Premergency First Aid, CPR and AED Manual

PREMERGENCY

First Aid, CPR & AED Manual

Second Edition - 2018 Copyright © Premergency Inc. ISBN# 978-0-9948867-0-5 • www.preohs.com is a division of Premergency Inc. Premergency Inc. is an approved First Aid, CPR and AED training organization of the Workplace Safety & Insurance Board (WSIB) of Ontario under Regulation 1101 and Ontario Regulation 565, Public Pools for lifeguard first aid certification. This resource was developed in accordance with these regulatory requirements of Ontario and the guidelines set forth by the International Liaison Committee on Resuscitation (ILCOR). • Aspirin ® is a registered trademark of Bayer Canada • Allerject ® is a registered trademark of Sanofi • Chain of Survival ® is a registered trademark of The American Heart Association • EpiPen ® is a registered trademark of EM Industries • Narcan (naloxone) ® is a registered trademark of Adapt Pharma

• Tempra ® is a registered trademark of Mead-Johnson Canada • Tylenol ® is a registered trademark of McNeil Consumer Products • Viagra ® is a registered trademark of Pfizer Pharmaceuticals Acknowledgments: Dr. Kristian Davis - M.D. CCFP/EM for providing medical direction and advice on current standards of practice in emergency procedures. Cal Garrioch - Graphic Designer for his awesome production of the layout, images and graphics within this manual. Jessica Lund - for her passion on reviewing our first version and ensuring our second version is up to date. Letisha and Dylan for their guidance, support and always patient demeanour. xo All first aiders who have the courage to help people!

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PREFACE This manual serves as the primary resource for the first aider. It also covers the knowledge and skills you will need to demonstrate to earn an accredited Premergency First Aid Certificate. In addition to the required core content, this manual includes additional information and tools to help you understand the materials and skills in the program. With the development of 911, Paramedic Services and increased public awareness, millions of people have been trained in First Aid, CPR and the operation of AED’s. A first aid course is designed to train a person so they may provide the necessary emergency care to a patient in the minutes before paramedics arrive.

Trained First Aiders are an important first component of emergency care. Knowing the skills outlined in this manual can save a life. DISCLAIMER Premergency Inc. has made every attempt to provide current standards of practice in First aid, CPR and AED guidelines based on ILCOR updates. This manual (and our online material) does not serve as a stand alone certification in First Aid, CPR and AED. As such all holders of this manual must attend a practical First Aid, CPR and AED course to obtain a valid First Aid, CPR and AED certificate. Premergency Inc., will not be held responsible for any losses that may occur from either an accidental error or omission in the information provided herein. Please check our website for any updated information and/or guidelines in First Aid, CPR and AED.

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“ If you memorize, you will forget. If you understand, you will remember. ” – Author Unknown This is the premise of our training program. As a

in an environment that builds your confidence. These skills are then repeated by you in a practical setting that guides you on how to render appropriate first aid care. I encourage all users of this manual to use it for your reference and workbook. Write notes within the manual to personally customize your recall of information and keep it with your first aid kit. Premergency is about establishing the skills and mindset to approach any emergency with confidence. That is our philosophy. Stay safe! Best regards, Dean DiMonte, A.C.P. (Land & Flight) Author and Founder Premergency Inc.

paramedic of over 20 years, I have responded to many emergencies in which the people who arrive first didn’t remember what to do, even though they had taken first aid training. During an emergency situation, people can respond with stress and anxiety that can cause forgetfulness. Our training program provides a foundation of understanding in learning what to do in an emergency. Understanding builds confidence and confidence gives you the courage to manage an emergency situation and apply appropriate emergency care to someone in need. Our program begins by explaining how emergencies present. We give real life examples from many years of experience. We then demonstrate the necessary skills,

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Our Mission As a company we have over 100 work years of experience in the field of Emergency Response and Preparedness. Our clients include a diverse cross section of society. We have provided training and education to health care providers, corporations, professional emergency personnel, military personnel and the lay person. We believe that transfer of knowledge and skills is achieved not through “teaching” but by sharing our years of experience with our clients in a concise, structured, reproducible, and retainable fashion. Our goal is to give our clients the knowledge of how to intervene in an emergency situation in a sharing, confidence building environment. With confidence, based on knowledge, our students have the courage to act when others around them “freeze.”

