Chapter 1
Background
Information
Agree or Disagree? (1 of 3)
1. Rub snow on frostbitten
skin.
2. Put butter on burned skin.
3. Immediately soak a
sprained ankle in warm
water.
4. Cut and suck the poison
out of a snakebite.
Agree or Disagree? (2 of 3)
5. Those “struck dead” by
lightning cannot be
resuscitated.
6. Do not let someone with a
head injury go to sleep.
7. Clean a wound by soaking it in
water.
8. Avoid using ointments on
burns.
Agree or Disagree? (3 of 3)
9. Kill germs in wounds by
using hydrogen peroxide.
10. Induce vomiting in all
ingested poison cases.
11. Legally, you must help an
injured person.
Need for First Aid Training
• At some point in their lives, everyone
will have to make the decision to
help in an emergency or not.
• It’s better to know it and not need it,
than to need it and not know it.
Reason for First Aid Training
Each year unintentional injuries:
• Are the number one cause of
death of people between the
ages of 1 and 38.
• Are the number five cause of
death in the entire population.
What is First Aid?
• First = immediate
• Aid = care
• Deals with injuries or sudden
illness
• DOES NOT replace the need for
medical care
Purpose of First Aid
• Find it
• Fix it
Consent
• Consent — permission to help
• Expressed consent — verbal
confirmation or head nod
• Implied consent
• Unresponsive victim
• Minors
• Mentally incompetent
Victim Refuses Aid
• Rarely happens
• Reasons why it occurs
• Religious beliefs
• Fear of physical pain
• Victim would prefer a doctor’s
care
Negligence Criteria
• Duty to Act existed
• Breach of that duty
• Injury and damage
occurred
Good Samaritan Laws
Immunity generally applies when:
• Rescuer acted in an emergency
• Rescuer acted in good faith
• Rescuer acted without compensation
• Rescuer did not commit gross
negligence
Introduction to EMS Systems
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The EMS System
Components of the EMS System
Activating the EMS System
In-Hospital Care System
Medical Oversight
Roles and Responsibilities of the First Responder
First Responder Skills
Equipment, Tools, and Supplies
The EMS System
A network of resources to provide
emergency care and transport
to victims of sudden illness and
injury.
The Emergency Scene
Recognition of Accident and Activation of EMS
EMS Dispatch
Arrival of First Responders
Care Given at the Scene
Arrival of Additional EMS
Care During Transport
Transfer to Hospital Emergency Department
Components of the EMS System
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Human Resources
Medical Oversight
Communications
Facilities
Transportation
Resource Management
Regulation and Policy
Public Education
Evaluation
Activating the EMS System
• Enhanced 9-1-1
• 9-1-1
• Non 9-1-1
In-Hospital Care System
• Emergency Department
• Specialty Facilities
• Trauma Centers
• Burn Centers
• Pediatric Centers
• Hospital Personnel
• Physicians
• Nurses
• Allied Personnel
Medical Oversight
The First Responder may be a designated
agent of the physician. Care rendered
may be considered an extension of the
medical director’s authority.
Medical Oversight
A formal relationship between the EMS
providers and the physician responsible
for the prehospital emergency medical
care provided in a community.
Medical Direction Given by On-line Orders
Medical Oversight
• Indirect Medical Control
• System Design
• Protocols
• Education
• Quality Management
Levels of Training
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EMT-Paramedic
EMT-Intermediate
EMT-Basic
First Responder
Roles and Responsibilities
• Personal health and safety
• Neat, clean, and professional
appearance
• Competency in knowledge and skills
• Caring attitude
• Maintain composure
Patient-Related Duties
• Size up the scene.
• Find out what is wrong with the patient.
• Lift or move the patient only when it is
necessary.
• Transfer the patient and patient information.
• Protect the patient’s privacy and maintain
confidentiality.
• Be the patient’s advocate.
