EMERGENCY LIFE-SAVING OPERATIONS COURSE

(ELOC)
DISASTER FIRST RESPONDER
DECEMBER 11-21, 2013
Disaster Risk Reduction and Management Office

EMERGENCY LIFE-SAVING OPERATIONS COURSE

(ELOC)
DISASTER FIRST RESPONDER
DECEMBER 11-21, 2013
Disaster Risk Reduction and Management Office

EMERGENCY LIFE-SAVING OPERATIONS COURSE

(ELOC)
DISASTER FIRST RESPONDER
DECEMBER 11-21, 2013
Disaster Risk Reduction and Management Office
MODULE 1: EMERGENCY MEDICAL RESPONDER

1.1 The Emergency Medical Services (EMS) system and the Emergency Medical Responder (EMR)
1.1.1 Emergency Medical Services (EMS) System
A network of resources linked together for the purpose of providing emergency care and transport to victims of sudden
illness or injury.

1.1.2 Emergency Medical Responder

The first person on the scene of an incident with emergency medical care skills, typically trained at the most basic EMS
level.

Qualities of the MFR

 Responsibility
 Sociability
 Honesty
 Pride (Hygiene, Uniform, Personal appearances)
 Emotional Stability
 Professional demeanour
 Good physical condition
 Demonstrated ability

Duties of the EMR
1. Protect your safety and the safety of your crew, the patient and
bystanders.
2. Gain access to the patient.
3. Assess the patient to identify life-threatening problems.
4. Alert additional EMS resources
5. Provide care based on assessment
6. Assist other EMS personnel.
7. Participate in record-keeping.
8. Act as liaison with other public safety workers.
9. Perform patient packaging and preparation for movement and transport.

1.1.3 EMR Legal Issues

Responsibility of EMR
Legal and ethical obligation of the persons who practice EMR to be accountable before the law for any acts that
cause harm as a result of carrying out an activity.
“You are responsible for what you do or don’t do”

Scope of Care - Actions that are legally allowed by the EMR when providing patient care.

Duty to Act - The contractual or legal obligation on the EMR to provide care.

Breach of responsibility
Abandonment - Discontinuing emergency medical care without making sure that another health care professional
with equal or better training has taken over.
Negligence - Failure to provide the expected standard of care, causing injury or death of the patient.

Rights of the Patient

 To solicit and receive pre-hospital care
 To confidentiality regarding personal information and condition
 To pursue legal recourse for facts of negligence, abandonment and/or violations of confidentiality.
 In some situations, the patient has the right to refuse care.
  The patient may be required to sign a refusal form in the presence of a witness

Expressed Consent - Permission obtained from every responsive, competent adult patient or relative.guardian (if child)
before providing emergency care.

Implied Consent - Consent assumed on the part of an unconscious, confused or seriously injured patient or, for a minor
patient that cannot make decisions.

Basic Personal Protective Equipment (It is your right and duty to protect yourself)
1. Latex gloves 4. Gown
2. Personal Mask 5. CPR Mask
3. Eye Protection

1.2 Infectious Diseases

Infectious Diseases – Illnesses caused by pathogens, microorganism such as bacteria or viruses, that can be transmitted.

Means of Transmission
Direct contact – occurs through contact with
 Bodily fluids
 Open wounds or exposed tissues
 Mucous membranes of the mouth, eyes or nose.
Indirect contact – through airborne pathogens spread by tiny droplets sprayed during breathing, coughing or sneezing
or by way of contaminated objects, such as needles.

Infectious Diseases of greatest concern

 Hepatitis (A,B,C,D and E)
 Tuberculosis (TB)
 AIDS (HIV)

Other Common Infectious Diseases

 Influenza
 Cholera
 Sexually transmitted diseases (STD’s)
 Common colds

Infectious Diseases - Signs and Symptoms

1. Fever (lagnat) 5. Coughing, shortness of breath
2. Nausea (naduduwal) 6. Diarrhea
3. Yellowish coloration of the skin and white of the eyes 7. Fatigue (medaling mapagod)
4. Headache, chest or abdominal pain 8. Weight loss

Body Substance Isolation (BSI)

 A strict form of infection control based on the premises that blood and bodily fluids are infectious
 Combination of equipment and procedure that protect YOU from bodily fluids of a patient

Categories
 Hand Washing
 Cleaning Equipment (Cleaning, Disinfecting, Sterilizing)
 Using PPE

Immunization
 Tetanus prophylaxis
 Hepatitis – A Vaccine
 Hepatitis – B Vaccine
 Influenza Vaccine
 Rubella (German Measles)
 Measles
  Polio
 Mumps

1.3 Anatomy of the Human Body

A. Anatomical Position

B. Positional Terms

 Prone: Lying face down, on the stomach

 Supine: Lying face up, on the back
 Recovery: Lying on one side of the body

C. Body Regions D. Head and Neck

E. Trunk F. Upper and Lower Extremities

G. Cranial Cavity – Houses and protects brain H. Abdominal, thoracic and Pelvic Cavities
I. Spinal Cavity – Houses and protects spinal cord J. Abdominal Quadrants

