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Pathogens

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1) Bacteria - Microscopic organism that lives in water, soil, or organic material... 2) Virus - Submicroscopic agent that is capable of infecting living cells.

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Transfer of pathogens

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- Airborne - Blood borne

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BSI

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Body Substance Isolation

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PPE

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Personal Protective Equipment - Gloves - Eye Protection - Masks - Gowns - Ventilation Devices - General Supplies - Soap, Leak proof....

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Immunity from liability:

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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.

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Implied consent

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Is a legal position that assumes that an unconscious or confused victim would consent to receiving emergency medical services if that person were able to do so.

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Right to refuse help

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A conscious and competent adult has the right to refuse any emergency medical services but will be required to sign a release form.

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Primary Assessment Actions:

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1) Check for responsiveness 2) Check ABC's 3) Control major bleeding 4) Treat for shock 5) Consider C-Spine

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Secondary Assessment Actions:

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1) Check and document vital signs - Skin color - Temperature - Respiratory Rate - Pulse 2) Head to toe check for injuries 3) Gather information regarding the victim, incident and medical history.

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Secondary Assessment Acronym:

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D - Deformities O - Open Injuries T - Tenderness S - Swelling

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Responsiveness Acronym

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A - Alert V - Verbal P - Painful U - Unresponsive

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Mechanisms for opening airway

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1) Head-tilt/ Chin-lift - No C-spine suspected 2) Jaw-thrust - C-spine suspected NOTE: if unable to establish an airway with jaw-thrust use head-tilt.

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Triage Categories:

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Black - Deceased Red - Immediate Yellow - Delayed Green - Minor

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Triage System time limit:

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Less than one minute per person.

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Assessment Criteria:

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Breathing: - None - Deceased - Over 30/min - Immediate - Below 30/min - Continue assessment Circulation (Capillary refill): - More than 2 sec - Immediate - Less than 2 sec - Continue assessment Mental Status (Give commands): - Unable to follow commands - Immediate - Follows commands - Delayed or minor

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When to move victim

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- Imminent danger to officer or victim - Unable to access to do assessment *DO NOT MOVE unless absolutely necessary *Only more as far as necessary

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5 Links in adult chain of survival:

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1) Immediate Recognition/ Activation 2) Early CPR 3) Rapid Defibrillation 4) Effective advanced life support 5) Integrated post-cardiac arrest care

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Clinical and Biological death

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Clinical Death is reversible Biological Death is irreversible - Brain cells have began to die (4 to 6 minutes)

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Adult Responsiveness / Pulse Check

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- Tap and shout - Assess for breathing - Check carotid pulse - 2 or 3 fingers in the groove between the trachea and the muscles at the side of the neck. - Feel for 5 but no more than 10 seconds

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Adult chest compression and Ventilation:

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- Heel of hand at center of chest on lower half of breastbone - At least 2 inches - 2 inches (5cm) - 2.4 inches (6cm) - 100-120 compression/min - 30:2 - 2 breaths with each lasting 1 second *NOTE: If unsure of pulse, continue CPR.

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Child Responsiveness / Pulse Check (1 year to puberty)

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- Tap & Shout - Assess for breathing *NOTE: If you witness fall you may leave to get help. If not, do 5 cycles of CPR then leave to get help. - Check carotid for no longer than 10 seconds - If no pulse OR pulse is less than 60 BPM with poor perfusion START COMPRESSION.

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Child Chest Compression and Ventilation (1 year to puberty)

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- 30:2 (15:2 for two person) - Heel on chest on lower half of breastbone - 100/ min to 120/ min - 1/3 the depth of chest - or 2 inches (5cm)

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Infant Responsiveness / Pulse Check (under 1 year of age)

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- Tap and Shout - Assess breathing - Check Brachial for no more than 10 seconds (5-10) - If no pulse OR less than 60 BPM with poor signs of perfusion, Start CPR.

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Infant Chest Compression and Ventilation (Under 1 year of age)

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- 30:2 (15:2 for two person) - 2 fingers in center of chest just below nipple line - Press breastbone down 1/3 depth of chest (1 1/2 inch or 4cm) - 100/ min to 120/ min

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Rescue breathing

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Adult - 1 breath every 5-6 seconds Children - 1 breath every 3-5 seconds *Check pulse every 2 minutes *Breath should take 1 second

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Gastric Distention

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Rescue breathing forcing air into the stomach and causing the stomach to become distended.

