Chapter 1

Background Information

Agree or Disagree? (1 of 3)

11. Rub snow on frostbitten skin.

2. Put butter on burned skin.

3. Immediately soak a sprained ankle in warm water.

4. Cut and suck the poison out of a snakebite.

Agree or Disagree? (2 of 3)

5. Those “struck dead” by lightning cannot be resuscitated.

6. Do not let someone with a head injury go to sleep.

7. Clean a wound by soaking it in water.

8. Avoid using ointments on burns.

Agree or Disagree? (3 of 3)

9. Kill germs in wounds by using hydrogen peroxide.

10. Induce vomiting in all ingested poison cases.

11. Legally, you must help an injured person.

Need for First Aid Training

• At some point in their lives, everyone will have to make the decision to help in an emergency or not.

• It’s better to know it and not need it, than to need it and not know it.

Reason for First Aid Training

Each year unintentional injuries:

• Are the number one cause of death of people between the ages of 1 and 38.

• Are the number five cause of death in the entire population.

What is First Aid?

• First = immediate

• Aid = care

• Deals with injuries or sudden illness

• DOES NOT replace the need for medical care

Purpose of First Aid

• Find it

• Fix it

Consent

• Consent — permission to help

• Expressed consent — verbal confirmation or head nod

• Implied consent

• Unresponsive victim

• Minors

• Mentally incompetent

Victim Refuses Aid

• Rarely happens

• Reasons why it occurs

• Religious beliefs

• Fear of physical pain

• Victim would prefer a doctor’s care

Negligence Criteria

• Duty to Act existed

• Breach of that duty

• Injury and damage occurred

Good Samaritan Laws

Immunity generally applies when:

• Rescuer acted in an emergency

• Rescuer acted in good faith

• Rescuer acted without compensation

• Rescuer did not commit gross negligence

• The EMS System• Components of the EMS System• Activating the EMS System• In-Hospital Care System• Medical Oversight• Roles and Responsibilities of the First Responder• First Responder Skills• Equipment, Tools, and Supplies

Introduction to EMS Systems

The EMS System

A network of resources to provide emergency care and transport to victims of sudden illness and

injury.

The Emergency Scene

Recognition of Accident and Activation of EMS

EMS Dispatch

Arrival of First Responders

Care Given at the Scene

Arrival of Additional EMS

Care During Transport

Transfer to Hospital Emergency Department

Components of the EMS System

• Human Resources• Medical Oversight • Communications• Facilities• Transportation• Resource Management• Regulation and Policy• Public Education• Evaluation

Activating the EMS System

• Enhanced 9-1-1

• 9-1-1

• Non 9-1-1

In-Hospital Care System

• Emergency Department• Specialty Facilities

• Trauma Centers• Burn Centers• Pediatric Centers

• Hospital Personnel• Physicians• Nurses• Allied Personnel

Medical Oversight

The First Responder may be a designated agent of the physician. Care rendered may be considered an extension of the

medical director’s authority.

Medical Oversight

A formal relationship between the EMS providers and the physician responsible for the prehospital emergency medical

care provided in a community.

Medical Direction Given by On-line Orders

Medical Oversight

• Indirect Medical Control

• System Design

• Protocols

• Education

• Quality Management

Levels of Training

• EMT-Paramedic

• EMT-Intermediate

• EMT-Basic

• First Responder

Roles and Responsibilities

• Personal health and safety• Neat, clean, and professional

appearance• Competency in knowledge and skills• Caring attitude• Maintain composure

Patient-Related Duties

• Size up the scene. • Find out what is wrong with the patient. • Lift or move the patient only when it is

necessary. • Transfer the patient and patient information. • Protect the patient’s privacy and maintain

confidentiality. • Be the patient’s advocate.

Skills• As a First Responder, you should be able to:

• Assess and control the scene of a simple incident.• Gain access to patients. • Evaluate a scene for safety. • Properly use all items of personal safety.• Gather information from patients and bystanders.• Conduct a patient assessment.• Relate signs and symptoms to illnesses and injuries.• Determine vital signs.• Document.• Perform airway management.• Perform Cardiopulmonary Resuscitation.• Operate an Automatic External Defibrillator.• Control bleeding.

Skills• As a First Responder, you should be able to:

• Assess and care for shock.• Assess and provide care for closed injuries and open

injuries. • Carry out basic dressing and bandaging techniques.• Assess and care for painful, swollen, deformed

extremities.• Assess and care for possible injuries of the head,

neck, and spine.• Assess and care for cardiac and medical emergencies. • Identify and care for poisoning cases.• Classify and provide care for burns.• Identify and care for smoke inhalation.

Skills• As a First Responder, you should be able to:

• Assess and care for environmental emergencies. • Assist a mother in delivering her baby.• Provide initial care for the newborn.• Identify and care for drug-abuse and alcohol-abuse

patients.• Perform non-emergency and emergency patient moves

when required.• Perform triage at a multiple-patient emergency scene.• Work under the direction of an Incident Commander. • Work under the direction of EMTs.

