LD 34 V-6.1.pdf

CALIFORNIA COMMISSION ON PEACE OFFICER STANDARDS AND TRAINING Basic Course Workbook Series Student Materials Learning Domain 34 First Aid, CPR, and AED Version 6.1 THE MISSION OF THE CALIFORNIA COMMISSION ON PEACE OFFICER STANDARDS AND TRAINING IS TO CONTINUALLY ENHANCE THE PROFESSIONALISM...

CALIFORNIA COMMISSION ON PEACE OFFICER STANDARDS AND TRAINING Basic Course Workbook Series Student Materials Learning Domain 34 First Aid, CPR, and AED Version 6.1 THE MISSION OF THE CALIFORNIA COMMISSION ON PEACE OFFICER STANDARDS AND TRAINING IS TO CONTINUALLY ENHANCE THE PROFESSIONALISM OF CALIFORNIA LAW ENFORCEMENT IN SERVING ITS COMMUNITIES  Basic Course Workbook Series Student Materials Learning Domain 34 First Aid, CPR, and AED Version 6.1 © Copyright 2007 California Commission on Peace Officer Standards and Training (POST) All rights reserved. Published March 2001 Revised August 2004 Corrected December 2004 Revised July 2005 Revised January 2006 Revised April 2007 Revised December 2013 Correction April 2014 Revised January 2017 Correction February 2017 This publication may not be reproduced, in whole or in part, in any form or by any means electronic or mechanical or by any information storage and retrieval system now known or hereafter invented, without prior written permission of the California Commission on Peace Officer Standards and Training, with the following exception: California law enforcement or dispatch agencies in the POST program, POST-certified training presenters, and presenters and students of the California basic course instructional system are allowed to copy this publication for non-commercial use. All other individuals, private businesses and corporations, public and private agencies and colleges, professional associations, and non-POST law enforcement agencies in-state or out-of- state may purchase copies of this publication, at cost, from POST as listed below: From POST’s Web Site: www.post.ca.gov Go to Ordering Student Workbooks  COMMISSION ON PEACE OFFICER STANDARDS AND TRAINING COMMISSIONERS Joyce Dudley – Chair District Attorney Santa Barbara County Rick Braziel Educator Humboldt State University Lai Lai Bui Sergeant Sacramento Police Department Thomas Chaplin Chief Walnut Creek Police Department Richard DeLaRosa Mayor City of Colton Robert Doyle Sheriff Marin County Sandra Hutchens Sheriff - Coroner Orange County Peter Kurylowicz, Jr Deputy Sheriff Riverside County Laren Leichliter Deputy Sheriff San Bernardino County Geoff Long Public Member Jim McDonnell Sheriff Los Angeles County Jethroe Moore, II Public Member Batine Ramirez Sergeant Placer County Sheriff’s Department Laurie Smith Sheriff Santa Clara County Larry Wallace Director of Division of Law Enforcement Representing Kamala Harris Attorney General Ex-Officio Member  THE ACADEMY TRAINING MISSION The primary mission of basic training is to prepare students mentally, morally, and physically to advance into a field training program, assume the responsibilities, and execute the duties of a peace officer in society.  FOREWORD The California Commission on Peace Officer Standards and Training sincerely appreciates the efforts of the many curriculum consultants, academy instructors, directors and coordinators who contributed to the development of this workbook. We must also thank the California law enforcement agency executives who allowed their personnel to participate in the development of these training materials. This student workbook is part of the POST Basic Course Training System. The workbook component of this system provides a self-study document for every learning domain in the Basic Course. Each workbook is intended to be a supplement to, not a substitute for, classroom instruction. The objective of the system is to improve academy student learning and information retention and ultimately contribute to you becoming a peace officer committed to safety, and to the communities you will serve. The content of each workbook is organized into sequenced learning modules to meet requirements as prescribed both by California law and the POST Training and Testing Specifications for the Basic Course. It is our hope that the collective wisdom and experience of all who contributed to this workbook will help you, the student, to successfully complete the Basic Course and to enjoy a safe and rewarding career as a peace officer. MANUEL ALVAREZ, Jr. Executive Director  LD 34: First Aid & CPR Table of Contents Topic See Page Preface v Introduction v How to Use the Student Workbook vi Chapter 1: Law Enforcement and Emergency Medical 1-1 Services Overview Components of the EMS System 1-1 Peace Officer Roles and Responsibilities 1-3 Peace Officer Welfare and Safety 1-8 Legal Protections Regarding Emergency Medical Services 1-14 Workbook Learning Activities 1-18 Chapter 2: Victim Assessment 2-1 Overview 2-1 Victim Assessment 2-3 Multiple Victim Assessment 2-10 Moving a Victim 2-12 Workbook Learning Activities 2-18 Classroom Demonstrations 2-22 Continued on next page LD 34: First Aid & CPR i Table of Contents, Continued Topic See Page Chapter 3: Basic Life Support 3-1 Overview 3-1 Cardiopulmonary Resuscitation (CPR) 3-4 Airway Obstructions 3-23 Rescue Breathing 3-34 Bleeding Control 3-39 Shock 3-45 Workbook Learning Activities 3-48 Classroom Demonstration 3-52 Chapter 4: Traumatic Injuries 4-1 Overview 4-1 Head, Neck and Back Injuries 4-4 Chest and Abdominal Injuries 4-11 Bone, Joint, and Muscle Injuries 4-18 Burns 4-22 Violent Circumstances 4-30 Workbook Learning Activities 4-32 Classroom Demonstrations 4-36 Continued on next page ii LD 34: First Aid & CPR Table of Contents, Continued Topic See Page Chapter 5: Medical Emergencies 5-1 Overview 5-1 Cardiac Emergencies 5-4 Respiratory Emergencies 5-7 Drowning 5-11 Seizures 5-12 Strokes 5-15 Altered Mental States 5-17 Severe Abdominal Pain 5-18 Allergic Reactions and Anaphylaxis 5-19 Psychological Emergencies 5-21 Diabetic Emergencies 5-22 Poisoning and Substance Abuse 5-26 Temperature Related Emergencies 5-33 Stings and Bites 5-39 Workbook Learning Activities 5-45 Classroom Demonstration 5-48 Chapter 6: Childbirth 6-1 Overview 6-1 Normal Labor and Childbirth 6-3 Complications in Childbirth 6-5 Workbook Learning Activities 6-7 Supplementary Material S-1 Glossary G-1 LD 34: First Aid & CPR iii Table of Contents, Continued This page left intentionally blank. iv LD 34: First Aid & CPR How to Use the Student Workbook Introduction This workbook provides an introduction to the training requirements for this Learning Domain. It is intended to be used in several ways: for initial learning prior to classroom attendance, for test preparation, and for remedial training. Workbook To use the workbook most effectively, follow the steps listed below. format Step Action 1 Begin by reading the: Preface and How to Use the Workbook, which provide an overview of how the workbook fits into the POST Instructional System and how it should be used 2 Refer to the Chapter Synopsis section at the end of each chapter to review the key points that support the chapter objective 3 Read the text 4 Complete the Workbook Learning Activities at the end of each chapter. These activities reinforce the material taught in the chapter 5 Refer to the Glossary section for a definition of important terms. The terms appear throughout the text and are bolded and underlined the first time they appear (e.g., term) LD 34: First Aid & CPR v  Preface Introduction Student The student workbooks are part of the POST Basic Course Instructional workbooks System. This system is designed to provide students with a self-study document to be used in preparation for classroom training. Regular Basic Completion of the Regular Basic Course is required, prior to exercising peace Course officer powers, as recognized in the California Penal Code and where the training