Chapter 7
Before Providing Care and Victim
Assessment
Bloodborne Pathogens
 Bacteria and viruses present in blood and body fluids
that can cause disease in humans.
 Bacteria and viruses MOST COMMON forms of
pathogens
 Found almost everywhere in our environment.
Bacteria vs. Viruses
 BACTERIA
 Live can live outside of the body
 Commonly do NOT depend on other organisms of life
 Antibiotics and other medications often are used to treat
the infection
 VIRUSES
 Depend on other organisms to live
 Once viruses are in the body, they are difficult to kill
 Prevention is CRITICAL
Hepatitis B
 Liver infection caused by the hepatitis B virus.
 Severe or even fatal can be in body for up to 6 months before
symptoms appear.
 Prevention: Hepatitis B vaccine (3 doses)
 Primarily spread through direct or indirect contact with infected
blood or other body fluids
Hepatitis C
 Liver disease caused by the hepatitis C virus
 Most common chronic bloodborne infection in US
 No vaccine against hepatitis C and NO treatment available to
prevent infection after exposure
 Leading cause of liver transplants
 Primarily spread through direct or indirect contact with infected
blood or other body fluids
HIV
 Virus that causes acquired immunodeficiency
syndrome (AIDS)
 Weakens the body’s immune system
 People with AIDS eventually develop life-threatening
infections and can die from these infections.
 Currently NO vaccine against HIV
 Primarily spread through direct or indirect contact with
infected blood or other body fluids
How Pathogens Spread
For any disease to be spread, ALL four of the
following conditions must be met:
1. A pathogen is present
2. A sufficient quantity of the pathogen is present to cause
disease
3. A person is susceptible to the pathogen
4. The pathogen passes through the correct entry site
(eyes, mouth other mucous membranes; non-intact skin
or skin pierced by needle sticks, human bites, cuts,
abrasions and other means)
How infections occur
Present
Entry Site
Quantity
Susceptible
Direct Contact
 Occurs when infected blood or body fluid from one person
enters another person’s body at a correct entry site.
Example: *Infected blood splashing in the eye
*Directly touching the body fluids of an infected person and
that infected blood or other body fluid enters the body through a
correct entry site
Indirect Contact
 Occurs when a person touches an object that contains the
blood or other body fluid of an infected person and matter
enters the body through a correct entry site.
Example:
*Soiled dressings: when a person picks up
blood-soaked bandages with bare hands and the pathogens enter
through a break in the skin on the hand.
*Equipment and work surfaces that are contaminated
Droplet Transmission
 Occurs when a person inhales droplets from an infected
person’s cough or sneeze
Example:
Flu
Vector-Borne Transmission

Occurs when the body’s skin is penetrated by an
infectious source, such as an animal or insect bite or sting
Example:
*Malaria
*West Nile Virus
Risk of Transmission
 Very low but should be very cautious
 Neddlestick or cut exposure
 30% chance if unvaccinated person for Hep B (depending
on several factors)
 Risk of hep c is about 2%
 Risk of HIV infected blood less than 1%
OSHA Occupational Safety and Health Administration
“issue regulations about on-the-job exposure to bloodborne pathogens”
Exposure Control Plan  Written program outlining the protective measures that employers
will take to eliminate or minimize employee exposure incidents.
