Kampala Police 2010-11 FIRST AIDER ToT. Purpose of this course In Uganda, Police are often the...

Kampala Police Kampala Police 2010-112010-11

FIRST AIDERFIRST AIDER

ToTToT

Purpose of this course

• In Uganda, Police are often the frontline for trauma care

Police can make a difference

• Without an ambulance or specialized medical equipment you can save lives

• Goal is to empower cadets with knowledge to save lives

• Stress that you do not need to be a doctor, have an ambulance or other equipment to save lives!

Police can make a difference

Course Objectives

• Increase your medical knowledge

• Learn the highest-yield first aid techniques that save lives

• Demonstrate proficiency in performing and teaching these skills

Course Outline

• Safety

• Anatomy

• DR. ABCs & High-yield first aid

• Common medical and injury scenarios

• Skills station

• Post test

ROLES AND ROLES AND RESPONSIBILITY OF RESPONSIBILITY OF

THE THE FIRST AIDERFIRST AIDER

Qualities of the First Responder:

• Observant.• Resourceful.

– Use materials available at the time, improvise and implement necessary ones.

• Dexterous (skillfully and cleverly done).• Humanitarian.

– Able to work beyond social, tribal and religious boundaries.

• Perseverance.– Able to work without giving up until qualified help arrives.

• Sympathetic.• Explicit.

– Be clear with your instructions to the casualty and or bystanders.

Responsibilities of the First Responder:

• Safety

• Scene management

• Patient Assessment

• Patient Care

• Patient Transport

AnatomyAnatomy

Respiratory SystemRespiratory System

Inhalation Air Flows Into LungsInhalation Air Flows Into Lungs

ExhalationExhalation Air Flows Out of LungsAir Flows Out of Lungs

http://www.jeffersonhospital.org/diseases-conditions/peripheral-vascular-disease.aspx?disease=063600f1-9f7a-4773-9401-d8229ee8d834

•Away from the Heart•High Pressure

•Back to the Heart•Low Pressure

Arterial

Capillary

Venous

Carotid Pulse (find yours)Carotid Pulse (find yours)

Femoral Pulse (find yours)Femoral Pulse (find yours)

Radial Pulse (find yours)Radial Pulse (find yours)

Nervous SystemNervous System

Spinal ColumnSpinal Column

Scene Management and Scene Management and SafetySafety

Personal Safety is #1Personal Safety is #1

•Universal precautions

Infectious DiseasesInfectious DiseasesWhat diseases can you contract from exposure to blood and body fluids?

•HIV•Hepatitis B and C•Others?

What are the chances of contracting HIV from a needlestick from an HIV infected victim?

What should you do if you are exposed to bodily fluids?

•You cannot get cancer from blood/fluid contact with a victim

Scene Safety: Assess the sceneScene Safety: Assess the scene

Scene Safety: Secure the sceneScene Safety: Secure the scene•Turn off ignition & secure brake•Use patrol car to protect the scene

Scene Safety: Secure the sceneScene Safety: Secure the scene•Protect the bystanders

Scene Safety: Assess Scene Safety: Assess CasualtiesCasualties

Scene Management: Get helpScene Management: Get help

High-Yield First AidHigh-Yield First Aid

Casualty Casualty Management & Management &

Initial AssessmentInitial Assessment

AAirwayirway

BBreathingreathing

CCirculationirculation

Don’t Panic, use ABCsDon’t Panic, use ABCsDDangeranger

RResponseesponse..

•Personal and scene safety

•“Are you alright?”

How does a road traffic How does a road traffic accident or any other accident or any other trauma kill a person?trauma kill a person?

AAirway Assessmentirway Assessment

AAirwayirway

• Without an open airway, a patient can die within seconds

ABCs for All Victims

AAirwayirway

Open the Airway-Clear nose and mouth-Lift Chin

ABCs for All Victims

Check if patient is conscious: “Are you ok?”

Victim Does NOT Respond Victim Responds

AAirwayirway

AAirwayirway

Without chin lift, jaw thrust With chin lift, jaw thrust

Adrian et al, Anesthesiology June 1999 - Volume 90 - Issue 6 - pp 1617-1623

BBreathing Assessmentreathing Assessment

BBreathingreathing

ABCs for All Victims

Look

Listen

Feel

If patient not breathing, keep airway open & transport ASAP!

BBreathingreathing

Adequate Breathing:Adequate Breathing: Normal RatesNormal Rates

Adults Children Infant

12-20/min.15-30/min.25-50/min.

CCirculation Assessmentirculation Assessment

CC

ABCs for All Victims

•If bleeding:•Apply pressure•Elevate wound•Wrap with bandage

CCirculationirculation

Arterial

Capillary

Venous

Methods for bleeding control

CCirculationirculation

Pressure, Pressure & more Pressure!!!

