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California Public Safety Instructor Supplement CPR/AED/First Aid
©2013 EMS Safety Services, Inc.
Guidelines 2010
2
Contents Introduction ..................................................................................................................................... 3
Course Outlines ............................................................................................................................... 4
Custom Training for California Public Safety Personnel .............................................................. 4
Initial Provider Training ............................................................................................................... 4
Title 22 Requirements ............................................................................................................. 4
CPR/First Aid Training: ............................................................................................................. 4
AED Training ............................................................................................................................ 4
Expanded Training Times ........................................................................................................ 4
Recommended Initial Certification Outline ................................................................................. 4
Recertification Provider Training / Refresher Training................................................................ 7
Title 22 Requirements ............................................................................................................. 7
Recertification vs. Refresher Training ..................................................................................... 7
Supplemental Student Information – A Title 22 Requirement ..................................................... 10
Orientation to the EMS System (Lesson: Chain of Survival) ...................................................... 11
Accessing the EMS System .................................................................................................... 11
EMS System and the First Responder .................................................................................... 12
Roles and Responsibilities of the First Responder ................................................................ 13
Medical Oversight.................................................................................................................. 14
Interacting with EMS Personnel ............................................................................................ 15
Follow‐Up and Event Review ................................................................................................. 15
Conclusion ............................................................................................................................. 16
CA Penal Code (Lesson: CPR Barrier Devices) ........................................................................... 17
Section 13518 ........................................................................................................................ 17
Section 13518.1 ..................................................................................................................... 17
Bag Mask Ventilation (Lesson: CPR Barrier Devices) ................................................................. 18
START Triage* (Lesson: Responding to Emergencies) ............................................................... 19
Equipment for Moving Patients: (Lesson: Moving a Victim) ..................................................... 21
Non‐Emergency Transfers ..................................................................................................... 21
Equipment for Moving Patients ............................................................................................ 21
Wound Care and Infection (Lesson: Bleeding and Shock) ......................................................... 23
Back Injuries (Lesson: Head, Neck and Back Injuries) ............................................................... 24
3
Pregnancy – Related Emergencies (Lesson: Chest & Abdominal Injuries) ................................ 25
1st Trimester Emergencies ..................................................................................................... 25
2nd Trimester Emergencies .................................................................................................... 26
3rd Trimester Emergencies ..................................................................................................... 26
General Treatment of All Pregnancy‐Related Emergencies .................................................. 27
Childbirth ............................................................................................................................... 27
3rd Phase: From the delivery of the baby to the delivery of the placenta ............................ 28
Complications / Abnormal Presentations during Childbirth ................................................. 28
Closed Wounds/Bruising (Lesson: Muscle, Bone & Joint Injuries) ............................................ 29
Respiratory Illness (Lesson: Difficulty Breathing) ...................................................................... 30
Croup ..................................................................................................................................... 30
Respiratory Syncytial Virus (RSV) .......................................................................................... 30
Pneumonia ............................................................................................................................ 30
Pertussis / Whooping Cough ................................................................................................. 31
Suspected Drug Abuse (Lesson: Poisoning) ............................................................................... 32
General Treatment for Suspected Drug Abuse ..................................................................... 32
Types of Abuse ...................................................................................................................... 32
Marine Animal Stings (Lesson: Bites & Stings) .......................................................................... 35
CDCR Training Scenarios (Lesson: N/A) ......................................................................................... 37
3 Corrections Scenarios: ........................................................................................................ 37
Introduction The CDCR Course Pack contains information on:
Initial Training Requirements
Recertification and Refresher Training Options
Supplemental Course Information
CDCR Required Scenarios
4
Course Outlines
Custom Training for California Public Safety Personnel
The Public Safety Officer must be trained to the standard of the California Code of Regulations
Tittle‐22, Division 9, Chapter 1.5: First Aid Standards for Public Safety Personnel. The
supplemental content covered in this Instructor Pack must be taught in every CPR/AED/First
Aid Provider Course to meet the expanded scope of CA Public Safety Personnel.
Initial Provider Training
Title 22 Requirements
CPR/First Aid Training: 100018: (a) The initial course of instruction shall at a minimum consist of not less than fifteen
(15) hours in first aid and six (6) hours in cardiopulmonary resuscitation.
AED Training 100020. Optional Skill (a) In addition to the activities authorized by Section 100019 of this
Chapter, public safety personnel may perform AED when authorized by a public safety AED
service provider. (1) Training for the AED shall consist of not less than four (4) hours…
Expanded Training Times The primary use of the EMS Safety CPR/AED/First Aid course for California Public Safety
Personnel is to maintain the current status of the Officers’ provider training by conducting
regular recertification and refresher courses.
For the initial training of California’s Public Safety Personnel, there are much longer time
requirements than during recertification training. The California Code of Regulations requires
expansion of the training times.
This is an opportunity for Instructors to maximize times allowed for training so that Public Safety
Personnel are proficient in the required life saving skills.
Recommended Initial Certification Outline
Public Safety Personnel:
Initial Hours
T-22 Required Hrs.
Currently Scheduled: Min Hrs
CPR: 6 361 6
AED: 4 (Optional) 243 4
First Aid: 15 899 15
Total: 25 1502 25
5
Major Topic Lesson Individual Topic Min.