Skills

• In some systems that have very special needs, First Responders may be required to:

• Determine blood pressure.• Use a bag-valve-mask resuscitator (ventilator).• Deliver oxygen using appropriate devices.• Apply or assist in applying a traction splint.• Apply or assist in applying an extrication collar.• Assist in securing a patient to a long spine board

(backboard) or other device used to immobilize the patient’s spine.

Equipment, Tools, and Supplies• First Responders should know how to use,

and have available whenever possible:• Appropriate barriers (masks and gloves)• Triangular bandages• Roller-type bandages• Gauze pads and trauma dressings• Occlusive dressings (for airtight seals)

Equipment, Tools, and Supplies• First Responders should know how to use,

and have available whenever possible:• Adhesive tape• Bandage shears• Eye protector (paper cup or cone)• Stick (for tourniquet)• Blanket and pillow• Upper and lower extremity splint sets

Equipment, Tools, and Supplies

• Optional items First Responders may use:• Blood pressure cuff and a stethoscope • Oxygen delivery systems

• Suctioning equipment

• The First Responder should be comfortable with the use of common hand and power tools.

• The EMS System• Components of the EMS System• Activating the EMS System• In-Hospital Care System• Medical Oversight• Roles and Responsibilities of the First Responder• First Responder Skills• Equipment, Tools, and Supplies

Summary

Well-Being of the First Responder

• Emotional Aspects of Emergency Care• First Responders and Stress• Critical Incident Stress Management • Body Substance Isolation (BSI)• Scene Safety• Hazardous Materials Incidents• Rescue Operations• Violence and Crime Scenes

Emotional Aspects of Emergency Medical Care

• First Responders and Stress:• Stress contributes to:

• Cardiovascular disease• Stroke• Diabetes• Cancer• Arthritis• Gastrointestinal conditions• Neurological disorders• Emotional disorders

Emotional Aspects of Emergency Medical Care

• First Responders and Stress:• Physical demands• Psychological demands • Personnel must respond quickly to

emergencies.• Personnel must react instantly to

situations.

Emotional Aspects of Emergency Medical Care

Emergencies can be stressful.

Stressful Situations

The First Responder will experience personal stress as well as

encounter patients and bystanders in severe stress.

Common Causes of Stress

• Multiple-casualty incidents

• Pediatric patients

• Death

• Violence

• Abuse and neglect

• Death or injury of a coworker

Multiple-Casualty Incident

Burnout

• A reaction to cumulative stress or exposure to multiple critical incidents

• The signs of burnout include:• Loss of enthusiasm and energy • Feelings of frustration• Hopelessness• Low self-esteem• Isolation• Mistrust

Death and Dying

• As a First Responder, you will at some time have to deal with a patient who has a terminal illness or injury.

• Patients, their families, and the providers will have many different reactions to the illness or injury.

The Grieving Process• The five stages include the following:

• Denial, or “not me” • Anger, or “why me?” • Bargaining, or “OK, but first let

me . . . ”• Depression• Acceptance

The Grieving Process• The First Responder should:

• Recognize the patients’ needs. • Be tolerant of angry reactions.• Listen empathetically.• Do not give false hope or

reassurance. • Offer comfort.

Signs and Symptoms of Stress

Stress Management

• Recognize warning signs.

• Lifestyle changes

• Balance work, recreation, and family.

• Exercise.

• Work environment changes

• Seek professional help.

Critical Incident Stress

The normal stress response to abnormal circumstances.

Critical Incident Stress Management

Critical Incident Stress Management

• When to access CISD:

• Line of duty death

• Serious injury of a co-worker

• Death or serious injury of a child

• Any event that has an unusual impact on personnel

Body Substance Isolation (BSI)

A form of infection control based on the presumption that all body

fluids are infectious.

Dealing with Risk• An estimated 250 health-care workers

die each year from hepatitis B or its complications, more than from any other infectious disease.

• EMS personnel must follow the rules for their own safety and the safety of others.

Dealing with Risk

• Infections are caused by organisms: • viruses (which cause illnesses such as colds,

flu, HIV, and hepatitis)

• bacteria (which cause sore throats, food poisoning, rheumatic fever, gonorrhea, Legionnaire’s disease, and tuberculosis, to name a few)

• There are both viral and bacterial forms of pneumonia and meningitis.

Dealing with Risk• Organisms are also called pathogens:

• The term pathogen means to generate suffering: • patho-, suffering• -gen, create or form

• Spread by exposure to body fluids

• Spread by exposure to airborne droplets

Personal Protective Equipment (PPE)

• Gloves—latex, vinyl, or other synthetic

• Face shields or masks—surgical-type masks: • For fine particles of airborne droplets

(coughing), wear a high-efficiency particulate air (HEPA) or N‑95 respirator.

• Eye protection—Use eyewear that protects them from both the front and sides.

• Gowns—Use when there is spurting blood, childbirth, injuries with heavy bleeding.