Knowledge instills confidence, which in turn gives courage. Our method of teaching through sharing leads to lifelong relationships with our clients, who in turn help us to continually modify and optimize our course programmes. Teaching should be a two-way street between those imparting knowledge and those receiving it. When all is said and done, the purpose of training personnel is to optimize outcome in an emergency situation. This means to minimize personal illness / injury through common sense interventions based on knowledge and training. Our courses and programmes produce superior, common sense individuals. Best Regards Dr. K. Davis, MSc, CCFP, EM

Medical Director Premergency Inc.

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About this manual Table of Contents - to find the necessary information in the first aid manual. The table of contents is located in the front of this manual and begins on the next page.

Colour Tabs to quick reference each chapter. There are a total of 12 chapters in this resource manual.

Images/Illustrations - are located throughout each chapter to emphasize the first aid material in a visual form.

Prenotes - are short tips or summaries throughout each chapter.

Skill Symbol - illustrates the skills required to demonstrate competency in our first aid training course(s) as part of your certification.

First Aider or First Aid Provider in Action are realistic scenarios based on actual paramedic responses to medical calls that summarizes each chapter. Names have been changed to maintain patient confidentiality.

SKILL

Summary and Vital Vocabulary - is presented at the end of each chapter to review key information within that chapter.

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CHAPTER 1 - Introduction to First Aid ...............1 • What is First Aid?................................................2 • Who is a First Aider? ..........................................2 • Legal aspects – First Aid and the law ...............4 • Introduction to First Aid....................................5 • Precautions and Personal Protection................7 • Harassment and Violence in the Workplace..10 • Communicating ................................................11 • Resources............................................................13 • Emergency Services / Other Services .............15 • Stress Management ...........................................21 • Multiple patients................................................22 • Post Traumatic Stress Disorder ......................27 • Vital Vocabulary................................................28

CHAPTER 2 - PREmergency Scene Management31 • PREmergency Scene Management ...................32 • Multiple Patients and TRIAGE..........................33 • Scene Safety & Assessment ...............................34 • Mechanism of Injury /Nature of Illness ..........37 • Trauma or Medical..............................................37 • Personal Protection.............................................39 • Glove Removal Technique .................................41 • Primary Assessment ...........................................42 • Assessing Responsiveness ..................................43 • Assessing an Airway ...........................................44 • Assessing Breathing ............................................47 • Assessing Circulation .........................................48 • Identifying Life Threats ......................................49 • The Recovery Position ........................................55 • Secondary Assessment........................................56 • History and SAMPLE ........................................57 • Vital Signs.............................................................59 • Ongoing Care, Handoff & Documentation .....76 • Summary ..............................................................81

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CHAPTER 3 - Airway & Breathing .......................87 • Anatomy of Airway and Breathing ................... 89 • Normal Breathing Rates ..................................... 90 • Signs of Ineffective Breathing ............................ 90 • Opening the Airway ........................................... 92 • Clearing the Airway............................................ 94 • Foreign Body Airway Obstruction (FBAO) .... 96 • Signs of Partial Obstruction – Choking ........... 97 • Signs of Complete FBAO – Choking ................ 97 • Complete Airway Obstruction - Choking ....... 98 • Assessment and First Aid................................... 98 • Unconscious Patient ......................................... 101 • Large Person Choking ...................................... 101 • Chest Thrust....................................................... 101 • Abdominal Thrusts for a Small Person .......... 102 • Infant Choking – First Aid............................... 103 • Choking Self Help – First Aid ......................... 106 • Apnea, Agonal Breathing & Hyperventilation . 107 • Difficulty Breathing due to Trauma ................ 109

• Environmental & Industrial Exposure ...........110 • Illnesses causing difficulty breathing ..............111 • Respiratory Illness.............................................111 • Asthma................................................................113 Severe Allergic Reaction – Anaphylaxis.........116 • Assessment and First Aid.................................118 • Vital Vocabulary................................................123 CHAPTER 4 - Circulation and Shock ................ 125 • Shock................................................................. 126 • Causes of Shock ............................................... 126 • Signs and Symptoms ....................................... 127 • Developing (Compensated) Shock ................ 127 • Severe Shock ..................................................... 128 • Assessment and First Aid................................ 128 • Vital Vocabulary............................................... 130

