First Aid

Duty to Act

• A duty to act is a responsibility to take action to prevent harm to another, and for the failure of which one may be liable, depending on the relationship of the parties and the circumstances.
• Duty to act refers to the contractual or legal obligation to provide care.

Correctional Officers and Correctional Probation Officers

• Have a duty to act to provide care to a patient who needs and consents to care only when they are on duty.

Law Enforcement Officers

• Have a duty to act 24/7 within their jurisdictional boundaries.
• Have a duty to render first aid following a use of force incident when it is evident that the person detained or in custody sustained injuries or requires medical attention.
• Must provide first aid or seek additional medical assistance when it is reasonable, based on the totality of the circumstances, and without jeopardizing their health or safety.

Responsibilities

• Responsible for a suspect's welfare and security, which does not end once they are restrained.
• Must not ignore a suspect's need for first aid while maintaining security and control of the suspect before EMS arrives.
• Must assist higher-level care providers, such as paramedics or EMTs, as needed while maintaining security and control of the suspect.

Breach of Duty

• Occurs when one fails to act or acts inappropriately.

Duty to Act

• Duty to act refers to a contractual or legal obligation to provide care, depending on the relationship of the parties and circumstances.
• Correctional officers and correctional probation officers have a duty to act when on duty, while law enforcement officers have a duty to act 24/7 within their jurisdictional boundaries.

Rendering First Aid

• Law enforcement officers have a duty to render first aid following a use of force incident when it is evident that the person detained or in custody sustained injuries or requires medical attention.
• First aid or additional medical assistance should be provided when reasonable, without jeopardizing one's health or safety.
• Officers should continue to provide care until a higher level of care arrives, such as a paramedic or EMT.

Breach of Duty

• Breach of duty occurs when an officer either fails to act or acts inappropriately.
• Failure to provide care or abandonment of a patient can lead to liability.

Standard of Care

• Standard of care is the degree of care that a reasonable person should exercise in a given situation.
• It involves giving attention to possible dangers, mistakes, and pitfalls, and ways of minimizing those risks.
• Standard of care is the care that a criminal justice first aid-provider would provide under the same conditions.

Good Samaritan Act

• The Good Samaritan Act protects a first-aid provider from liability for emergency care or treatment performed in good faith.
• The Act provides a defense if an officer performed according to the standard of care for a first-aid provider.
• The Act may provide protection for law enforcement officers when they are acting outside their jurisdictions and for correctional officers and correctional probation officers when providing care during off-duty hours.

Abandonment

• Abandonment is giving up a right or interest with the intention of never again claiming it.
• Abandoning a patient occurs when an officer stops providing care without ensuring the patient continues or begins to receive the same or better care.
• Officers should continue providing emergency first aid until another medical professional with the same or higher-level training replaces them or they are unable to continue.

Definition of Negligence

• Negligence is the failure to exercise the standard of care that a reasonably prudent person would have exercised in a similar situation.
• It involves any conduct that falls below the legal standard established to protect others against unreasonable risk of harm.

Elements of Negligence

Conditions for Negligence

• Duty to act: having a legal duty to the patient (e.g., administering care).
• Breach of standard of care: failing to act or acting in a way that a reasonable person with the same level of training would not act.
• Causation: the action or inaction directly resulting in the patient's injury.
• Damages: the patient was harmed as a result of the actions, and the court can compensate them (usually monetarily) for their injuries.

Definition of Negligence

• Negligence is the failure to exercise the standard of care that a reasonably prudent person would have exercised in a similar situation.
• It involves conduct that falls below the legal standard established to protect others against unreasonable risk of harm.
• Negligence excludes conduct that is intentionally, wantonly, or willfully disregardful of other's rights.

