Emergency First Aid CPR Level A

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AED, First Aid and CPR Manual

2016 Guidelines

By Kathryn Davies, EMCA Consultant IT

905-634-5678 WWW.LIFESEMERG.COM

Special Thanks to Bill and Paige Davies,

Gino and Cynthia Dippilito and Family

 

Life’s Emergency Training

2018

 

Copyright © 2018, 2017, 2016, 2014 by Kathryn Davies and Life’s Emergency Training

All rights reserved. This book or any portion thereof may not be reproduced or used in any manner whatsoever without the express written permission of the publisher except for the use of brief quotations in a book review or scholarly journal.

First Printing: 2014

 

Life’s Emergency Training

723 Brant St., Burlington,

ON, L8G 2Z1 www.lifesemerg.com

 

 

Contents

Chapter 1 – Terms and Information. 8

Legalities 9

Ontario Good Samaritan Act 10

Chase McEachern Act 10

Sabrina’s Law.. 10

Personal Protective Equipment 11

Communicable Diseases 12

Critical Incident Stress 14

Chapter 2 – Emergency Scene Management 16

Internal Response Plan. 20

Shock and Unresponsiveness 24

Positions used in First Aid. 26

Chapter 3 – Cardiovascular Emergencies 28

Chain of Survival 28

Heart attack. 29

Ischemic Stroke. 29

Chapter 4 – Cardiopulmonary Resuscitation. 32

Adult and Child CPR. 33

Infant CPR. 36

Automated External Defibrillator (AED) 38

Conditions Requiring an AED. 41

Children and Infants 43

Safety and Special Circumstances 44

Choking. 46

Adult and Child Choking. 46

Mild Choking. 46

Severe Choking. 46

Infant Severe Choking. 49

Special Circumstances 50

Chapter 5 – Severe Bleeding and Wound Care. 52

Dressings 52

Bandages 53

Minor Wounds 56

Chapter 6 – Burns 59

Chapter 7 – Medical Emergencies 63

Diabetic Emergencies 63

Seizures 65

Asthma. 66

Severe Allergic Reaction. 67

Chapter 8 – Physical Exam.. 69

SAMPLE History. 70

DOTS. 71

Head to Toe Examination. 73

Chapter 9 – Bone and Muscle Injuries 76

Factures 76

Femur (Thigh) Injury. 78

Tooth and Mouth Injuries 79

Repetitive Strain Injury. 80

Chapter 10 – Head, Spinal and Pelvic Injuries 82

Chapter 11 – Chest Injuries 86

Penetrating chest injury. 87

Blast injuries 87

Flail Chest and Rib Injury. 88

Closed Pneumothorax. 89

Blast Injury. 89

Chapter 12 – Heat and Cold Emergencies 91

Cold Injury. 92

Heat Injury. 93

Chapter 13 – Serious Injuries and Illness 95

Multiple Casualty Management 95

Eye Injuries 97

Poisons 98

Two-Person CPR. 100

Rescue Moves 102

Chapter 1 – Terms and Information

Objective of this chapter is for First Aiders to understand:

  • First aid terms
  • Protect themselves using the law and personal protective equipment.
  • Critical Incident Stress and Post Traumatic Stress Disorder

 

Lay Rescuer: A non-medically trained First Aider.

First Aid: “Emergency care or treatment given to an ill or injured casualty before medical aid can be obtained.” (mw.com)

First Aider: A Lay rescuer who may or more not have first aid training and has no medical training that offers first aid before any medically trained personnel arrive.

Medical Aid: Anyone who has formal medical training such as a doctor, nurse, or paramedic.

 

Ages of Casualty

Adult – 8 yrs. old and above

Child – 1 yr. to 8 yrs. old

Infant – under 1 yr. old

 

Signs: Changes in the casualty’s condition that is noticeable (examples: sweating, paleness, or bleeding).

Symptoms: Feelings that the casualty tells you (examples: pain, dizziness, or nausea).

Treatment: First aid to help the ill or injured casualty in correct priority.

 

Priorities of First Aid

Airway, Breathing, Circulation and Defibrillation (ABCD)

By ensuring that we preserve the casualty’s life, the primary concern when providing first aid treatment for a casualty is:

 

Objectives of First Aid and CPR

  • Preserve life
  • Prevent further injury or illness
  • Promote recovery

 

Legalities

Ontario WSIB First Aid Regulation 1101

First aid stations must be easily accessible and be supervised by workers who:

  • Have valid first aid certificates from a WSIB – recognized training organization.
  • Work in the immediate vicinity of the stations.
  • Employers must post all required first aid information where it can be seen clearly.
  • Employers must keep detailed records of all accidents and first aid treatment given.

 

First Aid Kits

You may assemble your own first aid kit for your workplace, using Regulation 1101 as a guide. You may also purchase ready-made first aid kits from the supplier of your choice. (First Aid Program, 1998-2011)

 

Ontario Good Samaritan Act – 2001

“A person described in subsection (2) who voluntarily and without reasonable expectation of compensation or reward provides the services described in that subsection is not liable for damages that result from the person’s negligence in acting or failing to act while providing the services, unless it is established that the damages were caused by the gross negligence of the person.”

“An individual, other than a health care professional described in clause (a), who provides emergency first aid assistance to a person who is ill, injured, or unconscious as a result of an accident or other emergency, if the individual provides the assistance at the immediate scene of the accident or emergency” (e-laws.gov.on.ca)

Chase McEachern Act – 2007

“Despite the rules of common law, a person described in subsection (2) who, in good faith, voluntarily and without reasonable expectation of compensation or reward uses a defibrillator on a person experiencing an emergency is not liable for damages that result from the person’s negligence in acting or failing to act while using the defibrillator, unless it is established that the damages were caused by the gross negligence of the person.”

“An individual, other than a health care professional described in clause (a), who uses a defibrillator at the immediate scene of an emergency” (e-laws.gov.on.ca)

 

Sabrina’s Law – 2006

Requires every school board to establish and maintain an anaphylaxis policy. The legislation requires school boards to have policies that include:

Training for school staff on dealing with life-threatening allergies

  • On a regular basis;
  • Creating individual plans for pupils who have an anaphylaxis allergy;
  • Having emergency procedures in place for anaphylactic pupils. (e-laws.gov.on.ca)

 

Ryan’s Law – Ensuring Asthma Friendly Schools April 2015

  • Every school principal shall permit a pupil to carry his or her asthma medication if the pupil has his or her parent or guardian’s permission.
  • If the pupil is 16 years or older, the pupil is not required to have his or her parent or guardian’s permission to carry his or her asthma medication.

Administration of asthma medication

  • Employees may be preauthorized to administer medication or supervise a pupil while he or she takes medication in response to an asthma exacerbation; if the school has the consent of the parent, guardian, or pupil, as applicable.
  • If an employee has reason to believe that a pupil is experiencing an asthma exacerbation, the employee may administer asthma medication to the pupil for the treatment of the exacerbation, even if there is no preauthorization to do so. (e-laws.gov.on.ca)

 

Personal Protective Equipment – (P.P.E.)

Non-latex examination gloves and barrier devices are P.P.E for First Aiders. When used properly, gloves and barrier devices greatly help reduce the chance of contracting a communicable disease. These diseases can be contracted through the air and through body fluids. Examples are blood, vomit, spit, and feces.

Keychain face shield and gloves

Pocket mask and gloves

After the emergency is over, you must remove and dispose of all contaminated supplies, ideally in a biohazard bag.

 

If a biohazard bag is unavailable, double bag gloves and other contaminated materials prior to disposing in a garbage bag. Gloves should be removed safely using the following steps:

With a clean pair of gloves, you should change any contaminated clothing and change and/or clean footwear. A simple bleach and water solution (1-part bleach to 9 parts water) will decontaminate footwear and any surface affected by body fluids.

 

Communicable Diseases can be:

Airborne – Tuberculosis (TB)

Body Fluids – HIV, Hepatitis A, B, and C

Droplets – Cold (sneeze)

 

Diseases

Tuberculosis (TB) – Is usually communicated by the inhalation of the airborne causative agent which greatly affects the lungs but may spread to other areas.

HIV – (Human Immunodeficiency Virus) – Any of several retroviruses and especially HIV-1 that infect and destroy helper T cells of the immune system causing the marked reduction in their numbers that is diagnostic of AIDS.

