Chapter 1.docx

Chapter 1 Introduction to First Aid This guide covers a wide range of information that will help you respond appropriately in a first aid or medical emergency. The introductory chapter contains background information, definitions and other material related to giving first aid. Chapter 2 explains cas...

Chapter 1 Introduction to First Aid This guide covers a wide range of information that will help you respond appropriately in a first aid or medical emergency. The introductory chapter contains background information, definitions and other material related to giving first aid. Chapter 2 explains casualty management including issues that relate to assessment of the casualty. This chapter also includes topics that are important to understand in the first critical moments at the emergency scene. Chapter 5 deals with issues of particular interest to health care providers-responders with a specific duty to respond within the health care system. This guide is used to support the teaching of these and other courses: Standard and Emergency First Aid Basic and Intermediate First Aid CPR at all levels including Basic Life Support/Health Care Provider (BLS/HCP) Some content contained in this guide will not pertain specifically to the level of training you have received. First aiders should always remember not to exceed their training, or the regulations/ legislation of their province or territory. Roles and responsibilities What is first aid? First aid is emergency help given to an injured or suddenly ill person using readily available materials. A person who takes charge of an emergency scene and gives first aid is called a first aider. The injured or ill person is called a casualty. The three priorities of first aid, in order of importance, are to: Preserve Iife Prevent the illness or injury from becoming worse Promote recovery What can a first aider do? First aiders do not diagnose or treat injuries or illnesses (except, perhaps, when they are very minor)-this is what medical doctors do. A first aider suspects injuries and illnesses, and gives first aid at the scene. Besides giving first aid, it is important to: Protect the casualty's belongings Keep unnecessary people away Reassure family or friends of the casualty Clean up the emergency scene and work to correct any unsafe conditions that may have caused the injuries in the first place First aiders within a workplace may have obligations and protections under federal, provincial, and territorial legislation regarding administering medications. Refer to federal, provincial, or territorial legislation and regulations for the requirements in your area. When assisting with medications, the first aider should check the label and ensure the following "5-rights" are met: Right Person - the name of the casualty is the name on the medication Right Medication - is this the right medication for this situation? Right Amount - what are the dosing instructions Right Method - how is this medication to be taken? (By mouth, inhaled, etc.) t :J Right Time - is this the right time to take this medication? A casualty's age in first aid and CPR The procedures related to the provision of first aid and cardiopulmonary resuscitation (CPR) differ in some ways, depending on the age and size of the casualty. In first aid and CPR: An infant casualty is under one year old A child casualty is from age one to age eight An adult casualty is over eight years of age It is important to recognize that these ages are guidelines. The size of the casualty must be considered. First Aid in the Workplace Workplace first aid is emergency care given by a person who is trained (and designated) to be the first aid provider to a co-worker who is injured or suddenly ill. All provinces and territories have a provision within legislation relating to first aid in the workplace. Refer to your provincial or territorial regulations for what is required in your area. Giving first aid as part of your job When giving first aid is part of your job, you have a duty to use reasonable skill and care based on your level of training. There are regulations to protect the first aider. For example in workplaces regulated by the Canada Labour Code, Section 126(3) of the Code states: "No employee is personally liable for anything done or omitted to be done in good faith by the employee when the employee is assisting the employer, as requested by the employer, in providing first-aid or in carrying out any other emergency measures." Every workplace in Canada is required under federal, provincial, or territorial regulations to have a first aid kit. The size and contents of the first aid kit will be determined by those regulations. First aid providers are encouraged to be familiar with the contents of their workplace first aid kit, its location, and to conduct regular inspections of the kit. First Aid as part of OHS Provincial and territorial regulations and legislation contain requirements for first aid training in their jurisdiction. Most regulations require at least one designated first aid provider at work at all times. The level of training required by the first aid provider will depend on the size of the workplace, the distance to medical help, and the risk of injury in the workplace. To help ensure compliance with regulations, it is recommended to have more than one person on each shift trained in first aid to account for holidays, illness, and breaks. OHS Legislation Provinces and territories are responsible for establishing Occupational Health and Safety legislation to protect workers. All workplaces that fall under provincial or territorial jurisdiction concerning regulations are required to adhere to the legislation and regulations of that province or territory. Those work places that fall under federal jurisdiction are subject to the Canada Labour Code. Housed within the legislation and regulations are provisions for adequate first aid coverage for a workplace, usually based on some or all of the following: The number of workers The potential risks The distance from medical care First aid and the law Note that St. John Ambulance is not giving legal advice. This guide is not intended to replace advice given by a lawyer or legal professional. Principles of the Good Samaritan Across Canada Good Samaritan laws and principles protect first aiders from lawsuits. You are a Good Samaritan if you are a bystander who helps a person when you have no legal duty to do so. As a Good Samaritan, you give your help without being paid, and you give it in good faith. Whenever you help a person in an emergency situation, you should abide by the following principles: You identify yourself as a first aider and get permission to help the injured or ill person before you touch them-this is called consent You use reasonable skill and care in accordance with the level of knowledge and skill that you have You are not negligent in what you do You do not abandon the person Consent The law says everyone has the right not to be touched by others. As a first aider, you must respect this right. Always ask if you can help. If the casualty cannot answer, you have what is called implied consent, and you can help. If the casualty is an infant or a young child, you must get consent from the child's parent or guardian. If there is no parent or guardian at the scene, the law assumes the casualty would give consent if they could, so you have implied consent to help. A person has the right to refuse your offer of help. In this case, do not force first aid on a conscious casualty. If you do not have consent to help, there may be other actions you can take without touching the casualty, such as controlling the scene, and calling for medical help. Be aware of difficulties in communicating when a casualty: Is hard of hearing Speaks a different language Is visually impaired Is a child Is in pain Shows signs of mood disorder Reasonable skill and care As a Good Samaritan, when you give first aid you are expected to use reasonable skill and care according to your level of knowledge and skills. Negligence Give only the care that you have been trained to provide, and always act in the best interest of the casualty. Abandonment Never abandon a casualty in your care. Stay until: You hand them over to medical help You hand them over to another first aider They no longer want your help-this is usually because the problem is no longer an emergency, and further care is not needed Giving first aid in Quebec Check your applicable workplace legislation/ regulations The Quebec Charter of Human Rights and Freedoms declares that any person whose life is in danger has the right to be helped. This means that you are required to help a person whose life is at risk, provided you do not put your own life, or anyone else's, in danger. Safety and personal protection In any emergency, first aid providers must always be aware of hazards and give first aid safely. A hazard is anything that poses a risk of injury or death to a first aid provider. There are three basic types of risks to be aware of: The energy source that caused the original injury-is the mechanism that caused the original injury still active, causing injury to others? Example: where an injury has been caused by machinery, is the machinery still running? There may be hazards caused by external factors. Example: passing vehicles may pose a risk at the scene of a motor vehicle incident There may be hazards associated with first aid procedures or a rescue. Example: moving a heavy casualty could place the first aider at risk of injury Some hazards can be controlled by the first aid provider. When controlling hazards, keep the following principles in mind: Use mechanical means whenever possible (broom, dustpan, tools, etc.) Be careful when lifting or moving objects on or near a casualty Have someone assist you where possible Turn on lights where no other risks to doing so exist Ensure safe footing - many injuries to first aiders are a result of slips and falls. Hazards that require specialized training to control (electrical hazards, fire, gases, etc.) should only be controlled by those who are properly trained. Most workplaces that deal regularly with these types of hazards will have a specialized response team. Refer to your workplace's policies and protocols. When dealing with chemical hazards, a Safety Data Sheet (SDS/ MSDS) should be accessible and will provide information on how to control the hazards along with first aid directions. Preventing infection Airborne pathogens Examples of infections that can be spread through the air are: Meningitis is a bacterial or viral infection which causes swelling that affects the spinal cord and brain Tuberculosis is a bacterial infection that primarily affects the lungs, but can affect any part of the body Influenza, or "the flu," is a viral infection which is easily spread, and can vary from being mildly debilitating to fatal Body fluid and blood-borne pathogens Exposure to blood or body fluids (i.e. vomit, feces) poses a health risk to first aiders. There are three diseases that first aiders should be aware of: Human immunodeficiency virus (HIV) is the virus responsible for AIDS. There is no vaccine to protect people from this virus. The best defence remains adequate protection to help prevent infection. Hepatitis B is one of the three common forms of hepatitis, a viral disease that can cause severe liver damage. Some people who have Hepatitis B have no symptoms but are still contagious. There is a vaccine to prevent Hepatitis B. Hepatitis C causes much of the same liver damage as Hepatitis B, but there is currently no vaccine available to prevent this disease. Sharp objects If a sharp object touches infected blood andthen pricks or cuts your skin, you could become infected. First aiders do not use sharp objects like scalpels and needles, but there may be broken glass or other sharp objects that have been in contact with blood or other bodily fluids. Always wear gloves and handle