CPR-AED for Professional Rescuers Handbook.pdf

© 2011, 2016 The American National Red Cross. All rights reserved. Professional Rescuers CPR/AED for PARTICIPANT’S HANDBOOK  American Red Cross...

© 2011, 2016 The American National Red Cross. All rights reserved. Professional Rescuers CPR/AED for PARTICIPANT’S HANDBOOK  American Red Cross CPR/AED for Professional Rescuers © 2011, 2016 The American National Red Cross. All rights reserved. PARTICIPANT'S HANDBOOK This handbook is part of the American PLEASE READ THE FOLLOWING Red Cross CPR/AED for Professional TERMS AND CONDITIONS (these Rescuers program. By itself, it does not “Terms and Conditions”) BEFORE constitute complete and comprehensive AGREEING TO ACCESS, USE OR training. Visit redcross.org to learn more DOWNLOAD THE FOLLOWING THE about this program. AMERICAN NATIONAL RED CROSS MATERIALS. BY PURCHASING, The emergency care procedures DOWNLOADING, OR OTHERWISE outlined in the program materials USING OR ACCESSING THE reflect the standard of knowledge and MATERIALS, YOU ACKNOWLEDGE accepted emergency practices in the AND HEREBY AGREE TO BE United States at the time this handbook LEGALLY BOUND BY BOTH THESE was published. It is the reader’s TERMS AND CONDITIONS AND responsibility to stay informed of THE AMERICAN NATIONAL RED changes in emergency care procedures. CROSS TERMS OF USE (AVAILABLE AT redcross.org/terms-of-use). YOU The care steps outlined within AGREE THAT THE INCLUDED this handbook are consistent with COURSE MATERIALS ARE the 2015 International Liaison PROVIDED “AS IS” AND WITHOUT Committee on Resuscitation (ILCOR) WARRANTIES OF ANY KIND, AND Consensus on Science and Treatment THAT ANY ACCESS TO OR USE OF Recommendations (CoSTR). The THESE COURSE MATERIALS IS AT treatment recommendations and related YOUR OWN RISK. training guidelines have been developed © 2011, 2016 The American National Red Cross. All rights reserved. by The American National Red Cross Scientific Advisory Council (SAC), a panel of nationally recognized experts in fields that include emergency medicine, emergency medical services (EMS), nursing, occupational health, sports medicine, school and public health, aquatics, emergency preparedness and disaster mobilization. ii |  The following materials (including Any rights not expressly granted herein downloadable electronic materials, are reserved by the Red Cross. The as applicable) including all content, Red Cross does not permit its materials graphics, images and logos, are to be reproduced or published without copyrighted by, and the exclusive advance written permission from the property of, The American National Red Red Cross. To request permission Cross (“Red Cross”). Unless otherwise to reproduce or publish Red Cross indicated in writing by the Red Cross, materials, please submit your written the Red Cross grants you (“Recipient”) request to The American National Red the limited right to download, print, Cross. photocopy and use the electronic materials only for use in conjunction with © 2012, 2016 by The American teaching or preparing to teach a Red National Red Cross. ALL RIGHTS Cross course by individuals or entities RESERVED. expressly authorized by the Red Cross, subject to the following restrictions: The Red Cross emblem, American The Recipient is prohibited from Red Cross® and the American Red creating new electronic versions of the Cross name and logo are registered materials. trademarks of The American National The Recipient is prohibited from Red Cross and protected by various revising, altering, adapting or modifying national statutes. the materials, which includes removing, altering or covering any copyright Printed in the United States of America notices, Red Cross marks, logos, or © 2011, 2016 The American National Red Cross. All rights reserved. other proprietary notices placed or ISBN: 978-0-9983745-3-6 embedded in the materials. The Recipient is prohibited from creating any derivative works incorporating, in part or in whole, the content of the materials. The Recipient is prohibited from downloading the materials, or any part of the materials, and putting them on Recipient’s own website or any other third party website without advance written permission of the Red Cross. The Recipient is prohibited from removing these Terms and Conditions in otherwise-permitted copies, and is likewise prohibited from making any additional representations or warranties relating to the materials. | iii INTRODUCTION The American Red Cross CPR/AED for Professional Rescuers program is designed to train professional-level rescuers to respond to breathing and cardiac emergencies in adults, children and infants until more advanced medical personnel take over. The technical content within this CPR/AED for Professional Rescuers Handbook is consistent with the most current science and treatment recommendations from the International Liaison Committee on Resuscitation (ILCOR) 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations (CoSTR), the 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, and the American Red Cross Scientific Advisory Council (SAC), a panel of nationally recognized experts in fields that include emergency medicine, emergency medical services (EMS), nursing, occupational health, sports medicine, school and public health, aquatics, emergency preparedness and disaster mobilization. More information on the science of the course content can be found at the following websites: ilcor.org redcross.org/take-a-class/scientific-advisory-council ACKNOWLEDGMENTS This handbook is dedicated to the thousands of employees and volunteers of the American Red Cross who contribute their time and talent to supporting and teaching lifesaving skills worldwide and to the thousands of course participants and other readers who have decided to be prepared to take action when an emergency strikes. © 2011, 2016 The American National Red Cross. All rights reserved. Many individuals were involved in the development and revision process in various supportive, technical and creative ways. The American Red Cross CPR/AED for Professional Rescuers Handbook was developed through the dedication of employees and volunteers. Their commitment to excellence made this handbook possible. iv |  © 2011, 2016 The American National Red Cross. All rights reserved. | v  CONTENTS CHAPTER 1 CHAPTER 3 The Professional Rescuer Cardiac Emergencies Legal Considerations.............................. 3 Cardiac Chain of Survival..................... 87 Before Providing Care............................ 5 Heart Attack............................................88 Bloodborne Pathogens........................... 