First Aid Chapter 2 PDF

Unit 1: Prepare to Respond to a 2 Medical Emergency Lesson 1: Introduction to First Aid Lesson Goal At the end of this lesson, you will be able to describe your responsibilities within the Emergency Medical Services (EMS) system and be able to provide emergency first aid according to the Criminal Justice Standards and Training Commission (CJSTC) standards. As the first officer to respond to the scene of an emergency, you can make a difference in a life-threatening situation. By applying your knowledge, skills, and abilities, you can stabilize patients and keep things from getting worse until EMS arrives. Emergency Medical Services The EMS system is a network of trained professionals linked to provide advanced, out-of-hospital care for victims of sudden traumatic injury or illness. The roles and responsibilities of criminal justice officers differ from those of other professional out-of- hospital caregivers. At the scene of an emergency, the criminal justice officer ensures the safety of every- one, alerts the EMS system, and is usually the first person to provide basic first aid to patients. Advanced, specialized training prepares paramedics, emergency medical technicians (EMTs), and other responders to provide more comprehensive care than criminal justice officers can provide. The EMS system has teams of highly skilled people trained to respond to emergencies daily. ; HL211.1. Describe the duties of the criminal justice first-aid provider within the Emergency Medical Services (EMS) system Criminal Justice First-Aid Provider Responsibilities When you first arrive on the scene, your initial duty is to determine if the scene is safe for you and other responders to enter. Always maintain awareness of your surroundings. After ensuring scene safety, your next concern as a criminal justice first-aid provider is the patient. Your first-aid duties may include: Wearing personal protective equipment (PPE) to help prevent infection Gaining access to a patient (in some emergencies, you may need to move one patient to reach a more critically injured patient) Assessing a patient for life-threatening injuries Alerting EMS providers and relaying all relevant medical information Chapter 2 First Aid for Criminal Justice Officers / 37 Providing a patient with basic medical care based on needs you identified during your assessment Remaining with a patient until EMS providers relieve you and transport the patient to an ad- vanced medical facility Stay calm. Some emergencies are life-threatening or involve emotionally charged situations with patients, family members, and bystanders. Let everyone know more help is on the way. Maintaining your composure can help you to assess the scene, set priorities, and establish that you are in control of the scene. Commu- nicate clearly with the patient and responding EMS personnel so that there are no misunderstandings. Try to work efficiently, but avoid working so quickly that you make mistakes or have misunderstandings with others. As a criminal justice officer that provides basic first aid, you play a vital role in delivering emergency first aid to patients who experience sudden illness or injury. What makes your role so vital is that you are respon- sible for the patient in the first few minutes after the event. The EMS system depends on your actions dur- ing those minutes. What you do sets the foundation for the remainder of the rescue. Correcting a breathing problem or stopping bleeding can save a life. In this role, you also help other patients who are not in critical condition by preventing more injuries, performing proper assessments, gathering medical histories, and preparing for EMS personnel to arrive. ; HL211.2. Describe the officer’s responsibilities for providing emergency first aid according to the Criminal Justice Standards and Training Commission (CJSTC) standards 38 / Florida Basic Recruit Training Program (HL): Volume 2 Unit 1: Prepare to Respond to a 2 Medical Emergency Lesson 2: Legal and Ethical Issues Lesson Goal At the end of this lesson, you will be able to describe the legal guidelines associated with your responsibilities as a criminal justice first-aid provider to include your duty to act and the role of consent. Legal and Ethical Responsibilities Legal and ethical considerations significantly affect your roles and responsibilities as a criminal justice of- ficer, for example, asking for and receiving a patient’s consent, or documenting a patient’s refusal of treat- ment. The public expects—and the law requires—you to be competent with behavior that is always above reproach. Placing the public’s well-being first during an emergency will help you reduce your likelihood of acting unethically. ; HL212.1. Describe the legal and ethical responsibilities for a criminal justice first-aid provider Duty to Act According to Black’s Law Dictionary, a duty to act is “a duty to take some action to prevent harm to an- other, and for the failure of which one may be liable, depending on the relationship of the parties and the circumstances.” Duty to act refers to your contractual or legal obligation to provide care. If you are a correctional officer or a correctional probation officer, you have an obligation to provide care to a patient who needs and con- sents to care only when you are on duty. If you are a law enforcement officer, you have a duty to act 24/7 within your jurisdictional boundaries. You also have the duty to render first aid following a use of force incident when you know, or it is evident, that the person detained or in custody sustained injuries or requires medical attention. Provide first aid or seek additional medical assistance when it is reasonable, based on the totality of the circumstances, and without jeopardizing your health or safety. Keep in mind that your responsibility for a suspect’s welfare and security does not end once they are restrained. Do not ignore their need for first aid while maintaining security and control of the suspect before EMS arrives. Once a higher level of care arrives, such as a para- medic or EMT, assist as needed while maintaining security and control of the suspect. Breach of duty occurs when you either fail to act or act inappropriately. ; HL212.2. Describe how the duty to act applies to the criminal justice first-aid provider Chapter 2 First Aid for Criminal Justice Officers / 39 Standard of Care Black’s Law Dictionary defines the standard or scope of care as “the degree of care that a reasonable person should exercise.” Under the law of negligence, it is “the conduct demanded of a person in a given situation. Typically, this involves a person giving attention to possible dangers, mistakes, and pitfalls, and ways of minimizing those risks.” Standard of care is the care that you are expected to provide to the same patient under the same condi- tions as would any criminal justice first aid-provider who received the same level of training. For example, providing CPR is within your scope of care as a criminal justice officer but performing open-heart surgery is not. ; HL212.3. Describe how the standard of care applies to the criminal justice first-aid provider Good Samaritan Act The Good Samaritan Act protects a first-aid provider from liability for emergency care or treatment per- formed in good faith or emergency care or treatment that would be expected of another first-aid provider with equal training. The Good Samaritan Act does not stop someone from filing a lawsuit; however, it does provide a defense if you performed according to the standard of care for a first-aid provider. Always pro- vide care to the best of your ability. Do not go beyond the scope of and level of your training and maintain the patient’s best interest. The Good Samaritan Act may provide protection for law enforcement officers when they are acting outside their jurisdictions and it may also protect correctional officers and correctional probation officers when they are providing care during off-duty hours. ; HL212.4. Describe how the Good Samaritan Act affects the criminal justice first-aid provider Abandonment Abandonment is giving up a right or interest with the intention of never again claiming it. You abandon the patient when you stop providing care without ensuring that the patient continues or begins to receive the same or better care. Continue providing emergency first aid until another medical professional with the same or higher-level training replaces you, or you are unable to continue. ; HL212.5. Describe the implications of abandonment for the criminal justice first-aid provider Negligence Negligence is defined in Black’s Law Dictionary as “the failure to exercise the standard of care that a rea- sonably prudent person would have exercised in a similar situation; any conduct that falls below the legal standard established to protect others against unreasonable risk of harm, except for conduct that is inten- tionally, wantonly, or willfully disregardful of other’s rights.” 40 / Florida Basic Recruit Training Program (HL): Volume 2 Negligence occurs if all these conditions are present: duty to act—you had a legal duty to the patient (you were supposed to administer care to the patient) breach of standard of care—you had a legal duty to act or you failed to act in a certain way (you failed to act in a manner that a reasonable person with the same level of training would act) causation—your action or inaction directly resulted in the patient’s injury (makes the distinction that a person’s negligent behavior actually caused the injury) damages—the patient was harmed as a result of your actions and the court is able to compensate the patient (usually monetarily) for their injuries ; HL212.6. Describe the implications of negligence for the criminal justice first-aid provider Consent Before you begin to provide first aid, gain the patient’s consent or permission. Fully explain the care you plan to provide and its possible related risks. Expressed consent is permission given for an action that is clearly and unmistakably stated or written by the patient or legal guardian. Expressed consent is positive confirmation, and can be supported by verbal communication such as, “yes, I consent” or a physical gesture such as a nod in agreement to medical care. Implied consent is the assumption that a person has given permission for an action because of their actions, rather than explicitly expressed. An example is when a patient rolls up their sleeve for a blood sample or extends their arm for a blood pressure reading. You make assumptions under implied consent. An example would be a situation where an unre- sponsive patient is at risk of death, disability, or deterioration of their condition and you would assume they would agree to life-saving care if able to consent. Implied consent may also apply to conscious patients who do not stop you from providing treatment. Informed consent is a person’s agreement to allow something to happen, made with full knowl- edge of the facts, benefits, risks, and alternatives. The information given to the patient must be fully understood by the patient or their legal guardian. A patient chooses a treatment or a pro- cedure after a physician or other health-care provider discloses the information regarding the risks involved. Informed consent involves additional information exchange between the medical provider and the patient than expressed consent does. To refuse medical care, a patient must be competent. A competent adult is one who can make an informed decision about medical care. The patient must understand your question and the implications of decisions made about medical care. Consider an adult incompetent if they are under the influence of alcohol or drugs with an altered mental