CPR
Introduction
Instructor
15 Course Overview
Requirements for Certification
Building Blocks
DVD Chapter(s) 19
Chain of Survival Lecture
75
CPR Overview Lecture
C-A-B Lecture
Recovery Position Lecture
CPR Barriers Lecture
Bag Mask Lecture and Demo
Practice Session (Building Blocks) 60
AED Use
DVD Chapter(s) 3
Using an AED Lecture 60
Practice Session (AED Use) 90
Adult CPR
DVD Chapter(s) 2
Adult CPR Lecture 20
Two-Rescuer Adult CPR 10
Practice Session (Adult CPR) 40
Child CPR
DVD Chapter(s) 4
Child CPR Lecture 15
Practice Session (Child CPR) 30
Infant CPR
DVD Chapter(s) 1
Infant CPR Lecture 15
Practice Session (Infant CPR) 30
Considerations
Special Considerations-CPR Lecture
105 Special Considerations-AED Lecture
AED Safety Lecture
Discussion How Would You REACT? 10
General Information
REACT DVD Chapter(s) 10
REACT Lecture
60 Legal Issues Legal Issues Lecture
BBP Protection from Infection Lecture
Practice Session (Glove Removal) 10
Heart Attack & Stroke
DVD Chapter(s) 5
Heart Attack Lecture 60
Stroke Lecture
Choking Emergencies
DVD Chapter(s) 4 Adult/Child Choking Lecture 15
6
Practice Session (Adult Choking) 20
DVD Chapter(s) 3
Infant Choking Lecture 10
Practice Session (Infant Choking) 20
Discussion How Would You REACT? 10
First Aid Assessment
Assessing and Moving
DVD Chapters(s) 7
Assessing a Victim Lecture
50 Positioning a Victim Lecture
Moving a Victim Practice Session (Assess & Position)
45
Injuries
Bleeding & Shock
DVD Chapter(s) 6
Bleeding, Shock, Trauma Lecture 30
Practice Session (Bleeding Control) 45
Discussion How Would You REACT? 10
Trauma
DVD Chapter(s) 1
Head, Neck & Back Injuries Lecture 40
Chest & Abdominal Injuries Lecture
DVD Chapter(s) 5 Muscle, Bone & Joint Injuries Lecture
20
Practice Session (Splinting) 45
DVD Chapter(s) 4
Burns Lecture 20
Discussion How Would You REACT? 10
Medical Emergencies
Breathing Difficulty
DVD Chapter(s) 7
Difficulty Breathing Lecture 30
Allergic Reactions Lecture
Practice Session (Auto-Injector) 20
Seizures DVD Chapter(s) 2
Seizures, Fainting Lecture 15
Diabetes Diabetic Emergencies Lecture 15
Environmental Emergencies
Poisoning Lecture/Drug Abuse 15
Heat & Cold Emergencies
DVD Chapter(s) 7
Heat-related Emergencies Lecture 20
Cold-related Emergencies Lecture
Bites & Stings Bites & Stings Lecture 15
Discussion How Would You REACT? 10
Prevention and Planning
FA Kits First Aid Kits Lecture 5
Checklist Checklist Review Lecture 5
7
T-22 Content Lectures
See Course Pack and PowerPoint: T-22 Content is inserted into the corresponding lesson above.
START Triage Lecture 30
Pregnancy-Related Emergencies 15
Respiratory Emergencies 15
Patient Movement Equipment 30
Orientation to the EMS System 10
CA Penal Code: 13158 10
CDCR Scenarios 60
Recertification Provider Training / Refresher Training
Title 22 Requirements 100025. Retraining Requirements.
(a) The retraining requirements of this Chapter shall be satisfied by successful completion of
either:
(1) An approved retraining course which includes a review of the topics and demonstration of
skills prescribed in this Chapter and which consists of no less than twelve (12) hours; or
(2) A competency based written and skills pretest of the topics and skills prescribed in this
Chapter with the following restrictions:
(A) That appropriate retraining be provided on those topics indicated necessary by the pretest,
in addition to any new developments in first aid and CPR;
(B) A final test be provided covering those topics included in the retraining for those persons
failing to pass the pretest; and
(C) The hours for the retraining may be reduced to those hours needed to cover the topics
indicated necessary by the pretest.
(b) The entire retraining course or pretest may be offered yearly by the training agency, but in
no event shall the retraining course or pretest be offered less than once every three (3) years.
Recertification vs. Refresher Training
Suggested course times can be adjusted based on student needs
*Splinting: Provide Demo or Optional Practice
** Ensure that each CDCR scenario is covered during practice sessions
^^ Testing only required for 'recertification' class, not required for 'refresher' training
Major Topic Lesson Individual Topic Min.
Test^^ Pre-Test Written and Skills 20
CPR Introduction
Instructor
5.00 Course Overview
Requirements for Certification
8
Building Blocks
DVD Chapter(s) 1-2 10.95
Chain of Survival Lecture 0.00
CPR Overview Lecture
DVD Chapter(s) 3-5 9.98
C-A-B Lecture
4.00 Recovery Position Lecture
CPR Barriers Lecture
Practice Session (Building Blocks) 10.00
Bag Mask Lecture and Demo 2.00
Practice Session (Bag Mask) 5.00
AED Use
DVD Chapter 6 3.78
Using an AED Lecture N/A
Practice Session (AED Use) 10.00
Teams Team CPR (Pro-Rescuer Only) 3.00
Adult CPR
DVD Chapter 7 2.13
Adult CPR Lecture N/A
Practice Session (Adult CPR) 10.00
Child CPR
DVD Chapter 8 4.97
Child CPR Lecture N/A
Practice Session (Child CPR) 5.00
Infant CPR
DVD Chapter 9 4.27
Infant CPR Lecture N/A
Practice Session (Infant CPR) 5.00
Considerations
Special Considerations-CPR Lecture
10.00 Special Considerations-AED Lecture
AED Safety Lecture
Discussion How Would You REACT? N/A
General Information
REACT DVD Chapters 10-12 6.70
REACT Lecture
0.00 Legal Issues Legal Issues Lecture
BBP Protection from Infection Lecture
Practice Session (Glove Removal) 2.00
Heart Attack & Stroke
DVD Chapters 13-14 8.93
Heart Attack Lecture 0.00
Stroke Lecture
Choking Emergencies
DVD Chapter 15 3.43
Adult/Child Choking Lecture N/A
Practice Session (Adult Choking) 5.00
DVD Chapter 16 2.43
Infant Choking Lecture N/A
9
Practice Session (Infant Choking) 5.00
Discussion How Would You REACT? N/A
First Aid Assessment
Assessing and Moving
DVD Chapters(s) 7
Assessing a Victim Lecture
N/A Positioning a Victim Lecture
Moving a Victim
Practice Session (Assess & Position) 5
Injuries
Bleeding & Shock
DVD Chapter(s) 5.5
Bleeding, Shock, Trauma Lecture N/A
Practice Session (Bleeding Control) 10
Discussion How Would You REACT? N/A
Trauma
DVD Chapter(s) 1
Head, Neck & Back Injuries Lecture 4
Chest & Abdominal Injuries Lecture
DVD Chapter(s) 5
Muscle, Bone & Joint Injuries Lecture N/A
Practice Session (Splinting*) 5
DVD Chapter(s) 3.5
Burns Lecture N/A
Discussion How Would You REACT? N/A
Medical Emergencies
Breathing Difficulty
DVD Chapter(s) 2
Difficulty Breathing Lecture N/A
Allergic Reactions Lecture
Practice Session (Auto-Injector) 2
Seizures DVD Chapter(s) 7
Seizures, Fainting Lecture N/A
Diabetes Diabetic Emergencies Lecture N/A
Environmental Emergencies
Poisoning Lecture N/A
Heat & Cold Emergencies
DVD Chapter(s) 7
Heat-related Emergencies Lecture N/A
Cold-related Emergencies Lecture
Bites & Stings Bites & Stings Lecture 2
Discussion How Would You REACT? N/A
Prevention and Planning
FA Kits First Aid Kits Lecture N/A
Checklist Checklist Review Lecture (optional) N/A
CDCR-Specific
See Course Pack and PowerPoint: T-22 Content is inserted into the corresponding lessons above.