5 Cardiac Arrest........................................90 How Pathogens Spread......................... 7 CPR..........................................................90 Preventing the Spread AEDs........................................................93 of Bloodborne Pathogens.................... 10 Multiple-Rescuer Response...............100 If You Are Exposed.................................17 Wrap-Up................................................102 Taking Action..........................................17 Wrap-Up..................................................28 CHAPTER 2 Glossary................................................113 Index.......................................................119 Breathing Emergencies Recognizing and Caring © 2011, 2016 The American National Red Cross. All rights reserved. for Breathing Emergencies................... 41 Giving Ventilations.................................46 Airway Obstruction................................56 Emergency Oxygen................................61 Oxygen Delivery Devices......................64 Suctioning...............................................67 Wrap-Up..................................................68 vi |  SKILL SHEETS REMOVING DISPOSABLE CHOKING..............................................74 GLOVES.................................................. 29 o Adult and Child.....................................74 USING A o Infant........................................................77 RESUSCITATION MASK.................... 30 EMERGENCY OXYGEN....................79 o Head-Tilt/Chin-Lift............................... 30 o Assembling the Oxygen System.......79 o Jaw-Thrust (With Head o Administering Emergency Extension) Maneuver............................ 31 Oxygen....................................................81 o Jaw-Thrust (Without Head USING A MANUAL Extension) Maneuver............................ 32 SUCTIONING DEVICE.......................82 MOVING A VICTIM– CPR.........................................................103 EMERGENCY MOVES....................... 33 o One-Rescuer CPR............................103 o Pack-Strap Carry................................. 33 o Two-Rescuer CPR— o Clothes Drag......................................... 33 Adult and Child...................................105 MOVING A VICTIM– o Two-Rescuer CPR—Infant...............107 NON-EMERGENCY MOVES........... 34 USING AN AED................................. 109 o Walking Assist...................................... 34 o Two-Person Seat Carry...................... 34 PRIMARY ASSESSMENT– ADULT, CHILD AND INFANT............ 35 © 2011, 2016 The American National Red Cross. All rights reserved. GIVING VENTILATIONS.................... 70 o Giving Ventilations............................... 70 o Using a Bag-Valve-Mask Resuscitator—Two Rescuers............ 72 | vii 1 The Professional Rescuer For many professional rescuers, there is a job-related duty to act in an emergency. You may be called on to provide care, and your actions are often critical and may determine whether a seriously injured or ill victim survives. 3 LEGAL CONSIDERATIONS 5 BEFORE PROVIDING CARE 5 BLOODBORNE PATHOGENS 7 HOW PATHOGENS SPREAD PREVENTING THE SPREAD OF 10 BLOODBORNE PATHOGENS 17 IF YOU ARE EXPOSED 17 TAKING ACTION 28 WRAP-UP 1-1 LEGAL CONSIDERATIONS Adults who are awake and alert have consent verbally or through a gesture, a basic right to accept or refuse care. then consent is implied. Consent to treat can be obtained verbally or through a victim gesture. If the victim is While providing care to a victim, you may a minor, consent must be obtained from a learn details about the victim that are parent or guardian, if available. If a parent private and confidential. Do not share or guardian is not present, then consent this information with anyone except is implied. personnel directly associated with the victim's medical care. To obtain consent from a victim, follow these steps: Always document care that is provided. Identify yourself to the victim (parent By documenting, you establish a written or guardian for a minor). record of the events that took place, State your level of training. the care you provided and the facts you discovered after the incident occurred. Explain what you observe. Explain what you plan to do. Remember, laws vary from state to Ask for permission to state. Table 1-1 highlights some of the provide care. common legal considerations. If a victim is unresponsive, has an altered mental status, or is unable to give © 2011, 2016 The American National Red Cross. All rights reserved. 3 | Chapter 1: Th e Professional R escu er  Table 1-1: Legal Considerations Duty to Act The duty to respond to an emergency and provide care. Failure to fulfill these duties could result in legal action. Standard of Care Professional Rescuers are expected to meet a minimum standard of care, which may be established in part by their training program and in part by state or local authorities. This standard requires rescuers to: Communicate proper information and warnings to help prevent injuries. Recognize someone in need of care. Provide emergency care according to their level of training. Negligence Failure to follow a reasonable standard of care, thereby causing or contributing to injury or damage. Refusal of Care A competent victim's indication that a responder may not provide care. Refusal of care must be honored, even if the victim is seriously injured or ill or desperately needs assistance. A victim can refuse some or all care. If a witness is available, have the witness listen to, and document in writing, any refusal of care. Abandonment Discontinuing care once it has begun. You must continue care until someone with equal or more advanced training takes over. Confidentiality The principle that information learned while providing care to a victim is private and should not be shared with anyone except personnel directly associated with the victim’s medical care. © 2011, 2016 The American National Red Cross. All rights reserved. Chapter 1: Th e Professional R escu er | 4 1-2 BEFORE PROVIDING CARE While caring for a victim, it’s crucial that you protect yourself and others from the transmission of infectious disease. Throughout this section, you will learn the general procedures for responding to sudden illness or injury, and how to protect yourself and others against the spread of infectious diseases while providing care. 1-3 BLOODBORNE PATHOGENS Bloodborne pathogens, such as bacteria and viruses, present in blood and other potentially infectious material (OPIM), such as other body fluids, can cause disease in humans. Pathogens are found almost everywhere in our environment. Bacteria