POST-required standard is the POST Regular Basic Course. requirement Student The following elements are included in each workbook: workbook elements  chapter contents, including a synopsis of key points  supplementary material  a glossary of terms used in this workbook vi LD 34: First Aid & CPR  Law Enforcement and Emergency Medical Services Overview Learning need Peace officers must recognize they have a responsibility to act in good faith and to provide emergency medical services (EMS) to the best of their abilities and within the scope of their training. Learning The following table identifies the student learning objectives for this chapter: objectives After completing study of this chapter, the student will be Objective ID able to:  Discuss the components of the EMS system including: 34.01.01 - EMS access - Interaction with other EMS personnel - Local EMS and trauma systems  Identify the primary responsibilities of peace officers as 34.01.02 EMS first responders at an emergency including: - Safety Exposure to chemical, biological, radiological, or nuclear (CBRN) substances and scene safety - Scene size-up Law enforcement actions - Assessment and care of victims  Identify the links of the chain of transmission of 34.01.03 infectious pathogens Continued on next page LD 34 – Chapter 1: Law Enforcement and Emergency Medical Services 1-1 Overview, Continued Learning After completing study of this chapter, the student will Objective ID objectives be able to: (continued)  Recognize first aid equipment and precautions peace 34.01.04 officers may utilize to treat others and to ensure their own personal safety when responding to an emergency including: - Types and levels of Personal Protective Equipment (PPE) used to accomplish Body Substance Isolation (BSI) - Removal of contaminated gloves - Decontamination considerations  Identify conditions under which a peace officer is 34.01.05 protected from liability when providing emergency medical services In this chapter This chapter focuses on the peace officer’s role within the EMS system. Refer to the following table for specific topics: Topic See Page Emergency Medical Services (EMS) System 1-3 Peace Officer Roles and Responsibilities 1-4 Peace Officer Welfare and Safety 1-8 Legal Protections Regarding Emergency Medical Services 1-14 Workbook Learning Activities 1-18 1-2 LD 34 – Chapter 1: Law Enforcement and Emergency Medical Services Emergency Medical Services (EMS) System Introduction Law enforcement officers are part of the Emergency Medical Services (EMS) System. The EMS System is a coordinated response by public safety, public health, and health care providers to provide emergency medical care. EMS Access The public accesses EMS by utilizing the 9-1-1 system. These calls are handled by a dispatcher at a Public Safety Answering Point (PSAP). Law enforcement officers who encounter a medical or traumatic emergency should render aid and request additional EMS resources as appropriate. The Components of the EMS System include: Dispatcher: Coordinates type and level of EMS response and dispatches the appropriate agencies. An Emergency Medical Dispatcher (EMD) may give medical instructions to the public. First Responder: Entry level medically trained person Emergency Medical Technician (EMT): Provides basic life support (BLS) Paramedic: Provides advanced life support (ALS) Receiving facility: The medical treatment facility that provides emergency care. Interaction with As first responders, peace officers are part of the EMS system and should other EMS provide information to other responders. Sharing information, providing Personnel assistance, and team work are essential to the EMS system. Local EMS and Ill or injured individuals may be transported to a receiving facility. Some Trauma facilities are designated to specialize in the provision of emergency, stroke, Systems trauma, or cardiac care. LD 34 – Chapter 1: Law Enforcement and Emergency Medical Services 1-3 Peace Officer Roles and Responsibilities Introduction The first person at the scene of an emergency situation is often a peace officer. When the situation involves a medical emergency, peace officers assume the role of EMS first responder. Primary As first responders, peace officers should assume the primary responsibility responsibilities for:  ensuring peace officer safety as well as the safety of ill or injured individuals and the public  evaluating the emergency situation (scene size-up)  initiating actions regarding the well-being and care of ill or injured persons  taking necessary enforcement actions related to the incident En route The primary objective of all peace officers responding to any emergency call to the should be to get to the location as quickly and safely as possible. scene Continued on next page 1-4 LD 34 – Chapter 1: Law Enforcement and Emergency Medical Services Peace Officer Roles and Responsibilities, Continued Scene At the scene peace officers should evaluate the nature of the incident and size-up communicate critical information to dispatch and other involved units as soon as possible. The following table identifies a number of factors that may be considered when evaluating the scene: Factor Related Information/Examples Location  Exact address or location of the incident  Conditions present at the scene (e.g., large number of bystanders, heavy vehicle traffic in the area, remote location, etc.)  Potential hazards related to the incident or the area (e.g., fire, gas/chemical leak, presence of hazardous materials, power lines, etc.) Type of  Conditions related to the actual emergency such as, Emergency but not limited to: - a vehicle collision involving injuries - an individual complaining of severe chest pain - a person injured as a result of criminal action (e.g., shot during a robbery), etc. Nature of  Number of victims Ill/Injured  Apparent age of the victim(s) (i.e., adult, adolescent, Person(s) child, infant)  Whether victim(s) is conscious or unconscious  Appearance of injury (e.g., heavy bleeding, exposed bone, location of wound, etc.) Continued on next page LD 34 – Chapter 1: Law Enforcement and Emergency Medical Services 1-5 Peace Officer Roles and Responsibilities, Continued Scene Factor Related Information/Examples size-up (continued) Need for  Fire department Additional  Additional law enforcement units Resources  Medical emergency services (e.g., ambulance, EMTs)  Public utility services  Other specialty units (e.g., search and rescue, HAZMAT, etc.) Urgent  Protection of victim(s) from aggressor(s) Enforcement  Control of suspect(s) and/or bystanders Actions  Immediate protection of a crime scene Required Safety Peace officers are responsible for taking action to protect their own safety as well as the safety of other EMS personnel, the ill or injured person, the public, and to control the scene. When determining appropriate safety precautions to take, peace officers should consider possible dangers from:  exposure to biological hazards (e.g., body fluids such as blood, saliva, etc.)  armed suspects, angry bystanders, etc.  unsafe scene conditions (e.g., unstable buildings, nearby vehicle traffic, etc.)  environmental hazards (e.g., fire, chance of explosion, etc.)  exposure to chemical, biological, radiological, or nuclear (CBRN) substances  explosives and explosive devices  animals (e.g., pets, wild animals) Continued on next page 1-6 LD 34 – Chapter 1: Law Enforcement and Emergency Medical Services Peace Officer Roles and Responsibilities, Continued Assessment Based on this initial assessment, peace officers may need to provide basic care and care for victim(s). Such care may include providing basic emergency medical care of victim until relieved by other personnel with equal or higher levels of training. Law If the care and well-being of the victim has been turned over to other EMS enforcement