American Red Cross
Emergency Response
EMERGENCY
RESPONSE
TRAINING
Copyright © 2000 by the American National Red Cross
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When Help Can’t Wait
American Red Cross
Emergency Response
Emergency Response Training
 Instructors
 Books
 Facilities
 Certificates
upon completion
 Schedule
 Tests
 Participation
 Hands-on
training
 Physical requirements
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When Help Can’t Wait
TM2
American Red Cross
Emergency Response
Chapter 1
The First Responder
 Components
of the EMS system
 Roles and responsibilities of the First
Responder
 Medical Oversight
 Statutes and regulations
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When Help Can’t Wait
American Red Cross
Emergency Response
Links in the Chain of Survival
1. Citizen Response
2. Early activation of EMS
3. First Responder Care
4. Advanced Out-of-Hospital Care
5. Hospital Care
6. Rehabilitation
Pg 5-11
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When Help Can’t Wait
TM1
American Red Cross
Emergency Response
First Responders
 Fire
fighters
 Law enforcement personnel
 Lifeguards
 Ski patrollers
 Industrial response team
 Athletic trainers
 Disaster team members
 First aid station attendants
Pg 12-14
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When Help Can’t Wait
TM2
American Red Cross
Emergency Response
Video
The First Responder
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When Help Can’t Wait
American Red Cross
Emergency Response
First Responder Characteristics
 Maintains
caring and professional attitude
 Controls fears
 Presents professional appearance
 Maintains skills and knowledge
 Stays healthy
 Recognizes and keeps victim’s needs as
priority
Pg 12-13
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When Help Can’t Wait
TM3
American Red Cross
Emergency Response
Primary Responsibilities of
First Responders
 Ensure
safety of self and others
 Gain access to victim
 Identify life-threatening conditions
 Summon more advanced medical personnel
when necessary
 Provide care
 Assist more advanced medical personnel
Pg 13-14
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When Help Can’t Wait
TM 4
American Red Cross
Emergency Response
Secondary Responsibilities of
First Responders
 Summon
additional help.
 Control and direct bystanders.
 Keep records.
 Reassure others at scene.
Pg 13-14
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When Help Can’t Wait
TM 5
American Red Cross
Emergency Response
Medical Oversight
 Includes
medical director
 Direct medical control
 Indirect medical control
 protocols
 standing
orders
Pg 14
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When Help Can’t Wait
TM 6
American Red Cross
Emergency Response
Chapter 2
First Responder Well-Being
 Recognizing
Stress
 Emotional Reactions
 Scene Safety
 Protective Equipment
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When Help Can’t Wait
American Red Cross
Emergency Response
Emotional Aspects of
Emergency Care
 Stressful
Situations
 Death and Dying
 The Grieving Process
 Helping the Victim and the Family
Pg 18-20
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When Help Can’t Wait
American Red Cross
Emergency Response
Stress Management
Warning Signs of Stress
Irritability
 Inability to concentrate
 Difficulty sleeping/nightmares
 Anxiety
 Guilt
 Loss of interest in work

Managing Stress
Healthy physical and mental habits
 Diet
 Balance of work, recreation, family and health
 Seek professional help if necessary

Pg 20
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When Help Can’t Wait
TM 7
American Red Cross
Emergency Response
Critical Incident Stress
 Strong
emotional reaction that interferes
with ability to function
 Can build-up over days, weeks, months or
years
 May require counseling
 See Pages 442-443
Pg 20-22
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When Help Can’t Wait
TM 8
American Red Cross
Emergency Response
CIS Management
 Pre-incident
stress education
 On-scene peer support
 Critical Incident Stress Debriefing (CISD)
 Critical Incident Stress Defusing
 Family support
 Know when to Access CISD
Pg 21
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When Help Can’t Wait
American Red Cross
Emergency Response
The Emergency Scene
 Scene
Safety
 Personal Safety
 Safety of Others
 Be aware of special emergency situations
 Hazardous
Materials
 Motor Vehicle Crashes
Pg 22-25
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When Help Can’t Wait
American Red Cross
Emergency Response
At the Scene, Evaluate  Location
 Problems
 Dangers
 Number
of victims
 Behavior of victims/bystanders
 Need for additional assistance
Pg 22-25
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When Help Can’t Wait
TM 9
American Red Cross
Emergency Response
Evaluate the scene
Pg 23
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When Help Can’t Wait
CT 3
American Red Cross
Emergency Response
Ensure Your Safety By Evaluating
potential dangers.
 Wearing proper gear.
 Doing what you are trained to do.
 Summoning additional resources.
Pg 23
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When Help Can’t Wait
TM 10
American Red Cross
Emergency Response
Possible Dangers at an
Emergency Scene
Crime
 Traffic
 Fire
 Electricity
 Water/ice
 Hazardous materials

Unstable structures or
vehicles
 Natural disasters
 Multiple victims
 Hostile situations
 Suicide
 Hostage situations

Pg 29-33
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When Help Can’t Wait
TM 11
American Red Cross
Emergency Response
Enrichment
Specific Emotional Crisis
 Suicide
 Assault
 Sexual Assault
 Physical Assault
 Crisis
Intervention
 Dealing with Emergency Situations at the
Scene
Pg 26-29
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When Help Can’t Wait
American Red Cross
Emergency Response
Chapter 3
Disease Transmission
 How
the immune system works
 How diseases are transmitted
 Conditions required for disease
transmission
 Body Substance Isolation
 Exposure control and documentation
 OSHA requirements
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When Help Can’t Wait
American Red Cross
Emergency Response
Video
Preventing Disease Transmission
Part I
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When Help Can’t Wait
American Red Cross
Emergency Response
OSHA Regulations
 Occupational
Safety and Health
Administration regulations regarding “blood
borne pathogens”
 Apply
to employers whose employees, as a
result of job requirements, have potential
exposure to blood borne pathogens.
 Provide safeguards to reduce disease
transmission
Pg 45-46
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When Help Can’t Wait
American Red Cross
Emergency Response
Potentially Infectious Body Fluids
 Semen
 Vaginal
Secretions
 Cerebrospinal fluid Synovial fluid
 Pleural fluid
 Pericardial fluid
 Amniotic fluid
 Peritoneal fluid
Pg 36-37
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When Help Can’t Wait
American Red Cross
Emergency Response
How Infections Occur
Disease-causing Agents
 Viruses
(Hepatitis, measles, mumps, meningitis,
colds, HIV, herpes)
 Bacteria (Tetanus, meningitis, tuberculosis,
diphtheria, food poisoning)
 Fungi (Athlete’s foot, ringworm)
 Protozoa (Malaria, dysentery)
 Rickettsia (Typhus, Rocky Mountain spotted
fever)
Pg 37-38
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When Help Can’t Wait
American Red Cross
Emergency Response
The Body’s Defenses
 Immune
system (antibodies)
 Acquired
immunity
 Specific immunity by Immunization
 Understanding
how diseases spread
 Taking precautions (BSI)
Pg 38-39
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When Help Can’t Wait
American Red Cross
Emergency Response
Conditions Necessary for Disease
Transmission
Pathogen
present
Pg 39
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When Help Can’t Wait
TM 12
American Red Cross
Emergency Response
Conditions Necessary for Disease
Transmission
Pathogen
present
Sufficient
Quantity
Pg 39
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When Help Can’t Wait
TM 12
American Red Cross
Emergency Response
Conditions Necessary for Disease
Transmission
Susceptibility to
the disease
Pathogen
present
Sufficient
Quantity
Pg 39
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When Help Can’t Wait
TM 12
American Red Cross
Emergency Response
Conditions Necessary for Disease
Transmission
Susceptibility to
the disease
Pathogen
present
Sufficient
Quantity
Transmission
Site
Pg 39
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When Help Can’t Wait
TM 12
American Red Cross
Emergency Response
How Pathogens Enter the Body
Direct
Pg 40
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When Help Can’t Wait
TM 13
American Red Cross
Emergency Response
How Pathogens Enter the Body
Direct
Indirect
Pg 40
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When Help Can’t Wait
TM 13
American Red Cross
Emergency Response
How Pathogens Enter the Body
Direct
Indirect
Airborne
Pg 40
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When Help Can’t Wait
TM 13
American Red Cross
Emergency Response
How Pathogens Enter the Body
Direct
Indirect
Airborne
Vector
Pg 40
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When Help Can’t Wait
TM 13
American Red Cross
Emergency Response
Video
Preventing Disease Transmission
Part II
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When Help Can’t Wait
American Red Cross
Emergency Response
Diseases that Cause Concern
 Herpes
Simplex
 Meningitis
 Tuberculosis (TB)
 Hepatitis
 HIV
Pg 41-44
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When Help Can’t Wait
American Red Cross
Meningitis
• The bacteria are spread
through the exchange
of respiratory and throat
secretions (i.e.,
coughing, kissing)
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Emergency Response
Tuberculosis (TB)
• TB is spread from
person to person
through the air.
When Help Can’t Wait
American Red Cross
Emergency Response
Viral Meningitis
through direct contact with respiratory
secretions (saliva, sputum, or nasal
mucus) of an infected person. By
shaking hands with an infected person
or touching something they have
handled, and then rubbing your own
nose, mouth or eyes. The virus can
also be found in the stool of persons
who are infected.
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When Help Can’t Wait
American Red Cross
Emergency Response
Video
Preventing Disease Transmission
Part III
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When Help Can’t Wait
American Red Cross
Emergency Response
Exposure Control Plan
 Exposure
determination
 Schedules and methods for implementing
OSHA standard
 Procedures for evaluation exposures
 Immunizations
Pg 44-51
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When Help Can’t Wait
TM 14
American Red Cross
Emergency Response
Standard Precautions (BSI) to
Prevent Disease Transmission
 Protective
equipment
 Personal hygiene practice
 Engineering controls
 Work practice controls
Pg 49-51
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When Help Can’t Wait
TM 15
American Red Cross
Emergency Response
If an exposure occurs …
 Wash
any area of contact
 Document the situation. Most employers
have protocols for reporting infectious
disease exposure
 Notify your superior and any necessary
medical personnel immediately.
Pg 51-52
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When Help Can’t Wait
American Red Cross
Emergency Response
Video
Removing Gloves
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When Help Can’t Wait
American Red Cross
Emergency Response
Practice Session
Workbook Page 21
 Removing
Gloves
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When Help Can’t Wait
American Red Cross
Emergency Response
Chapter 4
Legal and Ethical Issues
 First
Responder responsibilities
 Victim’s rights
 Special populations (Enrichment)
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When Help Can’t Wait
American Red Cross
Emergency Response
Legal Considerations
 Scope
of Practice
 Standard of Care
 Duty to Act
 Competence
 Consent
Expressed (Informed)
 Implied

 Advance
Directives
/DNR Orders ….
Pg 56-62
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When Help Can’t Wait
TM 16
American Red Cross
• Refusal of Care
•Battery
•Abandonment
•Negligence
•Good Samaritan Laws
•Confidentiality
•Evidence Preservation
•Documentation
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When Help Can’t Wait
Emergency Response
American Red Cross
Emergency Response
Obtain Consent Before
Providing Care
 Identify
yourself
 State level of training
 Explain what you observe
 Explain what you plan to do
Pg 57
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When Help Can’t Wait
TM 17
American Red Cross
Emergency Response
Four Components of Negligence
 Duty
 Breach
of Duty
 Cause
 Damage
Pg 60
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When Help Can’t Wait
TM 18
American Red Cross
Emergency Response
Enrichment
Special Populations
 The
Elderly Victim
 Victims with Physical or Mental Disabilities
 Visually
Impaired
 Hearing Impaired
 Physically Disabled
 Developmentally Disabled
Pg 63-67
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When Help Can’t Wait
American Red Cross
Emergency Response
Chapter 5
Human Body Systems
 Describe
the various body systems and how
they interact.
 Anatomical terms (Enrichment)
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When Help Can’t Wait
American Red Cross
Emergency Response
Major Body Systems
 Respiratory
 Circulatory
 Nervous
 Musculoskeletal
 Integumentary
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(skin)
When Help Can’t Wait
TM 19
American Red Cross
Emergency Response
Video
Human Body Systems
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When Help Can’t Wait
American Red Cross
Emergency Response
The Body Systems
Cells performing a common
function form tissues.
Different tissues work together
to form organs.
Pg 70
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When Help Can’t Wait
CT 5
American Red Cross
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When Help Can’t Wait
Emergency Response
American Red Cross
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When Help Can’t Wait
Emergency Response
American Red Cross
Emergency Response
The Circulatory System
Pg 72-74
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When Help Can’t Wait
CT 9
American Red Cross
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When Help Can’t Wait
Emergency Response
American Red Cross
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When Help Can’t Wait
Emergency Response
American Red Cross
Emergency Response
The Nervous System
Images courtesy of the
EMTB Anatomy Review
Pg 74-76
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When Help Can’t Wait
American Red Cross
Emergency Response
The Muscular System
Pg 76-79
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When Help Can’t Wait
CT 11
American Red Cross
Emergency Response
Muscle Groups
Pg 78
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When Help Can’t Wait
CT 12
American Red Cross
Emergency Response
The Skeletal System
Pg 79
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When Help Can’t Wait
CT 13
American Red Cross
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When Help Can’t Wait
Emergency Response
American Red Cross
Emergency Response
The Integumentary System
Pg 79-80
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When Help Can’t Wait
American Red Cross
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When Help Can’t Wait
Emergency Response
American Red Cross
Emergency Response
Enrichment
Anatomical Terms (positions)
 Anatomical
Position is face forward with
palms front
 Medial/Lateral
 Proximal/Distal
 Anterior/Posterior
 Superior/Inferior
 Right/Left refer to victims right/left
Pg 81-83
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When Help Can’t Wait
American Red Cross
Emergency Response
Enrichment
Anatomical Terms (cavities)
 Cranial
 Spinal
 Thoracic
 Abdominal
 Pelvic
Pg 83-85
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When Help Can’t Wait
CT 16
American Red Cross
Emergency Response
Enrichment
The Digestive System
Images courtesy of the
EMTB Anatomy Review
Pg 84-87
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When Help Can’t Wait
American Red Cross
Emergency Response
Enrichment
The Endocrine System
Images courtesy of the
EMTB Anatomy Review
Pg 87
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When Help Can’t Wait
American Red Cross
Emergency Response
Enrichment
The Genitourinary System
Images courtesy of the
EMTB Anatomy Review
Pg 87-88
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When Help Can’t Wait
American Red Cross
Emergency Response
Interrelationships of Body
Systems
Body systems work together to maintain a healthy
state
 Systems do not work independently. Injury or
disease is rarely restricted to one system
 Significant injury or illness may result in shock
 The more systems involved the more serious the
emergency
 Basic care may be all that is needed until more
advanced care is available.