status and impaired judgement, have serious illness, have an injury that affects judgment, are mentally ill, or have a developmental disability. If you do not obtain consent, this can result in a criminal charge of battery. Battery is unlawful touch or strike without the person’s consent. Chapter 2 First Aid for Criminal Justice Officers / 41 Competent adults have the right to refuse treatment verbally or non-verbally by shaking their head in a negative manner. Competent adults also have the right to withdraw from treatment after it begins. This is true for patients who consent and then change their minds. It also applies to a patient who is unconscious when treatment begins, regains consciousness and mental competence, and asks you to stop. Make every effort to persuade the patient to consent to treatment. Obtaining consent can be a collaborative effort between officers and EMS to render emergency care for a patient who needs it. A person involved in a traumatic incident, such as an auto accident, may be emotionally, intellectually, or physically impaired. If the person continues to refuse treatment, keep them under observation until EMS arrives. If the patient loses consciousness and you believe a life-threatening situation exists, immediately begin first aid. ; HL212.7. Describe the role of consent when providing emergency first aid Consent and Minors In Florida, children younger than eighteen are minors. You must have a parent or legal guardian’s permis- sion before providing care. However, if the parent or legal guardian is not available in life-threatening emergencies or emergencies that could result in disability, provide emergency first aid based on the prin- ciple of implied consent. An emancipated minor is either financially independent, does not live with a parent or caregiver, is married, or is an active member of the military. You do not need a parent or legal guardian’s permission to treat an emancipated minor. The emancipated minor’s consent is enough. Competent adults have the right to refuse treatment for their children. For situations involving minors in life-threatening emergencies that need medical care and the parents will not consent, refer to your agen- cy’s policies and procedures for guidance. As this may be child abuse or neglect, notify the Department of Children and Families by calling the Florida abuse hotline, 1-800-962-2873. Do Not Resuscitate/Advance Directive A terminally ill patient may have a directive in place, written in advance, and signed by both the patient and a physician. Commonly known as a do-not-resuscitate order (DNR/DNRO) or an advance directive. The DNR/DNRO documents the terminally or chronically ill patient’s wish to refuse cardiopulmonary re- suscitation (CPR) if they stop breathing or if their heart stops beating. An advance directive documents the patient’s request to withhold specific medical care. Licensed medical professionals, EMTs, or paramedics, can be legally bound to honor a DNR/DNRO or advance directive; this however, does not apply to criminal justice officers. As a criminal justice first-aid provider, you have a duty to act, regardless of a DNR/DNRO. You cannot withhold CPR or first aid. Make sure to further consult your agency’s policies on DNR/DNROs. ; HL212.8. Describe the role of a Do Not Resuscitate Order (DNR/DNRO) for a criminal justice first- aid provider Medical Alert You may have a patient who wears an identification bracelet or necklace, carries a card in their wallet, or has a medical alert tattoo that alerts you to a specific medical condition, such as an allergy, epilepsy, or diabetes. On the jewelry or card, you may find a telephone number to call for detailed information about 42 / Florida Basic Recruit Training Program (HL): Volume 2 the patient. This bracelet, necklace, or card is known as a medical alert. If the patient can gain access to their phone, ask them for the name of their ICE (In Case of Emergency) contact person who may be able to provide medical alert information. Be aware that the medical emergency you are responding to and what the patient is experiencing may not always be related to the medical condition on the medical alert. For example, if the patient’s medical alert indicates that they are diabetic and the patient is experiencing seizure-like symptoms, do not assume that the patient is experiencing a seizure related to diabetes. They could be experiencing a stroke, or could have head trauma resulting in seizure. ; HL212.9. Describe the role of medical alerts or notifications for a criminal justice first-aid provider HIPAA A patient’s privacy, medical history, condition, and health-care treatment is, by law, confidential informa- tion. The patient or a legal guardian must sign a written release before the release of any medical informa- tion, except when relaying information to EMS. The Health Insurance Portability and Accountability Act (HIPAA) protects the rights of patients and the release of patient information. Do not release patient health information without a patient signature un- less another health-care provider needs patient information to continue medical care or you receive a request to provide patient information as part of a criminal investigation, such as child abuse, elder abuse, or spouse abuse. If you make the report in good faith, related laws often grant immunity from liability for libel, slander, or defamation of character. A legal subpoena may require you to provide patient information in court. Be careful when discussing a case with anyone to avoid unintentionally providing protected health informa- tion about the patient. ; HL212.10. Describe the legal and ethical considerations of HIPAA for the criminal justice first-aid provider Scene Evidence You may respond to a call that could be both a crime scene and a medical emergency. Examples may include any scene involving suicide, homicide, suspected drug overdose, domestic dispute, abuse, hit-and- run, or robbery. Additionally, any scene involving battery, gunfire, or a weapon, can potentially be a crime scene and medical emergency. Remember that any item on the scene may be evidence. If you suspect sexual assault or battery, advise the person not to bathe or wash. Explain the importance of preserving evidence. Always show empathy to a victim, as they have just undergone a traumatic event. ; HL212.11. Recognize that every call for emergency medical care can be a crime scene Chapter 2 First Aid for Criminal Justice Officers / 43 Unit 1: Prepare to Respond to a 2 Medical Emergency Lesson 3: Patient Communication Lesson Goal At the end of this lesson, you will be able to communicate effectively with patients who have special considerations as you provide emergency first aid. When responding to a crisis or medical emergency, effective communication helps you get needed infor- mation and provides reassurance to patients, their families, and bystanders. By responding in a calm, car- ing, and polite way, you convey a sense of confidence and assurance to those around you. When interacting with an emotional patient, family member, or bystander, redirect the conversation to divert their attention. Recognize the person’s worries or focus their attention on the immediate situation or a meaningful task. At the same time, do not let yourself get distracted during these interactions and remember to stay focused on treating the patient. Patients With Special Considerations You may need to help or render first-aid care to patients who have functional needs or require special con- siderations. To provide effective emergency first aid to these patients, be aware of their functional needs and disabilities. Take appropriate steps to ensure that communication with patients with disabilities is as effective as communication with patients without disabilities. Patients Who Are Blind or Have Limited Vision When initially surveying the scene, be alert to signs indicating that the patient is blind or has limited vision. Clues include eyeglasses, a collapsible white cane with a red tip, or a guide dog. If you are unsure, ask the patient if they have limited vision. Although people learn to compensate for limited vision by using other senses, an accident or emergency can cause disorientation. Speak to the patient and provide information about the surroundings. Clearly describe what you will do before you provide care. A patient with a guide dog may be more concerned about the dog than their own situation. If possible, keep the patient and the dog together. Let the patient direct the dog or tell you how to manage the dog. Remember that most guide dogs are protective. Taking charge of or handling the guide dog without the patient’s direction can confuse the dog. Patients Who Are Deaf or Hard of Hearing At the scene of emergency, it may not always be obvious at first when a patient is deaf, hard of hearing, or suffering from temporary hearing loss. Sometimes the patient may indicate to you that they are deaf or specify that they have a hard time hearing. 44 / Florida Basic Recruit Training Program (HL): Volume 2 People who are deaf or hard of hearing use a variety of ways to communicate, and your method of com- munication may vary depending on the abilities and preferences of the person. In general, the patient has the right to choose their preferred method of communication. When providing care to patients who are deaf or hard of hearing, attempt to get the patient’s attention before communicating (e.g. a gentle tap on the shoulder or hand wave). Identify yourself and show your identification. Face the patient directly when you are communicating. Speak slowly and clearly if you are relying on speech. Make sure you are understood by the patient if you are using writing (sign language grammar may be different from written English). Continue to keep the patient informed using whatever method you can reasonably accommodate and that works best for the patient, whether that means relying on physical gestures, writing, speech, an inter- preter, or some combination. Let the patient know that help is on the way. Patients With Developmental Disabilities “Developmental disabilities” is a broad term used to describe a group of conditions that affect physical or mental functioning that arise early in life. There are many types of developmental disabilities, such as autism spectrum disorder and Down syndrome, and no one is exactly alike. Remember that you may easily confuse or cause fear in a patient with developmental disabilities. General recommendations for commu- nicating include talking to the patient in a normal tone of voice, talking to the them directly, using concrete and specific language, speaking in short sentences, and using simple words. Repeat or rephrase your state- ments until the patient understands. Patients With Dementia “Dementia” is “a general term for a decline in mental ability severe enough to interfere with daily life,” ac- cording to the Alzheimer’s Association. Dementia is not a specific illness; it refers to a wide range of symp- toms. During a crisis, patients with dementia might experience greater fear, confusion, or frustration than they would otherwise. As a result, they could have trouble following directions and staying focused. Always introduce yourself and assure the patient that you are going to help them. Speak clearly and slowly to help them understand you. When needed, repeat instructions or questions in the same order. Moving patients with dementia to a quieter area can also help them focus and reduce their stress. Patients Who Are Juveniles When communicating with younger patients, staying calm is important. Get down to their eye level. Move slowly. Include the children in your conversation and keep them informed about