Emergency Care and Safety Institute



Chapter 1: Background Information (pg. 1-4)

1. What Is First Aid? The immediate care given to an injured or suddenly ill person

a. What does first aid consist of? It consists only of providing temporary assistance until competent medical care is obtained or until the chance for recovery without medical care is assured.

b. Do most injuries require medical care? In Figure 1-1 in the textbook what is the leading cause or nature of injury of nonfatal occupational injuries in 2008. No most injuries or illnesses do not medical care. Sprains or strains.

2. What items should be included in a first aid kit? List 10 see table 1-1 page 4.

Adhesive strip bandage, Antiseptic skin wipes and ointment, Triangular bandages, Medical exam gloves, Sterile eye, gauze, non-stick pads, Mouth-to-mouth barrier device Sterile conforming roller gauze , Instant cold packs, Waterproof tape/adhesive tape, Padded malleable splint, scissors, tweezers

3. What are the Good Samaritan Laws? Laws that encourage individuals to voluntarily help and injured or suddenly ill person by minimizing the liability for errors made while rendering emergency care in good faith.

a. Good Samaritan Laws vary from state to state but generally applies only when the rescuer is:

a. Acting during an emergency

b. Acting in good faith, which means he or she has good intentions.

c. Acting without compensation. (i.e. Without being paid financially)

d. Not guilty of malicious misconduct or gross negligence toward the victim (intentionally deviating from established medical guidelines)

4. When does “duty to act” require someone to render first aid? NO one is required to provide first aid when no legal duty exists. Duty to act may apply in the following situations:

• When employment requires it. Examples of occupations that involve a “duty to act” action.

law enforcement officer, park rangers, athletic trainers, teachers, life guards

• When preexisting responsibility exists. Examples: When preexisting responsibility exists: parent responsibility for a child, driver for a passenger, baby sitting.

4. What are the types of consent, and how is it obtained by the rescuer?

Consent (Permission) of an alert person providing care.

Expressed consent (verbally or with a nod of the head) Provide your name, tell them you have first aid training and what you would like to do to help.

Implied consent assumes that the victim would want care provided. Unresponsive (motionless) individual, someone who is mentally incompetent, or a child with a life threatening condition, whose parent or guardian is not available.

a. Define abandonment: Leaving the victim without help…once you have started first aid do not leave the victim until another trained person takes over.

b. Define negligence: when the victim suffers further injury or harm because the care that was given did not meet the standards expected…having the duty to act, but either not doing so or doing so incorrectly. Causing injury and damages, exceeding your level of training

6. Prevention Practices can reduce deaths, injuries and sudden illnesses. Three areas of intervention:

• Education: motivate people to change behaviors that put them at risk i.e. swimming lessons, gun safety, weather and road conditions alerts for drivers

• Enforcement: enforce laws and regulations that require change in behavior i.e. seat belt and helmet requirement laws, drunk driving laws, prohibiting fireworks, personal flotation devices, building codes and inspections

• Engineering: change in products and environment that provide automatic protection from injury: i.e. air bags in cars, helmets, child-resistant packaging and medications and chemicals, smoke and carbon dioxide detectors

Chapter 2: Action at an Emergency (pg. 8-11)

Recognizing emergencies: A critical and vital link to medical care for the victim is often a bystander who first recognizes a situation as an emergency and that bystander must decide how they can help the victim. At some time in one’s life you will notice or see a person who may be in distress, someone’s behavior or appearance is different or something unusual has happened. Now you have to decide whether to help the individual. If you have considered the possibility of helping others then you would most likely want to help and act. In this chapter you will learn how to act or respond.

1. Perform a scene size up consider three things:

a. Hazards that could be dangerous to you, victim, or bystanders. Scan area for immediate dangers like oncoming traffic, electrical wires.

b. Impression of what happened. Is it an injury or an illness and is it severe or minor?

c. How many people are involved. There may be more than one victim, so look around and ask others that might have been involved.