Hepatitis A – A virus that does not persist in the blood serum and is transmitted in contaminated food and water.

Hepatitis B – A virus that tends to persist in the blood serum and is transmitted by contact with infected blood (as by transfusion or by sharing contaminated needles in illicit intravenous drug use) or by contact with other infected bodily fluids (as semen).

Hepatitis C – A virus that tends to persist in the blood serum and is usually transmitted by infected blood (as by injection of an illicit drug, blood transfusion, or exposure to blood or blood products) and that accounts for most cases of non-A, non-B Hepatitis

Meningitis – The bacteria that cause these cases are common and live in the back of the nose and throat, or in the upper respiratory tract. The bacteria are spread among people by coughing, sneezing, and kissing. While these bacteria cannot live outside the body for long, individuals can carry the Meningitis bacteria for days, weeks, or months without becoming ill. In fact, about 25 percent of the population carries the bacteria. Only rarely do the bacteria overcome the body’s defenses.

 

Critical Incident Stress – (CIS)

A First Aider goes through tremendous stress, both in mind and body, during and after an emergency. Regardless of the outcome, we need to remember that anything you did to help mattered.

After the stress of an emergency, First Aiders and bystanders need to talk with all the people that were involved in the emergency. Try to:

  • Avoid alcohol
  • Avoid any big decisions
  • Eat properly
  • Get lots of sleep
  • Talk about the incident continuously for the next 24 to 48 hours

 

If after 48 – 72 hours the First Aider or someone else involved in the emergency starts to show the following:

 

  •  Lack of sleep or over sleeping
  • Alcohol or drug misuse
  • Change in mood – sudden anger, crying, or withdrawal
  • Change in behavioural traits – not showering, using sick time, over eating, or under eating

 

 

The affected individual must be referred to their Employee Assistance Program (EAP), immediate supervisor for professional assistance, or seek assistance from your family doctor.

Before moving on to the next chapter, be confident in your knowledge. Take the self evaluation quizzes found at the end of each chapter.

Knowledge Evaluation

What PPE is mandatory in all Ontario first aid kit?

  1. Gauze, tape, scissors
  2. Gloves, barrier devices, hand sanitizer
  3. Bandages, sun screen, blanket

When acting as a good Samaritan, which is true?

  1. No one has even been successfully sued in Ontario for providing first aid with good intentions.
  2. The casualty must give consent even when unresponsive

When removing soiled fist aid gloves, it is best to:

  1. Remove clean to clean to clean and dispose in a biohazard bag.
  2. Leave gloves on the ground.
  3. Wash them in soapy water prior to removal.

Chapter 2 – Emergency Scene Management

Objectives of this chapter are for the first aider to understand:

  • How to recognize shock, fainting, unresponsiveness, trauma, and unresponsive casualties.
  • To provider first aid treatment for shock, fainting, unresponsiveness, trauma, and unresponsive casualties.

Regardless of the type of emergency, the following steps can be used no matter what situation, injury, or illness is found. By the end of this chapter you will understand and be able to do:

 

  1. Scene Survey
  2. Primary Survey
  3. Secondary Survey
  4. Care and Monitoring

 

Scene Survey

Look – Look around as you approach any emergency. You want to remove any hazards like fire, wires, or glass. Find out how many people are injured and what happened.

Talk – Talk to the casualty, get consent. If no response, TAP and SHOUT for 5-10 seconds. If still no response

Call – Direct one bystander to call 911, and someone else to get a first aid kit and AED (start internal response) immediately when a casualty is seriously injured/ill or unresponsive.

 

Primary Survey

Airway – Open airway with head tilt, chin lift.

Breathing – Make sure casualty is breathing normally not agonal (gasping/fish out of water).

Circulation – Check for signs of circulation, such as coughing, breathing or movement, skin colour, or active bleed.

Defibrillator – If needed, deploy the AED immediately upon arrival

 

Secondary Survey – When a casualty’s condition is minor, and time will allow (ex. delayed EMS response).

 

Care and Monitoring – Frequently monitor the casualty’s ABCs, treat for shock, and reassure casualty. Record information and report to EMS on arrival.

 

Scene Survey

Always be aware of hazards that can harm you as you approach any emergency. You always want to look up, down, and all around for any hazards that can harm you. You are the most important person: if you become ill or injured, you cannot help the ill or injured casualty.

Look – listen and smell for hazards

  • Wire
  • Fire
  • Glass
  • Gas
  • Weapons
  • Angry people
  • Weather
  • Others

Think of your workplace. What might be a safety issue there? Is there any machinery, forklifts, or shelving to watch for? Always be aware of your surroundings. Always remember that safe scenes can become unsafe very quickly.

Let these experts deal with the hazards that we are not trained for.
If it’s not safe to enter a scene, go to a safe area and call 911 immediately. You may need Police, Fire, Hydro, or the Gas Company.

Protect yourself further by using Personal Protective Equipment (PPE) such as gloves and a barrier device. Always try to determine the Mechanism of Injury (MOI) or what happened. Ask the casualty or any bystanders if the casualty has any possible head and spinal injuries. Tell the casualty,

“DO NOT MOVE”

Determine how many people are injured so that the most appropriate casualty receives treatment first (ex. unresponsive or a deadly bleed).

For all responsive people:

Talk – To the casualty and ask what happened.

  • Use your first name to give the casualty confidence in allowing you to assist.
  • When you talk to people you learn a lot of information.
  • They can give consent.
  • When they talk to you it means they are breathing.
  • You can determine if they are alert or possibly confused.
  • If you are unsure if 911 needs to called or the paramedics will have a delayed response, you can ask other questions to determine the history (see fig.7.2).
  • Check quality of ABCs

Take Charge, Delegate, Treat Casualty

Bystanders can be a valuable resource in an emergency. What can you tell bystanders to do? What would help you, the First Aider, if someone else did it for you? Would the list at work be different from at home?

 

Call – Have a bystander call 911 on a cellular phone if the casualty has a serious illness, injury, or is unresponsive. When in a public area, ask for an AED and first aid kit. You need to take charge at all times.
When no help is immediately available call 911 on your cellular phone and use the speaker-phone feature.

 

You will need to answer all of the 911 dispatcher’s questions, so be sure to have the answers before you call 911:

  • Exact location – house number or intersection?
  • Best entrance to use?
  • Phone number calling from?
  • What happened?
  • How many people injured?
  • Is the casualty responsive?
  • Are they breathing?
  • Any severe bleeding?

 

Never hang up unless the 911 dispatcher tells you.

Internal Response Plan

When at work and a medical emergency happen

  • Do you have to call 9-911?
  • Is there a paging system?
  • Who will direct the fire fighters and the paramedics?
  • Is the elevator on service?
  • Do you have access to all areas of the company?
  • Who gets the First Aid Kit and AED?

Only you and your health and safety team can answer these questions. Make sure that you know the plan before you need to use it.

To assist EMS at home, turn outside lights on, clear the main doorway, and put pets in a safe area.

Avoid making the first call to 911 on a cell phone if possible. Cell phone reception and caller identification are not always reliable. Cell phones can be a good choice because they allow you to stay with the casualty and get additional first aid assistance from the dispatcher.

 

Trauma Injuries

If the mechanism of injury or other signs and symptoms indicate a possible head or spinal injury, DO NOT MOVE the casualty. Most traumas cause possible head, back, and spinal injuries.

Concussions are often difficult to determine, so anyone that has a blow to the head should stop all activities and seek medical advice. First Aiders may make these injuries worse if they move the casualty.

Always leave the casualty in position found unless:

  • Casualty’s safety is in danger (fire, water, or fumes)
  • Casualty’s airway is in danger (vomit)

 

If the First Aider must move the casualty with a suspected head, neck, or spinal injury, use the recovery position to protect the casualty’s airway.

 

 

Rapid Body Check

If the casualty has decreased ABCs or no ABCs, a quick check for life threatening bleeds and other injuries must be completed. Treat any life-threatening bleeds if found. Look for any jewelry with medical information. Use DOTS (below)to assist with this process.

Care and Monitoring

Always remember you are treating a casualty. Once you have treated them you cannot forget about them. While you wait for EMS…

  • Monitor the scene.
  • Monitor ABCs.
  • Keep casualty warm.
  • TALK TO THE CASUALTY (even if unresponsive).
  • Record information and report to EMS on arrival.