what you are doing. This can help ease their fears. Often maturity regresses during a crisis. Because you are an unfamiliar person, it may increase their anxiety and fear in an already frightening situation. Avoid removing a child from parents when you do not suspect abuse; separation anxiety can become a major concern. Involve parents or caregivers in the examination and treatment of their child. Patients With Medical Equipment Some patients might have chronic illnesses which require them to have complex medical devices such as pacemakers, insulin pumps, surgically inserted breathing tubes, ventilators, and catheters. Do not become Chapter 2 First Aid for Criminal Justice Officers / 45 distracted by a patient’s medical equipment. Respectfully ask the patient or caregiver how the special equipment works as you provide emergency first aid. Patients With Non-English Language Needs When providing first aid, you may encounter a patient who has non-English language needs and may need language assistance services to communicate across language barriers. Contact your public safety telecom- municator regarding access to an interpreter. If an interpreter is unavailable or not immediately available, use the same techniques used to communicate with patients who are hard of hearing. Do not ask children on the scene to interpret as they might be too upset at seeing a loved one in distress to be a reliable inter- preter. Non-verbal cues, such as hand gestures, may sometimes be the best way to communicate with the patient if no interpreter is available. ; HL213.1. Describe how to communicate with patients who have special considerations 46 / Florida Basic Recruit Training Program (HL): Volume 2 Unit 1: Prepare to Respond to a 2 Medical Emergency Lesson 4: Human Body Lesson Goal At the end of this lesson, you will be able to describe basic human anatomy with a focus on the re- spiratory and circulatory systems. Eleven systems interact and work together to make up the body. This lesson will focus on the systems and organs that are most relevant to providing life-saving first aid. By learning about the different systems inside the body, you can better determine the proper care for each individual patient and their specific symptoms. Respiratory System The respiratory system delivers oxygen to and removes carbon dioxide from the blood. The body can go with- out oxygen only for a few minutes. The nose, mouth, and throat make up the upper airway that brings oxygen to the lungs (lower airway). The passage that connects the upper airway with the lower airway includes the voice box (larynx) and the windpipe (trachea). At the upper end of this passageway is a small leaf-shaped flap (epiglottis) that keeps food and other foreign objects from entering the windpipe. A large muscle, the diaphragm, below the lungs at the bottom of the chest cavity, helps move air in and out of the lungs. ; HL214.1. Describe the function of the respiratory system and its main parts Figure 2-1: Respiratory system The respiratory systems of infants and children differ from an adult. Their tongues take up proportionally more space in their mouths. Their windpipes are narrower, softer, and more flexible. Very young infants breathe mostly through their noses and at a faster rate than adults. Circulatory System The circulatory system, or cardiovascular system, pumps blood throughout the body. It delivers oxygen and nutrients to and removes waste from the body’s tissues. Basic parts of the circulatory system are the heart, veins, capillaries, arteries, and blood. Positioned behind the breastbone (sternum), slightly to the left in the chest cavity, is the heart, a hollow, muscular organ about the size of your fist. The circulatory system is a closed system, and the blood is under constant pressure and circulation from the heart’s pump- ing action. Chapter 2 First Aid for Criminal Justice Officers / 47 Blood vessels are a system of tubes through which blood flows. Vessels called arteries carry blood away from the heart to the rest of the body. Vessels called veins carry blood back to the heart. Throughout the body, small vessels called capillaries connect arteries to veins. The following major arteries determine blood flow and are used to feel for a patient’s pulse: carotid: supplies blood to the head and neck, felt on either side of the neck brachial: supplies blood to the upper arm, felt on the inside of the upper arm femoral: supplies blood to the upper thigh and leg, felt in the groin area radial: supplies blood to the lower arm and hand, felt at the thumb side of the wrist ; HL214.2. Describe the function of the circulatory system and the four major arteries Figure 2-2: Taking a pulse Skeletal System The skeletal system is the supporting framework for the body, giving it shape and protecting vital organs. The main components of the skeletal system are: the skull, spinal column, shoulder girdle, rib cage, pelvis, lower extremities, and upper extremities. The skull—houses and protects the brain. It also gives shape and function to the face. The spinal column—protects the spinal cord and is the primary support for the entire body. It consists of separate bones called vertebrae that stack one on top of each other and are held together by muscles. The shoulder girdle—consists of the collarbone and shoulder blades. The rib cage—contains the sternum and ribs. It protects the heart, lungs, liver, and spleen. The pelvis—protects the reproductive organs and supports the organs in the lower abdominal cavity. 48 / Florida Basic Recruit Training Program (HL): Volume 2 The lower extremities—consist of the upper leg, lower leg, ankle, and foot. The upper extremities—consist of the upper arm, lower arm (forearm), wrist, hand, and finger bones that comprise the arm. ; HL214.3. Describe the function of the skeletal system and its main parts Muscular System The muscular system gives the body shape, protects internal organs, and allows for body movement. The body contains three types of muscles. Muscles used for deliberate acts, such as chewing, bending, lifting, and running, are voluntary muscles. These are muscles attached to the skeleton and under the control of the nervous system and brain. A person can contract and relax these muscles. Involuntary muscles, or smooth muscles, carry out many automatic body functions. They are in the walls of the tube-like organs, such as ducts, blood vessels, and the intestinal wall. A person does not consciously control these muscles. Involuntary muscles called cardiac muscles, found only in the heart, work constantly to expand and con- tract the heart. ; HL214.4. Describe the function of the muscular system and types of muscle Nervous System The nervous system controls voluntary and involuntary body activity. It also supports higher mental func- tions, such as thought and emotion. It lets a person be aware of and react to the environment and keeps the rest of the body’s systems working together. It has two main systems: The central nervous system—consists of the brain and the spinal cord. Its components are the body’s “mainframe computer” and processing center. This is where all communication and con- trol originate. The peripheral nervous system—includes nerves that connect to the spinal cord and branch out to every other part of the body. These nerves serve as a two-way communication system. Some carry information from the brain and spinal cord to the body. Others carry information from the body back to the brain. ; HL214.5. Describe the function of the nervous system and its two main parts Skin The skin is the largest organ of the body. It protects everything inside the body, provides a barrier against bacteria and other harmful substances and organisms, and regulates body temperature. Acting as a com- munication organ, the skin also receives and relays information about heat, cold, touch, pressure, and pain. It transmits this information to the brain and spinal cord through nerve endings. ; HL214.6. Describe the function of the skin Chapter 2 First Aid for Criminal Justice Officers / 49 Unit 1: Prepare to Respond to a 2 Medical Emergency Lesson 5: Infection Control Basics Lesson Goal At the end of this lesson, you will be able to describe the ways criminal justice officers may be exposed to pathogens while performing job-related duties and some practices for reducing and preventing risk of infection. Exposure to Pathogens While performing your first-aid duties, you may encounter injured people who are also sick with or are car- riers of an infectious disease. Some might display symptoms and others might be asymptomatic and show no symptoms. It is important to take steps to prevent infection, regardless of whether you suspect infec- tion or not. Since there is a higher chance of exposure to potentially infectious materials (such as blood) during first aid treatment, knowing how diseases are transmitted and how to minimize your exposure may help keep yourself and everyone safe while still allowing you to do your job with confidence. Some of your other job-related tasks may also expose you to substances or materials that contain pathogens—microorganisms, such as bacteria and viruses, that cause disease. These tasks could include property searches and confiscation, frisks and custodial searches, any response to resistance, crime scene investigation, or inmate transport. Exposure to pathogens can occur from person-to-person contact, indirectly through the air, or through direct contact with infectious materials that contain pathogens. Potentially infectious materials include things like bodily fluids, tissues, and organs. Bloodborne pathogens are microorganisms in human blood that can cause disease. You can be exposed to them through blood from an open wound while providing emergency first aid or from needlesticks and other sharps-related or sharp-device related injuries. Airborne pathogens are microorganisms discharged from an infected person by coughing, sneez- ing, laughing, or close contact. They remain suspended in the air on dust particles, and respira- tory and moisture droplets that you may breathe in. Bodily fluids are liquids within the human body, such as mucus, saliva, vomit, semen, vaginal secretions, and blood. Always regard bodily fluids that you encounter as potentially infectious or contaminated with pathogens. Staying aware of your community and knowing the ways infectious diseases can spread can help you pre- pare accordingly. ; HL215.1. Describe how exposure to pathogens occur when providing emergency first aid 50 / Florida Basic Recruit Training Program (HL): Volume 2 Universal Precautions, Body Substance Isolation (BSI), and Standard Precautions The Centers for Disease Control & Prevention (CDC) developed universal precautions as a set of procedures designed to prevent transmission of bloodborne pathogens to first-aid or health-care providers. Universal precautions instruct providers to assume that the blood and bodily fluids of all patients are potentially infectious. Body substance isolation (BSI) goes further than universal precautions, and is the practice of isolating your- self from all body substances (not just blood and bodily fluids) of patients undergoing medical treatment. It is critical in preventing disease transmission. BSI mainly relies on the use of personal protective equipment (PPE) and practicing personal behaviors that reduce risk. In more recent years, the CDC has recognized the need for new infection control measures to address the spread of airborne pathogens as well as bloodborne pathogens, as many highly infectious diseases can be transmitted through air or droplets and not just body substances. These new measures are referred to as standard precautions by the CDC. They include