Portfolio Userguide-First Responder Manual

First Responders Guide
Primary and Secondary Medical Assessment
First Aid
Rescue Breathing | CPR | AED Heart Defibrillation|

Wound Care | Airway Restoration
By Margaret Andersen-Morgan
First Aid
First Aid
Title and Publication Number

Publication Number: TWRT63
Printed: June 22, 2013
All rights reserved. No part of this publication can be reproduced, stored in a retrieval system, or
transmitted in any form or by any means, electronic, mechanical, photocopying, reading or otherwise,
without the prior permission of the author. While every precaution has been taken in the preparation of this
book, the author assumes no responsibility for errors or omissions, or for damages resulting from the use of
information contained herein.
Composed in Word 2010 on a PC

Fonts used: Candara, Calibri, Ariel, Cambria, Berlin Sans FB
Printed on glossy 30lb paper
Copyright Information
2013 by Margaret Andersen-Morgan
Margaret Andersen-Morgan June 23, 2013 i

Table of
Contents
ii June 23, 2013 Margaret Andersen-Morgan
Table of Contents
Intro|1 Equipment Removal| 33
Emergency Numbers | 2
Index| 35
Safety Precautions| 3
Hazard Awareness | 3
Glossary| 37
Safety Equipment | 4
Appendix| 43
Primary Medical Assessment| 5
CABC| 5
Dedications| 45
Rescue breathing | 7
CPR| 9
AED| 10
Blocked Airway| 13
Wound Care| 15
Secondary Medical Assessment| 17

Patient Interview| 17
Vital Signs| 19
Head-To-Toe Physical Exam| 23
Oxygen Delivery Equipment| 30
Oxygen Delivery System| 31
Margaret Andersen-Morgan June 23, 2013 iii

Introduction
iv June 23, 2013 Margaret Andersen-Morgan

Introduction
Watching a person suffer a heart attack, choking or bleeding can be frightening. Knowing what to do
in an emergency can mean the difference between life and death. Once trained in basic first aid
procedures you can assist a person in need and save a life. The First Responders Guide contains:
Life-Threatening Equipment
Safety Scene Minor Injury Oxygen
Injury Removal and
Precautions Assesment Exam/Interview Administration
Assesment Disposal
Being a first responder, the first person with first aid training to arrive on the scene of an
emergency, you are responsible for your own safety as well as the safety of others. Personal safety
should be your primary concern as you cannot help others if you injury yourself. Use basic safety
skills and personal protective equipment (PPE), or barrier devices to protect your body from
exposure.
Before approaching a scene, conduct a hazard assessment identifying any potential risks. Be aware
of hazards caused by the environment such as downed power lines, dangerous people, or exposure
to illness. Do not approach a patient if life-threatening conditions are present. Call 911instead, and
record information for emergency personnel.
After determining the scene is safe to approach, you can assess a patients medical condition.
Identify and treat life-threatening conditions like choking or blood loss, by checking their
Consciousness, Airway, Breathing, Circulation (CABC.) CABC is an assessment of the bodys
essential life systems.
Once you have determined no life-threatening injuries exist, you are ready to assess and treat non-
life-threatening medical issues. Interview and examine the patient and record all information for use
by medical personnel.
When you finish helping someone, you must remove your protective equipment correctly in order to
protect yourself from possible contaminates on the outside of the equipment. You must then dispose
of all equipment in a labeled biohazard disposal bin to prevent others from exposure to the
contaminants.
Margaret Andersen-Morgan June 23, 2013 1

Emergency Numbers
Emergencies are confusing. If you are responding to an emergency alone, call 911 first and then
proceed to help. If possible, send someone else to call 911 while you respond to the situation.
In the event of an emergency call:
911
Other Emergency Service Numbers:
Looking for a number in an emergency can be stressful. Save yourself time and frustration by
recording local emergency numbers for future use. Numbers to keep on hand include:
Local Police Dispatch:
Local Fire Dispatch:
Local Hospitals:
Local EMS Services:
Poison Control:
Hazardous Materials:
Gas Emergency:
2 June 23, 2013 Margaret Andersen-Morgan

Safety Precautions
Safety first is the #1 rule for first responders. You cannot help others if you compromise your own
safety. Be aware of potential hazards and assess the scene before approaching. Apply protective
equipment to limit you risk to exposure.
Hazard Awareness
Be aware of your surroundings and never rush into an emergency. Stop, look, listen! Stay calm and
use your senses to help you assess the scene for potential hazards. Danger exists in many forms.
Your environment, or surroundings, can pose many hazards such as fire, lightning or electricity.
Look for dangerous people and call law enforcement if needed. Potential biological hazards include
exposure to illness.
Do not approach the patient if the following hazards exist:
Environmental hazards
Look for environmental dangers including smoke, fire, downed/exposed
electrical lines, unstable structures, lightning, hazardous material
contamination, or chemical spills.
Call a hazardous materials team and do not approach.
Behavioral hazards
Watch for dangerous people. Dangerous people include people having
domestic disputes, mental instability or people holding weapons.
Call for law enforcement and observe from a safe location.
Biological hazards
Identify biological hazards such as blood, saliva and other bodily fluids.
Limit your risk of exposure with awareness and proper use of protective
equipment.
Caution
Always determine the scene is safe before you approach the patient.