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CHAPTER 5 - Cardiovascular, CPR & AED .......131 • Risk factors and Prevention ............................132 • Anatomy and Physiology of the Heart ...........133 • Acute Coronary Syndrome (ACS) ..................136 • Angina ................................................................136 • Heart Attack/AMI .............................................137 • Signs, Symptoms and First Aid .......................141 • CHF and Pulmonary Edema ...........................142 • Cardiac Arrest....................................................145 • Chain of Survival...............................................146 • Automated External Defibrillator (AED) ......147 • C.P.R. (Cardiopulmonary Resuscitation).......147 • Compression-only CPR....................................148 • Adult CPR ......................................................... 150 • Cardiac Arrest – Infants and Children...........152 • Child & Infant CPR...........................................153 • Health Care Provider (HCP) and BLS........... 156 • Using an AED ....................................................159 • AED Troubleshooting and Maintenance .......164 • Vital Vocabulary................................................169

CHAPTER 6 - Medical Emergencies ................. 171 • Stroke ............................................................... 172 • Transient ischemic attack (TIA).................... 174 • Types of Strokes............................................... 177 • Signs and Symptoms ...................................... 178 • F.A.S.T. Mnemonic for Stroke........................ 178 • Seizures ............................................................. 180 • Seizures – Infants and Children .................... 183 • Febrile seizures. .............................................. 183 • Causes of Altered Mental Status.................... 184 • Hypoglycemia and Diabetes .......................... 185 • Diabetic Emergencies ..................................... 185 • Headache .......................................................... 187 • Fainting............................................................. 188 • Vital Vocabulary.............................................. 190

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CHAPTER 7 - Bleeding, Wound Care & Trauma.193 • Bleeding ............................................................. 194 • External Bleeding ............................................. 195 • Signs and Symptoms ....................................... 196 • Severe external bleeding.................................. 196 • Controlling Bleeding........................................ 196 • Open Wounds and Precautions...................... 198 • Types of Wounds .............................................. 198 • Assessment and First Aid................................ 204 • Internal Bleeding .............................................. 205 • Wound Infection .............................................. 208 • Dressings and Bandages .................................. 208 • Securing bandages............................................ 213 • Head and Face injury....................................... 218 • Scalp Wound..................................................... 220 • Ear Injuries........................................................ 221 • Eye injuries........................................................ 222 • Nosebleed .......................................................... 229 • Mouth injuries .................................................. 230 • Neck and Throat injuries................................. 230

• Puncture injury................................................. 231 • Penetrating Chest Wound ............................... 232 • Abdominal wounds.......................................... 234 • Gunshot wounds .............................................. 236 • Blast injury ........................................................ 237 • Crush injury ..................................................... 239 • Burns.................................................................. 250 • Anatomy of a Burn........................................... 251 • Assessment and First Aid................................ 256 • Chemical burns ................................................ 256 • Electrical burns................................................. 258 • Inhalation burns ............................................... 261 • Radiation burns ................................................ 262 • Slivers or splinters ............................................ 263 • Bites and stings ................................................. 264 • Vital Vocabulary............................................... 277

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CHAPTER 8 - Muscle, Bone & Joint Injuries . 283 • Musculoskeletal injuries ............................. 284 • Anatomy of Bones........................................ 285 • Joints .............................................................. 286 • Common Joints in the Skeletal System ..... 286 • Musculoskeletal Injuries.............................. 287 • Fractures ........................................................ 288 • Dislocations................................................... 289 • Dislocated joint............................................. 290 • Sprains ........................................................... 291 • Strains ............................................................ 291 • Complications .............................................. 292 • Muscle, Bone and Joint injury .................... 292 • Head Injury ................................................... 295 • Skull fracture................................................. 298 • Concussion injury ........................................ 300 • Spinal Injury & Spinal Motion Restriction304 • Rib and Breastbone injury .......................... 311 • Flail Chest...................................................... 313

• Pelvis Injury .......................................................316 • Femur (Upper Leg) Fracture............................318 • Knee injury.........................................................321 • Tib/Fibula Injury...............................................323 • Ankle Injury.......................................................325 • Collarbone and Shoulder Blade Injury...........326 • Upper Arm Fracture .........................................327 • Elbow injury ......................................................328 • Splinting Basics..................................................329 • Summary ............................................................340 • Vital vocabulary.................................................343

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CHAPTER 9 - Other Emergencies...................... 347 • Environmental Injury ......................................348 • Hypothermia .....................................................351 • Frostbite..............................................................359 • Heat Exposure ...................................................362 • Heat cramps .......................................................363 • Heat exhaustion.................................................364 • Heatstroke ..........................................................366 • Poisoning and drug overdose ..........................368 • Opioid Overdose and Naloxone (Narcan).....376 • Lightning injury ................................................378 • Emergency Childbirth and Miscarriage.........379 • Mental Health Emergencies.................................. 393 • Ontario 211.............................................................. 395 • Assessment and First Aid.................................... 397 • First Aid Documentation & Acronyms..........405 • Vital Vocabulary................................................406