elements of universal precautions and BSI and are meant to apply to the care of all patients, regardless of suspected or known infection status. Like universal precautions and BSI, all bodily fluids (except sweat), bodily waste, and exposed wounds should be treated as potentially infectious under standard precautions. Standard precautions emphasize the practice of hand hygiene throughout patient care, not just if hands are visibly soiled or when removing gloves. The role of PPE, such as facial protection, gloves, and protective clothing, is also more important than ever in preventing transmission of airborne and bloodborne pathogens. With standard precautions, the focus is not only on protecting health-care providers from infection, but patients as well, by ensuring that health-care providers do not infect patients during treatment or through contaminated equipment. Refer to your agency policy and procedures regarding universal precautions, BSI, and standard precautions. ; HL215.2. Describe the importance of universal precautions, body substance isolation (BSI), and standard precautions when providing emergency first aid Practices to Reduce Risk Hand Hygiene Your hands can come into contact with potentially infectious materials or contaminated surfaces through- out the day. Practicing hand hygiene is one of the best ways to prevent infection and it works by helping to remove or inactivate pathogens and harmful substances that are on your hands. It includes handwashing or hand disinfection with an alcohol-based product. Routinely practice hand hygiene during your work shift and at the end of your shift and whenever you are treating a patient. When washing your hands with antimicrobial or plain soap and water, first wet them with water. Apply soap and rub your hands together vigorously for at least 20 seconds. Lather every part of your hand. Rinse your hands with water, and thoroughly dry them with a disposable towel. Use the towel to turn off the faucet. Chapter 2 First Aid for Criminal Justice Officers / 51 If your hands are not visibly soiled, and you do not have access to soap and water, use an alcohol-based hand rub or hand sanitizer with at least 60% alcohol to decontaminate them. Apply the hand sanitizer to one palm and rub your hands together until they are dry. If you have not had contact with blood or other body fluids, consider using sanitizing hand wipes as alternatives to washing with plain soap and water. ; HL215.3. Describe the importance of practicing hand hygiene to reduce the risk of infection when providing emergency first aid Use of Personal Protective Equipment Always use appropriate PPE in any emergency where you are providing first aid, as it is a barrier against infection. PPE includes eye protection, gloves, protective clothing (gown or coveralls, sleeves, shoe covers), masks or shields, and biohazard bags. Make sure to practice hand hygiene after removing PPE. ; HL215.4. Describe the importance of using personal protective equipment (PPE) when providing emergency first aid Gloves Gloves minimize skin contact with blood or other body fluids. Always use gloves if you expect to have physical contact with someone; if you have skin contact with people who are bleeding or have open sores, rashes, blisters, burns, or other broken skin conditions; and if you have open cuts, sores, burns, rashes, or other broken skin conditions on your hands. Standard precautions apply in any situation where you clean and decontaminate spilled blood or other bodily fluids, handle bodily fluids or blood-contaminated equipment (such as bloody handcuffs), or handle containers (such as red or yellow bags) labeled biohazardous or biomedical waste (note that anything that is placed into a red bag is not retrievable). How you remove disposable gloves is critical in maintaining BSI and standard precautions. See Figure 2-3 for instructions on using and removing disposable gloves. Follow hand hygiene procedures immediately after taking off gloves. ; HL215.5. Describe how to put on, properly remove, and discard disposable gloves 52 / Florida Basic Recruit Training Program (HL): Volume 2 Figure 2-3: Using and removing disposable gloves Chapter 2 First Aid for Criminal Justice Officers / 53 Facial Protection A filter mask, such as a surgical or respirator mask, can provide protection against airborne pathogens if worn over both your nose and mouth. Goggles or a face shield and a surgical mask can be used to protect eyes, nose, and mouth from splashes or exposure to body liquids. Maintain PPE Equipment and Supplies Take proper care of your equipment. As with any other tool you use on the job, be familiar with using and maintaining your medical and safety equipment. If you work with reusable items, clean, disinfect, or steril- ize them before the next use. During this process, be sure to wear protective gloves and eyewear, if appro- priate. Follow local protocol and department policy when maintaining supplies and equipment. ; HL215.6. Describe how to maintain equipment and supplies Disposal of Biohazardous Wastes To minimize the danger of bloodborne infections, properly handle and discard materials contaminated with blood or body fluids and other infectious materials. The procedures you use to handle biomedical or biohazardous wastes must comply with Federal Occupational Safety and Health Administration (OSHA) requirements for identifying and segregating blood or waste material saturated with body fluids. OSHA requires color-coded bags or containers for storing biomedical waste, such as red or yellow bags or con- tainers with the international biohazard symbol. Rigid plastic sharps containers secure used syringes and needles to prevent injuries. Follow local protocol or department policies for disposal of wastes classified as biomedical or biohazard. On the job practices can reduce your risk of occupational exposure to pathogens. If exposure occurs, report your exposure based on your agency policies and procedures. ; HL215.7. Describe the importance of proper handling of biomedical or biohazard materials to reduce the risk of infection when providing emergency first aid Bloodborne Diseases A disease that can be spread through contamination by blood and other bodily fluids is considered a blood- borne disease. Bloodborne pathogens that are of primary concern include hepatitis B virus, hepatitis C virus, and human immunodeficiency virus (HIV). Hepatitis B The hepatitis B virus causes hepatitis or inflammation of the liver. Outside occupational settings, sexual contact or sharing contaminated needles (through intravenous drug use) primarily transmits the hepatitis B virus. It can also remain infectious in dried bodily fluids for an undetermined time. A person can transmit the disease while asymptomatic or not experiencing obvious symptoms. 54 / Florida Basic Recruit Training Program (HL): Volume 2 Hepatitis C Hepatitis C is the most common chronic bloodborne infection in the United States. The hepatitis C virus causes hepatitis C. Direct contact with human blood primarily transmits hepatitis C. This occurs from shar- ing needles or drug paraphernalia, needle sticks, contaminated sharps, or from an infected person passing it to their child during pregnancy or childbirth. Sexual contact with an infected person can also (rarely) spread the virus. Signs and Symptoms of Hepatitis Signs and symptoms of hepatitis may include flu-like symptoms, fever, body aches, fatigue, loss of appetite, and weakness. Later stages of hepatitis include symptoms such as yellowing of the skin or eyes, dark urine, light colored stool, diarrhea, itchy skin, weight loss, severe liver damage, enlarged and tender abdomen, and even death. Not everyone infected necessarily experiences all these symptoms. ; HL215.8. Describe how to prevent transmission of hepatitis B and hepatitis C when providing emergency first aid Human Immunodeficiency Virus (HIV) A bloodborne virus that attacks and weakens the immune system is HIV, which can lead to acquired immu- nodeficiency syndrome (AIDS). Transmission occurs primarily through the following: during unprotected sexual intercourse with an HIV-positive person when sharing contaminated needles from an HIV-positive person to their child during pregnancy, birth, or breastfeeding direct contact with blood and certain body fluids, such as semen, vaginal or rectal fluids, or breast milk with a detectable viral load Someone who is HIV-positive may show no symptoms initially or have mild flu-like symptoms. The person may also live many years without obvious symptoms. Current HIV medicine may help certain people treat HIV and keep their viral load low so that it is undetectable, allowing them to stay healthy and reduce the risk of transmission. ; HL215.9. Describe how to prevent transmission of human immunodeficiency virus (HIV) when providing emergency first aid Airborne Diseases Any disease that spreads from person to person through the air is an airborne disease. An infected per- son who talks, sings, coughs, or sneezes into the air, particularly in a relatively confined space, can spread airborne pathogens. These pathogens can enter the body through the nose, throat, sinuses and lungs, affecting the respiratory system. Airborne diseases can require short or prolonged exposure for an infec- tion to occur. For those working in an enclosed correctional environment, a greater opportunity exists for exposure than for other criminal justice personnel. ; HL215.10. Describe ways a criminal justice officer can be exposed to airborne pathogens Chapter 2 First Aid for Criminal Justice Officers / 55 COVID-19 SARS-CoV-2 is the virus that causes COVID-19. The CDC recommends maintaining physical distance from an infected person, if possible, and practicing proper hand hygiene. Avoid touching your face (eyes, nose, and mouth) with unwashed hands. Follow your agency’s policies and procedures regarding exposure control and wearing face masks. If you have contact with someone confirmed or suspected to have COVID-19, fol- low the current CDC’s guidelines for EMS along with your agency’s policies and procedures. ; HL215.11. Describe ways to reduce the risk of COVID-19 transmission when providing emergency first aid Signs and Symptoms of COVID-19 COVID-19 affects different people in different ways. Infected people have a wide range of symptoms from mild symptoms to severe illness. If you are showing any of the following emergency warning signs—trouble breathing, persistent pain or pressure in the chest, confusion, inability to wake or stay awake, or pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone—seek emergency medical care. Tuberculosis Tuberculosis (TB) is an airborne disease that effects the respiratory system. Brief exposure to a TB source rarely results in infection. TB usually transmits through people who work or live together, sharing close, confined spaces over extended periods of time. Fresh-air and adequate ventilation can reduce the poten- tial for TB to spread. For example, when you transport people who might have TB infection or any other airborne disease, open your vehicle’s windows to allow for maximum ventilation. Signs and Symptoms of Tuberculosis A person with TB disease may have any, all, or none of the following symptoms: feelings of sickness or weakness, fever, weight loss, night sweats, chest pain, and coughing up blood. If you suspect you or some- one you know has signs and symptoms of TB disease, seeing a doctor immediately is important. Without treatment, a person can spread the infection and disease to others. Other Infectious Diseases MRSA Methicillin-Resistant Staphylococcus Aureus (MRSA) is a type of bacteria that is highly contagious and re- sistant to certain antibiotics. Staph infections, including MRSA, occur most frequently among people in hospitals, health-care facilities, and detention facilities. People are more likely to get an infection if they have contact with open wounds, wound drainage, or nasal secretions of a person infected with MRSA. Signs and symptoms of a skin infection can be a wound site that is red, swollen, or painful, or an area that is warm to the touch or is draining pus. The site may look like a spider bite, pimple, or boil, and the person may have a fever. 