START Triage Lecture
25 Pregnancy-Related Emergencies Lecture
Respiratory Illnesses Lecture
Marine Animal Stings Lecture
10
Equipment for Moving Patients Lecture
CDCR Scenarios**
Test^^ Post-Test Written and Skills 30
4.66
Supplemental Student Information – A Title 22 Requirement The information provided below must be discussed, demonstrated and/or practiced as
indicated. Instructors need to read and be familiar with the content.
This information is additional content beyond standard CPR/AED/First Aid training and is
required by the California Code of Regulations Title 22, Division 9, Chapter 1.5: First Aid
Standards for Public Safety Personnel.
Follow the course outlines to insert the supplemental student information into the lesson as
indicated.
If the EMS Safety CPR/AED/First Aid course is taught to the general public, follow the standard
EMS Safety course outline presented in Section 1 of the EMS Safety Instructor Manuals.
11
Orientation to the EMS System (Lesson: Chain of Survival)
The Emergency Medical Services (EMS) System is a network of resources to provide emergency
care and transport to victims of sudden illness and injury. Each state in the U.S. has an EMS
Authority which oversees state regulations pertaining to EMS responders, training and
treatment guidelines.
Each county usually has a Local EMS Authority (LEMSA) that regulates EMS‐related issues in
their county. Regulations may differ between counties, even within the same state. Be sure to
contact your LEMSA for clarification of regulations and policy. (Provide each student the contact
information for his/her LEMSA).
State and local EMS agencies are involved in the planning and execution of the following:
Prevention of injury
Occurrence of the event
Recognition of the event and activation of the EMS system
Bystander care / dispatch instructions
Arrival of first responders
o Fire / rescue personnel
o Law enforcement
o Industrial response teams
Arrival of additional EMS recourses
Transportation to the receiving facility
Transfer to in‐hospital care system and personnel
There are 10 classic components of an EMS System (local or state):
1. Regulation and policy
2. Resource management
3. Human resources and training
4. Transportation
5. Facilities
6. Communications
7. Public’s information and education
8. Medical oversight
9. Trauma systems
10. Evaluation
Accessing the EMS System In most counties, the best way to access the EMS System during an emergency is by calling 9‐1‐
1. However, some areas do not have 9‐1‐1 systems. Typical access methods include:
Call 9‐1‐1: Connect to police, fire, EMS agency or dispatch center
12
Enhanced 9‐1‐1 systems: As soon as the call is connected to the dispatch center, a
computer identifies the location of the caller.
A local 7 digit number: Small, rural communities may not have a 9‐1‐1 system. Contact
the LEMSA to obtain the number to access your EMS System. Be sure to provide it to
your students and post it around your home or office.
EMS System and the First Responder Many different types of responders provide care and transport of the sick and injured. The levels
of training and responsibility vary for each and depend on local and state regulations.
Types of Responders
First Responder
o Scope:
AED/CPR
Basic first aid
Assisting EMS personnel
Emergency Medical Technician‐Basic (EMT‐I)
o Scope
Assessment
AED/CPR
Advanced first aid
Use of breathing adjuncts & oxygen administration
Transport of sick and injured
EMT‐Intermediate (EMT‐II)
o Scope
All EMT‐I skills
ECG monitoring/defibrillation
Intravenous infusion
9 medications (scope varies by location)
EMT –Paramedic (EMT‐P)
o Scope
All EMT‐I, EMT‐II skills
Laryngoscope / Endotracheal (ET) intubation
Glucose measuring
Valsalva Maneuver
Needle thoracostomy and cricothyroidotomy
Nasogastric intubation
21 medications (scope varies by location)
13
Hospital Care Systems and Personnel
There are many levels of care in the hospital settings. EMS responders must be familiar with the
care centers available to them, and what protocols would determine to which center to
transport a patient. The LEMSA determines the protocols for transport to certain receiving
centers.
Types of Facilities / Receiving Centers
Trauma centers
Burn centers
Neuro‐science center / stroke center
Pediatric centers
Perinatal centers
Poison centers
Hospital Personnel
Physicians
Nurses
Emergency Care Technicians
Other allied health personnel
Roles and Responsibilities of the First Responder The role of the first responder varies depending on state and county protocols. Refer to your
LEMSA for determination of your scope of practice and exact role within your community’s EMS
system.
Typical roles for the first responder include the following:
1. Personal, crew, patient and bystander safety
2. Gaining access to the patient
3. First responder patient assessment to identify life‐threatening conditions
4. Continuation of care through additional EMS resources
5. Initial patient care based on assessment findings
6. Participation with recordkeeping and data collection as pertaining to local or state
requirements
7. Liaison with other public safety workers
a. Local law enforcement
b. State and federal law enforcement
c. Fire departments
d. EMS providers
14
Typical responsibilities of the first responder include the following:
1. Personal health and safety
2. Maintain a caring attitude – reassure and comfort patient, family, and bystanders while
awaiting additional EMS resources.
3. Maintain composure
4. Maintain composure
5. Neat, clean and professional appearance
6. Maintain up‐to‐date knowledge and skills
a. Continuing education
b. Refresher courses
7. Prioritize patient’s needs without endangering self
8. Maintain current knowledge of local, state, and national issues affecting EMS.
Medical Oversight Medical oversight is the formal relationship between the EMS provider and the physician
responsible for the out‐of‐hospital emergency medical care provided in a community. The
physician who is responsible is known as the System Medical Director. Every EMS system, both
state and local, must have medical oversight.
System elements under medical oversight include the following:
System design
Protocol development
Education
Quality management
Types of Medical Oversight
1. Direct Medical Control
a. Also known as
i. On‐line
ii. Base station
iii. Immediate
iv. Concurrent
b. Simultaneous physician director of field provider
c. Communication with EMS via:
i. Radio
ii. Telephone
iii. Contact with a physician on scene
2. Indirect Medical Control
a. Also known as:
i. Off‐line
ii. Retrospective
15
iii. Prospective
b. Includes everything that is not medical control
Interacting with EMS Personnel The transfer of care from the first responder to the EMS provider is important. An ineffective
transfer of care may waste valuable time and compromise patient care.