personnel, peace officers may be required to continue additional enforcement actions actions including:  documenting their initial observations and actions when first arriving at the scene  maintaining control of the scene to protect potential evidence  identifying and isolating witnesses and involved parties  recording statements or information provided by the victims, witnesses, etc.  noting whether items were moved in order to render medical emergency services (e.g., recording what was touched and by whom)  document medical care provided  any other investigative actions required LD 34 – Chapter 1: Law Enforcement and Emergency Medical Services 1-7 Peace Officer Welfare and Safety Introduction Peace officers and all others within the EMS system must take appropriate precautions at all times when in direct contact with blood, bodily fluids, or other potential infectious materials. Pathogens Infection and disease are caused by pathogens that are spread through the air or by contact with another person’s blood or bodily fluids. Bacteria are microscopic organisms that can live in water, soil, or organic material, or within the bodies of plants, animals, and humans. The human body contains a number of both beneficial and harmful bacteria. Only when a bacteria is harmful would it be considered a pathogen. A virus is a submicroscopic agent that is capable of infecting living cells. Once inside the cells of plants, animals, or humans, viruses can reproduce and cause various types of illness or disease. Transfer of There are two primary means by which pathogens can be transferred from one pathogens human being to another. Airborne pathogens are spread by tiny droplets sprayed during breathing, coughing, or sneezing. Airborne pathogens can be absorbed through the mucous membranes (e.g., eyes, mouth) or when contaminated particles are inhaled. Blood borne pathogens may be spread when the blood or other body fluids (e.g., semen, phlegm, mucus, etc.) of one person comes into contact with an open wound or sore of another. Continued on next page 1-8 LD 34 – Chapter 1: Law Enforcement and Emergency Medical Services Peace Officer Welfare and Safety, Continued Chain of Chain of transmission is how pathogens are spread such as: transmission  infectious agent (bacteria, viruses, fungi, and parasites)  reservoir/source  portal of exit  means of transmission  portal of entry  susceptible host Exposure Because of the nature of their occupation, peace officers are at a high risk of being exposed to both airborne and blood borne pathogens. NOTE: Exposure does not necessarily mean an individual will contract the illness. Personal By using personal protective equipment (PPE), peace officers using body protective substance isolation (BSI) can break the chain of transmission and prevent equipment possible exposure and infection. For equipment to be effective, it must be used and cared for properly. Continued on next page LD 34 – Chapter 1: Law Enforcement and Emergency Medical Services 1-9 Peace Officer Welfare and Safety, Continued Personal The following table identifies standard PPE to which peace officers may have protective access to: equipment (continued) PPE Examples Additional Information Protective  Vinyl  For single use only Gloves  Latex  Should be:  Other - put on before any contact with the synthetic victim, materials - changed between victims, and - disposed of properly. NOTE:  Leather gloves may not be an effective barrier to prevent contamination  Some individuals have a severe allergy to latex Eye  Protective  Used to prevent splashing, splattering, or Protection glasses spraying of a victim’s body fluids into a  Goggles person’s eyes  Clip-on side  Should provide protection from both the protectors front and the sides (for use with  Must be cleaned and sanitized after prescription exposure or disposed of properly glasses)  Face shields Continued on next page 1-10 LD 34 – Chapter 1: Law Enforcement and Emergency Medical Services Peace Officer Welfare and Safety, Continued Personal PPE Examples Additional Information protective equipment Masks  Surgical-  Used to prevent splashing, splattering, or (continued) type masks spraying of a victim’s bodily fluids into a  Approved person’s nose or mouth particulate  Only certain masks and respirators will masks filter airborne pathogens  Face shields  Disposable surgical-type masks  Particulate  Reusable masks, shields, and respirators air should be cleaned and sanitized after respirators exposure or contamination  N-95 masks Gowns  Disposable  Used to protect clothing and bare skin gowns from spilled or splashed fluids  Should be used only once and disposed of properly Ventilation  Portable  Contain valves to control direction of Devices pocket airflow and filters to reduce chances of masks and contamination one-way  Used when applying cardiopulmonary valve and resuscitation (CPR) filters NOTE: Penal Code Section 13518.1 recommends that law enforcement agencies provide peace officers with appropriate portable masks and instruct officers on the mask’s proper use. Continued on next page LD 34 – Chapter 1: Law Enforcement and Emergency Medical Services 1-11 Peace Officer Welfare and Safety, Continued Personal PPE Examples protective equipment General  Soap (continued) Supplies  Specialized cleaning solutions and disinfectants (e.g., and bleach, germicide, etc.) Equipment  Prepackaged antimicrobial skin wipe towelettes  Leak proof disposable bags  Biohazard disposable bags  Puncture resistant disposable containers (e.g., sharps containers, evidence containers, etc.) PPE Gloves, along with other equipment intended for single use, must be disposed disposal of in an approved manner according to manufacturer recommendations after use or contamination. Disposal may include but not be limited to use of:  biohazard bags  sharps containers  liquid proof containers NOTE: Peace officers are responsible for being aware of and complying with their agency’s policies and Occupational Safety and Health Administration (OSHA) guidelines regarding the disposal of hazardous PPE and materials. Decontamination When performing decontamination procedures officers should follow their considerations agency’s blood borne pathogens control plan.  Use proper cleaning procedures to disinfect and decontaminate any equipment that may have been exposed (e.g., vehicle steering wheel and interior, uniform, firearm, radio, etc.)  Use extra caution when handling broken glass or sharp objects NOTE: A solution of one part bleach and ten parts water can be used when disinfecting equipment. Continued on next page 1-12 LD 34 – Chapter 1: Law Enforcement and Emergency Medical Services Peace Officer Welfare and Safety, Continued Universal Along with using PPE, there are a number of universal precautions that peace precautions officers as first responders in the EMS system should take.  Treat all body fluids as if they are contaminated!  