurs Professionalism Sleeping in class Cell phones Doing other work in class

5. TOPICS IN FIRST RESPONDER CPR AED Basic lifesaving skills The Emergency Medical System Legal and Ethical issues Anatomy and Physiology Patient assessment – Trauma and Medical Oxygen administration Cardiac and Respiratory problems Medical emergencies – Diabetes, Shock, Stroke, Heat and Cold Traumatic Injuries – Bones and soft tissue Emergency Childbirth

6. EMS • The Emergency Medical System • What is the purpose of the EMS system? • It is a: • Network of resources • Linked together • To provide emergency medical care and transportation • To victims of sudden illness or injury

7. What is a typical sequence of events in a EMS event? Citizen calls 911 – Dispatch receives information and dispatches units First Responder arrives, situation assessed, takes over care Additional EMS resources requested/or are on the way EMT/Paramedics arrive, are briefed by First Responder, assume care EMT/Paramedics transport or call special services if needed and are not already on the way (Flight for Life) Patient arrives at the hospital and care is turned over to them

8. The Chain of Survival (performance standard)

9. Levels within the EMS system First Responder – most basic level EMT Basic – Performs immobilization, staff and drive ambulances, Completes 140 hours of training. EMT Advanced – Requires an additional 100 hours of training beyond EMT basic. EMT Intermediate – All of the above plus administers some meds and has some additional advanced techniques. Completes at least 335 hours of training. EMT Paramedic – Can administer medications and more advanced procedures. Completes at least 1000 hours of training.

10. FIRST RESPONDERS First Responders are taught the basics of emergency medical care and are able to treat life threatening problems prior to the arrival of the ambulance

12. What types of medical facilities can a EMS patient be transported to? Local community hospital ER Trauma center Burn center Pediatric center Perinatal center Poison center

13. The role of the First Responder Protect your safety as well as other rescuers, bystanders, patients * Gain simple access to the patient Assess patient for any life threats Alert additional EMS resources Provide care based on assessment and findings Assist other EMS personnel when requested Participate in record keeping and data collection as needed/required Act as a liaison with other public safety workers

14. Responsibilities of the First Responder Ensure a safe scene – scene safety (and your safety) is always #1* Maintain a caring attitude Keep a professional appearance – in uniform and in conduct Keep up to date skills – Do departments do retraining? If not?

15. CHAPTER 2 THE WELL BEING OF THE FIRST RESPONDER

16. THE WELL BEING OF THE FIRST RESPONDER • I don’t like the blood and guts stuff, how do I handle it? • Are we subject to mental anguish do to what we see? • What if someone's going to die and we know it? • I've heard about stress and burnout, what signs should I watch for? • What is critical incident stress and what's done about that? • How will my family and friends react to my job? • What about infectious diseases? • What do we do about unsafe emergency scenes?

17. Are we subject to mental anguish do to what we see? • YES - Especially Death and the Dying patient • 5 stages of the grieving process for those dying and those close to them • Denial • Anger • Bargaining • Depression • Acceptance

18. What if someone's going to die and we know it? Maintain patient dignity Show respect for the patient Communicate Listen with empathy Don’t give false assurances, but allow for hope Let the patient know that anything that can be done will be done Comfort the family as much as possible

19. I've heard about stress and burnout, what signs should I watch for? • Irritability with coworkers, family, friends • Inability to concentrate • Difficulty in sleeping/nightmares • Anxiety • Inability to make decisions • Guilt • Loss of appetite • Loss of sexual desire • Isolation • Loss of interest in work

20. How can I reduce stress and deal with it? Lifestyle changes - cut down on sugars, caffeine and alcohol, eat right exercise, relax Keep balance in your life - Work, Recreation, Family, Health Seek professional help Techniques and Critical Stress Management Training within your department

21. I don’t like the blood and guts stuff, how do I handle it? Nausea and fainting can occur, to avoid these you may: Remind yourself the patient desperately needs you and your skills Stay involved ( at the scene) Eat properly and maintain your blood sugar Continue to educate yourself

22. How will my family and friends react to my job? • Often negative feelings can be created by virtue of what we do and experience, this may be due to: • Lack of understanding • Fear of separation or being ignored • Worry about on call situations (weekends, holidays) • Frustrated desire to share • Poor communication at home

23. What is critical incident stress and what's done about that? • Critical incidents are any incident that may have unusual impact on the rescuer or law enforcement officer: • Serious injury or death on duty of a rescuer or fellow officer • Civilian injury or death caused by a rescuer or officer • Multiple casualty incidents or disasters • Suicide of a rescuer or officer • Death of a patient • Injury or death of someone you know • Events that attract media attention • Child abuse or neglect • Events with distressing sights, sounds or smells

24. Incidents leading to possible critical stress are now often identified by proactive supervisors and administrators and are addressed with a critical stress debriefing. This is a system developed to help rescuers and officers cope with critical incident stress. It may include: A meeting with an open discussion from participants Group counseling Offers of confidential counseling