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Tourniquet

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- Only use in life threatening situations when direct pressure did not work. - Apply close to wound between would and heart. - Never on a joint. - Note the time the tourniquet was applied.

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Types of open wounds:

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- Abrasion - Incision - Straight - Laceration - Jagged - Puncture - Avulsion - Part of structure of body that has been forcibly torn or cut away. - Amputation

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When to treat for shock:

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All victims of traumatic injuries should be treated for shock. - Control bleeding - be alert for vomiting - Maintain body temperature - Place in position to maintain blood flow to brain - reassure victim - continue monitoring *Do not give anything to drink!

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Mental Status with head injuries:

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- Agitated or confused - Combative - Decreased level of consciousness - Loss of short term memory - Loss of consciousness

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Appearance of head injuries:

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- Clear of bloody fluid from the ears and/or nose - Unequal pupils - Bruises behind ears - Bruising around eyes - Paralysis - Priapism - in the presence of a traumatic C-spine injury (ie. penile erection)

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What two things you do not do with head injuries:

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- Do not apply direct pressure - Do not elevate the legs - Do not move

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Impaled objects in face:

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- If there is no airway obstruction, leave object. - If removing an there is resistance, leave object. - If airway obstruction and object comes out the same way it went in, remove object.

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Objects in eye:

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- Do not remove - Do not apply direct pressure - Cover other eye to limit eye movement

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Chemical in eye:

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- Remove contact lenses - Do not rub eye - Identify chemical if possible - Flush eye with copious amounts of water

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Dental emergency:

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- Do not attempt to replace tooth or apparatus - Visually inspect area to see if there are any fragments - Tooth may be transported in saline, whole milk, or victims saliva.

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Types of chest and abdomen injuries:

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- Blunt trauma - Penetrating object - Compression

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Closed chest wound indicators:

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- Paradoxical breathing - When both sides of the chest do not move at the same time. - Painful and shallow breathing.

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Open chest wound treatment:

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- Occlusive dressing should be applied over the wound as quickly as possible. - Occlusive dressing - a nonporous dressing used to cover the wound that creates an air-tight seal. - Tension Pneumothorax - "burp" the seal if there is indication of respiratory distress.

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Fracture:

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- Complete or partial break of a bone. Open fracture - Break in the skin. Closed fracture - No break in the skin.

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Dislocation:

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- When a bone is pushed or pulled out of alignment from a joint.

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Sprains:

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- Severely stretched or torn ligaments. - Associated with joint injuries.

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Strains:

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- Over-stretching or tearing of muscles.

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First degree burn:

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- Damage only to the epidermis. (First layer of the skin) - Superficial burns.

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Second degree burns:

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- Damage to the epidermis and the dermis. (First and second layer of the skin) - Referred to as partial thickness burns.

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Third degree burns:

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- Damage to the epidermis, dermis, and into the fatty layer and the muscle beneath the skin. - Referred to as full thickness burns.

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Thermal burns:

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- Caused by direct heat. - Possible casual agents include: Radiation, Fire, Steam, Hot liquids, Hot object. First Aid Measures: - Remove from heat source - Stop the burning process by cooling burned area with cool water. - apply loose sterile dressing - Treat for shock NOTE: over-cooling large body surface burns may lead to hypothermia.

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Chemical burns:

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- Caused by acids of alkalis coming into contact with the skin. First Aid Measures: - PPE - Dry powder: brush off then flush with water. - Liquid: flush for 15-30 minutes. - Treat for shock

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Electrical Burns:

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- Alternating current, direct current, lighting. First Aid Measures: - Do not touch till the source of current is turned off. - Examine for external burns. - Treat for shock.

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Radiation Burns:

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- Sickness that occurs when the body is exposed to radiation in either a single large dose or chronically. First Aid Measures: - Evacuate the area - Remove all exposed clothing and seal in a bag - wash body with soap and water - dry and wrap the infected areas with a towel

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Coronary Artery Disease

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- A disease where fatty deposits build up in the walls of the arteries that feed the heart's muscle.