If possible, wash hands thoroughly with warm water and soap before and after each exposure, even when gloves are worn  Use hand sanitizer if hand washing is not available  Use bandages or other cover protections when open cuts or sores exist Personal Peace officers should also be aware of personal preventive measures they may preventive take to remain healthy and support their own immune systems. Staying in measures good physical condition can help breach the chain of transmission of pathogens to which they may be exposed. Documentation If a peace officer is exposed to an infectious pathogen (or even suspects to exposure exposure), no matter how slight, that officer should report the exposure verbally and in writing as soon as possible. NOTE: Peace officers should be aware of and comply with their agency policies or guidelines regarding reporting exposure information should be in compliance with Health Insurance Portability and Accountability Act (HIPAA) and OSHA regulations and specific actions to be taken. LD 34 – Chapter 1: Law Enforcement and Emergency Medical Services 1-13 Legal Protections Regarding Emergency Medical Services Introduction Under certain specified conditions, peace officers are afforded qualified immunity from liability when rendering emergency medical services at the scene of an emergency. Responsibility As trained professionals, peace officers have a responsibility to: to act  assess emergency situations  initiate appropriate emergency medical care within the scope of the officer’s training and specific agency policy A peace officer is not required to render care when reasonable danger exists (e.g., while under fire, exposure to hazardous materials, etc.). Immunity The California Legislature has declared that emergency rescue personnel from qualify for immunity from liability from civil damages for any injury caused liability by an action taken when providing emergency medical services under certain specified conditions. (Health and Safety Code Section 1799.102) To be protected from liability for civil damages, emergency rescue personnel must:  act within the scope of their employment  act in good faith  provide a standard of care that is within the scope of their training and specific agency policy Emergency rescue personnel means any person who is a peace officer, employee or member of a fire department, fire protection, or firefighting agency of the federal, state, city, or county government. Continued on next page 1-14 LD 34 – Chapter 1: Law Enforcement and Emergency Medical Services Legal Protections Regarding Emergency Medical Services, Continued Immunity Emergency medical services include, but are not limited to, first aid and from medical services, rescue procedures and transportation, or other related liability activities necessary to ensure the health or safety of a person in imminent (continued) peril. Negligence If peace officers attempt to provide emergency medical care beyond the scope of their training, or if they act in a grossly negligent manner, they may be held liable for any injuries they may cause. Failure to provide care, even though the peace officer has had the appropriate level of training to do so, may also lead to the officer being liable for any injuries caused because of lack of care (e.g., fear of contagious or infectious disease). NOTE: Peace officers are responsible for complying with their agency policies regarding providing emergency medical services. Expressed Peace officers should clearly identify themselves and ask for consent to consent administer emergency medical care. Consent (i.e., permission) must be obtained from the ill or injured person before providing emergency care. In order to give lawful consent, the ill or injured person must be:  conscious and oriented  mentally competent enough to make rational decisions regarding their well-being  18 years or older, or an emancipated minor Continued on next page LD 34 – Chapter 1: Law Enforcement and Emergency Medical Services 1-15 Legal Protections Regarding Emergency Medical Services, Continued Implied Implied consent is a legal position that assumes that an unconscious or consent confused victim would consent to receiving emergency medical services if that person were able to do so. Emergency rescue personnel have a responsibility to administer emergency medical services under implied consent whenever a victim is:  unconscious  incapable of giving consent due to a developmental, emotional, or mental disability  in an altered mental state due to alcohol, drugs, head injury, etc.  a juvenile, and the parent or guardian is not present NOTE: Whenever implied consent is assumed or if medical services are provided based on the seriousness of the victim’s condition, emergency rescue personnel should carefully document the conditions or the basis for their decision to treat the victim. Refusal A conscious and competent adult has the right to refuse any emergency of care medical services offered by emergency rescue personnel. The refusal must be honored as long as the person is mentally competent. Depending on specific agency policy or guidelines, an individual who refuses emergency medical services may be required to sign a release form relinquishing EMS personnel of responsibility for that individual. Continued on next page 1-16 LD 34 – Chapter 1: Law Enforcement and Emergency Medical Services Legal Protections Regarding Emergency Medical Services, Continued Life- If it is determined that an illness or injury is such that if left untreated the threatening victim’s condition will degenerate to a life-threatening condition, the conditions emergency rescue personnel may provide medical services regardless of the victim’s conscious condition. NOTE: Individuals who are terminally ill may have a specific advanced directive (e.g., do not resuscitate (DNR), physician orders for life sustaining treatment (POLST)). Peace officers are responsible for being aware of and complying with state and local policies and guidelines regarding following such instructions in an emergency situation. Duty to Once a peace officer initiates medical services, that officer must remain with continue the victim until: - the officer is physically unable to continue or - the officer is relieved by an individual with equal or greater training and skill, or - the scene becomes unsafe for the officer to remain LD 34 – Chapter 1: Law Enforcement and Emergency Medical Services 1-17 Workbook Learning Activities Introduction To help you review and apply the material covered in this chapter, a selection of learning activities has been included. No answers are provided. However, by referring to the appropriate text, you should be able to prepare a response. Activity 1. A peace officer responding to the scene of a vehicle collision finds the questions driver of one vehicle unconscious and slumped over the steering wheel. The driver of the second vehicle runs up to meet the officer and explain his side of the story. The cars are blocking a major intersection. As a component of the EMS system, what should the officer do first? What are the officer’s responsibilities to the two drivers? To others at the scene? What factors should the responding officer evaluate regarding the nature of the incident? What information should be relayed to dispatch? 2. Why should peace officers consider covering something as simple as a paper cut with a bandage prior to the start of their shift? Continued on next page 1-18 LD 34 – Chapter 1: Law Enforcement and Emergency Medical Services Workbook Learning Activities, Continued Activity 3. Name three controllable factors that could decrease a peace officer’s risk questions of contracting the HIV pathogen. What other general precautions can an (continued) officer take that may help prevent infections when exposed to common pathogens such as influenza (i.e., flu)? 