Pg 89
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When Help Can’t Wait
American Red Cross
Emergency Response
Chapter 6
Lifting and Moving
 Body
mechanics
 Safety Precautions
 Emergency and non-emergency moves
 Special equipment
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When Help Can’t Wait
American Red Cross
Emergency Response
Video
Lifting and Moving
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When Help Can’t Wait
American Red Cross
Emergency Response
Safety Precautions when
Moving a Victim
Consider the following:
 The distance the victim must be moved
 Dangerous conditions at the scene
 The size of the victim
 Your physical ability
 Whether others can help you
 The victim’s condition
 Any aids to transport at the scene
Pg 92
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When Help Can’t Wait
TM 20
American Red Cross
Emergency Response
Basic Guidelines for
Moving a Victim









Only move a victim you can safely handle
Bend at knees and hips
Lift with your legs, not your back
Take short steps
Move forward when possible
Look where you are walking
Protect victim’s head, neck and back
Communicate clearly and frequently with your partner, the
victim, and other EMS providers
Tell the victim what is expected of them
Pg 92
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When Help Can’t Wait
TM 20
American Red Cross
Emergency Response
Emergency Moves
General Considerations
Only perform an Emergency Move when  the victim is in immediate danger
 access must be gained to another victim
with life-threatening conditions
 the victim must be moved to provide proper
care
Pg 92-93
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When Help Can’t Wait
American Red Cross
Emergency Response
Moves
Emergency Moves
Walking Assist
Fire
Non-urgent Moves
Direct
fighter’s carry
Pack-strap carry
Two-Person Seat
Carry
Clothes Drag
Blanket Drag
Shoulder Drag
Foot Drag
lift
Extremity lift
Direct carry
Draw sheet method
Pg 93-98
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When Help Can’t Wait
TM 21
American Red Cross
Emergency Response
Practice Session
Workbook Pages 45-50
 Walking Assist
(One or Two Rescuers)
 Fire Fighter’s Carry
 Pack-Strap Carry
 Two-person Seat Carry
 Clothes Drag
 Direct Carry
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When Help Can’t Wait
American Red Cross
Emergency Response
As you approach a scene ...
… have a plan in mind.
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When Help Can’t Wait
CT 17
American Red Cross
Emergency Response
Scenario 1
Emotional Aspects of Emergency Medical Care:
Death of a Child
You are summoned to respond to a call for injuries from a
fall. You arrive to find a child lying motionless on the
ground. He has fallen from a third story window. Two
women are standing by the fallen child. One woman
rushes to you and starts to tell you it happened 10 minutes
ago. The child’s mother is kneeling next to her child,
crying and screaming. It appears the child is dead. As you
try to get close to the child to perform an initial
assessment, the mother refuses to let you near, screaming
at you to stay away. How do you respond?
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When Help Can’t Wait
TM 22
American Red Cross
Emergency Response
Scenario 2
Unconscious Victim, Bleeding:
Possible Crime Scene
A vehicle has struck a pedestrian. The victim is lying
motionless in the street, bleeding from a wound on the
thigh. Bystanders are surrounding the car, claiming the
driver had started to drive away. The driver is still in the
car. He is shouting out the window and looks extremely
upset. How do you respond?
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When Help Can’t Wait
TM 23
American Red Cross
Emergency Response
Scenario 3
Conscious Victim:
Dangerous Scene
You and another rescuer are searching for a missing hiker.
At the bottom of a dry gully, you find the victim who has
an injured leg resulting from a fall. He is in severe pain
and unable to walk. The sides of the gully are very steep.
You can see a rapidly approaching storm and realize that it
is going to rain very shortly and the gully will flood. How
do you respond?
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When Help Can’t Wait
TM 24
American Red Cross
Emergency Response
Scenario 4
Legal and Ethical Issues
You arrive at a scene where a man is lying on the sidewalk.
He has one leg that appears to be bleeding, but not
profusely. He is very pale, in pain and is breathing
heavily. He is conscious and able to speak. When you
approach him, he waves you off and yells at you to go
away. When you explain who you are and that you are
trained and want to help him, he says he doesn’t want any
help. His friends will take care of him. How do you
respond?
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When Help Can’t Wait
TM 25
American Red Cross
Emergency Response
Chapter 7
Assessment
 Components
of a scene size-up
 Initial Assessment
 CABC
 Physical
Exam
 SAMPLE history
 On-going assessment
 Common mechanisms of injury
 Taking vital signs
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When Help Can’t Wait
American Red Cross
Emergency Response
Assessment - Scene Size-Up
 Scene
safety
 Mechanism of injury/nature of illness
 Number of victims
 Resources needed
Pg 106
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When Help Can’t Wait
TM 26
American Red Cross
Emergency Response
Video
Performing an Initial Assessment
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When Help Can’t Wait
American Red Cross
Emergency Response
Assessment - Initial Assessment
 Form
a general impression
 Assess level of consciousness
 Assess airway
 Assess breathing
 Assess circulation (pulse, severe bleeding,
and skin characteristics)
Pg 109-116
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When Help Can’t Wait
TM 27
American Red Cross
Emergency Response
Levels of Consciousness - AVPU
Level
Characteristic Victim Behavior
Alert
Is able to respond to you
Verbal
Only responds to verbal
commands
Painful
Only responds to a painful
stimulus
Unresponsive Does not respond
Pg 110
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When Help Can’t Wait
TM 28
American Red Cross
Emergency Response
Airway Assessment
 May
need to position the head and neck to
open the airway
 Tongue can sometimes block the airway
 To open airway For
illness use head-tilt/chin-lift
 For injury use jaw-thrust without head-tilt
(protects neck and back)
 Inspect
for obvious obstructions
Pg 111
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Emergency Response
Breathing Assessment
 Look,
listen and feel
 Determine rate and quality of breathing,
note any abnormal sounds of distress
 If not breathing provide rescue breathing
Pg 112
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Emergency Response
Circulation Assessment
 Check
pulse rate and quality
 Check skin color, temperature and moisture
 Check for severe bleeding
 Record victim’s age, gender, chief
complaint, LOC and status of airway,
breathing and circulation. Note the time.
Pg 113
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Emergency Response
Signs of Circulation
 Breathing
 Coughing
 Any
type of body movement
 Pulse
Pg 113
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Emergency Response
Circulation Assessment
Pg 114
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When Help Can’t Wait
CT 18
American Red Cross
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When Help Can’t Wait
Emergency Response
American Red Cross
Emergency Response
Other Indications of Circulation
Color – pale, ashen or flushed
 Skin Temperature – hot or cold
 Skin Moisture – moist or dry
(Pale or bluish skin that feels cool and moist
indicates poor blood flow. Persons with
darker skin will appear ashen.)
 Capillary refill – normal or slow. Use for
infants and children. Less than 2 seconds
unless cold temperature.
 Skin
Pg 114-116
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When Help Can’t Wait
American Red Cross
Emergency Response
Video
Performing a Physical Exam and
SAMPLE History
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When Help Can’t Wait
American Red Cross
Emergency Response
Assessment - Physical Exam
 Gather
information about problem
 Identify signs and symptoms
 Check victim from head to toe
 Look and palpate (feel) for signs of
injury - (DOTS)
Pg 116-119
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When Help Can’t Wait
TM 29
American Red Cross
Deformity
Open
injuries
Tenderness
Swelling
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Emergency Response
American Red Cross
Emergency Response
Assessment - SAMPLE History
Signs and symptoms
Allergies
Medications
Pertinent past history
Last oral intake
Events leading up to injury or illness
Pg 120
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When Help Can’t Wait
TM 30
American Red Cross
Emergency Response
Ongoing Assessment
 Repeat
and record vital signs
 -every
5 minutes for serious problem (unstable)
 -every 15 minutes for non-serious problem
Pg 120
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When Help Can’t Wait
American Red Cross
Emergency Response
Practice Session
Workbook Pages 59-65
 Performing
an Initial Assessment
 Performing a Physical Exam and SAMPLE
History
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Emergency Response
When to Summon More
Advanced Medical Personnel
Unconscious or altered LOC
 Breathing problems
 Persistent chest or abdominal pain or pressure
 No pulse
 Severe bleeding
 Vomiting or passing blood
 Suspected poisoning
 Seizures, severe headache or slurred speech
 Suspected or obvious injuries to head or spine
 Painful, swollen or deformed areas
(when in doubt, summon the help)

Pg 121-122
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American Red Cross
Emergency Response
Video
Measuring Blood Pressure
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When Help Can’t Wait
American Red Cross
Emergency Response
Measuring Blood Pressure
Systolic Pressure
Reflects
pressure in arteries when heart is
working/contracting
Diastolic Pressure Reflects pressure in arteries when heart is
resting/refilling
Palpation
Measures
Auscultation
only the Systolic pressure by feeling for
the radial pulse. Record as palpated (eg. BP120p).
Announce as “BP <pressure> by palpation”
Measures both Systolic and Diastolic pressures
by listening for the pulse with a stethoscope.
Record as <systolic>/<diastolic> (eg. BP 120/80).
Announce as “BP <systolic> over <diastolic>”.
Pg 123-126
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When Help Can’t Wait
TM 31
American Red Cross
Emergency Response
Video
Blood Pressure Practice
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When Help Can’t Wait
American Red Cross
Emergency Response
Practice Session
Workbook Pages 66-70
 Blood
Pressure Measurement (Palpation)
 Blood Pressure Measurement (Auscultation)
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Emergency Response
Chapter 8
Breathing Emergencies
 The
Breathing Process
 Respiratory Distress
 Illness
causing respiratory distress
 Respiratory Arrest
 Airway
Obstruction
 Anatomical
 Mechanical
 Care
for choking victims
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When Help Can’t Wait
American Red Cross
Emergency Response
Respiratory System Review
The body requires a
constant supply of
oxygen. Various
illnesses and accidents
can cause breathing
emergencies.
Images courtesy of the
EMTB Anatomy Review
Pg 136
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Emergency Response
Asthma
Facts

Narrows air passages
Triggered byAllergic reaction to pollen/food/a drug/insect
stings
 Emotional stress/physical activity

Signs and symptoms
Struggling to breathe
 Wheezing when exhaling

Pg 137
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When Help Can’t Wait
TM 32
American Red Cross
Emergency Response
Emphysema
Facts

Lungs lose ability to exchange carbon dioxide and
oxygen effectively
Caused by
Smoking: usually develops over many years
Signs and symptoms
Shortness of breath
 Possible coughing, cyanosis, or high fever
 Advanced cases: Restlessness, confusion,
weakness

Pg 138
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When Help Can’t Wait
TM 33
American Red Cross
Emergency Response
Hyperventilation
Facts

Rapid breathing upsets body’s balance of oxygen and
carbon dioxide
Triggered by



Fear/anxiety
Injury to head/ severe bleeding/ illness
Asthma
Exercise
Signs and symptoms



Shallow, rapid breathing
Dizziness
Numbness in fingers/toes
Pg 138
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When Help Can’t Wait
TM 34
American Red Cross
Emergency Response
Anaphylaxis
(Severe Allergic Reaction)
Facts

Swelling of air passages restricts breathing
Triggered by
Food/ insect stings/ a drug
Signs and symptoms
Skin rash
 Tightness in chest/throat
 Swelling of face/ neck/ tongue

Pg 138
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When Help Can’t Wait
TM 35
American Red Cross
Emergency Response
Care for Respiratory Distress
 Have
victim rest in comfortable position
 Keep victim from getting chilled or
overheated
 Reduce heat; add moisture
 If authorized, help victim take any
medications
 Summon more advanced medical personnel
 Monitor vital signs
Pg 139
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When Help Can’t Wait
TM 36
American Red Cross
Emergency Response
Key Points of Respiratory Arrest
 Life
threatening
 Commonly caused by illness, injury or
choking
 Often preceded by respiratory distress
 Body systems will progressively fail
Pg 139-140
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When Help Can’t Wait
TM 37
American Red Cross
Emergency Response
Rescue Breathing
 Follow
BSI precautions - use a barrier
Pg 140-141
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When Help Can’t Wait
American Red Cross
Emergency Response
Rescue Breathing
 Check
LOC
 If unconscious, open the airway and check
for breathing
 If not breathing, give two breaths
 Check for signs of circulation
 If circulation is present, continue with
rescue breathing
 Check for circulation every minute
Pg 141
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American Red Cross
Emergency Response
Video
Face Shields/Barriers
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When Help Can’t Wait
American Red Cross
Emergency Response
Rescue Breathing
Special considerations
 Vomiting
 Mouth-to-nose
breathing
 Mouth-to-stoma breathing
 Victims with dentures
 Suspected injury to the spine
Pg 141-144
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Emergency Response
Airway Obstruction
Partial