Standard Precautions
 Personal protective equipment (PPE)
 Good hand hygiene
 Engineering controls
 Work practice controls
 Proper equipment cleaning
 Spill clean-up procedures
Personal protective equipment
(PPE)
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Breathing barriers
Non-latex disposable gloves
Gowns
Masks
Shields
Protective eyewear
 Guidelines for using PPE to prevent infection:
 Avoid contact w blood and other body fluids
 Use CPR breathing barriers when giving ventilations
 Wear disposable gloves when providing care
Recommended Protective Equipment against Hep B, Hep C, and HIV transmission
in prehospital settings
Disposable
Gloves
Gown Mask
Protective
Eyewear
Bleeding control with
spurting blood
Yes
Yes
Yes
Yes
Bleeding control with
minimal bleeding
Yes
NO
NO
NO
Emergency childbirth
Yes
Yes
Yes
Yes
Oral/nasal suctioning;
manually clearing airway
No
No
No,
No,
unless
splashing is
likely
unless splashing is likely
Handling and cleaning
contaminated equipment
and clothing
Yes
No
NO
No,
unless
soiling is
likely
 Good hand hygiene
 Most effective measure to prevent the spread of infection
 Wash hands frequently (for at least 15 seconds)
 Engineering controls
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objects used in the workplace that isolate or remove a hazard
Biohazard bags and labels
Personal protective equipment
Sharps disposal containers
Self-sheathing needles
Safer medical devices
 Work practice controls- things done to help reduce the risk
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Placing sharp items in puncture-resistant containers
Avoiding splashing, spraying, and splattering of droplets of blood
Removing and disposing of soiled clothing
Cleaning and disinfecting all equipment
Washing hands thoroughly with soap and warm water immediately
Not eating or drinking, smoking, applying cosmetics or lip balm, handling
contact lenses, or touching the eyes, mouth or nose when in an area where
exposure to infectious materials is possible
 Isolating contaminated areas so other employees or people do not walk
through and become exposed
 Equipment cleaning and Spill-clean up procedures
 Always clean and disinfect the equipment and surfaces used
 Wear disposable gloves and other personal protective equipment
when cleaning up spills
 Clean up spills immediately or as soon as possible after the spill
occurs
 Dispose of the absorbent material used to collect the spill in a
labeled biohazard container
 Flood the area with fresh disinfectant solution of approximately 1
½ cups of liquid chlorine bleach to 1 gallon of water and allow to
stand for about 10 minutes
 Use appropriate material to absorb the solution, and dispose of it in
a labeled biohazard container
 Scrub soiled boots, leather shoes, and other leather goods, such as
belts, with soap, a brush and hot water. If a uniform is worn to
work, was and dry it according to the manufacture's instructions.
If you are exposed
 Clean the contaminated area thoroughly with soap and
water
 If you are splashed with blood or other potentially infectious
material around your mouth or nose, flus the area with
water.
 If your eyes are involved, irrigate them with clean water,
saline for 20 minutes
 Report the exposure incident
 Document what happened (include time date)
 Seek immediate follow-up care
General Procedures for injury or
sudden illness on land
1. Size up the scene
 Move victim only if necessary for his or her safety
2. Perform a primary assessment
 Obtain consent if the victim is conscious.
3. Summon EMS, if needed
4. Perform secondary assessment, if no life-threatening
conditions are found.
5. Provide care for the conditions found.
6. Report, advise, and release
Size up the Scene:

Determine if the scene is safe for LGs, other rescuers, victim(s) and
bystanders
•
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Use your senses to check hazards (gas leak or fire, look for things explosion)
Determine what caused the injury or illness
Determine the number of injured or ill victims
Determine what additional help may be needed
Put on the appropriate PPE
 Moving a victim
victim on land move only:
You are faced w immediate danger
You need to get to other victims who have more serious injuries or illnesses
It is necessary to provide appropriate care (stairs)
Moves
Non-emergency moves
 Walking assist: one or two responders conscious person who
simply needs assistance
 Two-person seat carry: requires a second responder.
Conscious person no serious injury
Moves
Emergency moves:
 Clothes drag:
conscious or unconscious person suspected of
having a head, neck, or spinal injury
 Pack-strap carry:
 Ankle drag:
conscious and unconscious
(foot drag) to move a person who is too large to carry or
move in any other way.
Perform an initial
assessment:
to identify any Life-threatening conditions
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Checking the victim for responsiveness
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A person who speaks is CONSCIOUS
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Breathing and pulse
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Scanning for severe bleeding
Continue sudden illness on land
 Perform Secondary assessment
 To identify additional conditions
 Only do it if you know that there are no life-threatening
conditions
 To gather additional info about injuries or conditions that
may need care
 Not life-threatening but could be if not cared for
Summon EMS if any of the following conditions are
found:
 Unconsciousness or altered level of consciousness (LOC) “confusion or
drowsiness”
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Breathing problems (difficulty or no breathing)
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Persistent abdominal pain or pressure
Any victim recovered from underwater who may have inhaled water
Chest pain, discomfort, or pressure lasting more than a few minutes or goes
away and comes back
No pulse
Severe external bleeding
Vomiting blood or passing blood
Severe (critical) burns
Suspected poisoning
Seizures in the water
Seizures that last more than 5 minutes or cause injury
Suspected or obvious injuries to head, neck or spine
Stroke
Painful, swollen, deformed areas (broken bones) or open fracture
Victim's physical condition is unclear or is worsening (allergic reaction)
Open the Airway and check for breathing and
Pulse
 No more than 10 seconds
 Perform concurrently
 If able to speak, airway is functioning
Opening Airway
To check breathing and give ventilations, you must manually tilt
the head or thrust the jaw to move the tongue away from the
back of the throat
 Head-tilt/chin lift: used when the rescuer is positioned at
the victim’s side
 Jaw-thrust maneuver (with head extension): used when
the rescuer is positioned above the victim’s head
 Jaw-thrust maneuver (without head extension) used when
the victim is suspected of having an injury to the head, neck
or spine
Child, tilt the head slightly past the neutral position not as far as adult
Infant, tilt head to neutral position
Checking for Breathing
 Position your ear over the mouth and nose so that you
can hear and feel air as it escapes while you look for
the chest to rise and fall.
