Chapter One
Before Giving Care and Checking an
Ill or Injured Person
The EMS System

Network of community resources
and medical personnel that provides
emergency care to victims of injury
or sudden illness
The Lay Responder


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Someone who recognizes an
emergency and decides to help
First aid – is immediate care given
to a victim of injury or sudden
illness until more advanced care can
come
In other words – this is you doing
what you have learned
The EMS Dispatcher

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The dispatcher is the person who
receives the call from the citizen
responder
This person determines what help is
needed
Some are trained to give the caller
instructions until EMS comes
In other words, the person who
answers when you call 9-1-1
First Responder


This is the first person to arrive on
the scene who is trained to provide
a higher level of care
They are often close to the scene
and have the appropriate
equipment and supplies to give care
The Emergency Medical Technician


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The EMT is capable of providing more
advanced care and life support
techniques
EMT Basic Level – all ambulance
personnel have this basic training
EMT Paramedics – at this level they
can give medication, IV fluids, and
provide advanced airway care. They
are the highest level of care outside of
the hospital
Hospital & Rehabilitation


Hospital – once the victim arrives at
the hospital, the personnel there
takes over
Rehabilitation – the goal of rehab is
to return the victim to his/her
previous state of health
Your Role in the EMS System

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Recognize that an emergency exists
Decide to act
Activate the EMS system
Give care until help arrives
Step 1: Recognizing an Emergency
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Unusual Noises
Unusual Sights
Unusual Odors
Unusual
Appearance
and
Behavior
Step 2: Deciding to Act
Barriers to Action
Definition - Things that would stop you from helping a victim.
1.
2.
3.
4.
5.
6.
7.
Panic of fear of doing something wrong
Being unsure of the person’s condition
and what to do
Assuming someone else will take
action
The type of injury or illness
Fear of catching a disease
Fear of being sued
Being unsure when to call 9-1-1
The Good Samaritan Law


Usually protects citizens who act the
same way that a “reasonable and
prudent person” would if that
person were in the same situation.
Good Samaritan laws were
developed to encourage people to
help others in emergency situations.
Examples of being “reasonable
and prudent” include 

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Moving a person only if the person’s life
were in danger.
Asking a conscious person for
permission, also called consent, before
giving care.
Checking the person for life-threatening
conditions before giving further care.
Calling 9-1-1.
Continuing to give care until a trained
responder takes over.
Disease Transmission



Infectious diseases – spread from one
person to another when germs enter
the body and cause illness.
Bacteria – can live outside the body
and do not need other organisms for
life. Treated with antibiotics.
Viruses – depend on other organisms
to live. They have few medications for
treatment.
Disease Transmission


Direct contact – germs from another
person’s body fluids pass directly into
your body through breaks in the skin or
mucus membranes.
Indirect contact – germs pass through
shared objects like spoons, doorknobs
and pencils which have been exposed
to infected droplets.
Disease Transmission

In order to get a disease the following
conditions must be present –
1.
2.
3.
4.
The victim must be infected with a disease
The rescuer must be exposed to the
infected victim’s body substance
The rescuer must come in contact with the
substance through an entry site
There must be a sufficient amount of the
infected body substance to cause infection
Preventing Disease Transmission
Standard Precautions - practices used to prevent spread of diseases
1.
2.
3.
4.
5.
6.
7.
8.
9.
Avoid contact
Use breathing barriers
Use disposable gloves
Cover any of your own open wounds before
putting on personal protective equipment
(PPE)
Do not eat, drink or touch your face when
giving care or before washing your hands
after care has been given
Avoid touching your personal items while
giving care
Do not touch objects that may have come in
contact with body fluids
Wash your hands thoroughly after care
Tell EMS personnel or your doctor if you come
in contact with a victim’s body fluids
Cleaning Up Blood Spills

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Clean up the spill immediately or as
soon as possible after it occurs.
Use disposable gloves and other PPE
when cleaning.
Wipe up the spill with paper towels.
After the area has been wiped up, flood
the area with a disinfectant – 1 ½ cups
bleach to 1 gallon of water.
Dispose and label “biohazard”
Step 3: Activate the EMS System
Step 4: Give Care Until Help Arrives
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Consent – getting permission to give care
You must tell the victim –
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Your name
Your training
What you think is wrong
What you plan to do
Expressed consent – when a conscious person
who understands your questions and what you
plan to do gives you permission to give care
If the victim is an infant or a child, get
permission from the parent or guardian
Denied Consent


Do not touch or give care to a
conscious person who refuses care.
If the person refuses care or
withdraws consent at any time, step
back and call 9-1-1.
Implied Consent
Definition – assumption that if the person could respond, he or
she would agree to care.
Consent is implied when –


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If an adult is unconscious
If an adult is conscious but too seriously
injured or ill to respond
If an infant or child has a life threatening
condition and the parent or guardian is not
present
Giving Care Until Help Arrives
In general, you should give the
appropriate care to an ill or injured
person until:
o
o
o
o
You see an obvious sign of life, such as
breathing
Another trained responder takes over
You are too exhausted to continue
The scene becomes unsafe
Taking Action
Emergency Action Steps

Check the scene and the person

Call 9-1-1

Care for the person
Check
Is the scene safe?