CHAPTER 10 - Lifting and Moving .................409 • Body Mechanics for Lifting and Moving ...410 • Emergency clothes drag ...............................413 • Blanket drag ...................................................414 • Arm drag ........................................................414 • Extremity drag ...............................................415 • Human crutch ................................................416 • Pack strap carry .............................................416 • Seat carry ........................................................417 • Fore/aft carry ..................................................417 • Stretchers .........................................................420 • Improvised stretchers ....................................423 • Blanket stretcher.............................................424 • Chair Carry .....................................................425 • Vital Vocabulary.............................................426

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CHAPTER 11 - Accident Prevention ..................427 • Training .............................................................428 • Risk mitigation ..................................................428 • Hazardous Material and Toxic Substances ....429 • WHMIS .............................................................429 • Slip, Trip and Fall Hazards ...............................429 • Choking ..............................................................429 • Environmental hazards.....................................430 • Fire Hazards .......................................................430 • Drowning ...........................................................430 • Education ...........................................................430 • Occupational Health and Safety......................431 • Additional Premergency Services ...................431

CHAPTER 12 - Glossary ..................................... 432 • Notes: ..................................................................447

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NOTES:

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Chapter 1 Introduction to First Aid

1 Introduction to First Aid

Who is a First Aider? Like first aid, a first aider or first aid provider is simply the first person to provide help to those in need. A first aider could be a professional health care provider (HCP) trained in first aid, or simply a good samaritan. The First Aider is the person who takes control of the scene and provides first aid. It is important to remember that the first aider does not diagnose illness and injury. All emergency care is built upon basic life support and safe transport. What trained first aiders and all Paramedic personnel do is suspect injuries and illness. They give aid and support until the patient is transferred to the next level of care.

What is First Aid? First Aid is simply that, the first assistance (or aid) given to an injured or suddenly ill person. First aid may involve nothing more than being aware and noticing the possibility of an emergency. Is the woman who’s coughing at the next table choking, or is she just coughing on a bit of food that went down the wrong way? Is a crying child hurt or just upset? Did the skateboarder injure herself when she fell? The key to first aid is managing emergencies in a calm and concise manner.

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No matter what the situation, the objectives of first aid are the three P’s.

• Preserve life – Identify and treat life-threatening conditions. • Prevent further harm – Don’t let the patient’s condition become worse through your actions. • Promote healing and recovery – Provide care that will give the best chance for a healthy recovery.

As you will learn, there is more to first aid than just providing aid to a person who is ill or injured. Unexpected or sudden emergencies are by nature a frightening experience for many people. They may be upset and confused. People may be willing to help but are not sure how. Learning to ensure safety and taking control of a scene are the first steps in any care you provide. (See PREmergency Scene Management, Chapter 2).

Some important steps in first aid include: The activation of 911 Safety to yourself, the patient, and others at the scene.

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Legal aspects – First Aid and the law In situations where you give first aid as part of your job, you have a legal obligation to respond to an emergency and you must provide reasonable care within your job description and level of training. Working in a job that requires you to use first aid is a serious responsibility. As a professional you have an obligation to always improve your knowledge and education. The more you learn and practice, the better and more confident a provider you will be. In the private setting and with the exception of Quebec, Canada and most of the United States have no legal requirement for you to provide first aid. The choice is left up to the individual. In Quebec, the law is different. If another person’s life is in risk you have a legal requirement to help them, provided you do not greatly risk your own life to do so.

Fearing legal issues, many people hesitate to help an injured or ill person. To help alleviate this dilemma, the law recognizes the principle of the good samaritan. The good samaritan law protects you if you choose to help. The principle of a good samaritan is the act of good faith. You are not obligated to help – you choose to help. You are not expecting to be recognized or rewarded in any way. If you become involved in an emergency, then you have some responsibilities. Patient’s in first aid can be categorized into three age groups. See the table below. (age range is a guidelines only based on lean body weight)

Patient Age Groups

Infant Child Adult

< 1 year

1 - puberty

at and beyond puberty

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Introduction to First Aid Legal Aspects

Given the nature of first aid, many times you will not have access to medical supplies. The first aider must think and improvise. Many common items are excellent temporary substitutes. Additional legislation exists such as the “Sabrina Law” for administering Epi-Pen to an Anaphylaxis patient and “Chase McEachern Act” for performing Automated External Defibrillation (AED) to a sudden cardiac arrest.