4. In your own words, define implied consent. Give an example of a situation where a peace officer as a first responder would assume implied consent. Continued on next page LD 34 – Chapter 1: Law Enforcement and Emergency Medical Services 1-19 Workbook Learning Activities, Continued Student notes 1-20 LD 34 – Chapter 1: Law Enforcement and Emergency Medical Services  Victim Assessment Overview Learning need Peace officers must be able to assess the immediate condition of adult and pediatric victims, a fellow officer, or themselves prior to beginning any form of medical care. Learning The following table identifies the student learning objectives for this chapter: objectives After completing study of this chapter, the student will be Objective ID able to:  Demonstrate appropriate actions to take during a primary assessment for assessing both conscious and unconscious victims: - Responsiveness 34.02.01 - Airway 34.02.02 - Breathing 34.02.03 - Circulation 34.02.04  Demonstrate appropriate actions to take during a 34.02.05 secondary assessment for both conscious and unconscious victims: - Vital Signs - Head to toe assessment - Patient history  Identify assessment criteria for establishing priorities 34.02.08 when assessing multiple victims at a single scene Continued on next page LD 34 – Chapter 2: Victim Assessment 2-1 Overview, Continued Learning After completing study of this chapter, the student will Objective ID objectives be able to: (continued)  Recognize conditions under which an injured victim 34.02.09 should be moved from one location to another  Recognize proper procedures for moving a victim 34.02.10 including: - Shoulder drag - Lifts and carries which may include using: Soft litters Manual extractions including fore/aft, side- by-side, shoulder/belt In this chapter This chapter focuses on techniques for assessing the immediate condition of a victim at the scene of a medical emergency. Refer to the following table for specific topics: Topic See Page Victim Assessment (Conscious/Unconscious) 2-3 Multiple Victim Assessment 2-10 Moving a Victim 2-12 Workbook Learning Activities 2-18 Classroom Demonstrations 2-22 2-2 LD 34 – Chapter 2: Victim Assessment Victim Assessment (Conscious/Unconscious) Introduction Once the emergency scene has been evaluated and necessary safety precautions taken, the next step for the First Responder is to assess the victim’s condition. The purpose of this two-part assessment process is to identify and immediately treat life-threatening conditions and to set priorities for further treatment. Two part There are two parts to the victim assessment process: the primary process assessment and the secondary assessment. The following table presents a brief description of each: Description Actions Primary  Rapid, systematic 1 Check for responsiveness assessment process to detect life- 2 Check (ABC) threatening conditions - Airway - Breathing - Circulation 3 Control major bleeding 4 Treat for shock 5 Consider C-spine stabilization based on mechanism of injury Continued on next page LD 34 – Chapter 2: Victim Assessment 2-3 Victim Assessment (Conscious/Unconscious), Continued Two part Description Actions process (continued) Secondary  Systematic head-to-toe 1 Check and document assessment assessment to vital signs: determine whether - Skin Color conditions - Temperature exist - Respiratory Rate - Pulse Rate 2 Conduct a head-to-toe check to identify injuries 3 Gather initial information regarding the victim and the incident including patient history NOTE: Be prepared to advise EMS of the assessment results. Continued on next page 2-4 LD 34 – Chapter 2: Victim Assessment Victim Assessment (Conscious/Unconscious), Continued Respiration The number of times a person inhales and exhales in a minute. rate Peace Prior to and after any contact with a victim, peace officers as first responders officer should take standard precautions including the use of personal protection safety equipment (PPE) (e.g., gloves). Responsiveness Before taking any action, the victim’s level of responsiveness (mental status) (AVPU) should be determined. To determine responsiveness, the peace officer should speak with the victim directly, asking, “Are you okay?” If the victim does not respond, the officer should tap the victim or shout in order to elicit a response from the victim. Depending on the level of responsiveness, a victim may be determined to be:  Alert. Awake, responsive and oriented (i.e., can talk and answer questions appropriately)  Verbal. Patient appears unresponsive at first but will respond to loud verbal stimulus (e.g., talking or shouting)  Painful. If the patient does not respond to verbal stimuli but may respond to painful stimuli (e.g., tapping or pinching, earlobe, or skin above collar bone rubbing)  Unresponsive. Patient does not respond to verbal, nonverbal, or painful stimuli. IF the victim is: THEN the officer should: unresponsive  request additional EMS resources  check the victim’s airway breathing and circulation responsive  control any major bleeding  treat for shock  request additional EMS resources if necessary Continued on next page LD 34 – Chapter 2: Victim Assessment 2-5 Victim Assessment (Conscious/Unconscious), Continued Primary The primary assessment is designed to identify the presence or absence of life- assessment threatening conditions. When a victim is alert and able to speak, it can be assumed that the victim has a clear airway and is able to breathe. If the victim is unable to speak or is not responsive, then appropriate steps should be taken to assess the victim’s:  Airway  Breathing  Circulation Airway The responding peace officer should determine if the victim’s airway is open. IF the THEN the officer should open the airway using the victim’s appropriate technique: airway is not open and has: no suspected  Head-tilt/chin-lift C-spine injury suspected c-  Jaw thrust maneuver spine injury NOTE: If you are unable to establish an airway using the jaw thrust maneuver use the head-tilt/chin-lift technique. 2-6 LD 34 – Chapter 2: Victim Assessment Victim Assessment (Conscious/Unconscious), Continued Breathing The responding peace officer should determine if the victim is breathing. IF the THEN the officer should: victim is: not  begin rescue breathing breathing with pulse not  begin CPR breathing with no pulse breathing  complete primary assessment Circulation The presence of a pulse is an indication that the victim’s heart is functioning. (pulse) IF the victim THEN the officer should: has: no pulse  begin cardiopulmonary resuscitation (CPR) a pulse but is not  begin rescue breathing breathing Continued on next page LD 34 – Chapter 2: Victim Assessment 2-7 Victim Assessment (Conscious/Unconscious), Continued Circulation IF the victim THEN the officer should: (pulse) has: (continued) a pulse, is  check for indications of life-threatening conditions breathing, but (e.g., major bleeding, shock, etc.) unconscious  place the victim in the recovery position (on the side with the head supported by the lower forearm), if appropriate, to aid breathing and allow fluids or vomit to drain from the mouth a pulse, is  check for indications of life-threatening conditions breathing, and (e.g., major bleeding, shock, etc.) conscious NOTE: Techniques for performing CPR and rescue breathing are noted in a later chapter of this workbook. Life- Once it is determined that the victim is breathing and has a pulse, the peace threatening officer must control any major bleeding and treat the victim for shock. Such conditions conditions must be treated first before any further assessment of the victim takes place. NOTE: Techniques for administering emergency first aid measures for controlling bleeding, treatment for shock, and other conditions are noted in later chapters of this workbook. 