Continuation of Care
Sometimes a first responder’s initial reaction is to step back when EMS personnel arrive. The
first responder should work together with EMS personnel to ensure optimum care is maintained
throughout the transfer of care. When EMS personnel arrive:
Continue care while EMS personnel ready equipment and additional resources
EMS personnel will notify the first responder when ready to assume patient care
Be ready to assist EMS personnel with additional patient care tasks, if asked
o Continue to stabilize a suspected neck or back injury
o Continue performing chest compressions, relieve other rescuers
o Provide AED shock if indicated by AED prompt
o Continue to apply pressure to a bleeding wound
o Help lift a patient to a stretcher
o Any other task within the first responder’s scope of practice
Continue care until formally relieved by EMS personnel
FollowUp and Event Review Contact your local and EMS agency before an event occurs. Arrange a tour of your facility to
meet with local EMS providers and discuss logistics:
Where will EMS arrive?
What is the best access point?
Who will escort them to the emergency at the facility?
It is important to review an event with the first responders. Follow‐up with the local EMS to
improve the quality of care and effectiveness of the system. The goal of follow‐up and event
review is to correct mistakes, shorten responder times and find ways to improve overall.
First responders and EMS professionals should focus on the following:
How quickly the EMS system (9‐1‐1) was called
Improvement of response times within the facility
How to increase the effectiveness of care
Was there easy access to first aid kits, personal protective equipment, AED/CPR
supplies?
Was there easy access to the patient?
16
Streamlining the transfer of care from first responders to EMS personnel
Improvement of EMS providers’ ability to access and leave with the patient
Conclusion Visit your state EMS agency’s website for more information on specific statutes and regulations
related to state‐EMS protocols. Defer to your LEMSA for county‐specific treatment guidelines.
Continue care upon the arrival of EMS personnel. Be ready to assist as needed, within your
scope of practice. Meet with your LEMSA to prepare for an event. Review events to improve the
quality of care.
17
CA Penal Code (Lesson: CPR Barrier Devices)
Review the following sections of the penal code:
Section 13518 (a) Every city police officer, sheriff, deputy sheriff, marshal, deputy marshal, peace officer
member of the Department of the California Highway Patrol, and police officer of a district
authorized by statute to maintain a police department, except those whose duties are primarily
clerical or administrative, shall meet the training standards prescribed by the Emergency
Medical Services Authority for the administration of first aid and cardiopulmonary resuscitation.
This training shall include instruction in the use of a portable manual mask and airway assembly
designed to prevent the spread of communicable diseases. In addition, satisfactory completion
of periodic refresher training or appropriate testing in cardiopulmonary resuscitation and other
first aid as prescribed by the Emergency Medical Services Authority shall also be required.
(b) The course of training leading to the basic certificate issued by the commission shall include
adequate instruction in the procedures described in subdivision (a). No reimbursement shall be
made to local agencies based on attendance at any such course which does not comply with the
requirements of this subdivision.
(c) As used in this section, “primarily clerical or administrative” means the performance of
clerical or administrative duties for a minimum of 90 percent of the time worked within a pay
period.
Reference: http://law.onecle.com/california/penal/13518.html
Section 13518.1 In order to prevent the spread of communicable disease, every law enforcement agency
employing peace officers described in subdivision (a) of section 13518 shall provide to each of
these peace officers an appropriate portable manual mask and airway assembly for use when
applying cardiopulmonary resuscitation.
Reference: http://law.onecle.com/california/penal/13518.1.html
18
Bag Mask Ventilation (Lesson: CPR Barrier Devices)
The bag valve mask (BVM) can increase the amount of oxygen delivered and prevent rescuer
exposure to pathogens. It is generally used by healthcare providers and professional rescuers
who train often and in varied conditions to ensure proper use.
The bag mask consists of a non‐rebreathing mask and self‐inflating bag attached to an oxygen
reservoir. Tubing connects the bag mask to the oxygen tank. During cardiac arrest, the bag mask
uses positive pressure ventilation when the rescuer squeezes the bag to push air into the lungs.
The bag mask is most effective when used together with emergency oxygen.
1‐Rescuer Bag Mask Use:
1. Select the appropriate size (adult, child or infant) and assemble the bag mask.
2. If supplemental oxygen is available, connect the bag mask tubing to the oxygen
regulator. Deliver oxygen at 15 LPM (minimum flow rate of 10‐12 LPM).
3. Position yourself at the top of the victim’s head.
4. Tilt the head back into the open airway position.
5. Apply the mask to the face using the bridge of the nose as a guide for correct position.
Ensure proper fit.
6. Use the thumb and index finger to create a tight seal around the nose and mouth. Place
your other fingers along the bony portion of the jaw, and lift the jaw up into the mask.
7. While maintaining the seal and head tilt with 1 hand, use the other hand to squeeze the
bag and deliver the air. Ensure that no air escapes the seal around the mouth and nose.
a. Deliver each breath for 1 second.
b. Watch for chest rise.
c. Do not over‐ventilate.
Alternate technique: Squeeze the bag between your arm and body or arm and leg.
2‐Rescuer Bag Mask Use:
Effective ventilation can be provided more easily when 2 rescuers use the bag mask.
1. One rescuer holds the mask in place, creating a seal and maintaining a head tilt/chin lift.
2. The other rescuer squeezes the bag for 1 second and observes for chest rise.
Tips:
Use a bag mask to deliver about 600mL of air for an adult. Squeeze a 1‐L adult bag about
2/3 of its volume, or a 2‐L adult bag about 1/3 of its volume.
A bag mask is not recommended for use by a lone rescuer during CPR.
19
START Triage* (Lesson: Responding to Emergencies)
START stands for Simple Triage and Rapid Treatment. It is a system that was developed by Hoag
Hospital and the Newport Beach Fire Department in the early 1980’s. START Triage is a method
used when the number of patients exceeds the number of rescuers. Situations requiring triage
are often known as mass‐casualty incidents. Using triage, rescuers with basic first aid training
can rapidly assess large numbers of casualties and separate them into groups of victims with
minor, moderate or severe injuries, and also identify those who are uninjured or deceased.
Once triage has been completed, rescuers can begin treating and transporting the victims with
the most serious needs.
Triage comes from the French language, meaning to sort.
The purpose of triage is to identify those with the most serious, life‐threatening injuries and
treat them before they succumb to their wounds. Without triage, persons with less severe
injuries may be treated before those with serious injuries. Categorizing those who are injured
and treating the most seriously wounded first can save more lives.