sharp objects with extreme care. Personal Protective Equipment Personal Protective Equipment (PPE) is clothing and equipment used to protect the first aider and to minimize the risks of health and safety hazards when in contact with a casualty. PPE can be gloves, a pocket mask used for ventilations, a helmet, eye protection, safety boots, etc. Use a face mask or shield when providing artificial respiration or CPR. Always follow the manufacturer's directions for disinfecting and cleaning reusable items. Single-use masks, one-way valves, and gloves are disposed of by double bagging with other contaminated articles. If used in the workplace, follow provincial/territorial and/or company protocols for disposal of hazardous items. Disposable gloves prevent direct hand contact between the first aider and the casualty. Wear gloves when you might touch blood, bodily fluids, tissue or anything that has come in contact with one of these. If you tear a glove, wash your hands as soon as possible, and put on a new pair. Dispose of contaminated gloves by sealing them in a plastic bag and double-bagging them. How to remove gloves Once gloves have been used, they are contaminated and are a possible source of infection. Take them off without touching their outer surface following the steps below. Grasp the cuff of one glove Slide your fingers under the cuff of the other glove. Pull the cuff towards the fingers, turning the glove inside out. Pull the cuff towards the fingers over the first glove. Proper Disposal As the glove comes off, hold it in the palm of your other hand. Tie a knot in the top of the outer glove and dispose of properly-see below. Wash your hands with soap and running water as soon as possible. Seal the used gloves in a plastic bag and put them in your household garbage. Check with health professionals or your first aid instructor for specific regulations in your area. Protecting the first aider Areas of the body that may have come into contact with a casualty need to be cleaned with hot, soapy water, an anti-septic solution, or a mixture of bleach and water (at a ratio of 1:10). Spills should be cleaned, then sanitized with the bleach and water solution for 20 minutes. Anyone who has been exposed to possible contaminants should take a hot shower with soap and rinse thoroughly. Anyone who has been exposed to contaminants from a needle stick or sharps injury should seek medical attention. If an injury occurs due to violence, or a first aider and/or casualty becomes at risk due to violence, you must protect yourself and call for help. Your skills as a first aider are valuable only when the area is safe. Clean up After an emergency, it is important to clean-up the area and equipment used properly. Any hard surfaces should be disinfected. Fabrics, where possible, should be laundered. Porous surfaces or materials that cannot be laundered may need to be disposed of. Items intended to be reused (scissors, forceps) should be wiped of blood and fluids, immersed in a 10% bleach solution (or other disinfecting solution) for 10 minutes, then rinsed and dried One-time use items (gauze, gloves) should be put into a garbage bag and tied. That garbage bag can then be put into the regular garbage. Any surfaces contaminated by blood or other fluids should be cleaned with a bleach solution or other disinfecting solution Sharps In an emergency, sharp objects (or "sharps") may be the cause of the injuries, or used in the first aid. It is important to dispose of these sharp objects properly for both the safety of first aid providers and others. Sharps can include needles, knives, and broken glass. These items may contain contaminated blood and can cut the first aider, exposing them to the contamination. Cleaning up glass should always be done with mechanical means such as a broom and dustpan. The cleaned up glass should be placed in a puncture-proof container like a cardboard box. When handling knives, always grasp by the handle and carried blade down. Cleaning knives should follow the steps above for hard surfaces. Needles should be disposed of in a sharps container. These plastic containers have thick walls and a secured lid that prevents accidental punctures. Ambulances will carry sharps containers and any needles found or used during an emergency '\ can be placed in these containers. t. j Always handle needles by the barrel (the plastic part with the plunger) and never try to re-cap a used needle. Needles must never be disposed of into the general garbage. Help at the emergency scene Bystanders should be asked to leave unless asked to stay and assist. Other first aiders may offer to help. Identify yourself and accept their assistance. If someone is more qualified to handle the situation, you may ask that person to take control. First responders include ambulance personnel, police officers and firefighters. They will take charge of the scene as soon as they arrive. Other authorities may be called to the scene (e.g. an electrical utility crew may arrive if there are downed power lines). Identify yourself and continue giving first aid. Off-duty doctors, nurses and other health professionals may identify themselves and offer to help. Ten ways a bystander can help Make the area safe Find all the casualties Find a first aid kit Control the crowd Call for medical help Help give first aid, under your direction Gather and protect the casualty's belongings Take notes Reassure the casualty's relatives Lead the paramedics to the scene of the emergency Signs and symptoms and mechanism of injury When referring to injuries, first aiders need to understand signs and symptoms. A sign is something we can see, feel, hear or smell (e.g. bleeding, bruising, agonal breathing, skin discolouration). A symptom is something the casualty is feeling (e.g. nauseous, weakness, pain) and must tell you. Mechanism of injury encompasses both what happened to the casualty, and how the injury has affected the casualty. It identifies the cause of the