This procedure needs to be repeated several times while waiting for EMS to take over.

 

After you have completed:

Look – Look around as you approach any emergency. You want to remove any hazards

like fire, wires, or glass. Find out how many people are injured and what happened.

 

Talk – To casualty, if no response, TAP and SHOUT for 5-10 seconds. If still no response…

Call – Direct a bystander to call 911 and someone else to get a first aid kit and AED, then return to the location.

Airway – Open the casualty’s airway with a head tilt chin lift for all casualties on their back.

Breathing – Check the casualty’s breathing for normal breathing for 5-10 seconds.

Circulation – When a casualty is breathing normally they have circulation or signs of life.

 

If not breathing or not breathing normally, start CPR and use the AED.

Defibrillation – Ensure the AED is turned on as soon as it arrives if required.

 

Shock and Unresponsiveness

People go into all kinds of shock from many different causes. Shock should always be treated as life threatening by First Aiders.  Therefore, always treat for shock before you see any signs of shock.

 

Shock: A state in which the circulatory system fails to

supply enough blood to peripheral tissues to meet basic requirements. (mw.com)

 

Common Causes

  • Blocked arteries (heart attack)
  • Swollen airways (severe allergic reaction)
  • Cut or burst arteries (stroke)
  • Dehydration (vomiting)
  • Spinal cord injury
  • Head Injury

 

Signs and Symptoms

  • Anxiety
  • Dizzy/confused
  • Short of breath
  • Pale
  • Sweaty and cold (clammy)
  • Rapid heart rate
  • Nausea and vomiting
  • Unresponsiveness

 

Treatment of Shock

  • Look for hazards, MOI, and number of injured
  • Talk to the casualty
  • Call 911, AED, First Aid Kit (internal response)
  • Stop any life threating injuries
  • Rest casualty in comfortable position
  • Keep warm with clothing or blanket
  • Keep comforting casualty
  • No food or water
  • Monitor casualty condition and record information until EMS arrive

 

Fainting: “a temporary loss of responsiveness that is self-correcting”
 (thefreedictionary.com)

 

A fainting casualty will have all the signs and symptoms of shock. When the casualty collapses, their brain receives the oxygen it needs, and the casualty wakes up and starts to improve.

 

The most common causes of fainting are:

  • Low blood sugar – haven’t eaten all day
  • Dehydration – haven’t drank enough on hot days or during exercise
  • Low blood pressure – getting up too quickly
  • Slow heart rate – heart arrhythmias
  • Overheated – overdressed in crowd
  • Standing for too long – parades

 

Treatment of Fainting

  • Leave casualty in lying position until feeling better
  • If unsure of their condition, call 911
  • Keep warm (unless overheated)
  • When feeling better, allow casualty to sit up slowly
  • Check for any secondary injuries caused by the fall

 

Positions used in First Aid

 

Supine (on back) position or position found

Recovery position

Semi sitting or position of comfort

Knowledge Evaluation

In first aid the term ABC stands for.

  1. Assess, Bandages, Cuts
  2. Airway, Breathing, Circulation
  3. Area, Body, Crisis

The three actions that complete “Look” of the scene survey are:

  1. Police, Fire, EMS
  2. Bystanders, witnesses, doctors
  3. Hazards, MOI, how many casualties

First aid treatment of casualty in shock is:

  1. Ensure resting position, nothing to drink, and reassure
  2. Yell at them until you get their attention
  3. Go outside and wait for EMS

ar 2 – Emergency Scene Management

Chapter 3 – Cardiovascular Emergencies

Objectives of this chapter are for the first aider to understand:

  • Signs and symptoms of a possible heart attack or angina.
  • Signs and symptoms for a possible stroke and TIA.
  • First aid treatment for casualty until EMS arrives.

 

Chain of Survival

 

®HSF 2015

 

  • Immediate recognition and activation of 911
  • Early CPR
  • Rapid Defibrillation
  • Effective advanced life support

 

Cardiovascular Emergencies

Common reasons for Cardiac Arrest due to coronary artery disease are heart attacks and strokes. In fact …in 2008, of all cardiovascular deaths (Statistics Canada, 2011c):

  • 54% were due to ischemic heart disease
  • 20% to stroke
  • 23% to heart attack

 

Definitions are:

Heart attack “Usually occurs when a blood clot blocks the flow of blood through a coronary artery (a blood vessel that feeds blood to a part of the heart muscle). “The interrupted blood flow that occurs during a heart attack can damage or destroy a part of the heart muscle.” (www.mayoclinic.org)

Angina “… Is a type of chest pain caused by reduced blood flow to the heart muscle. Angina is a symptom of coronary artery disease. Angina is typically described as squeezing, pressure, heaviness, tightness or pain in your chest.” (www.mayoclinic.org)

Ischemic Stroke “Occurs when the blood supply to part of your brain is interrupted or severely reduced, depriving brain tissue of oxygen and food” (www.mayoclinic.org)

Hemorrhagic Stroke “A brain aneurysm can leak or rupture, causing bleeding into the brain.” (www.mayoclinic.org)

Transient Ischemic Attack (TIA) – “Is like a stroke, producing similar symptoms, but usually lasting only a few minutes and causing no permanent damage. Often called a mini stroke, a transient ischemic attack may be a warning. About 1 in 3 people who have a transient ischemic attack will eventually have a stroke, with about half occurring within a year after the transient ischemic attack” (www.mayoclinic.org)

Signs and symptoms:

Heart Attack

Paleness

Anxiety

Sweating

Short of Breath

Indigestion

Tightness in chest

Overall weakness

Nausea or vomiting

Stroke

Facial Droop

Arm drift

Speech problems

Time of onset

Tightness in chest can also be described as pressure, heaviness or heart burn. Discomfort or pain can also be found in arm or arms, shoulders, in upper back, side of the neck or in the jaw.

May time elderly person that have diabetes for years never complain of any pain or discomfort. They may deny anything is wrong. They will exhibit signs and symptoms of shock.

 

First Aid Treatment

 

Look for hazards, talk to the casualty, call 911, and ask someone to get an AED. Place casualty in position of comfort, keep them warm, reassure them, do not offer food or water, and assist casualty with their medications.

Remember the 5 Rights (right casualty, medication, dose, time, and route of medication) when assisting with medications such as Nitroglycerin or ASA, wait until EMS arrives. Report all recorded information to EMS.

 

Knowledge Evaluation

Signs and symptoms of a stroke, FAST are:

  1. Fainting, Arm Twitching, Squinting, Tension
  2. Facial Droop, Arm Drift, Slurred Speech, Time of Onset
  3. Farting, Ankles, Swelling, Tongue

All casualties always experience pain or discomfort during a heart attack.

  1. True
  2. False

For signs and symptoms of a heart attack, fill in the blanks.

Pale, Anxiety, S______, Short of breath, I_________, Tightness in Chest,

O___ ________, Nausea and Vomiting

Chapter 4 – Cardiopulmonary Resuscitation

Objectives of this chapter are for the first aider to understand:

  • When and how to do CPR effectively for all age groups.
  • Signs and symptoms of mild and severe choking with effective treatment for all ages.
  • When and how to apply an AED in a timely manner.

 

CPR has been used in a pre-hospital setting since the 1970’s. Unfortunately, there has been little increase in the survival rate over the last 40 or so years. Less than 5-10 % of adults that get CPR alone will ever have a chance of walking out of a hospital.

Regardless of this statistic, CPR is very important because it gives oxygen to the brain. If CPR is delayed:

  • 4-6 minutes brain damage starts to occur.
  • 6-8 minutes brain damaged.
  • 10 minutes or more, brain damage is usually permanent.

 

CPR is started immediately for a casualty in cardiac arrest (unresponsive and not breathing), so the casualty’s brain and heart stay oxygenated until an AED or the paramedics arrive with their medical equipment.

Remember, urban EMS systems take 8-12 minutes to arrive on scene.

Adult and Child CPR

Look – All hazards (listen and smell), how many people injured, and MOI.

Talk – Talk to casualty, if no response, tap and shout for 5-10 seconds.

Call – Direct one person to call 911 and someone else to get a first aid kit and AED (start internal response).

Airway – Open the airway with a head tilt chin lift.