K. Respiratory System L. Digestive System

M. Urinary System N. Female Reproductive System

O. Male Reproductive System P. Nervous System

 D. Endocrine System R. Skeletal System

S. Major Muscle Types T. Cardiovascular System

U. Skin

1.4 The Incident

Incident – An event caused by a natural phenomenon or human activity that requires the intervention of emergency
services personnel to prevent or mitigate loss of life and damage to property and the environment
Information to Obtain
 Location/address of the incident
 Indentify the origin of the call
 Incident type
 Victims
  Actions taken

Response
 Day of the week (traffic…,)
 Time of the day (school, business hours, people at home, etc..,)
 Weather (rain, wind, storms, etc..,)
 Social Disturbance (riot)
 Topography (winding roads, etc)
 Hazardous Materials (fuel leaks, radiation, etc..,)
 Access routes (free-way, bridges, width road, road works.)
 Power Lines
 Proper vehicle placement

Type of Incident
1. Motor vehicle collision 6. Medical emergency
2. Structural fire 7. Hazardous materials
3. Natural phenomenon 8. Structural collapse
4. Water rescue 9. Aircraft accident
5. Electrical

Steps to Assess the Scene

 What is the current situation?
 Where is it going?
 How do I control it? (operations and resources needed)

Reporting
 Address/location
 Incident type
 Environmental conditions
 Current situation
 Number of victims
 Resources needed

Securing the scene

 Place vehicle properly
 Isolate and mark the scene
 Mitigate risks

Personal Protective Equipment

- Safety equipment used to help and protect EMT personnel, rescuers, responders in protecting themselves from the
hazards of their environments
1.5 PATIENT ASSESSMENT
Patient Assessment Plan
1. Scene Size-Up
2. Initial Assessment
3. Physical Examination
4. Patient History
5. Ongoing Assessment
6. Endorsement

1. Scene Size-Up
 Ensures the safety of the people at the scene, identifies MOI/NOI and determines need for additional assistance
- Arrival on the scene
- Identify yourself
- Immediate Sources of Information
a) Arrival on the Scene
 o Personal safety
o Patient safety
o General impression
o Begin initial assessment
o Identify yourself (if responsive)
o Identify life-threatening injuries
o Stabilize and continue to monitor
b) Identify yourself
 State name and organization
 Ask patient if you may help (obtain consent)
c) Immediate sources of Information
 Scene itself
 Patient (if responsive)
 Relative or bystanders
 Mechanism of Injury
 Any deformity/injury
 Sign of illness
2. Initial Assessment
 A process used to identify and treat conditions posing an immediate threat to the patient’s life.
 Form a general impression
 Check for level of responsiveness (AVPU – Alert, Verbal, Pain and Unconscious)
 Airway
 Breathing
 Circulation
 Patient’s status update
3. Physical Exam
RAPID TRAUMA ASSESSMENT
Use D.O.T.S. (head to toe)
(Deformity, Open Wound, Tenderness, Swelling)
 Head
 Neck
 Chest/Back
 Abdomen
 Pelvis
 Extremities
 Vital signs
- Respirations -Pulse
- Skin -Pupils
- Blood pressure
4. Patient History
“S.A.M.P.L.E.”
 Signs and symptoms
 Allergies
 Medications
 Past medical history
 Last oral intake
 Events leading to injury

5. Ongoing Assessment
 Repeat initial assessment
 If with pain, use OPQRST
 Onset
 Provocation
 Quality
 Radiation
 Severity
 Time
  Repeat physical exam
 Reassess treatment and interventions
 Calm and reassure the patient

6. Endorsement
 Patient’s age and sex
 Chief complaint
 Level of responsiveness
 Patient’s status (Airway, Breathing and Circulation)
 Physical exam findings
 SAMPLE history
 Interventions/Treatment given
 Special reports

SIGNS OF ADEQUATE RESPIRATION

 Chest and abdomen rise and fall with each breath
 Air can be heard and felt exiting the mouth or nose
 Ease of breathing
 Adequate rate

SIGNS OF INADEQUATE RESPIRATION

 Inadequate rise and fall of the chest
 Abnormal breath sounds
 Increased respiratory effort
 Cyanosis-bluish discoloration
 Inadequate rate
 Altered mental status

SIGNS OF ABSENT RESPIRATION

 No chest or abdominal movement
 Air cannot be heard or felt exiting the mouth or nose

Station 1 (Patient Assessment) Station 2 (Taking Vital Signs)

1. Scene size – up Inform patient
- Ensure personal safety * Check respirations
- Identify yourself * Check pulse
2. Initial assessment * Check skin condition
3. Physical exam * Check pupils
4. Patient history * Check blood pressure
5. Ongoing assessment
6. Endorsement

