Chapter 9

1. Chapter 9 First Aid

2. Considerations for Responding to Injuries and Illnesses • Recognize that an emergency has occurred • Decide to act • Help make decisions in an emergency situation, consider the following: • Should I provide care where the victim was found, or move him or her to the first aid room? • Is the safety of the victim or others compromised? • Is there a risk of further injury to the victim? • Is there a risk of exposing the victim or others to pathogens (e.g., by leaving a trail of blood or body fluids)? • Should I summon EMS personnel? • When should I recommend that the victim see a health care provider to seekfurther medical treatment?

3. Secondary Assessment • Take a Brief History • Head-to-Toe Examination for an adult • Toe-to-Head for child • Children get down at eye level, speak slowly and in a friendly manner, use simple words and ask questions that the child can easily understand. • Look for signs and symptoms that indicate changes in LOC

4. Using SAMPLE to take a Brief History • “S”igns or “S”ymptoms: bleeding, skin that is cool and moist, pain, nausea, headache, and difficulty breathing • What happened?, Where do you feel any pain or discomfort? Do you have any numbness or loss of sensation? • “A”llergies: Do you have any allergies to medications, food, environmental elements, such as pollen or bees • What type of reactions do you usually have? • “M”edications: Do you have any medical conditions or are you taking any medications? • Have you taken any medications in the past 12 hours? • Pertinent past “M”edical history: Have you experienced any recent falls, accidents or blows to the head? Have you ever been in any medical, surgical or trauma incidents? • Have you recently been ill? • “L”ast oral intake: find out what the victim most recently took in by mouth as well as the volume or dose consumed. This includes food, drinks and medication. • “E”vents leading up to the incident: What the victim was doing before and at the time of the incident.

5. Checking a Conscious Person • Head-to-examination • Tell the victim what you are going to do • Visually inspect victim’s body looking carefully for any bleeding, cutes, bruises, and obvious deformities • Look for medical identification necklace or bracelet • Do NOT ask the victim to move any areas in which he/she has discomfort or pain

6. Areas to check: • The Head: scalp, face, ears, eyes, nose and mouth for cuts, bumps, bruises, and depressions or changes in consciousness • Skin Appearance and Temperature: coloring face and lips, moist or dry skin • Neck: move from side-to-side, pain, discomfort or inability to move • Shoulders: shrug • Chest and abdomen: difficulty breathing or pain when breathing • Arms: check one at a time, move hand and fingers • Legs: check one at a time, move foot and toes

7. If victim is unable to move or experiencing dizziness or pain • Help the victim rest in a comfortable position • Keep the victim from getting chilled or overheated • Reassure the victim • Determine whether to summon EMS • Continue to watch for changes in level of consciousness

8. If any life-threatening conditions develop when performing the secondary assessment, stop the assessment and provide appropriate care immediately!

9. Sudden Illness • Check for a tag “medical information” • Types of sudden illness: • A diabetic emergency • Fainting • A seizure • A stroke • An allergic reaction

10. Signs and symptoms of sudden illness Changes in (LOC)Nausea or vomiting Difficulty speaking or slurred speechNumbness or weaknessLoss of vision or blurred visionChanges in breathing; the person may have trouble breathing or may not be breathing normally Changes in skin colorSweatingPersistent pressure or painDiarrheaSeizuresParalysis or inability to moveSevere headache

11. General care steps for sudden illness • Care for any life-threatening conditions first • Monitor the victim’s condition and watch for changes in LOC • Keep the victim comfortable and reassure him/her • Keep the victim from getting chilled or overheated • Do not give the victim anything to eat or drink unless the victim is fully conscious and is not in shock • Care for any other problems that develop “vomiting”

12. Diabetic emergency • Illness because too much or too little sugar in blood • If conscious and can safely swallow food or fluids give him/her sugar “preferably in liquid form” Juices or non-diet soft drinks are GREAT • Summon EMS if: • Unconscious or loses consciousness • Unable to swallow • Victim does not get better in 5 min after taking sugar • Cannot find sugar to give

13. Fainting • Is not usually harmful, and the person will usually quickly recover. • Lower the person to the ground or other flat surface and position the person on his/her back. • Do not give the victim anything to eat or drink