2-8 LD 34 – Chapter 2: Victim Assessment Victim Assessment (Conscious/Unconscious), Continued Secondary The purpose of a secondary assessment is to: Assessment (DOTS) - check vital signs - include a detailed head-to-toe assessment o Deformities –differences in natural body o Open Injuries – indicated by visible blood o Tenderness – to gentle touch o Swelling – of the tissue around an affected area - care for a patient’s specific injuries or medical problems - obtain a patient history and include any information relating to the current complaint or condition as well as past medical problems that could be related LD 34 – Chapter 2: Victim Assessment 2-9 Multiple Victim Assessment Introduction In some emergency situations, there will be more than one victim. In such situations, it is the peace officer’s responsibility as first responders to classify the victims for treatment. By doing so, treatment will be rendered first to those victims needing immediate attention for life-threatening conditions. Classification Peace officers should move from one victim to another, making a quick (less categories than one minute) assessment of each victim’s condition and classifying each victim into a category. First responders utilize a standardized triage system that includes specific terms and colors to readily identify patient treatment priorities. The following table identifies the classification categories and colors associated with each: Category Color Action DECEASED  Black  No respiration after opening the airway IMMEDIATE  Red  Receives treatment first, once all victims are classified DELAYED  Yellow  Receives treatment once all victims classified as IMMEDIATE have been treated MINOR  Green  Direct to a safe area away from other victims and possible scene safety hazards Continued on next page 2-10 LD 34 – Chapter 2: Victim Assessment Multiple Victim Assessment, Continued Assessment Classification categories should be based on assessment of the victim’s criteria breathing, circulation, and mental status. The following table describes the order of the assessment process and criteria for classifying each victim: Actions IF: THEN: Breathing  Clear airway no respiration  classify victim as if necessary DECEASED  Measure over 30  classify victim as respiration cycles/min. IMMEDIATE rate below 30  continue assessment by cycles/min. checking the victim’s circulation Circulation  Capillary more than  classify victim as (pulse) refill on two seconds IMMEDIATE extremities less than two  continue assessment by seconds checking the victim’s mental status Mental  Give simple unable to  classify victim as Status commands follow IMMEDIATE such as commands “Open your follows  classify victim as eyes,” or commands DELAYED or “Close your eyes.” MINOR Begin After completing the assessment and classification of all victims, treatment of treatment victims classified as IMMEDIATE can begin. LD 34 – Chapter 2: Victim Assessment 2-11 Moving a Victim Introduction As a first responder, one of the most difficult decisions a peace officer may need to make at an emergency scene is whether or not to move a victim. Do not More harm can be done to a victim by moving them than by the original move injury. This is especially true if a spinal cord injury is suspected. DO NOT MOVE any injured victim unless it is absolutely necessary for scene safety, patient safety or officer safety. An unconscious, suspected trauma victim should be treated as though the victim has a spinal injury and therefore should not be moved unless it is absolutely necessary. Spinal Traumatic injury to the head and/or neck can result in damage to the spinal stabilization cord. Recognize the need for potential spinal immobilization precautions that are needed in order to prevent the possibility of further injury. Conditions A victim should be moved only when the victim or officer is in a life- for moving threatening situation. a victim Life-threatening situations including but not limited to: Imminent  When the danger  Fire or threat of fire or danger outweighs the risk of explosion further injury from being  Toxic gases or radiation moved  Electrical hazards (e.g., downed power lines)  Uncontrolled moving traffic Continued on next page 2-12 LD 34 – Chapter 2: Victim Assessment Moving a Victim, Continued Conditions Life-threatening situations including but not limited to: for moving a victim Unable to  When it is not possible to  Slumped over a steering (continued) assess do a primary assessment wheel of the victim’s condition  When CPR is required  When the victim’s condition or an officer’s ability to provide basic life-saving procedures is not possible due to the victim’s position General If an injured person must be moved, peace officers should consider the guidelines following guidelines. General Guidelines Plan  Identify a safe location before attempting to move the Ahead victim  Move only as far as is absolutely necessary Reassure  Tell the victim(s) what is going on and why the victim Victim is going to be moved  Keep the victim as calm as possible Continued on next page LD 34 – Chapter 2: Victim Assessment 2-13 Moving a Victim, Continued General General Guidelines guidelines (continued) Victim  Keep victim in a straight line during the movement Stability  Keep victim lying down  Move the victim rapidly but also as carefully and gently as possible  Be careful not to bump the victim’s head during movement NOTE: If an infant is fastened in an infant seat, do not remove the infant. Move infant and the seat together. The lifts and carries described herein should not be considered the only methods for patient movement. The steps used to describe the lifts and carries may not necessarily be performed in the direct order and are dependent on the totality of the circumstances facing the rescuer. All lifts and carries must involve assessing the patient injuries, need for movement and officer safety. Shoulder A number of different techniques may be used to move an injured victim. One drag maneuver that may be used is the shoulder drag technique. To avoid straining their backs when dragging a victim, peace officers should:  bend their knees  keep their backs straight  let their leg muscles do most of the work Continued on next page 2-14 LD 34 – Chapter 2: Victim Assessment Moving a Victim, Continued Shoulder The basic steps for the shoulder drag technique are noted in the following drag table: (continued) Step Action 1 Use hands and grasp the victim under the armpits. 2 Stabilize the victim’s head and neck to reduce the risk of injury. 3 Carefully lift the victim keeping the head and shoulders as close to the ground as possible. 4 Drag the victim so that the head, torso, and legs remain in a straight line. DO NOT pull sideways. 5 Gently place the victim in the new location. Assess the victim’s condition. Lifts and There are several methods for moving victims which may be employed Carries depending on specific circumstances. Soft litters The basic steps for the soft litter technique are: Step Action 1 Place litter to side of victim. 2 Maintaining spinal immobilization, roll victim towards rescuer. 3 Position litter under victim. 4 Maintaining spinal immobilization, roll victim onto litter. 5 Secure victim to the litter as appropriate. LD 34 – Chapter 2: Victim Assessment 2-15 Moving a Victim, Continued Manual The following techniques are completed with at least two rescuers. extractions Fore/aft The basic steps for the fore/aft technique are noted in the following table: sometimes called the “Trunk-Leg” Step Action lift and carry 1 Place victim in a seated position. 2 Rescuer one squats behind victims back. Places arms under victim’s armpits grasping the victim’s wrists in the center of the victim’s chest. 3 Rescuer two squats facing away from victim grasping the legs under the victim’s knees. 4 Rescuers coordinate their movement to lift victim. 5 Gently place the victim in the new location. Assess the victim’s condition. Side-by-side The basic steps for the side-by-side technique are noted in the following table: sometimes called two handed seat Step Action 1 Pick up the victim by having both rescuers squat down on either side of the victim. 2 Reach under the victim’s shoulders and under their knees. 3 Grasp the other rescuer’s wrists. 4 From the squat, with good lifting technique, stand. 5 Move in the direction that the victim is facing. 6 Gently place the victim in the new location. Assess the victim’s condition. 2-16 LD 34 – Chapter 2: Victim Assessment Moving a Victim, Continued Shoulder/belt The basic steps for the techniques are noted in the following table: Step Action 1 Rescuers lift victim to seated position with victim’s arms over rescuers’ shoulders. Rescuers grab belt (or top of pants) at victim’s mid back. 2 Rescuers lift/carry/drag the victim. 