ProTrainings Instructor Manual

Follows 2010 ECC/ILCOR Guidelines Copyright 2013 Update 4/1/2013 ProTrainings Instructor Certification Facts ............................... 1 Course Description, Purpose, and Design ........................................ 1 Course Delivery Options ................................................................... 2 Instructor Course Content ................................................................. 3 ProTrainings Skill Evaluator Certification Facts ..................... 4 Course Description, Purpose, and Design ....................................... 4 Blended Courses ............................................................................. 5 Course Content Chart ......................................................................... 6 Instructor/Skill Evaluator Training Checklist ............................ 8 Instructor/Skill Evaluator-Objectives, Needs, Philosophy 10 How to Conduct Skill Practice and Evaluation ....................... 11 Common Errors and Corrections ..............................................12-13 Instructor Activities Introduction ................................................. 14 ProCPR Instructor Course Activities .......................................... 15 Course Introduction ....................................................................... 16 Five Fears .................................................................................16-17 Basic Physiology and CPR Philosophy.......................................... 17 The ProCPR Method ..................................................................... 18 Cardiovascular Disease and Heart Attacks ..............................18-19 Stroke ............................................................................................ 19 Bloodborne Pathogens and Reducing Risk ................................... 20 The Chain of Survival ...............................................................20-21 Rescue Breathing– Adult, Child & Infant...................................21-22 Rescue Breathing Skill Session ......................................22-23 One Rescuer CPR- Adult, Child & Infant ....................................... 24 One Rescuer CPR Skill Session .....................................24-25 AED– Adult, Child & Infant ........................................................26-27 AED Skill Session ................................................................. 27 Conscious Choking- Adult, Child & Infant ...................................... 28 Conscious Choking Skill Session .......................................... 28 Unconscious Choking- Adult, Child & Infant .................................. 29 Unconscious Choking Skill Session .................................29-30 2 Rescuer CPR– Adult, Child & Infant ........................................... 31 Bag Valve Mask ........................................................................31-32 2 Rescuer CPR Skill Session ................................................ 32 Bleeding Control ............................................................................ 33 Shock............................................................................................. 33 Perform Ongoing Assessment ..................................................33-34 Special Considerations– Spinal Injury and Jaw Thrust .................. 34 Written Test ................................................................................... 35 After Course Responsibilities ......................................................... 35 ProFirstAid Instructor Course Activities................................... 36 Course Introduction ....................................................................... 37 Five Fears .................................................................................37-38 Basic Physiology and CPR Philosophy.......................................... 38 The ProCPR Method ..................................................................... 39 Cardiovascular Disease and Heart Attacks ..............................39-40 Stroke ............................................................................................ 40 Bloodborne Pathogens and Reducing Risk ................................... 41 The Chain of Survival ...............................................................41-42 CPR- Adult, Child & Infant ............................................................. 43 CPR Skill Session ...........................................................33-44 AED– Adult, Child & Infant ........................................................45-46 AED Skill Session ................................................................. 46 Conscious Choking- Adult, Child & Infant ...................................... 47 Conscious Choking Skill Session .......................................... 47 Unconscious Choking- Adult, Child & Infant .................................. 48 Unconscious Choking Skill Session .................................48-49 Bleeding Control ........................................................................... 50 Bleeding Control Skill Session .............................................. 51 Shock............................................................................................. 52 Perform Ongoing Assessments ................................................52-53 First Aid: Perform Ongoing Assessments ........................................... 52 Head to Toe Exam............................................................... 53 Suspected Spinal Injuries .................................................... 54 Muscle and Bone Injuries .................................................... 54 Burns ................................................................................... 55 Eyes ............................................................................... 55-56 Heat and Cold Emergencies ........................................... 56-57 Allergic Reactions and Snake Bites ................................ 57-58 Poisoning ........................................................................ 58-59 Chest and Head Injuries ...................................................... 59 Abdominal Injuries ............................................................... 59 Diabetic Emergencies.......................................................... 60 Seizures .............................................................................. 60 Moving Patients ................................................................... 61 Written Test ................................................................................... 61 After Course Responsibilities ........................................................ 61 ProFirstAid Basic Instructor Course Activities ..................... 64 Course Introduction ....................................................................... 65 Five Fears ................................................................................ 65-66 Basic Physiology and CPR Philosophy ......................................... 66 The ProCPR Method ..................................................................... 67 Cardiovascular Disease and Heart Attacks .............................. 67-68 Stroke ............................................................................................ 68 Bloodborne Pathogens and Reducing Risk ................................... 69 The Chain of Survival ............................................................... 69-70 Adult CPR...................................................................................... 71 Adult CPR Skill Session ................................................. 71-72 AED– Adult ............................................................................... 73-74 AED Skill Session ................................................................. 74 Conscious Choking ....................................................................... 75 Conscious Choking Skill Session .......................................... 75 Unconscious Choking .................................................................... 76 Unconscious Choking Skill Session ................................. 76-77 Bleeding Control ........................................................................... 78 Bleeding Control Skill Session .............................................. 79 Shock ............................................................................................ 80 First Aid: Perform Ongoing Assessments ...................................... 80-81 Head to Toe Exam............................................................... 81 Suspected Spinal Injuries .................................................... 82 Muscle and Bone Injuries .................................................... 82 Burns ................................................................................... 83 Eyes ............................................................................... 83-84 Heat and Cold Emergencies ........................................... 84-85 Allergic Reactions and Snake Bites ................................ 85-86 Poisoning ........................................................................ 86-87 Chest and Head Injuries ...................................................... 87 Abdominal Injuries ............................................................... 87 Diabetic Emergencies.......................................................... 88 Seizures .............................................................................. 88 Moving Patients ................................................................... 89 Written Test ................................................................................... 89 After Course Responsibilities ........................................................ 89 ProCPR Basic Instructor Course Activities ............................. 91 Course Introduction ....................................................................... 92 Five Fears ................................................................................ 92-93 Basic Physiology and CPR Philosophy ......................................... 93 The ProCPR Method ..................................................................... 94 Cardiovascular Disease and Heart Attacks .............................. 94-95 Stroke ............................................................................................ 95 Bloodborne Pathogens and Reducing Risk ................................... 96 The Chain of Survival ............................................................... 96-97 Adult CPR...................................................................................... 98 Adult CPR Skill Session ................................................. 98-99 AED– Adult ............................................................................ 100-101 AED Skill Session ............................................................... 101 Conscious Choking ..................................................................... 102 Conscious Choking Skill Session ........................................ 102 Unconscious Choking ................................................................. 103 Unconscious Choking Skill Session............................. 103-104 Bleeding Control ......................................................................... 105 Shock .......................................................................................... 106 Perform Ongoing Assessments ........................................... 106-107 Moving Patients........................................................................... 107 Written Test ................................................................................. 107 After Course Responsibilities ...................................................... 107 ProFirstAid Advanced Instructor Course Activities .......... 109 Course Introduction ..................................................................... 110 Written Test ................................................................................. 110 After Course Responsibilities ...................................................... 110 Appendices: Appendix A– Skill Evaluation Checklists and Skill Sheets ......................... 112 ProCPR Skill Evaluation Checklist .............................................. 114 ProCPR Skill Sheets ............................................................ 116-131 ProFirstAid Skill Evaluation Checklist .......................................... 134 ProFirstAid Skill Sheets........................................................ 136-146 ProFirstAid Basic Skill Evaluation Checklist ................................ 148 ProFirstAid Basic Skill Sheets .............................................. 150-155 ProCPR Basic Skill Evaluation Checklist .................................... 156 ProCPR Basic Skill Sheets .................................................. 158-162 ProFirstAid Advanced Skill Evaluation Checklist ......................... 164 ProFirstAid Advanced Skill Sheets .............................................. 166 Appendix B– Blended Course Information and Skill Evaluator Facts ........ 168 Blended Course Information ....................................................... 170 Skill Evaluator/Instructor Application .................................... 172-173 Skill Evaluator Training Facts ...................................................... 174 Appendix C– Quality Assurance ................................................................ 177 Course Evaluation ....................................................................... 