Safety Equipment
Using personal protective equipment (PPE) protects your body from exposure to the bodily
fluids of a person you are trying to help. Barrier devices include gloves, aprons, masks, and
goggles.
Blood borne illnesses are diseases transmittable through contact with the blood or other
bodily fluids of an infected person. Transmittable diseases include HIV and Hepatitis.
Limit exposure by protecting the points of entry on your body. Points of entry, the areas of your
body vulnerable to disease transmission, include the eyes, hands, mouth, nose and hands. The most
critical areas to protect are your hands and face.
Common types of PPE barrier devices include:
Gloves Disposable Apron

Gloves protect your hands from Disposable aprons protect your
contact with biological hazards. body and clothing from
exposure to profuse bleeding.
N95 Airway Mask Goggles

Airway masks protect your Goggles shield your eyes
mouth and nose from exposure. from exposure.

Primary Medical Assessment
The purpose of a Primary Medical Assessment (PMA) is to identify and treat life-threatening
conditions. Life-threatening conditions include loss of consciousness, respiratory arrest, cardiac
arrest, blocked airway, and blood loss. Based on your assessment you can apply the following rescue
techniques:
Rescue breathing
CPR
Heart defibrillation
Clearing a blocked airway
Controlling blood loss
If the patient is conscious and responsive, skip the Primary Medical Assessment and begin the
Secondary Medical Assessment.
CABC
Identify life-threatening conditions with the acronym CABC (Consciousness,-Airway-Breathing
Circulation.) CABC assesses the bodys essential life systems. You must restore CABC to preserve life.
To assess CABC:
Conscious Airway Breathing Circulation
1. Check for consciousness.

Check consciousness by tapping and
rubbing the chest while shouting,
Can you hear me?
A conscious person responds to tapping and

shouting. If the person responds, you can
begin the secondary medical assessment.

CABC
2. Open the airway.

Place one hand on top of patients forehead and
the other underneath the chin and tilt head back
to open the airway.
Caution
If you suspect a spinal injury, do not tilt the head

back to open the airway. Instead, without moving
the rest of the head, push the jaw forward like an
underbite.
3. Check for breathing.

Place your ear over the patients mouth to feel for
breath on your cheek. At the same time, watch
the chest for movement for 10 seconds.
4. Check the pulse.

Check the carotid pulse, located on the nearside
of the neck under the chin, for 10 seconds. Feel
for the pulse by gently pressing on the carotid
artery with your index and middle fingers.
If you cannot find a pulse, adjust your finger

placement and check again.
If the patient is unconscious, but breathing with a

pulse, gather information from bystanders and
monitor the patient until emergency personnel
arrive.

Rescue Breathing
If a person has a pulse, but is not breathing, you can keep them alive by providing rescue breathing.
Rescue breathing is the process of forcing oxygenated air into the lungs of a person who is in
respiratory arrest, or unable to breathe on their own. A Bag-Valve-Mask (BVM) is a breath-
administering device used when the patient has a pulse, but is not breathing.
Bag
Valve
Mask
To perform rescue breathing using a BVM:
Position Self Apply Mask Open Airway Deliver Breath Check Pulse
1. Position yourself.
Lay the patient flat on their back facing up. Kneel
at their head with the BVM and position the top
of the mask over the mouth and nose.
2. Apply the mask.

Hold the mask by making an OK hand gesture,
with your thumb and index finger encircling the
stem of the mask. Place the mask over the
patients nose and mouth. Apply gently pressure
securing the mask to the face ensuring a tight a
tight seal.

Rescue Breathing
3. Open the airway.

Open the airway by placing one hand on top of
the patients head while you place three fingers
from the other hand underneath the patients jaw
to tilt the head back.
4. Deliver a breath.
Deliver a breath by holding the mask in place
with your lift hand while you squeeze the bag
with your right hand. Force air into the lungs by
pressing the bag against the side of the patients
head with your other hand.
For an adult squeeze the bag every 5 seconds. For

a child or infant, squeeze the bag every 3 seconds.
If you feel resistance, the airway is not open.

Reopen the airway by tilting the head back further.
5. Recheck the carotid pulse.

After 2 minutes of rescue breathing, recheck the
pulse on the carotid artery, located on the
nearside of the neck under the chin. Continue
providing rescue breathing until emergency
medical personnel relieve you.