Elements of Negligence

• Having a legal duty to act, meaning you had a responsibility to provide care to the patient
• Breach of standard of care, where you failed to act or acted in a way that a reasonably prudent person with similar training would not have, given the circumstances

Causation and Damages

• Causation: your actions or inactions directly resulted in the patient's injury, showing a direct link between your behavior and the harm caused
• Damages: the patient suffered harm as a result of your actions, and the court can award monetary compensation for the injuries sustained

Elements of Negligence

• Having a legal duty to act, meaning you had a responsibility to provide care to the patient
• Breach of standard of care, where you failed to act or acted in a way that a reasonably prudent person with similar training would not have, given the circumstances

Causation and Damages

• Causation: your actions or inactions directly resulted in the patient's injury, showing a direct link between your behavior and the harm caused
• Damages: the patient suffered harm as a result of your actions, and the court can award monetary compensation for the injuries sustained

Importance of Consent

• Before providing first aid, gain the patient's consent or permission
• Fully explain the care planned and its possible related risks

Types of Consent

• Expressed Consent: clearly and unmistakably stated or written by the patient or legal guardian
  • Examples: verbal "yes, I consent" or a physical gesture like a nod in agreement
• Implied Consent: assumption of permission based on the patient's actions
  • Examples: rolling up their sleeve for a blood sample or extending their arm for a blood pressure reading
• Informed Consent: agreement made with full knowledge of the facts, benefits, risks, and alternatives
  • Requires full understanding of the information by the patient or their legal guardian

Refusing Medical Care

• A patient must be competent to refuse medical care
• A competent adult is one who can make an informed decision about medical care
  • Consider an adult incompetent if they are under the influence, seriously ill, injured, mentally ill, or have a developmental disability

Consequences of Not Obtaining Consent

• Failure to obtain consent can result in a criminal charge of battery (unlawful touch or strike without consent)

Patient Rights

• Competent adults have the right to refuse treatment verbally or non-verbally
• Patients have the right to withdraw from treatment after it begins
  • Applies to patients who consent and then change their minds, or those who regain consciousness and mental competence

Consent in First Aid

• Gain the patient's consent or permission before providing first aid care
• Fully explain the planned care and its possible related risks to the patient

Types of Consent

• Expressed Consent: Clearly and unmistakably stated or written permission from the patient or legal guardian
  • Can be verbal (e.g., "yes, I consent") or physical (e.g., a nod in agreement)
• Implied Consent: Assumed permission based on the patient's actions
  • Examples: patient rolls up their sleeve for a blood sample or extends their arm for a blood pressure reading
  • Applies to unresponsive patients at risk of death, disability, or deterioration of their condition
  • Also applies to conscious patients who do not stop the provider from giving treatment
• Informed Consent: Agreement to allow treatment or procedure with full knowledge of the facts, benefits, risks, and alternatives
  • Patient or legal guardian must fully understand the information provided
  • Involves more information exchange between the medical provider and patient than expressed consent

Before Providing First Aid

• Gain patient's consent or permission before providing first aid
• Fully explain the care you plan to provide and its possible related risks to the patient

Types of Consent

• Expressed Consent: Clearly and unmistakably stated or written permission given by the patient or legal guardian
• Expressed consent can be supported by verbal communication (e.g., "yes, I consent") or physical gesture (e.g., a nod in agreement)

Informed Consent

• A person's agreement to allow something to happen, made with full knowledge of the facts, benefits, risks, and alternatives
• The patient or legal guardian must fully understand the information given
• Informed consent involves additional information exchange between the medical provider and the patient
• Patient chooses a treatment or procedure after a physician or healthcare provider discloses risks involved

Expressed Consent

• Expressed consent is permission given for an action that is clearly and unmistakably stated or written by the patient or legal guardian.
• It is a positive confirmation of permission, which can be demonstrated through verbal communication.
• Examples of verbal communication that can demonstrate expressed consent include saying "yes, I consent".
• Physical gestures, such as a nod in agreement, can also be used to demonstrate expressed consent in a medical care setting.

Minors in Florida

• In Florida, children under 18 years old are considered minors.
• To provide care to minors, you must have a parent or legal guardian's permission.

Emergency Situations

• If a parent or legal guardian is unavailable in life-threatening emergencies or potential disability situations, provide emergency first aid based on implied consent.

