Health and Wellness - Fire - Acronyms Section FFD PDF

FIRST AID, HEALTH, WELLNESS & PERSONAL SAFETY FIRST AID Professional truck drivers may confront a number of different first aid and injury prevention challenges as a part of their jobs. In the follow- ing pages, you will find basic information that will he...

FIRST AID, HEALTH, WELLNESS & PERSONAL SAFETY FIRST AID Professional truck drivers may confront a number of different first aid and injury prevention challenges as a part of their jobs. In the follow- ing pages, you will find basic information that will help you respond to those challenges. This chapter is provided as “information only” and is not intended to replace an approved course of instruction in first aid, nor does it replace company policies for personal protection. In every instance, the professional truck driver should know and follow any company policies with respect to providing or not providing emergency assistance. Anaphylaxis: First Aid A severe allergic reaction (anaphylaxis) can cause a body to go into shock, respiratory distress, and circulatory collapse — in other words, make it hard to breathe and impede blood flow. For some, anaphylax- is can occur within minutes; for others, several hours after exposure to a specific allergy-causing substance like insect venom, pollen, latex, and certain foods and drugs. Someone experiencing an allergy attack may break out in hives and/ or have their eyes or lips swell severely. The inside of the throat may swell and may cause difficulty in breathing and shock. Blood pressure may drop, internal organs may be affected and the victim could possibly become unconscious. Dizziness, mental confusion, abdomi- nal cramping, nausea, vomiting or diarrhea may also accompany anaphylaxis. Prepare for an Allergic Reaction: Individuals who have had a previ- ous anaphylactic reaction should carry medications with them as an antidote. Epinephrine ts the most commonly used drug for severe allergic reactions. It comes only as an injection that must be pre- scribed by a doctor. Epinephrine can be self-admuinistered with an auto-injector. Before using an auto-injector, be sure to read the injection instructions, and have household members and colleagues read them as well. lle ‘Those who are hyper-allergic should also carry an antihistamine pill, such as diphenhydramine, because the effects of epinephrine are only temporary. If you observe someone having a severe allergic reaction/anaphylaxis: « Call 911 or your local emergency medical (EM) number. - Check for special medications that the person might be carrying to treat an allergy attack. Ask permission, and then if permitted, administer the drug as directed, usually by pressing the auto-in- jector against the person's thigh and holding it in place for several seconds. Massage the injection site for 10 seconds to enhance absorption, then have the person take an antihistamine pill if the person is able to do so without choking. Look for a medical emergency ID bracelet or necklace. -« Have the person lie still on their back with feet higher than their head. + Loosen tight clothing and cover the person with a blanket. Don't give anything else to drink. « If there is vomiting or bleeding from the mouth, turn the person on the side to prevent choking. - If there are no signs of breathing or movement, begin Cardiopul- monary Resuscitation (CPR) (if trained and company policy allows). Burns: First Aid According to the American Burn Association's 2015 data collection’, there were 9,461 medically treated burn incidents occurring on streets or highways and 25,729 occurring due to occupational haz- ards. Burns can result from dry heat (fire), moist heat (steam, hot liquids), electricity, chemicals, and radiation (sunlight). Treatment for burns depends on: 1) the depth of the burn; 2) how much area of the body ts affected; and, 3) the location of the burn. The first step is to determine the degree and the extent of damage to body tissues. The three classifications of first-degree burn, second- degree burn and third-degree burn will help you determine emergen- cy care. *2016 National Burn Repository, Report of Data from 2006 — 2015 ll? First-Degree Burn According to the Mayo Clinic, the least serious burns are those in which only the outer layer of skin is burned. The first degree burn usually leaves the skin looking dry and red, with some swelling, sensitivity, and pain sometimes present. Mild sunburn and brief contact with a heat source such as a hot pan are examples. Signs and symptoms of first degree burns usually appear within a few hours of exposure, bringing pain, redness, swelling, and, at times, blistering, headache, fever and fatigue. Treatment for Minor Burns: « Take a cool bath/shower. Adding baking soda to a bath may provide relief. +» Apply aloe or other cooling agent several times a day, but not petroleum jelly, butter or oil-based remedies. They retain heat and delay healing. « Leave blisters intact to avoid infection. Apply an antibacterial ointment. Treat a first-degree burn as a minor burn unless it involves substantial portions of the hands, feet, face, groin, buttocks, or a major joint. Second-Degree Burn When the first layer of skin has been burned through and the second layer of skin, or dermis, is also burned, the injury ts called a second- degree burn. Blisters develop and the skin takes on an intensely reddened, splotchy appearance. These burns produce severe pain and swelling, and develop a weepy, watery surface. Examples include severe sunburn or burns caused by hot liquids. If the second-degree burn is no larger than 3 inches in diameter, treat it as a minor burn. If it is larger or if the burn 1s on the hands, feet, face, groin, buttocks, or over a major joint, treat it as a major burn and get medical help promptly. Treatment for Minor Second-Degree Burns: « Cool the burn. Hold the burned area under cold running water for at least 5 minutes, or until the pain subsides. If this is imprac- 118  tical, immerse the burn in cold water or cool it with cold com- presses. Cooling the burn reduces swelling and helps prevent more skin layers from being affected by conducting heat away from the skin. Do not put ice on the burn. -« Cover the burn. Loosely wrap the burn with a sterile gauze bandage. Avoid putting pressure on burned skin. Bandaging keeps air off the burned skin reduces pain and protects blistered skin. Do not use fluffy cotton, which may irritate the skin. « Take an over-the-counter pain reliever. Be sure to ask if the burn victim 1s allergic to any of these pain relievers. Never give aspirin to a child. Minor burns usually heal without further treatment. Watch for signs of infection such as increased pain, redness, fever, swelling or oozing. If infection develops, seek medical help. Avoid re-injuring or tanning if the burns are less than a year old. Caution: « Do not use ice. Putting ice directly on a burn can further damage burned skin. » Do not apply butter or ointments to the burn. ‘These hold in the heat and prevent proper healing. « Do not break blisters. Broken blisters are vulnerable to infection. Third-Degree Burn The most serious burns affect and may cause permanent damage to all layers of skin, underlying tissue, and nerves. Fat, muscle and even bone and organs may be affected. Areas may be charred black or appear dry and white. Difficulty inhaling and exhaling, carbon monoxide poisoning, or other toxic effects may occur if smoke inhalation accompanies the burn. ‘There may be no pain at all in the burned areas where nerve endings are destroyed but pain may be felt around the margin of the affected area. Treatment for Third-Degree Burns: - Check for signs of breathing. If none, begin CPR tf trained, and if company policy and the patient's condition allows. Avoid touching the burned area. 119  « Elevate the burned body part(s) above heart level when possible. Avoid contact with the burned area. « Gently cover the area of the burn. Use a cool, moist, sterile bandage or cloth. If you are dealing with a major burn, dial 911 or call for EM assistance. Caution: * Do not remove burnt clothing. Do make sure the victim is no longer in contact with smoldering materials or exposed to smoke or heat. « Do not immerse large severe burns in cold water. Shock could result. Chemical Burns Chemical burns occur when skin is exposed to a corrosive substance. Chemical burns follow the standard three burn classifications; however, they can occur without any source of heat, can occur immediately upon contact, but may not be immediately evident. They can cause tissue damage under the skin without immediate signs of damage to the skin's surface. Symptoms of a chemical burn include redness, Irritation, and either pale skin or black dead skin; sometimes blisters may form. Treatment for Chemical Burns: « Remove chemicals causing the burn. Brush off any dry chemi- cals with a cloth and rinse off the affected area under cool water. Remember to protect your own skin, eyes, etc. « Take off clothing or jewelry. Remove any article of clothing contaminated by the chemical. Again protect yourself from direct contact with the contaminated clothing. « Gently cover over damaged area with a loosely wrapped dress- ing or clean cloth. Always seek emergency medical assistance if the burn penetrates the first layer of skin, burn occurs in your eyes, on your hands, feet, face or over a Major joint. 120 Electrical Burns Electrical burns occur when tissue comes in contact with electrical current, in turn causing electricity to pass through the body. Electri- cal burns are different from typical heat burns or chemical burns in that they cause more damage beneath the first layer of skin and throughout a body. Typical symptoms of electrical burns may include visible burns on skin, muscle contractions, numbness, weakness, and low blood pressure. Due to the severity of electrical burns, it is imperative to call paramedics immediately. While waiting for medical help to arrive, one should follow these steps: - Look at the victim, but don't touch. The victim may still be in contact with the electrical source and could pass the current through you. - Turn off the source of electricity or move the source away using a non-conducting object. - Check for signs of breathing and cover the affected areas with a sterile gauze bandage. Avoid direct contact. Call for emergency assistance or 911 immediately. CPR: First Aid Cardiopulmonary resuscitation (CPR) is a lifesaving technique used in emergencies when someone's breathing or heartbeat has stopped. CPR may involve one or two actions: chest compressions or chest compressions combined with mouth-to-mouth rescue breathing. Whether you should employ CPR in an emergency situation, depends on your knowledge and comfort level, training, and company policy. 