56 / Florida Basic Recruit Training Program (HL): Volume 2 Follow these precautions to avoid transmission of MRSA: Shower with soap and water as soon as possible after direct contact with an open sore and use a clean, dry towel. Do not share equipment, towels, soap, or any personal care items. Do not share drinking containers. Do not share ointments, creams, or eye drops. Keep your hands away from your nose, mouth, and eyes. Keep all skin wounds completely covered with a bandage. Wash towels, equipment, uniforms, and any other laundry in hot water and detergent daily. ; HL215.12. Describe how to prevent transmission of MRSA when providing emergency first aid Hepatitis A The hepatitis A virus causes hepatitis A. It is highly infectious, but is preventable with isolation precau- tions and appropriate PPE. While hepatitis B and hepatitis C are spread through contact with blood and bodily fluids, hepatitis A is primarily spread through person-to-person contact through fecal contamination and oral ingestion. Poor personal hygiene, poor sanitation, and intimate contact facilitate transmission. Common-source epidemics from contaminated food and water also occur. ; HL215.13. Describe how to prevent transmission of hepatitis A when providing emergency first aid Chapter 2 First Aid for Criminal Justice Officers / 57 2 Unit 2: Respond to a Medical Emergency Lesson 1: Scene Size-Up Lesson Goal At the end of this lesson, you will know the components of scene size-up, and how to communicate scene information with other responders. The scene size-up has four components: scene safety, mechanism of injury or nature of illness, the number of victims, and the need for more rescuers and special equipment. Scene Safety Scene size-up begins as soon as you receive notice from dispatch or you come upon it. Although it takes only moments to perform, scene size-up is crucial to all involved. Before you enter the scene, take an over- all view of what is happening. Always maintain situational awareness. Remember, if you get injured, you may not be able to help anyone else. If the scene is unsafe and you have no means to make it safe, do not enter. Pay attention to what you see, hear, smell, and feel. Quickly put all your observations together to help determine what you and others need to do to make the scene safe. Only after determining the scene is safe to enter can you help patients. Possible dangers vary greatly, depending on the scene type. Officers respond to a variety of incidents, including natural disasters, domestic violence calls, nuisance animal calls, and active threat/shooter inci- dents. Keep in mind that although some scenes may be similar, none is the same. Each presents its own dangers and will require a different level of awareness. There may be times when a patient can render their own first aid based on your verbal direction from outside the scene. This lesson provides information on general approaches for scene safety assessment. You will learn more about providing care while under a direct threat in a separate lesson. ; HL221.1. Describe how to determine if the scene is safe to enter before providing emergency first aid Mechanism of Injury or Nature of Illness While assessing scene safety, try to determine the mechanism of injury to the patient or the nature of the illness. Simply put, try to determine what happened. What is the patient’s chief complaint? Understanding what happened helps you judge the extent of injury or illness. Are you dealing with a trauma patient or a medical patient? A trauma patient is an injured person while a medical patient is a person who is ill. Knowing the patient type that you have helps you determine the type of first aid or equipment needed. A patient who belongs to both categories requires treatment for each; for 58 / Florida Basic Recruit Training Program (HL): Volume 2 example, a patient that suffered a heart attack or lost consciousness due to low blood sugar that lead to a vehicle crash would need treatment for the trauma injury as well as medical illness. ; HL221.2. Describe how to recognize the difference between a trauma patient and a medical patient before providing emergency first aid Number and Location of Patients The next size-up component is determining the number of patients. If there is more than one, find out how many and where they are. In certain situations, such as rollover car crashes, patients ejected from a vehicle may be difficult to find. You may need to question other patients, witnesses, or bystanders. When there are multiple patients, you will need to prioritize care and triage patients depending on several factors. You will learn more about how to triage in the lesson on mass casualty incidents and triage. ; HL221.3. Describe how to identify all the victims on the scene Need for More Responders or Special Equipment Assess the need for and relay a request for more resources based on your local protocol and department policy. In a clear and concise manner, verbally transmit all information gathered during your size-up so that the communications center or responding units are aware of the circumstances. Relay your information about overall scene safety, type and extent of injuries, number of patients, and the need for special units to assist. The quicker you relay information; the faster additional resources can respond. Relaying scene size-up information accurately and quickly better prepares responding units for what they might encounter when they arrive on scene. ; HL221.4. Describe how to determine the need for more or specialized help when providing emergency first aid Chapter 2 First Aid for Criminal Justice Officers / 59 2 Unit 2: Respond to a Medical Emergency Lesson 2: Patient Assessment Lesson Goal At the end of this lesson, you will be able to conduct an initial assessment for level of conscious- ness, a primary assessment following the MARCH guidelines, a secondary assessment that includes a comprehensive physical examination and patient medical history, as well as how to record and relay vital signs to EMS. Every patient you encounter in an emergency needs an assessment while you wait for EMS to arrive. Your approach will usually go from general to specific. Begin with a scene size-up and generally observe the pa- tient, scanning for whether they are conscious and whether they are breathing normally. Following the initial assessment, there are two types of patient assessments—primary and secondary. Per- form a primary assessment to identify and address any immediate life-threatening conditions. The second- ary assessment is a thorough, full head-to-toe assessment of the patient. Assess for Level of Consciousness When you first approach a patient, quickly check their level of consciousness (LOC). Level of consciousness is used to indicate how awake, alert, and aware someone is of their surroundings. The AVPU scale can be useful when measuring a patient’s level of consciousness. AVPU stands for: alert, verbal, pain, and unresponsive. Alert: Is the patient fully awake? A patient who is alert will be aware of their surroundings and can react to their environment. They are fully awake and their eyes usually open spontaneously. Verbal: Does the patient respond when you talk to them? A patient who might not seem alert or awake but is verbally responsive will usually respond in some way when you talk to them (such as grunting in response to a question or moving slightly when you prompt them). Pain: Does the patient respond to pain with a voluntary or involuntary movement? Do they only respond to painful stimulation? If the patient is not alert or verbal, check whether the patient re- sponds when you apply gentle pressure to their hand or shoulder. The patient who is responsive to pain may moan, make a sound, or attempt to withdraw. Unresponsive: Is the patient not responding to anything at all? An unresponsive or unconscious patient will not respond to any stimuli or make any movements or sounds. If you determine that the patient is unresponsive, follow the steps for CPR. When determining the LOC of an infant or child, visual assessment is your most valuable tool. If an infant or child appears drowsy or is in obvious respiratory distress, consider this condition serious. This could be a symptom of head trauma or severe infection. 60 / Florida Basic Recruit Training Program (HL): Volume 2 If the patient is a criminal justice officer and they drop below the level of alert, disarm them to avoid pos- sible safety concerns. ; HL222.1. Describe how to conduct an assessment for level of consciousness (LOC) and if the patient is alert, verbal, in pain, or unresponsive (AVPU) Complete the Primary Assessment Regardless of their LOC, you will need to do a primary assessment of the patient. During the primary as- sessment, the priority for care is the rapid identification and management of life-threatening conditions. A patient that is unresponsive will not be able to provide information and will immediately require a primary assessment. Make sure to relay all vital information to responding medical personnel. Primary Assessment Guidelines Complete the primary assessment in the exact order and priority outlined in the mnemonic MARCH. MARCH Massive hemorrhage Is the patient experiencing life-threatening bleeding? Airway Is the patient’s airway obstructed or closed? Respirations Is the patient’s chest rising and falling? Circulation Does the patient have a pulse and blood flow? Hypothermia/Head injury Does the patient have low body temperature or decreasing LOC? ; HL222.2. Describe the primary assessment guidelines Assess and Manage Life-Threatening Injuries Massive Hemorrhage Massive hemorrhage or uncontrolled severe bleeding is the number one preventable cause of trauma- related deaths. It is critical to focus on stopping life-threatening bleeding first. Very low blood pressure, rapid heart rate, loss of consciousness, paleness, and weak pulse can accompany severe bleeding. If you see signs of severe bleeding, look for the source. Some helpful bleeding control techniques include: ap- plying direct pressure to the wound with a sterile dressing to stop the bleeding, packing the wound, or applying a tourniquet, if possible (in later lessons you will learn more about the techniques for treating and controlling life-threatening bleeding). ; HL222.3. Describe how to conduct an assessment for a massive hemorrhage Airway An obstructed airway will restrict or completely impede a patient’s ability to breathe. Refer to your CPR training to safely clear objects in the airway and the various methods of airway management, such as head Chapter 2 First Aid for Criminal Justice Officers / 61 tilt/chin lift and jaw thrust. Do not move forward to the respirations assessment until you establish and maintain an open airway. ; HL222.4. Describe how to conduct an assessment for an open airway Respirations To assess for respirations or breathing, look for the rise and fall of the chest or abdomen. Does the patient’s chest have equal rise and fall on both sides? If the patient is breathing, are they breathing adequately? Look for signs of movement around the mouth and lips. Signs of inadequate breathing include labored or painful breathing, wheezing, snoring, blue or purplish