Victim can still move air to and from lungs; can
cough, speak, breathe
Complete

Victim is unable to speak, breathe, cough; no air
movement
Pg 146-147
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When Help Can’t Wait
TM 40
American Red Cross
Emergency Response
Chapter 9
Breathing Devices
 Suctioning
 Airways
 Oral
 Nasal
 Barrier
Shields
 Resuscitation Masks
 Oxygen (Enrichment section)
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American Red Cross
Video
Suctioning
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When Help Can’t Wait
Emergency Response
American Red Cross
Emergency Response
Steps for Suctioning
 Turn
head to side or roll body if head, neck,
or back injury suspected
 Open victim’s mouth
 Remove large pieces of matter
 Measure distance of insertion
 Insert suction device into back of mouth
 Suction for no more than 15 seconds at a
time
Pg 164
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When Help Can’t Wait
TM 41
American Red Cross
Emergency Response
Practice Session
Workbook Pages 101
 Suctioning
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American Red Cross
Emergency Response
Video
Airway Insertion
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When Help Can’t Wait
American Red Cross
Emergency Response
Airway Adjuncts
 Two
types of airways: Oral(oropharyngeal)
and nasal (nasopharyngeal)
 Available in various sizes
 Oral airways are only used on unresponsive
victims
 Nasal airways may be used on victims who
are responsive but need assistance keeping
the tongue from obstructing the airway
Pg 165-166
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When Help Can’t Wait
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Emergency Response
Inserting an Oral Airway
 Select
airway of proper size
 Open victim’s mouth
 Insert airway with curved end along roof of
mouth
 Advance airway gently until resistance is
felt
 Rotate airway 1/2 turn
 Flange should rest on lips
Pg 166
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When Help Can’t Wait
TM 42
American Red Cross
Emergency Response
Inserting an Oral Airway
Insert and advance
Rotate
Pg 167
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When Help Can’t Wait
CT 20
American Red Cross
Emergency Response
Inserting a Nasal Airway
 Select
airway of proper size
 Lubricate nasal airway
 Insert nasal airway into right nostril with
bevel toward middle of nose
 Advance airway gently, until flange rests on
nose
Pg 166
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When Help Can’t Wait
TM 43
American Red Cross
Emergency Response
Inserting a Nasal Airway
Pg 168
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When Help Can’t Wait
American Red Cross
Emergency Response
Practice Session
Workbook Pages 102-105
 Inserting
an Oral Airway
 Inserting a Nasal Airway
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When Help Can’t Wait
American Red Cross
Emergency Response
Video
Using a Resuscitation Mask
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When Help Can’t Wait
American Red Cross
Emergency Response
Criteria for a Resuscitation Mask
 Transparent,
pliable
 One-way valve
 15mm or 22mm coupling assembly
 Able to deliver supplemental oxygen
 Able to withstand extreme temperatures
 Easily assembled and used
Pg 168
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When Help Can’t Wait
TM 44
American Red Cross
Emergency Response
Using a Resuscitation Mask
 Tilt
head back
 Lift jaw
 Open mouth
Pg 169
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When Help Can’t Wait
TM 45
American Red Cross
Emergency Response
Practice Session
Workbook Pages 106-107
 Using
a Resuscitation Mask
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When Help Can’t Wait
American Red Cross
Emergency Response
Video
Oxygen Delivery
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American Red Cross
Emergency Response
Supplemental Oxygen Delivery
System Components
 Oxygen
cylinder
 Pressure regulator with flowmeter
 Delivery device
Pg 173-179
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When Help Can’t Wait
TM 46
American Red Cross
Emergency Response
Oxygen Delivery Devices
Device
Common Oxygen
Flow Rate Concentration
Function
Nasal
cannula
1-4 lpm
24-36%
Breathing victims only
Resuscitation
6+ lpm
35-55%
Breathing and
nonbreathing victims
Bag-valvemask
10+ lpm
90+%
Breathing and
nonbreathing victims
90+%
Breathing victims only
Nonrebreather- 15 lpm
mask
Pg 177
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When Help Can’t Wait
TM 47
American Red Cross
Emergency Response
Precautions During
Oxygen Delivery
 Do
not operate around flames/ sparks
 Do not stand cylinder upright
 Do not use grease/ oil/ petroleum products
to lubricate
 Check oxygen flow before placing delivery
device on victim
Pg 179
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When Help Can’t Wait
TM 48
American Red Cross
Emergency Response
Practice Session
Workbook Pages 110-113
 Oxygen
Delivery
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When Help Can’t Wait
American Red Cross
Emergency Response
Chapter 10
Cardiac Emergencies
 Heart Attack
 Cardiac Arrest
 CPR
for Adults
 Cardiac Emergencies in Infants and
Children
 CPR in Infants and Children
 Two-Rescuer CPR
 Preventing Cardiovascular Disease
 AED s
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When Help Can’t Wait
American Red Cross
Emergency Response
The Heart




Right atrium - receives
blood from body
Left atrium - receives
blood from lungs
Right ventricle - pumps
blood to lungs
Left ventricle - pumps
blood to body
Pg 190
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When Help Can’t Wait
TM 49
American Red Cross
Emergency Response
Video
Recognizing a Heart Attack
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When Help Can’t Wait
American Red Cross
Emergency Response
The Heart Attack
 Heart
muscle does not get enough oxygen
through coronary arteries and dies
 Depending upon which heart muscle and
how much is affected, a heart attack may
range from undetected to sudden cardiac
death
 Usually caused by Cardiovascular disease
Pg 192
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When Help Can’t Wait
American Red Cross
Emergency Response
Signs and Symptoms of
Heart Attack
 Persistent
chest pain or discomfort
 Breathing difficulty
 Changes in pulse rate
 Pale, bluish, or moist skin
 Nausea, vomiting
 Sweating
 General ill appearance
Pg 192-193
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When Help Can’t Wait
TM 50
American Red Cross
Emergency Response
Care for Heart Attack
 Stop
victim’s activity
 Have victim rest in a comfortable position
 Summon more advanced medical personnel
 Be calm and reassuring
 Monitor breathing and pulse, look for
changes in victim’s appearance or behavior.
 Administer supplemental oxygen if it is
available and you are trained
Pg 194
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When Help Can’t Wait
TM 51
American Red Cross
Emergency Response
Controllable Risk Factors for
Cardiovascular Disease
 Smoking
 Diet
high in fat
 High blood pressure
 Obesity
 Lack of regular exercise
Pg 209-211
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When Help Can’t Wait
TM 52
American Red Cross
Emergency Response
Cardiac Arrest
 Cardiovascular
disease is most common
cause but also caused by drowning,
suffocation, drugs, injuries, loss of blood,
electrocution or stroke
 CPR will delay death
 Defibrillation might restart heart rhythm
Pg 209-211
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When Help Can’t Wait
American Red Cross
Emergency Response
Time Without Breathing Until
Brain Damage Occurs
Pg 198
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When Help Can’t Wait
American Red Cross
Emergency Response
When to Stop CPR
 Another
trained rescuer takes over
 You are too exhausted to continue
 Victim’s heart starts beating
 Scene becomes unsafe
 A defibrillator is available with trained user
present
 You are presented with a valid DNR order
 Advanced medical personnel order you to
discontinue
Pg 202
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When Help Can’t Wait
TM 53
American Red Cross
Emergency Response
Ways to Prevent Cardiac
Emergencies in Children
 Prevent
injuries leading to cardiac emergencies
 Proper medical care
 Recognize early signs of respiratory
emergency
 Agitation
 Drowsiness
 Change
in skin color
 Increased difficulty breathing
 Increased heart and breathing rates
Pg 202
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When Help Can’t Wait
TM 54
American Red Cross
Emergency Response
Special Resuscitation Situations
 Near
drowning
 Must
seek follow-up care
 Electrocution
 Insure
personal safety
 Serious burns can occur along the entire path
from the entry to the exit sites. Identify both if
possible.
 Lightening
strike
 Can
cause severe burns and fractures, including
the spine.
From CPR-PR
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When Help Can’t Wait
American Red Cross
Emergency Response
Special Resuscitation Situations
 Traumatic
injury
 Survival
rate is poor, transport ASAP. Always
suspect head/neck injury
 Hypothermia
 Pulse
is hard to find, check for 45 seconds
 Transport ASAP
 Warm slowly, handle gently
From CPR-PR
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When Help Can’t Wait
American Red Cross
Emergency Response
Special Resuscitation Situations
 Difficult
locations
 Only
move if unsafe or impractical to do CPR
 When transporting up or down stairs, perform
CPR for one minute on the landings, try not to
interrupt CPR for more than 30 seconds
From CPR-PR
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When Help Can’t Wait
American Red Cross
Emergency Response
As you approach a scene ...
… have a plan in mind.
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When Help Can’t Wait
CT 17
American Red Cross
Emergency Response
Scenario 5
Conscious Person,
Difficulty Breathing
At work, you are summoned to assist a fellow worker who
is ill. As you arrive, you notice the person lying on the
ground, having obvious difficulty breathing. How do you
respond?
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When Help Can’t Wait
TM 55
American Red Cross
Emergency Response
Scenario 6
Conscious Person,
Breathing, with Severe Bleeding
While hiking, a man strays from the path in search of more
challenging terrain. The man loses his footing on loose
rocks and slides approximately 15 feet down the rocky
slope. When you arrive, you notice that he is bleeding
badly from a deep wound on the lower leg. You notice that
he appears pale, cool, and is sweating. He tells you he is
feeling dizzy, nauseated, and thirsty. How do you
respond?
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When Help Can’t Wait
TM 56
American Red Cross
Emergency Response
Scenario 7
Unconscious Person,
Breathing
A frantic neighbor is knocking at your door. She says that
she cannot wake her sleeping roommate. She remembers
that her roommate took some pills about two hours ago,
but she is not sure what they were or where her roommate
keeps them. You enter and see a woman lying face up on
the couch, not moving. She has vomited. How do you
respond?
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When Help Can’t Wait
TM 57
American Red Cross
Emergency Response
Scenario 8
Unconscious Person,
Not Breathing, Has Pulse
It’s early morning, and you are the lifeguard at a local
pool. The pool is almost deserted. Only two people were
swimming, but now they are finished and have gone to the
locker rooms. It is time to lock up the pool, and you
proceed to the locker rooms. You are startled to see a body
lying motionless on the damp floor next to a row of
lockers. You recognize the older woman who had been
swimming laps earlier. How do you respond?
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When Help Can’t Wait
TM 58
American Red Cross
Emergency Response
Scenario 9
Unconscious Person,
Not Breathing, No Pulse
In the early morning, you respond to a call dispatched as a
“heart attack.” You find an elderly man lying motionless
on the floor. His wife tells you that he had been feeling ill
for several hours and had vomited. She says that he
emerged from the bathroom clutching his chest and in
apparent pain, and suddenly collapsed on the floor. How
do you respond?
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When Help Can’t Wait
TM 59
American Red Cross
Emergency Response
Scenario 10
Unconscious Person,
Breathing, With Severe Bleeding
You witness a bicyclist struck by a car. The bicyclist is
thrown from the bike, striking her head. The driver of the
vehicle gets out to help. As you approach, you see the
bicyclist lying on her side, twitching. Blood is spurting
from her thigh onto the pavement. You want to help. How
do you respond?
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When Help Can’t Wait
TM 60
American Red Cross
Emergency Response
Chapter 11
Bleeding and Shock
 Blood
and Blood Vessels
 When Bleeding Occurs
 External
 Internal
 Shock
(Hypoperfusion)
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When Help Can’t Wait
American Red Cross
Emergency Response
Blood Components
 Plasma
 Liquid.
 White
Carries nutrients and waste products
Blood Cells
 Disease
fighting component. Aids in producing
antibodies needed to fight infection
 Red
Blood Cells
 Transport
Oxygen and Carbon Dioxide
 Platelets
 Essential
to the clotting process
Pg 222
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When Help Can’t Wait
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Emergency Response
Major Functions of Blood
 Protects
against disease
 Maintains constant body temperature
 Transports oxygen, nutrients and wastes
Pg 222
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When Help Can’t Wait
TM 61
American Red Cross
Emergency Response
Blood Vessels

Arteries -
Systemic Arteries carry oxygen-rich blood from the
heart to the rest of the body
 Pulmonary arteries carry oxygen-poor blood from the
heart to the lungs
 Capillaries - Deliver oxygen and nutrients and remove
waste products from the cells


Veins Systemic Veins carry waste products from the cells to
the heart
 Pulmonary Veins carry oxygen-rich blood from the
lungs to the heart for delivery to the body

Pg 222-223
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When Help Can’t Wait
American Red Cross
Emergency Response
When Bleeding Occurs
Brain, Heart and Lungs attempt to compensate for
blood loss to maintain flow to vital organs
 Platelets collect to clot the blood, white blood cells
try to attack infections, body produces more red
blood cells
 Fluid is reabsorbed from the kidneys, lungs and
intestines to maintain needed volume

Pg 223
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When Help Can’t Wait
American Red Cross
Emergency Response
Bleeding