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Most common indicators of cardiac emergency:

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- Chest Pain: Crushing, dull, heavy or persistent pain, sensation of squeezing or pressure. - Radiating Pain: Pain, pressure or discomfort moving down either arm, Jaw, shoulder, or back, dawn upper abdomen. - Vital Signs: Difficulty breathing or shortness of breath, abnormally slow or fast pulse. - Mental Status: Anxiety or feeling of impending doom, Irritability or short temper, denial of indicators. - Other: Profuse sweating, cool, moist, pale skin, Nausea or heartburn.

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Breathing Rate:

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Adult: 12-20 Child: 15-30 Infant: 25-50

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Respiratory Injury Indicators:

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- Breathing rate abnormal - Labored Breathing - Breathing Sounds - Wheezing, gurgling, deep snoring sound or no sound at all. - Coloring - Blue/Gray - Mental Status - Anxious, fearful, panicky, altered

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Seizure:

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A result of a surge of energy throughout the brain. Instead of discharging electrical energy in a controlled manner, the brain cells continue firing.

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Causes of Seizures:

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- Medical - Trauma - Environmental

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Stroke:

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A victim experiences a stroke (cerebrovascular accident (CVA)) when an artery providing blood to the brain is blocked.

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Indicators of a stroke:

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- Mental Status: Confusion, delirium, dizziness, headache, unconsciousness. - Mobility: Paralysis on one side of the body, Numbness or weakness, Convulsions, severe neck or facial pain, poor balance. - Vision: Blurred or double vision, unequal pupil size, sensitivity to light. - Communication: Impaired or slurred speech - Other: Difficulty breathing, vomiting.

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Stroke treatment

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- Request EMS - If conscious, elevate head and shoulders slightly - Do not give anything by mouth

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Hypoglycemia:

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- Low blood sugar - Sudden onset - More common - Pale, cold, moist, clammy - Profuse perspiration - Hostile or aggressive - Fainting, seizure - May appear intoxicated - Rapid pulse - Dizziness - Hunger - Drooling, Nausea, Vomiting

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Hyperqlycemia:

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- High blood sugar - Usually slow onset - Red, warm, dry - Labored breathing - Sweet smell (Fruity) - Decreased level of consciousness - Restless, confusion, intoxicated - Weak rapid pulse - Dry mouth, intense thirst - Excessive hunger, sunken eyes

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Exposure to poisons:

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- Ingestion - Inhalation - Absorption - Injection

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Frostnip:

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- Superficial freezing of the skin's outer layer. - Remove victim from cold source and loosen and restrictive clothing.

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Frostbite:

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- Freezing tissue below the skin's surface. - Wrap area in dry, loose bandage. - Wrap each digit individually. - Allow to rewarm slowly.

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Heat cramps:

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- When the body looses too much salt due to prolonged perspiration. - Painful muscle spasms - Weakness - Lightheaded

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Heat exhaustion:

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- A form of shock that can occur when the body becomes dehydrated. - Profuse sweating - Dizziness - Headache - Pale, clammy skin - Weakness - Nausea and vomiting

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Heat Stroke:

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- When the bodies internal temperature rises abnormally high. - Red, hot, dry skin - Rapid irregular pulse - Confusion - Shallow breathing - Remove from heat source - Cool victim's body as rapidly as possible - Place a towel with ice in groin and armpits and neck - Heat stroke is life-threatening

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Stages of labor:

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- Contraction to crowning - Crowning to Delivery - Delivery to Placenta

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When can you transport a mother in labor:

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- The patient can be transported only if she is in the first stage of labor. (not straining, contractions are greater than 5 minutes apart, no signs of crowning.)

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Preventing explosive delivery:

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- Support the babies head while supporting the mothers perineum.

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Indications that birth may be imminent:

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- Contractions that are occurring less than two minutes apart (five minutes if second ir subsequent birth) - The woman feels the urgent need to bear down. - Crowning is present. - The amniotic sac has ruptured and the amniotic fluid is released.

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Immediate transportation if:

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- Limb presentation - Breach presentation - Cord presentation

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