178 Appendix D– Written Tests ........................................................................ 181 ProCPR Test Answer Key ........................................................... 183 ProCPR Test Answer Sheets ...................................................... 185 ProCPR Written Test............................................................ 187-190 ProFirstAid Test Answer Key ...................................................... 192 ProFirstAid Test Answer Sheets ................................................. 193 ProFirstAid Written Test ....................................................... 195-200 ProFirstAid Basic Test Answer Key............................................. 202 ProFirstAid Basic Test Answer Sheets........................................ 205 ProFirstAid Basic Written Test ............................................. 207-211 ProCPR Basic Test Answer Key ................................................. 213 ProCPR Basic Test Answer Sheets ............................................ 215 ProCPR Basic Written Test .................................................. 217-219 ProFirstAid Advanced Test Answer Key ..................................... 221 ProFirstAid Advanced Test Answer Sheets ............................... 223 ProFirstAid Advanced Written Test ...................................... 225-231 Appendix E- Sample Certification Cards ............................................ 233-234 Appendix F– Manikin Decontamination & Participant Safety ..................... 235 Appendix G– ProBloodborne Course ........................................................ 237 ProTrainings Instructor Certification Facts Description: The ProTrainings, LLC Instructor trainings are designed to prepare individuals to teach CPR, FirstAid, and Bloodborne Pathogens courses. Instructors will have several options available to provide certification to students: traditional classroom, blended classroom, online blended, and reselling of 100%online programs. Purpose: ProTrainings, LLC Instructor certification is designed to provide individuals with the skills, tools, and knowledge to successfully teach students CPR, First Aid, and Bloodborne Pathogens. Upon successful completion, Instructors can issue student certificates according to their level of training. Course Design: Prerequisite:  Must have a current ProTrainings, LLC student/provider level certificate or equivalent that is equal to the skill level of desired instructor certificate. Instructor Training: Complete course content is available at www.proinstructortraining.com  Total time: 8-16 hours  Instructor Training- Includes a blended combination of online training, live skills demonstration, practice teaching and skill assessment. The time for the online portion is dependent on the level of certification desired and individual student needs. Instructor Bridge for Current Certified Instructors:  Current certified Instructors with a recognized organization must complete the ProTrainings online instructor training for the equivalent instructor level of certification, and submit a current recognized equivalent CPR/FirstAid instructor certification to be bridged as a ProTrainings, LLC Instructor. Certificate Awarded: There are four levels of ProTrainings, LLC certified Instructors:  ProCPR Instructor–Can issue certificates for ProCPR, ProFirstAid Advanced, ProFirstAid, ProFirstAid Basic, ProCPR Basic, and ProBloodborne  ProFirstAid Instructor-Can issue certificates for ProFirstAid, ProFirstAid Basic, ProCPR Basic, and ProBloodborne  ProFirstAid Basic Instructor– Can issue certificates for ProFirstAid Basic, ProCPR Basic, and ProBloodborne  ProBloodborne Instructor– Can issue certificates for ProBloodborne Each instructor certificate is valid for 2 years. Instructors must complete a minimum of 2 classes or skill evaluations before expiration date and complete all updates as required 1 in order to renew the certification. Also one can submit a current equivalent instructor certification from another recognized organization for Instructor certificate renewal. ProTrainings Instructor Course Delivery Options Blended Course (Active for a 2 year period): An individual completes cognitive training and testing online by watching video segments, completing activities, and passing a written test. A hands-on skills session for skills practice and evaluation by a registered ProTrainings, LLC Instructor or Skill Evaluator is required to complete the certification process. Classroom (Active for a 2 year period): . The class is led by a registered ProTrainings, LLC Instructor. The instructor uses the video segments for the course to conduct the training. The instructor is then responsible to lead the students in skills practice, provide a skills evaluation and administer a written test. Online Cognitive Recertification (Active for a 2 year period): An individual who holds a certificate from a recognized organization, expired by no more than 6 months, can complete cognitive recertification online. The online certification is for awarenesslevel cognitive training. Individuals must check with their administration or licensing body to determine if the online awareness level certification will meet their licensure or organizational requirements. Certification Format Training URL Accredited 2 Year Certification Blended ProCPR: Healthcare Provider Adult/Child/& Infant CPR/AED 2 year certification Classroom Cognitive Only 100% Online Online Training Online training, testing, & & required hands-on Training, testing, and skill evaluation in classroom Testing skill evaluation Length: 5 Hours www.procpr.org Skill Eval Length: 45 min ProFirstAid Advanced Online training, testing, Healthcare Provider Adult/Child/ & required hands-on Training, testing, and skill Online Training evaluation in classroom & & Infant CPR/AED & First Aid skill evaluation Skill Eval Length: 45 min Length: 8 Hours Testing 2 year certification www.advanced.profirstaid.com ProFirstAid: Adult/Child/ & Infant CPR/AED & First Aid 2 year certification Online training, testing, Online Training & required hands-on Training, testing, and skill & skill evaluation evaluation in classroom Testing Skill Eval Length: 30 min Length: 6 Hours www.profirstaid.com ProFirstAid Basic: Adult CPR/AED & First Aid 2 year certification Online training, testing, Online Training & required hands-on Training, testing, and skill & skill evaluation evaluation in classroom Testing Length: 4 Hours www.basic.profirstaid.com Skill Eval Length: 20 min ProCPR Basic: Adult CPR/AED 2 year certification Online training, testing, & required hands-on Training, testing, and skill Online Training & evaluation in classroom skill evaluation Testing www.adult.procpr.org Length: 2 Hours Skill Eval Length: 15 min ProBloodborne: OSHA 29 CFR 1910.1030 & Infection Control 1 year certification 2 Training and testing in classroom Length: 2 Hours Online Training & Testing www.probloodborne.com Instructor Course Content: ProCPR Instructor Certification: Healthcare provider adult, child, infant CPR/AED and First Aid Skills and knowledge include:  Rescue breathing for all ages  Conscious choking for all ages  Unconscious choking for all ages  CPR for one and two rescuers for all ages  AED for all ages  Mouth to mask and a bag-valve mask usage  Heart attack and stroke  Bloodborne Pathogens  Bleeding Control  Musculoskeletal Injuries  Poisoning           Shock Management Breathing Emergencies Diabetic Emergencies Burns Bites and Stings Allergic Reactions Seizures Heat and Cold Emergencies Evaluating students Classroom management ProFirstAid Instructor Certification: Layrescuer adult, child, infant CPR/AED and First Aid Skills and knowledge include:  Conscious choking for all ages  Unconscious choking for all ages  CPR for one rescuer for all ages  AED for all ages  Mouth to mask usage  Heart attack and stroke  Bloodborne Pathogens  Bleeding Control  Musculoskeletal Injuries  Poisoning           Shock Management Breathing Emergencies Diabetic Emergencies Burns Bites and Stings Allergic Reactions Seizures Heat and Cold Emergencies Evaluating students Classroom management ProFirstAid Basic Instructor Certification: Layrescuer adult CPR/AED and First Aid Skills and knowledge include:  Conscious choking for adults  Unconscious choking for adults  CPR for one rescuer for adults  AED for adults  Mouth to mask usage  Heart attack and stroke  Bloodborne Pathogens  Bleeding Control  Musculoskeletal Injuries  Poisoning           Shock Management Breathing Emergencies Diabetic Emergencies Burns Bites and Stings Allergic Reactions Seizures Heat and Cold Emergencies Evaluating students Classroom management ProBloodborne Instructor Certification: OSHA 29 CFR 1910.1030 and Infection Control Skills and knowledge include:  What are Bloodborne Pathogens  How Bloodborne Pathogens are spread  HIV and AIDS  Hepatitis B Virus and Vaccine  Hepatitis C Virus  Reducing Risk  Work Practice Controls  Hazardous Disposal Procedures         Body Fluid Cleanup Procedures Glove Removal and Disposal Hand Hygiene Clean Technique Tattoos Safe Injection Practices Skin Diseases Healthcare Professionals Exposure Incident 3 ProTrainings Skill Evaluator Certification Facts Description: The ProTrainings, LLC Skill Evaluator training is designed to prepare individuals to conduct hands-on skill evaluations for students who complete the blended course online for ProCPR and ProFirstAid courses. Purpose: ProTrainings, LLC skill evaluator certification provides individuals with the skills, tools, and knowledge to successfully evaluate student’s CPR and First Aid skills. Upon successful completion, Evaluators can mark students passed according to their level of training. Course Design: Prerequisite:  Must have a current ProTrainings, LLC student/provider level certificate or equivalent that is equal to the skill level of desired skill evaluator certificate. Complete course content is available at www.proskilleval.com Skill Evaluator Training:  Total time: 4-12 hours  Includes a blended combination of online training, live skills demonstration, practice teaching and skill assessment. The time for the online portion is dependent on the level of certification desired and individual student needs. Skill Evaluator Bridge for Currently Certified Instructors:  Instructors must submit a current equivalent CPR/FirstAid instructor certification from a recognized organization, and complete the instructor/skill evaluator application to be bridged as a ProTrainings, LLC Skill Evaluator. Certificate Awarded: There are three levels of ProTrainings, LLC certified Skill Evaluators:  ProCPR Skill Evaluator–Can evaluate skills for ProCPR, ProFirstAid Advanced, ProFirstAid, ProFirstAid Basic, ProCPR Basic  ProFirstAid Skill Evaluator-Can evaluate skills for ProFirstAid, ProFirstAid Basic, ProCPR Basic  ProFirstAid Basic Evaluator– Can evaluate skills for ProFirstAid Basic, ProCPR Basic Each skill evaluator certificate is valid for 2 years. Skill Evaluators must complete a minimum of 2 skill evaluations before expiration date and complete all updates as required in order to renew the certification. Also one can submit a current equivalent instructor certification from another recognized organization for skill evaluator certificate renewal. Blended Courses Blended Course (Active for a 2 year period): An individual completes cognitive training and testing online by watching video segments, completing activities, and passing a written test. A hands-on skills session for skills practice and evaluation by a registered ProTrainings, LLC Instructor or Skill Evaluator is required to complete the certification process. Certification Accredited 2 Year Certification ProCPR: Healthcare Provider Adult/Child/& Infant CPR/AED 2 year certification Format Training URL Blended Online training, testing, & required hands-on skill evaluation Skill Eval Length: 45 min www.procpr.org ProFirstAid Advanced Online training, testing, Healthcare Provider Adult/Child/ & & required hands-on Infant CPR/AED & First Aid skill evaluation Skill Eval Length: 45 min www.advanced.profirstaid.com 2 year certification ProFirstAid: Adult/Child/ & Infant CPR/AED & First Aid 2 year certification Online training, testing, & required hands-on skill evaluation Skill Eval Length: 30 min www.profirstaid.com ProFirstAid Basic: Adult CPR/AED & First Aid 2 year certification Online training, testing, & required hands-on skill evaluation Skill Eval Length: 20 min www.basic.profirstaid.com ProCPR Basic: Adult CPR/AED 2 year certification Online training, testing, & required hands-on skill evaluation Skill Eval Length: 15 min www.adult.procpr.org ProTrainings Course Content Chart Provider/Student Level Certifications Healthcare Provider Skills Adult CPR Child CPR Infant CPR AED First Aid ProFirstAid AdvancedHealthcare Provider CPR/AED and First Aid     ProCPRHealthcare Provider CPR/AED      ProFirstAidLayrescuer Adult and Pediatric CPR/AED and First Aid   ProFirstAid BasicLayrescuer Adult CPR/AED and First Aid      ProCPR BasicLayrescuer Adult CPR/AED and First Aid       Instructor/Skill Evaluator Level Certifications Can Conduct Hands-On Skill Evaluations ProCPRInstructor ProCPRSkill Evaluator ProFirstAidInstructor ProFirstAidSkill Evaluator ProFirstAid BasicInstructor ProFirstAid BasicSkill Evaluator 6 ProBloodborne Instructor Can Teach Classroom Courses Includes ProFirstAid Advanced Includes ProCPR Includes ProFirstAid Includes ProFirstAid Basic Includes ProCPR Basic Includes ProBloodborne                                              7 ProTrainings Instructor/Evaluator Training Checklist 1-888-406-7487 support@protrainings.com Fax: 810-592-5007 5005 Plainfield Ave NE, Suite B, Grand Rapids, MI 49525 Signature ______________________________________ Training Date: Instructor Trainer’s Signature & Registry #: _________________________________ Instructor/Evaluator Printed Name & Registry #: _________ Registry # The above name candidate is authorized as: ______/______/_______ MM DD YYYY ProCPR Instructor ProCPR Skill Evaluator ProFirstAid Instructor ProFirstAid Skill Evaluator ProFirstAid Basic Instructor ProFirstAid Basic Skill Evaluator ProBloodborne Instructor ProCPR Required Skill Scenarios ProFirstAid Required Skill Scenarios Instructor/Evaluator Requirements Rescue Breathing Adult or Child CPR Completed Online Training Adult/Child CPR Infant CPR Has Current Student Certificate Infant CPR AED Completed Application AED Adult or Child Conscious Choking Instructor Manual/DVD Training Adult/Child Conscious Choking Infant Conscious Choking Instructor Dashboard Training Infant Conscious Choking Adult or Child Unconscious Choking Adult/Child Unconscious Choking Infant Unconscious Choking Infant Unconscious Choking Bleeding Control Adult 2 rescuer CPR NOTE: Only Adult skills are required for ProFirstAid Basic certification. Child/Infant 2 rescuer CPR Individual Skills –May be assessed while performed during skill scenarios. Individual Skills –May be assessed while performed during skill scenarios. Assessing the scene for safety Using personal protective equipment: Gloves Face Shield/Rescue Mask Bag Valve Mask Assessing the scene for safety Using personal protective equipment: Gloves Face Shield/Rescue Mask Assessing patient responsiveness Checking for a pulse: Adult and Child– Carotid Artery Infant– Brachial Artery Giving Compressions: Adult- 2 hands on the center of the chest between the nipples. Child– 1 or 2 hands on the center of the chest between the nipples. Infant– 2 fingers on the center of the chest just below the nipples. 