Lay rescuers can use triage techniques before the arrival of professional rescuers. Remain calm.
Request help; give 9‐1‐1 dispatchers a brief overview of the scene, the situation, and the
approximate number of victims. Be clear about the location of incident. During the triage phase
of a mass causality incident, trained rescuers should not provide care until the victims are
sorted. Use bystanders to apply pressure to stop bleeding or hold open an airway.
In the START triage system, each initial patient assessment and treatment should take less than
30 seconds. No medical equipment is needed initially, because you provide only the most basic
intervention possible; you do not stop. If you stop to treat each patient before completing
triage, you will be unable to quickly assess all the patients and identify those who need
immediate treatment.
A triage tag is used to identify four categories of patients. Their transport and treatment are
based on the victim’s triage category.
The four categories are:
Minor
Delayed
Immediate
Deceased
When first on scene, give verbal instructions to clear everyone who is walking wounded (i.e. can
walk out of the scene on their own). Direct them to a safe area for further assessment and
treatment, and tag them as minor. Anyone who is left will be assessed and triaged.
20
Rescuer will use the RPM assessment:
Respirations
Perfusion
Mental status
Triage begins where you stand. As systematically as possible, move from victim to victim,
stopping for approximately 30 seconds, but no longer than 60 seconds. Use the following steps
to assess RPM and quickly categorize each victim.
1. Respiration: assess for breathing
a. None: Open airway
i. If no breathing, tag deceased
ii. If breathing, tag immediate
b. Greater than 30 breaths per minute
i. Tag Immediate
c. Less than 30 per minute, assess victim’s perfusion
2. Perfusion: assess capillary refill
a. Capillary refill greater than 2 seconds, tag immediate
b. Capillary refill less than 2 seconds, assess victim’s mental status
3. Mental Status: give simple command
a. Ask victim to “Open your eyes.” Or “Squeeze my hands.” If command not
followed, tag immediate.
b. Tag victim delayed if victim can follow a simple command.
Record the number and descriptions of persons you’ve assessed or tagged. As professional
rescuers arrive, the first responder should report his or her findings. Include information about
your scene size‐up, and the number of victims triaged into the four categories. Provide any
further assistance or other information as requested.
* This information is used with permission of the Newport Beach Fire Department and
represents only a brief overview of the START triage system. For more information visit
http://www.start‐triage.com/index.html or contact the Newport Beach Fire Department at (949)
644‐3358.
21
Equipment for Moving Patients: (Lesson: Moving a Victim)
NonEmergency Transfers Non‐emergency transfers are used to transfer a victim to a stretcher or board. Use these moves
when spinal or had injury is not suspected. It is very helpful to practice before using these
techniques.
Direct Carry: Transfer a supine patient to a stretcher
1. Prepare stretcher: adjust height, lower rails, unbuckle straps.
2. Position stretcher next to bed with head end at the foot of the bed.
3. Rescuers stand between the bed and stretcher, facing the patient.
4. 1st rescuer slides arm under the patient’s neck and cups patient’s shoulder.
5. 2nd rescuer slides hand over the hip and lifts slightly.
6. 1st rescuer slides arm under patient’s back.
7. 2nd rescuer places other arm under patient’s calves.
8. Slide patient to edge of bed and lift toward the rescuer’s chest
9. Rescuers rotate and place the patient gently onto the stretcher.
Draw Sheet: Transfer a supine patient from a bed to a stretcher
1. Loosen bottom sheet of the bed.
2. Prepare stretcher: adjust height, lower rails, unbuckle straps.
3. Position stretcher next to bed.
4. Rescuers stand next to each other, with stretcher between them and the bed.
5. Reach across stretcher and grasp sheet firmly at patient’s head, chest, hips, and knees.
6. Slide patient gently onto the stretcher.
Equipment for Moving Patients Although most first responders are not equipped with devices for moving patients, it is helpful
to be familiar with the equipment EMS responders may bring to the scene. First responders who
assist their local EMS agency should practice with them to become familiar with the types and
operation of the following:
Wheeled Ambulance Stretcher (cot or gurney)
Can be raised or lowered, head can raise to sit patient up, sometimes foot can be raised.
Can be rolled by two or four people with rescuers at the head and foot ends.
Can be carried by two or four people
o Best with four rescuers, one at each corner.
o With two rescuers, face each other from the head and foot of the stretcher.
Portable Stretcher
Use when a wheeled stretcher cannot be moved into a small area.
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Carry in the same manner as a wheeled stretcher, with 2 to 4 rescuers.
Long Backboard
Use for trauma patients to protect neck and spine.
Use to lift patients from small spaces or up onto a stretcher.
Immobilize head and neck; secure patient to board with straps before moving.
Short Backboard
Use to immobilize the head, neck and spine of a patient found in a seated position (e.g.
automobile or confined space).
Some are simple boards with straps; others wrap around the patient and secure the
head, neck and torso (e.g. KED splint).
Once extricated, patients stay attached to the short backboard and they are secured to
a long backboard in a supine position.
Stair Chair
Use to carry a patient in a seated position.
Good for small spaces, stairs and patients with difficulty breathing.
Can be tilted back, rolled or carried.
To carry, rescuers face each other, similar to a stretcher.
Not suited for suspected trauma patients.
Scoop Stretcher
A rigid device that separates into right and left halves.
Rescuers scoop each half under the patient and reconnect the ends.
Helpful for moving patients out of small or tight spaces.
Straps can be attached.
Not used for suspected trauma patients.
Activities
Emergency moves: discuss/demonstrate drags and carries (from workbook).
Non‐emergency moves: Demonstrate and practice with volunteers:
o Direct lift
o Extremity lift
Equipment: Discuss and demonstrate use of facility specific patient moving equipment.
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Wound Care and Infection (Lesson: Bleeding and Shock)
An infected wound can be a source of shock. Be aware of signs of wound infection including:
Pus or cloudy discharge
Increasing redness and/or swelling around the wound site
Red streaks from the wound heading towards the heart
Increased pain or tenderness after 48 hours from the occurrence
Fever
Wound is not healing after 10 days
If a wound is infected, the patient will usually require antibiotics to treat the infection. Consult
medical control.
Minor wounds or wounds with minor redness can be treated to prevent infection. Treatment
includes:
Warm soaks or local heat with a damp cloth soaked in warm water for 20 minutes, 3
times/day. For closed wounds or sutures use a heating pad or warm, moist cloth. Avoid
moisture to sutured wounds for at least 24 hours; do not soak sutured wounds.