Bleeding may be internal or external. Whichever
the case, uncontrolled bleeding is a lifethreatening emergency
Pg 223-229
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When Help Can’t Wait
American Red Cross
Emergency Response
Recognizing External Bleeding
Visible blood
 Bleeding is serious when 
Blood is spurting from a wound
 Blood fails to clot after all measures have been taken

Arterial bleeding is bright red and oxygen rich.
May spurt and be harder to control
 Venous bleeding is dark and flows at a steady rate
 Capillary blood is dark red and “oozes”. Usually
clots spontaneously

Pg 223-226
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When Help Can’t Wait
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Emergency Response
Care for External Bleeding
 Direct
pressure
 Elevation
 Pressure bandage
If necessary Use pressure points
 Summon more advanced medical personnel
Pg 226-227
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When Help Can’t Wait
TM 62
American Red Cross
Emergency Response
Practice Session
 Bleeding
control
 Direct
pressure
 Elevation
 Pressure bandage
 Pressure points
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Emergency Response
Recognizing Internal Bleeding










Discoloration of the skin
Soft tissues are tender, swollen or firm
Anxiety or restlessness
Rapid, weak pulse
Rapid breathing
Skin feels cool or moist or looks pale, ashen or bluish
Nausea and vomiting
Excessive thirst
Declining level of consciousness (LOC)
Drop in blood pressure
Pg 228
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Emergency Response
Care for Internal Bleeding
If minor injury Apply ice or cold pack
If serious injury
 Summon more advanced medical personnel
 Do no further harm
 Monitor ABCs and vital signs
 Have victim rest in a comfortable position
 Keep victim from getting chilled or over heated
 Reassure victim
 Provide care for other conditions
 Administer Oxygen if it is available and you are
trained to do so
Pg 229
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When Help Can’t Wait
TM 63
American Red Cross
Emergency Response
When the Body is Healthy …
Three conditions are necessary to maintain
adequate blood flow –
 The heart must be working well
 An adequate amount of blood must be
circulating in the body
 The blood vessels must be intact and able to
adjust blood flow
Pg 229
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Emergency Response
Shock
 The
circulatory system fails to provide
oxygen-rich blood to all body parts
 Several types of shock - Anaphylactic,
Cardiogenic, Hemorrhagic, Metabolic,
Neurogenic, Psychogenic, Respiratory, Septic
 Three
phases of shock -
Compensated
 Decompensated
 Terminal

 Care
is the same in all cases
Pg 230-231
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Emergency Response
Shock
Pg 231
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Emergency Response
Signs and Symptoms of Shock
 Restlessness/irritability
 Rapid/weak
pulse
 Rapid breathing
 Pale, ashen or bluish/cool/moist skin
 Excessive thirst
 Nausea and vomiting
 Drowsiness/loss of consciousness
Pg 232
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When Help Can’t Wait
TM 64
American Red Cross
Emergency Response
Stages of Shock
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Emergency Response
Compensated Shock:
 Pulse
fast - Bounding
 Breathing rate increases
 Superficial blood vessels constrict
 Blood pressure maintained
 Increased diastolic
 Body sweats
 capillary refilling prolonged (2-4 seconds)
 Anxious
Pg 232
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When Help Can’t Wait
TM 65
American Red Cross
Emergency Response
Decompensated Shock:
•
•
•
•
•
•
•
LOC deteriorates
Tachycardia
Tachypnea and shallow
Decreased systolic pressure
Decreased diastolic pressure
weak and thready pulse
Blue/pale skin
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Emergency Response
Terminal Shock:
•
•
•
•
Very low blood pressure
dilation of peripheral blood vessels
Unconscious
death
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When Help Can’t Wait
Emergency Response
American Red Cross
Emergency Response
Care for Shock
 Do
no harm
 Monitor ABCs
 Help victim rest in a position of comfort
 Keep victim from getting chilled or
overheated
 Reassure the victim
 Provide care for specific conditions
Pg 232-233
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Emergency Response
Further Care for Shock
 Control
any external bleeding as soon as
possible
 Elevate the legs about 12 inches if you do
not suspect head, neck or back injuries or
injuries to the hips or legs
 Administer Oxygen if available
 Give nothing to eat or drink
 Call advanced medical assistance
Pg 233
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Emergency Response
Chapter 12
Specific Injuries
 Soft
Tissue Injuries
 Closed
 Open
 Burns
 Chest
Injuries
 Injuries to the Abdomen
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Video
Injuries
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Emergency Response
American Red Cross
Emergency Response
The Structure of the Skin
The epidermis provides a barrier
to bacteria and other organisms
that can cause infections and
helps regulate the body’s
temperature
The dermis contains structures of
the nerves, the sweat and oil
glands and the blood vessels
Pg 238
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When Help Can’t Wait
CT 29
American Red Cross
Emergency Response
Wounds
 Closed
 Open
Types
 Abrasion
 Laceration
 Avulsion
 Puncture
 Impaled Object
 Infection
Pg 239-243
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TM 66
American Red Cross
Emergency Response
Wounds
 Closed
Pg 239
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CT 29
American Red Cross
Emergency Response
Wounds
 Abrasion
Pg 240
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CT 30
American Red Cross
Emergency Response
Wounds
 Laceration
Pg 241
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CT 30
American Red Cross
Emergency Response
Wounds
 Avulsion
Pg 241
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When Help Can’t Wait
CT 31
American Red Cross
Emergency Response
Wounds

Puncture
Pg 242
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When Help Can’t Wait
CT 31
American Red Cross
Emergency Response
Wounds
 Impaled
Object
Pg 243
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CT 31
American Red Cross
Emergency Response
Wounds
 Infection
Pg 249
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When Help Can’t Wait
CT 32
American Red Cross
Emergency Response
Dressings
 Dressings
absorb blood and must be sterile.
Commonly 2” or 4” square
 Universal dressings cover very large
wounds
 Occlusive dressings do not allow air to pass
Pg 243
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Emergency Response
Bandages
Wrap or cover any part of the body to hold
dressings in place
 Adhesive bandages are small pads of nonstick
gauze and a strip of adhesive tape
 Bandage compresses can be tied in place
 Roller bandages are self adhering and are used to
cover dressings
 Elastic bandage keeps pressure on a body part but
must be used with caution
 Triangular bandages are used as slings

Pg 244-246
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Emergency Response
Applying a Roller Bandage
 Elevate
injured part
 Secure end of bandage
 Completely cover dressings
 Don’t cover fingers or toes
 Apply additional dressings if necessary
Pg 244
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When Help Can’t Wait
TM 70
American Red Cross
Emergency Response
Care for closed injuries
 Direct
pressure
 Elevation
 Cold
 Do
not apply ice directly to the skin
Pg 247
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Emergency Response
Care for severe open injuries
 Don’t
waste time washing the wound
 Control the bleeding
 Control with direct pressure
 Summon more advanced medical care
 Use pressure points as necessary
 Wash hands after completing care
Pg 247-248
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Emergency Response
Pressure Point Location
Pg 227
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Emergency Response
Video
Controlling External Bleeding
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American Red Cross
Emergency Response
Types of Burns
 Depth
 Superficial
 Partial-thickness
 Full-thickness
 Source
 Thermal
 Chemical
 Electrical
 Radiation
Pg 249-250
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TM 67
American Red Cross
Emergency Response
Types of Burns
 Depth
 Superficial
 Red
and dry and usually painful
 Often cause swelling in the burn area
 Generally heal in a few days without scarring
Pg 250
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CT 33
American Red Cross
Emergency Response
Types of Burns
 Depth
 Partial-thickness
 Red and wet and may have blisters that may open and weep
clear fluid
 Are usually painful
 Often cause swelling in the burn area
 Generally heal in 3-4 weeks
 May result in scarring
Pg 250-251
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When Help Can’t Wait
CT 34
American Red Cross
Emergency Response
Types of Burns
 Depth
 Full-thickness
 Appear brown or charred (black) with tissues underneath
sometimes appearing white
 May either be extremely painful or relatively painless if the
burn destroyed the nerve ending
 Take longer to heal
 Usually result in scarring
Pg 251-252
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CT 35
American Red Cross
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Emergency Response
American Red Cross
Emergency Response
Critical Burns
 Burns
causing breathing difficulty
 Burns covering more than one body part
 Burns on the head, neck, hands, feet or
genitals
 Any partial- or full-thickness burns to
children or the elderly
 Burns from chemicals, explosions or
electricity
Pg 252
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When Help Can’t Wait
TM 68
American Red Cross
Emergency Response
The “Rule of Nines”
 Used
to estimate the percentage of the body
affected by a burn
Head = 9%
 Front of trunk = 18%
 Back of trunk = 18%
 Arm = 9%
 Leg = 18%
 Groin = 1%

Pg 253
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Emergency Response
Care for Burns
 Cool
burned area with cool water
 Cover burned area with dry dressings
 Minimize shock by keeping victim from
getting chilled or overheated
 If caused by a chemical have the victim
remove any contaminated clothes
 If an eye is burned by a chemical flush the
eye for at least 20 minutes
Pg 252-255
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When Help Can’t Wait
TM 69
American Red Cross
Emergency Response
Care for Electrical Burns
 Make
sure the scene is safe
 Turn off electrical current before
approaching the victim
 During the physical exam, look for all entry
and exit wounds. All tissue between these
areas may be affected
Pg 256
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American Red Cross
Video
Bandaging
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When Help Can’t Wait
Emergency Response
American Red Cross
Emergency Response
Practice Session
Workbook Pages 158-163
 Care
for a Major Open Wound (Forearm)
 Care for a Major Open Wound (Leg)
 Care for a Wound with an Embedded Object
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Emergency Response
Signs and Symptoms
of Chest Injury
 Difficulty
breathing
 Severe pain
 Obvious deformity
 Discoloration of skin
 Coughing up blood
Pg 258-259
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When Help Can’t Wait
TM 71
American Red Cross
Emergency Response
Types of Chest Injuries
 Rib
Fractures
 Flail
Chest
Pg 259
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When Help Can’t Wait
CT 36
American Red Cross
Emergency Response
Types of Chest Injuries
 Puncture
Injuries
Pg 260
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CT 37
American Red Cross
Emergency Response
Types of Chest Injuries
 Sucking
Chest Wound
Pg 261
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CT 38
American Red Cross
Emergency Response
Care for Serious Chest Injury
 Summon
more advanced medical personnel
 Position victim to aid breathing
 If ribs are broken, bind arm to injured side
 Cover sucking chest wound
 Administer oxygen
 Monitor breathing and pulse
Pg 259-260
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When Help Can’t Wait
TM 72
American Red Cross
Emergency Response
Practice Session
(Not in the workbook)
 Chest
Injury
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American Red Cross
Emergency Response
Signs and Symptoms
of Abdominal Injury
 Nausea
and vomiting
 Pale or ashen, moist skin
 Thirst
 Pain, tenderness or rigid abdomen
 Weakness
 Organs protruding from the abdomen
Pg 261-262
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American Red Cross
Emergency Response
Abdominal Organs
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When Help Can’t Wait
CT 39
American Red Cross
Emergency Response
Care for Serious Abdominal Injury
Open Wound
 Do not put pressure on protruding organs or try
to put them back inside
 Position victim on back
 Remove clothing around wound
 Cover loosely with moist, clean dressing
 Cover dressing with plastic wrap
 Cover with folder towel to maintain warmth
 Administer oxygen
Pg 262
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When Help Can’t Wait
TM 73
American Red Cross
Emergency Response
Closed Wound
 Position victim on back
 Bend knees slightly
 Administer oxygen if available
 Minimize shock
 Summon more advanced medical personnel
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Emergency Response
Signs and Symptoms
of Pelvic Injury
 Same
as for abdominal injury with the
addition of loss of sensation or movement in
the legs, which sometimes occurs
Pg 261-264
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When Help Can’t Wait
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Emergency Response
Care for Serious Pelvic Injury
 Summon
more advanced medical personnel
 Minimize movement
 Control bleeding
 Administer oxygen if available
 Minimize shock
Pg 261-264
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When Help Can’t Wait
TM 74
American Red Cross
Emergency Response
Care for Open Wound to Genitalia
 Cover
with sterile dressing
 Control bleeding
 Do not put anything into the vagina
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Emergency Response
Embedded Objects
 Do
not remove objects in the eye, ear or
nose
 Remove objects from the cheek
 Remove objects from the chest if it will
interfere with chest compressions
Pg 263
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Emergency Response
Amputations
 Wrap
the part in a sterile dressing
 Wrap the dressing in plastic
 Pack in ice to cool, not freeze. Transport
with the victim.
Pg 263
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When Help Can’t Wait
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Emergency Response
Chapter 13
Muscle and Bone Injuries
 Musculoskeletal
System Review
 Injuries to Bones and Joints
 Immobilization
 The Skeletal system
 Types of Musculoskeletal injuries
 Caring for specific injuries
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Emergency Response
Musculoskeletal System Review
 Muscles
attach to bones
with tendons
 Joints are held together
by ligaments
Images courtesy of the
EMTB Anatomy Review
Pg 277
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When Help Can’t Wait
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Emergency Response
Musculoskeletal System Review
Bones are different shapes and sizes
Pg 287
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Emergency Response
Musculoskeletal System Review
Bones can fracture or separate in various ways
Crack
Broken
Through
Separation
Chip
Pg 289
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Emergency Response
Common Signs and Symptoms
of Musculoskeletal Injury
Pain
 Swelling
 Deformity
 Discoloration
 Bone protruding from wound
 Inability to use affected part
 Grating bones
 Snapping or popping sound
 Cause of injury, such as fall from a height