injury. Mechanisms of injury that require an ambulance right away: A fall from 6.5 meters (20 feet) or more A vehicle collision with signs of a severe impact Severe damage to the inside of the vehicle, a bent steering wheel, or a broken windshield Casualty was thrown from a vehicle The vehicle has rolled over Casualty was struck by a vehicle Crush injuries When any of these mechanisms are apparent, call an ambulance as soon as you can. When we understand the cause of the injury, we are able to predict what injuries may be present and what injuries are not likely, even in situations in which there are no visible signs of injury and/or the casualty is unable to describe their symptoms. Signs and symptoms Examples of Signs and Symptoms Signs you can see Blood, deformity, bruising, unequal pupils, painful expression and/ or flinching, sweating, wounds, unusual chest movement, skin colour, swelling, foreign bodies, vomit, incontinence Signs you can hear Noisy or distressed breathing, groans, sucking wounds (chest injury), bones scraping together, quality of speech Signs you can feel Dampness, skin temperature, swelling, deformity Signs you can smell Casualty's breath (fruity breath, acetone/nail polish breath, or alcohol), vomit, incontinence, gas fumes, burning, solvents or glue Symptoms the casualty may tell you about Pain, fear, heat, cold, loss of normal movement, loss of sensation, numbness, tingling sensation, thirst, nausea, faintness, stiffness, feeling faint, weakness, memory loss, dizziness, sensation of a broken bone The importance of medical help In first aid, any type of medical care is referred to as medical help. Unless an injury is very minor, you should always make sure the casualty receives medical help following first aid. Medical help may be given at the scene, en route to a medical facility, or in a hospital. Know the EMS telephone number for your community. This is often 9-1-1 in urban areas. If you are outside of your community, find the EMS phone numbers in the first few pages of the telephone book, or search online. Calling for medical help is important. The period immediately following a severe, life-threatening injury is known as the golden hour. This time is "golden" because the faster a casualty makes it to a hospital emergency room or operating room, the better the chances of survival and recovery. You can ask a bystander to call for medical help. Provide the person with: Necessary phone number A description of the casualty's condition Directions to follow to reach the scene Instructions to report back to you after getting medical help If you are alone, you must decide whether to stay with the casualty or leave to get help. The correct decision will depend on the specifics of the situation. If you have a mobile phone, call from the scene and perform first aid with the dispatcher's assistance. Medical care As a first aider you are not trained to diagnose the nature and extent of an injury or illness; a medical doctor has the training to do this. As a rule, make sure the casualty receives medical care following first aid. For minor injuries, this may not be necessary. Medical care is either given by a medical doctor or under the supervision of a medical doctor. Paramedics give medical care because they work under the supervision of medical doctors. Medical care is given in hospitals but it can also be given at the emergency scene or on the way to a medical facility. Call an ambulance or drive the casualty to the hospital? Always call an ambulance if you can; only transport the casualty to medical help yourself if that is the only possible way to get medical help. Transporting an injured person is often difficult and time­ consuming. An ambulance or other rescue vehicle is well-equipped, and the casualty can begin receiving medical help as soon as it arrives. When an ambulance arrives, do not stop the first aid you are providing until the crew has arrived to the casualty and indicates they are ready to take over. Give a short report to the ambulance crew on the situation; the condition of the casualty; and what you have done so far. Use MIST to help remember what to report: M - Mechanism of Injury I - Injuries or illnesses found S - Signs and symptoms T - Treatment (first aid) provided so far The Good Samaritan principles only protect you when giving care at the scene of the emergency, or while transporting the casualty when this is needed to save the casualty's life and medical help is not available. Transporting the casualty unnecessarily leaves you liable if it results in further injury should an accident or incident occur while en route to a hospital or medical station. Good communication Communication is necessary in every emergency situation, regardless of the details. As the first aider, there are many people you may need to communicate with - the casualty, bystanders, family members, other first aiders, EMS providers, and other professionals (e.g. police, fire, hydro). Effective communication skills will help you to assess the casualty's condition, and explain what you are doing and why. Some rules for effective communication: Be calm and direct Be respectful Do not use medical terms Call the casualty by name Do not diagnose the casualty's condition Always be honest, reassuring, and choose your words carefully As a first aider, the first thing you do when you arrive at an emergency scene is take charge of the situation. You stay in charge until you hand control of the scene over to more qualified people. While in charge, many other people may offer to help. When handing the scene over to someone other than the casualty, describe the complete history of the incident and pass along any notes you have taken. Be sure to include: Your name The time you arrived The history of the illness or injury, including signs and symptoms observed What first aid has been given Any changes in the casualty's condition since you took charge Principles of communication Though each situation is different, the