3 Gently place the victim in the new location. Assess the victim’s condition. LD 34 – Chapter 2: Victim Assessment 2-17 Workbook Learning Activities Introduction To help you review and apply the material covered in this chapter, a selection of learning activities has been included. No answers are provided. However, by referring to the appropriate text, you should be able to prepare a response. Activity 1. What are standard precautions? Describe three situations when peace questions officers should use these measures when in contact with a person with an injury or illness. Continued on next page 2-18 LD 34 – Chapter 2: Victim Assessment Workbook Learning Activities, Continued Activity 2. Peace officers on patrol are flagged down by a woman who saw her questions husband collapse as they were painting the front of their house. When (continued) officers reach the man, they find him lying on his side on the grass. His wife tells officers that the victim fell from the fourth rung of the ladder. Describe, in a step-by-step fashion, how officers, as first responders, should conduct an primary assessment of the victim. What, if any, precautions should they take, presuming the victim does not appear to have any external bleeding? 3. During multiple victim assessment (four victims and one officer), under what, if any, circumstances might a victim who has no respiration be classified as deceased? Should an officer attempt rescue breathing or CPR (as appropriate) before moving on to assess the next victim? Continued on next page LD 34 – Chapter 2: Victim Assessment 2-19 Workbook Learning Activities, Continued Activity 4. Peace officers respond to the scene of a drive by shooting. After the questions officers render the scene safe, they discover a woman sitting on the (continued) sidewalk, leaning her head on the shoulder of a teenaged boy. The woman has an apparent bullet wound to the shoulder. The primary assessment shows that she is conscious and appears pale, cool, and moist with rapid respirations. Describe how officers, as first responders, should proceed. What actions should the officers take if the woman loses consciousness? 5. Approximately ten people are injured in a fight outside of a dance club. As a first responder, explain how you would proceed after the scene has been secured and is safe to enter. What indications are present that a victim should be classified as needing immediate attention? Continued on next page 2-20 LD 34 – Chapter 2: Victim Assessment Workbook Learning Activities, Continued Activity 6. A peace officer responded to the scene of a collision and car fire. The questions officer pulled an injured driver out just before flames engulfed the (continued) passenger compartment. It was later determined that the driver had suffered a spinal injury as a result of the collision, and that moving the victim may have worsened the condition, leading to the victim being partially paralyzed.  Is the officer liable?  How would this change if there was no immediate danger? LD 34 – Chapter 2: Victim Assessment 2-21 Classroom Demonstrations Introduction During class, the instructor will discuss and demonstrate specific techniques for conducting assessments on an injured victim. Students will have the opportunity to practice each technique and develop their own levels of skill. 2-22 LD 34 – Chapter 2: Victim Assessment  Basic Life Support Overview Learning need Peace officers may be required to provide basic life support for a victim, fellow officer, or themselves until additional medical services become available. Learning The following table identifies the student learning objectives for this chapter: objectives After completing study of this chapter, the student will Objective ID be able to:  Identify the components of the Chain of Survival 34.03.25  Demonstrate Cardiopulmonary Resuscitation (CPR) for adults, children, and infants, following current American Heart Association (AHA) Guidelines for CPR and Emergency Cardiovascular Care (ECC) at the Healthcare provider level including: - Ventilation duration 34.03.08 - Pulse location 34.03.09 - Compression depth 34.03.10 - Compression rate 34.03.11 - Compression-to-ventilation ratio (one-person CPR) 34.03.12 - Compression-to-ventilation ratio (two-person CPR) 34.03.13 - Automated External Defibrillator (AED) 34.03.26  Discuss Basic Automated External Defibrillator (AED) 34.03.27 operation including: - Special considerations - Troubleshooting  Recognize circumstances under which a victim’s airway should be opened by using a: - Head-tilt/chin-lift maneuver 34.03.01 - Jaw-thrust maneuver 34.03.02 Continued on next page LD 34 – Chapter 3: Basic Life Support 3-1 Overview, Continued Learning After completing study of this chapter, the student will Objective ID objectives be able to: (continued)  Identify the difference between a mild and a severe 34.03.03 airway obstruction  Demonstrate procedures for clearing an obstruction from the airway of both a conscious and an unconscious: - Adult 34.03.21 - Child 34.03.22 - Infant 34.03.23 - Pregnant or obese individual 34.03.24  Discuss rescue breathing techniques including: 34.03.07 - Mouth-to-mouth - Pocket mask or other barrier devices - Bag valve mask  Discuss the recovery position 34.03.28  Discuss bleeding control techniques to including: 34.03.15 - Direct pressure/pressure dressings - Tourniquet - Types of hemostatic dressings and packing the wound  Demonstrate the general guidelines for controlling 34.03.16 bleeding from an open wound  Recognize the first aid treatment for traumatic injuries including: - Impaled objects 34.03.29 - Amputations 34.03.30  Recognize the signs and symptoms of shock 34.03.19  Discuss first aid measures to treat shock including the 34.03.31 importance of maintaining normal body temperature  Demonstrate first aid measures to treat shock 34.03.20 Continued on next page 3-2 LD 34 – Chapter 3: Basic Life Support Overview, Continued In this chapter This chapter focuses on techniques for performing basic emergency and life support maneuvers. Refer to the following table for specific topics: Topic See Page Cardiopulmonary Resuscitation (CPR) 3-4 Airway Obstructions 3-23 Rescue Breathing 3-34 Bleeding Control 3-39 Shock 3-45 Workbook Learning Activities 3-48 Classroom Demonstration 3-52 LD 34 – Chapter 3: Basic Life Support 3-3 Cardiopulmonary Resuscitation (CPR) Introduction If a victim is unresponsive, not breathing or inadequately breathing, and has no definite carotid pulse to indicate circulation, then the victim is in a state of cardiac arrest. Chain of The 5 links in the adult Chain of Survival are Survival Immediate recognition of cardiac arrest and activation of the emergency response system Early cardiopulmonary resuscitation (CPR) with an emphasis on chest compressions Rapid defibrillation Effective advanced life support Integrated post-cardiac arrest care A strong Chain of Survival can improve the chances of survival and recovery for victims of heart attack, stroke and other emergencies. NOTE: American Heart Association (AHA) CPR Cardiopulmonary Resuscitation (CPR) is a method of artificially restoring and maintaining a victim’s breathing and circulation. Early CPR is a key element of basic life support and the Chain of Survival. CPR sequence In order to survive, oxygenated blood must circulate through the body and reach the victim’s brain. In order to ensure that this process takes place, a peace officer/first responder must:  provide external chest compressions to circulate the victim’s blood  maintain an open airway  provide rescue breaths With the exception of newborns, the sequence for CPR is chest compressions, airway, and breathing (C-A-B). Continued on next page 3-4 LD 34 – Chapter 3: Basic Life Support Cardiopulmonary Resuscitation (CPR), Continued Clinical and A victim is clinically dead the