Skills
• As a First Responder, you should be able to:
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Assess and control the scene of a simple incident.
Gain access to patients.
Evaluate a scene for safety.
Properly use all items of personal safety.
Gather information from patients and bystanders.
Conduct a patient assessment.
Relate signs and symptoms to illnesses and injuries.
Determine vital signs.
Document.
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Perform airway management.
Perform Cardiopulmonary Resuscitation.
Operate an Automatic External Defibrillator.
Control bleeding.
Skills
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As a First Responder, you should be able to:
• Assess and care for shock.
• Assess and provide care for closed injuries and open
injuries.
• Carry out basic dressing and bandaging techniques.
• Assess and care for painful, swollen, deformed
extremities.
• Assess and care for possible injuries of the head,
neck, and spine.
• Assess and care for cardiac and medical emergencies.
• Identify and care for poisoning cases.
• Classify and provide care for burns.
• Identify and care for smoke inhalation.
Skills
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As a First Responder, you should be able to:
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Assess and care for environmental emergencies.
Assist a mother in delivering her baby.
Provide initial care for the newborn.
Identify and care for drug-abuse and alcohol-abuse
patients.
Perform non-emergency and emergency patient moves
when required.
Perform triage at a multiple-patient emergency scene.
Work under the direction of an Incident Commander.
Work under the direction of EMTs.
Skills
• In some systems that have very special needs, First
Responders may be required to:
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Determine blood pressure.
Use a bag-valve-mask resuscitator (ventilator).
Deliver oxygen using appropriate devices.
Apply or assist in applying a traction splint.
Apply or assist in applying an extrication collar.
Assist in securing a patient to a long spine board
(backboard) or other device used to immobilize the
patient’s spine.
Equipment, Tools, and Supplies
• First Responders should know how to
use, and have available whenever
possible:
• Appropriate barriers (masks and gloves)
• Triangular bandages
• Roller-type bandages
• Gauze pads and trauma dressings
• Occlusive dressings (for airtight seals)
Equipment, Tools, and Supplies
• First Responders should know how to
use, and have available whenever
possible:
• Adhesive tape
• Bandage shears
• Eye protector (paper cup or cone)
• Stick (for tourniquet)
• Blanket and pillow
• Upper and lower extremity splint sets
Equipment, Tools, and Supplies
• Optional items First Responders may use:
• Blood pressure cuff and a stethoscope
• Oxygen delivery systems
• Suctioning equipment
• The First Responder should be
comfortable with the use of common hand
and power tools.
Summary
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The EMS System
Components of the EMS System
Activating the EMS System
In-Hospital Care System
Medical Oversight
Roles and Responsibilities of the First Responder
First Responder Skills
Equipment, Tools, and Supplies
Well-Being of the First Responder
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Emotional Aspects of Emergency Care
First Responders and Stress
Critical Incident Stress Management
Body Substance Isolation (BSI)
Scene Safety
Hazardous Materials Incidents
Rescue Operations
Violence and Crime Scenes
Emotional Aspects of Emergency Medical
Care
• First Responders and Stress:
• Stress contributes to:
• Cardiovascular disease
• Stroke
• Diabetes
• Cancer
• Arthritis
• Gastrointestinal conditions
• Neurological disorders
• Emotional disorders
Emotional Aspects of Emergency Medical
Care
• First Responders and Stress:
• Physical demands
• Psychological demands
• Personnel must respond quickly to
emergencies.
• Personnel must react instantly to
situations.
Emotional Aspects of Emergency Medical
Care
Emergencies can be stressful.
Stressful Situations
The First Responder will experience
personal stress as well as
encounter patients and bystanders
in severe stress.