Breaths – Look for normal breathing not gasping or agonal breaths

Circulation – Start compressions pushing hard and fast at the rate of at least 100 compressions/min. Allow chest to fully expand (chest recoil) before next compression.

Breaths – Give 2 normal breaths just until the chest rises; each breath lasting approximately 1 second.


If the first breath does not go in, readjust the head and try again. Whether or not the breaths go, start compression’s immediately. If no barrier device available, DO NOT give breaths. Instead, go right to compression’s and perform non-stop compression-only CPR until a barrier device is available or EMS takes over or …

 

Stop doing CPR 

You may stop CPR as a lay rescuer anytime:

  • The casualty regains signs of circulation.
  • An individual with a higher level of trained help takes over.
  • Your health or safety is in danger.

Interrupt CPR

You may briefly stop CPR when:

  • Casualty vomits – turn to recovery position.
  • AED is on casualty and advises “DO NOT TOUCH PERSON” – listen carefully to all the instructions.

Defibrillation – As soon as the AED arrives, turn on AED and follow the directions.

 

CPR is very tiring, so it is recommended that every 5 cycles of CPR or approximately two minutes, the First Aider switches with another First Aider to stay effective. Two rescuer CPR helps conserve the energy of First Aiders and delivers high quality CPR to the casualty. Just remember to stop compressions while the other First Aider gives 2 breaths.

Pregnant women in their third trimester need a 2.5 cm (1”) wedge placed under their right hip. This moves the unborn off the mother’s main blood vessel allowing for better return circulation.

Infant CPR

Look – Notice all hazards, how many people injured, and MOI.

Talk – Talk to infant, if no response, tap bottom of foot for 5-10 seconds.

Call – 911 ask someone to get an AED (start internal response).

Airway – Open the airway with a head tilt chin lift, be careful not to tilt too far (sniffing position).

Breathing – Look, listen, and feel for normal breathing for 5-10 seconds. If no normal breath is found:

Circulation – Start compressions, pushing hard and fast at the rate of at least 100-120 compressions per minute. If no barrier devices on scene, just continue with compressions only. Perform non-stop compressions until a barrier device is available or EMS takes over.

Breathing – If there is a barrier device available, give 2 normal breaths covering the infant’s mouth and nose with your mouth. Give just enough air to see the chest rise. Each breath should take approx. 1 second. If the first breath does not go in, readjust the head and try again. Whether the breaths go in, start compressions immediately.

Infant Chest

Head tilt, Chin lift

Defibrillation – As soon as the AED arrives, turn on AED and follow the directions.

Continue CPR and AED until EMS takes over or infant shows signs of circulation.

 

CPR Review

  • Push Hard and Fast at the rate of at least 100 compressions per minute.
  • Don’t stop.
  • Allow chest to completely rise (chest recoil).
  • Remember high quality compressions is best.

 

Knowledge Evaluation

The ratio compressions to breaths for all casualties in cardiac arrest is:

  1. 30:2
  2. 15:1
  3. 5:4

The rate of compressions is:

  1. 80 – 100 per minute
  2. 90 – 110 per minute
  3. 100 – 120 per minute

When giving breaths to an infant you must pinch their nose and seal their mouth.

  1. True
  2. False

Automated External Defibrillator (AED)

Cardiac Arrest is suspected when a casualty is unresponsive and not breathing. Many cardiac arrests happen in a public place. Some contend that over 65% of cardiac arrests happen outside of a hospital setting. Because of this, many public places now have automated external defibrillators (AEDs) available in their facility.

 

Cardiovascular System

The respiratory system is what delivers oxygen into the body and lungs. Then the circulatory system delivers it to all the other systems requiring oxygen. The respiratory system starts with the two entry ways: the nose and the mouth. It then carries on into the trachea, bronchus, and bronchioles, then into the alveoli. This is where the gas exchange happens with the blood replacing oxygen-poor air with oxygen-rich air.

Many organs, including the heart, use large amounts of oxygen. When these organs don’t get enough oxygen, they are not able to function properly. When the heart becomes too deprived of oxygen, the muscle and the electrical system suffer.

The heart is a muscle. It has four chambers; the top two are the atria and the bottom two are called the ventricles. The pumping action of the heart is created by the heart’s own electrical system. During normal heart function, the atria fills with blood and when full, allow that blood to flow into the ventricles. When the ventricles are full, they push blood out to the body and lungs.

When the electrical system of the heart doesn’t get enough oxygen, it becomes confused and stimulates the bottom (ventricles) of the heart. This sends the whole heart into a quivering-like shake called fibrillation and it stops pumping blood. When the heart is in fibrillation the only thing that will help the heart is a defibrillator. When someone collapses in SCA, Ventricular Fibrillation (VF or V Fib) is the most common wrong rhythm (dysrhythmia) for the first 3-4 minutes. A casualty loses 7-10% chance of survival for every minute that nothing is done.

Ventricular Fibrillation on ECG monitor

 

Look for These Signs

Public Access Defibrillation programs with user friendly AEDs (PAD/AED), can be found in most communities and more and more workplaces every day. No matter what kind of defibrillator you find inside the unlocked wall cabinet, they are all similar to use.

All AEDs have

1.Easy on/off

2.Voice directions

3.Electrodes (sticky pads)

4.Shock button, which you must push

5.The ability to record data

 

Places to Find AEDs

  • Ontario Government Buildings
  • Elementary and High Schools
  • Mass Transit (GO Train)
  • Libraries
  • Arenas
  • Community Centres
  • Ontario Colleges and Universities
  • Municipal Government Building
  • Public Pools

“In 2008 cardiovascular disease accounted for … more than 69,500 deaths in Canada.” (Statistics Canada, 2011c) Their best chance of survival is performing CPR and using an AED as soon as possible.”

Conditions Requiring an AED:

Unresponsive and not breathing for all ages


When the AED arrives, place AED at casualty’s head. TURN IT ON. Continue CPR until the AED is ready.

Follow the AED’s directions:

  • Clear clothes from the casualty’s chest
  • Open electrodes package
  • Place electrodes on casualty’s bare chest as shown
  • STOP CPR when AED says “Analyze”
  • Push the shock button, if directed
  • It is safe to touch the casualty
  • Start CPR with 30 compressions then 2 breathes
  • Continue CPR for 2 minutes
  • Stop CPR when AED says “Analyze”
  • Push the shock button if directed
  • It is safe to touch the casualty
  • Start CPR with 30 compressions then 2 breathes

AED Accessories

Repeat sequence until EMS takes over or casualty shows signs of life

When the AED says, “NO SHOCK ADVISED”, there are several dysrhythmias that can be present. Here are two examples of non-shockable rhythms.

Asystole

 

 

Normal Sinus Rhythm

 

When the AED says, “NO SHOCK ADVISED” the AED will not charge and will instruct you to start or continue CPR. This means that as lay rescuers, we are unable to help this casualty right now but with good CPR, the paramedics will have a well-oxygenated heart to use their advance skills on.

Remember, pregnant women in their third trimester need a 2.5 cm (1”) wedge placed under their right hip. This moves the unborn off the mother’s main blood vessel allowing for better return circulation.

Children and Infants

Most AED manufacturers make child or pediatric electrodes, but many AED sites do not carry them. It is always better to use the proper electrodes for the casualty’s size but if they are not available, use ADULT electrodes. Children and infants use the same electrodes. Place the front pad in centre of infant or child’s chest. Place lower left pad in centre of back between shoulder blades.

Safety and Special Circumstances

If the casualty is in a puddle of water, you need to move them to a drier area. Quickly dry off the chest.

If the casualty is lying on metal (grates, fire escapes, or loading docks, etc.) they need to be moved off the metal surface before defibrillation.

Ensure that neither you nor anyone else is touching the casualty when you deliver the shock.

 

You can use an AED if a casualty is in cardiac arrest with any of the following circumstances:

  • Drowning
  • Electrocution
  • Trauma
  • Pregnant
  • Choking
  • Excessive chest hair
  • Medication patches
  • Implanted pacemakers or defibrillators

 

Knowledge Evaluation

Who can use and AED?