CPR
Perform CPR when a person is in cardiac arrest. Cardiac arrest occurs when the heart stops beating
and stops circulating blood and oxygen to vital organs and tissue. Cardiopulmonary Resuscitation
(CPR) is the process of using your body weight to compress the heart of a patient who is in cardiac
arrest. The compressions pump the heart circulating blood and oxygen throughout the body. CPR
does not restore the patients heart to normal functioning. However, it does prevent their condition
from deteriorating until an AED can shock the heart and restore the natural rhythm.
If you do not have access to an AED device, perform CPR until advanced emergency personnel arrive.
To perform CPR:
Position Patient Position Hands Compress Chest Repeat
1. Position the patient.

The patient should be flat on their back face up.
Kneel at their side next to their chest.
2. Position your hands.

Position your hands by placing one hand on top
of the other, interlocking your fingers, and
locking your elbows. Place the heel of your
bottom hand on the center of the patients chest
between the nipples while you lift your finger.
Use the palm of your hand for compressions.
3. Compress the chest.

Use your body weight to push the chest in about
2 inches with each compression.
Tip
The Bee Gees Stayin Alive provides a good

tempo for timing your compressions.
4. Continue CPR until AED prompts you.

Continue performing compressions until an AED
device is available to use. Compressions should
be hard and fast. Allow the chest to rebound
between compressions. Do not stop
compressions until the patient has revived or
emergency personnel takes over.

AED (Automated External Defibrillator)
An Automated External Defibrillator (AED) is a device used to send an electrical signal through a
patients heart to restore normal heart activity. An AED can restart the heart if it is not functioning
effectively. The AED consists of the base unit and the connector pads. When activated, the AED
guides you through a series of prompts to help you restart a heart.
Pad Connector
Power Button
LED Display
Shock Button
Contact Pad
Contact Pad Plug
Caution
Turn off the flow of oxygen before delivering shocks and remove
any flammable material from the area.

AED
To restart a heart with an AED device:

Bare Activate Apply Insert Pad AED Deliver Continue
Chest AED Pads Connector Analysis Shock CPR
1. Bare the chest.

Remove or cut away any clothing covering the
chest area and remove all metal jewelry found
anywhere on the body.
You need a smooth dry area to stick the contact
pads.
If the patient is sweating profusely, dry the area

with towel. If necessary, use a safety razor to shave
the chest.
2. Activate the AED.

Activate the AED by pushing the green power
button next to the number 1. The AED takes 10
seconds to power up and indicates activity by
prompting:
Insert pad connectors.
3. Apply the contact pads.

Place one pad under the patients left armpit
below the left nipple. Place the other pad above
the patients right nipple and below the
collarbone. Modern pads depict placement
images directly on the pads to assist you.
Warning
Position contact pads correctly in order to

deliver an effective shock.

AED
4. Connect contact pads with base unit.

Connect the contact pads to the base unit by
inserting the pad connectors yellow plug into the
hole next to the flashing yellow light at the top of
the base unit.
5. Allow the AED to analyze.

The AED prompts you:
Stand back, unit is analyzing.
Do not touch the patient while the AED is

analyzing the patients heart rhythm. The AED
determines if the patient is truly in cardiac arrest.
6. Deliver a shock.
The AED prompts:
Deliver shock.
Tell bystanders to stand back. Verify no one is

touching the patient. Deliver a two second jolt by
pressing the flashing orange number 3 button.
7. Continue CPR.
The AED prompts:
Continue CPR.
Continue CPR and follow the prompts from the

AED device until emergency personnel respond.

Blocked Airway
A person is choking when a foreign object blocks their airway. The international sign for
choking is both hands around the throat. Other indications of choking include:
Inability to talk
Difficulty or noisy breathing
Inability to cough forcefully
Skin, lips and nails turning blue or grey
Loss of consciousness
Help a person clear a blocked airway by hitting them squarely in

the back between the shoulder blades five times, followed by
administering five abdominal thrusts. Repeat alternating back
blows and abdominal thrusts until the blockage clears.
5 Back
Blows
Heimlich
Repeat Manuver
Back Blows
Back blows or striking the patients back can dislodge a foreign object from a patients
airway. Deliver five back blows before performing the Heimlich maneuver.
To administer back blows:
Position Self Deliver Back Blow Repeat 5x
1. Position yourself.
Stand behind the choking person.
2. Deliver back blows.
Use your palm and aim between the shoulder
blades. Strike with enough force to dislodge the
object. (Repeat 5 times.)

Heimlich Maneuver
If delivering five back blows fails to dislodge the object, continue by performing the
Heimlich maneuver.
To perform Heimlich maneuver:
Position Your Abdominal Repeat Thrusts

Position Yourself Make a Fist
Hands Thrusts 5x
1. Position yourself behind the patient.