can live outside of the body and commonly do not depend on other organisms for life. If a person is infected by bacteria, antibiotics and other medications often are used to treat the infection. Viruses depend on other organisms to live. Once viruses are in the body, they are difficult to kill. This is why prevention is critical. Bloodborne pathogens of primary concern to professional rescuers are the hepatitis B virus, hepatitis C virus and human immunodeficiency virus (HIV) (Table 1-2). Table 1-2: How Bloodborne Pathogens Are Transmitted © 2011, 2016 The American National Red Cross. All rights reserved. Disease Signs and Symptoms Mode of Infectious Transmission Material Hepatitis B Fatigue, abdominal pain, loss of appetite, Direct and Blood, nausea, vomiting, joint pain, jaundice indirect contact saliva, vomitus, semen Hepatitis C Fatigue, dark urine, abdominal pain, loss of Direct and Blood, saliva, appetite, nausea, jaundice indirect contact vomitus, semen HIV Symptoms may or may not appear in the Direct and Blood, early stage; late-contact-stage symptoms possibly saliva, may include fever, fatigue, diarrhea, skin indirect vomitus, rashes, night sweats, loss of appetite, contact semen, swollen lymph glands, significant weight vaginal fluid, loss, white spots in the mouth, vaginal breast milk discharge (signs of yeast infection) and memory or movement problems 5 | Chapter 1: Th e Professional R escu er  Hepatitis B Hepatitis B is a liver infection caused provides immunity to the disease. by the hepatitis B virus. Hepatitis B may Scientific data show that hepatitis B be severe or even fatal; the hepatitis vaccines are safe for adults, children B virus can live in the body for up to and infants. Currently, no evidence exists six months before symptoms appear. indicating that hepatitis B vaccines These may include flu-like symptoms cause chronic illnesses. such as fatigue, abdominal pain, loss of appetite, nausea, vomiting and joint pain. Your employer must make the hepatitis Jaundice (yellowing of the skin and B vaccination series available to you eyes) is a symptom that occurs in the because you could be exposed to the later stage of the disease. virus at work. The vaccination must be made available after appropriate training Medications are available to treat has been completed. However, you can chronic hepatitis B infection, but they choose to decline the vaccination series. do not work for everyone. The most If you decide not to be vaccinated, you effective means of prevention is the must sign a form affirming your decision. hepatitis B vaccine. This vaccine, which is given in a series of three doses, Hepatitis C Hepatitis C is a liver disease caused vaccine exists against hepatitis C, by the hepatitis C virus. Hepatitis C is and no treatment is available to prevent the most common chronic bloodborne infection after exposure. Hepatitis C infection in the United States. The is the leading cause of liver transplants. © 2011, 2016 The American National Red Cross. All rights reserved. symptoms are similar to those of the For these reasons, hepatitis C is hepatitis B infection and include fatigue, considered to be more serious than abdominal pain, loss of appetite, nausea, hepatitis B. vomiting and jaundice. Currently, no HIV HIV is the virus that causes AIDS. HIV severe pneumonia, tuberculosis, Kaposi’s attacks white blood cells and destroys sarcoma and other unusual cancers. the body’s ability to fight infection. This weakens the body’s immune system. People infected with HIV initially may not The infections that strike people whose feel or look sick. A blood test, however, immune systems are weakened by HIV can detect the HIV antibody. When an are called opportunistic infections. infected person has a significant drop Some opportunistic infections include in a certain type of white blood cells or Chapter 1: Th e Professional R escu er | 6 shows signs of having certain infections There are many other illnesses, viruses or cancers, they may be diagnosed and infections to which you may be as having AIDS. These infections can exposed. Keep immunizations current, cause fever, fatigue, diarrhea, skin have regular physical check-ups and be rashes, night sweats, loss of appetite, knowledgeable about other pathogens. swollen lymph glands and significant For more information on the illnesses weight loss. In the advanced stages, listed above and other diseases and AIDS is a very serious condition. People illnesses of concern, contact the with AIDS eventually develop life- Centers for Disease Control and threatening infections and can die from Prevention (CDC) at 800-342-2437 or these infections. Currently, there is no go to cdc.gov. vaccine against HIV. 1-4 HOW PATHOGENS SPREAD Exposures to blood and other potentially of a puzzle (Figure 1-1). All of the pieces infectious materials occur across a must be in place for the picture to be wide variety of occupations. Rescuers, complete. If any one of these conditions healthcare providers, emergency is missing, an infection cannot occur. medical services (EMS) personnel, public safety personnel and other At the workplace, bloodborne workers can be exposed to blood pathogens, such as hepatitis B virus, through injuries from needles and other hepatitis C virus and HIV, are spread sharp devices, as well as from direct and primarily through direct or indirect indirect contact with skin and mucous contact with infected blood or other membranes. For any disease to be body fluids. These viruses are not © 2011, 2016 The American National Red Cross. All rights reserved. spread, including bloodborne diseases, spread by food or water, or by casual all four of the following conditions must contact, such as hugging or shaking be met: hands. The highest risk of transmission A pathogen is present. while at work is unprotected direct or A sufficient quantity of the pathogen indirect contact with infected blood. is present to cause disease. A person is susceptible to the Entry pathogen. Present Site The pathogen passes through a portal of entry (e.g., eyes, mouth and other mucous membranes; non-intact skin or skin pierced by needlesticks; animal and human Susceptible bites, cuts, abrasions and other Quantity means). Figure 1-1 | How pathogens spread To understand how infections occur, think of these four conditions as pieces 7 | Chapter 1: Th e Professional R escu er  Direct Contact Direct contact transmission occurs when infected blood or other potentially infectious material from one person enters another person’s body. For example, direct contact transmission can occur through infected blood splashing in the eye or from directly touching the