Emancipated Minors

• Emancipated minors are those who are financially independent, do not live with a parent or caregiver, are married, or are an active member of the military.
• To treat an emancipated minor, you do not need a parent or legal guardian's permission; their consent is sufficient.

Refusing Treatment for Minors

• Competent adults have the right to refuse treatment for their children.

Life-Threatening Emergencies and Child Abuse

• In situations involving minors in life-threatening emergencies that need medical care, but the parents refuse to consent, refer to your agency's policies and procedures for guidance.
• If you suspect child abuse or neglect, notify the Department of Children and Families by calling the Florida abuse hotline (1-800-962-2873).

Respiratory System Function

• Delivers oxygen to the blood
• Removes carbon dioxide from the blood

Upper Airway

• Composed of the nose, mouth, and throat
• Brings oxygen to the lungs (lower airway)

Connection between Upper and Lower Airways

• Includes the voice box (larynx) and windpipe (trachea)

Key Structures

• Epiglottis: a small, leaf-shaped flap that prevents food and foreign objects from entering the windpipe
• Diaphragm: a large muscle below the lungs at the bottom of the chest cavity that helps move air in and out of the lungs

Scene Size-Up Components

• The scene size-up has four essential components: scene safety, mechanism of injury or nature of illness, the number of victims, and the need for more rescuers and special equipment.
• Scene size-up begins as soon as you receive notice from dispatch or arrive at the scene.

Importance of Scene Safety

• Always maintain situational awareness to ensure your own safety and ability to help others.
• If the scene is unsafe and you cannot make it safe, do not enter.
• Pay attention to what you see, hear, smell, and feel to determine the scene's safety.

Determining Mechanism of Injury or Nature of Illness

• Try to determine what happened to the patient to understand the extent of injury or illness.
• Identify the patient's chief complaint to judge the type of first aid or equipment needed.
• Distinguish between trauma patients (injured) and medical patients (ill), and provide treatment accordingly.

Determining the Number of Patients

• Identify the number of patients and their locations, even if it requires questioning others.
• In situations with multiple patients, prioritize care and triage patients based on several factors.

Requesting Additional Resources

• Assess the need for more resources based on local protocol and department policy.
• Relay a request for additional resources, including special units, in a clear and concise manner.
• Provide accurate and timely information about scene safety, injuries, number of patients, and resource needs to better prepare responding units.

Consent and First Aid

• Before providing first aid, gain the patient's consent or permission
• Explain the care you plan to provide and its possible related risks
• There are three types of consent:
  • Expressed consent: clearly and unmistakably stated or written by the patient or legal guardian
  • Implied consent: assumed permission based on the patient's actions, e.g., rolling up their sleeve for a blood sample
  • Informed consent: patient's agreement with full knowledge of the facts, benefits, risks, and alternatives

Competent Adults

• A competent adult has the right to refuse medical care verbally or non-verbally
• Can withdraw from treatment after it begins
• If a patient loses consciousness and regains mental competence, they can ask to stop treatment

Minors and Emancipated Minors

• Children under 18 require a parent or legal guardian's permission for care
• Emancipated minors (financially independent, married, or in the military) can consent to care themselves
• In life-threatening emergencies, provide care based on implied consent

Duty to Act

• A contractual or legal obligation to provide care
• Applies to correctional officers, correctional probation officers, and law enforcement officers in certain situations
• Breach of duty occurs when failing to act or acting inappropriately

Standard of Care

• The care that a reasonably prudent person would exercise in a similar situation
• Defined by Black's Law Dictionary as "the degree of care that a reasonable person should exercise"
• Negligence occurs when failing to exercise the standard of care

Abandonment

• Giving up a right or interest with the intention of never again claiming it
• Abandoning a patient occurs when stopping care without ensuring the patient receives the same or better care

Scene Size-Up

• Has four components: scene safety, mechanism of injury or nature of illness, number of victims, and need for more rescuers and special equipment
• Assess scene safety before entering the scene
• Determine the number of patients and prioritize care and triage accordingly