Pg 278-279
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When Help Can’t Wait
TM 75
American Red Cross
Emergency Response
Video
Immobilizing Muscle and Bone
Injuries
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When Help Can’t Wait
American Red Cross
Emergency Response
Care for Muscle and Bone Injury
 Rest
 Ice
 Elevation
 Immobilization
Or
 Rest
 Ice
 Compression
 Elevation
Pg 280
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When Help Can’t Wait
TM 76
American Red Cross
Emergency Response
Immobilization - Types of Splints
 Soft
 Rigid
 Anatomic
 Traction
 Air
splints- precautions
 Vacuum
Pg 281
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American Red Cross
Video
Splinting
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When Help Can’t Wait
Emergency Response
American Red Cross
Emergency Response
Emergency Care for Muscle and
Bone Injuries  Take
BSI precautions
 Control life-threatening injuries
 Allow victim to rest in comfortable position
 Apply cold to reduce pain and swelling
 Support area above and below injury
 Cover open wounds with sterile dressing
 Do not reposition protruding bones
Pg 279-283
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When Help Can’t Wait
TM 77
American Red Cross
Emergency Response
Types of
Muscle and Bone Injuries
 Fracture
 Dislocation
 Sprain
 Strain
Pg 288-289
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Emergency Response
Caring for Specific Injuries to
Bones and Muscles
 Upper
Extremity injuries
 Shoulder
-
 The
clavicle is the most frequently injured, typically
from a fall
 Great force is required to break the scapula. Suspect
other injuries is this occurs
 Splint in position. Use a pillow or rolled blanket to
fill any gaps between the arm and chest
Pg 290-292
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When Help Can’t Wait
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Emergency Response
Caring for Specific Injuries to
Bones and Muscles
 Upper
Extremity injuries
 Upper Arm
 the
humerus is the longest bone in the arm and can
be broken at any point
 Injury may be very painful and may have
considerable deformity
 Control external bleeding and immobilize the upper
arm from the shoulder to elbow
 Sling and bind to the chest
Pg 295-296
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Emergency Response
Caring for Specific Injuries to
Bones and Muscles
 Upper
Extremity injuries
 Elbow
 Injuries
are made worse by movement
 Immobilize from the shoulder to the wrist in the
position found
 Splint and secure to the body
 If the elbow is bent, splint diagonally across the
inside of the arm
Pg 296
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When Help Can’t Wait
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Emergency Response
Caring for Specific Injuries to
Bones and Muscles
 Upper
Extremity injuries
 Forearm,
Wrist and Hand
 Apply
a pressure bandage in a figure-eight
 Place a roll of gauze in the hand
 Put the arm in a sling and secure to the chest
 If fingers are broken, splint to an adjacent finger
Pg 297-299
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Emergency Response
Caring for Specific Injuries to
Bones and Muscles
 Lower
Extremity injuries
 Thigh
 Many
femur fractures involve the upper end of the
bone and are called hip fractures
 A leg with a broken femur may appear shorter than
the other leg and be turned outward
 Femur fractures can cause serious internal bleeding
which may result in life-threatening shock. A
traction splint may be used for mid-shaft fractures
Pg 299-302
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Emergency Response
Caring for Specific Injuries to
Bones and Muscles
 Lower
Extremity injuries
 Lower
Leg
 Open
fractures are common. With some fractures of
the fibula the victim may still be able to walk
 Immobilize using a rigid splint or anatomical splint
Pg 299-302
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Emergency Response
Caring for Specific Injuries to
Bones and Muscles
 Lower
Extremity injuries
 Knee
 Very
vulnerable to injury. Sprains, fractures and
dislocations are especially common with athletic
injuries
 Violent force may fracture the kneecap
 If the knee can be straightened, splint as with any
other leg injury. If bent, splint in the position found
Pg 303-304
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Emergency Response
Caring for Specific Injuries to
Bones and Muscles
 Lower
Extremity injuries
 Ankle
and Foot injuries
 It
can be difficult to distinguish between minor and
severe foot and ankle injuries. Treat as if they were
serious
 Victims of a fall may injure the foot or ankle as well
as other parts of the body, such as the back. Do a
full physical survey
Pg 304
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Emergency Response
Practice Session
Workbook Pages 176-183
 Applying
a Rigid Splint
 Applying a Sling and Binder
 Applying an Anatomic Splint
 Applying a Soft Splint
 Applying a Traction Splint
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Emergency Response
Chapter 14
Head, Neck and Back Injuries
 Recognizing
Serious Head, Neck and Back
Injuries
 Injury Situations
 Care for these injuries
 Immobilizing the victim
 Preventing Head, Neck and back injuries
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Emergency Response
Head, Neck and Back Injury
 Although
a small percentage of injuries they
account for over half of the fatalities
 Nearly 80,000 victims are permanently
disabled each year in the U.S.
 Prompt care can prevent some injuries from
becoming more serious
 Bleeding in the skull can occur rapidly or
slowly over a period of days
Pg 313
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Emergency Response
Head, Neck and Back Injury
Injuries to the skull can
cause bleeding inside the
skull or brain which can
result in severe pain,
headaches or changes in
level of consciousness
Pg 313-314
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When Help Can’t Wait
American Red Cross
Emergency Response
Head, Neck and Back Injury
The spine consists of
individual vertebrae which
protect the spinal cord while
allowing flexibility. The
disks are separated by
compressible disks and
individual nerves or nerve
bundles exit between the
vertebrae.
Pg 314-315
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When Help Can’t Wait
American Red Cross
Emergency Response
When to Suspect a Head, Neck
or Back Injury
Any fall greater than victim’s height
 Any motor vehicle collision
 A person found unconscious for unknown reasons
 Any injury that penetrates the head or trunk
 A motor vehicle crash involving a driver or
passengers not wearing safety belts
 Any person thrown from a motor vehicle
 Any injury in which a victim’s helmet is broken

Pg 314
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When Help Can’t Wait
TM 78
American Red Cross
Emergency Response
Signs and Symptoms of Serious
Head, Neck or Back Injuries
 Change
in level of consciousness
 Severe pain/pressure in head/neck/back
 Tingling/loss of sensation/movement in
extremities
 Unusual lumps/depression on head/spine
 Blood/fluids in the ears/nose
…….
Pg 314-317
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When Help Can’t Wait
TM 79
American Red Cross
 Profuse
Emergency Response
external bleeding of head/neck/back
 Seizures
 Impaired breathing/vision
 Nausea/vomiting
 Persistent headache
 Loss of balance
 Bruising of head: around eyes/back of head
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When Help Can’t Wait
American Red Cross
Emergency Response
Assessing a victim with a
Head, Neck or Back Injury
Responsive victim
 Ask about the mechanism of injury
 Ask the victimDoes your head, neck or back hurt?
What happened?
Where does it hurt?
Can you move your hands and feet?
Can you feel me touching your fingers
Can you feel me touching your toes?
Pg 317
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When Help Can’t Wait
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Emergency Response
Unresponsive victim
 Look for the mechanism of injury
 Maintain airway and breathing
 Stabilize the head, neck and back manually
in the position the victim is found
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When Help Can’t Wait
American Red Cross
Emergency Response
Video
Immobilizing Head, Neck
and Back Injuries
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When Help Can’t Wait
American Red Cross
Emergency Response
Care for
Head, Neck and Back Injuries
 Minimize
 In-line
Movement
stabilization unless contra-indicated
 Maintain
an open airway
 Complete physical assessment and on-going
assessment
 Control external bleeding
 Keep victim from getting chilled or
overheated
Pg 317-319
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Emergency Response
Additional Care for
Head, Neck and Back Injuries
Head injury may include a concussion, which is a
temporary impairment of the brain function
 Never place pressure on the eyeball. For an
embedded object, stabilize with a paper cup
 For a nosebleed, pinch the nostril and have the
person lean forward
 For teeth knocked out, control the bleeding and
save the teeth. They can be replanted

Pg 319-325
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When Help Can’t Wait
American Red Cross
Emergency Response
Practice Session
Workbook Pages 194-196
 Bandaging
an Eye with an Embedded
Object
Pg 322
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When Help Can’t Wait
American Red Cross
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When Help Can’t Wait
Emergency Response
American Red Cross
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When Help Can’t Wait
Emergency Response
American Red Cross
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When Help Can’t Wait
Emergency Response
American Red Cross
Emergency Response
When Not to Use
In-line Stabilization
 When
victim’s head is severely angled
 When victim complains of pain, pressure or
muscle spasms on initial head movement
 When rescuer feels resistance when
attempting to move head
Pg 317
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When Help Can’t Wait
TM 80
American Red Cross
Emergency Response
Specific Injuries
 Concussion
 Scalp
 Cheek
Injury
 Nose Injury
 Eye Injury
 Ear Injury
 Mouth, Jaw and Neck Injury
Pg 319-324
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Emergency Response
Immobilizing the Victim
 Hold
in-line stabilization
 Apply a cervical collar
 Secure the body to a backboard
 Secure the head (last!)
 Note:
Only remove helmets if they interfere
with breathing or breathing assistance. ER
will want helmet with the victim
Pg 326-328
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When Help Can’t Wait
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Emergency Response
Ways to Prevent Head,
Neck and Back Injuries Wear safety belts
 Wear helmets and protective eyewear
 Safeguard against falls
 Take safety precautions in sports and recreation
 Avoid improper drug use
 Inspect equipment
 Think and talk safety

Pg 334-336
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When Help Can’t Wait
TM 81
American Red Cross
Emergency Response
Practice Session
Workbook Pages 194-196
 Immobilizing
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a Head, Neck or Back Injury
When Help Can’t Wait
American Red Cross
Emergency Response
Chapter 15
Medical and Behavioral Emergencies
Medical Emergencies
 Altered
Mental Status
 Seizures
 Stroke
 Diabetic Emergency
 Heat and Cold Exposure
Behavioral Emergencies
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Emergency Response
General Signs and Symptoms
of Medical Emergencies
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When Help Can’t Wait
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Emergency Response
General Signs and Symptoms
of Medical Emergencies
 Change
in level of consciousness
 Headache/lightheaded/dizzy/weak
 Nausea/vomiting
 Change in breathing, pulse, or
skin temperature, color or moisture
Pg 341-342
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TM 82
American Red Cross
Emergency Response
Video
Medical Emergencies
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When Help Can’t Wait
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Emergency Response
Altered Mental Status
Can Result From Fever
 Infection
 Poisoning, including substance abuse or misuse
 High or low blood sugar or insulin reactions
 Head injury
 Any condition that results in decreased blood flow
to the brain
 Conditions resulting from mental, emotional, or
behavioral disorders

Pg 341
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When Help Can’t Wait
TM 83
American Red Cross
Emergency Response
Altered Mental Status
A person who faints has experienced an altered
level of consciousness. The brain was deprived of
its normal flow of blood
 Fainting usually resolves itself when the blood
flow is restored
 Fainting by itself does not usually harm the victim
but injury may occur from falling
 Fainting does have an underlying cause that
should be explored

Pg 341
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Emergency Response
Care for a Victim of an
Altered Level of Consciousness
 Do
initial assessment, physical exam,
and SAMPLE history as needed
 Elevate legs
 Do ongoing assessment
 Check airway;
…….
Pg 342
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When Help Can’t Wait
TM 84
American Red Cross
 put
Emergency Response
unconscious victims in recovery
position
 Loosen any restrictive clothing
 Do not give victim anything to eat
 Have suction equipment available
 Summon more advanced medical
personnel
 Reassure victim
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When Help Can’t Wait
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Emergency Response
Causes of Seizures
Fever
 Infection
 Chronic medical conditions
 Poisoning
 Low blood sugar
 Head injury
 Any condition causing decreased Level Of
Consciousness (LOC)
 Pregnancy complications

Pg 342
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When Help Can’t Wait
TM 85
American Red Cross
Emergency Response
Seizure Indications
The chronic form of seizure is known as epilepsy
 Before a seizure, the victim may experience a
warning called an aura. This is an unusual
sensation or feeling such as a visual hallucination;
strange sound, taste or smell; or an urgent need to
get to safety
 Seizures may range from mild blackouts that
appear to be daydreaming to sudden uncontrolled
muscular contractions lasting several minutes

Pg 342-343
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Emergency Response
To Care for a Seizure Victim Summon more advanced medical personnel
 Do not try to stop seizure or restrain victim
 Protect victim from injury
 Protect victim’s modesty
 Manage airway by rolling victim onto his or her
side
 Remove nearby objects and protect victim’s head
 Do not place anything between teeth
 When seizure is over, do physical exam and care
for any injuries found

Pg 343
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When Help Can’t Wait
TM 86
American Red Cross
Emergency Response
For a Seizure Victim, Call if The seizure lasts more than a few minutes
 The victim has repeated seizures
 The victim appears to be injured
 You are uncertain about the cause of the seizure
 The victim is pregnant
 The victim is a known diabetic
 The victim is an infant or child
 The seizure takes place in water
 The victim fails to regain consciousness after the
seizure

Pg 343
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When Help Can’t Wait
American Red Cross
Emergency Response
Those at Greatest Risk
for Heat-related Illness
 Young
children and the elderly
 Those involved in strenuous activity in a hot
environment
 Those with pre-existing health problems
 Those using illicit drugs or medications
 Those who have had a heat-related illness in
the past
Pg 343-346
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When Help Can’t Wait
TM 89
American Red Cross
Emergency Response
Signs and Symptoms
of Heat-related Illness
Headache
 Cool, moist, pale or ashen skin (early stages)
 Dry, red, hot skin (later stages)
 Nausea
 Exhaustion
 Progressive loss of consciousness
 Rapid, weak pulse (later stages)
 Rapid, shallow breathing (later stages)
 High body temperature (later stages)