potentially infectious material of an infected person with a hand that has an open sore (Figure 1-2). Figure 1-2 | Direct contact Indirect Contact Some bloodborne pathogens also can be transmitted by indirect contact (Figure 1-3). Indirect contact transmission can occur when a person touches an object that contains the blood or other potentially infectious material of an infected person and that blood or potentially infectious material enters the body through a portal of entry. Such objects include soiled dressings, equipment and work surfaces that have © 2011, 2016 The American National Red Cross. All rights reserved. been contaminated with an infected person’s potentially infectious material. For example, indirect contact can occur Figure 1-3 | Indirect contact when a person picks up blood-soaked bandages with a bare hand and the pathogens enter through a break in the skin on the hand. Chapter 1: Th e Professional R escu er | 8  Droplet and Vector-Borne Transmission Other pathogens, such as the flu when the body’s skin is penetrated by virus, can enter the body through an infectious source, such as an animal droplet transmission. This occurs or insect bite or sting when a person inhales droplets (Figure 1-5). Examples of diseases from an infected person’s cough or spread through vector-borne sneeze (Figure 1-4). Vector-borne transmission include malaria and West transmission of diseases occurs Nile virus. Figure 1-4 | Droplet transmission Figure 1-5 | Vector-borne transmission Risk of Transmission Hepatitis B, hepatitis C and HIV share a infection from hepatitis B-infected blood © 2011, 2016 The American National Red Cross. All rights reserved. common mode of transmission—direct from a needlestick or cut exposure can or indirect contact with infected blood be as high as 30 percent, depending on or other potentially infectious material— several factors. In contrast, the risk for but they differ in the risk of transmission. infection from hepatitis C-infected blood Individuals who have received the after a needlestick or cut exposure is hepatitis B vaccine and have developed about 2 percent, whereas the risk of immunity to the virus have virtually no infection from HIV-infected blood after risk for infection by the hepatitis B virus. a needlestick or cut exposure is far less For an unvaccinated person, the risk for than 1 percent. 9 | Chapter 1: Th e Professional R escu er  1-5 PREVENTING THE SPREAD OF BLOODBORNE PATHOGENS OSHA Regulations The federal Occupational Safety and Health Administration (OSHA) issued regulations about on-the-job exposure to bloodborne pathogens. OSHA determined that employees are at risk when they are exposed to blood or other potentially infectious material. Employers should follow OSHA requirements regarding job-related exposure to bloodborne pathogens, which are designed to protect you from disease transmission. This includes reducing or removing hazards from the workplace that may place employees in contact with infectious materials, including how to safely dispose of needles. These regulations and guidelines apply to employees who may come into contact with blood or other body substances that could cause an infection. These regulations apply to professional rescuers because they are expected to provide emergency care as part of their job. OSHA has revised the regulations to include the requirements of the federal Needlestick Safety and Prevention Act. These guidelines can help professional rescuers and their employers meet the OSHA bloodborne pathogens standard to prevent transmission of serious diseases. For more information about the OSHA Bloodborne Pathogens Standard 29 CFR 1910.1030, go to osha.gov. © 2011, 2016 The American National Red Cross. All rights reserved. Chapter 1: Th e Professional R escu er | 10  EMPLOYERS’ RESPONSIBILITIES OSHA’s regulations on bloodborne Soliciting input from pathogens require employers to nonmanagerial employees in protect employees in specific workplaces where there is ways, including: potential exposure to injuries from Identifying positions or tasks contaminated sharps regarding covered by the standard. the identification, evaluation and Creating an exposure control selection of effective engineering plan to minimize the possibility and work practice controls. of exposure and making the plan Recording the appropriate easily accessible to employees. information about needlestick Developing and putting into action injuries in the sharps injury a written schedule for cleaning and log, including: o Type and brand of device decontaminating the workplace. involved in the incident. Creating a system for easy o Location of the incident. identification of soiled material and its proper disposal. o Description of the incident. Developing a system of annual Maintaining a sharps injury log training for all covered employees. in a way that protects the privacy Offering the opportunity for of employees. employees to get the hepatitis B Ensuring confidentiality of vaccination at no cost to them. employees’ medical records and Establishing clear procedures to exposure incidents. follow for reporting an exposure. Creating a system of © 2011, 2016 The American National Red Cross. All rights reserved. recordkeeping. 11 | Chapter 1: Th e Professional R escu er  Exposure Control Plan OSHA regulations require employers such as recordkeeping. The exposure to have an exposure control plan. control plan guidelines should be This is a written program outlining the made available to rescuers and other protective measures that employers will personnel who may come into contact take to eliminate or minimize employee with blood or other potentially infectious exposure incidents and how to respond materials and should specifically explain should an exposure occur. The plan what they need to do to prevent the also should detail how the employer spread of infectious diseases. will meet other OSHA requirements, Standard Precautions Standard precautions are safety measures that combine universal precautions and body substance isolation (BSI) precautions and are based on the assumption that all body fluids may be infectious. Standard precautions can be applied through the use of: Personal protective equipment (PPE). Good hand hygiene. Engineering controls. Work practice controls. Proper equipment cleaning. Spill clean-up procedures. Personal Protective Equipment © 2011, 2016 The American National Red Cross. All rights reserved. PPE appropriate for your job duties should be available at your workplace and should be identified in the exposure control plan. PPE includes all specialized clothing, equipment and supplies that prevent direct contact