1.6 Communications and Documentation

Documentations
Essential components of pre-hospital care:
 Verbal communications are vital.
 Adequate reporting and accurate records ensure continuity of patient care.
 Reporting and record keeping are essential aspects of patient care.
DISPATCH RESPONSIBILITIES
 Screen and assign priorities
 Select and alert appropriate units to respond
 Dispatch and direct units to the location
 Coordinate response with other agencies
 Provide pre-arrival instructions to the caller
INFORMATION RECEIVED FROM DISPATCH
 Nature and severity of injury, illness or incident
 Location of incident
 Number of patients
  Responses by other agencies
 Special information
 Time dispatched
COMMUNICATING WITH DISPATCH
 Report any problems during run.
 Advise of arrival
 Communicate scene size-up
 Keep communications brief.
COMMUNICATING WITH MEDICAL CONTROL
 Radio communications facilitate contact between providers and medical control.
 Consult with medical control to:
 Notify hospital of incoming patient.
 Request advice or orders.
 Advise hospital of special circumstances.
 Organize your thoughts before transmitting.
PATIENT REPORT
 Identification and level of services
 Receiving hospital and ETA
 Patient’s age and gender
 Chief complaint
 History of current problem
 Physical findings
 Summary of care given and patient response
ROLE OF MEDICAL CONTROL
o May be off-line or online
o Guides treatment of patients
o May have to contact directly for orders
o Many variations from system to system
POINTS TO REMEMBER
• Physician bases his or her instructions on report received from the EMR
• Never use codes while communicating.
• Repeat all orders received.
• Do not blindly follow an order that does not make sense to you.
• Notify as early as possible
• Estimate the potential number of patients.
• Identify special needs.
• Keep transmission brief.
• Develop effective radio discipline.
• Identify the called unit, followed by the calling. –“Dispatch, this is Medic One.”
• Acknowledge dispatch information.
• Notify arrival at scene.
• Notify departure from scene.
• Notify arrival at hospital or facility
• Notify you are clear of the incident.
• Notify arrival back in quarters.
• Radio equipment must be properly serviced.
• Non-functioning equipment should be removed from service.
• Backup plans should be in place in case of communication failure.
• Standing orders: Written documents signed by the EMS system’s medical director.
• Essential part of quality patient care.
• You must be able to find out what the patient needs and then tell others.
• You are a vital link between the patient and the health care team.
• Patient’s name, chief complaint, nature of illness, mechanism of injury
• Summary of information from radio report
• Any important history not given earlier
• Patient’s response to treatment
• The vital signs assessed
• Any other helpful information
 • Make and keep eye contact.
• Use the patient’s proper name.
• Tell the patient the truth.
• Use language the patient can understand.
• Be careful of what you say about the patient to others.
• Be aware of your body language.
• Always speak slowly, clearly and distinctly.
• If the patient is hearing impaired, speak clearly and face him or her.
• Allow time for the patient to answer questions.
• Act and speak in a calm, confident manner.
• Determine the person’s functional age.
• Do not assume that an older patient is senile or confused.
• Allow patient ample time to respond.
• Watch for confusion, anxiety, or impaired hearing or vision.
• Explain what is being done and why.
• Children are aware of what is going on.
• Allow people or objects that provide comfort to remain close.
• Explain procedures to children truthfully.
• Position yourself on their level.

IMPAIRED PATIENTS
 Always assume that the patient has normal intelligence.
 Make sure you have a paper and pen.
 Face the patient and speak slowly, clearly and distinctly.
 Never shout!
 Learn simple phrases used in sign language.
 Ask the patient if he or she can see at all.
 Explain all procedures as they are being performed.
 If a guide dog is present, transport it also, if possible.
SPEAKING PATIENTS
 Use short, simple questions and answers.
 Point to specific parts of the body as you ask questions.
 Learn common words and phrases in the non-English languages used in your area.
CARE REPORT
 Pre-hospital care report serves six functions:
 Continuity of care
 Legal documentation
 Education
 Administrative
 Research
 Evaluation and quality improvement
 Written forms
 Computerized versions
 Narrative sections of the form
 Use only standard abbreviations.
 Spell correctly
 Record time with assessment findings.
 Report is considered confidential.
 Do not write false statements on report.
 If error made on report then:
 Draw a single horizontal line through error.
 Initial and date error.
 Write the correct information
 Document assessment findings and care given.
 Have the patient sign then form.
 Have a witness sign the form.
 Include a statement that you explained the possible consequences of refusing care to the patient.
 Be familiar with required reporting in your jurisdiction, including:
  Gunshot wounds
 Animal bites
 Certain infectious diseases
 Suspected physical,sexual or substance abuse
 Multiple-casualty incidents (MCI)

1.7 Soft Tissue Injuries

 Also known as WOUNDS
 Injury to the skin, muscle, nerves and blood vessels.

TYPE OF WOUNDS
OPEN WOUND - Soft tissue injury resulting in breaking of the skin
1. Abrasion (GASGAS) 5. Amputation (PUTOL)
2. Laceration (HIWA) 6. Puncture (SAKSAK)
3. Avulsion (TUKLAP) 7. Crush Injury
4. Impaled Object
CLOSED WOUND – Injury to soft tissue beneath unbroken skin

1.8 Hemorrhage and Shock

HEMORRHAGE
 Loss of blood from the body.
 Can be external or internal.

