Emergency Medical Assistance AFD Fire Specialist Garee.pdf

11/20/2023 Emergency Medical Assistance FIRST RESPONDER CPR/AED AND FIRST AID Lesson Goals Lesson Goal 1.0 – Discuss the legal aspects of providing emergency medical treatment. Lesson Goal 2.0 - Identify the essential principles of trauma patient assessment. Lesson Goal 3.0 - Demonstrate emergency a...

11/20/2023 Emergency Medical Assistance FIRST RESPONDER CPR/AED AND FIRST AID Lesson Goals Lesson Goal 1.0 – Discuss the legal aspects of providing emergency medical treatment. Lesson Goal 2.0 - Identify the essential principles of trauma patient assessment. Lesson Goal 3.0 - Demonstrate emergency aid procedures for effective bleeding control. Lesson Goal 4.0 - Demonstrate emergency aid procedures for burns. Lesson Goal 5.0 - Demonstrate the emergency aid procedures for treatment of shock. Lesson Goal 6.0 - Demonstrate the emergency aid procedures for broken bones and severe sprains. 1 11/20/2023 Lesson Goals Lesson Goal 7.0 - Demonstrate the emergency aid procedures for Choking and Rescue breathing emergencies. Lesson Goal 8.0 - Complete course in CPR Lesson Goal 9.0 - Demonstrate the emergency aid procedures for victims of diabetic emergencies, strokes, and seizures Lesson Goal 10.0 - Explain emergency aid procedures for childbirth. Lesson Goals Lesson Goal 11.0 - Identify universal precautions for preventing transmission of communicable diseases. Lesson Goal 12.0 - Demonstrate the emergency aid procedures for illness related to exposure to the elements. Lesson Goal 13.0 - Demonstrate the emergency aid procedures for overdoses Lesson Goal 14.0 - Identify factors associated with treatment of different cultures in emergency medical assistance. 2 11/20/2023 Lesson Goal 1.0 Legal Aspects of Providing Emergency Medical Treatment CPRC Sec. 74.151. LIABILITY FOR EMERGENCY CARE. (a) A person who in good faith administers emergency care is not liable in civil damages for an act performed during the emergency unless the act is willfully or wantonly negligent, including a person who: (1) administers emergency care using an automated external defibrillator; or (2) administers emergency care as a volunteer who is a first responder as the term is defined under Section 421.095, Government Code. PC Sec. 9.34. PROTECTION OF LIFE OR HEALTH. (a)A person is justified in using force, but not deadly force, against another when and to the degree he reasonably believes the force is immediately necessary to prevent the other from committing suicide or inflicting serious bodily injury to himself. (b) A person is justified in using both force and deadly force against another when and to the degree he reasonably believes the force or deadly force is immediately necessary to preserve the other's life in an emergency. Legal Aspects of Providing Emergency Medical Treatment Sec. 550.023. DUTY TO GIVE INFORMATION AND RENDER AID. The operator of a vehicle involved in an accident resulting in the injury or death of a person or damage to a vehicle that is driven or attended by a person shall: (3) provide any person injured in the accident reasonable assistance, including transporting or making arrangements for transporting the person to a physician or hospital for medical treatment if it is apparent that treatment is necessary, or if the injured person requests the transportation. 