121  Chest Pain: First Aid Causes of chest pain can vary from minor indigestion or stress, to a heart attack or pulmonary embolism. The exact cause of chest pain can be difficult to interpret. Heart Attack A heart attack occurs when an artery supplying blood and oxygen to the heart becomes blocked or occluded so that the blood supply becomes severely reduced or cut off. This loss of blood flow injures heart muscle. A heart attack generally causes chest pain for more than 15 minutes, but it can also be “silent” and have no symptoms at all. Many people who suffer a heart attack have warning symptoms hours, days, or weeks in advance. The earliest predictor of an attack may be recurrent chest pain that is triggered by exertion and relieved by rest (angina). Someone having an attack may experience any or all of the following: « Uncomfortable pressure, fullness or squeezing pain in the center of the chest that may last several minutes or come and go and may be triggered by exertion and relieved by rest * Prolonged pain in the upper abdomen * Discomfort or pain spreading beyond the chest to shoulders, neck, jaw, teeth, or one or both arms « Shortness of breath « Lightheadedness, dizziness, fainting « Sweating » Nausea If you or someone else may be having a heart attack: * Dial 911 or your local EM assistance number. Do not “tough out” the symptoms of a heart attack for more than five minutes. A person experiencing a heart attack should not drive, because driving while experiencing a heart attack may put the driver and others at risk. 12z  » Chew and swallow an aspirin unless you are allergic to aspirin or have been told by a doctor never to take rt. Aspirin thins the blood and prevents clotting. + Take nitroglycerin, if prescribed. If a doctor has prescribed nitroglycerin for you, take it as directed. Do not take anyone else's nitroglycerin because that could put you in more danger. - Begin CPR if trained and in accordance with company policy should the person become unconscious and stop breathing. Use the following information to help determine whether the chest pain is a medical emergency. Pulmonary Embolism A pulmonary embolism occurs when a clot forms in a vein in another part of the body — usually in the legs or pelvis — and travels to and lodges in an artery of the lung, stopping blood flow. Without proper blood flow, tissue dies. Signs and symptoms of a pulmonary embolism: » Sudden, sharp chest pain that begins or worsens with a deep breath or a cough, often accompanied by shortness of breath « Sudden, unexplained shortness of breath, even without pain - Cough that may produce blood-streaked sputum (coughed up saliva or mucus) * Rapid heartbeat » Anxiety and excessive perspiration As with a suspected heart attack, dial 911 or call for EM assistance immediately. Pneumonia with Pleurisy According to the Mayo Clinic, signs and symptoms of pneumonia are chest pains with chills, fever, and a cough that may produce bloody or foul-smelling sputum. When pneumonia occurs with an inflamma- tion of the membranes around the lung (pleura), you may have considerable chest discomfort when inhaling or coughing. This 123 condition is called pleurisy. Unlike a heart attack, with pleurisy, the pain is usually relieved temporarily by holding one's breath or putting pressure on the painful area of the chest. A doctor should be consult- ed if a cough, fever, or chills accompany your chest pain. Pleurisy usually accompanies other chest diseases or conditions. If it occurs without any underlying medical condition, see a doctor promptly. Chest Wall Pain Chest wall pain is harmless and ts associated with pain and tenderness in and around the cartilage that connects ribs to the breastbone (sternum). If finger pressure along the outer edge of the sternum duplicates your chest pain, it is likely costochondri- tis (a chest wall pain), not a heart attack. Other causes of chest pain: Strained chest muscles from overuse or excessive coughing Bruised chest muscle from trauma Acute anxiety with rapid breathing Pain from the gastrointestinal tract, such as esophageal reflux, peptic ulcer pain, or gall-bladder pain Choking: First Aid Choking is an inability to breathe because a foreign object, usually food or small objects blocks the trachea. Because the trachea Is blocked, constricted, or swollen shut, oxygen to the lungs and shortly thereafter the brain is cut off, making a quick first aid response essential. ‘The universal sign for choking ts hands clutched to the throat. If the person does not give the signal, look for these indicators: « Inability to talk or cough forcefully « Dithculty breathing or noisy breathing e Face and lips turn blue » Loss of consciousness 124 According to the Red Cross if someone its choking one should follow the “five-and-five” approach to delivering first aid: + Deliver five blows (firm but not harmful): lean the choking person forward and place five firm blows to the back between the shoulder blades with the heel of your hand. « Perform the “Heimlich” maneuver — see instruction below. » Repeat until the blockage is dislodged. If you're the only rescuer, perform the above before calling 911 for first aid. If someone else is available, have that person call while you perform first aid. To perform the Heimlich maneuver on another adult: - Stand behind the person. Wrap your arms around their waist. Tip the person forward slightly. « Make a fist with one hand. Position it slightly above the person's navel. - Grasp the fist with the other hand. Press hard into the abdomen with a quick, upward thrust — as if trying to lift the person. - Perform a total of five abdominal thrusts if needed. Repeat the “five-and-five” cycle as necessary. To perform the Heimlich maneuver on yourself: » Place a fist slightly above your navel. - Grasp your fist with the other hand and bend over a hard surface. - Shove your fist inward and upward. To perform the Heimlich maneuver on a pregnant woman or obese person, the only difference is your hands should be placed higher at the base of the breast-bone, just above the joining of the lowest ribs. To perform the Heimlich maneuver on an unconscious person: -« Lower the person to their back on the floor. + Clear the airway. If the object is visible reach a finger into the 125  mouth and sweep out blocking object. Be careful not to push the object deeper into the airway. « Begin chest compressions like CPR. It may dislodge the object. To perform the Heimlich maneuver on an infant: » Sit and hold the infant face-down on your forearm, which is resting on your thigh. » Thump the infant gently but firmly five times on the middle of the back using the heel of your hand. Gravity and the thumps should dislodge the object. « Hold the infant face up on your forearm with the head lower than the chest/abdomen if the above doesn’t work. Using two fingers on the center of the breastbone, give five quick compres- slons. » Repeat as needed. Call for EM help if the item won't dislodge. If the child is older than age one, give abdominal thrusts only. Cuts and Scrapes: First Aid According to the Mayo Clinic, minor cuts and scrapes (abrasions) usually don't require emergency treatment. Yet proper care is essential to avoid infection or other complications. For example: + Stop the bleeding. Minor cuts and scrapes usually stop bleeding on their own. Apply gentle pressure with a clean cloth or bandage if they do not stop on their own. Hold the pressure continuously for 20 to 30 minutes. Don't keep checking the wound because this may disturb the freshly formed clot and cause bleeding to re- sume. If the blood spurts or continues to flow after continuous pressure, seek medical assistance. « Clean the wound. Rinse out the wound with clear water, and clean around the wound with soap and washcloth. Avoid getting soap in the wound as this may irritate rt. Use tweezers cleaned with alcohol to remove any remaining dirt or debris in the wound. See a doctor if there is any remaining debris. A thorough cleaning reduces the risk of infection and tetanus. » Apply an antibiotic. Apply a thin layer of antibiotic cream or 126  ointment to the wound after cleaning to keep the surface moist. Certain ointments may cause a mild rash. Ifa rash appears, stop using the ointment. Cover the wound. Bandages help keep the wound clean and harmful bacteria out. Change the dressing. Change the dressing at least daily or whenever it becomes wet or dirty. If allergic to bandage adhesive, switch to sterile gauze with paper tape, gauze roll or a loose elastic bandage. When a sufficient scab has formed, uncover the wound so it is exposed to open air. ‘This will speed healing time. Get stitches for deep wounds. Stitches are usually required fora wound that is more than 44 inch deep, gaping or jagged edged or has fat or muscle protruding. To reduce the risk of infection, proper closure is needed. Watch for infection. See a doctor if the wound ts not healing or there is redness, increasing pain, drainage, warmth, or swelling. Get a tetanus shot. Doctors advise you get a tetanus shot every 10 years. A doctor may suggest getting a tetanus shot booster if the wound is deep or dirty and your last shot was more than five years ago. Ifa shot is prescribed, get it within 48 hours of the injury. Dislocation: First Aid According to the Mayo Clinic, a dislocation is an injury in which the ends of your bones are forced from their normal positions. A blow or fall is usually the major cause but it could also be due to a disease, for example, rheumatoid arthritis. Dislocations may occur in major joints (shoulder, hip, knee, elbow, or ankle) or in smaller ones (finger, toe). ‘The injury will temporarily deform and tmmobilize your joint and may result in sudden and severe pain and swelling. Returning your bones to their original positions requires immediate medical atten- tion. If you believe you have dislocated a joint: « Get medical help immediately. * Do not move or force a dislocated joint back into place. ‘This can damage the joint and the surrounding muscles, ligaments, 12?  nerves or blood vessels. Apply a splint to the injury if you have been trained in doing so. + Put ice on the injured joint. This can help reduce swelling by controlling internal bleeding and fluid buildup around the joint. Fever: First Aid Fever is the body’s reaction to infection. What's normal for you may be a little higher or lower than the average temperature of 98.6° F or a rectal temperature higher than 100.4° EF An oral temperature higher than 99.4° F is considered a fever. For very young children and infants, even shghtly elevated temperatures may indicate a serious infection. In newborns, a lower temperature may indicate a serious illness. Do not treat adult fevers below 102° F with medication unless advised by a doctor. If you have a fever of 102° F or higher, a doctor may suggest taking an over-the-counter medication such as acetaminophen or ibuprofen. Adults may also use aspirin. Note: aspirin in children may trigger a rare, but potentially fatal disorder known as Reye's syn- drome. Ibuprofen is not advised for infants younger than 6 months. How to take a temperature: Today, most thermometers have digital readouts. Some take the temperature from the ear canal and can be especially useful for young children and older adults. Other types are listed below. When using a digital thermometer, be sure to read the instructions so you know what the beeps mean and when to read the temperature. Under normal circumstances, temperatures tend to be highest around 4 p.m. and lowest around 4 a.m. Because of the potential for mercury exposure or ingestion, glass mercury thermometers are no longer recommended. Orally: To take a temperature orally, place the bulb under the tongue, then close mouth gently over it for the recommended amount of time (usually three minutes); remove and read the temperature per in- structions. 