TYPES OF EXTERNAL HEMORRHAGE

ARTERIAL: bright red in color blood spurts coinciding with pulse
VENOUS: dark red in color, steady
CAPILLARY: blood flows smoothly

SHOCK
 Failure of the circulatory system to provide adequate oxygenated blood supply throughout the body (inadequate
tissue perfusion)

CAUSES OF SHOCK
 Inability of heart to pump enough blood through organs
 Severe loss of blood
 Excessive dilation of blood vessel

SIGNS
- Cool Clamy Skin - Restlessness
- Pale - Difficulty of Breathing

SYMPTOMS
 Hypotension
 Tachycardia
 Tachypnea

TYPES OF SHOCK
 Anaphylactic Shock
 Septic Shock
 Neurogenic Shock
 Cardiogenic Shock
 Hypovolemic Shock

CARE FOR SHOCK

 Position patient
 Modified Trendelenburg Position
  Start Oxygen
 Start IV fluids

1.9 Burns and Environmental Emergencies

Burns – Injuries caused by exposure to excessive heat from thermal, chemical, electrical or radiation.

Burn classification (by depth)

 Superficial
 Partial thickness
 Full thickness
RULES OF NINES
(% BODY SURFACE AREA)

Inhalation Injury
Sign and Symptoms
1. Severe muscle cramps 5. Respiratory distress
2. Burns to the face 6. Hoarseness, cough or difficulty speaking
3. Specks of soot in the sputum 7. Restricted chest movement
4. Sooty or smoky smell on the breath 8. Cyanosis

Degree of Burns
 First Degree - Superficial
 Second Degree - Partial Thickness
 Third Degree - Full Thickness
First Degree
• Painful, red, dry, and blanch with pressure
• Only a superficial layer of epidermal cells is destroyed
• Usually heal within 2-3 days

Second Degree
• Partial-thickness burns
– Characterized by blisters
• Injury extends through epidermis to dermis
– In the absence of infection, these wounds generally heal without scarring
Third Degree
• Entire thickness of the epidermis and dermis is destroyed
– Eschar present
– Sensation and capillary refill absent
– Skin grafts are necessary for timely and proper healing
Types of Burns
 Thermal Burn
 Electrical Burn
 Chemical Burn

Care for the Burn

- Flush Skin With Water
 - Remove contaminated clothing
- Apply Antibiotic Ointment
- Cover with Non stick sterile dressing

1.10 Injuries to the Skull, Spinal Column and Chest

BONES OF THE HEAD

 Skull
 Provide protection for the brain
 Cerebrospinal Fluid (CSF) –a Clear,
water –like cushion that protects the
brain and spinal cord from the trauma
 Protects the spinal cord
 Cervical (7)
 Thoracic (12)
 Lumbar (5)
 Sacrum (5 fused)
 Coccyx ( 4 fused)

REVIEW OF AXIAL SKELETON

Chest
 Bony Structure
 Ribs
 Thoracic Vertebrae
 Sternum
 Organ
 Lungs
 Heart
 Major Blood Vessels (arteries and veins)

SKULL FRACTURES
• Suspect the possibility of brain injury
• DANGER!!!
 Do not try to remove any impaled object in the skull.
 Do not to stop the flow of CSF if fluid is leaking from ears or head wound.
Cover opening loosely with sterile gauze dressi

TYPES OF SKULL FRACTURE

 Open Penetrating
 Closed

WHAT TO DO
1. Perform initial assessment
2. Control bleeding.
3. Suspect C-spine injury.
4. Stabilize head and neck
5. Administer O2.
6. Cover and bandage wounds.
7. Position patient properly
Consider all suspected head injuries to be serious.

FACIAL FRACTURES
 Main danger is the possibility of bone fragments and blood causing airway obstruction.

Always check for airway obstruction.

PENETRATING AND SUCKING CHEST WOUNDS

1. Assess patient’s breathing.
 2. Administer oxygen if needed.
3. Expose wound area and seal with a gloved hand initially.
4. Apply occlusive dressing (5cm wider than the wound to the wound.
5. Seal dressing on four sides.
6. If flutter valve is needed, unseal one corner.

IMPALED OBJECT TO THE CHEST

1. Assess patient’s breathing.
2. Administer oxygen if needed.
3. Manually stabilize the object.
4. Expose the area around the wound.
5. Apply direct pressure to the edges of the wound to control bleeding, if needed.
6. Use bulky dressing to stabilize object.
7. Apply a rolled gauze bandage or elastic bandage to secure the bulky dressing and impaled object.

RIB FRACTURE
1. Assess patient’s breathing.
2. Administer oxygen if needed.
3. Option 1: Apply a sling and swath (to hold the injured patient’s arm against the injured side.
Option 2: Give patient pillow or blanket to hold against the injured side.

FLAIL CHEST
1. Assess patient’s breathing.
2. Administer oxygen if needed.
3. Expose patient’s chest.
4. Stabilize the flailed section with a bulky dressing, then tape it in place.

CERVICAL SPINE INJURY (USING A BACKBOARD)

Standing Patient (5 Rescuers)
1. Rescuer 1 stands behind the patient and maintains manual stabilization throughout the procedure.
2. Rescuers 2 places the cervical collar on the patient.
3. Rescuer 3 moves the backboard into position between Rescuer 1 and the patient.
4. Rescuers 4 and 5 grab the backboard under the patient’s arm.
5. Rescuers 2 and 3 grab the backboard along the patient’s hips and legs.
6. All rescuers gently lower the backboard and patient to the ground.