• Consent • Actions • Responsibility

Consent – Before treating a patient you must identify yourself as a First Aider and get permission to treat them. This is called patient consent. Actions – You must use reasonable skill and provide care within your knowledge and training. Responsibility – If you provide first aid for a person, then you assume responsibility for them until they are well enough to not require help greater than your own. You cannot be negligent or abandon the patient.

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Minors (Children under 18) can give consent or implied consent in the absence of a parent or guardian. In the case of a minor, if a parent or guardian is available, consent must be obtained from them before you proceed with any first aid. Actions are measures that other people with similar training would do in the same situation. Only do what you know you can do and do not attempt to give aid beyond your level of training. Give first aid carefully so you do not cause undue pain or make an injury or situation worse. Responsibility – When you give first aid you must use common sense. Don’t do actions against a person’s interests. Negligence is doing something knowingly against the patient’s interest. A good rule is to provide first aid in a manner that you would want done for you by a person with similar training.

Consent – The law states that a person has the right to refuse help and not be touched by others. First Aiders must respect this right. Identify yourself and your level of training and get permission before providing aid to a person. Ask if you can help. If the answer is yes, then you have obtained consent and have permission to help. If there is no response or the person doesn’t answer you, then you have obtained implied consent to continue. Implied consent is most often obtained when a seriously injured or ill person is unable to ask or to communicate he need for help. Consent – Special Considerations Cultures and religions may prohibit you from giving aid to a person. If a person is unable to respond to your offer of first aid and you are informed by a spouse or close relative not to provide first aid to an unconscious person, there may be a good reason. Consider activating 911.

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Abandonment is a situation in which you provide first aid to your patient but leave before completing the initiated aid or transferring care to another provider. Unless the patient no longer needs help, you must stay with your patient and continue to provide care until you transfer care to another person with training equal to or higher than yours. By being aware of the legal aspect of first aid and your rights and responsibilities as a first aider, you are able to provide safe, appropriate, and effective care.

Precautions and Personal Protection When the First Aider and the patient are in contact at a time when the patient is ill or injured, standard precautions to prevent disease transmission must be considered. Standard precautions are measures to protect you from transmissible diseases. These precautions are the same for all healthcare providers. Gloves – Gloves are the minimum standard for patient contact if there is any possibility of coming in contact with blood or bodily fluids. Wear two pairs of gloves if there is substantial bleeding or fluids.

Introduction to First Aid Legal Aspects

• Consent • Actions • Responsibility

Precautions and Personal Protection

Nitrile Gloves

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Always change gloves between patients. Vinyl, Nitrile and Latex materials both provide adequate protection but latex may cause an allergic reaction for some people. Latex cannot be exposed to petroleum based products and must be changed if it comes in contact with gasoline, oil, etc. Latex gloves cannot be used with petroleum jelly. Always follow guidelines for safe removal and disposal of gloves. Proper Hand Washing – This is the simplest and most effective way to control disease transmission. Always try to wash your hands before and after patient contact, even if wearing gloves. Although soap and water are not protective in all cases, they are excellent protection against transmitting a disease to others. If running water and soap are not available, then a waterless hand-washing substitute may be used. Wash hands with soap and water as soon as you are able.

Hand Sanitizer as a substitute for hand washing

Pocket Masks and Shields – Although there are limited evidence regarding cases of disease transmission to a rescuer from performing unprotected mouth to mouth resuscitation on a patient with an infection, you should always use a mask or shield with a one way valve designed to prevent contact with blood or bodily fluids. Disposable masks or ones with disposable one-way valves are a better choice than ones that require re-sterilization.

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Wear eye protection to avoid exposure to any splashed water or cleaning products. Beware of sharp objects. An object that has been in contact with infected blood or bodily fluid may transmit disease if it punctures a glove and cuts you. Even plastic can have an edge sharp enough to cut when broken or torn.

All disposable objects used in patient care should be discarded in a sealed, airtight bag placed in another bag. Although rarely encountered in first aid, needles or cutting blades pose a special danger and must be stored in a rigid container. All reusable equipment needs to be cleaned and disinfected according to manufacturers directions. Wash any affected surfaces with hot, soapy water or a disinfectant, following manufacturers’ directions. Clothing contaminated with blood or bodily fluids may be dry cleaned or machine washed with soap and hot water for at least 25 minutes. Any body part contaminated during patient contact should be washed with hot water and soap and rinsed thoroughly. Cuts from any possibly contaminated sharp object should be reported and medical attention should be sought.