moment breathing and circulation stop. biological Clinical death may be reversible if basic life support techniques such as CPR death are initiated immediately. When a victim’s breathing and circulation stop and brain cells die due to lack of oxygen, irreversible changes begin to take place, and vital organs begin to deteriorate. At this point, a victim is biologically dead. Biological death usually takes place within four to six minutes after breathing and circulation stop. NOTE: If any doubt exists as to whether or not the victim is alive, CPR should be started. NOTE: The point at which a victim is considered to be biologically dead may be defined by specific agency guidelines and policy. “Do not A valid emergency medical services prehospital do not resuscitate (DNR) resuscitate” form, Physician Orders for Life Sustaining Treatment (POLST), or other orders advance health care directive are reasons for not beginning CPR on a victim. If there is doubt that the order may not be valid start CPR. Specific Different agencies may have specific policies and guidelines regarding agency performing CPR on unconscious adults, children, and infants, or DNR orders. policy Peace officers are responsible for knowing and complying with their agency policy. Continued on next page LD 34 – Chapter 3: Basic Life Support 3-5 Cardiopulmonary Resuscitation (CPR), Continued Adult CPR: Once a peace officer has confirmed the victim’s responsiveness, and has one-person determined that there is no breathing or circulation, CPR should be initiated immediately. Actions Determine  Tap & shout responsiveness  Request additional EMS resources and get an AED if available  Assess for breathing  Look for no breathing or abnormal breathing Pulse check  Locate the trachea, using 2 or 3 fingers  Slide these 2 or 3 fingers into the groove between the trachea and the muscles at the side of the neck, where you can feel the carotid pulse  Feel for a pulse for at least 5 but no more than 10 seconds. If you do not definitely feel a pulse, begin CPR, starting with chest compressions, airway, and breathing (C-A-B) Chest  Position yourself at the victim’s side compression  Make sure the victim is lying face-up on a firm, flat surface. If the victim is lying face-down, carefully roll the victim face-up. If you suspect the victim has a head or neck injury, try to keep the head, neck, and torso aligned when rolling the victim to a face-up position Continued on next page 3-6 LD 34 – Chapter 3: Basic Life Support Cardiopulmonary Resuscitation (CPR), Continued Adult CPR: Actions one-person (continued) Chest  Put the heel of one hand on the center of the victim’s compression chest on the lower half of the breastbone (continued)  Put the heel of your other hand on top of the first hand  Straighten your arms and position your shoulders directly over your hands  Push hard and fast  Press down at least 2 inches (5 cm) not to exceed 2.4 inches (6 cm) with each compression (this requires hard work). For each chest compression, make sure you push straight down on the victims breastbone  Deliver compressions at a rate of 100/min to 120/min  At the end of each compression, make sure you allow the chest to recoil (re-expand) completely. Chest recoil allows blood to flow into the heart and is necessary for chest compressions to create blood flow. Incomplete chest recoil is harmful because it reduces the blood flow created by chest compressions. Chest compression and chest recoil/relaxation times should be approximately equal  Minimize interruptions Ventilation  Open the victim’s airway using head-tilt or jaw-thrust maneuver  Provide ventilation  Give 2 breaths with each lasting 1 second  Victim’s chest to visibly rise Compression  After 30 compressions, open victim’s airway, give two Cycle breaths  Continue cycle of 30 compressions to 2 breaths Continued on next page LD 34 – Chapter 3: Basic Life Support 3-7 Cardiopulmonary Resuscitation (CPR), Continued Adult CPR: When performed correctly, two-person CPR is more efficient than CPR two-persons performed by one person. With two people, chest compressions are interrupted less and the individuals performing CPR do not tire as easily. Actions Determine  Tap & shout responsiveness  Request additional EMS resources and get an AED if available  Assess for breathing  Look for no breathing or abnormal breathing  Pulse check  Locate the trachea, using 2 or 3 fingers  Slide these 2 or 3 fingers into the groove between the trachea and the muscles at the side of the neck, where you can feel the carotid pulse  Feel for a pulse for at least 5 but no more than 10 seconds. If you do not definitely feel a pulse, begin CPR, starting with chest compressions Chest  Position yourself at the victim’s side compression  Make sure the victim is lying face-up on a firm, flat surface. If the victim is lying face-down, carefully roll the victim face-up. If you suspect the victim has a head or neck injury, try to keep the head, neck, and torso aligned when rolling the victim to a face-up position  Put the heel of one hand on the center of the victim’s chest on the lower half of the breastbone  Put the heel of your other hand on top of the first hand  Straighten your arms and position your shoulders directly over your hands Continued on next page 3-8 LD 34 – Chapter 3: Basic Life Support Cardiopulmonary Resuscitation (CPR), Continued Adult CPR: Actions two-person (continued) Chest  Push hard and fast compression  Press down at least 2 inches (5 cm) not to exceed (continued) 2.4 inches (6 cm) with each compression (this requires hard work). For each chest compression, make sure you push straight down on the victim’s breastbone  Deliver compressions at a rate of 100/min to 120/min  At the end of each compression, make sure you allow the chest to recoil (re-expand) completely. Chest recoil allows blood to flow into the heart and is necessary for chest compressions to create blood flow. Incomplete chest recoil is harmful because it reduces the blood flow created by chest compressions. Chest compression and chest recoil/relaxation times should be approximately equal  Minimize interruptions Ventilation  Open the victim’s airway using the head-tilt/chin-lift technique or jaw-thrust maneuver  Provide ventilation  Give 2 breaths with each lasting 1 second  Victim’s chest to visibly rise Continued on next page LD 34 – Chapter 3: Basic Life Support 3-9 Cardiopulmonary Resuscitation (CPR), Continued Adult CPR: Actions two-person (continued) Compression  After 30 compressions, open victim’s airway, give two Cycle breaths  Continue cycle of 30 compressions to 2 breaths  Every 5 cycles or approximately every 2 minutes duties should be switched  Switching duties with the second rescuer should take less than 5 seconds NOTE: If unsure there is a pulse, continue CPR. NOTE: All findings, counting, etc. should be announced clearly and out loud to avoid confusion between the assisting peace officers. NOTE: When performing two-person CPR, the rescuer providing chest compressions may become fatigued and reduce the effectiveness of CPR. Continued on next page 3-10 LD 34 – Chapter 3: Basic Life Support Cardiopulmonary Resuscitation (CPR), Continued Child CPR The technique for performing CPR on a child, (one year to puberty) is similar One person to that for adults, but with adjustments that take into account the child’s size. The following table identifies the process for performing CPR on a child: Actions Determine  Tap & shout responsiveness  Request additional EMS resources and get an AED if available  Assess for breathing  Look for no breathing or abnormal breathing  Shout for help  If someone responds, send that person to activate the emergency response system and get the AED NOTE: If alone and child collapsed in front of you, you may leave the child to request additional EMS resources and obtain an