1.11 Bone, Joint and Muscle Injuries

FRACTURE
 Any break in the continuity of a bone
DISLOCATION
 Injury in which a bone is moved out of its normal postion in a joint and remains that way.
SPRAIN
• Injury in which ligaments are stretched or partially torn, commonly associated with joint injuries.
STRAIN
• Injury in which a muscle, or a muscle and tendon, are over-extended.
FRACTURES, DISLOCATIONS AND SPRAINS
• Signs and Symptoms
– Deformity or angulation - Exposed bone ends
– Pain and tenderness - Joint locked position
– Crepitus (grafting) - Numbness or paralysis
– Swelling - Compromised circulation
– Bruising or discoloration
FRACTURE OF THE SHOULDER
1. Stabilize the upper arm between two rigid splints.
2. Secure splints in place.
3. Support the arm with sling.
4. Immobilize the arm with a swath.
FRACTURE OF THE UPPER ARM
 • Stabilize the arm between two rigid splints.
• Secure the splints in place.
• Secure the arm and splints to the patient’s side using two swaths.
FRACTURE OF THE FOREARM OR WRIST
• Stabilize the forearm using one rigid splint (remember to pad wrist and hand).
• Secure splint in place.
• support forearm with a sling.
Fracture or Dislocation of the elbow
Splint the elbow in the position found-
If the elbow is bent:
1. Stabilize the arm between two rigid splints.
2. Secure the splints in place.
3. Support the arm and splints with a sling.
If the elbow is straight:
1. Stabilize the arm between two rigid splints.
2. Secure the splints in place.
3. Support the arm and splints to the patient’s side using two swaths.
If the knee is bent:
1. Stabilize the leg between two rigid splints.
2. Secure the splints in place.
3. Support the leg with a pillow or other bulky material.
If the knee is straight:
1. Stabilize the leg between two rigid splints.
2. Secure the splints in place.
FRACTURE OR DISLOCATION OF THE ANKLE
 Method 1:
• Stabilize the ankle between two rigid splints.
• Secure the splints in place.
 Method 2:
• Wrap the foot and ankle using pillow or blanket.
• Secure the pillow or blanket in place.
FRACTURE OF THE THIGH
 Fracture of the Thigh
 Place rigid splint on inside of patient’s leg, from groin to foot.
 Place the rigid splint on inside of patient's leg, from groin to foot.
 place rigid splint on outside of patient’s leg, from armpit to foot.
 Secure splints in place.
FRACTURE OF THE LOWER LEG
1. Stabilize the leg between two rigid splints.
2. Secure splints in place.
SPLINTING
• Applying a device to stabilize any painful, swollen or swollen or deformed body part

REASONS FOR SPLINTING

• Prevent motion of bone fragments or dislocated joints
• Reduce pain and suffering
• Minimize damage of soft tissues
• Prevent closed fracture from becoming open fracture
• Minimize blood loss or shock
PRE- HOSPITAL TREATMENT (FOR SUSPECTED FRACTURES< DISLOCATIONS AND SPRAINS)
1. Initial assessment: Identify and treat life-threatening problems.
2. Physical exam
3. Stabilize
4. Expose injury
5. Treat open wounds
6. Prepare splinting materials.
7. Splint injuries/immobilize body.
8. Reassess P.M.S.
 9. Apply cold packs or ice.
10. Treat for shock.

1.12 Lifting and Moving

BODY MECHANICS
• Proper use of the body to facilitate lifting and moving, and to prevent injury
BASIC RULES
• Plan your move.
• Use your legs to lift, not your back
• Keep weight closer to the body.
• Stack. Move body as a vertical unit.
• Reduce the height or distance you need to move an object
• Reposition and lift in stages.

EMERGENCY MOVE
• Make an emergency move only when there is immediate danger to the patient
WHEN TO DO EMERGENCY MOVE
• Fire or threat of fire
• Explosion or threat of explosion
• Inability to protect the patient from hazards at scene
– Unstable building
– Rolled over car
– Hazardous materials
– Spilled gasoline
• When life saving cannot be given due to patient’s location or position