Common Causes of Stress
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Multiple-casualty incidents
Pediatric patients
Death
Violence
Abuse and neglect
Death or injury of a coworker
Multiple-Casualty Incident
Burnout
• A reaction to cumulative stress or exposure to
multiple critical incidents
• The signs of burnout include:
• Loss of enthusiasm and energy
• Feelings of frustration
• Hopelessness
• Low self-esteem
• Isolation
• Mistrust
Death and Dying
• As a First Responder, you will at
some time have to deal with a patient
who has a terminal illness or injury.
• Patients, their families, and the
providers will have many different
reactions to the illness or injury.
The Grieving Process
• The five stages include the following:
• Denial, or “not me”
• Anger, or “why me?”
• Bargaining, or “OK, but first let me
...”
• Depression
• Acceptance
The Grieving Process
• The First Responder should:
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Recognize the patients’ needs.
Be tolerant of angry reactions.
Listen empathetically.
Do not give false hope or
reassurance.
• Offer comfort.
Signs and Symptoms of Stress
Stress Management
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Recognize warning signs.
Lifestyle changes
Balance work, recreation, and family.
Exercise.
Work environment changes
Seek professional help.
Critical Incident Stress
The normal stress response to
abnormal circumstances.
Critical Incident Stress Management
Critical Incident Stress Management
• When to access CISD:
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Line of duty death
Serious injury of a co-worker
Death or serious injury of a child
Any event that has an unusual impact
on personnel
Body Substance Isolation (BSI)
A form of infection control based
on the presumption that all body
fluids are infectious.
Dealing with Risk
• An estimated 250 health-care workers
die each year from hepatitis B or its
complications, more than from any
other infectious disease.
• EMS personnel must follow the rules
for their own safety and the safety of
others.
Dealing with Risk
• Infections are caused by organisms:
• viruses (which cause illnesses such as
colds, flu, HIV, and hepatitis)
• bacteria (which cause sore throats, food
poisoning, rheumatic fever, gonorrhea,
Legionnaire’s disease, and tuberculosis, to
name a few)
• There are both viral and bacterial forms of
pneumonia and meningitis.
Dealing with Risk
• Organisms are also called pathogens:
• The term pathogen means to generate
suffering:
• patho-, suffering
• -gen, create or form
• Spread by exposure to body fluids
• Spread by exposure to airborne droplets
Personal Protective Equipment (PPE)
• Gloves—latex, vinyl, or other synthetic
• Face shields or masks—surgical-type masks:
• For fine particles of airborne droplets
(coughing), wear a high-efficiency particulate
air (HEPA) or N-95 respirator.
• Eye protection—Use eyewear that protects them
from both the front and sides.
• Gowns—Use when there is spurting blood,
childbirth, injuries with heavy bleeding.
Dealing with Risk
• Handwashing:
• Wash hands and change gloves
between patients.
• OSHA has stated that handwashing is
one of the most important steps to take
for infection control.
Dealing with Risk
Bloodborne and Airborne Pathogens
• HIV (human immunodeficiency virus):
• HIV is the pathogen that causes AIDS.
• HIV does not survive well outside the
body.
• Routes of exposure to HIV:
• Direct contact with non-intact (open)
skin or mucous membranes
• Blood, semen, or other body fluids
Bloodborne and Airborne Pathogens
• Hepatitis:
• Hepatitis B virus (HBV) is a very tough
virus:
• It can survive on clothing, newspaper, or
other objects for days after infected
blood has dried.
• HBV causes permanent liver damage in
many cases.
• Can be fatal
• Hepatitis C
• Non-A and Non-B hepatitis:
• Less common than HBV
Bloodborne and Airborne Pathogens
• Tuberculosis (TB):
• Most often affecting the lungs, can also be
fatal.
• Thought to have been nearly eradicated as
recently as 1985.
• Has had a recent resurgence.
• New strains of the disease are resistant to
treatment with traditional medication.
Bloodborne and Airborne Pathogens
• Tuberculosis (TB):
• Spread by aerosolized droplets in the air,
usually the result of coughing and
sneezing.
• TB can be contracted even without direct
physical contact with a carrier.