Dealing with Risk

• Handwashing:

• Wash hands and change gloves between patients.

• OSHA has stated that handwashing is one of the most important steps to take for infection control.

Dealing with Risk

Bloodborne and Airborne Pathogens

• HIV (human immunodeficiency virus):

• HIV is the pathogen that causes AIDS.

• HIV does not survive well outside the body.

• Routes of exposure to HIV: • Direct contact with non-intact (open) skin

or mucous membranes • Blood, semen, or other body fluids

Bloodborne and Airborne Pathogens• Hepatitis:

• Hepatitis B virus (HBV) is a very tough virus: • It can survive on clothing, newspaper, or

other objects for days after infected blood has dried.

• HBV causes permanent liver damage in many cases.

• Can be fatal• Hepatitis C • Non-A and Non-B hepatitis:

• Less common than HBV

Bloodborne and Airborne Pathogens• Tuberculosis (TB):

• Most often affecting the lungs, can also be fatal.

• Thought to have been nearly eradicated as recently as 1985.

• Has had a recent resurgence.

• New strains of the disease are resistant to treatment with traditional medication.

Bloodborne and Airborne Pathogens• Tuberculosis (TB):

• Spread by aerosolized droplets in the air, usually the result of coughing and sneezing.

• TB can be contracted even without direct physical contact with a carrier.

• Use face masks with one-way valves for rescue breathing and (HEPA) respirator or N-95 respirator.

Bloodborne and Airborne Pathogens• Meningitis:

• An inflammation of the lining of the brain and spinal cord

• The most infectious varieties of meningitis are caused by bacteria.

• Meningitis is transmitted by respiratory droplets.

• First Responders should make sure that EMS and hospital staffs inform them if they have been in contact with a patient infected with meningitis or a scene that may be contaminated with it.

Protecting First Responders• In 1992, OSHA issued guidelines for employers whose workers run a

risk of occupational exposure to bloodborne diseases.

• All such agencies are required to implement plans to meet the OSHA standards. • Provide a free hepatitis B vaccination. • Educate employees about bloodborne diseases. • Establish safe workplace procedures.• Supply personal protective equipment. • Set up engineering controls.• Provide an equipment-cleaning site.• Ensure proper waste disposal according to local regulations.• Implement post-exposure follow-up:

• Determine the significance of exposure.• Document the event.• Test the employee.

Employee Responsibilities• An infection-control program will only work if

First Responders learn and follow correct procedures.

• As a First Responder, you have an obligation to adhere to safe work practices: • Washing hands regularly• Using gloves and other personal

protective equipment

Employee Responsibilities• You may not withhold emergency care

from a patient who you think may have an infectious disease.

• To date, there are no known cases of emergency workers contracting HIV or HBV during routine patient care using gloves and appropriate personal protective equipment.

Scene Safety• Starts before First Responders actually

arrive at the scene

• En route to the scene, get information from dispatch.

• Approaching an emergency scene:

• look around for hazards

• listen for noises

Scene Safety• Position the vehicle.

• You must ensure the safety for:

• Yourself

• Your Partner

• The Patient

• Bystanders

Scene Safety

• Look for:

• Environmental conditions

• Violent situations

• Weapons

• Crowds

• Other situations

Scene Safety

Ensure the scene is safe.

Hazardous Materials Incidents

• Some chemicals can cause serious illness or even death, even if your exposure is brief.

• First Responders should maintain a safe distance from the source of any materials and treat it as a hazardous materials incident.

Hazardous Materials Incidents

• Transport and Storage:

• Truck

• Train

• Boat

• Various storage containers and facilities

Hazardous Materials Incidents

• Placards may help with identifying materials in vehicle collisions.

• Coded colors and identification numbers

Hazardous Materials Incidents• Listed in the Emergency Response Guidebook :

• Published by the U.S. Department of Transportation (DOT)

• It can provide important information:• About a hazardous substance• Safe distances• Emergency care• Suggested procedures in the event of spills

or fire

Hazardous Materials Incidents• Procedures:

• Identify hazardous materials placards from a safe distance, thus ensuring your own safety.

• Recognize potential problems and take action to preserve your own safety and that of others.

• Notify hazardous materials response teams.

Rescue Operations

• Rescue scenes may include dangers from electricity, fire, explosion, hazardous materials, traffic, or water and ice.

• Evaluate each situation and request the appropriately trained teams to assist in handling these incidents:• Police• Fire department• Utility companies• Other specialized personnel

Rescue Operations

• Never perform acts that you are not properly trained to do.

• Use personal protective equipment:• Turnout gear• Protective eyewear• Helmet• Gloves

Violence and Crime Scenes

• Your first priority—even before patient care—is to be certain the scene is safe before you enter it.

• Recognize the situation.

• Request the necessary help.

Summary

• Emotional Aspects of Emergency Care• First Responders and Stress• Critical Incident Stress Management • Body Substance Isolation (BSI)• Scene Safety• Hazardous Materials Incidents• Rescue Operations• Violence and Crime Scenes