color inside of the lips or fingernails, and skin color changing to a pale or gray color. Pay attention to the depth or manner of breathing. No visible rise and fall of the chest or abdomen are a sign that the patient has stopped breathing. A patient that is not breathing may rapidly deteriorate into car- diac arrest, meaning the heart is no longer pumping blood throughout the body, which can lead to death. This requires rescue breathing to provide supplemental ventilations with a barrier mask. (Remember that you need an open airway to effectively provide rescue breaths.) Immediately request an automated exter- nal defibrillator (AED) and be prepared to perform CPR. ; HL222.5. Describe how to conduct an assessment for respirations Circulation Assess for blood circulation by confirming the existence of a pulse and note skin color and skin tempera- ture. Find a pulse by placing your fingers (not your thumb) on a pulse point. For an infant, always check the brachial pulse on the upper arm, located near the inside of the elbow. For an unconscious adult or child, check the carotid pulse on the neck. For a conscious adult or child, check the radial pulse on the inside of the wrist, below the thumb. Assume that a conscious patient has a pulse. Determine the force or strength of the pulse. A patient with no pulse or an absent pulse may be in cardiac arrest and require immediate intervention through effective CPR and an AED. Another way to assess for adequate circulation is by performing a capillary refill time test. This test is used to rapidly assess changes in blood flow in the arms and legs. Apply pressure by squeezing the patient’s finger or toe nail bed for two seconds. After releasing pressure, if the squeezed nail bed returns to a pink color within two seconds, blood flow is adequate. Blue skin coloring can indicate possible circulation problems. Change in normal body temperature can also indicate poor circulation or death. ; HL222.6. Describe how to conduct an assessment for circulation 62 / Florida Basic Recruit Training Program (HL): Volume 2 Hypothermia/Head Injury Rapidly decreasing body temperature can be a main concern when treating trauma patients, as it can make bleeding symptoms worse by decreasing the blood’s ability to clot or gel, leading to more bleeding and other complications. To prevent the patient from suffering from dangerously low body temperature, mini- mize their exposure to the elements and protect them from wind and water. Keep the patient warm and dry and remove any wet clothing. Consider moving them to an insulated surface such as a rescue blanket or a climate-controlled vehicle or structure. For head injury, a possible concern is permanent brain damage from lack of oxygen or proper blood flow to the brain. Assess the patient for unequal pupil size and any fluids coming out of their ears. Check for an impaled object or deformity to their skull. The patient may have decreasing LOC. You will learn more about treating head injuries in the lesson on spinal, head, and neck injuries. ; HL222.7. Describe how to conduct an assessment for hypothermia and a head injury Complete the Secondary Assessment Once all immediate life-threatening injuries have been addressed and the patient is stabilized, the patient will require a secondary assessment. During the secondary assessment, you will complete a comprehen- sive physical examination of the patient for all injuries and take a detailed patient medical history. In some cases, you might not always be able to complete a secondary assessment, especially if you do not success- fully address all primary assessment concerns before EMS arrives. Secondary Assessment Guidelines The following acronyms, DOTS and PMS, can be useful to keep in mind and will help guide you when per- forming the secondary assessment. DOTS can be used when examining each body part while PMS can help you when examining the extremities. ; HL222.8. Describe the secondary assessment guidelines DOTS An abnormal shape of a body part that may indicate fractures. Compare an injured Deformities body area to a similar, uninjured area. Wet clothing may indicate external bleeding. Carefully remove or cut open the Open injuries clothing to find the bleeding, and try to control it immediately. A conscious patient may complain of a pain when touched. In an unresponsive Tenderness patient, observe the face for pain response (such as a grimace). Swelling Raised skin that may indicate soft-tissue injury and fractures. ; HL222.9. Describe how to conduct an assessment for deformities, open injuries, tenderness, and swelling (DOTS) Chapter 2 First Aid for Criminal Justice Officers / 63 PMS Pulse Assess for presence or absence of pulse. Motor Assess for motor function (movement). Assess for sensation before movement. Ask the patient if they have feeling in the Sensory area you touch. ; HL222.10. Describe how to conduct an assessment for pulse, motor, and sensory (PMS) functions Perform a Comprehensive Physical Assessment Complete a head-to-toe physical examination of the patient. Systematically inspect and touch each body part before moving to the next. Look, listen, and feel for DOTS. 1. Head—start at the top of the head, gently examine by touching the scalp and skull, assessing for and feeling for depressions. Observe anything out of the ordinary, such as fluid loss from the ears or nose, discoloration around the eyes (raccoon eyes), mouth injuries that may obstruct the airway, and discoloration behind the ears (Battle’s sign) that may indicate brain trauma. 2. Eyes—look at the patient’s pupils, the small dark holes in the center of the eyes. Normal pupils appear round and equally sized. Constricted pupils appear smaller or pinpoint and dilated pupils appear enlarged. If you have a low candlepower penlight, flash it at each pupil. They should both react equally by constricting briskly in response to the light. Nonreactive pupils are often associ- ated with severe brain damage. This test can also help you detect the presence of alcohol, drugs, or other substances. 3. Neck—gently feel the neck area. Look at the throat for signs of trauma, asymmetry, swelling, and airway obstructions. While doing this, ask the conscious patient to wiggle their fingers and toes. Ask if the patient’s extremities feel numb or tingly and if they have neck pain. 4. Shoulders—gently squeeze the shoulders inward feeling and listening for grinding which may indicate a fracture. 5. Chest and abdomen—look to see if both sides of the chest rise and fall equally during breathing, for bruising, and for holes in the chest wall. Listen for noises coming from the chest wall. Feel the chest for areas of pain or tenderness and feel for fractured ribs. Squeeze lightly on the ribcage. Continue to the abdomen, following the same touching procedures. Tenderness and swelling in the abdomen may indicate internal injury or pregnancy. 6. Pelvis and groin—gently squeeze inward, checking for tenderness or deformities, and whether the pelvis is stable. Note any bleeding or injury in the groin area; the pelvis has a lot of blood ves- sels and bleeding in this area may be life-threatening. 7. Lower extremities—individually and systematically assess the lower extremities. If you find that one leg is shorter, this may indicate a fracture of the femur. Place your hands along the soles of the patient’s feet and ask them to press them against your hands. You should feel equal pressure from both feet. 64 / Florida Basic Recruit Training Program (HL): Volume 2 8. Upper extremities—after assessing both arms for DOTS, check for circulation, movement, and sensation on both sides. Check circulation in the fingers. Does the patient feel their hands and fingers? Can the patient move their hands and fingers? Ask the patient to hold your fingers and squeeze them simultaneously. Both hands should have equal strength. 9. Spine and back—if you have the necessary assistance and a compelling medical reason such as blood pooling under the patient, roll the patient to check their back while trying to maintain strict spinal precautions (you will learn more about moving patients in a following lesson). Feel along the spine for possible spinal fractures and deformities. Look for any bruising or swelling that could indicate internal bleeding. ; HL222.11. Describe how to perform a comprehensive physical assessment during a secondary assessment Gather Patient Medical History While conducting your comprehensive physical assessment, talk to the patient. Try to gather relevant medical information or history to relay to EMS. If the patient is unconscious, begin by questioning family members or bystanders. Any information you get helps in providing care for the patient. Ask if the patient is experiencing any symptoms and whether they have allergies or wear medical alert jew- elry. If the patient is taking medication, note when the last dose was. Ask about past history, such as other medical problems that may contribute to the patient’s current condition. Record the time the patient last ate or drank. Lastly, you’ll want to note what events led to the emergency and the time of injury or sudden illness (some medications may be harmful if given too long after time of injury). All this information can help you determine the extent of injuries or illness. Include the information in your report when handing the patient off to appropriate medical personnel. Remember: you may be the last person to speak to the patient, so gathering this information could be critical. ; HL222.12. Describe how to gather patient medical history during a secondary assessment Record Vital Signs The primary assessment addressed all necessary life functions and the secondary assessment addressed injuries or illnesses that required basic intervention. Once both assessments are complete and the patient is stable, there may be time to record the patient’s pulse and breathing rate. This information helps re- sponding EMS determine if the patient’s condition is improving, stable, or deteriorating. To take a patient’s pulse, place your fingers on a pulse point. Count the number of beats for fif- teen seconds. Multiply this number by four to arrive at the patient’s average pulse rate. To calculate a patient’s breathing rate, watch the patient’s chest rise; count the number of breaths taken over fifteen seconds. Multiply this number by four to arrive at the average breathing rate. ; HL222.13. Describe how to record pulse and breathing rates while providing emergency first aid Chapter 2 First Aid for Criminal Justice Officers / 65 Complete an Ongoing Assessment If the patient is stable, reassess every fifteen minutes. If unstable, reassess every five minutes. Continue an ongoing assessment until EMS relieve you. In your ongoing assessment, reassess the patient’s responsive- ness level, airway and breathing, and pulse rate and quality. You may need to repeat parts of the secondary assessment to detect changes in the patient’s condition. ; HL222.14. Describe how to conduct an ongoing assessment while awaiting additional EMS resources Update EMS Once EMS arrives, relay scene and patient information to medical responders. In some situations, you will provide information by radio to dispatch while EMS is on their way. Doing so prepares them to treat the patient as soon as they arrive. Here are some typical questions EMS may ask: “How many patients are there?” “Where are they?” “Who are the high priority patients?” “What treatment did you render?” Specialized personnel, such as firefighters and EMS, may become involved in a rescue, based on local pro- tocol and department policy. EMS may ask you to render emergency first aid, provide protection to a pa- tient, or assist with moving a patient. As a criminal justice