128 Under the arm (axillary): Although it’s not the most accurate way to take a temperature, you can also use an oral thermometer for an armpit reading. To do so, place the thermometer under one armpit with that arm down; hold both arms across the chest; wait five minutes or as per the instructions; remove and read the temperature. Conversion lable Fahrenheit Celsius Fahrenheit Celsius 105° F 40.6° C 100° F 37.8°C 104° F 40.0° C 99° F 37.2° C 103° F 39.4° C 98° F 36.7°C 102° F 38.9°C 97° F 36.1° C 101° F 38.3° C 96° F 35.6°C An axillary reading is generally 1° F (about 0.5° C) less than an oral reading. (set medical help for a fever in these cases if an adult has a temperature of more than 103° F or has had a fever for more than three days. Call a doctor promptly if any of these signs or symptoms accompanies a fever: » A severe headache + Severe swelling of the throat « Unusual skin rash « Unusual sensitivity to bright light « A stiff neck and pain when head ts bent forward » Mental confusion + Persistent vomiting « Difficulty breathing or chest pain « Extreme listlessness or irritability « Abdominal pain or pain when urinating « Any other unexplained symptoms When reporting a fever to a doctor, don't convert the reading, just report what the reading was and how you took it. 129  Fractures: First Aid The American Academy of Orthopedic Surgeons states that a fracture is a broken bone. It requires medical attention. Call 911 or your local EM number tf the broken bone ts the result of major trauma or injury; or if: « The injured person is unresponsive, is not breathing or is not moving « There is excessive bleeding « Even gentle pressure or movement causes pain « The limb or joint appears malformed « The bone has perforated the skin + Toe or finger of the injured leg or arm is numb or bluish at the tip * You suspect a bone is broken in the neck, head, back, hip, pelvis, or upper leg Take these actions immediately while waiting for medical help: « Stop any bleeding. See the Cuts and Scrapes section or Severe Bleeding section * Immobilize the injured area. Do not try to realign the bone, but if you have been trained in how to splint and medical help ts not readily available, apply a splint to the area. » Apply ice packs to limit swelling and help relieve pain. Do not apply ice directly to skin. Instead, wrap ice in a towel, or other material. + Treat for shock. If the person feels faint or 1s breathing in short, rapid breaths, lay the person down with their head slightly lower than chest/abdomen and, if possible, elevate the legs. 130  Head Trauma: First Aid According to the American College of Emergency Physicians, most head trauma involves injuries that are minor and do not require hospitalization. However, dial 911 or call for EM assistance if any of the following signs are apparent: * Severe head or facial bleeding - Bleeding from the nose or ears * Severe headache e Change in level of consciousness for more than a few seconds; confusion « Black-and-blue discoloration below the eyes or behind the ears - Cessation of breathing « Loss of balance « Weakness; inability to use an arm or leg « Unequal pupil size - Repeated vomiting * Slurred speech » Seizures If severe head trauma occurs: - Keep the person still. Keep the person lying with their head and shoulders somewhat elevated and calm in a darkened room until medical help arrives. Do not move the person unless necessary, and avoid moving their neck. - Stop any bleeding, but if you suspect a skull fracture do not apply any direct pressure. - Watch for changes in breathing and alertness. If the person shows no signs of blood circulation (not breathing, coughing or moving), begin CPR, if trained and in accordance with company policy. 131  Heat Exhaustion: First Aid According to the Mayo Clinic, heat exhaustion is more severe than mild heat cramps but less severe than a potentially life-threatening heatstroke. Heat exhaustion usually happens unexpectedly, and occasionally occurs after excessive exercise, heavy perspiration and inadequate fluid intake. Its signs and symptoms resemble those of shock and include: « Feeling faint, dizzy or fatigued « Nausea e Heavy sweating « Rapid, weak heartbeat « Low blood pressure « Cool, moist, pale skin « Low-grade fever « Heat cramps « Headache « Dark-colored urine If you suspect heat exhaustion: * Remove the person from the sun and into a shady or air- condi- tioned site. « Lay the person down and elevate the legs and feet slightly. + Loosen or remove the person's clothing, as appropriate. « Have the person drink cool water. « Cool the person by spraying or sponging with cool water and fanning. « Monitor the person's condition. Heat exhaustion can quickly become heatstroke. Call 911 or for EM assistance if the person has a fever of more than 102° F, has fainted, 1s confused, or has a serzure. I3z  Hypothermia: First Aid Hypothermia its a condition in which your core temperature drops below the required temperature for normal metabolism and body function. Hypothermia occurs when you are exposed to freezing temperatures or a cold, damp environment for a prolonged period and when your body temperature is below 95° F. Wet or inadequate clothing, falling into cold water, and even having an uncovered head during cold weather can all increase the chances of hypothermia. Slowly developing signs and symptoms: « Shivering, mental confusion « Cold skin, pale or blue fingers & toes * Slurred speech - Fatigue, weariness « Abnormally slow breathing » Loss of coordination - Fatigue, lethargy or apathy - Confusion or memory loss Hypothermia gradually impacts a person's ability to think clearly and move, so they may be unaware they need medical help. At risk: Older adults, infants, young children, and the very lean are at particular risk, as well as those whose judgment may be impaired by intoxication, mental illness, or Alzheimer's disease. Other conditions that may influence hypothermia are malnutrition, cardiovascular disease and an under-active thyroid (hypothyroidism). To care for someone with hypothermia: « Dial 911 or call for EM assistance. If breathing stops or seems dangerously slow or shallow, begin CPR if trained and in accor- dance with company policy. 133  * Seek Warmth. If going indoors ts not possible, shield the person from the wind, cover their head, and insulate their body from the cold ground. « Remove wet clothing. Replace wet items with a warm, dry covering, if possible and appropriate. « Do not apply direct heat. Do not use hot water, a heating pad or a heating lamp to warm the victim. Instead, apply warm com- presses to the neck, chest wall and groin. Do not attempt to warm the arms and legs. Heat applied to the arms and legs forces cold blood back toward the heart, lungs and brain, causing the core body temperature to drop. ‘This can be fatal. « Do not give the person alcohol. Offer a warm non-alcoholic drink, unless the person is vomiting. +» Do not massage or rub the person. Handle those with hypother- mia gently, as they are at risk for cardiac arrest. Insect Bites and Stings: First Aid According to the Mayo Clinic, signs and symptoms of an insect bite result from venom or other substances being injected into the skin. The venom triggers an allergic reaction. The severity of the reaction depends on a person's sensitivity to the insect venom or substance. Most reactions to insect bites are minor and include swelling, redness, pain and itching. Delayed reactions for those more susceptible to allergies may include fever, hives, painful joints, and swollen glands. Those bitten or stung by an insect might suffer both immediate and delayed reactions from the same bite or sting. Only a small percent- age develop severe reactions (anaphylaxis) to insect venom. Stings from bees, wasps, hornets, yellow jackets and fire ants are typically the most taxing. Bites from mosquitoes, ticks, biting flies and some spiders also can cause reactions, some mild, some severe, depending on the type and what diseases they are carrying. For mild reactions: « Move to a safe area to avoid more stings. « Scrape or brush off the stinger with a straight-edged object, such as a credit card or the back of a knife. Wash the affected area 134  with soap and water. Do not try to pull out the stinger. Doing so may release more venom. -» Apply a cold pack or cloth filled with ice to reduce pain and swelling. -» Apply hydrocortisone cream (0.5% or 1%), calamine lotion ora baking soda paste - with a ratio of three teaspoons baking soda to one teaspoon water - to the bite/sting several times a day until symptoms subside. » Take an antihistamine containing diphenhydramine or chlor- pheniramine maleate. Allergic reactions may include mild nausea and intestinal cramps, diarrhea or swelling larger than 2 inches in diameter at the sting site. See a doctor promptly if you experience any of these reactions. For severe reactions, dial 911 or call for EM assistance if the person experiences: « Difficulty breathing « Swelling of the lips or throat « Faintness, dizziness, confusion « Rapid heartbeat « Hives « Nausea, cramps and vomiting « Severe allergic reactions may progress rapidly. If so, take the actions described under the Anaphylaxis section above while waiting for medical help. Overdoses: First Aid Drug overdoses can be accidental or intentional. The amount of a certain drug needed to cause an overdose varies with the type of drug and the person taking it. Overdoses from prescription or over- the-counter medicines, “street” drugs, and/or alcohol can be life- threatening. Mixing certain medications or “street” drugs with alcohol can also be deadly. 