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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