2 Rescuer Infant- 2 thumbs hands encircling chest technique Opening the Airway using a head tilt chin lift Giving rescue breaths: Adult and Child– Covering mouth Infant– Covering mouth and nose Removing a foreign object Assessing patient responsiveness Giving Compressions: Adult- 2 hands on the center of the chest between the nipples. Child– 1 or 2 hands on the center of the chest between the nipples. Infant– 2 fingers on the center of the chest just below the nipples CPR and First Aid Instructors: Practice Teaching 3 Scenarios Topics Covered: What are Bloodborne Pathogens? How Bloodborne Pathogens are spread HIV and AIDS Hepatitis B Virus and Vaccine Hepatitis C Virus Reducing Risk Work Practice Controls Hazardous Disposal Procedures Body Fluid Cleanup Procedures Opening the Airway using a head tilt chin lift Glove Removal and Disposal Giving rescue breaths: Adult and Child– Covering mouth Infant– Covering mouth and nose Exposure Incident Removing a foreign object Clean Technique Tattoos Hand Hygiene Skin Diseases Healthcare Professionals Safe Injection Practices Final Test—(Must pass with 80% ) 8 Form is to be used by Instructor Trainers to certify Instructors and Skill Evaluators 9 Instructor/Skill Evaluator- Objectives, Needs, Philosophy I. Instructor/Skill Evaluator Objectives Effectively conduct CPR and First Aid classes/evaluations Fairly and accurately evaluate CPR and First Aid candidates through use of scenarios.  Diagnose and correct faulty CPR and First Aid performance.  Perform proper manikin maintenance, cleaning, and decontamination techniques.  Record participants’ progress.   II. III. Instructor/Skill Evaluator Equipment Needs  A clean, well lit area with adequate room to perform skills on manikins.  A minimum of 1 adult and 1 infant manikin (for healthcare provider and pediatric courses) for every 3 participants: Adult and infant manikins must have a visible chest rise when breaths are given . (Adult manikins can be used for child skills).  A minimum of 1 AED Trainer for every 3 participants.  Bag Valve Mask (Only for healthcare provider level certification)  Proper cleaning products for decontamination (refer to manikin decontamination Appendix F).  Disposable practice face shields or individual lung system for each participant. Philosophy of Online Learning Blended with Hands-On Practice Hands-on practice with a manikin will NOT ensure that a participant has mastered each skill. The innumerable variations of stress, patient size, location, and real-life needs of humans cannot be replicated on one manikin in one class. Therefore, hands-on practice simply allows participants the opportunity to become comfortable with the basic techniques used to perform skills. Just because a participant can perform the skills perfectly in class one day does not ensure that the participant will be able to perform the skills needed for a real person. The primary benefit of hands-on practice is that a participant’s comfort level will be higher when a real situation arises.    10 More important than hands on practice of BLS skills is the knowledge of when, how, and why. Regular review and practicing scenarios will better prepare a participant to perform skills in real-life. The goal of blending online learning with skill evaluation is for each participant to become successful with critical thinking in an emergency so one can exercise the basic skills necessary to adequately provide care. With this in mind, skill verification is not about testing people and focusing on small differences in techniques. Skill verification is about allowing people to practice until they feel comfortable with the skills so they will know when to initiate specific skills, how to perform each skill, and why to use different skills. How to Conduct Skill Practice and Evaluation Participants should be given time and assistance to practice skills with manikins. The Instructor should answer individual questions regarding manikin practice and help as needed during this time. If questions arise regarding course material, participants should conduct further review of course content, with instructor, online or contact the ProTrainings training department.  For skill sessions, the instructor should use the skill sheets to prompt the participant and watch the skill practice through various scenarios. (Refer to Scenario Skill Sheets in Appendix A). A participant who does not effectively perform an action should receive immediate feedback with the correction so the proper action can be practiced.  Positive coaching and gentle correction is the key to successful evaluation. Never put-down or criticize a participant. For example, rather than say, “You did that wrong!” say, “This is a more effective way to perform the skill.”  Suggested methods of evaluating skills:  One-on-One  This method is primarily for blended courses. It is best were an evaluator has flexibility in scheduling and can plan to spend about 15-45 minutes with each participant dependent upon the certification level. Benefits of this structure allow students to receive the most attention and most practice for their certification.  The instructor prompts the participant through the scenarios with the skill sheets and evaluates the skills. Instructor/Evaluator uses skill checklist to record student progress.  Group  This method is the typical classroom method. It is suggested for groups up to 12. If more than twelve participants are involved it is suggested to have another instructor of evaluator for every 12 participants. More time will need to be built into the class when more students are taught because of increased interaction and manikin sharing.  Have the participants gather in a semicircle around the evaluator with the manikins facing the same direction. This provides for great visibility for the evaluator and for participants to learn from the correction of others. Make sure the evaluator can see the actions of the participants in order to adequately evaluate skills.  The evaluator prompts the participant through the scenarios with the skill sheets and evaluates the skills. Instructor/Evaluator uses skill checklist to record student progress.  1 to 1 manikin to student ratio 1 to 2 manikin to student ratio 11 Common Errors and Suggested Corrections Common Participant Errors Suggested Evaluator Corrections Beginning: Neglects to check for safe environment Doesn’t apply gloves and prepare face shield “Make sure to check the scene for safety and protect yourself. Think of your own safety first in any rescue situation. It does no good to have two patients.” Checking for responsiveness: Vigorously shakes patient Doesn’t touch patient “Remember to tap on the collar bone area and shout. Be careful not to move the patient excessively in case a spinal injury is present.” Forgets to activate EMS (call 911) “Send someone to call 911 and get an AED if available. Make sure to tell them to come back and let you know that 911 has been called” “To properly find a pulse your fingers should be Circulation: Fingers are on the wrong location for carotid pulse placed on the middle of the neck or adam’s apple. Slide over to just inside the large muscle on Thumb is used to check pulse the side of the neck and gently push in. You should feel a pulse in the valley area.” Checks infant pulse on the neck Airway: Does not open airway before giving breaths Does not tilt head back far enough “Remember to check an infant’s pulse on the brachial artery. You should place your fingers on the upper inside arm and press in slightly to feel the pulse.” “Opening the airway first is one of the most important steps to CPR. The tongue can block the airway. Simply doing a head tilt chin lift will remove the tongue from the airway.” Breathing: Breaths do not make chest rise “Try giving some more air so the chest will rise.” Compressions: Jab like compressions Hands bounce off chest “Smooth even compressions will be most effective. Make sure to kneel close to the patient, lock your elbows, and pivot at the waste allowing your body to do the work, not just your arms.” Compressions too slow Compressions too fast “Keep the compressions moving at rate of about 100 per minute. That’s close to 2 each second. Count 1 and 2 and 3 and… You should have just enough time to say ‘and’ in-between each one.” Incorrect numbers or sequences 12 “It is most important to focus on giving adequate breaths and good compressions. However, the correct number and sequence is_________.” Common Errors and Correction (Continued) Common Participant Errors Suggested Evaluator Corrections Conscious choking (FBAO removal): Does not put one foot in-between patient’s feet Does not locate correct hand position for thrusts “Stand behind the patient with one of your feet inbetween the patient’s feet, and your other foot behind you. This will give you a solid stance in case the patient becomes unconscious. The thumb side of the closed fist should be located just above the belly button.” “Think simple first. If the first breath attempt does Unconscious choking (FBAO removal) Does not reposition head after first breath attempt not make the chest rise, retilt the head and try again.” does not make the chest rise. Forgets to check mouth after compressions before attempting breaths. “Compressions for choking are the same as CPR with an added step. Remember to check the mouth for a foreign object. If you see one, clear it out.” 13 Instructor Activities Introduction: The instructor activities provide the tools, details, and key points to teach an entire course from beginning to end. There are three basic instructor activities required in order to teach a course: video, teaching sessions, and skill practice. Throughout the instructor activities you will see three symbols to represent how to present the material: When you see the camera symbol it is time to show the video. The video titles will be highlighted in red. When you see the teacher symbol it is time to teach key points. Yellow highlighted text is information the instructor needs to know. Green highlighted text is information the instructor needs to say. Make sure to state the key points to the students in each section. The key points are the most important things the students need to know after each activity. When you see the CPR symbol it is time for skills practice. In short, the color coding system is as follows: Red= Stop and show the video to the students Yellow= Slow down and review the information before proceeding Green= Go present the information to the students The end of each section is indicated with a line. Before beginning a class, make sure that all of your equipment is in working order including manikins and video equipment. Manikins, skill sheets, and equipment should be laid out in practice area before students arrive. Required equipment for the ProTrainings courses: ProCPR & ProFirstAid Adv. ProFirstAid ProFirstAid/ProCPR Basic  Adult/Child Manikins with inflatable lungs *(an adult manikin can be used for child skills)  Infant Manikins with inflatable lungs  Proper disinfectant or replaceable lung/face-shield system for each student  AED trainers  Set of skill sheets for each student  Bag Valve Masks  Video projector or monitor  Video player for the type of media you have  Adult/Child Manikins with inflatable lungs *(an adult manikin can be used for child skills)  Infant Manikins with inflatable lungs  Proper disinfectant or replaceable lung/face-shield system for each student  AED trainers  Set of skill sheets for each student  Video projector or monitor  Video player for the type of media you have  Adult Manikins with inflatable lungs  Proper disinfectant or replaceable lung/face-shield system for each student  AED trainers  Set of skill sheets for each student  Video projector or monitor  Video player for the type of media you have 14 ProCPR CourseHealthcare Provider Adult, Child, Infant CPR/AED 15 ProCPR Instructor Activities: Course Introduction: Key Points: Videos for the ProCPR Course are available online at www.procpr.org and on the ProCPR Instructor DVD Use ProCPR Skill Sheets for Skill sessions from appendix A  The goal of the ProCPR healthcare provider program is to help the student gain the knowledge and skills necessary to provide basic life support in a medical emergency until more advanced help is available.  