with infected materials (Figure 1-6). These include, but are not limited to, breathing barriers, nitrile latex-free disposable (single-use) gloves, gowns, masks, shields and Figure 1-6 | Personal protective equipment protective eyewear (Table 1-3) on the includes breathing barriers and gloves. following page. Chapter 1: Th e Professional R escu er | 12  Table 1-3: Recommended Personal Protective Equipment Against Hepatitis B, Hepatitis C and HIV Transmission in Prehospital Settings Task or Activity Disposable Gown Mask Protective Gloves Eyewear Bleeding control with spurting blood Yes Yes Yes Yes Bleeding control with minimal Yes No No No bleeding Emergency childbirth Yes Yes Yes Yes Oral/nasal suctioning; manually Yes No Yes Yes clearing airway Handling and cleaning Yes No, unless No No contaminated equipment and soiling is likely clothing Guidelines for using PPE to prevent infection include the following: Avoid contact with blood and other In addition to gloves, wear potentially infectious material. protective coverings, such as a Use CPR breathing barriers when mask, eyewear and a gown, when giving ventilations to a victim. there is a likelihood of coming into contact with blood or other body © 2011, 2016 The American National Red Cross. All rights reserved. Wear nitrile, latex-free disposable gloves when providing care. fluids that may splash. o Do not use gloves that are Remove gloves without contacting discolored, torn or punctured. the soiled part of the gloves, Do not clean or reuse and dispose of them in a proper disposable gloves. container. See the skill sheet o Cover any cuts, scrapes or located at the end of the chapter for steps to remove gloves properly. sores, and remove jewelry, including rings, before wearing gloves, if possible. o Avoid handling items such as pens, combs or radios when wearing soiled gloves. o Change gloves before providing care to a different victim. 13 | Chapter 1: Th e Professional R escu er  Hand Hygiene Wash your hands with anti-bacterial Hand washing is the most effective hand soap and water as soon as measure to prevent the spread of they are available. infection. Wash your hands before and after providing care, if possible, In addition to washing your hands so that they do not pass pathogens frequently, it is a good idea to keep your to or from the victim. Wash your hands fingernails shorter than one-fourth inch frequently, such as before and after and avoid wearing artificial nails. eating, after using the restroom and every time you have provided care. By Engineering Controls and Work washing hands often, you can wash Practice Controls away disease-causing germs that have Engineering controls are objects been picked up from other people, used in the workplace that isolate or animals or contaminated surfaces. remove a hazard, thereby reducing the risk of exposure. Examples of To wash your hands correctly, follow engineering controls include: these steps: Biohazard bags and labels. 1. Wet your hands with warm water. PPE. 2. Apply soap to your hands. Sharps disposal containers 3. Rub your hands vigorously for at least (Figure 1-7). 15 seconds, covering all surfaces of Safer medical devices, such your hands and fingers, giving added as sharps with engineered injury attention to fingernails and jewelry. protections or needleless systems. 4. Rinse your hands with warm, running water. 5. Dry your hands thoroughly with a disposable towel. © 2011, 2016 The American National Red Cross. All rights reserved. 6. Turn off the faucet using the disposable towel. Alcohol-based hand sanitizers and lotions allow you to cleanse your hands when soap and water are not readily available and your hands are not visibly soiled. If your hands contain visible matter, use soap and water instead. When using an alcohol-based hand sanitizer: Apply the product to the palm of one hand. Rub your hands together. Rub the product over all surfaces of your hands, including nail areas and between fingers, until the product dries. Figure 1-7 | Sharps disposal container Chapter 1: Th e Professional R escu er | 14 Work practice controls are methods Do not eat, drink, smoke, apply of working that reduce the likelihood of cosmetics or lip balm, handle an exposure incident by changing the contact lenses or touch the eyes, way a task is carried out. Examples of mouth or nose when in an area work practice controls include: where exposure to infectious Dispose of sharp items (e.g., broken materials is possible. glass) in puncture-resistant, leak- Isolate contaminated areas so other proof, labeled containers. employees or people do not walk Avoid splashing, spraying and through and become exposed. splattering droplets of blood or other potentially infectious materials Be aware of any areas, equipment or when performing all procedures. containers that may be contaminated. Remove and dispose of Biohazard warning labels are required soiled protective clothing as on any container holding contaminated soon as possible. materials, such as used gloves, bandages or trauma dressings. Signs Clean and disinfect all equipment should be posted at entrances to work and work surfaces soiled by blood areas where infectious materials may or other body fluids. be present. Use good hand hygiene. Equipment Cleaning and Spill Clean-Up After providing care, you should clean are properly cleaned and disinfected and disinfect the equipment and (Figure 1-8). Place all used disposable surfaces. In some cases, you will need to items in labeled containers. Place all properly dispose of certain equipment. soiled clothing in marked plastic bags Handle all soiled equipment, supplies for disposal or washing (Figure 1-9). © 2011, 2016 The American National Red Cross. All rights reserved. and other materials with care until they Commercial blood spill kits are available. Figure 1-8 | Clean and disinfect all Figure 1-9 | Use a biohazard bag to equipment after use. dispose of soiled materials. 