2. When to call 9-1-1. Table 2-1 found on page 6. If the answer is yes to the following:

1. Is the victim’s condition life threatening?

2. Could the condition get worse and become life threatening on the way to the hospital

3. Does the victim need the skills or equipment of emergency technicians or paramedics?

4. Would the distance or traffic conditions cause a delay in getting to the hospital?

5. Could moving the victim cause further injury?

6. Do you suspect a spinal injury?

a. Other serious conditions where you should call 9-1-1 include: Table 2-1. (List 8)

1. Fainting 2. Chest/abdominal pain or pressure 3. Sudden dizziness, weakness, or change in vision 4.Difficulty breathing or shortness of breath 5.Severe or persistent vomiting 6.Sudden, severe pain anywhere in the body 7.Suicidal or homicidal feelings 8.Gaping wound with edges that do not come together

3. When calling 9-1-1, be ready to give the following information:

1. Your name and phone number

2. Victim’s location

3. What happened?

4. Number of victims and special conditions

5. Victims condition: ie. bleeding

Do not hang up the phone on the dispatcher. You may be asked to provide care.

4. Define bloodborne disease: Infections or diseases transmitted/carried by an infected person’s blood

1. Hepatitis B (HBV) is a viral infection of the liver. Long-term infections with the liver can lead to liver cancer. Vaccines are available to prevent HBV (Hepatitis B)

2. Hepatitis C (HCV) is a viral infection of the liver. no vaccines available

3. Human immunodeficiency virus (HIV): can infect others and those infected with HIV almost always develop acquired immunodeficiency syndrome (AIDS) a major cause of death worldwide. No vaccine

5. Airborne Diseases define and provide example: Transmitted through the air by coughing and sneezing. Examples: Tuberculosis (TB). TB is caused by bacteria which usually settles in the lungs and can be fatal. Symptoms include fatigue, weight loss, chest pain and coughing up blood. Wear a mask if there is a concern and have the victim cover their mouth when coughing.

6. What is PPE: Personal protective equipment. Blocks entry of organisms into the body

• Examples of PPE: Medical exam gloves, protective eyewear, and also mouth to barrier devices for CPR

7. List steps you can follow to protect yourself from disease transmission when providing care. (list 6)

1. Wear PPE such as gloves, or plastic bags.

2. If you have been trained: use absorbent barriers to soak up blood or other infectious materials

3. Clean the spill area with an appropriate disinfecting solution such as diluted bleach (1/4 cup of bleach in a gallon of water)

4. Discard contaminated materials in a appropriate waste disposal

5. Wash your hands with soap and water after giving first aid

6. If exposed report incident to your supervisor. Otherwise, contact your personal physician.

8. Handwahsing is an effective way to prevent disease transmission. Wash hands with soap and water for at least 20 seconds scrubbing all surfaces of the hand. Rinse with clean water and clean towel

9. Posttraumatic stress disorder: Stressful events can be psychologically overwhelming and may result in this condition. Symptoms include depression and flashbacks. If an individual shows signs of emotional problems seek help within the first 24-72 hours after the event.

Chapter 3: Finding Out What's Wrong (pg 13-21)

1. What is “scene size-up”? What is the purpose of performing a scene size-up? Quick survey of an emergency scene prior to providing care for an individual. The individual will determine safety, general type of problem, number of victims. Determine the number of victims; go to the quiet motionless victim first. With the victim you check to see what is wrong. Identify and correct any immediate life-threatening conditions first. If there is no immediate threats to life, do a quick physical exam and gather information (history) about the problem.

2. What is the primary check? What does it include? It is the first step in dealing with an emergency situation; this step determines whether there are life-threatening problems requiring quick care. Initial check determines whether there are life-threatening problems requiring immediate care. Primary check includes: Responsiveness, breathing, Severe Bleeding.

a. How do you check responsiveness and breathing for a victim? If victim is alert and talking, then breathing and heartbeat are present. Ask the victim his or her name and what happened. If victim is motionless (answer the next step) If victim is motionless, tap shoulder and ask, “Are you okay?” If no response, victim is considered unresponsive and someone should call 9-1-1

b. Severe bleeding: check for severe bleeding by quickly scanning for blood up and down the body, for clothes that may be blood soaked or if blood is pooling or collecting on the ground or floor. Control bleeding by providing pressure to wound.