Pg 347-348
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When Help Can’t Wait
TM 90
American Red Cross
Emergency Response
Care for Heat Exposure
 Remove
victim from hot environment
 Give small amounts of cool water to
conscious victim
 Have victim lie down in a cool or shady
area and elevate legs if possible
 Loosen or remove clothing
 Apply cool, wet towels or cold packs to
wrists, armpits, groin and legs
 Fan victim
Pg 348
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When Help Can’t Wait
TM 91
American Red Cross
Emergency Response
Scenario 11
Heat Emergency
You are involved with a fire-fighting training
exercise involving a burning structure. It has been
a really hot day, with temperatures in the 90s. You
and others have been wearing you heavy turnout
gear for hours. Suddenly, someone collapses.
You notice that her skin is hot, flushed and wet.
Her pulse is very fast. How do you respond?
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When Help Can’t Wait
TM 92
American Red Cross
Emergency Response
Factors Affecting
Normal Body Temperature
 Air
temperature
 Humidity
 Wind
 Clothing
 Intensity of activity
 Body’s ability to adapt (physical fitness
level)
Pg 348
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When Help Can’t Wait
TM 93
American Red Cross
Emergency Response
Those at Greatest Risk
for Cold Exposure
 Young
children and elderly
 Those without adequate equipment, clothing
or training for cold environment
 Those with health problems
 Those using illicit drugs, medications or
alcohol
Pg 345-346
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When Help Can’t Wait
TM 94
American Red Cross
Emergency Response
Signs and Symptoms
of Hypothermia
 Cool
skin
 Shivering
 Numbness
 Decreasing level of consciousness (LOC)
 Poor coordination
 Difficulty speaking
 Rigid posture
Pg 348-350
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When Help Can’t Wait
TM 95
American Red Cross
Emergency Response
Care for Hypothermia
Summon more advanced medical personnel
 Reassure victim
 Handle victim gently
 Remove victim from cold environment
 Have victim stop all activity and rest
 Remove wet clothing
 Place victim in dry blankets or clothing and wrap
in plastic if available
 Protect from any further heat loss

Pg 348-349
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When Help Can’t Wait
TM 96
American Red Cross
Emergency Response
Frostbite
Superficial frostbite
 Most common form of frostbite
 Skin is frozen, underlying tissues are not
 Involves loss of feeling and sensation
 Person feels tingling sensation when rewarmed
Deep frostbite
 Skin is white and waxy
 Skin is firm when palpated
 Swelling and blisters may be present
 When rewarmed, skin appears red with areas of
purple and blue
Pg 349
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When Help Can’t Wait
TM 97
American Red Cross
Emergency Response
Care for Localized Cold Injury
Handle the affected area gently
 Remove wet clothing and any jewelry from the
affected area
 Cover the affected area with dry dressings and
bandage loosely
 Do not rub the area or break any blisters
 Do not re-expose the injury to cold
 Do not apply heat

Pg 349
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When Help Can’t Wait
American Red Cross
Emergency Response
To Prevent
Overexposure Emergencies
 Do
not work in the hottest or coldest part of
the day
 Take frequent breaks
 Replenish body with food and fluids
 Reduce work intensity
 Wear clothing appropriate for task and
environment
Pg 350
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When Help Can’t Wait
TM 98
American Red Cross
Emergency Response
Behavioral Emergencies
A behavioral emergency is a situation in which a
person exhibits abnormal behavior that is
unacceptable or intolerable.
Common causes for the behavior alteration include -
Pg 350-351
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When Help Can’t Wait
American Red Cross
 Situational
Emergency Response
stress
 Illness or injury resulting in lack of oxygen
or low blood sugar
 Substance abuse
 Mental illness, including crises involving
panic, agitation, self destructive behavior,
and/or violence.
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When Help Can’t Wait
American Red Cross
Emergency Response
Actions Indicating a
Behavioral Emergency
 Threatening
posture
 Possessing a weapon(s)
 Threatening harm to others or self
 Being verbally abusive
 Speaking in a nonsensical manner
 Withdrawing deeply
 Hallucinating
Pg 351
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When Help Can’t Wait
TM 99
American Red Cross
Emergency Response
To Calm a Victim of a
Behavioral Emergency Assume non-threatening posture
 Acknowledge that victim appears upset
 Get in front of victim and at eye level
 Avoid unnecessary contact
 Do not threaten, challenge or argue with victim
 Involve others that victim trusts
 Encourage victim to discuss whatever is troubling
him/her

Pg 351-352
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When Help Can’t Wait
TM 100
American Red Cross
Emergency Response
Diabetic Emergencies
Too much Sugar
Too much Insulin
Pg 354-359
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When Help Can’t Wait
American Red Cross
Emergency Response
Hyperglycemia
 Too
much sugar and too little insulin in the
blood stream
 Without insulin the body cells can not
convert the available sugar into energy
 Without sugar the body breaks down other
food sources
 The result can be a diabetic coma
Pg 354-359
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When Help Can’t Wait
American Red Cross
Emergency Response
Causes of Hyperglycemia
• Eating too much food relative to the amount
of insulin injected
• Missing an insulin injection
• Blockage in insulin pump tubing
• Disconnected insulin pump infusion set
• Illness or stress
hyperglycemia caused by insufficient insulin can
lead to diabetic ketoacidosis.
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When Help Can’t Wait
American Red Cross
Symptoms of Hyperglycemia
• Frequent urination
• Frequent thirst
• Blurry vision
• Dry mouth
• Fatigue
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When Help Can’t Wait
Emergency Response
American Red Cross
Emergency Response
Hypoglycemia
 Adequate
insulin
 Too little sugar
 Sugar is used rapidly
 Also called insulin reaction
Pg 355
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When Help Can’t Wait
TM 87
American Red Cross
Emergency Response
Signs and Symptoms of
Diabetic Emergencies
 Change
in level of consciousness (LOC)
 Rapid breathing and pulse
 Feeling and looking ill
Pg 359
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When Help Can’t Wait
TM 88
American Red Cross
Emergency Response
Signs and Symptoms of
Hyperglycemia
•
•
•
•
•
Frequent urination
Frequent thirst
Blurry vision
Dry mouth
Fatigue
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When Help Can’t Wait
American Red Cross
Emergency Response
Signs and Symptoms of
Hypoglycemia
•
•
•
•
•
•
•
Grouchiness
Shakiness
Sweating
Fast heart rate
Pale skin
Dizziness
Yawning….
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When Help Can’t Wait
American Red Cross
• Confusion
• Poor coordination
• Inability to cooperate
• Slurred speech
Severe
• Unconsciousness
• Convulsions …
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When Help Can’t Wait
Emergency Response
American Red Cross
Emergency Response
Care for
Diabetic Emergencies
 If
conscious, ask victim about medical
conditions
 Do a SAMPLE history. (Important to know
when medication and food were last taken)
 If conscious and able to swallow, give sugar
in some liquid form
 If no improvement in 5 minutes, summon
advanced medical personnel
Pg 359
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When Help Can’t Wait
American Red Cross
For Hyperglycemia
• Drink lots of water
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When Help Can’t Wait
Emergency Response
American Red Cross
Emergency Response
Enrichment
Stroke
 Called
a Cerebrovascular Accident (CVA)
 Caused by a disruption of blood flow to a
part of the brain
 Can be caused by a blood clot lodging in an
artery or a ruptured artery
 A Transient Ischemic Attack (TIA) is a
short-term stroke
Pg 359-360
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When Help Can’t Wait
American Red Cross
Emergency Response
Enrichment
Stroke
Pg 360
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When Help Can’t Wait
American Red Cross
Emergency Response
Enrichment
Signs and Symptoms of a Stroke
 Ill
appearance
 Changes in LOC
 Sudden weakness and numbness in face,
arm or leg, usually on one side
 Difficulty speaking or understanding speech
 Pupils of unequal size, blurred vision
 Headache, confusion, change in mood
Pg 360
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When Help Can’t Wait
American Red Cross
Emergency Response
Enrichment
Care for a Stroke Victim
 Care
for life-threatening conditions
 Summon advanced medical help
 Comfort and reassure victim
 Administer Oxygen if available
 Nothing to eat or drink
 Prompt medical attention is critical
 Do NOT give aspirin
Pg 360-362
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When Help Can’t Wait
American Red Cross
Emergency Response
Chapter 16
Poisoning
 How
Poisons Enter the Body
 Care for Poisoning
 Inhaled
Poisons
 Ingested Poisons
 Absorbed Poisons
 Injected Poisons
 Anaphylaxis
 Substance Abuse
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When Help Can’t Wait
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Emergency Response
How Poisons Enter the Body
Ingestion
Inhalation
Injection
Absorption
Pg 367
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When Help Can’t Wait
TM 101
American Red Cross
Emergency Response
Clues of Poisoning
 Odors
 Flames
or smoke
 Containers that are open or out of place
 Plants partially eaten or disturbed
Pg 367
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When Help Can’t Wait
TM 102
American Red Cross
Emergency Response
Signs and Symptoms
of Poisoning
 Nausea
or vomiting
 Chest or abdominal pain
 Breathing difficulty
 Altered consciousness
 Seizures
 Burns sometimes found on or around the
mouth
Pg 368
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When Help Can’t Wait
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Emergency Response
Poisoning Severity
 The
type and amount of poison
 How and when it entered the body
 Victim’s size, weight and age
Pg 369
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When Help Can’t Wait
TM 103
American Red Cross
Emergency Response
General Principle for
Poisoning Emergencies
 Conduct
scene size-up
 Remove victim from source of poison
 Conduct initial assessment
 Conduct physical exam and SAMPLE history
 Summon more advanced medical personnel
 Contact PCC (as per local protocols)
 1-800-222-1222
 Do not give anything to eat or drink
Pg 369
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When Help Can’t Wait
TM 104
American Red Cross
Emergency Response
When NOT to Induce Vomiting
for Ingested Poisons
 Victim
is unconscious
 Victim is having a seizure
 Victim is pregnant
 Victim has ingested corrosive substance or
petroleum product
 Victim is known to have heart disease
Pg 371-372
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When Help Can’t Wait
TM 105
American Red Cross
Emergency Response
Care for
Inhaled Poisons
 Conduct
scene size-up, toxic fumes may be
colorless, odorless and tasteless.
 Remove victim from source of poison if
possible
 Administer Oxygen
 Care for life-threatening conditions
 Call for advanced medical personnel
Pg 370-371
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When Help Can’t Wait
American Red Cross
Emergency Response
Care for
Absorbed Poisons
 Brush
off dry chemicals using gloved hand
or cloth. Keep out of eyes and eyes of
victim and bystanders
 Flush area with large amounts of cool
running water, remove jewelry if necessary
 Summon advanced medical personnel
Pg 372-374
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When Help Can’t Wait
American Red Cross
Emergency Response
Care for
Injected Poisons
 Remove
stinger, scrape it away with a card
or knife
 Wash the site, cover it and apply cold to
reduce the pain and swelling
 Monitor for anaphylaxis
 Specific care depends on source. Know the
local risks
Pg 374
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When Help Can’t Wait
American Red Cross
Emergency Response
Care for
Tick bites
 Rocky
Mountain spotted fever is a serious
tick-borne disease. Another is Lyme disease
 Deer ticks are difficult to see. They can
attach themselves without your knowledge
 If you find an embedded tick, pull it off
with a fine-tipped tweezers and seek
treatment
Pg 374-378
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When Help Can’t Wait
American Red Cross
Deer Tick
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When Help Can’t Wait
Emergency Response
American Red Cross
Emergency Response
Female deer tick with dime for
size comparison.
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When Help Can’t Wait
American Red Cross
Emergency Response
Care for
Spider and Scorpion bites
In the United States the two spiders to be careful
of are the Black Widow and the Brown Recluse
 Spiders prefer dark places where they are seldom
disturbed. Bites occur usually on the hands or
arms
 Antivenin is available for the black widow. Those
bit by the Brown Recluse should seek medical
treatment

Pg 378-380
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When Help Can’t Wait
American Red Cross
Black Widow
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When Help Can’t Wait
Emergency Response
American Red Cross
Emergency Response
Brown Recluse
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Emergency Response
Guidelines for
Initial Snakebite Care
Take victim to medical care immediately
 Wash wound if possible
 Immobilize affected part
 Minimize victim’s movement
 Keep affected part lower than heart
 Summon more advanced medical personnel
 Consider using a commercial suction kit if
advanced medical care is more than 30 minutes
away.