14. Seizures • Provide care to person who has a seizure in the same manner as for any unconscious victim. • Protect victim from being injured • Remove any nearby objects that may cause injury • Protect head by placing soft cushion under it • Roll to side if fluid in mouth “vomit, blood, saliva” • If in water support victim with his/her head above water until the seizure ends • Let the seizure to run its course because attempting to restrain the person can cause further injury

15. Summon EMS for a Seizure when: • Occurs in water • Lasts more than 5 minutes • Multiple seizures no sign of slowing down • Appears to be injured • The person is pregnant • The person is diabetic • Fails to regain consciousness • The person is elderly and may have suffered a stroke • This is the first person’s first seizure No need to summon EMS if victim has PERODIC seizures

16. Stroke • May have weakness or numbness on one side of the face, arm, or leg • Difficulty taking or being understood when speaking • Have blurred vision • Experience sudden severe headache • THINK FAST • Face: weakness on one side of the face ask to smile • Arm: weakness on one side ask to raise one arm • Speech: Slurred speech or trouble speaking have them repeat a sentence to you • Time: time to summon EMS note the time signs/symptoms began

17. Wounds • Injury to the body’s soft tissue: skin, fat and muscles • Germs can get into the body through a scrape, cut, puncture or burn and cause infection

18. Closed wound • Occurs beneath the surface of the skin (simplest= contusion) • Internal bleeding may occur when the skin’s surface is NOT broken and damage to soft tissue and blood vessels happens below the surface. • Caring for internal bleeding: summon EMS if: • Severe pain or cannot move a body part without pain • Force that caused the injury was great enough to cause serious damage • An inured arm or leg is blue or extremely pale • Excessive thirst, becomes confused, faint, drowsy or unconscious • Vomiting blood or coughing up blood • Skin that feels cool or moist, or looks pale or bluish • Rapid, weak pulse • Tender, swollen, bruised or hard areas of the body , such as abdomen

19. Open Wound • Break in the skin can be as minor as a scrape of the surface layers or as severs as a deep penetration • 4 main types • Abrasion: skin has been rubbed or scraped away (scrape, road rash) clean wound to prevent infection • Laceration: cuts bleed freely, and deep cuts can bleed severely can damage nerves, large blood vessels and other soft tissue • Avulsion: cut in which a piece of soft tissue or even part of the body, “finger”, is torn loose or torn off entirely • Puncture: do not bleed a lot and can easily become infected

20. External Bleeding • Control any bleeding.*Place a sterile dressing over the wound. *Apply direct pressure until bleeding stops • Clean the wound thoroughly with soap (if available) and water. If possible, irrigate an abrasion with clean, warm running tap water for about 5 minutes to remove any dirt and debris. • If bleeding continues, use a new sterile dressing and apply more pressure. • After bleeding stops, remove the dressing and apply antibiotic ointment, if one is available, the victim has no known allergies or sensitivities to the medication and local protocols allow you to do so. • Cover the wound with a sterile dressing and bandage (or with an adhesive bandage) to keep the wound moist and prevent drying. • Wash your hands immediately after providing care.

21. Major wound: external bleeding • Activate the EAP, summon EMS personnel and follow the general procedures for injury or sudden illness on land. • Cover the wound with a sterile gauze dressing and apply direct pressure using the flat part of your fingers. A large wound may require more pressure; use pressure from your full hand with gauze dressings to try to stop the bleeding. For an open fracture, do not apply direct pressure over the broken bones, but instead pack sterile gauze around the area to control bleeding and prevent infection. • If the dressing becomes saturated with blood while you are applying pressure, do not remove it. Instead, place additional dressings over the soaked bandage and reapply direct pressure. Then cover the dressings with a bandage to hold them in place. • Keep the victim warm and position the victim on his or her back. • Care for other conditions, including shock. • Wash your hands immediately after providing care.