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Chemicals, traffic,
fire, smoke,
extreme weather
Avoid confined
areas with no
ventilation
If you can’t get
near the victim, call
9-1-1
Check
Is there immediate
danger involved?


Do not move seriously
injured victims unless
there is immediate
danger or you have to
move the person to
give proper care such
as CPR.
Make sure bystanders
do not move the
victims.
Check
What happened?

Look for clues to what caused the
emergency.

Nearby objects, broken glass, spilled
bottle
Check
How many people were involved?

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Look carefully for more than one person.
If one person is bleeding or screaming you
may not notice an unconscious person.
In an emergency with more than one victim
you may have to prioritize care.
Is anyone else available to help?
Check
What is wrong?


Try to find out what is wrong.
Look for signals of life threatening
emergencies.


Unconscious, no breathing, no pulse,
severe bleeding
Use all senses to try to notice if
anything is abnormal
Call
Often times the most important thing you
can do is call 9-1-1.
When to call 
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Unconscious or altered
level of consciousness
Breathing problems
Persistent chest pain
Persistent abdominal
pain or pressure
Severe external
bleeding
Severe burns
Suspected poisoning

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Vomiting blood or
passing blood
Seizures
Stroke
Injuries to the
head, neck, or
back
Suspected broken
bone or an open
fracture
Also call for these situations 
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Fire or explosion
Downed electrical wires
Swiftly moving or rapidly rising water
Presence of poisonous gas
Serious car accident
Injured or ill person who cannot be
moved easily
Call First or Care First?

You should always CALL FIRST for –

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An unconscious adult or adolescent (12 y/o)
A witnessed sudden collapse of a child or
infant
An unconscious infant or child known to
be at high risk for heart problems
These are all possible cardiac
emergencies therefore time is crucial
Call First or Care First?

You should CARE FIRST for –

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An unwitnessed collapse of an
unconscious person younger than 12
years old
Any victim of a drowning
Conscious person who is choking
These situations are more likely to
be breathing emergencies
Call

Provide information requested by
the dispatcher

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Location
Description of person’s condition
Do not hang up first
Whenever possible have a
bystander make the call for you
Care
1.
2.
3.
4.
5.
6.
Do no further harm
Monitor the person’s breathing and
consciousness
Help the person rest in the most
comfortable position
Keep the person from getting
chilled or overheated
Reassure the person
Give any specific care needed
Give Care Until Help Arrives

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If you are trained in first aid, you can give
help that can save a life in the first few
minutes
Get bystanders to help by –

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Calling 9-1-1
Clearing the scene
Directing EMS personnel when they arrive
Helping provide care
Providing information about the victim
Comforting and reassuring victims
Should you just take them to the
hospital yourself?

Never transport a person –

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When the trip might cause greater damage
to the person
When the person may develop a life
threatening condition
If you are unsure of the injury or illness
If you take the person to the hospital –


Take someone with you and the victim
Pay attention to any changes in the victim
while en route
Why would you move a victim?

Only move the ill or injured person
if –

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You are faced with immediate danger
You have to get to another person who
may have a more serious problem
You have to move the person to give
them proper care
Emergency Moves
Walking Assist
Two Person Seat Carry
Pack Strap Carry
Blanket Drag
Emergency Moves
Clothes Drag
Reaching Assist
Foot Drag
Throwing Assist
Conscious Ill or Injured Person no immediate life threatening conditions
Two Basic Steps –
Step One
Interview the victim and bystanders
What happened?
2.
Do you feel pain or discomfort
anywhere?
3.
Do you have any allergies?
4.
Do you have any medical conditions or
are you taking any medication?
Write down the information and give it
to EMS personnel when they arrive.
1.
Conscious Ill or Injured Person no immediate life threatening conditions
Two Basic Steps –
Step Two
Do a Head to Toe Check of the Victim
1.
2.
3.
4.
5.
6.
Do not move areas of the body that hurt.
Look for cuts, bruises, bumps, and
depressions.
Watch for changes in consciousness and
breathing.
Notice how the skin looks and feels.
Look over the body.
Look for a medical ID tag.
Checking an Ill or Injured Infant or
Child – What You May Do Differently