3 11/20/2023 Lesson Goal 2.0 Essential Principles of Trauma Patient assessment Assessment principles Make sure location is safe for you and patient Highways Criminal activity Environmental hazards Situational hazards SITUATIONAL AWARNESS Assessment principles ▪ Responsiveness (AVPU) ▪ ALERT – Awake, Aware, Oriented ▪ VERBAL – Appears unresponsive but will respond to verbal prompts ▪ PAIN – Tapping, Pinching, Sternum Rub ▪ UNRESPONSIVE – No response can be observed ▪ Conduct primary trauma survey (B.A.T.H) ▪ ▪ ▪ ▪ Bleeding Airway (Open or Obstructed) Tension Pneumothorax Hypothermia 4 11/20/2023 Patient Assessment Ctd… Additional Considerations - After Trauma Assessment ▪ Shock ▪ C-Spine ▪ Vital Signs: ▪ ▪ ▪ ▪ Skin Color Temperature Pulse Rate Respiratory Rate ▪ Head to Toe (as applicable) ▪ Multiple Casualties Lesson Goal 3.0 Bleeding Control Controlling bleeding: Apply direct pressure PPE Compressible areas Arms Legs Neck Groin, buttocks Armpit, shooters pocket Non compressible Head Chest Abdomen Dressings and Bandages and Pressure bandage 5 11/20/2023 Bleeding Control Tourniquet application Preferred for temporary control of life-threatening extremity hemorrhage Can be applied in seconds, allowing rescuers to move on to other injured personnel Can be left in place for an extended period of time with little or no damage Can be applied with one hand Bleeding Control Remove solid objects Pens, knives, etc… “Go High or Die” Crotch / Armpit Over clothing 6 11/20/2023 Bleeding Control Wound packing Wound packing is more time intensive and requires two hands When to use Extremity injuries NOT responsive to use of TQ Junctional injuries where TQ cannot be applied Do NOT pack head, chest or abdominal wounds Open clothing around wound Remove excess pooled blood from the wound Locate source of most active bleeding Hemostatic Dressing: Treated with Clot-formation substance. Lesson Goal 4.0 Burns Treating thermal burns: STOP, COOL, COVER ▪ Make sure location is safe for you and victim ▪ Remove source causing burns ▪ Remove constricting clothing and jewelry as necessary ▪ Cover burn with sterile dressing ▪ Help the victim to prevent heat loss 7 11/20/2023 Burns Other burns: Chemical: Dry versus Liquid Electrical: Scene Evaluation Entry/Exit wounds Lesson Goal 5.0 - Shock What is Shock? A Perfusion Problem! Shock is a critical condition brought on by the sudden drop in blood flow through the body. Shock may result from trauma, heatstroke, blood loss, an allergic reaction, severe infection, poisoning, severe burns or other causes. When a person is in shock, his or her organs aren't getting enough blood or oxygen. (Excerpt from Mayoclinic.org. Emphasis added) Signs and Symptoms: Cool, clammy skin Pale or ashen skin Bluish tinge to lips or fingernails (or gray in the case of dark complexions) Rapid pulse Rapid breathing Nausea or vomiting Enlarged pupils Weakness or fatigue Dizziness or fainting Changes in mental status or behavior, such as anxiousness or agitation 8 11/20/2023 Shock Treating shock ▪ ABCs ▪ Place victim in recovery position (if unconscious) ▪ Cover the victim to prevent heat loss ▪ Do not give food or drink Recovery Position ▪ ▪ ▪ ▪ ▪ ▪ Protect the airway Does not require maintenance Stable position Identifies victim has already been assessed Allows fluids to drain May identify injuries on back 9 11/20/2023 Lesson Goal 6.0 –Broken Bones and Sprains Treating broken bones and severe sprains: Make sure location is safe for you and patient Victim Assessment Immobilize affected arm or leg (basic splinting/sling)Re-assess after immobilization for circulation in affected arm or leg Broken Bones and Sprains 10 11/20/2023 Lesson Goal 7.0 – Choking and Rescue Breathing (Review) Choking: (technique below is for responsive child or adult) ▪ ABDOMINAL THRUSTS ▪ Place thumb side of fist against middle of abdomen, just above naval ▪ Grasp fist with other hand ▪ Give quick, upward thrusts ▪ Responsive infant: ▪ Place baby face down on your forearm while supporting baby’s head ▪ Deliver five palm/heel strikes to the upper back (between shoulder blades) ▪ Firm but not overenthusiastic!!! ▪ Rotate the baby on her back on your forearm while supporting baby’s head ▪ Place two fingers below an imaginary line connect baby’s nipples ▪ Give five chest thrust to the infant (Same as CPR compressions) ▪ Repeat process until infant expels the object or goes unresponsive Choking and Rescue Breathing Choking: Unresponsive Child or adult ▪ Go to steps of CPR ▪ Give chest compressions ▪ Give ventilations (as equipment allows) ▪ Visually look into mouth to see if obstruction is there ▪ Do not do blind finger sweep ▪ Continue CPR until patient becomes responsive or help arrives. Infant: ▪ Go to steps of CPR ▪ Give chest compressions using two fingers ▪ Give ventilation ▪ Visually look into mouth to see if obstruction is there ▪ Do not do a blind finger sweep 11 11/20/2023 Choking and Rescue Breathing Per AHA Guidelines Rescue breathing: ▪ ▪ ▪ ▪ Tilt head back and lift chin Pinch nose shut Give two slow breaths, checking to see if chest gently rises. Continue rescue breathing as long as a pulse is present even if the victim is not breathing Lesson Goal 8.0 – Cardio Pulmonary Resusciation (CPR) AMERICAN HEART ASSOCIATION INSTRUCTOR LED PROGRAM ADULT/ INFANT CPR WITH AED 12 11/20/2023 Lesson Goal 9.0 – Diabetic Emergencies, Strokes, and Seizures ▪ DIABETIC EMERGENCIES ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ Signs and Symptoms: General feeling if illness Dizzy or Shaky Headache Cool/Clammy skin Pale appearance ALOC (Agitated Aggressive, Combative,) Sweet smell to breath/perspiration (Ketoacidosis….as differentiated from ETOH) Diabetic Emergencies Diabetic: ▪ Conscious patient ▪ Administer sugar, glucose, juice etc…(any form the subject can tolerate). ▪ Often the person can have an ALOC/ appear ETOH ▪ Can be combative (common call for assistance by EMS) ▪ Police may be called to assist in restraint…..gently ▪ Unconscious patient ▪ Avoid giving food or liquids ▪ Place victim in recovery position 13 11/20/2023 Strokes/TIA STROKES ▪ Signs and Symptoms ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ Slurred Speech, difficulty or inability to speak Difficulty understand /communicating Drooling or difficulty swallowing Facial Droop Vision deterioration (one or both eyes) Weakness, paralysis of limbs, side of body Sudden Severe Headache Dizziness, Loss of Balance ALOC Strokes/TIA Stroke (also TIA): ▪ Maintain an open airway ▪ Head, neck, and shoulders slightly elevated. Turn head slightly to side for drainage (Recovery Position if possible) ▪ Do not administer anything by mouth (NPO) ▪ Monitor patient for possible shock, respiratory or cardiac arrest 14 11/20/2023 Seizures Seizures ▪ Signs and Symptoms: ▪ Convulsions (uncontrolled body movements) ▪ May also exhibit “absence seizure” characterized by lapse of consciousness, becoming very quiet, or blank stare. ▪ Aura ▪ Oftentimes will know the seizure is coming on and may tell someone prior to onset. Common Causes ▪ Epilepsy, Sudden Trauma (Head strike), Fever/Illness (Febrile Seizures in infants), Overdose Seizures Seizures: ▪ Place subject on floor or ground ▪ Position head for drainage in case of vomiting. (Recovery Position) ▪ Loosen restrictive clothing ▪ Do not try to hold subject during convulsions. ▪ DO NOT PUT ANYTHING IN SUBJECT’S MOUTH ▪ Protect the subject from injury (falling objects or falls. ▪ After convulsions have passed, keep patient at rest. ▪ They may be disoriented for a few minutes Lasting longer then 5 minutes = Grand Mal Seizure Can become multiple seizures in quick succession 15 11/20/2023 Lesson Goal 10.0 – Emergency Aid for Childbirth Emergency aid procedures for childbirth: ▪ First responder’s job is to assist the mother in the delivery of her baby Emergency Aid for Childbirth Normal Stages of Childbirth: Stage 1 Contractions mild and irregular (more then 2 minutes apart) Can last for hours or days Stage 2 Contractions stronger, more regular, and closer together Cramping “water breaks” Stage 3 Baby begins to crown Birth imminent Stage 4 Afterbirth of placenta 16 11/20/2023 Emergency Aid for Childbirth Signs