• Use face masks with one-way valves for
rescue breathing and (HEPA) respirator or
N-95 respirator.
Bloodborne and Airborne Pathogens
• Meningitis:
• An inflammation of the lining of the brain and
spinal cord
• The most infectious varieties of meningitis are
caused by bacteria.
• Meningitis is transmitted by respiratory droplets.
• First Responders should make sure that EMS and
hospital staffs inform them if they have been in
contact with a patient infected with meningitis or
a scene that may be contaminated with it.
Protecting First Responders
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In 1992, OSHA issued guidelines for employers whose workers run a
risk of occupational exposure to bloodborne diseases.
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All such agencies are required to implement plans to meet the OSHA
standards.
• Provide a free hepatitis B vaccination.
• Educate employees about bloodborne diseases.
• Establish safe workplace procedures.
• Supply personal protective equipment.
• Set up engineering controls.
• Provide an equipment-cleaning site.
• Ensure proper waste disposal according to local regulations.
• Implement post-exposure follow-up:
• Determine the significance of exposure.
• Document the event.
• Test the employee.
Employee Responsibilities
• An infection-control program will only work if
First Responders learn and follow correct
procedures.
• As a First Responder, you have an obligation
to adhere to safe work practices:
• Washing hands regularly
• Using gloves and other personal
protective equipment
Employee Responsibilities
• You may not withhold emergency care
from a patient who you think may have
an infectious disease.
• To date, there are no known cases of
emergency workers contracting HIV or
HBV during routine patient care using
gloves and appropriate personal
protective equipment.
Scene Safety
• Starts before First Responders actually
arrive at the scene
• En route to the scene, get information
from dispatch.
• Approaching an emergency scene:
• look around for hazards
• listen for noises
Scene Safety
• Position the vehicle.
• You must ensure the safety for:
• Yourself
• Your Partner
• The Patient
• Bystanders
Scene Safety
• Look for:
• Environmental conditions
• Violent situations
• Weapons
• Crowds
• Other situations
Scene Safety
Ensure the scene is safe.
Hazardous Materials Incidents
• Some chemicals can cause serious illness
or even death, even if your exposure is
brief.
• First Responders should maintain a safe
distance from the source of any materials
and treat it as a hazardous materials
incident.
Hazardous Materials Incidents
• Transport and Storage:
• Truck
• Train
• Boat
• Various storage containers and
facilities
Hazardous Materials Incidents
• Placards may help with identifying
materials in vehicle collisions.
• Coded colors and identification
numbers
Hazardous
Materials
Incidents
• Listed in the Emergency Response Guidebook :
• Published by the U.S. Department of
Transportation (DOT)
• It can provide important information:
• About a hazardous substance
• Safe distances
• Emergency care
• Suggested procedures in the event of spills
or fire
Hazardous Materials Incidents
• Procedures:
• Identify hazardous materials placards
from a safe distance, thus ensuring
your own safety.
• Recognize potential problems and take
action to preserve your own safety and
that of others.
• Notify hazardous materials response
teams.
Rescue Operations
• Rescue scenes may include dangers from
electricity, fire, explosion, hazardous materials,
traffic, or water and ice.
• Evaluate each situation and request the
appropriately trained teams to assist in handling
these incidents:
• Police
• Fire department
• Utility companies
• Other specialized personnel
Rescue Operations
• Never perform acts that you are not
properly trained to do.
• Use personal protective equipment:
• Turnout gear
• Protective eyewear
• Helmet
• Gloves
Violence and Crime Scenes
• Your first priority—even before
patient care—is to be certain the
scene is safe before you enter it.
• Recognize the situation.
• Request the necessary help.
Summary
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Emotional Aspects of Emergency Care
First Responders and Stress
Critical Incident Stress Management
Body Substance Isolation (BSI)
Scene Safety
Hazardous Materials Incidents
Rescue Operations
Violence and Crime Scenes