C. Positioning the victim. If victim is unresponsive and laying face down, roll the victim onto his or her back so you can begin CPR. If victim is vomiting, has heavy secretions or you must leave the victim to call 9-1-1 then roll victim into recovery position. You can leave the victim in this position if you suspect has possible back or spine injuries

3. Secondary check: This is performed when primary check is completed and no life-threatening conditions are present. A secondary check involves checking an abnormalities and gathering information that may be helpful in your immediate care or for EMS.

a. Look for the follow items (physical) when performing a secondary check?

Signs— Conditions of the victim that you can see, feel, hear or smell, such as seeing a dislocation like a finger or shoulder

Symptoms—Things the victim feels and is able to describe like chest pain

a. The DOTS guideline helps you identify key signs of a problem. The DOTS guideline helps you identify key signs of a problem.

D= Deformities: broken bones causing abnormal shape

0= Open wounds: break in skin and often bleeding

T= Tenderness: Sensitivity, discomfort, or pain when touched

S= Swelling: Fluids that accumulate under the skin. Area looks larger than usual

4. To conduct a physical exam, follow these steps: (list 7)

All 7 steps use the DOTS guideline

1. Head: Compare pupils-they should be the same size and react to light. Check ears and nose for clear or blood-tinged fluid. Check mouth for objects that could block airway.

2. Neck: Medical ID necklace

3. Chest: Gently squeeze

4. Abdomen: Gently push

5. Pelvis: Gently push downward on the tops and on the sides of the hips.

6. Extremities: arms and legs

7. Back: Spinal injuries. No spinal injuries suspected turn victim on his/her side check back.

Note: When check the head look at the skin color, temperature and moisture of the skin.

5. What is cyanosis? If skin is becoming blue or gray it is a sign of low levels of oxygen (Cyanosis) in the blood and mucous membrane. Lips and skin of light-skinned person will be easily seen. In darkly pigmented persons visual check for cyanosis in the mouth’s mucous membranes, nail beds, inner lining of the eyelids of the victim.

6. List and describe the steps to using the SAMPLE guideline to gather information found on Table 3-3 on page 14:

S= Signs: What’s wrong?

A= Allergies: Are you allergic to anything?

M= Medications: Are you taking any medications? What are they for?

P= Past Medical History: Have you had this problem before? Do you have other medical problems?

L= Last Oral intake: When did you last eat or drink anything?

E= Events leading up to the illness or injury: How did you get hurt? What were you doing before the illness started?

Chapter 4: CPR (pg. 23-35)

1. Define heart attack: When heart muscle tissue dies….blood supply is severely reduced or stopped due to a clot in one or more coronary arteries.

2. Define cardiac arrest: If damage to the heart muscle is too severe, the victim’s heart can stop beating. 250,000 people each year are affected

3. List and describe the links in the chain of survival. (List 5)

1. Recognition and Action. Recognize early signs of cardiac arrest and immediately call 9-1-1 to activate emergency medical services (EMS)

2. CPR: CPR or cardiopulmonary resuscitation is chest compressions that circulate blood to the heart and brain buying time until a defibrillator and EMS personnel arrive

3. Defibrillation: administering shock to the heart

4. Advanced care: Paramedics provide advanced cardiac life support to victims. IV fluids, medications, and advanced airway devices.

5. Post-Arrest Care: Hospital can provide lifesaving medications, surgical procedures and advanced medical care to enable the victim of sudden cardiac arrest to survive and recover.

4. A. Risk factors of cardiovascular disease that you cannot control: Explain below:

• Heredity: tendencies appear in family lines.

• Gender: Men have a great risk. Even after menopause, when women’s death rate from heart disease increases, it is never as high as men’s. Coronary heart disease is the leading cause of death in American women.

• Age: Over 80% of those who die of heart disease are 65 or older.

B. Risk factors that you can control: Explain the risk factors:

• Tobacco: Smokers have a 2-4 times greater chance of developing heart disease than nonsmokers during their lifetime.

• High blood pressure: Increases the heart’s workload. Normal blood pressure is 120/80

• High cholesterol: Too much cholesterol can cause a build up in the walls of the arteries.

• Diabetes: This affects blood cholesterol and triglyceride (sugar) levels.

• Overweight and obesity: Excess body fat, especially around the waist, increases the likelihood of developing heart disease. Being overweight affects blood pressure and cholesterol and places added strain to the heart.