The techniques you will practice today will cover adult, child, and infant skills in rescue breathing, 1 person CPR, 2 person CPR, conscious choking, unconscious choking, AED, and bag valve mask usage.  The course will combine short video segments, skill practice and demonstration on manikins, and teaching sessions. There will be a written test at the end. Make sure to pay attention to the key points in each of our activities.  Are there any questions before we begin? (briefly answer any questions) Five Fears: Show video: Five Fears Key Points:  16 Five Fears: Most people don’t get involved in performing first aid or CPR because of fear. Don’t let fear stop you. You will give the best possible care for the patient by doing something rather than nothing. We can break down almost all fears into five categories. Don’t let these fears stop you.  Fear of Disease: The Solution: Universal precautions. Always use personal protective equipment. In other words, gloves and a face shield. If you don’t have it available, you can perform hands only CPR.  Fear of Lawsuits: The Solution: Good Samaritan Laws protect you from legal liability when you act in good faith and do not have a duty to act. Fear of Uncertainty: The Solution: Emphasis is placed on the role of CPR, not merely on the number sequences. Even if numbers are forgotten, remember to push hard and push fast. The key is to circulate blood with oxygen to the brain until advanced medical care is available.  Fear of Hurting a Patient: The Solution: Patients who are clinically dead can only be helped, not made worse with resuscitation efforts.  Fear of Unsafe Scene: The Solution: Never enter an unsafe scene! Rescuers are no use to patients if they become patients themselves. A dead rescuer is no rescuer.  Basic Physiology and CPR Philosophy: ProNote: The Chain of Survival AED  Early Activation of EMS  Early CPR  Early Defibrillation Providing CPR early after a person col Early Advanced Care lapses keeps a person from going into  biological death. At the moment a per- The earlier these steps take place in an emerson’s heart stops and breathing stops, gency, the better the chance of a patient’s survival. Key Points:  the condition is called clinical death. A person has about 4-6 minutes of oxygen in the blood and body tissues. After 10 minutes of no breathing and no circulation, the body goes into biological death. Brain cells have died. It is rare to revive a person after biological death has occurred. CPR helps extend this time before biological death occurs, by getting circulating oxygen. CPR is not intended to restart the heart. Advanced care is needed to get the heart back into a regular rhythm.  Basic Anatomy & Physiology The cardiovascular system comprises the heart, arteries, capillaries, and veins. a) Heart – consists of four chambers, about the size of your fist, located under the breastbone. Function of the heart is to pump the blood to the brain, lungs and body. b) Lungs – there are two lungs, functions to take in oxygen and release carbon dioxide. c) Brain – tells the rest of the body what to do and needs oxygen on a regular basis. Brain cells will begin to die in 4 to 6 minutes (without oxygen). d) Cells – all cells of the body consistently require oxygen to carry out normal functions. Carbon dioxide is produced as a waste product and must be eliminated from the body through the lungs. 17  The ProCPR Method Protect yourself Safety first! Make sure the scene is safe. Do not enter an unsafe scene! If it is unsafe, stay at a safe distance and activate EMS (call 911). Prepare and apply appropriate personal protective equipment Respond Is the scene safe or can the scene be made safe for the rescuer? Is there a true medical emergency? Observe signs and symptoms Shout to the patient first then tap and shout to determine the level of responsiveness. Ask what happened? Are there any life threatening conditions? Call If no response or a life threatening condition exists, activate EMS (call 911). Provide proper care Care for the patient based on present medical conditions. Relinquish care to the provider of the next level of care Show video: Cardiovascular Disease and Heart Attacks Key Points:  Cardiovascular Disease and Heart Attacks Cardiovascular disease is the number one killer in the United States. The Center for Disease Control reports that in the United States over 650,000 people die each year from cardiovascular disease. Controllable risk factors:  cigarette smoking  high blood pressure  obesity  lack of exercise  high blood cholesterol levels  uncontrolled diabetes  high fat diet  high stress 18 Uncontrollable risk factors  Race  Heredity  Sex  Age  Heart Attack Signs and Symptoms may include  Chest discomfort/pressure, tightness that may radiate to jaw and arms..  Nausea  Sweating  Shortness of breath  Denial  Feeling of weakness Treatment: Recognize the signs and symptoms of a heart attack, activate EMS, have patient remain in a position of comfort, offer 1 adult dose aspirin, and keep the patient calm and quiet. Show video: Stroke Key Points:  Much like a heart attack, a stroke is a blockage of a vessel. However, blocked vessel is in the brain. The more time that the stroke is let go, the more damage occurs to brain tissue.  Signs & Symptoms  Numbness or weakness of the face, arm or leg, especially on one side of the body  Confusion  Trouble speaking or understanding  Trouble seeing in one or both eyes  Trouble walking  Dizziness  Loss of balance or coordination  Severe headache with no known cause Treatment: Recognize stroke signs and symptoms, activate EMS, check and correct ABC. Give nothing by mouth. Keep patient calm and reassure. Place patient in recovery position if the patient is unconscious, breathing effectively, and there is no suspected head neck or back injury. 19 Show video: How to Reduce Your Risk Show video: Glove Removal and Disposal Key Points: Before treating patients you need to know how to use personal protective equipment properly to prevent contact with potentially infectious body fluids.  Treat all body fluids as potentially infectious because bloodborne pathogens, HIV, HBV, and HBC, can be present when blood is not visible to the eye.  Using personal Protective Equipment 1. Putting Gloves on: Always use disposable gloves when providing first aid care. If you have a latex allergy use a latex alternative such as nitrile or vinyl. Before providing care, make sure the gloves are not ripped or damaged. You may need to remove rings or other jewelry that may rip the gloves. 2. Removing Gloves: Remember to use skin to skin and glove to glove. Pinch the outside wrist of the other gloved hand. Pull the glove off turning the glove inside-out as you remove it. Hold it in the gloved hand. Use the bare hand to reach inside the other glove at the wrist to turn it inside out trapping the other glove inside. Dispose of gloves properly. If you did it correctly, the outside of either glove never touched your exposed skin. 3. Use a Rescue Mask or Face Shield: If you have to provide rescue ventilations, use a rescue mask or face shield that has a one way valve. To prevent exposure, avoid giving direct mouth to mouth ventilations.  The Chain of Survival Key Points:  20 The earlier these steps take place in an emergency, the better the chance of a patient’s survival.      Early Recognition and Activation of EMS Early CPR Early Defibrillation Early Advanced Care Activating EMS – Call 911  Send someone to call 911 and tell them to come back. The caller should give dispatch the patient’s location, what happened, how many people are injured, and what is being done.  If alone and no one is available PHONE FIRST for adults and get the AED. Return to start CPR and use the AED.  CARE FIRST for children and infants by providing about 5 cycles or 2 minutes of CPR before activating the emergency response number.  CARE FIRST for all age patients of hypoxic (asphyxial) arrest (ei., drowning, injury, drug overdose). Show video: Adult Rescue Breathing Show video: Child Rescue Breathing Show video: Infant Rescue Breathing Key Points:  For the purpose of CPR skills, an infant is under 1 year old, a child is 1 year of age to the onset of adolescence or puberty (about 12 to 14 years of age) as defined by the presence of secondary sex characteristics, and an adult is 12-14 years of age or older.  Order of skills:  Check the scene  Check responsiveness and normal breathing  Activate EMS  Check the Circulation for no more than 10 seconds  Adult and Child– Check the carotid artery in the neck. 21      Infant– Check the brachial artery on the inside of the upper arm. If there is a pulse but no breathing, start rescue breathing. Each breath should last 1 second each. Open Airway using head tilt chin lift and give Breaths.  Adult – give 1 breath every 5 seconds  Child and Infant– give1 breath every 3 seconds Reassess Circulation every two minutes If unsure a pulse exists, start CPR. Don’t waste more critical time searching for a pulse Rescue Breathing Skill Session         22 Direct students to the area where the manikins are ready. Arrange students in groups as needed. Make sure students have the proper supplies. Gloves, practice face shields, manikin cleaning supplies, lungs, etc… There should be no more than 3 students per manikin. Tell students you will start with the adult manikin and adult scenario. Provide copies of the evaluator skill sheets for each student to use in class. Tell students you are going to direct them through the entire rescue breathing scenario, step by step. If you have more than 1 person per manikin, tell the other students to help coach and assist their partners with the skills as the scenario is presented. Lead the first set of students, as a group, through the scenario. Provide positive corrective feedback as necessary. Then allow the first set of students to practice on their own. Instructors should roam through the groups giving positive corrective feedback as necessary. After you have watched all of the students perform the skill correctly, check off their skills on the student skill sheet. If you have more than 1 person per manikin, disinfect the manikins and lead the next group of students through the scenario. Provide positive corrective feedback as necessary. Then allow the second student to practice on his or her own. Instructors should roam through the groups giving positive corrective feedback as necessary. After you have watched all of the students perform the skill correctly, check off their skills on the student checklist. Emphasize CAB: Circulation, Airway, Breathing  C– means that the rescuer will check for circulation and start compressions when there is no circulation; carotid artery on adults and children, brachial artery on infants.  A– means that the patient’s airway is opened using a head tilt chin lift. The airway should be clear and free of any obstructions.  B– means that the rescuer will give breaths if the patient is not breathing. Breaths should last 1 second each and make the chest rise. At any time the air does not go in and make the chest rise, the rescuer should reposition the head and try again.      Lead students together through the Adult scenario. Use the Adult Rescue Breathing ProCPR skill sheet from Appendix A. Make sure all students have satisfactorily passed the Adult Rescue Breathing skills. Lead the group together through the Infant Rescue Breathing scenario. Use the Infant Rescue Breathing ProCPR skill sheet from Appendix A. Make sure all students have satisfactorily passed the Infant Rescue Breathing skills. It is optional, but not required to practice Child Rescue Breathing using the adult/child manikin. Remember the pulse check is on the carotid artery of the child and rescue breathing is 1 breath every 3 seconds. 23 Show video: Adult CPR Show video: Child CPR Show video: Infant CPR ProNotes:  Infant is under 1 year old  Child is 1 to onset of puberty. Approx 12-14 years old.  Adult is onset of puberty and older. Key Points:  Breaths: Watch for chest rise. Breaths should last 1 second each. When chest rises or resistance is felt, stop the breath.  Compressions:  The purpose of CPR is to circulate blood with oxygen in it to the brain and vital organs. Your focus should be on consistent smooth compressions at a rate of at least 100 per minute, pressing hard and fast.  Order of skills: Push hard and  Check the scene push fast, and  Check responsiveness and normal breathing come up fully allowing the heart to re Activate EMS fill. Compressions  Check the Circulation for no more than 10 seconds for all ages should  If no pulse and not breathing normal– give 30 chest be given at a rate of compressions at a rate of at least 100 compressions per at least 100 per minute. minute. Depth Open Airway using head tilt chin lift Adult– at least 2”  Give 2 Breaths lasting 1 second each. Watch for chest Child & Infantrise and fall. At least 1/3 the  Continue cycles of 30 compressions to 2 breaths until depth of the an AED arrives, advanced medical personnel take over, chest. the patient shows signs of life, the scene becomes un If you are unable or safe, or you are too exhausted to continue. unwilling to give  Hand placement for compressions: breaths, at least Adult— Place heel of hand of the dominant hand on give compressions. the center of the chest between the nipples. The Compression only CPR has been second hand should be placed on top. found to be effecChild— Place heel of one hand in the center of the tive. chest between the nipples. Use the second hand if necessary. Infant— Place 2 fingers on the center of the chest just below the nipples. For two rescuers, use the preferred two thumbs hands encircling chest technique. One Rescuer CPR Skill Session  24 Direct students to the area where the manikins are ready. Arrange students              ProNote:  Advanced Airways (Combitube, Endotracheal tube, LMA, etc...)