15 | Chapter 1: Th e Professional R escu er  Take the following steps to clean up spills: Wear disposable gloves and other Flood the area with a PPE, such as eye protection. fresh disinfectant solution of Clean up spills immediately, or approximately 1½ cups of liquid as soon as possible, after the chlorine bleach to 1 gallon of water spill occurs. (1 part bleach per 9 parts water, or Rope off or place cones around about a 10 percent solution), and the area so others do not allow it to stand for at least accidentally get exposed by 10 minutes. walking through the spill. Use appropriate material to absorb If the spill is mixed with sharp the solution, and dispose of it in a objects, such as broken glass labeled biohazard container. and needles, do not pick these Scrub soiled boots, leather shoes up with your hands. Use tongs, a and other leather goods, such as broom and dustpan or two pieces belts, with soap, a brush and hot of cardboard. water. If you wear a uniform to work, wash and dry it according to the manufacturer’s instructions. © 2011, 2016 The American National Red Cross. All rights reserved. Chapter 1: Th e Professional R escu er | 16 1-6 IF YOU ARE EXPOSED If you are exposed to a bloodborne pathogen, immediately take the following steps: Clean the contaminated area thoroughly with soap and water. Wash needlestick injuries, cuts and exposed skin. If you are splashed with blood or other potentially infectious material around your mouth or nose, flush the area with water. If your eyes are involved, irrigate them with clean water, saline or sterile irrigants for 20 minutes. Following any exposure incident: Report the exposure incident to the appropriate supervisor immediately and to the EMS personnel when they take over the care of the victim. This step can be critical to receive appropriate post-exposure treatment. Document what happened. Include the time and date of the exposure, as well as the circumstances of the exposure, any actions taken after the exposure and any other information required by your employer. Seek immediate follow-up care as identified in your facility exposure control plan. 1-7 TAKING ACTION When called to an emergency, you must 1. Size-up the scene and form an initial © 2011, 2016 The American National Red Cross. All rights reserved. keep in mind a few critical steps for impression. your safety and the safety of your team, o Only move the victim only if in addition to the safety of the victim necessary for the victim's safety. and bystanders. Use appropriate first 2. Perform a primary assessment. aid equipment and supplies, and follow o Obtain consent if the victim these general procedures: is responsive. 3. Summon EMS, if needed and not already done. 4. Provide care according to the conditions found. 17 | Chapter 1: Th e Professional R escu er  Size Up the Scene When you size-up the scene, your Determine the nature of the illness goal is to determine if the scene is or what caused the injury. Look for safe for you, other responders, EMS clues to what may have caused personnel, the victim(s) and any the emergency and how the victim bystanders. You should: became ill or injured. Use your senses to check for Form an initial impression that may hazards that could present a danger indicate a life-threatening emergency, to you or the victim, such as unusual including unresponsiveness or odors that would indicate a gas leak severe bleeding. or fire, sights that would indicate Determine what additional resources anything out of the ordinary or may be needed. sounds, such as an explosion. Use appropriate PPE. If the scene appears to be unsafe, move Determine the number of injured or to a safe distance, notify additional ill victims. members of the safety team and wait for their arrival. To form an initial impression, look for signs that may indicate a life-threatening emergency: Does the victim look sick? Is the victim awake and moving? Signs that may indicate a life-threatening emergency might consist of: © 2011, 2016 The American National Red Cross. All rights reserved. Unresponsiveness. Abnormal skin color. Severe life-threatening bleeding. If you see severe life-threatening bleeding, use any available resources to control the bleeding, including a tourniquet or hemostatic dressing, if one is available and you are trained. Chapter 1: Th e Professional R escu er | 18 Moving a Victim Move an injured victim only when: victim to the top or bottom of steps You are faced with immediate to perform CPR). danger. You need to get to other victims If you must leave a scene to ensure who have more serious injuries or your personal safety, you must make illnesses. all attempts to move the victim to safety as well. It is necessary to provide appropriate care (e.g., moving a EMERGENCY MOVES Your safety is of utmost importance. There are several ways to move a Lifting and moving a victim requires victim. Non-emergency moves include: physical strength and a high level of Walking assist. Either one or fitness. If you improperly lift a victim, two responders can use the you can permanently injure yourself or walking assist for a responsive further injure the victim. person who simply needs assistance to walk to safety. When moving a victim, consider Two-person seat carry. The the victim’s height and weight, your two-person seat carry requires physical strength, obstacles such a second responder. This carry as stairs and narrow passages, the can be used for any person who distance the victim needs to be moved, is responsive and not seriously the availability of others to assist, the injured. victim’s condition and the availability of © 2011, 2016 The American National Red Cross. All rights reserved. transport aids. Emergency moves include: To improve your chances of Clothes drag. The clothes drag successfully moving a victim without can be used to move a responsive injuring yourself or the victim: or unresponsive person suspected of having a head, neck or spinal Lift with your legs, not your back. injury. This move helps to keep Keep your legs shoulder-width the person’s head, neck and apart, head up, back straight and back stabilized. shoulders square. Pack-strap carry. The pack-strap Avoid twisting or bending anyone carry can be used with responsive who has a possible head, neck or and unresponsive people. Using spinal injury. this carry with an unresponsive Do not move a victim who is too person requires a second large for you to move comfortably. responder to help position the Walk forward, when possible, injured or ill person on your back. taking small steps, and look where you are going. 