Stand behind the choking person. Tip them
forward slightly.
2. Make a fist.
Ball your right hand into a fist.
3. Position your hands.

Place the thumb side of your fist atop the
patients stomach just above the belly button.
Cover your fist with the other hand.
4. Deliver abdominal thrusts.

Pull your arms into the abdomen lifting the
patient up slightly.
The force you are applying combined with the
patients weight should dislodge the foreign
object
5. Repeat.
Deliver 5 abdominal thrusts.
Continue alternating between delivering back
blows and performing the Heimlich maneuver
until you clear the blockage or emergency
response personnel relieve you.

Wound Care
Blood loss occurs when blood is escapes the body through cuts or tears in the skin. Blood
loss can be life threatening. A person can bleed to death in a matter of moments; you must
act quickly to control bleeding.
To stop blood loss:
Apply Direct Pressure Point

Elevate Wound Use a Tournicut
Pressure Artery
1. Apply direct pressure to the wound.

Cover the wound with gauze and apply
direct pressure firmly with your hand.
2. Elevate the wound.

If bleeding does not stop, raise the wound
above the heart. Gravity slows the blood
flow to the wound and slows the rate of
blood loss.
3. Apply pressure to nearest artery.

If you are still unable to control blood
loss, cut off circulation by using your
hands to apply direct pressure nearest
artery.
4. Use a tourniquet.
If all else fails to stop bleeding, use a belt
or a rope as a tourniquet. Cinch the
tourniquet tight 4 inches above the
wound. The belt ties off the artery and
constricts blood flow.

Secondary Medical
Assessment

Secondary Medical Assessment
After assessing and treating life-threatening conditions, you need to conduct a Secondary Medical
Assessment (SMA). The SMA focuses on non-life-threatening issues and consists of interviewing
the patient, taking vital signs, performing a head-to-toe physical examination and setting up and
administering oxygen.
Your goal is to identify the patients chief complaint and collect information to assist hospital staff in
providing longer-term medical care.
Patient Interview
Identify the nature of the emergency by interviewing the patient. Begin the interview by identifying
yourself as a person trained in first aid. Ask the patient for consent to treat them and then proceed
to ask the following questions to identify their chief complaint:
Use the acronyms SAMPLE and PQRRRST to remember interview questions:
Identify yourself as a first responder and ask for consent to treat.

My name is [name], Im trained in first aid. Can I help you?
S - Ask about Signs and Symptoms.

Describe to me what youre experiencing.
A Ask about Allergies.

Do you have any allergies?
M Ask about current Medications.

Are you currently prescribed or taking any medication or supplements?
P Ask about Past medical history.

Have you seen a doctor in the last 10 years for diabetes, heart problems, epilepsy,
breathing problems, etc.? Do you have a family history of any of these conditions?
L Ask about Last oral intake.

What was the last thing you ate or drank today?
E Ask about Event.

Can you tell me what happened?

Patient Interview
P Ask about Pain.

Are you experiencing any pain?
Q Ask about Quality.

What does the pain feel like?
R Ask about Region.

Where is the pain located?
R Ask about Radiating.

Is the pain radiating or moving?
R Ask about Relief.

Does anything make the pain better or worse?
S Ask about Severity.

On a scale of 1 to 10, how bad is the pain?
T Ask about Time.

How long has the pain been present?
Conclude by asking:
Is there anything else you can tell me?
Record all answers with the time of response and give it to emergency response personnel.

Vital Signs
Vital signs are measurements of the bodys essential life systems. Taking a persons vital signs can
identify health problems not outwardly visible. Vital signs assess a patients heart rate, respiratory
rate and blood pressure. Sit the patient down and begin vital sign assessment.
Assess vital signs by checking:
Heart Rate Respiratory Rate Blood Pressure
Heart Rate
The heart rate is the number of times the heart beats (contracts) per minute. The normal range for
an adult is 60 to 100 beats per minute. The normal range for children is 80 to 120 beats per minute.
To assess a patients heart rate:
1. Check the pulse.

Use your index and middle finger to feel
the patients radial pulse at the wrist.
2. Count heartbeats.
Use a wristwatch or clock to count
the number of heartbeats for 15
seconds. Make note of the number
of heartbeats.
3. Multiply the number of

heartbeats by 4.
The number is an estimate of the
number of heartbeats per minute.

Respiratory Rate
The patients respiratory rate is the number of breaths per minute. The normal range for an adult
is 12 to 20 breaths per minute. The normal range for children is 18 to 24 breaths per minute.
Silently count the number of breaths for 15 seconds after counting heartbeats.
To assess respiratory rate:
1. Count breaths.
Count breaths while you are taking the patients pulse. Do not let the patient know you
are counting breaths,, a persons awareness can effect the number rate of breathing.
2. Multiply the number of by 4.