5. Describe how to perform CPR on an adult by answering the following questions

Situation: When a victim’s heart stops beating, the individual needs CPR, defibrillation and EMS professionals quickly to ensure that the victim can survive. CPR consists of moving blood to the heart and brain through chest compressions. A rescuer will also provide periodic breaths to place oxygen into the victim’s lungs.

Steps to Performing CPR

a. How do you check for responsiveness? Tap shoulders asking if he/she is okay.

b. What should you do if there is no response? If the victim does not respond ask bystander to call 9-1-1. If alone with an unresponsive child or infant, give CPR for five cycles (2 minutes) then call 9-1-1.

c. Give chest compressions: Two hands for an adult, one or two hands for a child, two fingers for an infant. Adult compression depth is at least 2 inches, a child about 2 inches and for an infant about 1 ½ inches. Hands or fingers are positioned at the center of the chest. Compressions are given at a rate of 100 compressions per minute for all victims which is about 30 compressions in 18 seconds and then give rescue breaths.

d. Give Rescue Breaths. How is this done? Head tilt and chin lift. Pinch the nose and make a tight seal over the victim’s mouth with your mouth. Give one breath lasting 1 second and take a normal breath for yourself and give another 1 second breath. You only need to make the victim’s chest gently rise. Forceful breaths can make the stomach distend.

e. How should you position your body to give chest compressions properly? Your shoulder over the victim’s chest pressing downward on the center of the chest between the nipples for infant just below nipple line

f. When is it ok to stop CPR? Continue until AED becomes available, victim shows life, EMS arrive or you are too tired to continue

6. What is an airway obstruction? Object lodged in the airway

a. The signs of a severe airway obstruction include: (List 4)

1. Breathing becomes more difficult

2. Weak and ineffective cough

3. Inability to speak or breathe

4. Skin, fingernail beds and inside of the mouth appear bluish gray (cyanosis)

b. How do victims communicate that they are choking? By nodding their head

C. List and describe the steps for assisting a responsive adult or child who cannot cough, speak, or breathe. (List 4)

1 Check victim for choking

2 Locate the navel

3 Place thumb side of fist just above the navel

4 Place hand on top of first hand and give abdominal thrusts until object is removed.

D. For a responsive Infant with a severe airway obstruction, give back blows and chest compressions instead of abdominal thrusts. Support the infants head and neck and lay infant face down on your forearm, then lower your arm to your leg. Give five back blows with the heel of your hand. While still supporting the back of the infant’s head, roll the infant face up and give five chest compressions with two fingers on the infant’s sternum. Repeat steps until the object is removed or infant becomes unresponsive.

Skill Drill for Adult: steps to performing CPR:

• Check for responsiveness and ____________Breathing__________________.

• Make sure ___9-1-1_________ has been called.

• If unresponsive and not breathing provide ___30_____ compressions deep and fast.

• Provide ____2______ rescue breaths. Repeat the compressions and breaths cycles until an ___AED______ available or ____EMS______ personnel arrive.

Skill Drill for Child: steps to performing CPR:

• Check for responsiveness and _____breathing_______________. Make sure __9-1-1_________ has been called.

• If unresponsive and not breathing provide 30 chest compressions using ____one___ or two ___hands________.

• Provide _____2_____ rescue breaths. Repeat the compressions and breaths cycles until an __AED_______ is available or ____EMS______ personnel arrive.

Skill Drill for Infant: steps to performing CPR.

• Check for responsiveness and ____________breathing________. Make sure _____9-1-1______ has been called.

• If unresponsive and not breathing provide 30 chest compressions using ____two_________ fingers

• Provide ____2______ rescue breaths. Repeat the compressions and breaths cycles until an ____AED_____ is available or ____EMS______ personnel arrive.

1. How do you determine if a victim is unresponsive?

2. If a person is unresponsive, but breathing, what should you do?

3. You determine that a person is unresponsive, there are bystanders present, and what do you do next?

4. If your rescue breaths are initially unable to make the chest rise what should you do?

5. How should you open the airway for a victim who has not been injured?

6. How should you determine if a person has stopped breathing?

7. When performing adult CPR, what is the ratio of breaths to compressions?

8. How deep should you compress the chest of an adult?

9. To perform chest compressions on an adult how and where should you place your hands?

10. Before beginning CPR, what do you need to determine?

11. You can stop CPR if you are what?

12. The “universal distress sign” of choking is:

13. You give one breath and are unable to make the chest rise. You then reposition the head and give another breathe and are still unable to make the chest raise what should you do next?