TYPES OF EMERGENCY MOVES

• Clothes drag
• Shoulder drag
• OTHER TYPES
“PICKING UP”
– Blanket drag
– Piggyback carry
– Cradle/ lover’s carry
– Firefighter drag
TYPES OF NON EMERGENCY MOVES
• Direct-ground/bed lift
• Extremity lift
– Do not use on patients with extremity injuries
NON EMERGENCY MOVES
• When there is no immediate threat to life
• Complete the on-scene assessment and treat patient first.
• Prevent additional injury and avoid causing discomfort and pain to the patient
PATIENT CARRYING EQUIPMENT
1. Wheeled stretcher 4. Basket stretcher
2. Scoop stretcher 5. Draw sheet
3. Stair chair 6. Back boards
• Long back board/Short back board
STATION 1
• Lifts and carries
– These lifts and carries should be practiced on level ground and going up and down stairs. Each participant will
demonstrate the following lifts or carries. These will be done individually or as a team.
• Blanket drag
• Shoulder or forearm drag
• Direct ground lift
• Extremity lift
STATION 2
• Removing a patient from an automobile using a long backboard
 1. Maintain manual stabilization
2. Apply cervical collar
3. Rotate the patient into position
4. Move the backboard into position
5. Lower the patient onto the backboard
6. Slide the patient into position on the backboard using small movements
STATION 3
• Strapping a patient to a long backboard
Secure the patient’s torso
1. Place the female end of buckle on patient’s chest
2. Run the male end of the strap over one shoulder and down through the hand hole
3. Bring the strap back up through a hand-hole by the patient’s hips
4. Run the strap over the hips and down the hand-hole on the other side
5. Bring the strap out and onto the chest
6. Connect the buckle ends and tighten
7. Repeat steps 1-6 on the other side
8. If the patient is unconscious, tie hands together over the stomach
• Strapping a patient to a long backboard
Secure the patient’s legs
9. Place the female end of the buckle on the patient’s legs above the knees
10. Run the male end of the strap to one side and down through the hand-hole
11. Bring the strap back up through a hand-hole on the other side
12. Run the strap over the legs and down the hand-hole on the other side
13. Bring the strap back up through a hand-hole above the knees (in line with the female end of the buckle)
14. Connect the buckle ends and tighten
 Strapping a patient to a long backboard
Secure the patient’s head
15. Place a head roll under the patient’s head on the backboard
16. Run 5-cm tape across the patient’s forehead and head roll to both sides of the backboard
17. Run 5 cm tape across the patient’s chin and head roll to both sides of the backboard
STATION 4
• Removing a patient from an automobile using a short backboard
1. Maintain manual stabilization
2. Apply cervical collar
3. Position the short backboard behind the patient
4. Secure the patient’s torso to the backboard
5. Pad behind the patient’s head and secure it to the backboard
6. Rotate the patient into position
7. Lean back the torso of the patient
8. Using the backboard and supporting the patient’s legs, lift and remove the patient from the automobile