  1. Trained First Aiders
  2. The owner of the AED
  3. Anyone who wants to help

You can only use a defibrillator for:

  1. Adults and children
  2. Adults
  3. Adults, Children and Infants

The AED’s shock:

  1. Corrects the wrong rhythm
  2. Stops the heart
  3. Is checking for an external pacemaker

 

Adult and Child Choking – Responsive

Most choking occurs when you least expect it. Adults and children will always benefit from choking prevention by:

  • Not talking and eating
  • Taking small bites of food
  • Chewing food well
  • Chewing food slowly
  • Avoiding excessive alcohol during the meal

Choking can still occur, so let’s be prepared.

Mild Choking

Signs & symptoms

  • Coughing
  • Wheezing (with good colour)
  • Talking

Keep the casualty calm and talk to them. Encourage them to continue coughing forcefully.

DO NOT give water or hit the casualty on the back.

Stay with them until their airway clears or choking becomes severe.

Severe Choking

Ask the casualty to talk, if they cannot talk and you see:

  • Bulging eyes
  • Panicked expression
  • Hands around neck
  • Wheezing with poor colour

Reassure the casualty, ask if you can help, go to the casualty’s side and:

  • Lean the casualty forward, supporting them with one of your arms
  • Take your other hand and give up to 5 back blows using the heel of your hand between the shoulder blades

Adult back blows

Adult Abdominal

If the object has not cleared, go behind the casualty

  • Reach around the waist and locate their navel (belly button)
  • Place a flat fist just above the navel
  • Put your other hand on top of the first
  • Then push in past the ribs and up into the abdominal cavity
  • Give up to 5 abdominal thrusts

 

Depending on the age of the child you may have to kneel down to give first aid treatment.

Child back blows

Child abdominal thrusts

If the object has not been cleared continue administering 5 back blows and 5 abdominal thrusts until the airway clears or the casualty goes unresponsive.

If the casualty becomes unresponsive, lay them flat on the ground and make sure someone calls 911 and gets an AED.

Unresponsive Choking

Then start CPR. Remember, before you give breaths, check in the mouth to see if you can reach the object. If you can reach the object, then take it out. If you cannot see an object, DO NOT stick your fingers in the casualty’s mouth.

Continue this process until EMS takes over or the casualty regains sign of life.

Infant Severe Choking

If an infant cannot cry, talk, make noises or has:

  • Bulging eyes
  • Panicked expression
  • Wheezing with poor colour

 

Place infant in the football hold:

1.Put infant face down in palm of hand supporting face and neck. Ensure not to block mouth or nose.

2.Lay infant’s body on top of your arm, making sure infant’s head is lower than their buttocks and infant’s crotch is in the crook of your elbow.

3.With the heel of your free hand, strike the infant between the shoulder blades up to 5 times.

5 back slaps

5 chest thrusts

4.If object doesn’t clear, support back of infant’s head with your free hand and flip infant onto your free arm.

5.With infant face up, landmark same as CPR and give up to 5 chest thrusts pushing down 1/3 of the chest depth or 1.5 inches (4cm) with two fingers

If airway has not cleared, continue with 5 back blows and 5 chest thrusts until airway clears or until infant becomes unresponsive. Tell someone to call 911 and get an AED and return.

Then start CPR. Remember, before you give breaths, check in the mouth to see if you can reach the object. If you can reach the object, then take it out. If you cannot see an object, DO NOT stick your fingers in the infant’s mouth. Continue this process until EMS takes over or infant regains sign of life.

Special Circumstances

If you are by yourself and are severely choking you must act quickly. You must drop on your abdomen just above the navel on top of a hard edge.

Pregnant, obese or wheelchair

Self Administered

For a casualty who is sitting in a wheelchair, pregnant or too large to get your arms
around, use chest thrusts.

1.Give up to 5 back blows then standing behind the casualty put your arms under their
armpits.
2.Make a fist and place in the centre of the breastbone. Place other hand on top.
3.Then pull straight in, up to 5 times.

Continue until the casualty’s airway clears or the casualty becomes unresponsive. Start
CPR with compressions and continue looking in the casualty’s mouth before breaths.

Do Not Stop until EMS arrive or until the casualty shows signs of life.

Knowledge Evaluation

  1. The most common sign of a severe choking from an adult is:
    a. Arms raised in the air waving
    b. Hands to their throat, eyes bulging
    c. Someone screaming “I’m choking”
  2. Back blows should be administered when:
    a. Non-verbal consent has been given
    b. If they are unable to talk or breath
    c. All of the above
  3.  Signs and symptoms of mild choking in an infant:
    a. They can cough or cry
    b. Bulging eyes and bluish skin
    c. They push their food away

Chapter 5 – Severe Bleeding and Wound Care

Objectives of this chapter are for the First Aider to understand:

  • Signs and symptoms for internal and external bleeding and wounds.
  • Signs and symptoms of bites and stings.
  • Provide first aid treatment for the casualty until EMS arrives.

At work or play, injuries can happen. As a First Aider, you must understand what is happening with bleeds and injuries. When you understand what is occurring, the treatment will follow quicker.

There are as many kinds of bleeds and wounds, as there are ways to provide first aid treatment. Let’s look at these now.

Dressings

 Gauze is sterile, lint free and absorbent to control or stop

bleeding and control infection from open wounds.

Bandages

Many items can be used for bandages to apply pressure and secure the dressing to the wound.

Conforming gauze

Triangular

Depending on the industry you work in, a first aid kit contents may be different. Some common items are:

Sterile gauze

Adhesive bandages

Roller gauze

Scissors

Safety pins

Note pad and pencil

Splint Padding

Triangular

Tape

Barrier device

Splint

Non-latex gloves

Hand Sanitizer

Ice Pack

Blanket

Treatment of open or external wounds

REST and DIRECT PRESSURE

LOOK – Ensure scene is safe for you and injured casualty. While applying your personal protective equipment (PPE), give the gauze to the casualty and instruct them to apply pressure to the wound.

TALK – To the casualty and tell them to put direct pressure on the wound until you can get the gauze. Ask what happened.

CALL – Activate your internal response and decide if there is a need to call 911 and retrieve an AED.

Wounds that Need Immediate Medical Attention
Arterial Bleeds

Animal or human Bites

Impaled/Embedded Objects

Internal Bleeding

Head, back and spine wounds

Chest Wounds

 

With your gloved hand apply the gauze dressing to the wound and apply direct pressure. If bleeding is controlled, you may apply a gauze or triangular bandage to secure the dressing. Check for good circulation, sensation, and movement (CSM) before and after bandaging to ensure the bandage is not too tight.

Slings

 

Slings can be made from triangular bandages. The purpose of a sling is to immobilize the limb, reduce pain, and provide comfort to the casualty.

Here are a few slings that can be used depending on the type of injury.

Shoulder Sling

Arm Sling

Wounds

Treatment

Minor Wounds

Minor wounds are wounds that do not require medical attention:

  • Small cuts
  • Abrasions
  • Small bruises
  • Nose bleeds

Clean minor wounds by:

  • Removing any loose debris
  • Gently flushing with water, soap if available
  • Cover with sterile gauze
  • Ensure Tetanus (Lockjaw) immunization up to date

Watch for signs of infection such as…

Knowledge Evaluation

To stop an external bleed, you must

  1. Have the casualty rest and apply direct pressure
  2. Have a bandage bigger than wound
  3. Nothing it will stop

To stop a nose bleed you must:

  1. Put your head back
  2. Lean forward
  3. Shove tissue up nostrils

Signs and symptoms of an internal bleed may include:

  1. Pale, weak and vomiting
  2. Swelling of hands and feet
  3. Can only be diagnosed by a doctor

Chapter 6 – Burns Care

Objective of this chapter is for the First Aider to understand:

  • Signs and symptoms of first, second and third-degree burns.
  • Signs and symptoms of chemical, radiation, heat and electrical burns.
  • Provide first aid treatment for the casualty until EMS arrives.

Burns can be caused by one of these things:

Electrical – Chemical – Thermal – Radiation

Treatment

Chemical (liquid and dry)

Look – To ensure the area is safe. Only enter if the area is safe. You may have to open windows or doors.

Talk – To the casualty to find out what happened and what chemical injured them.

If the chemical is a dry chemical (ex. chlorine), with a covered hand remove excess chemical.

 

Whether dry or liquid chemical, flush for up to 20 minutes into a contained receptacle. Cover loosely with a sterile dressing. All chemical burns must go to the hospital.