— in groups as needed. Make sure students have the proper Rescuers should supplies. Gloves, practice face shields, manikin cleaning supperform compresplies, lungs, etc… There should be no more than 3 students sions without inper manikin. Tell students you will start with the adult manikin terruptions for resand adult scenario. cue breaths. The compressor perProvide copies of the evaluator skill sheets for each student to forms continuous use in class. chest compresTell students you are going to direct them through the entire sions at a rate of rescue breathing scenario, step by step. If you have more than 100 per minute 1 person per manikin, tell the other students to help coach and while the rescuer providing breaths assist their partners with the skills as the scenario is pregives 1 breath sented. every 6 to 8 secLead the first set of students, as a group, through the sceonds. nario. Provide positive corrective feedback as necessary. Then allow the first set of students to practice on their own. Instructors should roam through the groups giving positive corrective feedback as necessary. After you have watched all of the students perform the skill correctly, check off their skills on the student skill sheet. If you have more than 1 person per manikin, disinfect the manikins and lead the next group of students through the scenario. Provide positive corrective feedback as necessary. Then allow the second student to practice on his or her own. Instructors should roam through the groups giving positive corrective feedback as necessary. After you have watched all of the students perform the skill correctly, check off their skills on the student checklist. Emphasize CAB: Circulation, Airway, Breathing  C– means that the rescuer will check for circulation and start compressions when there is no circulation; carotid artery on adults and children, brachial artery on infants.  A– means that the patient’s airway is opened using a head tilt chin lift. The airway should be clear and free of any obstructions.  B– means that the rescuer will give breaths if the patient is not breathing. Breaths should last 1 second each and make the chest rise. At any time the air does not go in and make the chest rise, the rescuer should reposition the head and try again. Compressions: Consistent and smooth at a rate of 100 per minute, pressing hard and fast. Keep elbows locked and pivot at the waist. Press all the way down and come all the way back up without lifting off the chest. Lead students together through the Adult CPR scenario. Use the Adult CPR ProCPR skill sheet from Appendix A. Make sure all students have satisfactorily passed the Adult CPR skills. Lead the group together through the Infant CPR scenario. Use the Infant CPR ProCPR skill sheet from Appendix A. Make sure all students have satisfactorily passed the Infant CPR skills. It is optional, but not required to practice Child CPR using the adult/child manikin. 25 Show video: Adult AED Show video: Child AED Show video: Infant AED Key Points:               26 ProNote:  An AED should include a kit containing gloves, face shield, a cloth to dry the chest, and a battery powered beard trimmer or shaver.  It is rare for children and infants to need an AED. The majority of cardiac problems in children are caused from breathing difficulties. CPR and effective rescue breaths are most important. AED use for a child or infant is considered ages 1month-8 years old. Use pediatric pads if available. If not, use a regular AED designed for adults. AED stands for Automated External Defibrillator AEDs are designed to shock the heart to stop chaotic rhythms, usually ventricular fibrillation, in order for the heart to restart under a normal rhythm. The AED analyzes the heart’s rhythm, advises whether a shock is advised and then powers up. The operator then pushes a button that will deliver the shock. Each minute the defibrillation is delayed the chance of survival is reduced by 10 percent. After 10 minutes few people are resuscitated. Early defibrillation within the first 5-6 minutes increases survival rates from just CPR alone to greater than 50%. Rescuers should begin chest compressions as soon as possible, and use the AED as soon as it is available and ready. If you are giving CPR to a child or infant, and the available AED does not have child pads or a way to deliver a smaller dose, use a regular AED with adult pads. You may need to place one pad on the front and one pad on the back. Bare the chest. Dry it off if it is wet. If there is excessive hair you may need to shave it off. Turn the machine on first. Place one pad on the patients upper right chest just below the collarbone and above the nipple. Place the other pad on the patients lower left ribs below the armpit. **Make sure to follow the directions shown on the pads for the AED pad placement. Manufactures will vary. Make sure pads are pressed down firmly. Do not try to lift up and adjust pads or they will not stick. Attach electrode cables now if not preconnected. Follow the directions the AED gives. Make sure to shout, “Stand Clear” before pushing the shock button. The normal cycle is 1 shock, 2 minutes of CPR, 1 shock, 2 minutes of CPR, etc. The AED should be kept still while in operation. It is not designed for movement, such as in a vehicle.       AED Considerations: Remove a patient from standing water, such as a puddle, before AED use. Rain, snow, or a wet surface is not a concern. Patient should be removed from a metal surface if possible. Slightly adjust pad placement so as not to directly cover the area if the patient has an obvious bump or scar for a pacemaker. Remove medication patches found on the patient’s chest with a gloved hand. Never remove the pads from the patient or turn off the AED. AED Skill Session             Direct students to the area where the manikins are ready. Arrange students in groups as needed. Make sure students have the proper supplies. Gloves, practice face shields, manikin cleaning supplies, lungs, etc… There should be no more than 3 students per manikin. Tell students you will start with the adult manikin and adult scenario. Provide copies of the evaluator skill sheets for each student to use in class. Tell students you are going to direct them through the entire skill scenario, step by step. If you have more than 1 person per manikin, tell the other students to help coach and assist their partners with the skills as the scenario is presented. Lead the first set of students, as a group, through the scenario. Provide positive corrective feedback as necessary. Then allow the first set of students to practice on their own. Instructors should roam through the groups giving positive corrective feedback as necessary. After you have watched all of the students perform the skill correctly, check off their skills on the student skill sheet. If you have more than 1 person per manikin, disinfect the manikins and lead the next group of students through the scenario. Provide positive corrective feedback as necessary. Then allow the second student to practice on his or her own. Instructors should roam through the groups giving positive corrective feedback as necessary. After you have watched all of the students perform the skill correctly, check off their skills on the student checklist. Practice with AED trainer/simulator: never use a real AED for practice Emphasize turning on the AED first and following the directions it gives. Lead students together through the Adult AED scenario. Use the Adult AED skill sheet. It is optional but not required to practice Child AED use. Current guidelines recommend AED with pediatric pads for infants and children. If no pediatric pads are available, adult pads can be used. 27 Show video: Adult Conscious Choking Show video: Child Conscious Choking Show video: Infant Conscious Choking Key Points: Conscious Choking is when a victim cannot breath, cough or speak.  Look into the persons face and Ask, “Are you choking?”  If not able to breath, cough or speak, Activate EMS Adult and Child  The rescuer should stand behind the victim and place one foot in-between the victims feet and the other foot behind in order to have a firm stance in case the victim becomes unconscious. In the case of a child, the rescuer may need to kneel down to get into the proper position  Administer abdominal thrusts until the object comes out or the patient becomes unconscious Infant  Administer 5 back blows and 5 chest thrusts until the object comes out or the patient becomes unconscious.  Support the baby’s jaw when giving back blows and support the baby’s head when giving chest thrusts.  Special Circumstances: If the patient is pregnant or too large to reach around, give chest thrusts. Conscious Choking Skill Session         28 Arrange students in groups as needed. Tell students you will start the adult conscious choking scenario. The rescuer should use the manikin to practice. Provide copies of the evaluator skill sheets for each student to use in class. Tell students you will direct them through the skill scenario, step by step. REMIND STUDENTS: If using partners rather than manikin to practice, DO NOT ACTUALLY GIVE THRUSTS TO EACH OTHER. Lead the students, as a group, through the scenario. Provide positive corrective feedback as necessary. Then allow the students to practice on their own. Instructors should roam through the groups giving positive corrective feedback as necessary. After you have watched all of the students perform the skill correctly, check off their skills on the student checklist. After the adult scenario, lead the group together through the Infant scenario using the infant manikins: Show video: Adult Unconscious Choking Show video: Child Unconscious Choking Show video: Infant Unconscious Choking ProNote: Unconscious choking looks just like CPR with one added step, check the mouth. If you see an object sweep it out. Key Points: -Unconscious Choking  Unconscious  No signs of life. Absent breathing  Attempted rescue breaths will not go in Treatment:  If a conscious choking victim becomes unconscious, carefully lower person to the ground  Activate EMS  Give 30 chest Compressions at a rate of at least 100 compressions per minute.  Check the mouth for a foreign body. If something is seen sweep it out with a finger.  Open Airway using head tilt chin lift  Attempt a Breath  If first breath does not make the chest rise, reposition head and reattempt a breath. If first breath still does not make the chest rise, assume there is a foreign body airway obstruction.  Repeat 30 chest compressions, checking the mouth, and breathing attempts  After first breath goes in and makes the chest rise, give the second breath  Check the circulation for no more than 10 seconds  If pulse is present start rescue breathing. If no pulse, start CPR. Unconscious Choking Skill Session  Direct students to the area where the manikins are ready. Arrange students in groups as needed. Make sure students have the proper supplies. Gloves, 29         30 practice face shields, manikin cleaning supplies, lungs, etc… There should be no more than 3 students per manikin. Tell students you will start with the adult manikin and adult scenario. Provide copies of the evaluator skill sheets for each student to use in class. Tell students you are going to direct them through the entire skill scenario, step by step. If you have more than 1 person per manikin, tell the other students to help coach and assist their partners with the skills as the scenario is presented. Lead the first set of students, as a group, through the scenario. Provide positive corrective feedback as necessary. Then allow the first set of students to practice on their own. Instructors should roam through the groups giving positive corrective feedback as necessary. After you have watched all of the students perform the skill correctly, check off their skills on the student checklist. If you have more than 1 person per manikin, disinfect the manikins and lead the next group of students through the scenario. Provide positive corrective feedback as necessary. Then allow the second student to practice on his or her own. Instructors should roam through the groups giving positive corrective feedback as necessary. After the adult scenario, lead the group together through the Infant scenario using the infant manikins. The Child skill is optional. After you have watched all of the students perform the skill correctly, check off their skills on the student checklist. Show video: Adult 2 Rescuer CPR Show video: Child 2 Rescuer CPR Show video: Infant 2 Rescuer CPR Key Points: -Adult 2 rescuer CPR:  First rescuer performs assessment and ventilations. Second rescuer performs 30 compressions at a rate of at least 100 compressions per minute.  After every 5 cycles of 30:2, rescuers should switch positions. Switch should take less than 10 seconds.  During the switch, the person at the head finishes with 2 breaths, moves into position on the chest, and begins compressions. -Child and Infant 2 rescuer CPR:  Rescuers should use a compression to ventilation ratio of 15:2.  