1.13 Medical Emergencies

CHANGES IN CONSCIOUSNESS
• Responsive (conscious)
• Unresponsive (unconscious)
• Not all responsive victims are fully responsive.
• What to do
– If unresponsive and not breathing, perform CPR.
– If unresponsive and vomiting, roll victim onto side.
CHEST PAIN
• Causes
– Heart attack
– Respiratory infection
– Overexertion resulting in muscle pain
CARE FOR A HEART ATTACK
• Call for help.
• Have victim rest.
• Help victim take prescribed medication.
 • Give aspirin.
BREATHING DIFFICULTY
• Causes
– Asthma
– Hyperventilation
• Recognizing breathing difficulty
– Breathing is abnormally fast or slow.
– Breathing is abnormally deep (gasping) or shallow.
– Noisy breathing: wheezing, gurgling, crowing, snoring
– Bluish lips
– Pause when speaking to catch breath
CARE FOR BREATHING DIFFICULTY
• Place in position of comfort.
• Assist with asthma inhaler if needed.
• If hyperventilating, have victim inhale, hold breath,
then exhale slowly.
FAINTING
• Decreased blood flow to the brain
• Recognizing fainting
– Sudden, brief unresponsiveness
– Pale skin
– Sweating
CARE FOR FAINTING
Check responsiveness and breathing and provide care as needed.
• Loosen tight clothing.
• If victim fell, check for injuries.
• Call for help if needed.
– Condition does not improve quickly
– Repeated fainting episodes
– Elderly victim
SEIZURES
• Causes
– Epilepsy -- High fever
– Heatstroke -- Brain injury, tumor, or stroke
– Poisoning -- Electric shock
– Hypoglycemia -- Alcohol or other drug withdrawal or abuse
RECOGNIZING SEIZURE
• Sudden falling
• Unresponsiveness
• Rigid body and back arching
• Jerky muscle movement
CARE FOR A SEIZURE
• Protect from injury.
• Loosen restrictive clothing.
• Roll victim onto his or her side (recovery position).
• Call 9-1-1 if seizure occurs for an unknown reason.
DIABETIC EMERGENCIES
• Diabetes is the inability to use glucose normally due to deficiency in insulin.
• Hypoglycemia
– Low blood glucose
• Hyperglycemia
– High blood glucose
LOW BLOOD GLUCOSE
• Recognizing low blood glucose
– Sudden onset -- Confusion
– Staggering -- Sudden hunger
– Anger -- Excessive sweating
– Pale color -- Trembling, seizures, unresponsiveness
CARE FOR LOW BLOOD GLUCOSE
 • Provide sugar.
– Sugar, soda, juice, glucose tablets or gel
• If no improvement in a few minutes, call 9-1-1.
HIGH BLOOD GLUCOSE
• Recognizing high blood glucose
– Gradual onset -- Vomiting
– Drowsiness -- Fruity, sweet breath odor
– Extreme thirst -- Rapid breathing
– Frequent urination -- Unresponsiveness
– Warm and dry skin
CARE FOR HIGH BLOOD GLUCOSE
• If you are unsure whether it is high or low blood glucose, provide same care as you would for low blood glucose.
• If condition does not improve in 15 minutes, call 9-1-1.
EMERGENCIES DURING PREGNANCY
• Vaginal bleeding ● Dizziness or fainting
• Cramps in lower abdomen ● Blurring of vision or seeing spots
• Swelling of the face or fingers ● Severe continuous headache
• Uncontrollable vomiting
CARE FOR EMERGENCIES DURING PREGNANCY
• Keep victim warm and on her left side.
• For vaginal bleeding, place sterile pad over opening of vagina.
• Save blood-soaked pads and send them to hospital with victim.
• Seek medical care.
1.14 CARDIOVASCULAR EMERGENCIES
HEART ATTACK
• Blood supply to part of the heart muscle is reduced or stopped.
• Recognizing a heart attack
– Chest pressure, squeezing, or pain that lasts longer than a few minutes or goes away and comes back
– Pain spreading to shoulders, neck, jaw, or arms
– Dizziness, sweating, nausea
– Shortness of breath
CARE FOR A HEART ATTACK
• Help victim into comfortable position.
• Assist with prescribed medications.
– Nitroglycerin
• Provide aspirin.
– Regular or chewable
ANGINA
• Heart muscle does not get enough blood.
• Brought on by physical activity.
• Recognizing angina
– Signs are similar to heart attack.
– Usually does not last longer than 10 minutes.
– Almost always relieved by nitroglycerin.
CARE FOR ANGINA
• Have the victim rest.
• If the victim has nitroglycerin, help the victim use it.
If pain lasts longer than 10 minutes, suspect a heart attack and call 9-1-1
RISK FACTORS OF CARDIOVASCULAR DISEASE
• Cannot be changed
– Heredity
– Gender
– Age
• Can be changed
– Smoking -- Obesity
– High blood pressure -- Inactivity
– High cholesterol -- Stress
– Diabetes
 STROKE (BRAIN ATTACK)
• Blood flow to brain disrupted
• Blocked or ruptured blood vessel
• Recognizing stroke
– Weakness, numbness, partial paralysis
– Blurred or decreased vision
– Problems speaking
– Dizziness or loss of balance
– Sudden, severe headache
CARE FOR STROKE
• Seek medical care.
• If responsive, lay patient on back with head and shoulders slightly elevated.
• If vomiting, place in recovery position.
1.15 POISONING
POISON
• Any substance that can impair or cause death of cell structure or function
Can enter the body four ways:
1. Ingested
2. Inhalation
3. Absorption
4. Injected
Signs and Symptoms
5. Nausea and/or vomiting
6. Headache
7. Abdominal pain
8. Altered mental status or coma
9. Seizures
10. Rapid or slow heart rate
11. High, normal or low blood pressure
12. Possible dilation or constriction of pupils
13. Shortness of breath
14. Injury to skin (discoloration, burns, injection marks, swelling)
15. Diarrhea
INGESTED POISONS
• Specific signs and symptoms
– Burns, swelling or stains around the mouth
– Abnormal breathing
– Diaphoresis
– Excessive salivation or foaming at the mouth
INHALED POISONS
• Specific signs and symptoms
– History of inhalation abuse
– Chest pain or tightness
– Burning sensation in the chest or throat
– Coughing, wheezing or rales
ABSORBED POISONS
• Specific signs and symptoms
– History of exposures
– Liquid or residue on the skin
– Itching or irritation
– Rash or blisters
INJECTED POISONS
• Specific signs and symptoms
– Needle tracks
– Pain, swelling or redness at the injection site
– History of bites or stings
– Bite marks or embedded stinger
– Numbness at the injury site
– Other symptoms similar to ingested poisons
 SNAKE BITES
• Specific signs and symptoms
– Nausea and vomiting -- Blood oozing from the bite mark
– Weakness and paralysis -- Discoloration and swelling
– Seizures or decreased level of consciousness -- Puncture wound
– Pain and/or burning sensation around bite mark
CRITERIA FOR ADMINISTERING ANTI-VENIN
• Specificity (appropriate to the snake species)
• Appropriate quantity
• Within the shortest possible time
ALCOHOL ABUSE / POISONING
• Specific signs and symptoms
– Smell of alcohol on breath/clothes -- Altered behavior
– Staggering -- Redness of the face
– Slurred speech -- Nausea and vomiting
DRUG CATEGORIES
• Stimulants
• Depressants
• Analgesic narcotics
• Hallucinogens
• Volatile chemicals (valours)
DRUG ABUSE
• General signs and symptoms
– Excitement -- Distorted perception
– Drowsiness and slow reflexes -- euphoria
– Reduced pulse and breathing -- Aggressive behavior
– Accelerated pulse and breathing -- Constricted or dilated pupils
– Relaxed muscles
MEDICAL EMERGENCY SIGNS
Changes in:
- Mental status - Vomiting
- Heart rate, rhythm and/or quality - Muscular activity
- Breathing rate, rhythm, and/or quality - Breath scents
- Skin temperature, color and/or condition - Fever
- Pupil size, symmetry, reactivity to light - Chest or abdominal pain
- Condition and color of mucous membranes - Shortness of breath or difficulty breathing
- Stomach discomfort, nausea, atypical bowel or bladder activity - Pain
- Vertigo, fainting sensation, feeling of impending doom - Sensation of numbness and/or tingling
- Excessive thirst, hunger or strange taste in the mouth