14. What is a risk factor for cardiovascular disease that cannot be controlled?

15. What are the more common signs and symptoms of a heart attack?

16. What do you do in the Initial Check?

17. The Initial Check is used to determine what?

18. What are the signs of a stroke?

19. Signs of choking that indicate a need to provide care include.

20. Explain in brief detailed steps how to perform CPR on an adult.

Chapter 5: Automated External Defibrillation (pg 24-43)

1. What is an AED and where can you locate them in public settings: An electrical device capable of analyzing the heart rhythm and providing a shock to the heart. AED’s are located in airports, airplanes, stadiums, health clubs, golf courses, schools, government buildings, offices, homes and shopping centers or malls.

2. Heart how it works:

Heart is an organ with four hollow chambers. Two chambers on the right side receive blood from the body and send it to the lungs for oxygen. The two chambers on left side of the heart receive freshly oxygenated blood from the lungs and send it back out to the body.

The right upper chamber of the heart, there is a collection of special pacemaker cells. These cells emit electrical impulses about 60 to 100 times a minute that cause the other heart muscles cells to contract in a coordinated manner.

a. Ventricular fibrillation (V Fib) is: Most common abnormal heart rhythm in cases of sudden cardiac arrest in adults. The organized wave of electrical impulses that cause the heart muscle to contract and relax in a regular fashion is lost when V Fib occurs. The lower chambers of the heart quiver and cannot pump blood so circulation is lost and no pulse is found.

b. Ventricular tachycardia (V-tach) is: The heart beats too fast to pump blood effectively.

3. Care for Cardiac Arrest:

• Every minute that defibrillation is delayed the victims chance of survival is decreased by 7% to 10%.

4. About AEDs

5.

• An AED is a device capable of automatically analyzing the victim’s heart rhythm, determining and advising the rescuer of the need to shock, and administering the shock when the rescuer depresses the button.

• An AED eliminates the need for the rescuer to be trained in ECG rhythm recognition.

• AEDs are attached to the victim by a cable connected to two adhesive pads that are placed on the victim’s bare chest.

• AEDs store valuable information including the ECG rhythm, shock data, and performance data such as date, time, and number of shocks administered.

• Common Elements of AEDs

— Power on/off mechanism

— Cable and pads (electrodes)

— Analysis capability

— Defibrillation capability

— Prompts to guide the user

— Battery operation for portability

Using an AED

• The basic operation of all AED models for all ages follows this sequence:

— Perform CPR until an AED is available.

— Once the AED is available, turn the equipment on.

— Apply the AED pads to the victim’s bare chest and the cable to the AED.

— Stand clear and analyze the heart rhythm.

— Deliver a shock if indicated.

— Perform CPR for 2 minutes.

— Repeat the analysis, shock, and CPR steps as needed.

Special Considerations

• Water

— Because water conducts electricity, it may provide an energy pathway between the AED and the rescuer.

— Remove the victim from free-standing water.

— Quickly dry the chest before applying the pads.

• Children and Infants

— Cardiac arrest in children and infants is not usually caused by a primary heart problem as in adults.

— AEDs can deliver energy levels appropriate for children and infants. Appropriate for children aged 1 year or older.

— Use pediatric pads for a child or infant whenever available. Use adult pads if pediatric pads are not available.

• Medication Patches

— Some victims may be wearing medication patches such as nitroglycerin.

— Remove these patches and wipe the skin before applying the electrode pads.

• Implanted Devices

— Implanted pacemakers and defibrillators are used to automatically correct problems with the heart’s normal electrical rhythm.

— Avoid placing electrode pads over these implantable devices.

— If an implantable defibrillator is firing (victim twitching) allow it to stop before applying the electrodes.

AED Maintenance

• Periodic inspection of an AED ensures that the device has the necessary supplies and is in proper working condition.

• AEDs run automatic periodic self-checks. Additional self-checks are performed any time the device is turned on.

• Check the expiration and replacement dates on electrode pads and batteries.