135 Physical symptoms of a drug overdose vary with the drug type. They include: Abnormal breathing Slurred speech Lack of coordination Slow or rapid pulse Low or elevated body temperature Enlarged or small eye pupils Reddish face Heavy sweating Drowsiness Delusions and/or hallucinations. If you suspect someone has overdosed, call 911 and follow the Poisoning: First Aid instructions below. Poisoning: First Aid The U.S. Department of Health and Human Services asserts that many conditions mimic the signs and symptoms of poisoning, including a seizure, alcohol intoxication, stroke, and insulin reaction. Carefully considering all of those options are important when determining poisoning. Signs and symptoms of potsoning include: Redness or burns around the mouth (if poison was swallowed) Breath that smells like chemicals, such as gasoline or paint thinner Burns, stains and odors on the person, the person's clothing, or the furniture, floor, or other objects in the area Empty medication bottles and scattered pills Vomiting, difficulty breathing, sleepiness, confusion or other unexpected signs 136 Call 911 or your local EM number immediately if the person ts: Drowsy or unconscious Having difficulty breathing or has stopped breathing « Uncontrollably restless or agitated « Having seizures If you suspect poisoning even if the person exhibits no signs and seems stable, call the Poison Control Center at 800-222-1222 (USA). Describe the person's symptoms and, if possible, what was ingested, how much and when. While waiting for help, consider doing the following. If the poison was: - Poisonous fumes, such as carbon monoxide, get the person into fresh air immediately. -« Swallowed, remove anything remaining in the mouth. « A household cleaner or other chemical, read the label and follow instructions for accidental poisoning. If the product is toxic, the label will likely advise you to call the Poison Control Center at 800-222-1222. If you cannot determine the poison, if there are no instructions, or if it 1s a medication, call this number as well. « Follow Poison Control Center's treatment directions. « Remove clothing if the poison spilled on the person's clothing, skin or eyes. Flush the skin or eyes with cool or lukewarm water, using a shower if needed, for 20 minutes or until help arrives. - Bring the poison container (or any pill bottles) with you to the hospital. What NOT to do: Do not administer ipecac syrup or induce vomiting. The American Academy of Pediatrics asserts that there is no good evidence proving ipecac is helpful and suggests that it should not be kept in the house. ‘They stated that it may even cause more harm than good. 137  Puncture Wounds: First Aid A puncture wound does not usually cause excessive bleeding. Often the wound seems to close almost instantly, but that does not mean treatment is not necessary. A puncture wound — such as results from stepping on a nail — can be dangerous because there ts the risk of infection. The puncturing object may carry tetanus or other bacteria, especially if exposed to the soil. Puncture wounds resulting from bites, including those of domestic dogs and cats, may be especially prone to infection, as are puncture wounds on the foot. For most punctures, follow the steps under “Cuts and Scrapes: First Aid”. If the puncture is deep, continues to bleed, is in your foot, is contami- nated, or due to an animal bite, consult a doctor who will evaluate, clean and, if needed, close the wound. ‘The doctor may also recom- mend a tetanus shot booster within 48 hours of the injury, if the wounded has not had a tetanus shot within five years. If an animal — especially a stray dog or wild animal — is the biter, you may have been exposed to rabies. A doctor may prescribe antibiotics and a series of rabies vaccinations. Cases of rabies should be reported to county health officials. If you suspect your pet has rabies, have it confined for 10 days of observation by a veterinarian. Severe Bleeding: First Aid Severe bleeding requires different treatment than minor scrapes and cuts and must be tended to promptly. Look for signs of heavy bleed- ing or blood gushing from the wound. Cover the wound with gauze or medical dressing, if clotting doesn't begin to occur within a few minutes, seek medical attention immediately. For other cases of severe bleeding, follow these steps: +» Sanitize your hands. If available before you try to stop severe bleeding, wash your hands to avoid infection and put on synthetic gloves. 138 Lie the injured person down. If possible, position the person's head slightly lower than the chest/abdomen or elevate the legs. This reduces the risk of fainting by increasing blood flow to the brain. If possible, elevate what's bleeding. While wearing gloves, remove any loose dirt/debris from the wound. Do not remove any large or more deeply embedded objects. Do not probe the wound or clean it at this point. Stop the bleeding first. Apply pressure directly on the wound. Use a sterile bandage or clean cloth. If nothing else 1s available, use your hand. Maintain pressure until the bleeding stops. Hold continuous pressure for at least 20 minutes without looking to see if the bleeding has stopped. You can sustain pressure by binding the wound tightly with a bandage (or even a piece of clean clothing) and adhesive tape. Do not remove the gauze or bandage. If the bleeding continues and seeps through the gauze or other material you are holding on the wound, do not remove tt. Instead, add more absorbent material on top of it. Squeeze a main artery if mecessary. If the bleeding & 5 does not stop with direct pressure, apply pressure a 4, or a tourniquet to the artery delivering blood to the if at wound area. Artery pressure points are on the Ay of inside of the arm just above the elbow and just Jiko vA \ below the armpit, just behind the knee, and in the we Eto groin. To apply pressure, squeeze the main artery at 1 fog the pressure point against the bone. Keep your i | | fingers flat. With your other hand, continue to put pressure on the wound itself. a Immobilize the injured body part once the bleeding has stopped. Leave the bandages in place and get the person to the emergency room as soon as possible. If you suspect internal bleeding, call 911 or your local EM number. lf the bleeding is severe and cannot be controlled by direct pressure and squeezing an artery, consider using a tourniquet. A tourniquet can be applied to an extremity (arm or leg) using a variety of materials (such as a belt and a stick). You want to apply the tourniquet above the wound and you want it as tight as is necessary to slow or stop the bleeding. 139 Signs of internal bleeding may include: « Bleeding from body cavities (such as the ears, nose, rectum, etc.) « Vomiting or coughing up blood « Bruising on neck, chest, abdomen or side (between ribs and hip) e Wounds that have penetrated the skull, chest or abdomen « Abdominal tenderness, possibly accompanied by rigidity or spasm of abdominal muscles « Fractures - Shock Shock: First Aid Shock may result from trauma, heart conditions (heart attack; heart failure), heavy internal or external bleeding, severe allergic reactions or infections, burns, or even dehydration. Signs and Symptoms of Shock: « Cool, clammy skin, possibly pale or gray. Lips and fingernails may be bluish in color. « Low blood pressure with a weak and rapid pulse. « Slow, shallow breathing, or hyper-ventilation (rapid or deep breathing). « Feelings of nausea and chest pains. « Eyes staring and/or glossy. Sometimes the pupils are dilated. « Unconscious or if conscious, then faint, very weak or confused. Person may become overly excited and anxious. If the person acts normal but you suspect shock: « Dial 911 or call the local EM number. « Have the person lie down on the person's back with their feet elevated eight inches or so above the ground. If raising the legs will cause pain or further injury, keep the person flat. Keep the person still. 140  « Check for signs of circulation (breathing, coughing or move- ment). If absent, begin CPR, if trained and in accordance with company policy. - Keep the person warm and comfortable. Loosen any belt and tight clothing and cover the person with a blanket. Even if the victim ts thirsty, give nothing by mouth. - Turn the person on their side to prevent choking if they vomit or bleed from the mouth. >» Seek treatment for injuries, such as bleeding or broken bones. Spinal Injury: First Aid If you suspect a back or neck (spinal) injury, do not move the affected person. Permanent paralysis and other serious complica- tions can result. Assume a person has a spinal injury if: « There its evidence of a head injury with an ongoing change in consciousness » There is severe neck or back pain « The person will not move their neck - An injury has exerted substantial force on the back or head « The person complains of weakness, numbness, or paralysis, or lacks control of their limbs, bladder, or bowel * Their neck or back is twisted or positioned oddly. If you suspect someone has a spinal injury: « Dial 911 or call for EM assistance. * Keep the person still and in the same position as found in. Place heavy towels on both sides of their neck, or hold their head and neck to prevent movement. *« Provide as much first aid as possible without moving person's head or neck. If the person is not breathing, coughing or moving, begin CPR (if trained in accordance with company policy), but do not tilt the head back to open the airway. Use fingers to gently grasp the jaw and lift it forward. 141  « If you absolutely must roll the person because the person ts choking on blood or vomit or is in danger of further injury, use at least two people. Work together to keep the person's head, neck, and back aligned while rolling. Sprain: First Aid Ligaments are the tough, elastic-like tissue that attach to your bones and hold your joints in place. A sprain is an injury to a ligament caused by excessive stretching. The ligament can have tears in it or it can be completely torn apart. Ankle and knee sprains occur most often. Sprained ligaments swell rapidly and are painful. Generally, the greater the pain, the more severe the injury. Follow the instructions for R.L.C.E.: « Rest the injured limb, but do not avoid all activity. « Ice the area. Use a cold pack or a slush bath to help limit swelling right after the injury. If ice is used, do not use it for too long as this could cause tissue damage. « Compress the area with a wrap or bandage. » Elevate the injured limb whenever possible to help prevent or limit swelling. After the first two days, gently begin using the injured area. You should feel a gradual, progressive improvement. Over-the-counter pain relievers such as ibuprofen and acetaminophen may be helpful to manage pain during the healing process. Get emergency medical assistamce if: « Torn ligament: you heard a popping sound when the joint was injured; you can't use the joint; or you feel unstable when you try to bear weight on it. « Infection: you have a fever higher than 100° F and the area ts red and hot. * Severe sprain: inadequate or delayed treatment has caused long- term joint instability or chronic pain. « There is no improvement after 2 or 3 days. 142  Stroke: First Aid A stroke occurs when there is bleeding into the brain, or normal blood flow is blocked to the brain. Within minutes of being deprived of vital nutrients, brain cells start dying. Seek immediate EM assis- tance because every moment counts. The sooner treatment ts given, the more likely damage can be mini- mized. If you notice a sudden onset of one or more of the following symptoms, call 911 or your local EM number ASAP: - Sudden weakness or numbness in face, arm or leg on one side of your body e Sudden dimness, blurring or loss of vision, particularly in one eye « Loss of speech or trouble talking or understanding speech « Sudden, severe headache - a bolt out of the blue - with no appar- ent cause « Unexplained dizziness, unsteadiness or a sudden fall Risk factors for stroke include smoking, high blood pressure, a previous stroke, diabetes or heart disease. Your risk of stroke increas- €5 as you age. Sources The information listed in the First Aid section was gathered from the following websites. For further information regarding proper admin- istration of first aid or medical emergencies please visit one of the following websites. www. mayoclinic.com; www. webmd.com; we. ameriburn.org www.heartorg, www.emedicinehealth.com 143  First Aid