Apply antibiotic ointment 3 times/day
Cover the wound with a clean dressing if it may become dirty. Change regularly.
An untreated wound infection can lead to sepsis. Sepsis occurs as an inflammatory response to
the bacteria from the infection. If left untreated, sepsis can develop into septic shock. Sepsis is
diagnosed by a physician. Contact medical control for patients with an infected wound or if any
of the following signs are associated with a wound infection or recent illness:
Fever or chills
Altered mental status, confusion
Rapid heart rate
Rapid breathing rate
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Back Injuries (Lesson: Head, Neck and Back Injuries)
Back injuries are one of the most common injuries. It is also common that the rescuer
experiences a back injury when he or she lifts improperly!
Trauma to the back can be dangerous because of the major organs along the back, including the
spine, lungs, and large blood vessels. For victims of back trauma, assume there is also a neck
injury and treat the victim in the position found or the position of comfort until professional
help arrives.
More common back injuries include strains to the lower back muscles from lifting. Treat a back
strain similar to a bruise:
Rest the area.
Place ice in a plastic bag over a damp towel to the affected area for 20 minutes on and
at least 20 minutes off, 3‐4 times per day for the first 48 hours.
Use heat after 48 hours to the affected area: warm soaks or local heat with a damp
cloth soaked in warm water for 20 minutes, 3 times/day.
Seek medical care if worsening or not improving after a few days
Safe Lifting Techniques
If you have to lift a patient, use proper lifting techniques to avoid a back injury:
1. Know your limits; ask for help if needed.
2. Tell the person what you’re going to do.
3. Position your feet shoulder width apart, with one foot slightly in front of the other.
4. Keep your back straight, tighten your abdominal muscles, and bend your knees.
5. Communicate with your lifting partners. The person at the head is usually in charge.
6. Hold the person close to your body.
7. Lift with your legs, not with your back.
8. Lift and carry slowly, in unison with others.
9. Do not twist your back; pivot your feet.
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Pregnancy – Related Emergencies (Lesson: Chest & Abdominal Injuries)
Treatment of pregnancy related emergencies is extremely complex.
Responders should activate EMS at any sign of sudden illness or injury
Abdominal injuries should be evaluated by a physician.
If positioning is required, position a pregnant patient on the left side.
o Allows for adequate blood flow to mother.
o On the right side, the weight of the baby can cut off blood flow to the mother’s
brain.
A full term pregnancy is divided into 3 ‘trimesters.’
Pregnancy‐related emergencies can vary by trimester
The fetus (baby) develops in the mother’s uterus (womb).
o The uterus accepts the egg (ovum) as it implants to the inner‐wall of the uterus
(endometrium) where it’s nourished.
o If the ovum is fertilized it will develop from an egg to a fetus in the uterus.
The baby emerges through a process termed ‘labor.’ Signs of labor include:
o Lightening: When the baby’s head drops down into the pelvis for delivery. The
belly looks lower and the mother may have a sensation to urinate because the
baby is pressing on her bladder.
o Bloody Show: A blood‐tinged or brownish discharge is released from the cervix.
Can occur days before or at the time of labor.
o Diarrhea: Frequent loose stools may mean labor is imminent.
o Ruptured Membranes (Water Broke): Fluid gushing or leaking from the vagina.
o Contractions: Intervals of less than 10 minutes can indicate labor has begun.
Contractions will become longer and more frequent near delivery.
1st Trimester Emergencies Miscarriage
Loss of pregnancy before the 20th week.
Causes can include:
o Acute/chronic illness in the mother
o Abnormalities of the fetus
o Abnormal attachment of the placenta
Signs and symptoms
o Vaginal bleeding, often heavy
o Cramping, abdominal pain
o Passage of tissue
Ectopic Pregnancy
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The egg becomes implanted outside of the uterus
Ectopic pregnancy can rupture surrounding tissues and blood vessels
Signs and symptoms
o Lower abdominal pain
Abdominal pain in a female patient of childbearing age should be
considered an ectopic pregnancy until proven otherwise.
o Signs of shock
o Missed menstrual period
2nd Trimester Emergencies Complications/Miscarriage
Relatively rare during this stage, but miscarriages can occur
3rd Trimester Emergencies Placental Abruption
When the placenta separates from the wall of the uterus.
Can result in massive maternal bleeding and fetal death
Usually related to traumatic emergency (fall, motor vehicle accident, etc).
o More likely when mother has history of:
Hypertension
Multiple pregnancies
Previous placental abruption
Signs and symptoms
o Signs of trauma
o Sudden, severe and constant abdominal pain
o Bleeding, dark red (may or may not be present)
o Signs of shock
Placenta Previa
Occurs when the placenta forms over the opening to the birth canal.
When the uterus opens during the start of labor it causes tearing of the placenta.
Most often occurs in women over 35.
Signs and symptoms:
o Painless, bright red vaginal bleeding
o Signs of shock
Gestational Hypertension / Pregnancy Induced Hypertension (PIH)
Develops gradually during pregnancy.
Characterized by:
o Sudden weight gain
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o Blurred vision
o Increasing blood pressure
o Swelling of hands and/or feet
o Seizures (3rd trimester)
General Treatment of All PregnancyRelated Emergencies Call 9‐1‐1 for every pregnancy related emergencies. If there is bleeding or fluid loss, do not pack
the vagina to control it. Use the following treatment guidelines
Call 9‐1‐1
Monitor response, breathing and appearance
Treat for shock, position mother on her left side
Maintain body temperature
Save any passed tissue
Calm and reassure the mother
Childbirth All first responders should be prepared to assist with the delivery and initial care of the
newborn. Childbirth is seldom an emergency. However, multiple childbirths may make labor
occur much faster than in a first or second childbirth.
Providers should be aware of the mother’s history including how many children she has and if
there are any expected complications with this pregnancy.
Labor is broken down into three phases.
1st Phase: Contractions begin
Contractions occur at 5‐15 minute intervals
Can last many hours
2nd Phase: From the opening of the birth canal to the delivery of the baby
Birth is imminent if:
o Contractions are less than 5 minutes apart
o The mother feels an urge to push or bear down
Do not let the mother go to the bathroom!
If delivery is imminent, prepare for childbirth
o Call 9‐1‐1 for assistance
o Lay the mother on her back; remove clothing from lower half of her body.
o Bulging of the vagina or crowning (the the top of the baby’s head is visible)
means the baby is coming now.
o Support the emerging infant: DO NOT PULL THE BABY
o Usually comes head first, then shoulders and the rest of the body comes quickly
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o Anticipate about 2 cups of blood‐tinged fluid to be expelled with the baby.