Respiratory System

• Delivers oxygen to and removes carbon dioxide from the blood
• The body can only go without oxygen for a few minutes
• The nose, mouth, and throat make up the upper airway, which brings oxygen to the lungs

Good Samaritan Act

• Protects first-aid providers from liability for emergency care or treatment performed in good faith
• Does not stop someone from filing a lawsuit, but provides a defense if care was provided according to the standard of care

Patient Assessment Types

• There are two main types of patient assessments: primary and secondary
• Primary assessment is used to identify and address immediate life-threatening conditions
• Secondary assessment is a thorough, full head-to-toe assessment of the patient
• Primary assessment is performed first to stabilize the patient's condition before proceeding to the secondary assessment

Level of Consciousness (LOC)

• Level of consciousness indicates how awake, alert, and aware someone is of their surroundings

AVPU Scale

• AVPU stands for Alert, Verbal, Pain, and Unresponsive
• Used to measure a patient's level of consciousness

Alert

• Patient is fully awake and aware of their surroundings
• Eyes usually open spontaneously
• Reacts to their environment

Verbal

• Patient responds when spoken to
• May not seem alert or awake but responds with sounds (e.g. grunting) or slight movements

Pain

• Patient responds to pain with voluntary or involuntary movement
• May respond only to painful stimulation
• Check for response when applying gentle pressure to hand or shoulder
• May moan, make sounds, or attempt to withdraw

Unresponsive

• Patient does not respond to any stimuli or make movements/sounds
• If unresponsive, follow steps for CPR

Determining LOC in Infants and Children

• Visual assessment is the most valuable tool
• Consider drowsiness or respiratory distress as serious symptoms, potentially indicating head trauma or severe infection

Level of Consciousness (LOC)

• Level of consciousness indicates how awake, alert, and aware someone is of their surroundings
• The AVPU scale is used to measure a patient's level of consciousness

AVPU Scale

• A: Alert - patient is fully awake, aware of surroundings, and can react to their environment
  • Eyes usually open spontaneously
• V: Verbal - patient responds when spoken to
  • May respond with grunting, moving, or other non-verbal cues
• P: Pain - patient responds to pain with voluntary or involuntary movement
  • May respond with moaning, sound, or attempting to withdraw
• U: Unresponsive - patient does not respond to any stimuli or make any movements or sounds
  • Follow CPR steps if patient is unresponsive

Special Considerations

• Infants and children: visual assessment is most valuable in determining LOC
  • Drowsiness or obvious respiratory distress in infants/children is serious and may indicate head trauma or severe infection
• Criminal justice officers: disarm them if they drop below alert level to avoid safety concerns

Primary Assessment using MARCH Mnemonic

• Massive Hemorrhage: Check for life-threatening bleeding that can cause death
• Airway: Assess if the patient's airway is obstructed or closed, which can lead to respiratory failure

Respiratory Status

• Respirations: Verify if the patient's chest is rising and falling to ensure proper breathing

Cardiovascular Status

• Circulation: Check if the patient has a pulse and adequate blood flow to vital organs

Other Vital Signs

• Hypothermia/Head Injury: Monitor for low body temperature and decreasing level of consciousness (LOC)

Massive Hemorrhage

• Massive hemorrhage is the number one preventable cause of trauma-related deaths.
• Severe bleeding can be accompanied by very low blood pressure, rapid heart rate, loss of consciousness, paleness, and weak pulse.
• Signs of severe bleeding include: low blood pressure, rapid heart rate, loss of consciousness, paleness, and weak pulse.
• Helpful bleeding control techniques include:
  • Applying direct pressure to the wound with a sterile dressing
  • Packing the wound
  • Applying a tourniquet, if possible

Airway Management

• An obstructed airway can restrict or completely impede a patient's ability to breathe.
• Safely clear objects in the airway and establish open airway management techniques, such as:
  • Head tilt/chin lift
  • Jaw thrust
• Do not move forward to the respirations assessment until you establish and maintain an open airway.