Safety Glasses for Eye Protection

Clean Up – If you are required to clean up after an emergency you must follow precautions to protect yourself. Wear appropriate hand protection designed for cleaning and handle with care.

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Abuse and Neglect Abuse is any harm inflicted on anyone by a person in a position of trust or authority. Harm can take the form of physical, psychological, or financial abuse. Neglect means the basic provisions for life are not provided. Although anyone may be abused or neglected, children and the elderly require additional advocacy due to their increased vulnerability.

Introduction to First Aid Legal Aspects Precautions and Personal Protection Violence and Harassment Communicating

Workplace Violence and Harassment Ontario law exists to protect workers from violence and harassment in the workplace. Always be aware of the potential for violence. Do not expose yourself to violent or dangerous situations. Call 911 and have the police make the scene safe. If you suspect a crime, notify the police. If the scene is safe, then give first aid to patients, but try not to disturb the scene. If law enforcement is involved, then you should make sure to answer any questions they have before leaving the scene.

Special Populations are groups that require additional considerations when communicating and providing first aid. They can include religious and cultural concerns, language or developmental barriers, and disability or vulnerability. Part of first aid is being an advocate.

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You can also make a report anonymously to appropriate authorities. Communicating How you communicate with others is very important in first aid. You may encounter patients who are conscious or unconscious, bystanders who want to help or are simply curious, and other First Aiders or emergency services personnel. People can experience a wide range of emotions during an emergency including fear, anxiety, and confusion. They may even demonstrate frustration or anger towards the situation and others. Effective communications skills include speaking calmly and clearly and being polite and respectful with others. Empathy and compassion are important and effective in gaining trust.

Be aware of injuries that do not match the description of what happened or the described method of injury. Multiple cuts, oddly shaped bruises, and burns or evidence of multiple bruising in different stages of healing may be a sign of abuse. Apparent fear or agitation in the presence of a parent, family member, or caregiver may also be a sign of abuse. Inadequate clothing for the environment, signs of dehydration or malnourishment, any untreated medical condition or injury, and unsafe living conditions are all possible signs of neglect. If you are suspicious of a person being neglected or abused, then do not make any direct accusations. Insist that the person receive medical care. If you think that medical care may be withheld, then call 911. If you are unable to summon help to the scene, then notify family services and law enforcement of your suspicion as soon as possible. Be honest about what you have seen and heard, nothing more.

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Introduce yourself and ask the patient’s name. Speak to the patient with the name they give you. Certain situations can make it more difficult to communicate with a person. Hearing or visual impairment, foreign language speakers, or children all present additional challenges. Remain calm and caring. Use available resources such as interpreters, parents, or relatives to help. Follow these principals of communication to help you be more effective. Your body language should not be threatening or aggressive. Position yourself at the same level to address the patient. Look them in the eyes and watch their body language for clues to how they may behave. Allow for personal space, both yours and the patient’s. During initial contact and while obtaining consent keep some distance between yourself and the patient

proper communication with a patient

as they may initially perceive you as a threat. Listen while the patient is speaking to you and try to understand what they are saying. At times people may be hesitant to say directly what is wrong. Allow the patient to fully answer questions and pay attention to their response. Always tell the truth to a patient. Answer any questions honestly but limit unnecessary details that could upset the patient or relatives. Do not use medical terminology or ‘jargon’ Explanations and answers need to be clearly understood.

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Resources An important part of first aid is identifying needs and assessing the resources available to you. A first aid emergency may require very few resources, simply a dressing and bandage to address a small cut. It may also require much more. Consider a car striking a utility pole. 911 needs to be activated for paramedics, fire and police personnel. The scene needs to be made safe and will most likely require traffic and crowd control. The utility company needs to be contacted to cut power to the pole. Access to first aid supplies needs to be determined.

Do not raise your voice unless the patient has difficulty hearing or the environment is loud. Be courteous and professional. Always assume everything you say can be heard and understood by everyone around you, including an unconscious patient. Do not make inappropriate comments or say things that may concern or embarrass the patient. Introduction to First Aid Legal Aspects Precautions and Personal Protection Violence and Harassment Communications Resources

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car accident scene In some situations a lone First Aider may need to do all of these things. But many times there will be bystanders and possibly other First Aiders at the scene who can assist. If you arrive at the scene of an emergency and someone is already in control, then identify yourself and your training and ask if they need help. This allows the person to utilize your skills optimally.

premergency first aid kit

They may have you give aid or direct any traffic or bystanders. You might record vital signs, communicate with 911, or help calm a relative. Usually the person with more training assumes control but not always. A doctor or nurse with experience in the type of illness or injury may be the best person to provide direct aid but a First Aider might have more training in PREmergency Scene Management.