Questions and Answers What are the four primary purposes of first aid training? a First aid training is useful in: 1. Preventing and caring for accidental injury or sudden ilness 2. Caring for persons caught in a natural disaster 3. Equipping individuals with the information to deal with the whole situation, the person, the injury or the illness 4. Distinguishing between what to do and what not to do What should be done to summon emergency assistance? Pe To summon emergency assistance, dial 911 if a phone ts available. If that does not put you in contact with assistance, dial 0 (Opera- tor). Give the location of the emergency as accurately as possible, and the type of emergency that exists. Stay on the phone in case more information is needed. If you must stay at the scene, send the first available person to summon help. Notify the company dispatcher. What basic principles should be remembered when adminis- tering first aid? When administering first aid, remember to: 1. Not move the patient unless necessary to remove the patient from imminent danger or harm 2. Avoid or overcome chilling by using blankets or covers, if available 3. Determine, if possible, the injury(ies) or cause(s) of illness 4. Examine the patient carefully and methodically; have a reason for what you do 5. Loosen constricting clothing, as appropriate and necessary 6. Note the patient's general appearance; check their pulse 7. If patient is unconscious, look for evidence of head injury What is the first thing that must be done in giving first aid treatment? The first thing to do when giving first aid treatment is to secure the scene and ensure that the persons offering first aid, and then the patient, are not in harm's way (especially on a highway). 144 Q. What are the general directions for first aid treatment for shock? A. Ifa patient 1s in shock, maintain the patient's body heat (but do not add heat); and elevate the person's feet about 8 inches, if raising the legs will cause pain or further injury, keep the person flat. Q. What ts an infection? A An infection is the growth of harmful germs in any internal or external wound. ©. How do most serious infections and cases of blood poisoning start? A. Serious infection and blood poisoning most often start from very small wounds, particularly on hands and feet. Q. What is the risk of disease transmission while administering first aid? A. There is a potential risk of disease transmission, but there are no known cases involving first aid treatment. ©. What steps can be taken to minimize the risk of disease transmission during first aid? A. The steps that can be taken include: 1. Avoid contact with bodily fluids when possible. 2. Place barriers such as disposable gloves or a clean dry cloth between the patient's body fluids and yourself. 3. Wear protective clothing to cover any cuts, scrapes or skin conditions that you may have. 4. Wash your hands with soap and water ASAP before and after giving care. 5. Do not eat, drink or touch your mouth, nose or eyes when giving first aid. 6. Do not touch objects that maybe soiled with blood. Q. What are the signs of internal bleeding? A. The signs of internal bleeding are: 1. Tender, bruised or hard areas of the body such as the abdomen Rapid, weak pulse WI me ke be Skin is cool, moist, pale or bluish Excessive thirst Becoming confused, faint, drowsy or unconscious 145  What should you do before attempting to give first aid toa person who is conscious? Get the victim's permission. Do not attempt to give first ard against the victim's wishes. What conditions exhibited by a patient clearly indicate the need to obtain professional help? Professional assistance should be sought when the patient: 1. Is unconscious or becomes unconscious Has trouble breathing or is breathing in a strange way wh Has chest pain or pressure Is bleeding severely Is vomiting or passing blood NAY Has seizures, a severe headache or slurred speech Exhibits signs of poisoning Has head, neck or back injury eae Has possible broken bones Barring an immediate life-threatening situation, what actions must be taken by the first-aid provider before moving a patient? Before moving a patient, the first-aid provider should: 1. (Care for breathing, circulation and hemorrhaging 2. Dress wounds 3. Immobuilize fractures What circumstances justify immediate rescue efforts? a Immediate rescue is warranted when one or more of the follow- ing exists: 1. Danger of fire or explosion 2. Serious traffic hazards Risk of drowning Exposure to extreme cold, heat or severe weather Tm Danger of a collapsing structure(s) Electrical injury or potential injury Oo SO Pinning by machinery Asphyxia due to a lack of oxygen or the presence of toxic gases, but only if the first-aid provider is trained on how to identify and protect their own self from oxygen-deficient air 146 Q. Ifthe first-aid provider must attempt immediate movement, what principles must be observed to minimize further injury? A. To minimize the risk of further injury, the first-aid provider should: 1. Protect all parts of the body from the tensions of lifting 2. Provide support for the arms, legs, head, and back, keeping the body in a straight line and from moving as little as possible. ©. How should the seriously injured be transported? A. A seriously injured patient should be transported on a stretcher or backboard, lying face up. Possible fractures must be immobi- lized before transportation. Q. What are the basic objectives in the first aid care of a wound? A. ‘The first-aid provider's primary objectives are to control bleeding, protect the wound from contamination, and treat for shock while remembering to protect themselves from blood-borne diseases (e.¢., by wearing rubber gloves). ©. Is the loss of two pints of blood at one time serious or possibly fatal? A. Yes. Losing two pints of blood at one time ts serious or possibly fatal. Q. When should a tourniquet be used? A. A tourniquet should be used only for severe life-threatening hemorrhages (from an arm or leg) that cannot be controlled by other means. ©. Why should bandages be examined frequently after applica- tion? A. Swelling usually follows an injury and the bandage, which was just right when applied, may become too tight later on, cutting off the blood supply. ©. What is the difference between a closed and open fracture? A. An open fracture is a break in a bone with a wound extending from the break through the surface of the skin. There is no such wound associated with a closed fracture. 147  What are the most common methods of administering artifi- cial respiration? ‘The two most common methods of administering artificial respiration are by mouth-to-mouth or mouth-to-nose. What are the advantages of mouth-to-mouth or mouth-to- nose artificial respiration? Mouth-to-mouth and mouth-to-nose artificial respiration provide oxygen to inflate the patient's lungs. It also enables the first-aid provider to look, listen and feel that air is being moved in and out of the patient's lungs. Is giving mouth-to-mouth or mouth-to-nose artificial respira- tion likely to transmit disease? ‘The potential that a disease can be transmitted from mouth-to- mouth or mouth-to-nose exists although there are no known instances of disease being so transmitted. Face shields and masks are available which can be used to avoid direct contact with a victim of a breathing emergency. Note: those not trained should administer compressions only, not mouth-to-mouth. Why ts fast action important if a person stops breathing for any reason? Unless given artificial respiration, most persons will suffer irreversible brain damage within 4-6 minutes or less if breathing stops completely. Under what conditions may artificial respiration be helpful? Pe Artificial respiration may be life-saving if administered to non- breathing victims of: 1. Electric shock 2. Drowning 3. Poisoning by gas or respiration depressing drugs, such as morphine, barbiturates, and alcohol 4. Compression of the chest Choking, partial obstruction of the breathing passages mw In some cases of gas and drug poisoning breathing may be extremely slow and shallow. 148 Q. Under what conditions ts it most likely necessary to administer artificial respiration for an extended period of time? A. Extended artificial respiration is most likely necessary with carbon monoxide poisoning, a drug overdose, near drowning (especially in cold water), or if electric shock are involved. ©. What are symptoms of recovery from a cardiac arrest? A. Typical symptoms of recovery are: 1. Skin tone becomes flushed Pulse normalizes atl a Mouth twitches Tee Pingertips creep “Catch-of-the-breath,” followed by a groan and gasping breaths 6. Breathing efforts readily detected Note: CPR should be administered by those who are trained. Drivers should also check their company policies regarding using CPR while on the job. ©. What are some of the special characteristics of electrical burns? A. The special characteristics of electrical burns are: 1. ‘The burns are often deep and may be accompanied by other problems such as the patient stops breathing and/or loses consciousness. 2. ‘There may be two external burns: one where the current entered the victim's body and one where the current exited. ©. What special precautions should be taken in dealing with a possible victim of electrical burns? A. When treating a person who has or may have suffered electrical burns, the first-aid provider should not approach the patient until the provider is certain that the power ts off. In case of a motor vehicle accident with downed wires, the first-aid provider should warn the patient not to move and to stay in the vehicle until the power is off. 149 Q. How can the ill effects of excessive heat be prevented? A. To prevent the ill effects of excessive heat, a driver should: Drink water led Dress lightly Eat lightly of easily digested foods like applesauce Avoid exposure to direct sun Avoid alcoholic, carbonated, caffeinated, and iced drinks 150  Health, Wellness, and Injury Prevention Truck driver health and wellness is important to ensure alert, atten- tive driving for overall safety on the nation’s highways. Studies show that drivers who are generally more health conscious and physically fit are more likely to maintain continuously high levels of driving alertness and attention. Nutrition: In order to perform at peak levels, the human body re- quires a healthy dose of proper nutrition. There are a few basic tips to remember to help stay healthy and alert to do one's job safely. Eat breakfast - it is the most important meal of the day. — 4 Eat small, frequent meals throughout the day to balance out ad blood sugar. Drink plenty of water. Limit refined foods such as white sugar and bleached flour. Ue Avoid fried foods and excess salt. Include plenty of fresh fruit and vegetables and stay away from junk food. Reduce trans-fats in foods and in food preparation which has been linked to heart disease. Most people know what constitutes good nutrition but fail to practice it in their everyday life. Por those drivers who are on the road much of the time, proper eating habits are even more important. Try to plan ahead and pack fruit and healthy snacks for times when you get hungry. Carry