Severe Bleeding• A bleeding patient can lose all of their

blood in ONE MINUTE and die

• DIRECT PRESSURE is best

• DO NOT USE TOURNIQUETS

•Unless amputation AND unable to control bleeding with pressure alone•A tourniquet WILL cause irreversible damage and possibly kill the limb

Artery Compression Technique

Artery Compression Technique

Carotid PulseCarotid Pulse

Femoral PulseFemoral Pulse

Radial PulseRadial Pulse

Infants: Check brachial pulse.Infants: Check brachial pulse.

AAirwayirway

BBreathingreathing

CCirculationirculation

Don’t Panic, recall ABCsDon’t Panic, recall ABCs

BASIC LIFE BASIC LIFE SUPPORT,SUPPORT,

CPR & Rescue CPR & Rescue BreathingBreathing

What have you been What have you been taught and what do taught and what do

you teach about CPR you teach about CPR and rescue and rescue breathing?breathing?

Old Teaching:

• If patient not breathing, classic teaching has been to give rescue breaths

Trauma 1st Responder Teaching

• If not breathing make sure airway open, no breaths, and transport ASAP

BBreathingreathing

Swenson et al. NEJM, July 2010

CCirculationirculation Current Teaching:

• If victim does not have a pulse, start chest compressions at 100 per minute

Trauma 1st Responder Teaching

• If no pulse transport ASAP (after ABCs)

• DO NOT DELAY TRANSPORT FOR CPR

CCirculationirculationTrauma 1st Responder Teaching

• If no pulse and not breathing transport ASAP (after ABCs)

• CPR and rescue breathing will not hurt as long as it does not delay transport!

• 30 chest compressions : 2 breaths

Lifting and Moving Lifting and Moving

VictimsVictims

• Secure victim in car

• Drive at a reasonable speed – Will not likely make a difference in

transport time

• If unconscious use the recovery position

Transport Key Points

Recovery Position: if unconscious

Emergency Move Emergency Move Blanket DragBlanket Drag

Emergency Move – Clothes DragEmergency Move – Clothes Drag

EmergencyEmergency Move - Back Pack Move - Back Pack CarryCarry

Emergency Move – Direct CarryEmergency Move – Direct Carry

Body RollBody Roll

Take positions to log roll patient.Take positions to log roll patient.Leader at head directs.Leader at head directs.

• Secure victim in car

• Drive at a reasonable speed – Will not likely make a difference in

transport time

• If unconscious use the recovery position

Transport Key Points

Special Injury Special Injury ConsiderationsConsiderations

Soft-Tissue InjuriesSoft-Tissue Injuries

Impaled ObjectImpaled Object

Impaled ObjectImpaled Object

Internal BleedingInternal Bleeding

Abdominal EviscerationAbdominal Evisceration

BurnsBurns

BurnsBurns

BurnsBurns

Burn CareBurn Care

• Stop the burning process with waterStop the burning process with water• Remove smoldering clothing & Remove smoldering clothing &

jewelryjewelry• ABCsABCs• Cover burn with dry, sterile dressingCover burn with dry, sterile dressing• NO ointments/creamsNO ointments/creams• Don’t break blistersDon’t break blisters• Seek medical attention Seek medical attention

MusculoskeletalMusculoskeletalInjuriesInjuries

Types of Musculoskeletal InjuriesTypes of Musculoskeletal Injuries

Fractures

• Move the limb as little as possible

• Use cardboard, cotton, and tape or cloth ties keep limb clean, still, and stable

ABC Initial Assessment

Patient talking &

Bleeding Controlled

Patient unable to talk or

Bleeding Uncontrolled

Take to hospital immediately!!!

SAFETY

Fractures

• Splint ONLY AFTER ABCs

• Do NOT delay transport for splinting in a patient who is unconscious or has uncontrolled bleeding

Improvised SplintsImprovised Splints

Making cardboard splintMaking cardboard splint

Splint for Injured ForearmSplint for Injured Forearm

Injuries to theInjuries to theHead and SpineHead and Spine

Nervous SystemNervous System

Spinal ColumnSpinal Column

Mechanisms of Spinal InjuryMechanisms of Spinal Injury

• If possible, get others to help, and maintain control of the neck, do not need special collar

• Transport victim onto carrier by log-rolling

Transport: Possible spine injury

Secure patient and transport.Secure patient and transport.

Skull Fractures and Concussions

• What do you teach about managing these conditions?

CommonCommonMedical Medical

EmergenciesEmergencies

Heart AttackHeart Attack

CHOKINGCHOKING

• ABCs !!! (check mouth if unconscious)

• If ABLE to speak or cough, then not complete obstruction– Encourage coughing– Heimlich if failed

• If UNABLE to speak/cough attempt then Heimlich

CHOKING: Heimlich ManeuverCHOKING: Heimlich Maneuver Position yourself behind patient.Position yourself behind patient.