Pg 380-381
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TM 106
American Red Cross
Emergency Response
Guidelines for
Initial Snakebite Care
 DO
NOT apply ice
 DO NOT cut the wound
 DO NOT apply a tourniquet
 DO NOT use electric shock
Pg 380-381
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Emergency Response
Guidelines for
Marine Life Injuries




Some marine life such as jellyfish can inflict painful
injuries
Care for injuries from jellyfish, sea anemone and
Portuguese man-of-war by soaking the injured part in
vinegar.
If the sting was from a sting ray, sea urchin or spiny fish
soak the affected area for 30 minutes in non-scalding hot
water
Summon advanced medical personnel if the victim has a
history of allergic reactions to marine life stings, is stung
on the face or neck or develops any severe problems such
as difficulty breathing.
Pg 381
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Emergency Response
Guidelines for
Animal Bites






The most serious result is from a wild animal with rabies
Rabies is fatal if not treated. Anyone bitten must get
medical attention
Get the victim away from the animal safely
Get a description of the animal and the area in which it was
last seen. Do not try to restrain or capture the animal
For minor wounds, wash with soap and water. For serious
bleeding control the bleeding and summon more advanced
medical personnel
Local laws may require a report to be filed
Pg 382
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Emergency Response
Human Bites
 May
be highly contaminated with bacteria
 Require professional medical care
immediately
 Need to be washed with soap and water
 Can bleed if severe; control severe bleeding
Pg 383
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TM 107
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Emergency Response
Substance Abuse
 Can
be intentional or unintentional
 Drug use can lead to dependency and
addiction
 Unavailability can lead to withdrawal
 Drugs can be stimulants, Hallucinogens,
Depressants, Narcotics, Inhalants, Cannabis
products, steroids or OTC (Over The
Counter) medications
Pg 384-388
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TM 108
American Red Cross
Emergency Response
Stimulants
 Stimulants
affect the central nervous system
by increasing physical and mental activity
 They produce temporary feelings of
alertness and prevent fatigue
 Stimulants can be ingested as pills, but
some can be absorbed or inhaled
 Cocaine and Crack are the most publicized
and powerful stimulants
Pg 388
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Emergency Response
Hallucinogens
 Hallucinogens
have physical effects similar
to stimulants. They are classified
differently because of the other mindaltering effects including  Panic,
paranoid delusions, vivid hallucinations,
profound depression, tension and anxiety
 The
most widely used are LSD,
mushrooms, PCP and mescaline, ecstasy
ketamine
Pg 389
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Emergency Response
Depressants
Depressants decrease physical and mental activity
and are commonly used for medical purposes
 Common depressants are alcohol, barbiturates,
benzodiazepines, narcotics and inhalants
 Depressants will 
Relieve anxiety
 Alter consciousness
 Promote sleep
 Depress respiration
 Relieve pain
 Relax muscles
 Impair coordination and judgement

Pg 390
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Emergency Response
Narcotics
 Narcotics
work on the central nervous
system to reduce pain. All are illegal
without a prescription. Some are not
prescribed at all.
 The some are morphine, opium, heroin and
codeine. Others, like demerol and percodan
are synthetic
Pg 390
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Emergency Response
Inhalants
 Produce
mood-altering effects and depress
the central nervous system.
 Inhalants will damage the heart, lungs, brain
and liver
 Solvents such as acetone, toluene and
butane may be inhaled for their effects
 The user will appear drunk
Pg 391
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Emergency Response
Cannabis Products
 Products
include marijuana, THC and
hashish
 Marijuana is the most widely used illicit
drug in the United States
 Cannabis products produce feelings of
elation, distorted perceptions of time and
space and impaired judgement and motor
coordination
Pg 391
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Emergency Response
Designer Drugs
 Variations
of other substances, designer
drugs do not fit neatly into any of the other
categories
 A user will experience a variety of
unpredictable and dangerous effects. Signs
and symptoms range from stimulant-like
effects to hallucinogenic effects and erratic
mood swings
Pg 391
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Emergency Response
Signs and Symptoms
of Substance Abuse




Stimulants - Sweating, chills, nausea, vomiting, fever,
headache, dizziness, rapid pulse, rapid breathing, high
blood pressure, chest pain, respiratory distress, disruption
of normal heart rhythms
Hallucinogens - Sudden mood changes, claiming to see or
hear things not present, acting anxious or frightened
Depressants - Drowsiness, confusion, slurred speech, slow
heart and breathing rates, poor coordination
Alcohol - Unconscious, hard to arouse, vomiting violently,
confused, restless, trembling and experiencing
hallucinations.
Pg 394
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Emergency Response
Care for Substance
Misuse and Abuse
 Your
initial care does not require you to
know the substance
 Care as you would for poisoning.
Pg 396
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TM 109
American Red Cross
Emergency Response
Preventing Substance Abuse
Contributing factors include –
 A lack of parental supervision
 The breakdown of the traditional family structure
 A wish to escape unpleasant surroundings and stressful
situations
 The widespread availability of substances
 Peer pressure and the basic need to belong
 Low self-esteem, including feelings of guilt or shame
 Media glamorization, especially of alcohol and tobacco,
promoting the idea that using substances enhances fun and
popularity
 A history of substance abuse in the home or community
environments
Pg 396
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Emergency Response
Preventing Substance Misuse
Read the product information and use only as
directed
 Ask doctor or pharmacist about the intended use
and side effects of prescription and over-thecounter medications. If taking more than one
medication ask about possible interactions.
 Never use another person’s prescribed medications
 Always keep medications in their appropriate,
marked containers
 Discard all out-of-date medications.
 Keep medications out of reach of children

Pg 397
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Emergency Response
Scenario 12
Substance Abuse
A 25-year-old woman has several drinks at a party. She
later says that she feels dizzy and nauseated. She goes into
another room. Soon after, someone enters shouting that
the woman has collapsed to the floor and is unconscious.
Among the object scattered on the floor from her open
purse are several containers of pills. One is marked
“Valium.” How would you help the woman? In terms of
providing initial care, does it matter that she may have
become unconscious because of substance abuse or
misuse?
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TM 110
American Red Cross
Emergency Response
Signs and Symptoms
of Anaphylaxis
 Hives
 Itching
 Rash
 Weakness
 Nausea/vomiting
 Dizziness
 Trouble
breathing
Pg 383-384
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TM 111
American Red Cross
Emergency Response
Care for Anaphylaxis
 Summon
more advanced medical personnel
immediately
 Position victim in the most comfortable
position that aids breathing
 Administer supplemental oxygen
 Have victim use anaphylaxis kit if one is
available
Pg 384
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TM 112
American Red Cross
Emergency Response
As you approach a scene ...
… have a plan in mind.
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When Help Can’t Wait
CT 17
American Red Cross
Emergency Response
Scenario 13
Conscious Person
Serious Head and Back Injury
At work, you are summoned to assist another employee
who has been injured in a nine-foot fall from a ladder. As
you arrive, you see the person lying on the ground. She is
trembling and moaning in pain. A bystander says that she
landed on her back. The victim has not moved from this
position. She says that she has tingling and numbness in
her lower legs and feet and pain in her back. She also has
a two-inch laceration on the side of her head. How do you
respond?
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TM 113
American Red Cross
Emergency Response
Scenario 14
Serious Extremity Injury
You are summoned to the scene of a collision between a
bicyclist and skateboarder. Both were thrown to the
pavement. Both were wearing helmets and other
protective padding and both are conscious and in pain.
The skateboarder was struck on the outside of his leg by
the bike. The leg is bent, and his knee has an obvious
deformity. The bicyclist was thrown over the handle bars,
landing on her arms. She is bleeding from abrasions on
both forearms and her wrist has an obvious deformity.
How do you respond?
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TM 114
American Red Cross
Emergency Response
Scenario 15
Conscious Victim
Limb Injury
You are a spectator at your child’s Little League baseball
game. The pitcher is struck with a line drive to the
forearm and falls to the ground. The victim is crying and
in pain, unable to move the limb. Swelling and deformity
are present. The nearest hospital is only a few blocks
away. The player’s parents are not at the game. How do
you respond?
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TM 115
American Red Cross
Emergency Response
Scenario 16
Medical Emergency
An elderly woman loses her balance and collapses to the
floor in a supermarket. When you arrive, she is not fully
conscious. Her eyes are open and the left side of her face
appears to be drooping. She is making mumbling sounds
but you can not tell what she is saying. She has also
vomited. How do you respond?
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TM 116
American Red Cross
Emergency Response
Scenario 17
Substance Abuse
A dangerous ritual is about to begin - 21 drinks for the 21st
birthday. A group of close friends has gathered for a special party
for the “birthday boy.” Everyone knows it is a dangerous game,
but because each of these friends when through it, they believe it
is a rite of passage into adulthood. The activities begin and the
guest of honor is soon “chugging beers” and downing shots of
liquor at a rapid pace. Four hours after the drinking began you
are summoned to assist the guest of honor who is vomiting
violently in the bathroom. He slumps to the floor and begins
violent convulsions, followed by unconsciousness. He seems to
stop breathing and then takes a deep breath. How do you
respond?
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TM 117
American Red Cross
Emergency Response
Scenario 18
Hypothermia
You have been involved in a search for a lost sixyear-old child. The search is now into its third
day. The child became lost when he wandered
away from his mountain campsite. He has already
spent two nights in the wilderness in cold, rainy
weather. When the child is discovered, he is
disoriented. His clothing is wet. His face and
hands are cold to the touch. He is shivering. How
do you respond?
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TM 118
American Red Cross
Emergency Response
Chapter 17
Childbirth
 The
Birth Process
 Preparing for Delivery
 Assisting with Delivery
 Caring for the Newborn and Mother
 Possible Complications
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Emergency Response
The Labor Process
Stage One Preparation
Stage Two Delivery of
the Baby
Stage Three Delivery of
the Placenta
Stage Four Stabilization
Woman’s body prepares for childbirth
Time period: From first contraction until
uterus is fully dilated
Crowning occurs
Delivery of the baby
Occurs within 30 minutes after birth
Placenta separates from the uterine wall
and exits through the vagina
Recovery and stabilization of mother
Lasts approximately 1 hour
Uterus contracts to control bleeding
Pg 403-404
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TM 119
American Red Cross
Emergency Response
Assessing Labor
 First
pregnancy?
 Amniotic sac ruptured?
 Contraction?
 Are
they close together?
 Are they strong?
 Blood
discharge?
 Urge to bear down?
Pg 404
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When Help Can’t Wait
TM 120
American Red Cross
Emergency Response
Preparing for Delivery
 Use
complete BSI protection
 Provide as sanitary an environment as
possible
 Reassure the mother
 STAY CALM
Pg 404
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Assisting with Delivery
 Time
the contractions. If less than 3
minutes apart, be prepared to help with
delivery of the baby
 Have bulb syringe, gauze pads and plastic
bag available
 Support the head, allow to emerge slowly
 Use a towel to catch the baby. If possible
note the time
Pg 405
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Emergency Response
Assisting with Delivery
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Emergency Response
Assisting with Delivery
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Emergency Response
Caring for the Newborn
Open the airway
 Stimulate the baby if crying does not occur
 Keep infant warm
 Record first set of vital signs
 Evaluate the following a 1 and 5 minutes after
birth 
Appearance
 Pulse
 Grimace (response to stimuli)
 Activity and muscle tone (not floppy or limp)
 Respirations

Pg 407-409
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Emergency Response
Assess APGAR Score at 1 and 5
minutes after birth
A ppearance
P ulse
G rimace
A ctivity
R espiration
0
Blue/Pale
Absent
None
Flaccid
Absent
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1
Body pink, hands blue
Below 100
Grimace
Some
Weak, slow
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2
Pink
Above 100
Cough, sneeze, cry
Active motion
Good, crying
American Red Cross
Emergency Response
Caring for the Mother
 Allow
mother to nurse newborn
 Prepare for delivery of the placenta within
30 minutes. Place in a bag or wrap in a
towel for transport to the hospital
 Gently clean the mother
 Gently massage the lower abdomen
 Monitor vital signs and maintain body
temperature
Pg 407-409
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Emergency Response
Scenario 19
Childbirth
A car pulls into the firehouse. The driver jumps
out screaming for help for his wife who is in the
back seat. The woman is 35 years old and full
term in her pregnancy. Her contractions are less
than 2 minutes apart. She says that “the baby is
coming” and she feels the need to push. Her
husband tells you this will be their fourth child.
How do you respond?
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When Help Can’t Wait
TM 121
American Red Cross
Emergency Response
Practice Session
 Childbirth
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Emergency Response
Possible complications
 Prolapsed
 Do
cord
not allow cord to wrap around infants neck
Pg 410
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Emergency Response
American Red Cross
Emergency Response
Possible complications
 Breech
 Be
birth
prepared to provide airway
Pg 411
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Emergency Response
If baby is delivering:
– Do not hurry or slow delivery
– Suction infant with bulb syringe (mouth,
then nose) as soon as head is delivered
– If cord wrapped around neck, attempt to
unwrap the cord. If unsuccessful, double
clamp and cut the cord at least 4” from baby
between clamps
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Chapter 18
Infants and Children
 Communicating
with children
 Anatomical and Physiological concerns
 Common problems
 Child abuse awareness
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Emergency Response
Steps to Gain a Child’s Trust
 Approach
child slowly
 Get to eye level
 Smile
 Ask the child’s name
 Talk slowly and distinctly using words the
child understands
 Ask simple, clear questions
 Reassure child
Pg 414
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When Help Can’t Wait
TM 122
American Red Cross
Emergency Response
Steps to Gain a Child’s Trust






Infants less than 6 months old are fairly easy to approach
Infants over 6 months show “stranger anxiety”. Conduct
the assessment in the caregivers arms or lap
Toddlers between 1-2 need reassurance that they will not
be separated from a parent or caregiver
Preschool between 3-5 need assurance that the first
responder will not leave them. Let them inspect equipment
and demonstrate on a doll or stuffed animal
School-aged children are self-conscious about their bodies.
Respect their modesty
Adolescents between 13-18 behave much like adults and
are more comfortable with same gender rescuers. Earn
their trust by speaking to them and not the parents or
caregivers
Pg 414
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Emergency Response
Anatomical and Physiological
Concerns
Infant and children have smaller airways than
adults. Airways are easily blocked by secretions
and swelling.
 Infant’s and children’s tongues are large in relation
to the jaw and can block the airway
 Infants normally breathe through the nose so
suctioning nasal secretions can improve problems
 Injured or ill infants or children are at risk for
generalized cold exposure