plenty of water with you and train yourself to drink it throughout the day. Exercise: Just as nutrition ts critical to a body's wellbeing, so is exer- cise. Regular exercise, consisting of extended periods of movement, helps the body to stay healthy and strong and have more vitality. It permits one to work strong too. The body ts built to move, not sit. Since drivers spend so much time sitting behind the wheel of a vehicle, they must make a concerted effort to get out and get moving or exercise when the vehicle is stopped. Keep it simple, move anywhere. Physical activity is what matters. Walking up stairs or around the truck a time or two every time it's parked, and/or taking the long way around buildings are easy ways to 151 stay active. It is recommended that a person start with 5-10 minutes of physical activity per day and work up to 30 minutes. Small im- provements to a driver's exercise regimen and frequent stretching can have a great impact on their physical and mental health. Sufficient Sleep and Rest: Getting sufficient sleep its an important component of any healthy lifestyle. Although each person has an individual sleep need, most adults require an average of seven to eight hours of sleep to feel alert and well rested. Lack of sufficient sleep can also undermine your physical and mental health. Sleep deprivation has been found to weaken the body's immune system, leaving you more susceptible to colds, diseases, and disorders such as diabetes, high blood pressure, and cardiovascular disease. It can also cause confusion, lack of concentration, memory loss, irritability, depres- sion, emotional highs and lows, as well as stress. It affects job perfor- mance and increases accidents and injuries. Obesity has also been associated with sleep deprivation as hormones are altered, causing an increase In appetite, according to the Annals of Internal Medicine. One of the causes of sleeplessness is obstructive sleep apnea (OSA) which is caused by a blockage of the airway. Breathing stops repeated- ly during sleep, causing the brain to arouse the sleeper in order to resume breathing. Sleep is therefore fragmented and of poor quality. The National Institutes of Health (NIH) report that more than 12 mil- lion Americans are affected by sleep apnea. The most affected popula- tions include males, and those who are overweight and over the age of 40, but anyone can be diagnosed. It ts treatable, but only tf it is diagnosed. Prevention: A healthy lifestyle includes more than eating, sleeping, and exercising well. It means avoiding unhealthy habits like smoking, drugs, and alcohol. It means maintaining a healthy weight, a good hygiene regimen, and getting regular check-ups to test cholesterol, blood pressure, and blood sugar levels. It also means strictly following the doctor's orders and taking all prescriptions exactly as instructed. Research has also linked poor oral (dental) hygiene to an increased risk of cardiovascular disease and other serious ailments. It 1s import- ant to brush, floss, and get your teeth cleaned regularly to not only make a good impression but to prevent plaque buildup, gingivitis or periodontal disease which causes gums to inflame and bleed, teeth to 152 be lost, and bacteria to be released into the bloodstream. ‘This can result in inflammation or thickening of the carotid arteries, which can contribute to a heart attack or stroke. Coronavirus Disease 2019 (COVID-19): COVID-19 is a respiratory disease caused by SARS-CoV-2, discovered in 2019. The virus spreads mainly from person to person through respiratory droplets produced when an infected person coughs, sneezes, or talks. Some people who are infected may not have symptoms. For people who have symp- toms, ilness can range from mild to severe. Symptoms may appear within 2 - 14 days after someone ts exposed and can include fever, chills, and cough. Vaccines are recommended to decrease severity and prevent the spread of the virus. Influenza: Influenza, or the flu is a virus that attacks the respiratory systems of humans, mammials, and birds. The Centers for Disease Control and Prevention'’s (CDC) estimated that during the 2019- 2020 influenza season, 38 million illnesses, 18 million medical visits, 405,000 hospitalizations, and 22,000 deaths were a result of regular seasonal epidemics in the United States, but occasionally strains of influenza recombine to form a new strain to which human immune systems have no resistance. These new strains are the sources of pandemic influenza such as the 1918 Spanish Flu or the 2009 H1IN1 influenza outbreaks. Depending on how flu strains recombine, they can be highly contagious, highly deadly, or both. Drivers should be aware of what the flu is (both seasonal and new strains) and how it spreads. Influenza primarily spreads through airborne passage although the virus can live on surfaces for several hours. As a general precaution, drivers should wash their hands frequently and avoid touching their eyes, nose, and mouth during the flu season. Those showing symptoms should stay home from work and avoid contact with others while their symptoms persist for a few days after. Sneeze and cough into your arm rather than your hand. In the case of a pandemic, the U.S. government will provide specific information through the CDC. The most current information is on their website at www.cdc.gov. Drivers should always follow the advice of hicensed medical professionals, first and foremost when making personal health decisions. 153 Health officials have recommended that companies issue isolation and quarantine guidelines; coordinate or know where area treatment centers are or will be; coordinate delivery and allocation of vaccines and anti- viral; have a priority list of those first to recerve the vaccine and work that needs to be done; have a communication system in place and be prepared to expand ongoing surveillance of the situation. They suggest stockpiling supplies now, including water, first aid supplies, etc. Slips, Trips, and Falls: Slips occur due to a loss of traction. Trips result when a foot hits an object. Falls occur when one's balance ts lost. 80% of accidents on stairs result in serious injury. Research indicates that if your head makes contact with a solid object at a speed of only 2.5 mph, the force generated is sufficient to crack a skull open. Know your hazards! When getting in and out of your cab, use the three- point rule; that is, maintain three points of contact at all tumes! Avoid bad habits such as jumping, over-extending and being in a hurry. Getting in and out of a truck safely is easy to take for granted. Think about your stake in taking care of yourself. Think about what could happen if you fell from your cab or trailer. Be especially careful when coupling and uncoupling. Be alert around loading docks. Watch for oil and grease, slippery ramps, stairs and platforms, and other hazards that could contribute to a slip, trip or fall. Wear appropriate clothing and footwear. Bad weather requires extra caution due to slippery conditions. Proper Lifting: According to the Bureau of Labor Statistics (BLS), more than one million workers suffer back injuries each year, with back injuries accounting for one out of every five workplace injuries and ilnesses. A BLS survey showed that four out of five of these injuries were to the lower back, and that three out of four occurred while lifting. This survey also shows the importance of reducing back injuries caused by lifting. Improper lifting techniques can lead to back, leg and arm pain, and can cause both acute injury and serious chronic effects. Learning the right way to lift will help you avoid these problems. Plan ahead before lifting. Stretch. Know what you are doing and where you are going. It will prevent you from making awkward moves while holding something heavy. Whether you are positioning a dock plate, rolling up a trailer door, or lifting a box, learn and use the proper lifting techniques to reduce injury. 154  » Lift close to your body. You will be stronger and more stable if the object 1s held close to your body rather than at the end of your reach. - Keep your feet about shoulder width apart and take small steps. A solid base of support is important while lifting. - Tighten your stomach muscles. Tightening your abdominal muscles will hold your back in a good lifting position and will prevent excess force on the spine. » Lift with your legs. Your legs are many times stronger than your back muscles. Let strength work in your favor. Bend your knees, not your back. Keep your eyes focused upwards to keep your back straight. If you are straining, then get help. If the object ts too awkward or too heavy, then get help. Preparation for a Physical: Whether you're preparing for your physical exam or the start of your workday, remember the following: « If you've been prescribed medication for blood pressure, diabetes, etc., TAKE IT. - Refrain from smoking. Smoking actually raises your blood pressure. - Drink plenty of water. Dehydration can lead to fatigue and overeating. - Avoid sugar and unhealthy foods like candy, cookies, cakes, pies, crackers, chips, biscuits, pizza and Chinese food. They are high in fat, sugar and sodium, which have a direct effect on your biomet- ric readings which are taken during a physical - Walk. A 15 minute walk can lower blood sugar levels by 20%. 155  Health, Wellness and jnjury Prevention Questions and Answers What is diabetes? ei Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. The cause of diabetes continues to be a mystery, al- though both genetic and environmental factors such as obesity and lack of exercise have been found to trigger the onset of the disease. What are symptoms of diabetes? ee Typical signs of diabetes include:. Frequent urination Ne Excessive thirst Extreme hunger Ln ew Increased fatigue Unusual weight loss Irritability Ss Blurry vision What are some easy ways to improve your nutrition? a) There are several painless ways to incorporate better foods into your diet. 1. Have a piece of fruit for a mid-morning snack 2. Substitute whole grains for processed foods; for example, brown rice, wheat bread 3. Drink at least one glass of water for every cup of coffee or can of soda 4. Eat one less sweet; for example, cookie, cake, ice cream, per day What can a driver do to keep physically fit? a) ‘The prime requisites for keeping fit are plenty of rest and no over- indulgence that would result in abuse of the body. Annual physical exams are beneficial, as are daily exercise and good eating habits. Loe Q. What is the proper way to lift a heavy object? A. When it is necessary to lift a heavy object, lifters should place their feet conveniently close to the object (about shoulder width apart), get a sure grip with their hands, and attempt to lift gradu- ally keeping the back straight, with the legs and thigh muscles bearing the load. In lifting, the amount of force that is exerted on the structures of the back is approximately eight to ten times greater with the back bent than with the back straight. Both a strain and hernia (rupture) are more apt to be avoided if proper lifting methods are used. In addition to proper lifting techniques, what steps can be taken to avoid lifting and carrying injuries? To further avoid lifting or carrying accidents and injuries, the lifter could: 1. Get assistance to handle objects that are too big or heavy for one person to handle. 