1. You bring an AED to a person who has just collapsed and is unresponsive. What do you do next?

2. ____shock(s) may be delivered, followed by ____minute(s) of CPR.

3. If an AED is immediately available following an adult’s collapse, you should:

4. You are about to administer a “Shock” with the AED when you notice someone touching the victim. You should:

5. A person is struck by lightning. The victim is unresponsive and not breathing. What should you do?

6. An AED should not be used on what type of individuals? Think age.

7. Accurate record keeping of an AED important because it helps to do what?

8. When inspecting your AED what should you check for?

9. When is it not safe to deliver a shock from an AED?

10. Proper preparation of the skin prior to attaching the electrodes includes:

11. After delivering a shock, you perform 2 minutes of CPR. Your next step should be to:

12. Upon arriving at the scene with an AED, you are responsible for doing what?

13. Victims who are successfully defibrillated often still need what to continue?

14. The abnormal heart rhythm most often present in the first few minutes of adult cardiac arrest is:

15. For each minute defibrillation is delayed, the victim’s chance of survival decreases about 7% to what percent?

16. Define ventricular fibrillation?

17. AED’s can store information about what? Why might this information be needed?

18. After analyzing the victim’s heart rhythm, the AED provides a “No Shock Needed” prompt. You should:

19. If a victim of cardiac arrest is wearing a medication patch such as nitroglycerin, you should:

20. You are summoned to care for a person that has just collapsed and is unresponsive

and not breathing. CPR is in progress and you have an AED. List in order the steps to provide care.

___Attach the electrodes ___ Turn on the AED ____ Analyze the heart rhythm ____ Deliver shock if indicated

22. Besides ventricular fibrillation, the next most often frequent heart rhythm present in the first few minutes of adult cardiac arrest is:

23. Define ventricular tachycardia?

24. What common elements are found in all AEDs?

25. Should an AED be used on a person submerged in water? An infant? An elderly person

|SKILLS TEST |STEPS |PASS |FAIL |

| |Introduce yourself to the victim as someone certified | | |

| |to help | | |

| |Ask if you can assist the choking victim | | |

| | | | |

| | | | |

| | | | |

|Heimlich Maneuver | | | |

| |Call 9-1-1 | | |

| |Position yourself behind the victim with 1 leg between| | |

| |theirs | | |

| |Place one fist on belly button | | |

| |Place other hand on top of the fist | | |

| |Press in and up to force the object up and out of the | | |

| |airway | | |

Notes:

|SKILLS TEST |STEPS |PASS |FAIL |

| |Check for responsiveness | | |

| |by _______ & ________ | | |

| | | | |

| | | | |

| | | | |

| | | | |

|CPR | | | |

| |Call 9-1-1 | | |

| |Look listen and feel for breathing | | |

| |________ seconds | | |

| |Head tilt chin lift | | |

| |________ rescue breaths | | |

| |__________ compressions | | |

| |Repeat _________ times | | |

| |Recheck breathing | | |

| |Continue CPR if necessary | | |

Notes:

|SKILLS TEST |STEPS |PASS |FAIL |

| |Check for responsiveness | | |

| |by _______ & ________ | | |

| | | | |

| | | | |

| | | | |

| | | | |

|Obstructed Airway/CPR | | | |

| |Call 9-1-1 | | |

| |Look listen and feel for breathing | | |

| |________ seconds | | |

| |Head tilt chin lift | | |

| |________ rescue breaths | | |

| |Re-tilt head | | |

| |_______________ rescue breaths | | |

| |__________ compressions | | |

| |Look in mouth / finger sweep if necessary | | |

| |Repeat _________ times | | |

| |Recheck breathing | | |

| |Continue CPR if necessary | | |

Notes:

|SKILLS TEST |STEPS |PASS |FAIL |

| |Check for responsiveness | | |

| |by _______ & ________ | | |

| | | | |

| | | | |

| | | | |

| | | | |

|AED | | | |

| |Call 9-1-1 | | |

| |Look listen and feel for breathing | | |

| |________ seconds | | |

| |Head tilt chin lift | | |

| |________ rescue breaths | | |

| |Get AED and attach pads | | |

| |Turn on AED and listen for directions | | |

| |Provide needed assistance | | |

Notes:

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