If possible, always flush directly on skin with low pressure. Also, if possible, remove:

  • Affected clothing – ensure clothing is not stuck to skin. If stuck flush through clothes.
  • Jewellery in affected area if possible.

Canadian workplaces currently have material safety data sheets (MSDS) available in the area. Starting in November 2018 all Canadian workplaces with chemicals on site will be switching to the new Global Harmonized System (GHS) by June 2019.

 

Ensure that the MSDS or SDS (Safety Data Sheet goes to the hospital with the casualty. At home, containers should go to the hospital with the casualty when possible.

 

People with chemical burns, electrical burns, or any degree of burns to the hands, face, and feet must seek medical attention

 

Thermal and Radiation Burns

Look –To ensure the area is safe. Only enter if the area is safe. You may have to open windows or doors.

Talk – To the casualty find out what happened.

1st and 2nd degree thermal burns – Rinse affected area with cool water for 15-45 minutes until the area is cool when removed from water. Do not use any substance that is oil or alcohol based to cool the burn.

Do not break any blisters. Watch for infection if the blisters break. Cover lightly with a gauze if needed.

Treat the casualty for shock.

3rd degree burns – ensure the source is extinguished.

Call – Call 911 and ask for an AED

Cover burns with a light gauze dressing and treat for shock and monitor casualty’s ABCs while waiting for EMS.

Electrical Burns

Look – Ensure that electricity is turned off and casualty is not attached to wires or lightning and

has been moved to safe distance. Be aware that falls often accompany electrocutions so suspect head, spinal, and pelvic injures.

Talk – To the casualty to find out what happened and what volts or amps injured them.

Call – Call 911 and ask someone to get an AED

Look for entry and/or exit wounds and gently cover wounds with gauze dressing. Treat for shock and monitor casualty’s ABCs. Record any information for EMS.

 

Knowledge Evaluation

Burns can be caused by which of the following four things?

  1. Electrical – Chemical – Turpentine – Radiation
  2. Electrical – Chemical – Thermal – Radiation
  3. Electrical – Chemical – Thermal – Radon

The proper way to treat a first-degree thermal burn is:

  1. Apply butter to the area
  2. Apply toothpaste to the area
  3. Cool the area with water

Chapter 7 – Medical Emergencies

Objective of this chapter is for the First Aider to understand:

  • Signs and symptoms diabetic emergencies, seizures, asthma, and severe allergic reactions.
  • Provide first aid treatment for the casualty until EMS arrives.

 

Diabetic Emergencies

There are causes of diabetic emergencies from Type 1, Type 2, and Gestational Diabetes. Regardless of the type of diabetes, a casualty can have a high or low blood sugar emergency.

 

Signs and Symptoms

 

High Blood Sugar Emergencies         Low Blood Sugar Emergencies

Hyperglycemia                                     Hypoglycemia

Slow onset                                          Fast onset

Flushed skin                                        Pale, cool, sweaty skin

Fruity breath                                          Combative

Sleepy                                                   Acts intoxicated

 

Causes:

  • Infections
  • Over eating
  • Not eating
  • Over exertion
  • Forgot insulin shot

 

Treatment

Look – Ensure you are not in danger from the casualty.

Talk – To the casualty and ask…

  • Last time they ate?
  • Did it happen fast or slow?
  • If they are a diabetic?

Call – 911 if you are in danger or you do not know the casualty.

 

When the casualty is responsive, offer sugar in this order:

  • Glucose pills/gel/drink
  • Candy (Mentos, Skittles, jelly beans)
  • Fruit juice (orange juice with more sugar added)
  • Whole Milk

If casualty is unresponsive, ensure casualty is breathing, place in the recovery position, and monitor ABCs. Record any findings to report to EMS upon arrival.

 

Seizures

Seizures are caused by an electrical malfunction in the brain. There are many different seizures and many different reasons. Seizures can last anywhere from 30 seconds to 2 ½ minutes.

Some causes are:

  • Head injuries
  • Diabetic emergencies
  • Brain tumour
  • Heat stroke

Treatment

Look – Clear the area to ensure the casualty cannot strike something.

Talk – To the casualty to see if they are responsive. If unresponsive tap and shout for 5-10 seconds.

Call – Have someone call 911 and someone else get an AED.

 

DO NOT 

  • Hold the casualty down or put anything in their mouth.
  • Do not place your hands or feet under the casualty’s head.

 

DO

  • Place protection under the casualty’s head (jacket, towel magazine, etc.).
  • When seizure finishes ensure the casualty is breathing normally.
  • Roll them into recovery position after the seizure. • Cover to keep them warm and give privacy.
  • Monitor the casualty’s ABCs and reassure the casualty until EMS takes over.

Asthma 

A chronic inflammatory disease of the airway that causes the following signs and symptoms:

 

  • Shortness of breath
  • Tightness in the chest
  • Coughing
  • Wheezing
  • Pale
  • Sweaty

Triggers

  • Weather
  • Dog and cat dander
  • Cockroach excrement
  • Smoke
  • Stress or emotional upset
  • Scents
  • Pollen and mold
  • Dust mites

Treatment

Look – For any hazards.

Talk – To the casualty, get consent, and sit them down.

Call – Have someone call 911 and get an AED.

  • Ask if they have their medication, if so assist.
  • Confirm colour of puffer needed (blue or grey).
  • Read prescription label to give assist with proper treatment.
  • Shake puffer for 5-10 seconds.
  • Reassure the casualty and monitor their breathing.

Severe Allergic Reaction (Anaphylactic Shock) – A severe allergic reaction can potentially become life threatening within seconds, sometimes minutes, of being exposed to an allergen.

Many things can cause severe reactions.

  • Foods – nuts, peanuts, shellfish, dairy
  • Medications – sulfate drugs or penicillin medications
  • Insect bites
  • Latex

Signs and Symptoms

  • Rash
  • Hives
  • Watery Eyes
  • Swelling of
  • Eyes
  • Face
  • Tongue
  • Neck
  • Difficulty Breathing
  • Coughing, wheezing
  • Cramps, diarrhea, vomiting

Treatment of Severe Allergic Reactions

Look – To ensure there are no objects or hazards. Talk – To the casualty to see if they are responsive. If unresponsive tap and shout for 5-10 seconds. Call – Have someone else call 911and ask for an AED immediately

 

Have casualty sit down and ask if they have any medication such as an EpiPen®.

If the casualty has their own EpiPen®, you can assist if the casualty needs assistance.

  • Look at expiry date and window.
  • Take the pen and ensure your thumb is not covering either end.
  • Remove BLUE safety cap.
  • Place ORANGE needle end against outer thigh.
  • Push EpiPen® while listening for click.
  • Hold in place for approx. 5 seconds.
  • Massage the area.

Continue to monitor the casualty’s breathing and reassure the casualty. Record any information to report to EMS on arrival. If any severe signs and symptoms reappear within five minutes, use their second EpiPen® if available.

 

Knowledge Evaluation

 

Watch this video EpiPen® Video

Chapter 8 – Physical Exam

Objectives of this chapter are for the First Aider to understand:

  • How to provide a secondary assessment of history of incident vital signs and a head to toe exam.
  • Provide minor wound care and ongoing care for a longer period due to an extended delay in the arrival of EMS.

 

When the life-threatening emergencies are taken care of and the paramedics haven’t arrived yet what can you do? The ambulance might be delayed because of your remote location, so now what?

 

Now the First Aider can move onto a secondary survey.

This may include:

  • History of illness or injury
  • Level of awareness
  • Vital signs
  • Head to toe examination

 

A secondary survey will assist the first aider in discovering any illness or injuries that you may have missed or that the casualty has been unable to relate.

A full head-to-toe physical exam may not always be necessary or appropriate.

Another example is a casualty who fell, is responsive but confused. They may require a head-to-toe exam checking for DOTS (fig.8.1) and asking SAMPLE questions.

For example, a casualty who fell and who is responsive and alert may only require an exam of the leg and arm combined with SAMPLE questions. (Fig.8.2)

 

Glasgow Coma Scale

This modified scale helps First Aiders determine the level of consciousness of the ill or injured casualty.

The scale has three categories:

  • Best Eye Response 1-4 points
  • Best Verbal Response 1-5 points
  • Best Motor Response 1-6 points

With each category awarding points for responsiveness a casualty could have a score anywhere between 3-15 points.