For infants, rescuers should use the 2 thumbs hands encircling hands chest compression technique.  After about 10 cycles, or 2 minutes, rescuers should switch positions. Switch should take less than 10 seconds. Show video: Adult Bag valve mask Key Points: When oxygen is available, a bag-valve mask can be attached and oxygen set at 12-15 L/min. If no O2 is available remove the residual bag reservoir at the end of the bag-valve mask and use room air.  Instructor should demonstrate on a manikin. Tell students that they will practice this skill in conjunction with 2 person CPR.  Using the "C-E" method for sealing the bag-valve mask to the patient's face, prepare to ventilate the patient. Please note that if for any reason the bag-valve ventilations are ineffective, revert to mouth-tomask or face shield delivery method for rescue breaths.  31 Ensure that thumb and forefinger are sealing the mask at the face of the patient. With middle, ring, and pinky fingers, grab the mandible (jaw) of the patient and pull the patient's face into the mask seal. If the mask is sealed well, there should be minimum to no air leakage on ventilation. Squeeze the bag fully so that the patient's chest rises. When the chest rises stop squeezing the bag so to avoid overinflation which may force the air into the stomach.  In some cases, the infant will benefit from turning the mask upside down so that the small point covers the patient's chin and the broad part of the mask is covering the mouth and nose.  Ventilate at 1 breath every 5 seconds while performing rescue breathing. If an advanced airway is in place, perform 1 breath every 6-8 seconds. Take care not to hyperventilate the patient.  2 Rescuer CPR Skills Session        32 Direct students to the area where the manikins are ready. Arrange students in groups as needed. Make sure students have the proper supplies. Gloves, practice face shields, manikin cleaning supplies, lungs, etc… There should be no more than 3 students per manikin. Tell students you will start with the adult manikin and adult scenario. Provide copies of the evaluator skill sheets for each student to use in class. Tell students you are going to direct them through the entire skill scenario, step by step. If you have more than 2 people per manikin, tell the other students to help coach and assist their partners with the skills as the scenario is presented. Lead the first set of students, as a group, through the scenario. Provide positive corrective feedback as necessary. Then allow the first set of students to practice on their own. Instructors should roam through the groups giving positive corrective feedback as necessary. After you have watched all of the students perform the skill correctly, check off their skills on the student checklist. If you have more than 2 people per manikin, disinfect the manikins and lead the next group of students through the scenario. Provide positive corrective feedback as necessary. Then allow the second student to practice on his or her own. Instructors should roam through the groups giving positive corrective feedback as necessary. After you have watched all of the students perform the skill correctly, check off their skills on the student checklist. Show Video: Arterial Bleeding Key Points: Control Severe Bleeding  Inspect the wound. Look for the exact point were the bleeding is coming from. Apply gloves.  Use direct pressure on the wound using an absorbent pad or gauze. Add more gauze or padding if necessary.  You may consider using a pressure bandage by wrapping a roller gauze or elastic bandage around the wound to maintain bleeding control. Show Video: Shock Key Points: How to recognize and manage shock  Signs & Symptoms restlessness, dizziness, confusion, cool moist skin, anxiety, delayed capillary refill time, and weakness.  Treatment: Recognize, Activate EMS, keep calm, Nothing to eat or drink, maintain body heat, raise the legs if no spinal injury or fracture of the legs. ProNote: Moving a Patient– First Aid providers should only conKey Points: sider moving patient when immediate life threatening Perform Ongoing Assessments conditions exist or if it is nec Check for and correct conditions which may not be essary to provide care. immediately life threatening but may become so if not corrected. 33  SAMPLE (if time permits) get a sample history and do a “Head to Toe Survey” Symptoms Allergies Medications Past Medical History Last meal eaten Events leading up to need for help Look from head to toe for: Deformities Contusions Abrasions Penetrations Burns Tenderness Lacerations Swelling Special Considerations: Spinal Injury and Jaw Thrust Key Points:  Suspect a spinal injury when victim has...  Neck or back pain, tingling in extremities, or weakness  Been injured diving into shallow water  Obvious head, neck or back injury  Occupant, rider or pedestrian in a motor vehicle, motorcycle, or bicycle crash  Been injured from a fall greater than standing height  Signs and symptoms of a spinal injury include:  Bruising of the head, especially around the eyes and behind the ears  Blood or fluids in the ears and nose  Siezures or changes in level of consciousness  Impaired breathing, vision, or body movement  Severe pain or pressure in head, neck or back  34 If you suspect a head, Neck or back injury a jaw thrust can be used to open the airway. However, for an unconscious, non-breathing person it is more important to have an open airway rather than consideration of a potential spinal injury. If you are not able to open the airway adequately with the jaw thrust, use a head-tilt chin-lift to open the airway. Use ProCPR Final Test and answer sheets in Appendix D Administer Written Test     Allow students ample time to complete the test. Check answers using the answer sheet provided Students must have 80% correct to pass the test Student who fail may be remediated and given a second opportunity to pass the test. Students who do not pass the second attempt must retake the course After-course responsibilities:  Instructor completes student checklist and keeps a copy on file for min. of 2 years.  Instructor completes online classroom records through instructor dashboard so students will receive certification cards. 35 ProFirstAid CourseLayrescuer Adult, Child, Infant CPR/AED and First Aid 36 ProFirstAid Course Instructor Activities: Course Introduction: Videos for ProFirstAid Course are available at: www.profirstaid.com and on the ProFirstAid Instructor DVD Key Points: Use ProFirstAid Skill Sheets for Skill sessions from appendix A  The goal of the ProFirstAid Layrescuer program is to help the student gain the knowledge and skills necessary to manage a medical emergency and to provide layrescuer level CPR until more advanced help is available.  The techniques you will practice today will cover adult, child, and infant skills in 1 person CPR, conscious choking, unconscious choking, AED, and First Aid.  The course will combine short video segments, skill practice and demonstration on manikins, and teaching sessions. There will be a written test at the end. Make sure to pay attention to the key points in each of our activities.  Are there any questions before we begin? (briefly answer any questions) Five Fears: Show video: Five Fears Key Points:  Five Fears: Most people don’t get involved in performing first aid or CPR because of fear. Don’t let fear stop you. You will give the best possible care for the patient by doing something rather than nothing. We can break down almost all fears into five categories. Don’t let these fears stop you.  Fear of Disease: The Solution: Universal precautions. Always use personal protective equipment. In other words, gloves and a face shield. If you don’t have it available, you can perform hands only CPR.  Fear of Lawsuits: The Solution: Good Samaritan Laws protect you from legal liability 37 when you act in good faith and do not have a duty to act.  Fear of Uncertainty: The Solution: Emphasis is placed on the role of CPR, not merely on the number sequences. Even if numbers are forgotten, remember to push hard and push fast. The key is to circulate blood with oxygen to the brain until advanced medical care is available.  Fear of Hurting a Patient: The Solution: Patients who are clinically dead can only be helped, not made worse with resuscitation efforts.  Fear of Unsafe Scene: The Solution: Never enter an unsafe scene! Rescuers are no use to patients if they become patients themselves. A dead rescuer is no rescuer. Basic Physiology and CPR Philosophy: ProNote: The Chain of Survival AED  Early Activation of EMS  Early CPR  Early Defibrillation Providing CPR early after a person col Early Advanced Care lapses keeps a person from going into  biological death. At the moment a per- The earlier these steps take place in an emerson’s heart stops and breathing stops, gency, the better the chance of a patient’s survival. Key Points:  the condition is called clinical death. A person has about 4-6 minutes of oxygen in the blood and body tissues. After 10 minutes of no breathing and no circulation, the body goes into biological death. Brain cells have died. It is rare to revive a person after biological death has occurred. CPR helps extend this time before biological death occurs, by getting circulating oxygen. CPR is not intended to restart the heart. Advanced care is needed to get the heart back into a regular rhythm.  Basic Anatomy & Physiology The cardiovascular system comprises the heart, arteries, capillaries, and veins. a) Heart – consists of four chambers, about the size of your fist, located under the breastbone. Function of the heart is to pump the blood to the brain, lungs and body. b) Lungs – there are two lungs, functions to take in oxygen and release carbon dioxide. c) Brain – tells the rest of the body what to do and needs oxygen on a regular basis. Brain cells will begin to die in 4 to 6 minutes (without oxygen). d) Cells – all cells of the body consistently require oxygen to carry out normal functions. Carbon dioxide is produced as a waste product and must be eliminated from the body through the lungs. 38  The ProCPR Method Protect yourself Safety first! Make sure the scene is safe. Do not enter an unsafe scene! If it is unsafe, stay at a safe distance and activate EMS (call 911). Prepare and apply appropriate personal protective equipment Respond Is the scene safe or can the scene be made safe for the rescuer? Is there a true medical emergency? Observe signs and symptoms Shout to the patient first then tap and shout to determine the level of responsiveness. Ask what happened? Are there any life threatening conditions? Call If no response or a life threatening condition exists, activate EMS (call 911). Provide proper care Care for the patient based on present medical conditions. Relinquish care to the provider of the next level of care Show video: Cardiovascular Disease and Heart Attacks Key Points:  Cardiovascular Disease and Heart Attacks Cardiovascular disease is the number one killer in the United States. The Center for Disease Control reports that in the United States over 650,000 people die each year from cardiovascular disease. Controllable risk factors:  cigarette smoking  high blood pressure  obesity  lack of exercise  high blood cholesterol levels  uncontrolled diabetes  high fat diet  high stress 39 Uncontrollable risk factors  Race  Heredity  Sex  Age  Heart Attack Signs and Symptoms may include  Chest discomfort/pressure, tightness, may radiate to jaw and arms.  Nausea  Sweating  Shortness of breath  Denial  Feeling of weakness Treatment: Recognize the signs and symptoms of a heart attack, activate EMS, have patient remain in a position of comfort, offer 1 adult dose aspirin, and keep the patient calm and quiet. Show video: Stroke Key Points: 40  Much like a heart attack, a stroke is a blockage of a vessel. However, blocked vessel is in the brain. The more time that the stroke is let go, the more damage occurs to brain tissue.  Signs & Symptoms  Numbness or weakness of the face, arm or leg, especially on one side of the body  Confusion  Trouble speaking or understanding  Trouble seeing in one or both eyes  Trouble walking  Dizziness  Loss of balance or coordination  Severe headache with no known cause Treatment: Recognize stroke signs and symptoms, activate EMS, check and correct ABC. Give nothing by mouth. Keep patient calm and reassure. Place patient in recovery position if the patient is unconscious, breathing effectively, and there is no suspected head neck or back injury. Show video: How to Reduce Your Risk Show video: Glove Removal and Disposal Key Points: Before treating patients you need to know how to use personal protective equipment properly to prevent contact with potentially infectious body fluids.  Treat all body fluids as potentially infectious because bloodborne pathogens, HIV, HBV, and HBC, can be present when blood is not visible to the eye.  Using personal Protective Equipment 1. Putting Gloves on: Always use disposable gloves when providing first aid care. If you have a latex allergy use a latex alternative such as nitrile or vinyl. Before providing care, make sure the gloves are not ripped or damaged. You may need to remove rings or other jewelry that may rip the gloves. 2. Removing Gloves: Remember to use skin to skin and glove to glove. Pinch the outside wrist of the other gloved hand. Pull the glove off turning the glove inside-out as you remove it. Hold it in the gloved hand. Use the bare hand to reach inside the other glove at the wrist to turn it inside out trapping the other glove inside. Dispose of gloves properly. If you did it correctly, the outside of either glove never touched your exposed skin. 3. Use a Rescue Mask or Face Shield: If you have to provide rescue ventilations, use a rescue mask or face shield that has a one way valve. To prevent exposure, avoid giving direct mouth to mouth ventilations.  