Assess, care for and warm the baby immediately after delivery
o A strong cry is a sign of a healthy newborn.
o If no crying, ensure the baby is breathing, start CPR if needed.
o Gently dry the baby and wrap the baby in blankets to prevent heat loss.
o Ensure the head is isolated and face is visible.
o Place the baby on the mother’s chest and let her hold him.
3rd Phase: From the delivery of the baby to the delivery of the placenta Contractions begin again to deliver the placenta (also known as afterbirth)
Typically takes about 15‐30 minutes
Do not delay transport to the hospital to wait for afterbirth
Complications / Abnormal Presentations during Childbirth Usually very rare
An arm, leg, buttocks or umbilical cord may appear first
A true emergency, ensure 9‐1‐1 has been called
The best treatment is safe, rapid transportation to the emergency room.
Usually requires a C‐section delivery
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Closed Wounds/Bruising (Lesson: Muscle, Bone & Joint Injuries)
The most common closed wound is a bruise, also known as a contusion. Because it is so
common, the fact that a bruise can be a clue to a more serious injury is easily overlooked.
A bruise is a soft tissue injury that occurs beneath the skin. The discoloration from a bruise
occurs because small blood vessels are broken, and localized bleeding under the skin causes the
area to swell. Simple bruising will heal over a few days.
Bruising can also be a sign of more serious injuries, including:
Severe internal bleeding
Fracture or dislocation
Strain or sprain
Bruising to specific regions should be evaluated by professional medical providers when signs of
additional injury are present:
Head/face/neck
Chest or flank
Abdomen
Severe bruising or swelling to an extremity
If bruising occurs to an extremity, treat it as a suspected fracture until otherwise diagnosed.
General care for a bruise includes the following:
1. Rest: Allow person to assume a position of comfort; reduce movement to bruised area.
2. Ice: Place ice in a plastic bag over a damp towel to the bruised area for 20 minutes on
and at least 20 minutes off 3‐4 times a day for the first 48 hours.
3. Compress: Wrap an elastic bandage around the extremity to control swelling. The wrap
should fit snugly but not restrict circulation to the extremity.
4. Elevate: for an extremity bruise, elevate above the level of the heart to reduce swelling
as long as it does not cause further pain.
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Respiratory Illness (Lesson: Difficulty Breathing)
Croup Breathing difficulty characterized by a barking cough caused by swelling around the vocal cords.
Croup is usually caused by a viral or bacterial infection.
Croup usually affects children from 3 months to 3 years old
Signs and symptoms
Difficulty breathing
Barking cough (sounds like a seal’s bark)
Difficult, unable to swallow
Tripod positioning
Hoarse voice
Rib retractions (pulling inward of the rib cage with breathing)
Fever
Treatment
Assess response, breathing, circulation and appearance.
Provide air with high humidity
o Night time air: take child outside
o Humidified air from humidifier
Control fever / take simple cooling measures
Respiratory Syncytial Virus (RSV) RSV is a virus that causes lung infection. It is more prevalent in the infant / toddler age group
and most commonly occurs in the winter months.
Signs and symptoms
Low grade fever
Sight cough
Nasal secretions: profuse, thick, clear
Watery eyes
Treatment
Bed rest
Fluid intake to thin secretions and prevent dehydration
Suction nose of young children with a bulb syringe
Pneumonia
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A serious lung infection, it can destroy lung tissue and kills 52,000 Americans every year.
Pneumonia requires antibiotics for treatment. It’s common throughout childhood, amongst
seniors and those with weakened immune systems.
If you suspect you have pneumonia, see your doctor promptly.
Signs & symptoms
Fever
Fatigue
Rapid, shallow respirations
Cough and runny nose
Chest pain
Treatment
Medical attention / antibiotics
Bed rest
Fluid intake
Fever control
Pertussis / Whooping Cough Whooping cough, which is caused by a bacteria, is a highly contagious childhood disease and is
particularly dangerous to infants less than 12 months of age. With an incubation period of 5‐21
days, it’s easy to spread around as it’s transmitted through droplets, direct contact or indirect
contact w/ a contaminated object or individual.
It’s characterized by sudden attacks of coughing.
Signs and symptoms
Fever
Malaise
24 hours of runny nose, cough and conjunctivitis
Coughing fits
Treatment
Bed rest during febrile period; fever control
Notify physician of any fever greater than 102oF
Keep skin clean and dry; use tepid bath
Cool mist vaporizer for dry cough
Encourage fluids and soft, bland foods
Clean eyelids with warm saline solution to remove secretions and crust (which are
contagious)
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Suspected Drug Abuse (Lesson: Poisoning)
Drug poisoning can occur from exposure to illegal, prescription or over‐the‐counter drugs. There
are now an equal number of emergency department visits for prescription and over‐the‐counter
drug overdoses as there are for illegal drug overdoses. The group mostly likely to die of
unintentional drug poisonings are men and people between the ages of 45 – 54.
Drugs, like any poison, can be ingested, injected, absorbed though the skin or inhaled.
A National Survey on Drug Use showed that there are 22 million substance abusers dependent
on alcohol or other drugs. 75% of substance and alcohol abusers are currently employed.
If you suspect drug or alcohol abuse, look for drug paraphernalia and empty pill or alcohol
containers. Follow general poisoning treatment guidelines, and ensure an escape route if the
person becomes violent.
A person addicted to drugs or alcohol will become sick if he or she suddenly stops using. If a
person admits to drug or alcohol abuse, ask about the last time they used drugs: when, what
and how much.
General Treatment for Suspected Drug Abuse 1. Ensure rescuer and bystander safety 2. Provide CPR if needed 3. Position victim as needed 4. Prevent victim from hurting self or others 5. Calm and reassure the victim 6. Call for medical control 7. Gather as much information as possible
a. What was taken b. When was it taken c. How much was taken d. How was it taken
8. Look for drugs, drug paraphernalia, and empty pill bottles or alcohol containers 9. Be aware of needles that may be on or around the victim
Types of Abuse Alcohol
Most commonly abused drug in the U.S.
Depressant
Involved in:
o More than ½ of all traffic fatalities
o More than ½ of all murders
o More than 1/3 of all suicides
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Other medical conditions can be confused with drunkenness, such as a diabetic
emergency (fruity odor on breath) or head injury (difficulty walking or speaking).