Conscious (responds) 11-15 points

Eyes open, appropriate words, correct movement response.

Semi-Conscious (semi-responsive) 8-11 points

Eyes open to verbal, inappropriate words, moves towards pain.

Unconscious (unresponsive) 3-8 points

Eyes closed, no verbal response, no movement.

Vital Signs

Vital signs are important to record to start a document of the casualty’s condition. Here are the four vital signs we look at:

 

  1. Pulse
  2. Breathing
  3. Level of Consciousness
  4. Skin Condition

Head to Toe Examination

Remember to always look at the casualty to see if they grimace when they are not alert or confused.

Begin checking for DOTS (Fig. 8.1) at the head. Only uncover the casualty as required and remember to constantly talk to the casualty even if they are confused. To locate any other injuries, gently squeeze the casualty’s body systematically. Remember to check your gloves often for fluids. Record any findings if possible to report to EMS when they arrive. Begin the head to toe exam checking for DOTS at the head:

 

Head – Note if you feel any bumps, depressions, or blood. Also check their ears and nose for any fluids.

Neck – Look to ensure their airway is in middle of the throat and there are no vessels sticking out. Read any medical tags you locate.

Chest – Gently squeeze the sides of their chest and have casualty take a deep breath if possible.

Abdomen – Gently press all four quadrants using the navel as the axis.

Pelvis – Gently squeeze together then push down on their pelvis. Note any sign of fluids on clothing.

Back – Do one side of their back at a time looking for blood or any fluids. Don’t forget to also check the buttocks area.

Legs and Arms – Check for any bumps, bruises, blood, or medical tags. Have casualty wiggle their toes or feet if possible. Check for radial pulse values. Remember to check both sides of the casualty’s legs and arms.

Use the sheet found on page 72 to record your findings. This form can be copied and placed inside your first aid kit.

  1. The four vitals signs in a physical exam are: Level of consciousness, Breathing, Pulse and:
    1. Colour
    2. Blood Pressure
    3. Skin Condition
  2. When performing a secondary assessment, you are treating:
    1. Life – Threatening Injuries
    2. Minor Injuries
    3. No injuries

Chapter 9 – Bone and Muscle Injuries

Objectives of this chapter are for a First Aider to understand:

  • Recognise signs and symptoms of bone, joint and muscle injuries.
  • Provide first aid treatment for the casualty until EMS arrives.

Accidents can happen anywhere and at any time. These accidents may cause a casualty to sustain a fracture, dislocation, or a muscle injury referred to as strains or sprains. (Fig. 9.1)

 

Factures – Also called breaks or cracks, fractures can be closed if the fracture doesn’t break the skin. If the fracture does break through the skin, then it is called an open fracture or compound fracture.

Dislocations – A joint is where two bones are joined together and then become separated.

Sprains – When ligaments are stretched beyond their abilities.

Strains – When tendons or muscles are stretched beyond their abilities.

Treatment

Look – Ensure it is safe to approach.

Talk – Ask the casualty what happened.

Call – 911 and retrieve an AED if either is needed.

Put the casualty in a resting position and use principals of RICE:

R – Rest the casualty in a comfortable position

I – Immobilize if a limb is affected

C – Cold for no more than 20 minutes with a barrier

E – Elevate a limb if elevation will not worsen injury

If it becomes necessary to move an injured casualty, splint the limb in a position found to reduce pain and reduce the chance of further injury.

Femur (Thigh) Injury

This is a very painful and dangerous injury. A casualty with a femur fracture can lose up to 1 litre of blood per fracture.

Movement or bearing weight may make this fracture worse.

Many internal organs and major blood vessels are located in, or pass through, the pelvis and abdominal areas. Any injuries to this area can cause severe internal bleeding, organ damage, and nerve damage. There are many incidents that cause pelvis and abdominal injuries and most require a significant mechanism of injury (MOI) such as a long fall or a car accident.

Tooth and Mouth Injuries

When a casualty has been injured in the mouth you must stop

the bleeding with moist gauze immediately. If a tooth has been dislodged, pick the tooth up by the exposed area (not root) and place in whole milk or persons own saliva in a cup to help preserve the tooth. Call the casualty’s dentist immediately.

Repetitive Strain Injury

Repetitive Strain Injuries (RSI) are repetitive rapid and forceful movements causing the over use of tendons.

This can affect a casualty’s hands, arms, shoulders, backs, or legs. Poor posture, extended length of standing, or remaining stationary in any position for too long can cause RSI’s. When you add in key boarding, cold environments, or vibrations, the strain can become a life altering injury. Stop activities and seek medical attention. Use the R.I.C.E. to help with pain and swelling.

 

Knowledge Evaluation

RICE stands for:

  1. Rotate, Immobilize, Compress, and Evaluate
  2. Rest, Immobilize, Cold and Elevate
  3. Rest, Ice, Cold and Evaluate

 

When a casualty looses a whole tooth, you should:

  1. Rinse off with water and replace in the casualty’s mouth
  2. Put in casualty’s spit and go to their Dentist

Chapter 10 – Head, Spinal and Pelvic Injuries

Objective of this chapter is for the first aider to understand:

  • Signs and symptoms head, spinal or pelvic injury.
  • Perform first aid treatment on casualty until EMS arrive.

The mechanism of injury (MOI) is commonly the cause of most injuries. When there is a force involved such as a long fall or a motor vehicle accident, there can be multiple injuries present.

Often you can ask the casualty or any bystanders what happened but there will be times that you may have to look at the casualty, their surroundings, and other items around you to decide whether or not to treat the casualty as if there is a possible head, spinal, or pelvic injury. Here are some signs and symptoms to look for.

When you have done your look (for all hazards) and they are cleared, or can be cleared, approach the casualty from their side or their vision path. Before you even introduce yourself say,

“DON’T MOVE!”

 

Remember, moving a casualty that has a possible head, spinal, or pelvic injury may cause spinal cord injuries, paralysis, decreased level of consciousness (LOC), or even death.

Then continue with your emergency scene management.

Talk – Introduce yourself, ask what happened, and remind them not to move. Get a bystander to hold their head in position found. Ensure that bystander keeps both elbows supported on the ground.

Call – Assign one bystander to call 911 and another bystander to get an AED and return with it. Then continue with…

Airway

Breathing

Circulation including gross bleeds

Treat any injury that may require first aid, such as bleeding.

Reassure the casualty and keep them warm.

 

Pelvic injuries can be stabilized if EMS is delayed. Place a coat or blanket between the casualty’s legs, and using 3-4 triangular (wide bandages), bandage and splint the casualty’s legs together.

Knowledge Evaluation

 

Sign and symptoms of a head injury may include:

  1. Black eyes, fluid leaking from their nose or ears
  2. Black eye, back pain and a bleeding arm
  3. Back pain, numbness in legs and a bleeding arm

 

Mechanism of injury to cause a traumatic injury may be:

  1. Tripping over a cat
  2. Falling off a step
  3. Falling from the second story roof

Chapter 11 – Chest Injuries

Collapse Lung

The Objective of this chapter is for the first aider to understand:

  • Signs and symptoms of penetrating chest, fractured ribs, and blast injuries.
  • Provide first aid treatment for the casualty until EMS arrives.

 

Chest injuries are always considered serious and usually life threatening. The purpose of the chest is to protect all the organs such as the heart, lungs, stomach, and large blood vessels in your body (aorta and superior vena cava).

Remember safety first, so always follow the emergency scene management steps. Look, Talk, Call, ABCD, then proceed with first aid treatment. While waiting for EMS, always treat for shock, reassure the casualty, monitor ABCs, then record and report any changes to EMS on arrival.

There are 3 typical chest injuries:

Penetrating chest injury, when the chest wall is broken such as a sucking chest wound or an open pneumothorax.

 

Fractured ribs with no chest wall break such as a flail chest.

 

Blast injuries, when there can be many injuries because of the blast, objects hitting the casualty, and the force of being thrown.

 

When the chest receives a significant force or has been penetrated by an object, the lungs also tend to get injured.

These chest injuries can cause the casualty’s lung to collapse (Fig 11.1) and should be considered life threatening.

The MOI and the casualty’s signs & symptoms will guide you in locating many potential injuries when providing first aid treatment.