first-aid provider, do what you can safely do, use the equipment available to you, and stay within the limits of your training and qualifications. ; HL222.15. Describe how to communicate with EMS during a medical emergency 66 / Florida Basic Recruit Training Program (HL): Volume 2 2 Unit 2: Respond to a Medical Emergency Lesson 3: Moving Patients Lesson Goal At the end of this lesson, you will be able to place a patient in a recovery position or position of comfort to avoid positional asphyxia in a non-emergency situation. You will also be able to move a patient in an emergency using drags, lifts, and carries. In an emergency, you may have to move a patient to safety or to reposition them in response to their changing medical conditions. When you must move an injured person, choose the method carefully to avoid making the injuries worse and to avoid injuring yourself. You may also need to assist EMS in moving patients or removing an entrapped patient. Follow EMS direction and assist when needed. Perform an emergency move when a patient is in immediate danger or the patient’s location prevents pro- viding care to them or another patient. Perform a non-emergency move when the situation is not urgent. Always perform BSI protocols and wear appropriate PPE when moving a patient. Proper Lifting Techniques When moving a patient, observe the rules of proper lifting and moving. Be aware of your physical limitations. Maintain correct alignment of your spine, shoulders, hips, and feet. Take a good athletic stance. Engage your abdominal muscles while lifting. Use proper breathing techniques. Look straight ahead. Do not look down. Lift with your legs, hips, and buttocks, not your back. Keep the patient’s weight as close to your body as possible. Limit the distance you need to move the patient if possible. ; HL223.1. Describe how to lift a patient properly Recovery Position Place an unresponsive, breathing patient with no suspected neck or back injuries in the recovery position. The recovery position helps maintain an open airway should the patient become nauseated or vomit, and may prevent breathing restrictions, such as positional asphyxia. Chapter 2 First Aid for Criminal Justice Officers / 67 Figure 2-4: Recovery position 68 / Florida Basic Recruit Training Program (HL): Volume 2 To place a patient in the recovery position: 1. Position the patient on their back without causing additional injuries and stand to one side of them. 2. Place the patient’s left or right arm straight up overhead, flat on the floor. 3. Place the back of the patient’s other hand on their opposite shoulder. 4. Grasp the patient on the shoulder and the knee and roll them towards you. 5. Pull the patient’s knee up and over towards you so that their leg is bending and resting on the floor, and their foot is either flat on the floor or hooked on their knee. Any patient placed in a recovery position is critically ill and should be reassessed every five minutes. Allow a responsive patient to assume a position of comfort, assuming it is safe to do so, while sitting up, or a tripod position where the patient sits down while leaning forward with their arms resting on their knees or stand- ing with their arms resting on another surface. If a restrained suspect is complaining about not being able to breathe and is not combative, place them in a position of comfort. ; HL223.2. Describe how to place a patient in a recovery position Positional Asphyxia Positional asphyxia occurs when someone’s body is in a position that interferes or prevents them from breathing adequately and leads to an insufficient intake of oxygen that the body needs. Some patients may have risk factors that can contribute to positional asphyxia, such as obesity, alcohol and drug use, or pre-existing conditions including bronchitis, emphysema, and chronic lung disease. Positional asphyxia can happen if a person is face down, with their chest on a hard surface, arms restrained behind their back, and left in this position for a significant amount of time. Positional asphyxia may also happen because of ac- cident or illness that places someone in a breathing-restricted position. Signs and symptoms of positional asphyxia include the patient making a gurgling or gasping sound with mucus or foam coming from their nose or mouth, visual signs that the patient is struggling to breathe, or a patient verbally complains of not being able to breathe. If the patient displays a change in mental status, escalating or de-escalating activity, a reduced LOC, or blue skin discoloration, these can indicate the patient is experiencing positional asphyxia. Prevention and treatment of positional asphyxia includes getting the patient out of a prone position (which may apply pressure to the diaphragm) as soon as practical and placing the unresponsive patient in a recov- ery position, or a responsive patient in a position of comfort. If the patient is a restrained suspect, search them, and place them in a position of comfort (often sitting upright leaning back against a solid surface). ; HL223.3. Describe factors that contribute to positional asphyxia Chapter 2 First Aid for Criminal Justice Officers / 69 Walking Assist Perform a walking assist for a responsive patient with leg injuries or who is blind or has low vision and is still capable of walking but may need some assistance. 1. Stand next to the patient on the same side as the injury. 2. Place the patient’s arm across your shoulder. 3. Place your arm around the patient’s waist. Grasp their belt, if necessary. 4. Help the patient to a safe or comfortable place and encourage the patient not to put body weight on the injury. ; HL223.4. Describe how to perform a walking assist of a patient Figure 2-5: Walking assist Emergency Drags Emergency drags are a life-saving component of first aid. Use an emergency drag when you need to move a patient quickly. Drags are physically demanding to perform over long distances. Be aware of any hazards that you may be dragging the patient over. A critical issue when moving a patient is the danger of making an existing spinal injury worse. Make every effort to maintain the patient’s head, neck, and shoulder align- ment. Whenever a drag is performed, the patient should be immediately assessed and any interventions checked once the drag is complete. It is easy to dislodge a tourniquet or wound packing during a drag. 70 / Florida Basic Recruit Training Program (HL): Volume 2 Shoulder Drag 1. If the patient is unconscious, secure their hands by folding them across their chest to protect them during the move. 2. Stand behind the patient’s head and squat by bending your knees. 3. Reach under the patient’s arms and grasp your own wrist. Consider grasping the patient’s oppo- site wrists. 4. Pull the patient in as close as possible to your chest. 5. Stand up, lean back, and walk backwards. 6. Move the patient with you. The patient’s feet will drag on the ground. Figure 2-6: Shoulder drag Chapter 2 First Aid for Criminal Justice Officers / 71 Blanket Drag Perform a blanket drag as an emergency move when you need to move a patient who you should not lift or carry by yourself and the environment is safe to do so. If you do not have a blanket, any large piece of fabric, plastic, or litter will work for this move. 1. Place a blanket directly against the patient’s side. 2. Gather the blanket into accordion-style, lengthwise pleats. 3. Position yourself on the patient’s side opposite the blanket. 4. Extend the patient’s arm that is closest to you straight up and beside their head. 5. Reach across the patient and grasp their hip and shoulder. 6. Roll the patient toward you onto their side. 7. Tuck the blanket under the patient. 8. Roll the patient onto the blanket and wrap the blanket around the patient. 9. Grasp the blanket so that it supports the patient’s head and neck. Drag the patient toward safety. Figure 2-7: Blanket drag Arm Drag Perform an arm or ankle drag when you need to move a patient short distances and in extreme emergency conditions. 1. Stand at the head of the patient and squat to grasp their wrist(s). 2. Pull the patient’s arms above their head and grasp their wrists or forearms. 3. Drag the patient to safety. 72 / Florida Basic Recruit Training Program (HL): Volume 2 Figure 2-8: Arm drag Ankle Drag 1. Stand at the feet of the patient and squat to grasp their ankle(s). 2. Drag the patient to safety. ; HL223.5. Describe how to perform an emergency drag of a patient Figure 2-9: Ankle drag Chapter 2 First Aid for Criminal Justice Officers / 73 Two-Officer Extremity Lift Extremity lifts are often easier than drags. Considered non-emergency moves, these lifts require at least two officers’ efforts. Use these techniques to move patients who are unresponsive or unable to move from the floor or ground. However, do not perform an extremity lift if you suspect or know a patient has an in- jury to the spine or an extremity injury. 1. Officer 1, kneel on one knee at the patient’s head. 2. Place your hands, palms up, under the patient’s shoulders. 3. Lift the patient to a sitting position. 4. Support an unconscious patient’s back with your kneeling leg. 5. Place your hands under the patient’s arms. 6. Firmly grasp the patient’s opposite wrists, and fold them across the patient’s chest. 7. Officer 2, position to one side of the patient’s knees with your non-weapon side to the patient. Wrap your inside arm over the patient’s thighs and your outside arm under their thighs. Be care- ful where you grasp the patient’s legs, preferably above the knees, to avoid hyperextension. Grasp your wrist(s). 8. Officer 1, at the patient’s head, delivers all commands. 9. Simultaneously both officers stand while lifting the patient. 10. Officer 2 should turn and face the direction of movement. ; HL223.6. Describe how to perform an extremity lift of a patient 74 / Florida Basic Recruit Training Program (HL): Volume 2 Figure 2-10: Two- officer extremity lift Chapter 2 First Aid for Criminal Justice Officers / 75 SEAL Team 3 Carry Use a SEAL Team 3 carry to move a patient who cannot walk. Remember to use proper lifting and mov- ing techniques. Do not perform this carry if you suspect or know a patient has an injury to the spine or an extremity injury. 1. Officers 1 and 2 stand behind the patient. 2. Place the patient’s arms around the shoulders of both officers. 3. If conscious, instruct the patient to use their arms to hold onto the officers. 4. Hold the patient’s arms around the officer’s neck if the patient is not able to hold on. 5. Grasp the patient’s belt, pants, or back pocket. 6. Lift and go. When performing a Seal Team 3 carry, always be aware of potential threats. One of the officers may have a free hand and should be prepared to provide security. ; HL223.7. Describe how to perform a SEAL Team 3 carry of a patient 76 / Florida Basic Recruit Training Program (HL): Volume 2 Figure 2-11: SEAL Team 3 carry Chapter 2 First Aid for Criminal Justice Officers / 77 Log Roll Use this technique only when moving the patient is necessary or when assisting medical personnel. Ideally, this technique is performed with at least two or three people. The purpose of a log roll is to roll the patient onto their back, front, or side, possibly on a blanket or board. 1. Perform a log roll on the floor or ground with at least three officers on their knees. 2. Officer 1, constantly maintain head, neck, and spinal motion restriction. 