The number gives you an approximate number of breaths per minute.
Blood Pressure
Blood pressure is the pressure of circulating blood against the walls of the blood vessels. Systolic
pressure is the pressure measured when the heart is in contraction. Diastolic pressure is the
pressure measured when the heart fills back up with blood. Low blood pressure is a
systolic/diastolic reading below 90/60 and causes inadequate blood flow to the organs. High blood
pressure is a systolic/diastolic reading above 120/90 and causes increased pressure along the
arterial walls and can lead to heart attack or stroke. Standard blood pressure ranges are:

Blood Pressure
You measure the patients blood pressure by using a stethoscope and blood pressure cuff. To take a
patients blood pressure:
Position Bare Fasten Insert Apply Deflate Listen Listen

Patient Arm Cuff Earpeice Bell Cuff for Loud for Soft
1. Position the patient.
Have the patient sit upright with both feet on the

floor. Their back should be resting against a wall
or chair.
2. Bare the left arm.

Remove clothing from the shoulder down.
3. Fasten the cuff.

Fasten the blood pressure cuff around the bicep,
with the bottom of the cuff resting at the inside of
the elbow.
4. Put the stethoscope on.

Ensure the earpieces are facing forward. Place in
ears and look down then up to position earpieces.
Earpieces should feel snug.

Blood Pressure
5. Apply the bell.

Place the bell (listening end) of the stethoscope
above the patients brachial artery, located on the
inner side of their elbow.
6. Deflate the cuff slowly.

Deflate the cuff at a rate of 5 mmHg/second, by
turning the knob on the valve located to the left
of the gauge.
7. Listen for heartbeat to become loud. Brachial Artery

Listen until the heartbeat becomes audible.
Record the number on the gauge as the patients
systolic blood pressure.
8. Listen for heartbeat to become soft.

Listen until you can no longer hear the heartbeat.
Record the number on the gauge when the
heartbeat becomes quiet again. The number
recorded is the patients diastolic blood pressure.
Knob

Head-to-Toe Physical Exam
The head-to-toe physical examination is an assessment of all major areas of the patients body.
Before examining the patient, advise them:
Now Im going to check you from head to toe to make sure were not missing anything. If anything
hurts as I touch you I want you to tell me.
You are palpating, or feeling with your hands, for additional signs of injury or illness the patient
may not have reported or is aware of. In general, you are checking for (DOTs):
Deformity
Open injuries
Tenderness
Swelling
Conduct a head-to-toe physical exam by checking:
Head & Neck Chest Stomach & Pelvis Legs & Feet Arms & Hands
Head and Neck Exam

Examine the patient from the top of their head to the base of their neck feeling for trauma. Record all
results for emergency response personnel. You are looking for bleeding, swelling, tenderness, and
signs of trauma.
To examine the head and neck:
1. Check the skull.

Use both hands and gently feel the back of
the patients head, the top of the head, and
the jaw.
2. Check around the eyes.

Use both hands and gently feel the bones
around the eyes.

Head and Neck Exam
2. Check inner eyelid tissue.

Pull the eyelids down to check the color
of the inner eyelid tissue. You are
checking for circulation, the tissue
should be pink.
3. Check the pupils.

Use a small flashlight to check pupils.
Direct the patient to keep their eyes on
the light while you move it up and down
and side to side (in the shape of a T.)
You are checking to see if the pupils
constrict, or get smaller in response to
the light. You are also checking to see if
both pupils are responding equally to the
light.
4. Check the mouth.

Ask the patient to open their mouth.
Inspect the teeth and airway.

Chest Exam
Check the patients chest area, from the base of their neck to the top of their stomach, for injury. Use
a stethoscope to listen to the patients breathing. You are listening for abnormal breath sounds such
as rattling crackling, popping or wheezing.
To examine the chest:
1. Observe breaths.
Watch the patients chest as they breath. You are looking
for equal movement on both sides of the chest. Uneven
chest rise and fall indicates a collapsed lung.
2. Listen to the lungs.

Ask the patient to continue to breathe deeply while you
use the stethoscope to listen to their lung sounds. Apply
the bell of the stethoscope to the upper back, upper chest,
and each side of the chest under the armpit.
3. Bare the chest.

Remove clothing over the chest. You are looking for
bruises or scars indicating recent surgery or trauma.
4. Check the chest.

Place hands on the sides of the patients chest atop the
ribs and gently compress. You are feeling for broken
bones.
If bones are broken, patient responds to painful stimulation.
5. Check the collarbone.

Place hands on the sides of the patients collarbones and
gently compress to identify tenderness. You are feeling for
broken bones.