25. What about infectious diseases? • Infectious diseases get spread from person to person through: • Blood to blood contact • Contact with open wounds • Contact with mucous membranes of the eyes or mouth • Indirectly by a contaminated object like a needle • Through infected droplets breathed into the respiratory system • So what can you do to prevent contamination? • BSI precautions

26. DISEASES OF CONCERN Hepatitis B Contracted through blood and body fluids Major source chronic carrier, may not even know he’s sick Concern because virus survives outside of body and is easily transmitted Law Enforcement pre-employment includes Hep B vaccinations

27. DISEASES OF CONCERN Tuberculosis Almost vanished but now back TB found in lungs fever cough night sweats weight loss If you suspect TB use a N-95 respirator or a HEPA respirator

28. DISEASES OF CONCERN AIDS Not spread via casual contact - transmission requires contact with body fluids Sexual contact Infected needles Infected blood Mother to child during pregnancy

29. BSI (Body Substance Isolation) precautions should be used at all times. * • Assume all bodily fluids are infectious. • Use your BSI equipment • Eye protection (eye shields, safety glasses, goggles) • Latex gloves (high quality) • Gowns • Masks (disposable) • Wash and disinfect after every call involving bodily fluids

31. What do we do about unsafe emergency scenes? If the scene is unsafe, make it safe before you enter or wait for help. Don’t rush in Get appropriate back up Conduct a scene safety sweep before rendering aid Don’t add an additional problem to the emergency scene (Don’t make the others have to rescue you too) Your safety is number one

32. HAZARDOUS MATERIALS Don’t enter the scene Get HAZMAT team in Protective clothing must be worn Decontamination procedures must be used

33. MOTOR VEHICLE ACCIDENTS Watch for downed power lines Watch for potential for fire, gasoline leaks (Careful with flares!) Explosion or potential for explosion Hazardous materials Oncoming traffic

34. CHAPTER 3 LEGAL AND ETHICAL ISSUES

35. LEGAL DEFINITIONS SCOPE OF CARE STANDARD OF CARE EXPRESSED CONSENT IMPLIED CONSENT PATIENT REFUSAL DNR ORDER ABANDONMENT NEGLIGENCE DUTY TO ACT GOOD SAMARITAN LAWS

36. SCOPE OF CARE Actions legally allowed State law defines scope of care Enhanced by local EMS director Also defined by National Curriculum established by US-DOT

37. CONSENT EXPRESSED IMPLIED

38. CONSENT EXPRESSED - Actual consent a competent adult or guardian gives IMPLIED - Consent to live saving care under the assumption that an unresponsive patient would give consent if they could

39. What is a DNR order? What should a first responder do if presented with one?

40. DNR ORDER DO NOT RESUSCITATE ORDER A do not resuscitate order documents the wish of a chronically ill or terminally ill person not to be resuscitated. If you can’t determine the order is valid you should resuscitate

41. PATIENT REFUSALS CAN A PATIENT REFUSE TREATMENT? WHAT CAN WE DO ABOUT REFUSALS?

42. PATIENT REFUSALS • If a patient refuses treatment – • Determine if the patient is competent • Does the patient understand the risks and consequences of refusal • Make every reasonable effort to persuade the patient • Have the patient sign a release • Encourage the patient to get help if certain symptoms develop

43. ABANDONMENT Once you start treating a patient and assume care for that patient, you can not leave that patient without turning the care of that patient over to another rescuer or care provider with a level of training equal or greater than yours.

44. NEGLIGENCE • FOR YOU TO BE GUILTY OF NEGLIGENCE A COURT MUST FIND THE FOLLOWING 4 CONDITIONS: • YOU MUST HAVE HAD A DUTY TO ACT • YOU MUST HAVE BREACHED THAT DUTY • THE PATIENT MUST HAVE BEEN INJURED PHYSICALLY OR PSYCHOLOGICALLY • YOU MUST HAVE CAUSED THE INJURY OR CAUSED IT TO BECOME WORSE

45. What is a “DUTY TO ACT”

46. “DUTY TO ACT” Contractual or legal obligation to provide care On duty first responder must care for anyone who needs, and consents, for care

47. State of Wisconsin - Good Samaritan Law 895.48(1) (1) Any person who renders emergency care at the scene of any emergency or accident in good faith shall be immune from civil liability for his or her acts or omissions in rendering such emergency care. This immunity does not extend when employees trained in health care or health care professionals render emergency care for compensation and within the scope of their usual and customary employment or practice at a hospital or other institution equipped with hospital facilities, at the scene of any emergency or accident, enroute to a hospital or other institution equipped with hospital facilities or at a physician's office.

48. What is “Standard of care” ?

49. What is “Standard of care” ? Care must be to the best of your ability Care must follow accepted guidelines Care must be the same level of care as anyone else with your level of training

50. CONFIDENTIAL INFORMATION MEDICAL RECORDS GENERALLY HELD AS CONFIDENTIAL CAN THEY BE RELEASED TO OTHERS?