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Introduction to First Aid Legal Aspects Precautions and Personal Protection Violence and Harassment Communications Resources Emergency Services / Other Services Medical Treatment Transport Emergency Services

How to utilize a bystander

1. Activate 911. 2. Direct traffic.

3. Control bystanders. 4. Make the scene safe. 5. Look for any and all possible patients. 6. Obtain a first aid kit. 7. Provide first aid under your direction. 8. Take notes. 9. Gather the patient’s belongings. 10. Direct emergency services personnel to the scene.

In most parts of North America the population has access to emergency services by calling 911. Local communication centers are staffed by trained call takers and dispatchers who obtain information from the caller and send out necessary Paramedic, Fire or Police responders. There is new protocols specific to dispatch assisted CPR, so allow the 911 communication officer to lead the call.

Use the resources you have in the most efficient way. If you are in control of a scene, then do not let other people try to help independently. Emergency scenes require a coordinated approach to provide safe, appropriate, and effective care.

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Many civil employees and those working for larger companies have first aid training. A first aid kit should be in their work vehicles. They may have alternate forms of communication such as radios, cell phones or satellite phones if needed. Many utility workers are trained in traffic control and have vehicles equipped with safety gear and emergency lights. Commercial and government vehicles often have a first aid kit and can be a good source of medical supplies. Use of a mobile phone, with a speaker module, may enhance rescuer effectiveness through supportive communication with 911 dispatch (e.g. dispatch-assisted CPR)

When emergency services personnel arrive at a scene they will take charge. Expect them to ask direct questions as to what happened, your involvement, and the condition of any sick or injured patient. Respond in a clear and direct manner. Tell them you are a First Aider and what you know of the situation. Describe any injured or ill people and any first aid you have provided. Follow any instructions you are given. In some cases you may be asked to continue providing first aid to a patient. Other Services Many other government or private service employees may be involved at the scene of an emergency. Utility or public service workers may also be on scene. They may have a specific job to do such as turning off the power or some other utility function that may provide support and safety.

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Medical Treatment First aiders provide care and support to the ill or injured, but do not provide diagnosis of an illness or injury. Diagnosis of an injury or illness can be provided by trained medical personnel. In most cases you will ensure that anyone you help will receive further care from medical personnel. When a person is ill or injured, the sooner they receive appropriate medical treatment, the better the outcome. Certain serious injuries and illnesses can be a life threatening to a patient, and any delay in treatment and transport to a hospital can increase the chance of permanent disability or death. As you will learn, certain types of accidents and health conditions pose a significant possibility of harm. Activating 911 or calling for medical help should be done without delay as soon as you determine the need.

Transport Transporting an ill or injured person can be a complicated process. Any injuries or illnesses must be supported and the patient moved safely and in such a way that avoids additional harm. Ambulances and other emergency vehicles are specially designed and equipped to move patients safely and should always be used when available. Although unlikely, if the only way to get medical help for a person is to take them yourself, or if they face a life threat and you feel they cannot wait for an ambulance, you may decide to transport them. Lifting and Moving Moving an injured or ill person requires special skills and procedures to be done safely and is not a decision to make lightly. Most patients will be better served by transport in an ambulance with medical personnel.

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1 Introduction to First Aid

If you need to transport a person to medical care, the best place to go is the emergency room (ER) at a hospital. An ER has all the needed resources to treat a patient. Activating 911 In most areas of Canada, access to Paramedics, Police, or Fire personnel is done by dialing 911with a landline or mobile phone. There are still some rural areas that do not have 911 access and require you to call a local emergency services phone number that can be found in local area phone directories. If a call to 911 is not connecting after several attempts, contact an operator or directory assistance. When speaking to 911 or any other emergency dispatcher be sure to listen carefully.

Emergency dispatchers are specially trained and have protocols to follow to dispatch the personnel most appropriate to an emergency.

Getting Help – Lone First Aider Every emergency is different. The more serious the condition of the patient, the greater the need to get help quickly. Calling 911 as soon as possible is the best way to get help quickly. However, if you are alone and need to summon help, the guidelines indicate when to treat and when to leave the patient to get help. Use the flow chart on the next page to help you decide when to leave and summon help. You need to assess the situation and make the best decision you can based on the condition of any ill or injured patient. Use common sense, your own training and experience to get the best care to the patient as soon as possible.