Abdomen and Pelvis Exam
Examine the patients abdomen and pelvis, from the base of their sternum (just below the nipples)
to the top of their hips for signs of trauma. You are feeling for lumps, masses, pulses, or tenderness,
which are signs of internal bleeding.
To examine the abdomen and pelvis:
1. Bare the abdomen.

Remove clothing from abdomen. Mentally divide
the abdomen into 4 sections, in the shape of a t.
Use your hands and gently palpate each section.
2. Palpate the abdomen.

Place one hand on top of the other, and
gently roll your hands through each
section. Press your hand 1-2 inches into
the abdomen.
3. Check the pelvis.

Place hands on sides of hips. Apply
pressure and check for discomfort.
4. Check the lower back.

Use both hands to reach behind the
patient and feel the lower back. Note any
abnormalities.

Legs and Feet Exam
Check the patients legs from the top of the thighs to bottom of the feet: You are looking for bleeding,
swelling, tenderness, and signs of trauma.
To examine the legs and feet:
1. Check for injury.

Start by encircling the thigh. Move your hands down the legs feeling for injury.
2. Check for circulation.

Check circulation by finding the pedal pulse, a pulse point located on the top of
the foot between the big toe and index toe, or a posterior tibial pulse, a pulse
point located behind the ankle bone on the inside of the leg. You are feeling for the
pulsation of the artery to indicate blood is circulating.
Posterior Tibial Pulse Pedal Pulse

Legs and Feet Exam
3. Check motor functioning.

Ask the patient to wiggle their toes. Motor functioning assesses a patients ability to
control the movement of both feet and toes. You are checking for spine or nerve
damage.
4. Check sensory functioning.

Sensory functioning assesses a patients ability to identify where you are touching
them; the test identifies nerve or spinal cord injury. Grab a toe and asking the
patient to identify which one it is. You are checking to see if they can identify where
you are touching them. Repeat for the other foot.

Arms and Hands Exam
Check the patients arms and hands from the top of the shoulders to the fingertips. You are looking
for bleeding, swelling, tenderness, signs of trauma:
1. Check for injury.

Use both hands to encircle the patients arm. Feel down the arm all the way to the
hand. Check for trauma as you go. Record the results.
2. Check the radial pulse.

Use two fingers to check the patients radial pulse (just above the wrist.) Verify pulses
are present and equal in both wrists. Record the results.
3. Check motor functions.

Check motor functions in the hands by asking the patient to wiggle their fingers.
Record the results.
4. Check sensory functions.

Check hands for sensory function by grabbing one of their fingers and asking the
patient to identify which finger you are holding. Record the results.

Oxygen Delivery Equipment
Oxygen delivery equipment is equipment used to administer oxygen to a patient who is not
breathing. You must assemble the oxygen delivery equipment before use. The equipment to
assemble consists of an oxygen tank, an airflow regulator, connective tubing and delivery mask.
Prepare the oxygen tank (Fig 1) for use by connecting the oxygen tanks connection nozzle to the
regulator assembly. The regulator assembly (Fig 2) regulates the flow of air from the oxygen tank.
The regulator assembly has an attachment nozzle to connect plastic tubing to the delivery mask. The
main components are a flow meter, an oxygen gauge, an O-ring at the connection point, and a nozzle
to dispense air. The flow meter sets the airflow rate. The oxygen gauge indicates how much oxygen
is in the tank. The O-ring is a round plastic ring sunken into the connection point to create a seal
between the tank and the regulator. The connection nozzle is a skinny cone shaped metal
dispenser at the end of the regulator used to connect tubing to carry air to delivery masks.
Figure 1:
Tank casing
Connection nozzle
Figure 2:
Flow meter
Oxygen gauge
Key
Elastic strap
Mask
Plastic tubing

Oxygen Delivery System
The oxygen delivery system is a series of components used to provide life-saving oxygen to a
person who is not breathing. The components include an oxygen tank, an airflow regulator, plastic
tubing and a delivery mask.
If the patient is not breathing, use a BVM. If the patient is breathing, use an NRM.
To set up an oxygen delivery system:
1. Prime the tank.

Hold the tank upright in one hand, and use the
other hand to quickly open and close the tank
using the key on top. Repeat a second time
ensuring all foreign matter disperses from the
tank.
2. Check O-ring.
Confirm the O-ring is in place. The black rubber
O-ring fits inside the connection point of airflow
regulator.
3. Connect airflow regulator.

Align the airflow regulator pins with the two
holes on the top of the oxygen tanks valve. Place
the regulator over the tanks valve and seat the
pins in the holes. Tighten the regulator to secure
it in place.
4. Open the tank.

Turn the key at the top of the regulator clockwise,
two full rotations.

5. Check oxygen level gauge.

Check the gauge to verify the tank has
oxygen before attaching to delivery
device tubing. Use tank if it is more than
50% full.
6. Connect plastic tubing.