of Imminent Childbirth Time between (2-5 minutes apart) Crowning Mother feels urge to push/ bear down/ BM Emergency Childbirth Assistance Support the baby's head (do not pull on the baby) Assist in birth of the upper shoulder Support the body and feet Clear the airway If baby is not breathing, encourage to breathe (Stimulation). CPR may be necessary Emergency Aid for Childbirth What to do… ▪ Clear EMS ▪ Don PPE (If time….sometimes there isn’t) ▪ Apply GENTLE pressure on baby’s head ▪ Prevent explosive delivery ▪ Firmly but gently grip the newborn as it delivers ▪ Newborns are initially VERY slippery ▪ Ensure airway (of baby) is clear. ▪ Place baby on Mother’s chest and keep both mother and baby warm. Baby should stay at the same level as mom until after the cord is cut. ▪ If Placenta Delivers, try to keep the material safe/contained for transport 17 11/20/2023 Emergency Aid for Childbirth What NOT to do… ▪ Tell the mother to stop or “Hold it” or otherwise try to delay deliver (exceptions apply) ▪ Pull the baby’s head or parts ▪ Insert fingers or other objects into the vagina* ▪ Let the woman use the restroom (toilet births have happened) Emergency Aid for Childbirth Complications ▪ ▪ ▪ ▪ ▪ Breach Birth Placenta Previa Limb Presentation Prolapsed Cord Blue baby/ Infant not breathing (Stimulation/CPR) Circumstances my require having the mother stop the birth and wait for advanced medical assistance (If possible) 18 11/20/2023 Lesson Goal 11.0 – Transmission Prevention of Communicable Disease. Types of communicable diseases generally encountered by first responders: ▪ Hepatitis B Virus (HBV) ▪ AIDS/HIV ▪ Viral diseases (Yep….Covid too) ▪ Other communicable diseases and infections ▪ Scabies, Lice, Tuberculosis, etc… Transmission Prevention of Communicable Disease. Universal precautions: ▪ Avoidance ▪ Gloves ▪ Masks ▪ Goggles ▪ Washing after exposure ▪ Changing clothing after exposure ▪ Testing after exposure (APD Policy 957.3) ▪ Treat all persons as if infected 19 11/20/2023 Lesson Goal 12.0 – Environmental Exposure Aid Heat-related illness: ▪ Get victim out of the heat and into cooler environment ▪ Loosen tight clothing ▪ Cool the victim with cool fluids, wet cloths to the skin ▪ If the victim is conscious, give them water to drink in small amounts at a time Environmental Exposure Aid Cold related illness: ▪ Move victim to a warm place ▪ Remove wet clothing and dry victim ▪ Warm victim slowly ▪ Unconscious victims ▪ If no pulse begin CPR ▪ Not dead unless “warm and dead” 20 11/20/2023 Lesson Goal 13.0 – Overdose Emergencies SCENE SAFETY IS PRIORTY ONE!!!! ▪ Hazardous substances present ▪ Scene may have been sanitized Conscious patient ▪ Obtain information regarding the medication(s) of drug(s) patient overdosed on ▪ Monitor for change in level of consciousness (LOC) Unconscious patient ▪ Place patient on floor or ground ▪ Place victim in recovery position Overdose Emergencies APD General Orders 415: Utilization of Narcan 21 11/20/2023 Overdose Emergencies Common Opioids ▪ hydrocodone (Vicodin®) ▪ oxycodone (OxyContin®, Percocet®) ▪ oxymorphone (Opana®) ▪ morphine (Kadian®, Avinza®) ▪ hydromorphone (Dilaudid) ▪ codeine ▪ fentanyl and Carfentanil (These are the bad ones) ▪ Heroin / Opium ▪ Tramadol (often from veteranary clinics) ▪ Demerol Overdose Emergencies Effects and emergency considerations ▪ Respiratory depression (Primary Emergency Concern) ▪ Consider nasal Narcan administration if patient is unconscious and you have known or suspected opioid overdose 22 11/20/2023 Lesson Goal 14.0 – Cultural Consideration in Emergency Medical Treatment. Discussion: ▪ Be aware of possible religious, lifestyle, or ethnic beliefs affecting medical care. ▪ Be sensitive to people’s differences – You must provide equity in treatment. ▪ However, you have a job to do….. ▪ When survival overshadows modesty. 23