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1 Introduction to First Aid

Primary Assessment Unconscious or a Life Threat?

Send someone to call 911 while you assess Breathing

Help available?

YES

YES

YES

BREATHING? NO

YES

BLEEDING

NO

NO

NO

YES

ADULT: Go call 911 and return to give 2 min CPR (30/2)

INFANT/CHILD Give 2 min CPR (30/2) then go call 911

Apply Direct Pressure

Recovery Position or a Position of Comfort

Reassess Patient

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Follow the 911 communication officer instructions and do not hang up until you are told to do so or the operator breaks the connection first. Although cell phones are common place and coverage is extensive, they are not 100% reliable. There may still be an occasion that someone needs to leave the scene to activate 911 or summon help.

Getting Help – Using Others If available, then use another person. Direct them to call 911 or a local emergency phone number. 1. Tell them the phone number, 911 or other. 2. Tell them the information you want to give emergency services: • What happened. • How many ill or injured. • What’s wrong with the ill or injured. • The location to send help to. 3. Tell them to report back to you and confirm that Emergency Services have been contacted. 4. Have them ready to guide emergency personnel to the scene.

911 Dispatcher

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Stress Management Providing First Aid can be stressful. Understanding the causes of stress, recognizing its effects, and knowing how to cope are important factors to maintain a healthy lifestyle. Stress refers to a particular human reaction to a perceived threat or demand. Stressors encountered in our environment may impact the way we are able to respond and think in a situation, while also impacting our physical and mental health in the long term.

Introduction to First Aid Legal Aspects Precautions and Personal Protection Violence and Harassment Communications Resources Emergency Services / Other Services Medical Treatment Transport Activating 911 Stress Management

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The stress response is characterized by a pattern of physiological activity, including changes in hormone levels and activity in the sympathetic nervous system (SNS). This is called the ‘flight or fight’ response and refers to the body’s preparation for action, as would be necessary when providing first aid in an emergency. During an emergency, the first aider may encounter some stressors. Stress reactions vary between people and situations, due to differences in personal and contextual factors. Unless you are highly trained and experienced, stress will impact the thought processes and reaction times of most people. The better your knowledge of first aid and the more you practice your skills will significantly prepare you to deal with an emergency.

Stressors

• Dangerous situations • Multiple patients

• High physical and mental demands • Angry or upset patients, family or bystanders • Badly hurt or dying people • Overpowering sights, sounds and smells

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Types of Stress Acute and Chronic stress can both affect the first aider. These two types of stress differ in duration. The effects of each are different and dependent on a person’s mental and physical makeup. Acute Stress is defined by short term physiological changes. This type of stress may be felt during an emergency. The first aider can feel nervous and excited. Their ability to focus becomes better, helping them to manage an emergency situation. But if the stress of the situation becomes too much, then the first aider risks becoming caught up in their own emotional and physical reactions.

Physiological Effects of Stress

• Increased breathing

(respirations) and heart rate (pulse) • Increased blood sugar • Movement of blood away from the skinsurface (cool, clammy skin) • Tense muscles • Sweating • Decreased blood flow to the stomach (cramps) • Increased blood pressure • Dilated pupils • Dry mouth, thirst

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Physical Symptoms of Acute Stress Trembling – When your body anticipates the need for intense physical effort, it releases adrenalin and glucose. Adrenalin is a chemical the body uses all the time in a controlled way, only giving you as much as you need. Blood sugar, or glucose, is also used for energy and in a healthy person is properly regulated as well. When you experience new stressors, your body may give you too much adrenalin and glucose. Too much adrenalin and glucose can cause you to tremble as your muscles try to deal with the extra energy. Recognize it and continue with your tasks. By remaining calm you will mentally signal to your body that you do not need any more adrenalin or glucose.

Nausea – Another byproduct of adrenalin can be nausea. The body releases adrenalin into the stomach and too much may cause varying degrees of discomfort. Certain sounds, smells, and sights may also cause nausea. Dizziness – When the body prepares for intense activity it increases your breathing and heart rate. It also narrows blood vessels close to the surface of the skin and widens them to the heart, lungs, and other major organs to provide them with an increased blood supply. When this happens suddenly there is a temporary drop in blood pressure and oxygenated blood may not reach the brain in enough quantity. This is usually short-lived but can cause feelings of dizziness or fainting.

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