The Chain of Survival Key Points:  The earlier these steps take place in an emergency, the better the chance of a patient’s survival. 41      Activating EMS – Call 911  Send someone to call 911 and tell them to come back. The caller should give dispatch the patient’s location, what happened, how many people are injured, and what is being done.  42 Early Recognition and Activation of EMS Early CPR Early Defibrillation Early Advanced Care If alone and no one is available PHONE FIRST for adults and get the AED. Return to start CPR and use the AED.  CARE FIRST for children and infants by providing about 5 cycles or 2 minutes of CPR before activating the emergency response number.  CARE FIRST for all age patients of hypoxic (asphyxial) arrest (ei., drowning, injury, drug overdose). Show video: Adult CPR Show video: Child CPR Show video: Infant CPR ProNotes:  Infant is under 1 year old  Child is 1 to onset of puberty. Approx 12-14 years old.  Adult is onset of puberty and older. Key Points:  Breaths: Watch for chest rise. Breaths should last 1 second each. When chest rises or resistance is felt, stop the breath.  Compressions: Push hard and push fast, and come up fully allowing the heart to refill. Compressions for all ages should be given at a rate of at least 100 per minute. DepthAdult– at least 2” Child & InfantAt least 1/3 the depth of the chest.  The purpose of CPR is to circulate blood with oxygen in it to the brain and vital organs. Your focus should be on consistent smooth compressions at a rate of at least 100 per minute, pressing hard and fast.  Order of skills:  Check the scene  Check responsiveness and normal breathing  Activate EMS  Give 30 chest Compressions at a rate of at least 100 compressions per minute.  Open Airway using head tilt chin lift  Give 2 Breaths lasting 1 second each. Watch for chest rise and fall.  Continue cycles of 30 compressions to 2 breaths until an AED arrives, advanced medical personnel take over, the patient shows signs of life, the scene becomes unsafe, or you are too exhausted to continue.   If you are unable or Hand placement for compressions: unwilling to give Adult— Place heel of hand of the dominant hand on breaths, at least the center of the chest between the nipples. The give compressions. second hand should be placed on top. Compression only CPR has been Child— Place heel of one hand in the center of the found to be effecchest between the nipples. Use the second hand if tive. necessary. Infant— Place 2 fingers on the center of the chest just below the nipples. . One Rescuer CPR Skill Session  Direct students to the area where the manikins are ready. Arrange students 43              44 in groups as needed. Make sure students have the proper supplies. Gloves, practice face shields, manikin cleaning supplies, lungs, etc… There should be no more than 3 students per manikin. Tell students you will start with the adult manikin and adult scenario. Provide copies of the evaluator skill sheets for each student to use in class. Tell students you are going to direct them through the entire scenario, step by step. If you have more than 1 person per manikin, tell the other students to help coach and assist their partners with the skills as the scenario is presented. Lead the first set of students, as a group, through the scenario. Provide positive corrective feedback as necessary. Then allow the first set of students to practice on their own. Instructors should roam through the groups giving positive corrective feedback as necessary. After you have watched all of the students perform the skill correctly, check off their skills on the student checklist. If you have more than 1 person per manikin, disinfect the manikins and lead the next group of students through the scenario. Provide positive corrective feedback as necessary. Then allow the second student to practice on his or her own. Instructors should roam through the groups giving positive corrective feedback as necessary. After you have watched all of the students perform the skill correctly, check off their skills on the student checklist. Emphasize CAB: Circulation, Airway, Breathing  C– means that the rescuer will start compressions when there is no normal breathing or signs of life.  A– means that the patient’s airway is opened using a head tilt chin lift. The airway should be clear and free of any obstructions.  B– means that the rescuer will give breaths if the patient is not breathing. Breaths should last 1 second each and make the chest rise. At any time the air does not go in and make the chest rise, the rescuer should reposition the head and try again. Compressions: Consistent and smooth at a rate of at least100 per minute, pressing hard and fast. Keep elbows locked and pivot at the waist. Press all the way down and come all the way back up without lifting off the chest. Lead students together through the Adult CPR scenario. Use the ProFirstAid Adult CPR skill sheet. Make sure all students have satisfactorily passed the Adult CPR skills. Lead the group together through the Infant CPR scenario. Use the ProFirstAid Infant CPR skill sheet. Make sure all students have satisfactorily passed the Infant CPR skills. It is optional, but not required to practice Child CPR using the adult/child manikin. Show video: Adult AED Show video: Child AED Show video: Infant AED Key Points:               ProNote:  An AED should include a kit containing gloves, face shield, a cloth to dry the chest, and a battery powered beard trimmer or shaver.  It is rare for children and infants to need an AED. The majority of cardiac problems in children are caused from breathing difficulties. CPR and effective rescue breaths are most important. AED use for a child or infant is considered ages 1month-8 years old. Use pediatric pads if available. If not, use a regular AED designed for adults. AED stands for Automated External Defibrillator AEDs are designed to shock the heart to stop chaotic rhythms, usually ventricular fibrillation, in order for the heart to restart under a normal rhythm. The AED analyzes the heart’s rhythm, advises whether a shock is advised and then powers up. The operator then pushes a button that will deliver the shock. Each minute the defibrillation is delayed the chance of survival is reduced by 10 percent. After 10 minutes few people are resuscitated. Early defibrillation within the first 5-6 minutes increases survival rates from just CPR alone to greater than 50%. Rescuers should begin chest compressions as soon as possible, and use the AED as soon as it is available and ready. If you are giving CPR to a child or infant, and the available AED does not have child pads or a way to deliver a smaller dose, use a regular AED with adult pads. You may need to place one pad on the front and one pad on the back. Bare the chest. Dry it off if it is wet. If there is excessive hair you may need to shave it off. Turn the machine on first. Place one pad on the patients upper right chest just below the collarbone and above the nipple. Place the other pad on the patients lower left ribs below the armpit. **Make sure to follow the directions shown on the pads for the AED pad placement. Manufactures will vary. Make sure pads are pressed down firmly. Do not try to lift up and adjust pads or they will not stick. Attach electrode cables now if not preconnected. Follow the directions the AED gives. Make sure to shout, “Stand Clear” before pushing the shock button. The normal cycle is 1 shock, 2 minutes of CPR, 1 shock, 2 minutes of CPR, etc. The AED should be kept still while in operation. It is not designed for movement, such as in a vehicle. 45       AED Considerations: Remove a patient from standing water, such as a puddle, before AED use. Rain, snow, or a wet surface is not a concern. Patient should be removed from a metal surface if possible. Slightly adjust pad placement so as not to directly cover the area if the patient has an obvious bump or scar for a pacemaker. Remove medication patches found on the patient’s chest with a gloved hand. Never remove the pads from the patient or turn off the AED. AED Skill Session             46 Direct students to the area where the manikins are ready. Arrange students in groups as needed. Make sure students have the proper supplies. Gloves, practice face shields, manikin cleaning supplies, lungs, etc… There should be no more than 3 students per manikin. Tell students you will start with the adult manikin and adult scenario. Provide copies of the evaluator skill sheets for each student to use in class. Tell students you are going to direct them through the entire skill scenario, step by step. If you have more than 1 person per manikin, tell the other students to help coach and assist their partners with the skills as the scenario is presented. Lead the first set of students, as a group, through the scenario. Provide positive corrective feedback as necessary. Then allow the first set of students to practice on their own. Instructors should roam through the groups giving positive corrective feedback as necessary. After you have watched all of the students perform the skill correctly, check off their skills on the student checklist. If you have more than 1 person per manikin, disinfect the manikins and lead the next group of students through the scenario. Provide positive corrective feedback as necessary. Then allow the second student to practice on his or her own. Instructors should roam through the groups giving positive corrective feedback as necessary. After you have watched all of the students perform the skill correctly, check off their skills on the student checklist. Practice with AED trainer/simulator: never use a real AED for practice Emphasize turning on the AED first and following the directions it gives. Lead students together through the Adult AED scenario. Use the ProFirstAid Adult AED skill sheet. It is optional but not required to practice Child or Infant AED use. Current guidelines recommend AED with pediatric pads for infants and children. If no pediatric pads are available, adult pads can be used. Show video: Adult Conscious Choking Show video: Child Conscious Choking Show video: Infant Conscious Choking Key Points: Conscious Choking is when a victim cannot breath, cough or speak.  Look into the persons face and Ask, “Are you choking?”  If not able to breath, cough or speak, Activate EMS Adult and Child  The rescuer should stand behind the victim and place one foot in-between the victims feet and the other foot behind in order to have a firm stance in case the victim becomes unconscious. In the case of a child, the rescuer may need to kneel down to get into the proper position  Administer abdominal thrusts until the object comes out or the patient becomes unconscious Infant  Administer 5 back blows and 5 chest thrusts until the object comes out or the patient becomes unconscious.  Support the baby’s jaw when giving back blows and support the baby’s head when giving chest thrusts.  Special Circumstances: If the patient is pregnant or too large to reach around, give chest thrusts. Conscious Choking Skill Session         Arrange students in groups as needed. Tell students you will start the adult conscious choking scenario. The rescuer should use the manikin to practice. Provide copies of the evaluator skill sheets for each student to use in class. Tell students you will direct them through the skill scenario, step by step. REMIND STUDENTS: If using partners rather than manikin to practice, DO NOT ACTUALLY GIVE THRUSTS TO EACH OTHER. Lead the students, as a group, through the Adult scenario. Provide positive corrective feedback as necessary. Then allow the students to practice on their own. Instructors should roam through the groups giving positive corrective feedback as necessary. After you have watched all of the students perform the skill correctly, check off their skills on the student checklist. After the adult scenario, lead the group together through the Infant scenario using the infant manikins: 47 Show video: Adult Unconscious Choking Show video: Child Unconscious Choking Show video: Infant Unconscious Choking ProNote: Unconscious choking looks just like CPR with one added step, check the mouth. If you see an object sweep it out. Key Points: -Unconscious Choking  Unconscious  No signs of life. Absent breathing  Attempted rescue breaths will not go in Treatment:  If a conscious choking victim becomes unconscious, carefully lower person to the ground  Activate EMS  Give 30 chest Compressions at a rate of at least 100 compressions per minute.  Check the mouth for a foreign body. If something is seen sweep it out with a finger.  Open Airway using head tilt chin lift  Attempt a Breath  If first breath does not make the chest rise, reposition head and reattempt a breath. If first breath still does not make the chest rise, assume there is a foreign body airway obstruction.  