3. Officer 2, take your position at the patient’s shoulder and hip. Stay far enough away from the side of the patient’s body so there is room to roll the patient toward you. 4. Officer 3, take your position on the same side of the patient as Officer 2. Position yourself at the patient’s thigh and lower leg. Stay far enough away from the side of the patient’s body so there is room to roll the patient toward you. 5. Officer 2, reach across the patient. Place your hand on the patient’s shoulder. Place your other hand on the patient’s hip. 6. Officer 3, reach across the patient. Place your hand above the other officer’s hand on the pa- tient’s belt line. Place your other hand on the outside of the patient’s knee area. 7. Officer 1, issue all commands to roll the patient toward Officers 2 and 3, and simultaneously maintain the patient’s head, neck, and spine alignment. 8. Assess the patient for injuries. 9. If applicable, reverse the process to return the patient to their original position. ; HL223.8. Describe how to perform a log roll of a patient 78 / Florida Basic Recruit Training Program (HL): Volume 2 Figure 2-12: Log roll Chapter 2 First Aid for Criminal Justice Officers / 79 2 Unit 2: Respond to a Medical Emergency Lesson 4: Mass Casualty Incidents and Triage Lesson Goal At the end of this lesson, you will be able to respond to a mass casualty incident as the first officer on the scene and participate in triage and a multiple agency response. You may respond to an incident that involves multiple casualties or multiple patients with severe injuries, also known as a mass casualty incident (MCI). Events such as traffic crashes involving multiple vehicles, severe weather events, and active threat/shooter incidents can quickly become an MCI. You may be the first person to arrive on the scene of an MCI, and should be able to prioritize patients for care based on the severity of their injuries before providing emergency first aid. Assuming there are no active threats, your role as the first responder involves conducting a scene size-up, establishing command of the scene, and communicating with other first responders through dispatch. Ide- ally, you accomplish these tasks simultaneously. Once additional resources are available, your next step is to begin triage. Triage is the process of sorting and categorizing patients. The goal of triage is to do the most for the most, rather than to provide extensive treatment to a single patient. Immediate life-saving interventions, particularly tourniquet application, can be performed, but the focus is on rapidly evaluating all patients to determine the order that patients will receive future medical attention based on the severity of their injuries. Check local protocol and department policy to determine if your agency uses a specific model. Although triage models differ slightly, the basic principles remain the same. ; HL224.1. Describe the role of the first officer on the scene of a mass casualty incident Triage Processes Simple Triage And Rapid Treatment (Start) The START method of triage can be used to assess many patients rapidly, and personnel with limited medi- cal training can use it effectively. 1. Use BSI and appropriate PPE. 2. Locate and remove all the walking wounded into one location away from the incident, if possible. Do not forget these patients. Someone should triage them as soon as possible. Say “Everyone who can hear my voice and can walk, come to this area.” Now move quickly through the remain- ing patients. 3. If available, triage and tag the remaining injured patients with triage ribbons (color-coded plastic strips) by tying them to an upper extremity in a visible location (wrist if possible). 80 / Florida Basic Recruit Training Program (HL): Volume 2 4. Classify patients according to the START protocols.  RED—immediate  YELLOW—delayed  GREEN—ambulatory (minor)  BLACK—deceased (non-salvageable) 5. Remember the mnemonic RPM: respiration, perfusion, mental status.  Assess respirations: a. If respiratory rate is 30 or fewer breaths per minute, assess perfusion. b. If respiratory rate is more than 30 breaths per minute, tag RED. c. If the patient is not breathing, open the airway, remove obstructions if seen, and as- sess for (a) or (b) above. d. If the patient is still not breathing, tag BLACK.  Assess perfusion: a. Perform by palpating a radial pulse or assessing capillary refill time. b. If no radial pulse is present or the capillary refill time is greater than two seconds, tag RED. c. If radial pulse is present or capillary refill time is two seconds or less, assess mental status.  Assess mental status or LOC: a. Assess the patient’s ability to follow simple commands and their orientation to time, place, and person. b. If the patient follows simple commands, tag YELLOW. c. If the patient does not follow simple commands, is unconscious, or disoriented, tag RED. d. Note: Depending on injuries (burns, fractures, bleeding) it may be necessary to tag YELLOW. 6. Make independent decisions for each patient. Do not base triage decisions on the perception of having too many patients in a single category. 7. If you encounter borderline decisions, always triage to the most urgent priority (GREEN / YELLOW patient, tag YELLOW). 8. Direct the movement of patients to proper treatment areas, if necessary. Chapter 2 First Aid for Criminal Justice Officers / 81 9. Provide appropriate medical treatment to patients before you move them and as incident condi- tions dictate. 10. The first assessment that produces a RED tag stops further assessment of that patient. During triage, only manage the correction of life-threatening problems, such as airway obstruction or severe bleeding. 11. The triage priority determined in the treatment phase should be the priority used for transport. 12. If you identify a patient in the initial triage phase as a RED and transport is available, transport right away. Sort, Assess, Life-saving interventions, Treatment/Transport (SALT) The SALT method of triage combines many approaches from other triage processes. SALT uses the same categories as START, but also adds another category, “GRAY,” meaning the patient is expected to die, but is not yet deceased. This signals to responders to focus their efforts on more immediate patients that have a higher chance of survival. 1. Begin with patient categorization: global sorting for patients that can walk, wave, or are still, with the goal of prioritizing patients based on severity of injuries. 2. Patients are further classified into categories of immediate (RED), expectant (GRAY), delayed (YELLOW), minimal (GREEN), and deceased (BLACK). 3. Perform individual patient assessments and rapid life-saving interventions, such as controlling massive hemorrhage or severe bleeding and addressing airway obstructions. 4. In general, the order of treatment or transport should be immediate patients first, then delayed, then minimal. Expectant patients should be provided with treatment or transport when re- sources allow. ; HL224.2. Describe how to triage during a mass casualty incident Multiple Agency Response In a multiple agency response, your role depends on your arrival time, department policies, and local pro- tocol. Florida implements the Incident Command System (ICS) for multiple agency response in times of disaster. If necessary, the original ICS commander will relinquish command by providing a situation report. An MCI can overwhelm anyone who reaches the scene first. Understanding the role of the first officer on the scene can reduce the stress of the situation. Taking control of the scene, getting information such as the number and category of patients to responding personnel, and beginning triage helps make the combined response successful. ; HL224.3. Describe the officer’s role when assisting in a multiple agency response to a mass casualty incident 82 / Florida Basic Recruit Training Program (HL): Volume 2 2 Unit 2: Respond to a Medical Emergency Lesson 5: Providing Care While Under Threat Lesson Goal At the end of this lesson, you will be able to provide care when under direct and indirect threat situations. You will also learn how to evacuate a scene and techniques for moving patients while under fire. When you are responding to an active threat/shooter incident, you may need to provide care for another officer who has been wounded. While the methods described below can be used with any patient, the section on providing care under different threat levels is primarily for providing care to fellow responding officers at a scene. For this reason, the term “officer” is used instead of “patient.” Direct Threat Care Direct threat care/hot zone/care under fire environment describes a scene that can include an active threat, multiple active threats, or any imminent danger. Your primary concern in direct threat care is to stop or neutralize the threat if possible. As threats are changing, continuously conduct a threat assessment until the threat no longer exists or involved parties are in an area of relative safety. Instruct a wounded officer to move out of the visual field of the threat or away from the source of imminent danger to an area of cover or relative safety. If the officer is alert and capable, direct them to stay engaged. In general, prioritize only the most life-threatening injuries that can be quickly addressed, such as massive hemorrhage. If the officer is bleeding from an extremity like a leg or arm, control the bleeding by applying a tourniquet while behind cover or something that can block bullets. If you become injured, the primary fo- cus should be applying your own tourniquet and providing self-care (the lesson on bleeding and soft-tissue injuries covers this in greater detail). Instruct the officer to render their own self-aid if possible, including the self-application of a tourniquet. If the officer is unresponsive or unable to render self-aid or move to safety, conduct a remote assessment to develop a rescue plan to maximize scene safety. Indirect Threat Care Indirect threat care/warm zone/tactical field care environment describes a scene in which the officer is out of imminent danger and but not yet in a safer zone. A hot zone can change to a warm zone once the officer is in a place of relative safety or an area of cover becomes cleared but not secured. This is an area where there is less of chance of you or other officers sustaining injuries. However, a warm zone can become a hot zone again simply by the return of the threat. Your level of care includes following the assessment and treatment priorities outlined in MARCH. Address any life-threatening bleeding first by applying direct pressure to a wound, wound packing, and using sterile Chapter 2 First Aid for Criminal Justice Officers / 83 dressings or seals in addition to tourniquets. Except for placing the patient in the recovery position, do not initiate any airway care, like CPR, until you and the patient are in the warm zone. Evacuation Care Evacuation care/cold zone/tactical evacuation care environment describes a scene in which you are mov- ing towards transporting an injured officer to a medical treatment facility. A cold zone can also refer to an area that has been cleared of threats and may include triage areas and incident command posts. The best medical care for an injured officer and other trauma patients is typically evacuation and hand-off to a higher and more skilled practitioner, but it is good practice to re-evaluate the injured person and all interventions so you can communicate the information to EMS. The only time that you should consider delaying evacuation is to address immediately life-threatening conditions, such as a massive hemorrhage and airway compromise. Any additional interventions during this phase of first aid can occur while on the way to higher care or when performed by EMS operations. ; HL225.1. Differentiate between direct threat care, indirect threat care, and evacuation care environments Moving Patients While Under Threat During active threat/shooter i

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