Start your check at the victim’s feet
instead of their head.
Check the victim while he or she is
seated in his or her parent’s or
guardian’s lap.
Shock

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A condition in which the
circulatory system fails to circulate
oxygen rich blood to all parts of
the body.
When vital organs do not get
oxygen rich blood they do not
work properly.
Vital organs – brain, heart, lungs
Shock

Three conditions must be present
for adequate blood flow –

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The heart must be working well.
An adequate amount of oxygen-rich
blood must be circulating in the body.
Blood vessels must be intact and able
to adjust blood flow.
Signs & Symptoms of Shock
1.
2.
3.
4.
5.
6.
Restlessness or irritability
Altered level of consciousness
Nausea or vomiting
Pale, ashen or grayish, cool, moist skin
Rapid breathing or pulse
Excessive thirst
Care for Shock
1.
2.
3.
4.
5.
6.
7.
CALL 9-1-1
Have the person lie
down
Control any external
bleeding
Maintain normal body
temperature
Do not give the person
anything to eat or drink
Reassure the person
Continue to monitor the
person’s breathing
Checking an Unconscious Person

If you think someone is unconscious –

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Tap their shoulder and ask if they are ok
Infant – tap shoulder or flick the bottom
of their foot
If they do not respond CALL 9-1-1
Check to see if the person –


Has an open airway and is breathing
Is bleeding severely
Signs of Life

Consciousness, normal breathing
and circulation and skin
characteristics are referred to as
signs of life.
Checking an Unconscious Person

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As easy to remember as
ABC!
Airway – open the airway
Breathing – check for
movement or breathing
Circulation – check for
severe bleeding
Checking the Airway & Breathing
 Head


Tilt/Chin Lift
Technique used to open
a victim’s airway
Moves the tongue away
from the back of the
throat, allowing air to
enter
Checking the Airway & Breathing


Look, listen, and feel
for breathing for no
more than 10
seconds.
Agonal breath is
irregular, gasping or
shallow. Someone
with agonal breathing
should be treated like
a non-breathing
victim.
If the victim is not breathing 
Adult – begin CPR immediately

Child or Infant – give 2 rescue breaths


Child – pinch nose, complete seal over mouth
and give 2 rescue breaths each lasting 1
second
Infant – complete seal over mouth and nose
and give 2 rescue breaths each lasting 1
second
Special Situations

Air in the Stomach


Avoid forcing air into the person’s
stomach by keeping the person’s head
tilted back.
Air in the stomach can cause the victim
to vomit.
Choking
 Harder to breathe

Special Situations

Vomiting

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
H.A.IN.E.S.
Clear it out
Continue care
Special Situations

Mouth to Nose Breathing


Close the mouth by pushing on the chin
If possible, open the victim’s mouth
between rescue breaths to let the air
out
Special Situations

Mouth to Stoma Breathing

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Expose the person’s neck down to the
breastbone
Keep the airway in neutral position
If the tube is blocked, remove the inner
tube
If partial breather, rescuer must seal
the mouth and nose
Special Situations

Head, Neck, and Spinal Injuries

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If a child is in a car seat, do not
remove the child from the seat
Minimize movement when opening the
airway
Tilt the head and left the chin just
enough to open the airway
Special Situations

Drowning Victim

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For an adult, give 2 rescue breaths as you
would for a child or infant once you
determine the victim is not breathing
Give 2 minutes of care before calling 9-1-1
for an unconscious person who has been
submerged
Do not go in the water to rescue someone
unless you are trained to do so
What to do next 
Vomit, fluids blocking the airway, or
if you must leave the victim, place
the person in the H.A.IN.E.S.
recovery position.
Incident Stress


Definition - a condition caused by
acute stress which overwhelms a
person to the point that they are
unable to cope with the stress.
If not appropriately managed, this
stress can lead to PTSD.
Signals of Incident Stress
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Anxiousness and unable to sleep
Nightmares
Restlessness
Confusion
Low attention span, poor concentration
Denial, guilt, anger, depression
Nausea
Increased or decreased eating
Change in interactions with others
Uncharacteristic, excessive humor or silence
Unusual behavior
Difficulty performing day to day tasks (job, school)
Guidelines for Coping with
Incident Stress
1.
2.
3.
4.
5.
6.
Seek help
Use relaxation techniques
Eat a balanced diet
Avoid alcohol and drugs
Get enough sleep
Participate in some type of physical
activity