Withdrawal symptoms called Delirium Tremors or DTs can last 3‐4 days.
o Shaking
o Restlessness
o Confusion, hallucination
o Chest pain
o Stomach upset
o Fever
Monitor responsiveness and breathing, transport to medical care, position victim, and
provide CPR as needed.
Amphetamines
Stimulant
Include:
o Speed
o Crystal
o ‘Ice’
o Cocaine
Signs of Abuse:
o Restlessness
o Irritability
o Jerky movements
o Talkativeness
Barbiturates
Depressant
Include:
o Tranquilizers
o Opiates
o Marijuana
Barbiturate overdose can quickly lead to respiratory or cardiac arrest.
Be prepared to start CPR.
Hallucinogens
Chemicals which cause people to see, feel or hear things that are not there.
Includes: o PCP o LSD o Peyote o Mescaline
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o Certain mushrooms
PCP can block patient’s pain receptors; therefore, they may injury themselves or others without knowing it.
Reduce bright lights and loud noises.
A victim on a hallucinogen like PCP may be prone to sudden and violent behavior; take
extra precautions to keep rescuers and bystanders safe.
Be honest with the victim. Don’t lie about seeing hallucinations. State, “I believe you are
seeing those things; however, I do not see them myself.”
Inhalants
Also known as huffing, users put chemicals in a plastic bag and inhale from the bag
Large increase in this type of abuse
Provides alcohol‐like high, cheap and quick
These are household or easily obtainable items, including: o Gasoline o Paint thinner o Cleaning compounds o Aerosol propellants
The complications from inhaling a poison from a bag (which also reduces oxygen intake) can include unconsciousness or death.
Ventilate the area, provide oxygen if possible, and provide CPR if needed. Injection Abuse
Almost any drug can be crushed down, mixed and injected. Common injectable drugs include
heroin, cocaine and speed. Be aware of needles or sharps on or near the victim.
Drugs that are injected are often diluted or cut down from a pure state and mixed with sugar or
other substances. Sometime the user doesn’t even know what he or she has injected. The
potency is difficult to tell; try to assess what and how much was taken.
When assessing a potential drug‐related emergency, check the victim for track marks. Common
areas for injection include the inner arm, neck, and between the toes. Many times injection sites
become infected; redness, swelling or skin that is hot may indicate an infection. Infections from
drug use will require antibiotics. Contact medical control.
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Marine Animal Stings (Lesson: Bites & Stings)
Coelenterates (coe‐len‐ ter‐ates)
Coelenterates include:
Jellyfish
Coral
Sea anemones
Portuguese man‐of‐war (similar to a jellyfish)
These animals have tentacles, which are the firing mechanism of the sting. They even continue
to function long after the animal is dead.
Typically stings only require cleaning. The stinging sensation will usually go away in one hour. In
the worst cases, however, some stings have resulted in anaphylaxis and death.
Signs and Symptoms of Marine Animal Stings
Pain, redness, hives / bumps / rash
Rash may develop blisters or pustules
Nausea, weakness, headache
Muscle pain, spasms
Runny eyes, nose
Fever, chills, sweating
Sever reactions can include
o Chest pain
o Difficulty breathing / swelling of the airway
o Coma
o Death
Treatment of Marine Animal Stings
1. Assess response, breathing, circulation and appearance for more serious reactions.
2. For Box Jellyfish stings, wash liberally with vinegar as soon as possible for at least 30
seconds. This will inactivate the nematocysts so they can’t release venom. If vinegar is
not available, use a baking soda slurry.
3. Remove tentacles with tweezers or a gloved hand.
4. After the nematocysts are deactivated, immerse in hot water for at least 20 minutes to
decrease the pain.
5. Seek medical treatment immediately for severe reactions.
Do I urinate on a jellyfish sting?
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Urinating on jellyfish stings is an old folk treatment; it has been shown to be ineffective in
treating the sting.
Stingrays
Stingrays are found in the ocean under the sand. They can hang out in shallow water near the
shore and when buried under the sand, are very difficult to see.
Most stings from a stingray occur when a person is walking in shallow water and accidently
steps on the stingray. It thrusts its tail‐spine, equipped with a large stinger, into the victim’s foot
or leg and injects venom.
Swimmers should wear water socks or other protective footwear when in ray habitat, and
shuffle their feet when walking through shallow water to warn the creatures of approach.
Signs and Symptoms of a Sting
Jagged, freely bleeding wound
Immediate painful or throbbing sensation, redness, swelling
Weakness, nausea, anxiety, fainting
Less common symptoms include vomiting, diarrhea, sweating, cramps, difficulty
breathing
Treatment
1. Remove person from water/environment.
2. Remove barb if it is superficial and not penetrating the chest, neck, or abdomen.
3. Apply firm direct pressure with sterile gauze to control bleeding.
4. See a physician to clean the wound and remove any remaining fragments of the spine.
Stitches may be required.
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CDCR Training Scenarios (Lesson: N/A) Use the following scenarios during CPR/First Aid Initial, Renewal and Refresher training. Use of
the scenarios is required by CDCR.
During the hands on skills training portions of the course insert the scenarios; discuss the
current policies of CDCR in terms of safety actions and activating/notifying personnel and your
initial patient actions once the scene is safe.
3 Corrections Scenarios: 1. Correctional Law Enforcement CPR training scenario (Adult CPR/AED)
a. You are in a break area having a cup of coffee and chatting with a fellow officer
when he suddenly stops talking, looks confused, and then collapses to the floor.
b. You tap and shout at the officer and he is not responding. There is an AED 20
yards down the hall.
c. What are your actions?
i. Safety?
ii. How to activate response?
iii. Initial treatment actions?
2. Attempted suicide response scenario (Responding to Emergencies)
a. You are responding to a possible suicide; an inmate has been reported hanging.
b. Upon arrival you find an inmate in a locked cell hanging from the bars. He
appears unresponsive. Another inmate shouts, “He just did it!”
c. What are your actions?
i. Safety?
ii. How to activate response?
iii. Initial treatment actions?
3. Transportation response scenario (First Assessment/Seizure)
a. You are transporting an inmate in a van to his court date; the inmate is chatting
and suddenly stops. He arches back in his chair and begins to convulse violently.
His face is turning purple.
b. You shout to him but he is not responding. After 30 seconds the convulsions
stop and the inmate is slumped in his chair with his head forward. You cannot
tell from where you are if he is breathing; he is still not responding to verbal
commands.
c. What are your actions?
i. Safety?
ii. How to activate response?
iii. Initial treatment actions?
