First Aid & Medical Emergencies

1. First Aid & Medical Emergencies Division of Immigration Health Services

2. The Chain of Survival Survival rates decrease with weak links in the chain Early access—call 911 Early CPR Early defibrillation Early advanced cardiac life support (ACLS)

3. What Is Our Role? First responder Tasking bystanders Assuring safety Assessing victim Identifying life-threatening conditions

4. Responsibilities • Maintain personal health and safety • Maintain composure • Maintain skills and knowledge • Maintain caring attitude • Maintain victim as priority without endangering yourself

5. What may we encounter? Stress Anger Fear Violence Serious illness/injuries

6. Stressful Situations for Staff • Motor vehicle accidents • Suicides • Mass fatalities • Incidents involving children • Abuse related incidents

7. Standard PrecautionsMust be aware of risks associated with emergency situations Barrier devices Personal protective equipment

8. Infection Control Prevention of disease transmission • Hand washing & personal hygiene • Equipment replacement or disposal Standard Precautions • Eye protection • Gloves • Masks • Change out of contaminated clothing

9. Scene Safety • Definition: Assessment of scene & surroundings that provide information and assures well-being of all involved • Personal protection: Is it safe to approach the scene/victim? • Protection of victim: Consider environmental issues • Protection of bystanders: Do not allow bystander to become a victim/liability • IF SCENE IS UNSAFE DO NOT ENTER

10. Legal/Ethical

11. Scope of Care from Legal/Ethical Viewpoint • Responsibilities to the victim • provide for the well-being of the victim • Moral/Ethical • Moral responsibility to render care • Make the physical/emotional needs of the victim priority • Maintain skills • Consent • Acceptance of care • Victim has the right to refuse care • Types of consent: 1. Expressed 2. Implied

12. Scope of Care from Legal/Ethical Viewpoint continued • Children • Parent or legal guardian gives consent • Life-threatening situation exists and no parent/guardian available • Refusals • Alert adult has right to refuse help • May withdraw from care after becoming responsive • In doubt? Err in the side of caution • Statutes • Good Samaritan Law • Policies and Procedures

13. Scope of Care from Legal/Ethical Viewpoint • Assault/Battery • Attempting to provide care to victim who has refused • Abandonment • Terminating care without proper continuation of care by same or higher trained provider • Negligence • Deviation from the general recognized standard of care

14. MOVING AND POSITIONING OF VICTIMS

15. Moving and Positioning of Victims • Roles • Moving victim(s) from immediate danger • Positioning victim(s) to prevent further injury • Body mechanics/Lifting techniques • Use legs to lift; NOT YOUR BACK • Keep weight as close as possible to body • Guidelines to lifting • Consider the victim’s size/weight • Know own physical abilities and limitations • Lift : DO NOT TWIST • Position feet properly to have good balance • Communicate clearly with persons assisting you

16. Principles of Moving Victims Move victim only if: - he or she is in immediate danger if not moved - care cannot be give due to location If there is no threat to life– DO NOT MOVE THE VICTIM

17. Emergency Moves • Moving victim quickly may aggravate spinal injuries • Efforts should be made to move the victim in the direction of the long axis of the body • It is impossible to remove the victim from a vehicle and provide protection to the spine

18. How to Move Victim If victim is on the ground/floor: • Pull victim by the clothing in the neck and shoulder area • Put victim on a blanket and pull on blanket • Dragging by victim’s underarms • NEVER PULL VICTIM’S HEAD AWAY FROM THE NECK AND SHOULDERS

19. Positioning of Victim Recovery position—for victim with pulse and breathing (no trauma) If trauma present--- Do Not Move Victim experiencing pain/discomfort--- Allow to assume position of comfort Victim experiencing nausea/vomiting--- Allow to assume position of comfort (responder must be appropriately positioned to manage airway)

20. Airway • A victim without an airway has no chance of survival. • Must maintain airway in order to assure oxygenation to brain.

21. Respiratory System

22. Respiratory System • Function: * Delivers oxygen to body * Removes carbon dioxide from body • Anatomy: * Nose and mouth * Lungs * Epiglottis * Wind pipe * Diaphragm * Chest wall muscles • Physiology: * Diaphragm moves down, chest moves out, air is drawn into lungs * Exchange of oxygen and carbon dioxide occurs in the lungs * Diaphragm moves up, causing air to exit lungs

23. Respiratory System Infant and children considerations: • Structures are smaller and obstruct easier • Tongues take up proportionally more space in the mouth • Trachea is more flexible • Smaller lung capacity • Large head-to-body ratio (different position for airway) • Primary cause of cardiac arrest is respiratory arrest

25. Opening the Airway Head-tilt, chin lift Jaw thrust (chin lift without head-tilt)

26. Inspection of the Mouth

27. Inspection of the Mouth • Victim may have fluids/solids • Responsive victim cannot maintain own airway • Unresponsive person will need to have airway maintained • Clearing the mouth: • Open mouth with gloved hand • Look inside: • Clear • Not clear • Fluids • Solids • Teeth/dentures