Attach one end of the plastic tubing to
the airflow regulator. Attach the other
end to your oxygen deliver device. Make
sure ends of tubing securely connect to
the tank and mask.
8. Turn the flow meter on.

Turn the black knob on the flow meter
clockwise to set the flow rate to 15 liters
per minute.
9. Verify air is flowing.

Hold the mask up to your cheek and feel
for airflow.
If you cannot feel air, check tubing

connections and verify airflow regulator is
set to 15.
10. Put mask on patient.

Apply the top of the mask over the
patients mouth and nose.

Equipment Removal
When you have finished assisting a person in need, you need to safely remove your protective
equipment to keeps contaminants on the outside of the equipment from coming in contact with your
body. The order of removal is important to prevent contamination. Prevent exposure to others by
disposing all items in a hazardous materials waste container.
The order to remove PPE:
1. Remove outermost equipment.

Remove equipment to protect your body such as an apron or booties.
2. Remove goggles.
Remove protective eyewear.
3. Remove the mask.

Remove mouth and nose equipment.
4. Remove gloves.
Remove your gloves and protect your bare skin from coming into contact with the
exterior of the gloves.
To remove used gloves:
1. Pinch base of the glove.

Pinch the exterior of one glove at the
base of your hand to pull it away from
your skin.
2. Pull the glove off.

Flip the glove inside out as you remove it
from your hand. Anything on the outside
of the glove is now inside the glove.

Equipment Removal
3. Ball the glove in the palm of hand.

Ball the used glove up in the
palm of your other hand like a
magician.
4. Pull glove away from skin.

While still holding the balled up glove,
insert two fingers from your bare hand
down the wrist of the other glove. Pull
glove away from the skin.
5. Remove second glove.

Flip the glove inside out so containing
the first glove within the second. All
contaminants are now safely inside the
gloves.
6. Dispose of gloves.
Gloves should be disposed of in a
biohazard disposal receptacle.

Index
A E
Abdomen /pelvis exam 26 Emergency Contact Numbers 2
Equipment Removal 33-34
AED 10
see cardiac arrest 9
External Iliac artery Appendix
Arms and hands exam 29
F
B
Femoral artery Appendix
Bag-Valve-Mask 7 First responder 1
Blocked airway 13
Blood borne illnesses 4
Blood pressure 20
H
systolic 20
diostolic 20 Hazard Awareness 3
low 20 Head-to-toe physical exam 23-29
high 20 see,
Head and neck 23-24
Chest 25
C Abdomen and Pelvis 26
Legs and feet 27-28
CABC 5 Arms and hands 29
Cardiac arrest 9 Heart rate 19
Carotid artery 8, appendix A Heimlich maneuver 14
Carotid pulse 6, appendix A High blood pressure 20
Chest Exam 25
CPR 9
L
Legs and Feet 27
D Low blood pressure 20
Diastolic pressure 20
O V
Vena cava Appendix A
Oxygen Vital signs 19-22
see, see,
Delivery Equipment30 Heart rate 19
Deslivery System31-32 Respiratory Rate 20
Blood Pressure 20-22
P
Personal protective equipment 4
Primary Medical Assess 5-15
see
CABC 5-6
R
Rescue breathing 7-8
S
Safety Equipment 4
Secondary Medical Assess 21-35
see,
Patient interview 17-18
Vital Signs 19-20
Head-to-toe exam 23-29
Subclavian artery Appendix A
Systolic pressure 20
Rescue breathing 7-8
CPR 9
AED 10-12
Blocked airway 13-14
Wound care, 15
Glossary
A
Automated External Defibrillator (AED)
Heart defibrillation device used to send an electrical signal through a patients
heart to restore normal heart activity.
B
Back Blows
Striking the patients back between the shoulder blades.
Bag-Valve-Mask (BVM)
Rescue breathing mask used when the patient is not breathing.
Barrier device
A device used to prevent contact with bodily fluids.
Blood loss
Occurs when blood is escaping the body through breaks or tears in the skin.
Blood Pressure
The pressure of circulating blood against the walls of the blood vessels.
C
Cardiac arrest
When the heart stops beating.
CABC
Circulation, Airway, Breathing, Circulation.
Choking
Occurs when a foreign object blocks the airway.
Connection Nozzle
Airflow tubing connection point on the airflow regulator.

Glossary
CPR
The process of using your body to compress the heart of a patient who is in
cardiac arrest in order to circulate blood through the body to provide oxygen
to vital tissues and organs.
D
Diastolic pressure
The pressure measured when the heart fills back up with blood
F
First Responder
First person with first aid training to arrive on the scene of an emergency.
Flow Meter
Controls rate of airflow from the airflow regulator.
H
Heart Rate
The number of heart beats per minute.
High Blood Pressure

A systolic/diastolic reading above 120/90 and causes increased pressure along
the arterial walls and can lead to heart attack or stroke
L
Low Blood Pressure
A systolic/diastolic reading below 90/60 and causes increased pressure along
the arterial walls and can lead to heart attack or stroke.
M
Motor Function
The ability to control ones movement.