2. When more than one person is involved, make sure every- body works as a team. One person should be in charge and give all signals for lifting, moving and setting down the object. 3. Make sure that the lifters can always see where they are going. How can a driver avoid injury when it is necessary to turn while carrying or lifting a heavy object? When a turn is necessary during a lift or while carrying an object, lifters should shift their feet to avoid twisting the body. Twisting the body puts great strain on the back muscles and increases the likelihood of injury. Q. What precautions can easily be taken to avoid hand injuries when moving freight? A. To avoid hand injuries when moving freight, the mover/lifter can: 1. Wear gloves, if available. 2. Inspect the article to be moved; look for splinters, protrud- ing nails or other rough surfaces and remove them or avoid them as handholds. 3. Place hands where they cannot be caught between the object being moved and any other nearby object. 4. Always avoid moving any object by grasping steel strapping. 157 Q. What precautions should be taken by a driver to avoid injury when working around the vehicle? A. To avoid injury around a vehicle, a driver should: 1. Always be sure of the foot and hand holds when climbing into or out of the cargo space, when climbing up behind the cab to connect air and light lines, and when getting in and out of the cab. [NOTE: some airlines may be connected from the ground.] 2. Avoid jumping out of the cab. 3. Use a flashlight when working around equipment at night. Q. How should drivers protect themselves against injury when closing overhead doors? A. To avoid injury when closing overhead doors, a driver should: 1. Dismount from the cargo space and use the rope or strap to pull the door down from ground level. 2. If no rope or strap ts available, pull the door slowly down- ward to where it can be reached from the ground; dismount from the truck or trailer body; pull the door to its closed position. Be sure to have the door strap replaced or installed. 3. Take care to avoid hand injuries when securing the door latch. Q. What hazards should the driver be alert to when using power tailgates (also called liftgates)? A. When using power tailgates, a driver should: 1. Be cautious of the numerous pinch points between the operating level and the body assembly, and between the gate itself and the cargo body. The driver must keep fingers, hands and arms clear of these points. Never ride the lift-gate down. he Make sure that the freight is strapped to the gate if it Is unstable. 158 What hazards should the driver be aware of and alert to when opening swing-back doors on a truck or trailer? When opening swing-back doors, a driver should be careful of: 1. ‘The pinch-points of the latching mechanism 2. The possibility that freight may fall out onto the driver - the driver should use the door as a shield 3. The possibility that a gust of wind will catch the door and cause it to injure the driver 4. Pinch-points on the door tie-backs What is the proper way to lift a roll up door or dock plates? To lift a roll up door or dock plate, a driver should always use proper lifting techniques, including lifting with the legs, rather than the arms and/or back. 159  FIRE SAFETY This chapter provides a brief overview on the statistics, potential risk, and requirements related to vehicle fires, and basic procedures in the event of a vehicle fire. This chapter is neither intended to answer all questions related to building or vehicle fires nor be a fire prevention and response guidebook. Readers should defer to their company’s policies and procedures related to the subject, seek training, as needed, and remain up-to-date on the laws governing the subject. Being prepared is critical. Fires can be very dangerous and you should always take steps to protect yourself or others when attempting to put out a fire. For this reason, when a fire is discovered: « Assist those in immediate danger to safety (1f able, without risk to you). « Activate the building fire alarm or notify the fire department by calling 911. When you activate the fire alarm, it will automatically notify the fire department. It will also sound the building alarm to notify other occupants, and shut down the air handling units to prevent the spread of smoke. e Only after having taken the above two actions and only if the fire is small, should you attempt to use an extinguisher. Before deciding to fight a fire, keep these rules in mind: « Know what ts burning. If you do not know what ts burning, then you do not know what type of extinguisher to use. Even if you have an ABC extinguisher, there may be something in the fire that is going to explode or produce highly toxic smoke. If you do not know what is burning, let the fire department handle it. * Determine tif the fire is spreading fast. The time to use an extinguisher ts in the beginning stages ofa fire. If the fire ts spreading quickly, then tt is best to simply evacuate the building, closing doors and windows behind you as you leave. Do not fight the fire if: « You do not have the correct type or size extinguisher. 16d  « The fire is producing lots of smoke that you would have to breath in order to fight it. Any sort of combustion will produce some carbon monoxide, but when synthetic materials such as nylon in carpeting or foam padding in sofas burn, they can produce highly toxic gases such as hydrogen cyanide, acrolein and ammonia in addition to carbon monoxide. These gases can be fatal even in very small amounts. - Your instincts tell you not to or you are uncomfortable with the situation for any reason. Just let the fire department do tts job. The final rule is to always give yourself a means of quick escape (be near an exit) before attempting to use a fire extinguisher. If the extinguisher malfunctions, or something unexpected happens, then you need to be able to get out fast, and you don’t want to become trapped. Just remember, always keep an exit at your back. (Source: National Fire Protection Association) How Vehicle Fires Happen: According to the National Fire Protection Association, 13% of all fires reported in the U.S. are highway vehicle fires. In 2021, there were 208,500 vehicle fires. 680 civilians died and another 1,500 were injured as a result of these 2021 wehicle fires which also resulted in $2.1 billion in property loss. 17% of all civilian fire deaths and 7% of all civilian fire injuries are attributable to vehicle fire. Statistically, highway vehicle fires occur 65% of the time in passenger vehicles. Only 10% of the time does a vehicle fire occur in a non- pas- senger vehicle with 6% of those in freight road transport vehicles. 47% of vehicle fires are due to some sort of mechanical failure. 63% of all vehicle fires and 36% of fatal highway vehicle fires originate in the engine, running gear or wheel area of the vehicle. Of those fires, 22% resulted from heat from miscellaneous powered equipment; 16% from electrical arcing; 17% from radiated or conducted heat from operating equipment; and 8% from a spark, ember or flame from operating equipment. Sparks that resulted from friction only made up 5% of the fires. Insulation around electrical wiring (29%) and flam- mable liquids in the engine area (18%) were the most common items first ignited. (Source: U.S. Fire Administration - 2014-2016 and 2021 Vehicle Fires Special Reports) 1lél Fire extinguisher inspection ts a vital part of a driver's daily vehicle inspection process. The FMCSRs require that the fire extinguisher must be designed, constructed and maintained to permit visual determination of whether it ts fully charged. It must be filled and located so that rt is readily accessible for use. And, tt must be securely mounted to prevent sliding, rolling, or vertical movement relative to the motor vehicle. l6ez  Fire Safety Questions and Answers Why is tt important for the driver to know the nature of the cargo in case of fire? ‘The nature of the cargo can greatly affect the severity of a fire on the vehicle. For example, paper, clothing or upholstered furniture will add more fuel to a fire than steel coils. What should a professional driver do if their truck is on fire? Most importantly, the driver should: 1. Stay calm and signal that the driver is moving to the shoul- der of the roadway; 2. Come to a complete stop as soon as possible; 3. Shut off the engine and turn off the ignition; 4. Remember to leave the vehicle in park or in a gear so it doesn't continue to move; 5. Grab the fire extinguisher, and if immediately available, grab any emergency procedures documents specific to the load; 6. Get out and away, and ensure others are away, from the burning vehicle; Call the fire department by dialing 911 or the local emer- | gency telephone number. Is it true that steel-belted radial truck tires are not subject to tire fires? No. The use of steel cord in steel-belted radial truck tires does not make these tires fireproof. Steel-belted radial truck tires have no inner tube or flap, so it may take longer for a tire of this construc- tion to reach its ignition temperature, but it can, with time. How can tire fires be prevented? Tire fires can be prevented by regularly checking all tires to be sure that they are properly inflated so that excessive internal heat will not build up. Care should also be taken to avoid overloading and driving at excessive speed in hot weather. How should the driver check tire temperature? To check tire temperature, the driver should place the back of their hand over and near the tire. If you feel strong heat, it is too hot to drive on. 163  Will the FMCSR-required extinguisher extinguish a tire? a No. ‘The extinguisher may briefly control the surface flames, but after the extinguisher has been emptied, the tire 1s likely to re-flash because of the heat built up deep inside the tire carcass. Q. What precautions can a driver take to minimize the risk of electrical fire? To minimize the risk of electrical fires, a professional driver should: 1. Be sure the battery 1s properly secured. 2. Look for worn, deteriorated or charred insulation on wiring. Report any such condition to the maintenance shop. 3. Not bypass or interfere with the normal functioning of fuses and circuit breakers. 4. Not install personal electrical equipment such as CB radios, CD players, recorders, etc., except in accordance with company policy. In the event of an electrical fire, what must be done besides attempting to comtrol the flames? The battery must be disconnected, if safe to do so. If it isn't, then the battery will continue to heat up the wiring and diminish the ability to successfully control or extinguish the fire. When might disconnecting the battery not be enough to control an electrical fire? In a severe crash, the vehicle's metal parts might penetrate the battery and allow a flow of current even after the battery cables have been disconnected. ‘This can permit the development of sufficient heat to cause a fire. At the scene of an accident, what checks should be made to minimize the risk of fire? To minimize the risk of fire at an accident, the professional driver should check to ensure that: 1. The engines of all damaged vehicles are turned off. 2. There is no leaking fuel. 3. No one is smoking in the vicinity, especially if there is leaking fuel. 4. If there is evidence of leaking fuel, then fusees should not be used to direct traffic or protect the scene. 