Respirations Assessment

• Assess for respirations or breathing by looking for:
  • Rise and fall of the chest or abdomen
  • Equal rise and fall on both sides
  • Breathing adequately
  • Signs of movement around the mouth and lips
• Signs of inadequate breathing include:
  • Labored or painful breathing
  • Wheezing
  • Snoring
  • Blue or purplish color inside of the lips or fingernails
  • Skin color changing to a pale or gray color
• No visible rise and fall of the chest or abdomen indicates the patient has stopped breathing.

Blood Circulation

• Assess for blood circulation by confirming the existence of a pulse and noting:
  • Skin color
  • Skin temperature
• Find a pulse by placing your fingers on a pulse point, such as:
  • Brachial pulse on the upper arm for an infant
  • Carotid pulse on the neck for an unconscious adult or child
  • Radial pulse on the inside of the wrist for a conscious adult or child
• Determine the force or strength of the pulse.
• A patient with no pulse or an absent pulse may be in cardiac arrest and require immediate intervention through effective CPR and an AED.

Capillary Refill Time Test

• This test is used to rapidly assess changes in blood flow in the arms and legs.
• Apply pressure by squeezing the patient's finger or toe nail bed for two seconds.
• After releasing pressure, if the squeezed nail bed returns to a pink color within two seconds, blood flow is adequate.
• Blue skin coloring can indicate possible circulation problems.

Additional Concerns

• Rapidly decreasing body temperature can be a main concern when treating trauma patients, as it can make bleeding symptoms worse.
• Minimize the patient's exposure to the elements and protect them from wind and water.
• Keep the patient warm and dry and remove any wet clothing.
• Consider moving them to an insulated surface such as a rescue blanket or a climate-controlled vehicle or structure.
• For head injury, a possible concern is permanent brain damage from lack of oxygen or proper blood flow to the brain.
• Assess the patient for:
  • Unequal pupil size
  • Any fluids coming out of their ears
  • Impaled object or deformity to their skull
  • Decreasing level of consciousness (LOC)

Secondary Assessment

• Use DOTS and PMS acronyms as guides when performing secondary assessment
• DOTS is used for examining each body part, while PMS is used for examining extremities

Body Part Examination

• Deformities: abnormal shape of a body part, possibly indicating fractures
• Compare injured area to uninjured area for identification

Open Injuries

• Wet clothing may indicate external bleeding
• Carefully remove or cut open clothing to locate and control bleeding immediately

Assessing Pain and Sensation

• Tenderness: conscious patients may complain of pain when touched
• In unresponsive patients, observe facial expressions for pain response (e.g., grimace)

Assessing for Soft-Tissue Injury and Fractures

• Swelling: raised skin, possibly indicating soft-tissue injury and fractures

PMS (Pulse, Motor, Sensory) Assessment

• Pulse: assess for presence or absence of pulse
• Motor: assess for motor function (movement)
• Sensory: assess for sensation before movement, ask patient if they have feeling in the touched area

Secondary Assessment

• Use DOTS and PMS acronyms as guides when performing secondary assessment
• DOTS is used for examining each body part, while PMS is used for examining extremities

Body Part Examination

• Deformities: abnormal shape of a body part, possibly indicating fractures
• Compare injured area to uninjured area for identification

Open Injuries

• Wet clothing may indicate external bleeding
• Carefully remove or cut open clothing to locate and control bleeding immediately

Assessing Pain and Sensation

• Tenderness: conscious patients may complain of pain when touched
• In unresponsive patients, observe facial expressions for pain response (e.g., grimace)

Assessing for Soft-Tissue Injury and Fractures

• Swelling: raised skin, possibly indicating soft-tissue injury and fractures

PMS (Pulse, Motor, Sensory) Assessment

• Pulse: assess for presence or absence of pulse
• Motor: assess for motor function (movement)
• Sensory: assess for sensation before movement, ask patient if they have feeling in the touched area