Glossary
N
Non-Rebreather Mask
Oxygen delivery mask used when the patient is able to breath.
O
Oxygen Delivery Equipment
Equipment used to administer oxygen.

Components used to provide oxygen to a patient.
Oxygen Gauge
Indicates the amount of oxygen left in the tank.
O-Ring
Rubber ring seated in regulator assemble connection point.
P
Palpate
To feel with the hands.
Personal Protective Equipment

Barrier devices used to prevent exposure to blood borne illness.
Primary Medical Assessment

Assessment of life-threatening conditions.
R
Regulator Assembly
Consists of a flow meter used to adjust flow rate, a gauge to indicate how much
oxygen is left in the tank, an O-ring to create a seal between the tank and the
regulator, and a connection nozzle to attach devices like an NRM or BVM.

Glossary
Rescue breathing
The process of forcing oxygenated air into the lungs of a person who is in
respiratory arrest.
Respiratory rate
The number of breaths per minute.
S
Secondary Medical Assessment
Assessment of a patients non-urgent medical needs.
Sensory Functions
A persons ability to feel touch.
Stethoscope
Instrument used to magnify sound of heart and lung sounds.
Systolic pressure
The pressure measured when the heart is in contraction.
V
Vital Signs
Assessment of blood pressure, heart rate, breath rate to determine a patients
general medical condition.

Appendix
The image below identifies the major arteries mentioned throughout:
Carotid Artery
Subclavian Artery
Heart
Vena Cava
External Iliac Artery
Femoral Artery

Dedications

Dedications
Thank you to all my classmates and my professor Marietta Reber. I would not have
been able to complete my project without your support.
Neil Murphy| Content Expert, Model

Chukwuweta Chukwudebe| Content Editor
Mai Pham | Content/Copy Editor
Anna Herrera | Model
To my fallen TWRTer peers:
Brian Trinh | TWRT 61-62

Michael Mannina |TWRT 61-62

First Aid

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First Responders Guide

Primary and Secondary Medical Assessment

Rescue Breathing | CPR | AED Heart Defibrillation|

Title and Publication Number

Composed in Word 2010 on a PC

Margaret Andersen-Morgan June 23, 2013 i

Secondary Medical Assessment| 17

Margaret Andersen-Morgan June 23, 2013 iii

iv June 23, 2013 Margaret Andersen-Morgan

Margaret Andersen-Morgan June 23, 2013 1

In the event of an emergency call:

Local Police Dispatch:

Local Fire Dispatch:

Local EMS Services:

2 June 23, 2013 Margaret Andersen-Morgan

Do not approach the patient if the following hazards exist:

Margaret Andersen-Morgan June 23, 2013 3

Common types of PPE barrier devices include:

Gloves Disposable Apron

N95 Airway Mask Goggles

4 June 23, 2013 Margaret Andersen-Morgan

Conscious Airway Breathing Circulation

1. Check for consciousness.

A conscious person responds to tapping and

Margaret Andersen-Morgan June 23, 2013 5

2. Open the airway.

If you suspect a spinal injury, do not tilt the head

3. Check for breathing.

4. Check the pulse.

If you cannot find a pulse, adjust your finger

If the patient is unconscious, but breathing with a

6 June 23, 2013 Margaret Andersen-Morgan

To perform rescue breathing using a BVM:

2. Apply the mask.

Margaret Andersen-Morgan June 23, 2013 7

3. Open the airway.

For an adult squeeze the bag every 5 seconds. For

If you feel resistance, the airway is not open.

5. Recheck the carotid pulse.

8 June 23, 2013 Margaret Andersen-Morgan

Position Patient Position Hands Compress Chest Repeat

1. Position the patient.

2. Position your hands.

3. Compress the chest.

The Bee Gees Stayin Alive provides a good

4. Continue CPR until AED prompts you.

Margaret Andersen-Morgan June 23, 2013 9

Contact Pad Plug

10 June 23, 2013 Margaret Andersen-Morgan

To restart a heart with an AED device:

1. Bare the chest.

If the patient is sweating profusely, dry the area

2. Activate the AED.

Insert pad connectors.

3. Apply the contact pads.

Position contact pads correctly in order to

Margaret Andersen-Morgan June 23, 2013 11

4. Connect contact pads with base unit.

5. Allow the AED to analyze.

Do not touch the patient while the AED is

Tell bystanders to stand back. Verify no one is

Continue CPR and follow the prompts from the

12 June 23, 2013 Margaret Andersen-Morgan