1G When might a truck's exhaust system create a fire hazard? A truck's exhaust system might create a fire hazard if there are leaks, or if the piping is routed too close to fuel lines, wiring or combustible material such as wood. What are the basic principles of extinguishing fires? Fires are extinguished in one of two ways: 1. By cooling the burning material below tts ignition temperature. 2. By smothering the burning material by cutting off the flow of oxygen to the fire and interrupting the ongoing chemical reaction. Fire extinguishers used on trucks are used to smother small fires. Can any extinguisher be used on any burning material? No. Basic classes of fires have been established. The classes for which a particular extinguisher 1s suitable are indicated by a combination of letters and symbols as follows: 1. Class A - Fires in ordinary combustibles (such as wood, cloth, paper, etc.) 2. Class B - Fires in flammable liquids 3. Class C - Fires in energized electrical equipment 4. Class D - Fires in combustible metals such as magnesium and aluminum What can you do if the material in your truck’s fire extinguish- er is exhausted? ‘Throwing sand or dirt on the fire may help to smother and control it. If you are driving a combination unit and fire occurs, what additional step(s) can be taken to minimize the severity of the situation? If it can be done safely, then a driver of a combination vehicle should disconnect the power unit, lower the landing gear of the semi-trailer, and drive the power unit clear of the fire. This action removes the power unit and its fuel supply from the danger zone. What is the most effective way to use a portable fire extin- guisher? To extinguish a fire using a portable fire extinguisher, aim the extinguishing agent at the base of the flames and the near edge of 165  the fire. Move the extinguisher back and forth in a sweeping motion. Approach the fire working with the wind at your back. Do not approach closer than it 1s safe to do so.. The National Fire Protection Association has developed the acronym “PASS” to help people remember how to use a porta- ble fire extinguisher. What does PASS stand for? PASS stands for: P = PULL the locking mechanism that prevents accidental discharge A = AIM the extinguisher at the base of the flames (at the burning material) S = SQUEEZE the handle to activate the extinguisher S = SWEEP the extinguisher back and forth across the fire. Why ts tt important to have the residue of the extinguishing powder removed once the fire ts completely extinguished? ‘The extinguishing agent in many extinguishers is corrosive. If the residue is not removed promptly, it can damage metal compo- nents in the area where the fire occurred. How should an extinguisher be used to put out burning liquid ina small container? To reduce the chance of splashing and spreading the fire, the extinguisher should be aimed at the internal side of the container so that the extinguishing agent slides/falls down onto the burning surface. Placing a cover over the top of a small container may also smother the fire.. What special challenges may exist if a vehicle with air condi- tioning or refrigeration equipment is involved in a fire? When exposed to fire, all refrigerants decompose and create toxic fumes.. What potential hazard exists if fire occurs on a vehicle equipped with an air suspensionf Vehicle air bags are made of material similar to tires and can burn through. If this happens, then the bag can drop down and injure any person who may get trapped underneath or between the bag and other parts of the vehicle. Let Upon arrival, what safety feature should a driver look for at a self- service fueling facility? Before fueling, the emergency shut-off for the pumps should be located. What fire safety precautions must be observed when refueling a truck? The driver should turn off the truck engine and be sure that no one is smoking in the vicinity and that there are no open flames or open lights nearby. A driver should maintain metal-to-metal contact between the nozzle and the fuel tank to prevent sparks. What precaution should drivers take any time they are using a self-service pump to fuel their vehicles? Drivers should point the self-service fuel pump nozzle away from themselves and others. By following that practice, drivers can avoid getting fuel on anyone if there is fuel residue in the nozzle or accidentally discharging fuel before the nozzle is inserted into the vehicle's tank. If the self-closing feature of a nozzle fails to operate, what can you do to shut off the flow of fuel? To shut off the flow of fuel, a driver can first shut off the control on the pump, itself. If that does not cut off the flow, the driver can activate the emergency pump shut-off for the facility. What should a driver avoid when using a self-service pump to fuel a vehicle? A driver should never use the fuel-tank cap or any other object to block the nozzle open if the nozzle is not equipped with a latch open device. While fuel nozzles are equipped with automatic shut-off, these devices can malfunction and allow fuel to overflow creating a fire and environmental hazard. What precautions should be observed to prevent fire when handling diesel fuel? The same precautions should be taken to prevent fire when handling diesel as when handling gasoline. There should be no smoking, open lights or flames in the vicinity. Metal-to- metal contact should be maintained between the nozzle and the tank to prevent sparks. le?  Ifa driver is taking off-duty time in a hotel or motel, what should the driver do to be protected in the event of a building fire? Upon arrival, the driver should locate the two closest exits and any fire alarms that may be installed. The driver should count the number of doors from the driver's room to each exit to help find it in darkness or smoky conditions. Study the emergency evacua- tion procedures as posted. What should a driver do if fire breaks out in the driver’s room at a hotel or motel? ‘The driver should get out as quickly as possible, closing the door to minimize the creation of a draft which will spread the fire. The driver should notify building management and be sure the fire department is summoned. If a driver ts awakened by the smell of smoke coming from outside the driver’s room, what initial precautions should be taken before attempting to leave the room? The driver should carefully determine if the door is hot. If the surface is hot, stay in the room and attempt to call the front desk and the fire department to let them know you're trapped. Fans and air conditioning should be shut off and cracks around the door should be covered with wet towels. Ifa safe escape is not possible from the window, the driver should stay low and stay alert to rescue crews. If clothing is on fire, what should be done? Pe If on fire, Stop, Drop and Roll; that is, stop where you are, don't run; drop to the ground or floor; cover your face with hands; and roll over and over slowly until the fire is out. Every effort should be made to extinguish the fire from head to toe in that order. Ifa blanket, coat or rug is available, roll yourself (or the individual on fire) in it to cut off oxygen to the fire. If assisting in putting out the flames and water 1s available, then douse the flames with the water. What is the safest way to get through a smoke-filled area? Pe To get through a smoke-filled area, crawl on hands and knees to take advantage of the clearer air close to the floor. 16s  COMMON TRUCKING INDUSTRY ACRONYMS AASHTO American Associations of State Highway and Transportation Officials ABS Anti-lock Braking System ACC Adaptive Cruise Control APTA American Public Transportation Association ATA American Trucking Associations ATRI American Transportation Research Institute BAC Blood Alcohol Content BASIC Behavioral Analysis and Safety Improvement Categories BLS Bureau of Labor Statistics CCSP Certified Cargo Screening Facilities CCSP Certified Cargo Screening Professional CDC Center for Disease Control & Prevention CDL Commercial Drivers License CDLIS Commercial Drivers License Information System CLP Commercial Learners Permit CMV Commercial Motor Vehicle CSA Compliance, Safety, Accountability CSR Corporate Safety Review CT Combination-Unit Truck (Tractor-Trailer) C-TPAT Customs-Trade Partnership Against Terrorism CVSA Commercial Vehicle Safety Alliance DHS United States Department of Homeland Security DOL United States Department of Labor DOT United States Department of Transportation EDR Electronic Data Recorder ELD Electronic Logging Device leo EPA Environmental Protection Agency ESC Electronic Stability Control FAST ACT Pree and Secure Trade FCC Pederal Communications Commission FCW Porward Collision Warning (system) FHWA Federal Highway Administration FMCSA Pederal Motor Carriers Safety Administration FMCSRs Federal Motor Carrier Safety Regulations FMVSS Pederal Motor Vehicle Safety Standard FR Federal Register FRA Pederal Railroad Administration GAO Government Accountability Office GCWR Gross Combined Vehicle Weight Rating GIS Geographic Information System GPS Global Positioning System GVWR Gross Vehicle Weight Rating H&Ww Health & Wellness HM Hazardous Materials HME Hazardous Materials Endorsement HMR Hazardous Materials Regulations HOS Hours-of-Service HRM Human Resource Management TAC Indirect Air Carrier Icc Interstate Commerce Commiussion ITHS Insurance Institute for Highway Safety IM Intermodal ITS Intelligent Transportation System LCV Long(er) Combination Vehicle LDWS Lane Departure Warning Systems LOC Loss of Control LTCCS Large Truck Crash Causation Study 170 LTL Less-than Truckload MCMIS Motor Carrier Management Information System MCSAC Motor Carrier Safety Advisory Committee MCSAP Motor Carrier Safety Assistance Program MSDS Material Safety Data Sheet MVR Motor Vehicle Record NAFTA North American Free Trade Agreement NATMI North American Transportation Management Institute NHTSA National Highway Traffic Safety Administration NIOSH National Institute for Occupational Safety & Health NMCSP National Motor Carrier Safety Program NPRM Notice of Proposed Rulemaking NPTC National Private Truck Council NRC National Response Center NSA National Security Agency NSC National Safety Council NTSB National Transportation Safety Board NTTC National Tank Truck Carriers Association OBSM On-Board Safety Monitoring OMB Office of Management and Budget OMC Office of Motor Carriers (within FHWA) OOIDA Owner-Operator Independent Drivers Association OOS Out of Service ORM - D Other Regulated Materials for Domestic Transport OSA Obstructive Sleep Apnea OSHA Occupational Safety and Health Administration OTR Over-the-road P&D Pickup & Delivery PAR Police Accident Report PHMSA Pipeline and Hazardous Materials Administration RFID Radio Fr