Flail Chest and Rib Injury

Flail chest injuries occurs when two or more ribs are broken in two or more places creating a separate segment. The casualty may have other rib injuries also. The most common cause of a flail chest injury is trauma. In addition, always suspect an accompanying head or spinal injury.

Flail Chest – 2 or more ribs broken in 2 or more locations

Closed Pneumothorax

Closed pneumothorax injuries can occur spontaneously.  Often this occurrence will be caused by trauma that has caused fractured ribs. The fractured rib injures the lung allowing air to collect between the lung and chest wall. This is a life-threatening emergency and can only be medically treated.

Blast Injury

This injury occurs when a casualty is thrown from a blast causing not only chest injuries, but also internal injuries. The casualty may have closed chest injuries, open chest injuries, or internal bleeding.

Knowledge Evaluation

An Example of an Open Chest wound is

  1. Flail Chest
  2. Fractured ribs
  3. Penetrating chest wound

 

Blast injuries are not serious.

  1. True
  2. False

Chapter 12 – Heat and Cold Emergencies

The objective of this chapter is for a first aider to understand:

  • Signs and symptoms of heat and cold injuries.
  • Provide first aid treatment for the casualty until EMS arrives.

 

These types of injuries can occur in any environment or country, regardless of the weather conditions.

To allow your body to properly cool itself, ensure that you are dressed for the weather, be aware of high humidity levels, hydrate routinely before and during exercise, or when working and rest in a cool area often, especially in extreme temperatures.

 

To help prevent heat loss, ensure you dress for the weather, hydrate before and during exercise or when working, be aware of wind chill, and do not allow sweat or wet clothes against your skin for a prolonged period.

Cold Injury Treatment

Get casualty into a warm area and replace wet clothes with dry clothes.

Frost bite can be warmed by using body temperature water (between 37C and 40C). Only rewarm frostbite if there is no chance of refreezing. Place gauze between fingers or toes so skin doesn’t stick together. Chemical warmers should not be used because they are too hot.

Hypothermia casualties should be given warm, sugary drinks (no alcohol) if responsive. If casualty becomes unresponsive, ensure 911 has been called, place casualty in recovery position, and monitor ABCs until EMS takes over. Ensure head and body is covered with blankets.

Frozen State

A casualty that is found to be stiff when you tap is said to be frozen. Do not attempt any first aid treatment. Call 911 and allow EMS to start medical aid.

Heat Injury Treatment 

Get casualty into a cooler area (cab of vehicle or shade), have them rest and sip room temperature drinks of water or a sports drink. Remove excessive clothing.

 

Heat cramps help the casualty to stretch out cramped muscles or massage the cramp.

Heat exhaustion casualties should lie down with head slightly elevated. If no improvement with 30 minutes, seek medical attention.

Heat stroke is life threatening so ensure 911 is called. Cool the casualty as fast as possible with cool wet cloths or ice packs in the neck, armpit and groin area. If unresponsive, monitor ABCs and give nothing to drink.

Knowledge Evaluation

Casualties in severe hypothermia may appear:

  1. Unresponsive and not breathing
  2. Shivering
  3. Not show any effects

Signs and symptoms of heat exhaustion are:

  1. Unconscious and vomiting
  2. Headache and nausea
  3. Shivering and cold

Chapter 13 – Serious Injuries and Illness

The objective of this chapter is for the First Aider to understand:

  • Recognize the signs and symptoms of eye injuries, poisoning, emergency moves, and multiple casualty management.
  • Provide first aid treatment until EMS arrive and the first aid treatment.

 

Multiple Casualty Management

There are several places you may come across many casualties at one time. As a First Aider, you may help when traveling on a highway, at a sports event, or perhaps a festival. Some accidents may cause injuries ranging from minor to life threatening all at the same scene.

When you have more casualties than First Aiders, Triage (to sort) must be used. To ensure that all casualties are treated in a timely manner for the severity of their injuries, First Aiders must sort them into four categories in order of most serious to least serious. This includes casualties that will have to wait for medical help before they get any treatment.

 

 

1st Priority – casualties with ABC difficulties and lightning strikes

2nd Priority – casualties with major fractures (back, femurs)

3rd Priority – casualties with minor cuts, bruising or minor fractures

4th Priority – casualties that require CPR or are trapped

 

When you are approaching an emergency scene, always:

Look and Talk to all the casualties, spending no more than 5-15 seconds with each.  DO NOT start any first aid treatment at this time.

Call 911 and answer all the EMS dispatcher’s questions. Then return to the highest priority casualty and perform first aid treatment.

Remember to re-evaluate all casualties and adjust treatment as signs and symptoms change. Remain in charge until EMS takes over.

 

Knowledge Evaluation

The First thing you do when attempting to triage is:

  1. Call 911 and leave
  2. Call out to find the most serious casualty and start first aid for them until
    EMS arrives
  3. Look around to ensure the scene is safe, how many people are hurt and the MOI.

 

Eye Injuries

We never realize how precious our eyes are until there is a problem with our vision. Preventing injuries to our eyes is undoubtedly the best practise. Always use protective glasses and know how to use machinery properly and keep safety guards on while operating machinery. Remember always keep your work area free of debris.

In the chart there are some examples of causes of different eye injuries and the first aid treatment for each.

Remember, always Look, Talk, Call, ABCD. Treat the injury first, then treat shock for all serious injuries and monitor ABCs until EMS takes over.

Poisons

There are four different ways poisons can enter your body

Narcotic (opioids or opiates) overdoses have increased dramatically. Public education programs have allowed many lay rescuers to provide Naloxone in narcotic overdose emergencies. Remember Naloxone has only temporary effects and 911 must be called.

Poisons come in many different forms and very different levels of severity. That is why prevention is always the best path to take.

Ensure cabinets are locked when chemicals are stored there. Chemicals should be kept in their original container and teach others the danger symbols.

 

Two-Person CPR

 

CPR is very tiring. After approximately two minutes (5 cycles of CPR), we start to become ineffective because we are unable to push deep enough, fast enough, or we are not allowing the chest to fully rise (recoil). Consequently, if possible, two-rescuer CPR is more effective than one. Remember, teamwork and communication between First Aiders is very important.

Rescuers should switch positions every two minutes (5 cycles) or whenever an AED analyzes.

When two people are performing CPR at the same time, ideally, they will be on opposite sides of the casualty’s chest. When the second First Aider is ready to take over compressions, the transition should be almost seamless with only one or two compressions skipped.

The First Aider that just finished compressions shifts, toward the casualty’s head and opens the casualty’s airway with the barrier ready to give breaths as soon as the other rescuer finishes their 30 compressions.

The First Aider giving compressions should stop compression but leave their hands in position on the casualty’s chest to monitor the

effectiveness of the breaths.

Remember to count compressions out loud and encourage or correct the other First Aider.

 

Knowledge Evaluation

When performing CPR with two first aiders the ratio of breathes to compressions is:

  1. 5:1
  2. 30:1
  3. 30:2

When two fist aiders are performing CPR and the AED arrives the next step is:

  1. All stop CPR to put the AED on
  2. Give breaths only until the AED is on
  3. Continue CPR and turn the AED on

Rescue Moves

Typically, First Aiders should not move casualties unless their life is in danger from an environmental hazard such as approaching fire or possible explosion. Or, you may determine that the casualty is not breathing or vomiting and needs to be moved. Other times you may find yourself and a casualty in a remote area and need to move the casualty to seek medical attention.

When moving casualties, always be honest about the weight that you can handle safely. Remember to use proper body mechanics when lifting. Ensure you, the First Aider, have a wide stance and good footing, keep your back straight, and lift with your legs.

Blanket/Ankle Pull for short distances over smooth surfaces.

Shoulder Drag for short distance. Casualty must not have any shoulder injuries

One person carry “fireman’s carry” for short distances.

Two-person chair lift. Very effective when ground is flat.

One casualty carry “backpack carry”. Casualty’s upper body must not be injured.

Human Crutch. Casualty must have one

When working with a partner the weight is more evenly distributed. Communication is The key to a safe lift for all.

Knowledge Evaluation

A one person move to remove a injured casualty is:

  1. Bunny Hop.
  2. Ankle drag.
  3. Arm Pull.

A reason to move a casualty is:

  1. They demanded you move them.
  2. The casualty is not breathing.
  3. None of the above.

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