Place thumb-side of fist in middle of abdomen,Place thumb-side of fist in middle of abdomen,between navel and rib cage.between navel and rib cage.

Heimlich ManeuverHeimlich Maneuver

Infant choking - consciousInfant choking - conscious

Deliver 5 chest thrusts.Deliver 5 chest thrusts.

Infant choking - Unconscious Infant choking - Unconscious

Perform tongue-jaw lift & remove Perform tongue-jaw lift & remove visible objects.visible objects.

DrowningDrowning

What do you teach What do you teach about managing a about managing a drowning victim?drowning victim?

DiabetesDiabetes

High Blood Sugar Need insulin If too much medication can have low blood sugarIf too little medication, high blood sugarCan cause fits, loss of consciousness or confusion

STROKESTROKE

Altered mental status Slurred speech or difficulty speaking Facial droop Unequal pupil Unable to move half of body Difficulty swallowing

Stroke: Signs & SymptomsStroke: Signs & Symptoms

(Continued)(Continued)

Fits (Seizures)Not Contagious!

Put patient in recovery

position ASAP

ABCs

Transport ASAP

SAFETY Make sure victim is clear of obstacles that could cause injury

Shock & FaintingShock & Fainting

What do you teach What do you teach about fainting?about fainting?

What about shock?What about shock?

Gabon ViperGabon Viper Puff AdderPuff Adder

Snake BitesSnake BitesCoin coverage and blackstones are ineffectiveOne review in Gulu, 108 snake bite patients, none received antivenom, all survivedDo not cut and suckImmobilization, cleaning of limb and immediate transport are key (Below the heart, light compression wrap)

Common Causes of Allergic ReactionsCommon Causes of Allergic Reactions

Insect StingsInsect Stings

FoodsFoods

MedicationsMedications

PlantsPlants

Four Routes of PoisoningFour Routes of Poisoning

INHALATION INJECTION

INGESTION

ABSORPTIONAcid – Intentional Burns

Acid BurnsAcid Burns

• ABCs !!!

• Rinse well with water – Even if no pain

• Acids and bases can cause damage without causing pain

Obstetrics andObstetrics andGynecologyGynecology

AnatomyAnatomy

PerineumPerineum

VaginaVagina

CervixCervix

Pubic BonePubic Bone

UterusUterus

AnatomyAnatomy

Amniotic SacAmniotic Sac

Umbilical CordUmbilical Cord

PlacentaPlacenta

Multiple-CasualtyMultiple-CasualtyIncidentsIncidents

Tasks for Mass Casualty Tasks for Mass Casualty

Extrication

Triage

Staging

Treatment

Transportation

Supply

Command

Mass Casualty: STEP 1Mass Casualty: STEP 1

Triage officer announces that Triage officer announces that all all patients that can walk should get up patients that can walk should get up

and walk to a designated area for and walk to a designated area for eventual secondary triage.eventual secondary triage.

Color codingColor coding

© Lou Romig MD, 2006. Used with permission.

Mass Casualty: STEP 2Mass Casualty: STEP 2

• If no breathing and no pulse, leave If no breathing and no pulse, leave alonealone

• If no breathing but has pulse, evaluate If no breathing but has pulse, evaluate ABCs and consider for immediate ABCs and consider for immediate transportationtransportation

• If breathing and has pulse, also If breathing and has pulse, also evaluate ABC and prepare for transportevaluate ABC and prepare for transport

© Lou Romig MD, 2006. Used with permission.

DeathDeath

• Do not decide if a patient is dead at the Do not decide if a patient is dead at the scene!scene!

• This must be done at a health facility!This must be done at a health facility!

• Live patients have been transported to Live patients have been transported to the morguethe morgue

QUICK REVIEWQUICK REVIEW

Police can make a difference

• Without an ambulance or specialized medical equipment you can save lives

• Goal is to empower cadets with knowledge to save lives

• You do not need to be a doctor, have an ambulance or other equipment to save lives!

Police can make a difference

Personal Safety is #1Personal Safety is #1

•Universal precautions

AAirwayirway

BBreathingreathing

CCirculationirculation

Don’t Panic, recall ABCsDon’t Panic, recall ABCs

AAirwayirway Chin lift & jaw thrust

Adrian et al, Anesthesiology June 1999 - Volume 90 - Issue 6 - pp 1617-1623

ABCs for All Victims

Look

Listen

Feel

If patient not breathing, transport ASAP!

BBreathingreathing

CCirculationirculation

Pressure, Pressure & more Pressure!!!

CPRCPR• If no pulse and not breathing trauma victim

transport ASAP (after ABCs)

• CPR and rescue breathing will not hurt as long as it does not delay transport!

• 30 chest compressions : 2 breaths

• Secure victim in car

• Drive at a reasonable speed – Will not likely make a difference in

transport time

• If unconscious use the recovery position

Transport Key Points