19 | Chapter 1: Th e Professional R escu er  Perform a Primary Assessment Following the scene size-up, including forming an initial impression, conduct a primary assessment to determine if the victim has any life-threatening conditions and, if so, summon EMS personnel if a call has not already been made. The primary assessment includes checking the victim for responsiveness, breathing and a pulse. Check the Victim for Responsiveness A person who can speak is responsive, but may not be alert. Remember, if a person is responsive and alert, you must obtain consent before providing care. Document any refusal of care by the victim on an incident or rescue report. If a witness is available, have them listen to, and document in writing, any refusal of care. If an adult or child appears to be unresponsive, shout, “Are you okay?” Use the person’s name if you know it. If the victim does not respond, tap the victim on the shoulder and again shout, “Are you okay?” in a shout-tap-shout sequence. If an infant appears to be unresponsive, follow the same shout-tap-shout sequence, but tap the infant’s foot to see if they respond instead of the shoulder. A response may be subtle, such as some slight movement or momentary eye opening that occurs when you speak to the victim or apply a stimulus, such as a tap to the shoulder. Use the mnemonic AVPU to help you determine the victim's level of consciousness: A - Alert—fully awake, but may still be confused V - Verbal—responds to verbal stimuli P - Painful—responds to painful stimuli U - Unresponsive—does not respond If the victim is not awake, alert and oriented or does not respond, call EMS if you © 2011, 2016 The American National Red Cross. All rights reserved. have not already done so. Chapter 1: Th e Professional R escu er | 20 Summon EMS Personnel If you are unsure of the victim’s condition or notice that the condition is worsening, summon EMS personnel. As a general rule, summon EMS personnel if victims experience any of the following conditions: Unresponsive or an altered level of consciousness (LOC), such as drowsiness or confusion Breathing problems (difficulty breathing or no breathing) Water inhalation after being recovered from under water Chest pain, discomfort or pressure lasting more than a few minutes, that goes away and comes back or that radiates to the shoulder, arm, neck, jaw, stomach or back Persistent abdominal pain or pressure No pulse Severe life-threatening bleeding Vomiting blood or passing blood Severe (critical) burns Suspected poisoning Seizures in the water Seizures on land, unless the person is known to have periodic seizures; if not, summon EMS personnel for a seizure on land if: o This is the person’s first seizure. o The seizure lasts more than 5 minutes. o The person has repeated seizures with no sign of gaining lucidity. o The person appears to be injured. © 2011, 2016 The American National Red Cross. All rights reserved. o The cause of the seizure is unknown. o The person is pregnant. o The person is known to have diabetes. o The person fails to regain consciousness after the seizure. Suspected or obvious injuries to the head, neck or spine Stroke Painful, swollen, deformed areas (suspected broken bone), or an open fracture above the hands or feet Victim’s condition is unclear or worsening 21 | Chapter 1: Th e Professional R escu er  Open the Airway and Check of the throat. The method used to open for Breathing and Pulse the airway depends on the number of rescuers responding, the position of the If the victim does not respond, open rescuer to the victim and whether you the victim’s airway and quickly check suspect the victim has an injury to the for breathing and a pulse for at least 5 head, neck or spine. You can open the seconds, but not more than 10 seconds airway from a position either to the side (Figure 1-10). Perform these tasks of the victim or the above the victim’s simultaneously. If a victim is able to head, using the following techniques: speak, the airway is functional, and they are breathing. However, even if a victim From the victim’s side: Use the can speak, you must continue to assess head-tilt/chin-lift. breathing, because breathing status, rate From above the victim’s head: and quality can change suddenly. Tilt the head back using the jaw-thrust maneuver. o When the victim is suspected Opening the Airway of having an injury to the head, When a victim is unresponsive, the neck or spine, use the jaw- tongue relaxes and can block the flow of thrust maneuver (without head air through the airway, especially if the extension) method. victim is lying on their back. To check for For a child, tilt the head slightly past the breathing and give ventilations, you must neutral position, but not as far as you manually tilt the head or thrust the jaw would for an adult. For an infant, tilt the to move the tongue away from the back head to the neutral position (Table 1-4). © 2011, 2016 The American National Red Cross. All rights reserved. Figure 1-10 | When performing a primary assessment, open the victim’s airway and check for breathing and a pulse simultaneously for at least 5 seconds, but no more than 10 seconds. Chapter 1: Th e Professional R escu er | 22  Table 1-4: Head Positions for Giving Ventilations to an Adult, a Child and an Infant © 2011, 2016 The American National Red Cross. All rights reserved. 23 | Chapter 1: Th e Professional R escu er  Checking for Breathing To check for breathing, position your ear over the mouth and nose so that you can hear and feel air as it escapes while you look for the chest to rise and fall. Normal, effective breathing is regular, quiet and effortless. Isolated or infrequent gasping in the absence of other breathing in an unresponsive person may be agonal breaths, which can occur even after the heart has stopped beating. Be aware that this is not normal breathing. Agonal breaths are a sign of cardiac arrest. In this situation, care for the victim as though they are not breathing at all. Checking for a Pulse With every heartbeat, a wave of blood moves through the blood vessels. This creates a beat called the pulse. You can feel it with your fingertips in the arteries near the skin. Sometimes the pulse may be difficult to find, since it may be slow or weak. If you do not find a pulse within 10 seconds, do not waste any more time attempting to find one. Assume that there is no pulse, and begin care immediately. To check for a pulse: For an adult or child, feel for a carotid pulse by placing two fingers in the middle of the victim’s throat; then slide your fingers into the groove of the neck, on the side that is closest to you. Press in lightly; pressing too hard can compress the artery. For an infant, feel for the brachial pulse on the inside of the upper arm between the infant’s elbow and shoulder. Press in lightly; pressing too hard can compress the artery. Give 2 Ventilations if Appropriate For an unresponsive person who is not breathing and does not have a pulse, it © 2011, 2016 The American National Red Cross. All rights reserved. is necessary to immediately begin CPR with chest compressions. However, in certain situations, such as drowning, giving ventilations before beginning CPR is important. If you find a victim who is unresponsive and not breathing and has no pulse as a result of drowning, you should give the victim 2 ventilations before starting compressions. Each one should be a quality ventilation that makes the victim’s chest clearly rise. If these