Pg 415-417
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Emergency Response
Maintaining an
Airway with Children
Do not hyper-extend the head and neck to open the
airway
 Placing a folded towel under the shoulders will
help to maintain good airway position
 During suctioning, take care not to stimulate the
back of the throat and activate the gag reflex
 Oral airway adjuncts are not used for initial
ventilation efforts. Nasal airways are not
commonly used by first responders

Pg 416
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American Red Cross
Emergency Response
Maintaining an
Airway with Children
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Emergency Response
Child and Infant Assessment
 When
you have an injured child or infant,
you have an injured family
 Calm the family and obtain consent
 Observe the child before touching. Look
for signs of life-threatening problems
 Whenever possible, do not separate the
child from the parent or caregiver
 Begin at the toes and work up
Pg 417-418
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Emergency Response
Signs of Partial Airway Obstruction
in Infants or Children
 Stridor
 Retraction
on breathing in
 Good circulation causing skin to become
very pink
Pg 418
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When Help Can’t Wait
TM 123
American Red Cross
Emergency Response
Signs of Complete Airway
Obstruction in Infants or Children
 Inability
to cough, cry or speak
 Cyanosis
 Loss of consciousness
 Altered mental status
Pg 419
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Emergency Response
Signs of Respiratory Distress in
Infants or Children
Infants: respiratory rate > 60 per minute
 Children: respiratory rate > 30/40 per minute
 Nasal flaring
 Use of neck muscles and muscles between and
below margin of the ribs to aid breathing
 Stridor
 Cyanosis
 Altered mental status
 Grunting

Pg 419
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When Help Can’t Wait
TM 124
American Red Cross
Emergency Response
Signs of Respiratory Arrest in
Infants or Children
Infants: respiratory rate <10 per minute
 Children: respiratory rate <20 per minute
 Limp muscle tone
 Unresponsiveness
 Slow or absent heart beat
 Weak or absent distal pulses
 Cyanosis

Pg 419
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Emergency Response
Other Common Problems with
Infants and Children

Circulatory Failure





Illness
Fever - may develop into febrile seizure
Poisoning
Altered Mental Status


Indicated by increased heart rate, unequal central and distal pulses,
poor skin circulation (slow capillary refill) and mental status
change
May be caused by low blood sugar, poisoning, post seizure,
infection, head trauma or decreased oxygen levels
Sudden Infant Death Syndrome (SIDS)
Pg 419
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Emergency Response
Signs and Symptoms
of Febrile Seizure
Sudden rise in body temperature
 Change in level of consciousness
 Rhythmic jerking of head and limbs
 Confusion
 Drowsiness
 Crying out
 Becoming rigid
 Holding breath
 Upward rolling of eyes

Pg 419
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When Help Can’t Wait
TM 125
American Red Cross
Emergency Response
Trauma in Children
 Injuries
are the #1 cause of child death in
the United States. Many are from motor
vehicle accidents
 Use equipment of the proper size
 Do not move an injured child from a safety
seat unless you must to provide further care
Pg 420-422
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Emergency Response
Trauma in Children
 The
head is often injured, as is the chest
cavity or abdominal cavity
 The most important objective is to ensure an
open airway
 Children have pliable ribs. There may be
significant injuries without external signs
 Abdominal injuries often are not obvious
Large amounts of blood may distend the
abdomen and not be visible
Pg 420-422
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Emergency Response
Signs of Child Abuse
Injury that does not fit description of cause
 Cigarette burns, whip marks or hand prints
 Fractures in children less than 2 years old
 Injuries in various stages of healing, especially
bruises and burns
 Unexplained lacerations, especially to mouth, lips
and eyes
 Injuries to genitalia
 More injuries than are typical for child of same
age
 Repeated calls to same address

Pg 422-423
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When Help Can’t Wait
TM 126
American Red Cross
Emergency Response
Signs and Symptoms of Neglect
 Lack
of adult supervision
 Malnourished appearance
 Unsafe living conditions
 Untreated chronic illness
 Untreated soft tissue injuries
Pg 423
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When Help Can’t Wait
TM 127
American Red Cross
Emergency Response
Responder Debriefing
 Even
when uneventful, calls involving
infants and children are some of the more
stress producing situations for first
responders
 Care for infants and children with the same
principles as with adults but keep in mind
the differences in developmental
characteristics and anatomy
Pg 423
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When Help Can’t Wait
American Red Cross
Emergency Response
As you approach a scene ...
… have a plan in mind.
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When Help Can’t Wait
CT 17
American Red Cross
Emergency Response
Scenario 20
Preparing for Childbirth
You are called to respond to a pregnant
woman who is in labor. During your
assessment you find that this is the mother’s
third pregnancy and her contractions are 2
minutes apart. The baby’s head is not yet
crowning, but the mother feels the urge to
move her bowels. How do you respond?
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When Help Can’t Wait
TM 128
American Red Cross
Emergency Response
Scenario 21
Delivering the Baby
After you have prepared the mother and
yourself for the imminent delivery of the
baby, the mother tells you that she feels an
urge to push. When you inspect the vaginal
area, you note that the baby’s head is
crowning. What should you do next?
Copyright © 2000 by the American National Red Cross
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When Help Can’t Wait
TM 129
American Red Cross
Emergency Response
Scenario 22
Care of the Newborn
You are called to the scene of a mother who
is in active labor. As you arrive on scene,
the baby has just emerged from the birth
canal. What steps would you take to care
for the newborn?
Copyright © 2000 by the American National Red Cross
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When Help Can’t Wait
TM 130
American Red Cross
Emergency Response
Scenario 23
Post Delivery Care of the Mother
After you have assisted with the
unscheduled delivery of a newborn and
ensured that the baby’s condition is normal,
list the steps in the post delivery care of the
mother
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When Help Can’t Wait
TM 131
American Red Cross
Emergency Response
Scenario 24
Assessment of the Child
On your way home from work, you approach your
neighborhood and see a group of people gathered
in the playground. As you approach the scene you
hear someone say that a child fell off the jungle
gym, a height of approximately 10 feet. As you
get closer, you see a child of 8 years old lying on
the ground, crying and you notice blood coming
from a laceration on his forehead. Demonstrate
how to assess the child.
Copyright © 2000 by the American National Red Cross
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When Help Can’t Wait
TM 132
American Red Cross
Emergency Response
Chapter 19
EMS Support and Operations
 Phases
of a Response
 Air-Medical Considerations
 Multiple Casualty Incidents
 Incident
Command Structure
 Triage
 Fundamentals
of Rescue Operations
 Hazardous Materials
 Water Rescues
Copyright © 2000 by the American National Red Cross
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When Help Can’t Wait
American Red Cross
Emergency Response
The EMS Response
Preparation for emergency call
 Dispatch
 En route to scene
 Arrival at scene
 Transferring victim to ambulance
 En route to receiving facility
 Arrival at receiving facility
 En route to station
 Post run

Pg 428-431
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When Help Can’t Wait
TM 133
American Red Cross
Emergency Response
Air Medical Considerations
 First
responders may have to assist with air
medical transport
 Considerations
 Victim
preparation
 Landing zone
 Safety
Pg 431
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When Help Can’t Wait
TM 134
American Red Cross
Emergency Response
Multiple Casualty Incidents
 Some
emergency situations may overwhelm
local responding groups
 The Incident Command System approaches
an emergency in an organized manner
 Triage is the process of sorting victims
according to how ill or injured they are
 The START system is an often used triage
method. The letters stand for Simple
Triage And Rapid Treatment
Pg 431-433
Copyright © 2000 by the American National Red Cross
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When Help Can’t Wait
American Red Cross
S.T.A.R.T.
 Simple
 Triage
 And
 Rapid
 Treatment
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When Help Can’t Wait
Emergency Response
American Red Cross
Emergency Response
Incident Command System (ICS)
 The
ICS manages a group of people to
achieve a common goal
 ICS clearly defines who is in charge, the
scope of authority and responsibility, the
goal and objectives to meet the goal
Pg 433
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When Help Can’t Wait
American Red Cross
Emergency Response
Advantages of ICS
 Use
of common terms
 One big “boss” – Incident Commander
 Unified command structure
 Integrated communications system
 Small, easily managed units
Pg 433
Copyright © 2000 by the American National Red Cross
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When Help Can’t Wait
TM 135
American Red Cross
Emergency Response
ICS
 Incident

Commander -
Directs the response
Appoints chiefs
Operations Section Officer 




Planning Section Officer 


Puts together plan
Coordinates actions of other leaders
Gather/analyzes information/resources
Provides updates
Logistics Section Officer 



Finds resources
Establishes communications
Coordinates crowd control
Evaluates scene if necessary
Pg 434-435
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When Help Can’t Wait
TM 136
American Red Cross
Emergency Response
The START System
 Injured
are rapidly prioritized to receive
adequate care
 Save more lives by sacrificing some victims
who are very severely injured
 Classify victims as Immediate treatment - Red Tag
Delay Care - Yellow Tag
Minor - Green Tag
Dead or non-salvageable - Black Tag
Pg 436
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When Help Can’t Wait
American Red Cross
Emergency Response
The START System
Pg 437
Copyright © 2000 by the American National Red Cross
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When Help Can’t Wait
CT 58
American Red Cross
Emergency Response
Fundamentals of Extrication
 First
responders administer necessary care
to minimize further injury
 Care
precedes extrication unless
delayed movement would endanger the
victim or rescuer
 Personal safety is the #1 priority. Wear
appropriate clothing and safety
equipment.
Pg 438-439
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When Help Can’t Wait
American Red Cross
Emergency Response
Gaining Access to Victim
Simple Access
 No equipment needed
 Try to open each door
 Have victim roll down the windows
 Have victim unlock doors
Complex Access
 Use of tools and equipment
Pg 440
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When Help Can’t Wait
TM 137
American Red Cross
Emergency Response
Hazardous Materials
 A HAZMAT
is any material that can pose a
threat to the health, safety and property
 Dealing with HAZMAT requires special
training
 Primary concern is the safety of the crew,
victim(s) and bystanders
 Safely obtain as much information as
possible
Pg 445
Copyright © 2000 by the American National Red Cross
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When Help Can’t Wait
American Red Cross
Emergency Response
General Procedures for
HAZMAT Situations
 Stay
upwind and uphill from incident
 Be alert to wind changes
 Stay away from area
 Keep people away from the danger zone
 Look for clues indicating hazardous
materials
 Never enter a HAZMAT area unless you are
trained
Pg 446
Copyright © 2000 by the American National Red Cross
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When Help Can’t Wait
TM 138
American Red Cross
Emergency Response
Scenario 25
Gaining Access
You arrive on the scene of an automobile collision
involving one vehicle that has struck a guard rail
head-on. The car is still running. The driver did not
have on a safety belt and struck the steering column.
He is seated behind the steering wheel, conscious
and complaining of chest and abdominal pain. The
other passenger also was not wearing a safety belt.
She is lying motionless, facedown on the floor of the
vehicle. You see blood around her body. She is
unconscious and not breathing. You are unsure if
she has a pulse.
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When Help Can’t Wait
TM 139
American Red Cross
Emergency Response
Water Rescues
 Throw,
row ... then go
 Do not endanger yourself, do not attempt
in-water rescue unless trained
 Distressed swimmer may be too tired to get
to shore but can float and call for help
 Active drowning victim may thrash to get
out of the water but can’t call for help
 If water has entered lungs, near-drowning
victims must go to hospital
Pg 448-451
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When Help Can’t Wait
American Red Cross
Emergency Response
Throwing Assists
 Keep
your balance
 Secure any line attached to device to be
thrown
 Throw device beyond victim
 Consider wind and current
 Once victim grasps device, pull him or her
slowly to safety
Pg 451
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When Help Can’t Wait
TM 140
American Red Cross
Emergency Response
As you approach a scene ...
… have a plan in mind.
Copyright © 2000 by the American National Red Cross
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When Help Can’t Wait
CT 17
American Red Cross
Emergency Response
Video
Putting it all Together
Copyright © 2000 by the American National Red Cross
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When Help Can’t Wait
American Red Cross
Emergency Response
Scenario 26
Extrication
You arrive at a scene in which a car has plunged
down an embankment, landing on one side at the
bottom. You can see at least two people in the car,
one of whom appears to be conscious. Several
bystanders have just arrived and are staring at the
car. The doors appear to be undamaged, but you
are unable to open them. How should you
respond?
Copyright © 2000 by the American National Red Cross
All rights reserved
When Help Can’t Wait
TM 141
American Red Cross
Emergency Response
Scenario 27
Multiple Casualty Incident
A small commuter airplane carrying eight people
and crew has made a crash landing in a cornfield.
Witnesses say the plane managed to land without
burning, with no smoke visible. When you reach
the scene, fire fighters and other rescue personnel
have already arrived. The plane is severely
damaged but is not of fire. There appear to be
survivors. What should you do?
Copyright © 2000 by the American National Red Cross
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When Help Can’t Wait
TM 142
American Red Cross
Scenario 28
Emergency Response
Multiple Casualty Incident - Triage
You are at the scene of a train derailment. Two cars have
been severely damaged and you are helping with the
victims. The incident commander has assigned you four
victims to triage as rapidly as possible, using the START
system. One of the victims is standing, leaning against a
tree. He says he can walk. Another victim is lying on the
ground moaning. You can see blood around her body.
The third victim is lying on the ground motionless, making
no sound. When you check for his pulse, you cannot find
it. The fourth victim is also lying on the ground
unconscious, but she has a pulse. When you open her
airway, she begins to breathe. How would you proceed?
Copyright © 2000 by the American National Red Cross
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When Help Can’t Wait
TM 143