22. ShockNatural body reaction usually means victim’s condition is VERY serious Signs/Symptoms • Restless or irritability • Altered LOC • Pale or ashen, cool, moist skin • Nausea or vomiting • Rapid breathing and pulse • Excessive thirst Minimize the effects by: • Call EMS • Watch for changes in LOC • Control any external bleeding • Keep victim from getting chilled or overheated • Have victim flat on back • Cover victim with blanket • Comfort and reassure the victim DO NOT GIVE FOOD OR DRINK

23. Care for wounds • Tooth: place in milk do not scrub tooth and touch only the crown (white part) if no milk place in clean water • Abdomen: remove clothing, do not attempt to put the organs back into abdomen, cover with moist sterile dressing and cover with plastic wrap, place blanket over to keep warm • Nosebleed: lean forward, pinch nostrils for about 10 minutes or until bleeding stops • Severed body parts: wrap bandage wound to prevent infection wrap the severed body parts in sterile gauze, place in plastic bag, put it on ice do NOT freeze it

24. Continue. . . • Scalp injuries: often bleed heavily, put pressure on the area around wound, if spongy do NOT apply pressure • Embedded Objects: object that remains in the wound keep it there, place sterile dressings around object to keep it from moving

25. Caring for Burns • Stop burning by removing from source • Cool burned area with large amounts of cool, running water • Cover the burned area loosely with sterile dressing • Minimize shock • Comfort and reassure the victim. Chemical: flush area for about 20 min flush affected eye from the nose outward and downward

26. Insect Stings • See if stinger is still in the skin: if so scrap the stinger away from the skin with plastic card • Wash the wound • Cover the site and keep it clean • Apply a cold pack to reduce pain and swelling • Watch for allergic reaction • Care for life threatening conditions • Monitor the victim’s conditions look for changes in LOC and keep victim comfortable

27. Heat and Cold Related injuries • Heat cramps: painful muscle spasms that usually occur in legs and abdomen • Heat exhaustion: body’s cooling system is becoming overwhelmed • Cool, moist, pale, flushed skin • Headache, nausea, dizziness • Weakness • Heavy sweating • Heat stroke: body’s system’s are overwhelmed can be life-threatening • Red, hot, dry skin • Changes in LOC • vomiting

28. Cold-Related Emergencies • Hypothermia: victim’s entire body cools because its ability to keep warm fails. Victim will die if care is NOT provided. • Summon EMS • Move victim to warm place gently • Remove any wet clothing • Warm the victim slowly by wrapping ALL exposed body surfaces especially head (most heat leaves throught the head) • Frostbite: body parts freeze having been exposed to the cold. • Never rub area • Do not warm areas if it might refreeze • Separate toes and fingers with dry, sterile gauze

29. Injuries to muscles, bones, and joints • Fractures: complete break, a chip or a crack in a bone. • Closed: the skin over the broken bone is intact • Open: There is an open wound in the skin over the fracture • Dislocations: the movement of a bone away from its normal position at a joint • Sprains: tearing of ligaments at a joint • Strains: stretching and tearing of muscles or tendons Difficult to know which it may be. It is not necessary to know what type of injury because the care is the same!

30. Care for muscle, bone, and joint injuries • Summon EMS • Support the inured area above and below the site of the injury • Check for circulation and sensation below the injured area • Immobilize and secure the injured area if the victim must be moved and it does not cause further pain or injury • Recheck for circulation and sensation below the injured area

31. RICE • General care for all musculoskeletal injuries • Rest: avoid any movements or activiites that cause pain • Immobilize: stabilze the injured area in the position in which it was found. • Cold: apply ice or a cold pack for periods fo 20 minutes. Repeat if needed • Helps to reduce swelling and eases pain and discomfort • Elevate: above the level of the heart helps slow the flow of blood, helping reduce swelling

32. Immobilizing • Splints: is a tool or device used to immobilize an injury. • Splint the injury in the position in which the injured area was found. • Splint the injured area and the joints or bones above and below the injury site. • Check for circulation and sensation before and after splinting.

33. Immobilizing muscle, bone, and joint injuries • Anatomic Splints: The person’s body is the splint. Example: an arm can be splinted to the chest, or an injured leg to the uninjured leg. • Soft Splints: soft materials; folded blanket, towel, pillow or folded triangular bandage can be used to form a splint. • Rigid Splints: Boards, folded magazines or newspapers or metal strips that do not have sharp edges can serve as splints.