ventilations do not make the victim’s chest clearly rise, re-tilt and attempt another ventilation. However, if the victim is not breathing, does not have a pulse and was not in the water, you should assume that the problem is a cardiac emergency. In this case, begin CPR with chest compressions. Chapter 1: Th e Professional R escu er | 24 Using a Resuscitation Mask to Recovery Positions Give Ventilations If a victim is unresponsive but breathing You should use a resuscitation mask and you do not suspect a head, neck or when giving ventilations (Figure 1-11). spinal injury, place the victim in a side- To ensure that you are giving adequate lying recovery position. If you suspect ventilations, the mask must be properly a head, neck or spinal injury, leave the placed and sealed over the victim’s victim in a face-up position unless you mouth and nose. Each ventilation should are unable to maintain an open airway last about 1 second and make the because of fluids or vomit or if you are victim’s chest begin to rise. Be careful alone and have to leave the victim (e.g., not to overventilate by blowing too to call for help); in these cases, a side- long or too forcefully. Overventilation lying recovery position will help to keep can cause gastric distention—air in the the airway open and clear. stomach—which results in vomiting. It can also increase the pressure in the chest, making CPR ineffective. To use a resuscitation mask to give ventilations: Position yourself at the victim’s head, either on the victim’s side or above the head. Position the mask over the victim’s mouth and nose, using both hands to hold the mask in place to create an airtight seal. If you are on the victim’s side, tilt the victim’s head back while lifting © 2011, 2016 The American National Red Cross. All rights reserved. the chin. If you are behind the victim’s head, tilt the head back and lift the jaw. For a victim with a suspected head, neck or spinal Figure 1-11 | Use a resuscitation mask when injury, use the jaw-thrust (without giving ventilations. head extension) maneuver. Blow into the one-way valve, ensuring that you can see the chest rise. Each ventilation should last about 1 second, with a brief pause between breaths to let the exhaled breath escape. 25 | Chapter 1: Th e Professional R escu er  CALL FIRST OR CARE FIRST? If you are alone when responding to someone who is ill, you must decide whether to Call First or Care First. If you are ALONE: Call First (call 9-1-1 or the Care First (provide 2 minutes designated emergency number of care, and then call 9-1-1 or before providing care) for: the designated emergency o Any adult or child about number) for: 12 years of age or older who o An unresponsive child (younger is unresponsive and not than about age 12) whom you suspected of drowning. did not see collapse. o A child or an infant whom you o Any victim suspected of witnessed suddenly collapse. drowning. o An unresponsive child or infant known to have heart problems. Call First situations are likely to be cardiac emergencies in which time is a critical factor. In Care First situations, the conditions often are related to breathing emergencies. © 2011, 2016 The American National Red Cross. All rights reserved. Chapter 1: Th e Professional R escu er | 26  WHEN IS A CHILD A CHILD? In most instances, determining whether younger than 1 year of age. However, to treat a child as a child or as an adult for the purposes of this course, a child has been based on age. Typically, an is defined as the age of 1 to the onset adult is defined as someone about of puberty, as evidenced by breast the age of 12 (adolescent) or older; development in girls and underarm someone between the ages of 1 and hair development in boys. An infant is 12 has been considered to be a child considered under the age of 1 year. for CPR care; and an infant is someone © 2011, 2016 The American National Red Cross. All rights reserved. Provide Care According to the Conditions Found Provide care according to the conditions found during the primary assessment. Always treat life-threatening situations first. Other responders should assist by retrieving equipment and summoning EMS personnel, or in the actual delivery of care, such as giving two-rescuer CPR and using an AED. Care should be continued until EMS personnel take over, if needed. 27 | Chapter 1: Th e Professional R escu er  1-8 WRAP-UP As a professional rescuer, you are an important link in the EMS system and have a duty to act and to meet professional standards. One of these standards is taking appropriate precautions to protect yourself and others against the transmission of infectious diseases. You also should be familiar with and always follow the general procedures for responding to injury or sudden illness. These procedures include sizing up the scene, performing an initial assessment and summoning EMS personnel by calling 9-1-1 or the designated emergency number after caring for any life-threatening injuries. BENCHMARKS FOR PROFESSIONAL RESCUERS Professional Rescuers should: Be familiar with and have the ability to operate facility-specific rescue equipment including resuscitation masks and bag-valve- mask (BVM) resuscitators. Expect to be equipped with and ready to use: o Personal protective equipment. o Resuscitation equipment, including resuscitation masks, BVMs and oxygen equipment. Obtain consent, identifying themselves as trained responders. © 2011, 2016 The American National Red Cross. All rights reserved. Conduct a primary assessment for timely determination of a victim’s level of consciousness, breathing and pulse. Chapter 1: Th e Professional R escu er | 28  R E MOVI NG DISPOSAB LE G LOVES Removing Disposable Gloves Note: To remove gloves without spreading germs, never touch your bare skin with the outside of either glove. Pinch the glove. 1 Pinch the palm side of one glove on the outside near your wrist. Pull the glove toward your fingertips, turning it inside out as you pull it off your hand. Slip two fingers under the glove. 2 Hold the removed glove in the palm of your gloved hand. Carefully slip two fingers under the glove at the wrist of the remaining gloved hand. Pull the glove off. 3 Pull the glove toward your fingertips, turning it inside out as you pull it off your hand. The other glove is now contained inside the first glove. Dispose of gloves and wash © 2011, 2016 The American National Red Cross. All rights reserved. 4 hands. Dispose of gloves and any other PPE in a proper biohazard container. Wash your hands thoroughly with soap and running water, if available. Otherwise, rub hands thoroughly with an alcohol-based sanitizer if hands are not visibly soiled. 29 |