following general guidelines help improve communication. Focus Maintain your attention on the casualty. Position yourself at eye level and maintain eye contact. Terminology Refrain from using medical terminology when communicating with the casualty or bystanders. Explanations and answers must be clear, concise and easily understood. Body Language Refrain from using body language that could be perceived as threatening or aggressive. Professionalism Always maintain your professionalism. Explain everything you are doing and why. If what you are doing may be painful, let the casualty know. Barriers to communication Despite following the principles of communication above, there are certain barriers that may arise making communication difficult. Language - the casualty or bystanders may not speak the same language as the first aid provider Physical - the casualty or bystanders may have a hearing, speech, or visual impairment Cognitive - the casualty or bystander may not understand the questions or requests Cultural - different cultures approach interactions with others which may impact communication Environment- noisy situations can make communication very difficult Technical - failure or limitations of communication devices (radios, phones) can hinder communication When faced with these barriers, the first aid provider may have to attempt several different ways to gather information or give directions. First aid providers should also remember to keep things simple, clear, and to the point. Drawn out descriptions using large words can make it very difficult for the casualty or those around to understand. An example would be "Get me the AED" instead of "I need you to find an Automated External Defibrillator so I can perform cardiopulmonary resuscitation." Injuries and illnesses Injuries When something from outside the body damages tissues, the damaged area is called an injury. How serious an injury is depends on: What tissues are injured-an injury to a vital organ, or tissues of a vital system, like the nervous system, is serious How bad the injury is-for instance, a bone broken in half may not be as serious as the same bone shattered into many pieces How much tissue is injured-a burned hand may be more serious than a burned finger Injuries and energy Injuries and energy Injuries result from too much energy being applied to the body. For instance: A thermal burn is caused by too much heat energy An acid burn is caused by too much chemical energy Snow-blindness is caused by too much light energy A broken bone is caused by too much mechanical energy A stopped heart from an electric shock is caused by too much electrical energy The body can take a certain amount of energy without being injured. But too much of any sort of energy will cause injury. Three factors determine whether an injury will occur. They are: How intense the energy was How long the energy was applied to the body What part of the body the energy was applied to Most injuries are caused either by something hitting the body or the body hitting something-this is mechanical energy. When something moves, it has mechanical energy. How much mechanical energy something has depends on how fast it is moving and how much it weighs. Illness We often think of first aid in the context of injuries only. But when someone becomes very sick, the result can be a medical emergency in which first aid can save a life. Some illnesses, like heart attacks or strokes come on very fast. Other illnesses progress more slowly and it can be hard to decide exactly when you have a medical problem that calls for a doctor's attention. Get medical help when any of the following is present: Sudden severe pain in any part of the body Sudden changes in vision, headache or dizziness Severe or persistent diarrhea or vomiting Sudden weakness or slurred/jumbled speech Persistent high temperature Changes in level of consciousness Rash of unknown origin Repeated fainting Obvious depression, suicide threats or attempts Whenever you are very worried about yourself or someone in your care If the casualty is an infant, the following are also reasons to get medical help (in addition to the reasons above): The baby has had a seizure The baby is blue or very pale You think the baby is having trouble breathing The baby cries a lot, or won't stop crying Stress management in emergency situations First aiders may experience a certain level of stress as a result of the assistance they provide. Stress is the body's normal reaction to physical and psychological events. It can be seen in certain attitudes and behaviours in both casualties and first aiders. It is a biological response and may be reflected in: An increase in heart rate An increase in blood pressure An increase in blood sugar Dilation of the bronchi and pupils Possible reactions of casualties Casualties may react to stressors in different ways and first aiders must observe and adjust to such reactions which can include: Denial-the casualty may deny the seriousness of the situation and refuse assistance Resignation-the casualty may be resigned to dying even if their life does not seem to be in danger, and doesn't want to make any effort to do what is needed Aggressiveness-the casualty may be hostile Assertiveness-the casualty is positive, cooperative, and may even want to take charge of their own care including directing the first aiders Stress management Managing stress in an emergency situation can make a significant difference in the quality of first aid provided. Appropriate mental preparation and regular first aid skill practice can help first aiders react effectively when faced with an emergency situation. The negative impact of stress can be reduced by understanding it and taking measures to try and overcome it. After serious incidents, it is important for first aiders to process their emotions. When faced with a highly stressful situation some first aiders may experience prolonged effects of stress and they should seek medical assistance.