 Agonal gasps, isolated or infrequent gasping (this is
NOT breathing) assume he/she is not breathing
Checking for a pulse
 If you do not find a pulse with your fingertips in the
arteries near the skin, within 10 seconds do not waste
time.
 Adult and child: feel for carotid pulse “place two
fingers in the middle of the victim’s throat and then slide
them into the groove of the neck closest to you.”
 Infant: feel for brachial pulse on the inside of the
upper arm between elbow and shoulder
Give 2 ventilations
 Victims of cardiac arrest (witnessed sudden collapse),
IMMEDIATELY begin CPR chest compressions.
 Other situations drowning or another respiratory event,
giving ventilations before beginning CPR is important
because victims of hypoxia (deprived of oxygen) likely to
experience respiratory emergencies.
 Adults: unconscious and not breathing as a result of
drowning, hypoxia or another respiratory problem, give the
victim 2 ventilations before compressions.
 If unconscious and no pulse begin compressions
 Child or infant: unconscious and not breathing give 2
ventilations. Only skip if you witness a sudden collapse
Scan for severe Bleeding
 Do a quick visual scan of the victim for severe bleeding.
Head to toe scan
Additional LGs should assist by controlling the bleeding
Recovery Position
 Leave the victim in a face-up position and maintain an
open airway if he/she unconscious but breathing
(especially suspected spinal)
 High arm endangered spine (H.A.IN.E.S):keep the
airway open and clear even if a spinal injury. You are
alone and have to leave victim to call for help, you
cannot maintain an open and clear airway because of
the fluids or vomit.
Perform secondary
assessment
 Victim does NOT have any life-threatening conditions,
to identify any additional problems
Provide Care for the
Conditions Found
 Always treat life-threatening situations FIRST.
 Care should be continued until EMS personnel take
over
Report, Advise, and Release
 Once care is given, be sure to complete incident report
forms, advise the victim on next steps and release the
victim to appropriate parties.
One Age does NOT fit all
 Purpose of the skills in this manual
 Anyone approx. 12 years of age or older is an ADULT
 Anyone age 1 year to about 12 years is a child
 An infant is anyone younger than 1 year
 AED anyone 1 to 8 years of age less than 55 pounds is
an child
Call first or care first
 If alone:
 Call first for : (cardiac emergencies)
 Any adult or child about 12 years of age or older who is
unconscious
 A child or an infant who you witnessed suddenly collapse
 An unconscious child or infant known to have heart problems.
 Care First (proved 2 minutes of care) for: (breathing emergencies)
 An unconscious child (younger than 12 years of age) who you did
not see collapse
 Any victim of a nonfatal drowning
Adult
Child
1. Tap the victims shoulder and shout, “Are you okay.”
Infant
Tap on foot
2. If no, response (Unconscious) summons EMS
3. Check for signs of life (movement and NORMAL
breathing)
a. If victim face down, roll victim onto back, while
supporting head.
b. Tilt head back and lift the chin to open airway.
Look for movement and look, listen and feel for normal
breathing for NO more than 10 seconds.
Head tilt
not as
dramatic
Very little to no
head tilt
4. If no movement or breathing, give two rescue breaths
with resuscitation mask. Each breath should last about 1
second and make the chest clearly rise.
5.
If chest clearly rises, check for pulse, CAROTID
ARTERY, for no more than 10 seconds.
a. One hand on the victim’s forehead, take other hand
and place two fingers on the front of the neck. Then,
slide the fingers down into the groove at the side of neck.
6. Quickly scan the victim for severe bleeding.
7. Care for conditions found.
a. If there is movement, breathing, and pulse, place
victim in H.A.IN.E.S. recovery position (if spinal is
suspected) continue to monitor ABCs (airway, breathing,
circulation)
One hand on infant’s forehead, use
other hand to find the brachial pulse
on the inside of the upper arm,
between the infant’s elbow and
shoulder