28. Breathing Look Listen Feel

29. Foreign Body Airway Obstruction in Adults (FBAO) Partial: • Victim remains responsive • May be able to speak • Can cough forcefully • May be wheezing between coughs • Poor air exchange • Weak ineffective cough • High-pitched noise on inhalation • Increased respiratory difficulty • Blue tissue color at lips and nail beds

30. Foreign Body Airway Obstruction in Adults (FBAO) continued Complete: • No air exchange • Inability to speak, breath or cough • Victim may clutch to neck--Universal sign for choking • Death will occur if prompt action is not taken

31. What do we do? Heimlich Maneuver

32. FBAO in Infants and Children • More than 90% of deaths in children younger than 5 yrs • 65% are infants • Causes: Toys Balloons Small Objects Food (hot dogs, round candy, nuts, grapes) Infections (respiratory—congestion, fever, drooling or inactivity) • NEVER DO “BLIND” SWEEPS IN CHILDREN

33. Special Considerations Persons with stomas: • Persons with permanent opening that connects the trachea to the front of the neck • Will require mouth-to-stoma breathing • Make airtight barrier around the stoma

34. Special Considerations Infants and Children: • Head in neutral position and extend a little past neutral position • Do not over-extend head • Limit amount of air to only make chest rise • Avoid too much air as it will go into the stomach or damage lungs if too forceful

35. Special Considerations Dental appliances: • Dentures—usually should be left in • Partial dentures– may become dislodged; may leave in place but be prepared to remove them

36. Circulatory System Function: • Delivers oxygen and nutrients to body tissues • Removes waste from tissues Anatomy: • Heart • Arteries: Carotid and Brachial • Veins: carry blood back to the heart • Blood: carries oxygen and carbon dioxide

37. Circulatory System Physiology: • Pulses can be felt anywhere an artery passes • If heart stops– no blood flow • Body cannot survive when the heart stops • Victim is in cardiac arrest • Brain damage begins 4 minutes after onset of cardiac arrest and becomes certain in 10 minutes • External compressions circulate blood • Compressions in combination with ventilations circulate oxygen and blood in body

39. Why does the heart stop? • Sudden death from heart disease • Respiratory arrest (infants & children) • Medical emergencies (stroke, epilepsy, diabetes, allergic reactions, electrical shock, poisoning, etc)

40. Cardiopulmonary Resuscitation CPR: • Combination of compressions and ventilations • Cannot sustain life indefinitely • Must be started as soon as possible • Increased the amount of time that defibrillation will be effective External chest compressions: • Depress the sternum to change the pressure in the chest • Causes sufficient blood flow to sustain life for a short period of time

42. Medical Emergencies First aid may be needed for various reasons • Injuries • Medical problems Warning signs and symptoms of emergency • Pain, severe pressure, or discomfort in the chest • Breathing difficulty or shortness of breath • Abdominal pain • Decreased level of responsiveness

43. Decreased Level of Responsiveness A sudden or gradual decrease in the victim’s level of responsiveness and understanding ranging from confusion to unresponsiveness.

44. Reasons for Decrease • Heart problems • Stroke • Poisoning (including drugs/ETOH) • Low blood sugar or diabetic problem • Fever • Head injury • Decreased levels of oxygen in the brain • Psychiatric conditions • Infections • Seizures

45. Seizures Seizures: sudden attack usually related to nervous system failure Causes: * Chronic medical conditions *Fever * Infections * Poisoning including drugs and alcohol * Low blood sugar * Head injury * Decreased level of oxygen * Brain tumors * Complications of pregnancy * Failure to take medication or inadequate anti-seizure medication * Unknown causes

46. What do we expect to see? • Some victims may have violent muscle contractions • Most are unresponsive and may vomit, lose bowel/bladder control • May be very tired or sleep after the seizure • May be brief, less than 5 minutes, or prolonged

47. What do we do? • Remain calm • Protect victim’s head and vital organs from injury • Prepare to maintain airway • Protect modesty • Never restrain victim • Never place anything in their mouth • Support and assure victim after seizure

48. Hypothermia(Exposure to cold) Signs and symptoms: • Obvious/non-obvious exposure • Cool/Cold skin temperature • Shivering • Poor judgment —person may actually remove clothing • Problems of joint/muscle stiffness Contributing factors: • Cold environment • Age (young/elderly) • Medical conditions • Alcohol/drugs/poisons

49. Hypothermia (continued) Decreased level of responsiveness or motor function: • relates to the seriousness of hypothermia Will see: • Poor coordination • Memory disturbances/confusion • Reduced or loss of touch sensation • Mood changes • Less communicative • Dizziness • Speech difficulty

50. Hyperthermia (Exposure to Heat) Contributing factors: • High ambient temperature reduces the body’s ability to lose heat by radiation • High relative humidity reduces the body’s ability to lose heat through evaporation • Exercise and activity—lose more than 1 liter of sweat per hour • Age (young/elderly) • Pre-existing conditions • Drugs and medication