MYOCARDIAL INFARCTION SIGN AND SYMPTOMS

- Discomfort in the chest - Profuse sweating
- Abnormal pulse - Fainting
- Nausea or vomiting - Anxiety
- Shortness of breath - Sudden weakness
- Difficulty breathing
1.16 BITES AND STINGS
ANIMAL AND HUMAN BITES
• Consider whether victim was exposed to rabies.
– Spread through saliva by bite or lick of infected animal
– Animal attacked without provocation.
– Animal was behaving strangely.
– High-risk species
• Animal should be captured or confined for observation whenever possible.
• Report animal bites to police or animal control.
CARE FOR ANIMAL AND HUMAN BITES
• Clean wound with soap and water.
• Flush wound under pressure.
 • Control bleeding and cover wound.
• Seek medical care for cleaning, tetanus shot, or rabies vaccination.
SNAKES BITES
• Poisonous species in United States
– Rattlesnake
– Water moccasin
– Coral snake
– Copperhead
RECOGNIZING A PIT VIPER BITES
• Severe burning pain
• Puncture wounds
• Swelling
• Discoloration and blood-filled blisters
• Nausea, vomiting, sweating, weakness
CARE FOR VENOMOUS SNAKE BITES
• Get victim and others away from snake.
• Keep victim calm; limit movement.
• Immobilize the area.
• Wash area with soap and water.
• If coral snake bite to a limb:
• Wrap elastic bandage over the limb.
• Seek medical care.
CARE FOR AN INSECT STING
• Remove any stinger and venom sac.
• Wash wound with soap and water.
• Apply ice.
• Apply hydrocortisone cream or antihistamine.
• Watch for signs of severe allergic reaction.
– Assist with prescribed medicine.
SPIDER BITES
• Black widow
– Sharp pinprick, then dull pain
– Two fang marks
– Abdominal pain, headache, fever, dizziness, nausea
• Brown recluse
– Local reaction
– Bull’s-eye pattern
– Headache, fever, weakness, nausea

CARE FOR ALL SPIDER BITES

• Catch spider for identification if possible.
• Wash wound with soap and water or rubbing alcohol.
• Apply ice.
• Seek medical care.
SCORPION STINGS
• Recognizing scorpion sting
– Local immediate pain and burning
– Numbness and tingling
• Care for scorpion sting
– Wash wound with soap and water or rubbing alcohol.
– Apply ice.
– Seek medical care.
1.17 HEAT AND COLD EMERGENCIES
HEAT REALATED EMERGENCIES
HEAT CRAMPS
• Painful muscle spasms
• Occurs after physical exertion
• Care for heat cramps
– Stop activity and rest in cool area.
 – Stretch or massage cramped muscle.
– Provide water or commercial sports drink if victim is not nauseated.
HEAT EXHAUSTION
• Heavy perspiration with normal or slightly above normal body temperature
• Signs of heat exhaustion
– Heavy sweating
– Severe thirst
– Weakness
– Headache
– Nausea and vomiting
CARE FOR HEAT EXHAUSTION
• Stop activity and rest in cool place.
• Remove excess or tight clothing.
• Provide water or commercial sports drink.
• Have victim lie down.
• Apply cool packs or wet towels.
• Seek medical care if condition does not improve.
HEAT STROKE
• Body temperature becomes extremely high
• Requires rapid intervention
• Signs of heatstroke
– Hot skin
– Dry skin (or may be wet from exertion)
– Confusion
– Seizures
– Unresponsiveness
CARE FOR HEATSTROKE
• Rapidly cool patient with cool, wet towels, fanning, and cold packs.
• If unresponsive and not breathing, start CPR.
COLD RELATED EMERGENCIES
• Frostbite
• Hypothermia
FROSTBITE
• Occurs when temperatures drop below freezing
• Affects feet, hands, ears, and nose
• Signs of frostbite
– White, waxy skin
– Cold and numb
– Blistering
CARE FOR FROSTBITE
• Get victim to warm area.
• Remove any wet/cold clothing or jewelry from affected part.
• Seek medical care.
• If more than an hour from medical care:
• Warm the part in warm water (100°F) for 20–40 minutes.
• If fingers or toes are affected, place dry dressings between these.
• Elevate affected limbs and provide pain reliever.
HYPOTHERMIA
• Recognizing hypothermia
– Body temperature falls and body cannot produce heat
– Signs of hypothermia
• Uncontrollable shivering
• Confusion, sluggish
• Cold skin even under clothing
CARE FOR HYPOTHERMIA
• Move out of the cold.
• Prevent heat loss.
– Replace wet clothes with dry clothes.
– Cover head.
• Have victim lie down.
• Give victim warm, sugary beverages if alert.
• Seek medical care if needed