Repeat 30 chest compressions, checking the mouth, and breathing attempts  After first breath goes in and makes the chest rise, give the second breath  If still not breathing normally and not moving, continue cycles of 30 chest compressions and 2 breaths. Unconscious Choking Skill Session  48 Direct students to the area where the manikins are ready. Arrange students in groups as needed. Make sure students have the proper supplies. Gloves,         practice face shields, manikin cleaning supplies, lungs, etc… There should be no more than 3 students per manikin. Tell students you will start with the adult manikin and adult scenario. Provide copies of the evaluator skill sheets for each student to use in class. Tell students you are going to direct them through the entire skill scenario, step by step. If you have more than 1 person per manikin, tell the other students to help coach and assist their partners with the skills as the scenario is presented. Lead the first set of students, as a group, through the scenario. Provide positive corrective feedback as necessary. Then allow the first set of students to practice on their own. Instructors should roam through the groups giving positive corrective feedback as necessary. After you have watched all of the students perform the skill correctly, check off their skills on the student checklist. If you have more than 1 person per manikin, disinfect the manikins and lead the next group of students through the scenario. Provide positive corrective feedback as necessary. Then allow the second student to practice on his or her own. Instructors should roam through the groups giving positive corrective feedback as necessary. After the adult scenario, lead the group together through the Infant scenario using the infant manikins. The Child skill is optional. After you have watched all of the students perform the skill correctly, check off their skills on the student checklist. 49 Show video: Arterial Bleeding Key Points: 50  Bleeding  For all bleeding, remember to use personal protective equipment.  Capillary bleeding is usually minor unless other injuries exists. Venous bleeding may be severe and potentially life threatening if a large cut and large blood loss exists. Arterial bleeding should always be considered severe and life threatening.  Treatment: Activate EMS if severe bleeding is present, use direct pressure at the site of the wound using an absorbent pad or gauze. Do not take off what you have applied. Add more gauze or padding if necessary. Watch for signs of shock and monitor ABC.  You may consider using a pressure bandage by wrapping a roller gauze or elastic bandage around the wound to maintain bleeding control.  If appears contaminated, irrigate with sterile or clean water. If wound is minor, wash and apply an antibiotic ointment, then bandage.  Nose Bleeds (Epistaxis)  Treatment: Pinch nose, tilt the head forward, and apply a cold pack to bridge of nose.  Evisceration (Disembowlment)  Treatment: Activate EMS, cover with sterile or clean moist dressing. Do not attempt to push bowl or organs back into place. Keep patient warm, care for shock, check and correct ABC.  Amputation  Treatment: Activate EMS, control bleeding with direct pressure, immobilize partial amputation with bulky dressing. If amputated part can be found wrap in clean or sterile dressing and place in plastic bag. Put bag in container of ice and water. Care for shock, check and correct ABC. Do not soak amputated part in water or allow it to freeze by putting it directly on ice. If teeth are knocked out, avoid handling by the root end, rinse with water, and store in milk. Bleeding Control Skill Session Direct students to the area where the supplies are ready. Arrange students in groups as needed. Make sure students have the proper supplies: gauze pads, roller bandage, gloves.  Provide copies of the evaluator skill sheets for each student to use in class.  Allow the students to practice on their own. Instructors should roam through the groups giving positive corrective feedback as necessary.  After you have watched all of the students perform the skill correctly, check off their skills on the student checklist.  51 Show video: Shock Key Points: Manage Shock  Shock is the body’s inability to circulate blood with oxygen to the brain and vital organs.  Signs & Symptoms: restlessness, anxiety, dizziness, confusion, cool moist skin, delayed capillary refill time, and weakness.  Treatment: Recognize, Activate EMS, keep calm, Nothing to eat or drink, maintain body heat, raise the legs if no spinal injury or fracture of the legs. Monitor ABC. Show video: Secondary Survey Key Points: Perform Ongoing Assessments  Check for and correct conditions which may not be immediately life threatening but may become so if not corrected.  SAMPLE (if time permits) get a sample history and do a “Head to Toe Survey” Symptoms Allergies Medications Past Medical History Last meal eaten Events leading up to need for help Look from head to toe for: Deformities Contusions Abrasions Penetrations Burns Tenderness 52 Lacerations Swelling  Head to Toe exam Head – soft spots, blood, look at the eyes, blood or loose teeth in the mouth, blood or fluid from nose or ears, bruising of the eyes and behind the ears Neck – bleeding, jugular vein distention, tracheal deviation, open wounds Chest – blood, accessory muscle breathing, broken ribs, or open wounds Abdomen – bleeding, abdominal evisceration, guarding, tenderness, bruising Pelvis – bleeding, unstable Legs – bleeding, bruising, deformity, open wounds, distal sensation and movement Arms – bleeding, bruising, deformity, open wounds, distal sensation and movement 53 Show video: Head, Neck, and Back Injuries Key Points:  Suspect Spinal Injuries in:  Motor Vehicle accidents  Pedestrian-vehicle collisions  Falls  Blunt trauma  Diving accidents  Any trauma leaving the patient unresponsive  Severe head injuries  Obvious bruising and injury to the neck  Treatment: Activate EMS, do not move the patient unless life threatening danger arises, maintain spinal stabilization, check and correct ABC. Show video: Musculoskeletal Injuries Key Points: 54 ProNote: Ice should not be placed directly on bare skin. Crepits- Crackling or grating feeling or sound under the skin.  Muscle & Bone Injuries  Consider the mechanism that caused the injury.  Look for deformity, open wounds, tenderness, swelling, discoloration, bruising, crepitus, and loss of movement.  Tell patient not to move the body part.  Cover any open wounds with dry clean dressings, but do not apply pressure over possible fracture.  General splinting is contraindicated in Current Guidelines. Stabilize fractures in the position found. Splinting may be appropriate if there will be an extended time for EMS response, EMS is not available, or an individual will be transporting the patient to a hospital.  Treatment: Activate EMS if necessary, manually stabilize the affected body part, do not attempt to straighten, use ice to minimize swelling. Show video: Burns Key Points:  Burns First Degree  Pain  Red Skin  Swelling  Second Degree  Pain  Blistering  White or Red Skin  Body fluids leaking from the burn site  Third Degree  Minimal pain at the burn site  Multicolored skin, black, white, gray, and red  Severe body fluid loss  Treatment: Cool burn with water, cover with dry sterile dressing (for chemical burns, flush with water for 15-20 minutes). For 1st and 2nd degree burns, activate EMS if severe conditions exist. For 3rd degree burns, electrical burns, and chemical burns activate EMS immediately. Care for shock, check and correct ABC.  For electrical burns look for an entrance and exit wound.  Show video: Eye injuries Key Points:  Eye Injuries  Burns – stop the burning, cool, and bandage both eyes  Chemical – flush with warm water for 15-20 minutes and bandage both eyes 55   Penetrating Trauma – Do not remove. Bandage the object into place, and cover both eyes. Treatment: Activate EMS if severe conditions exist. Seek professional medical treatment for all forms of eye injuries. Show video: Heat and Cold Emergencies Key Points:  56 Heat Related Emergencies  Heat Cramps  Faintness, dizziness  Exhaustion  Possible nausea and vomiting  Stiff boardlike abdomen  Normal mental status  Severe muscle cramps/pain  Sweating  Treatment: Get patient out of the hot environment, cool the patient, remove tight clothing, and give water if tolerated.  Heat Exhaustion  Moist and clammy skin, sweating  Pale  Weak, dizzy or faint  Headache  Nausea and vomiting  Treatment: Get patient out of the hot environment, remove clothing as necessary, gently cool the patient, give water if tolerated. If patient does not improve or becomes unconscious, activate EMS, check and correct ABC.  Heat Stroke  Life-threatening  Dry or wet skin, usually red  Very high body temperature  Coma or near coma  Treatment: Activate EMS immediately, get patient out of the hot environment, check and correct ABC, remove clothing as necessary, gently cool the patient, give nothing to drink or eat.  Cold Related Emergencies  Factors that affect onset  Weather severity  Age  Pre-existing medical condition  Alcohol or drug consumption  Clothing  Hypothermia signs and symptoms  Shivering (Usually in the early stages)  Feeling of numbness  Slow breathing  Slow pulse  Slurred speech  Decreased levels of consciousness  Hard, cold, painless body parts  Death  Treatment: Get patient out of cold environment. Gently rewarm by removing wet clothing and covering patient with a dry blanket. If patient does not improve, shows decreased level of consciousness or becomes unconscious, activate EMS.  Frost-Bite  Waxy looking, blistered, discolored, numb, swollen extremities (usually fingers and toes) after prolonged exposure to cold.  Black blisters may occur in severe cases.  Treatment: Seek immediate professional medical help. Do not rub the affected area. Do not rewarm area if chance of refreezing exists. Rewarm with warm or room temperature water, not hot. Show video: Allergic Reactions Show Video: Snake Bites \ Key Points:  Allergic Reactions  Allergic reaction can happen because of drugs, poisons, plants, inhalation, foods, or insect stings. 57  Signs and symptoms         Altered level of consciousness Hallucinations Burning sensation in the chest and throat Excessive sweating Difficulty breathing Nausea and vomiting Severe abdominal cramping Rashes/Hives Breathing Diffculty  If you see any signs of severe breathing difficulty, treat them as life threatening no matter the cause.  Signs & Symptoms  Shortness of breath or wheezing  Leaning forward to breath  Unable to make noise or speak  Blue lips and fingernails (Cyanosis)  Moist skin  Rapid, shallow breathing   Treatment for Allergic Reactions and Breathing Difficulties: Activate EMS and keep patient calm. Place in position of comfort. Ask about allergies, asthma, COPD or other medical conditions. Look for obvious bites and stings. If the patient has a prescribed inhaler or Epipen, assist patient to utilize the device. Check and correct ABC. Show video: Poison Control Key Points:  58 Poisoning  The most important thing you can do for poisonings is prevent them.  Signs & Symptoms  Altered level of consciousness  Hallucinations  Burning sensation in the chest and throat  Headache  Excessive sweating  Burns/stains around the mouth     Difficulty breathing Nausea and vomiting Severe abdominal cramping Treatment: Activate EMS, Check and correct ABC, and call Poison Control Services: 1-800-222-1222. Follow directions. Chest & Head Injuries Key Points:  Signs and Symptoms  Bruising around the eyes and behind the ears  Irregular or abnormal breathing patterns  Altered mental status (Most common sign of head injuries)  Slow or changing pulse  Blood or fluid draining from the nose or ears  Bruises, cuts, and swelling on the scalp  Dents or depressions in the skull  Headache  Penetrating injury  Nausea and vomiting  Visual disturbances  Treatment: Recognize life threatening conditions and activate EMS. Manually stabilize the head and spine. Check and correct ABC. Abdominal Emergencies Key Points: It is difficult to know what the exact problem may be with abdominal emergencies. Such emergencies may include but are not limited to: Internal bleeding, tubular pregnancy, appendicitis, bowl obstruction, organ damage, etc.  Signs and symptoms  Pain and tenderness  Rigidity  Nausea and vomiting  Bruising of the external abdomen  Treatment: Recognize life threatening emergencies and activate EMS. Care for shock, check and correct ABC.  59 Show video: Diabetes Key Points:  Diabetic Emergencies  Signs & Symptoms  Altered level of consciousness  Personality changes  Irritability  Weakness  Dizziness  Coma  Unusual breathing  Cool, clammy skin  Seizures or shakiness  Treatment: Give sugar if conscious. If unconscious or condition does not improve, activate EMS, check and correct ABC. Show video: Seizures Key Points:  60 Seizures  Signs & Symptoms  Altered level of consciousness  Uncontrollable shaking  Treatment: Activate EMS if the reason for the seizure is unknown or it lasts for more than 5 minutes. Protect patient from further harm, place nothing in the mouth, and do not try to restrain the patient. After seizure ends, open the airway, check and correct ABC, and consider moving patient into the recovery position if patient is unconscious and breathing. Moving Patients Key Points:  In general a rescuer should never move a patient unless it is necessary to provide care or there is a direct danger to the patients life. Remember to protect the patient’s head, neck and back.  Recovery Position  Helps keep airway open  Allows fluid to drain from mouth  Prevents aspiration  Extend victim’s arm closest to you above victim’s head  Place vicim’s leg farthest from you, over his other leg.  Support head and neck  Place victim’s arm farthest from you across his chest  Roll victim towards you  Position victims top leg so the knee acts as a prop for the body  Place victim’s hand under chin to keep airway open  Rescue Moves  Clothing Drag Grasp the shirt near the shoulders. Lift up and walk backwards dragging the patient.  Blanket Drag Place the patient on blanket or sheet. Grasp at head end, lift up and walk backwards dragging the patient.  Extremity drag If necessary simply drag by holding forearms and pulling. Use ProFirstAid Final Test and answer sheets in Appendix D Administer Written Test     Allow students ample time to complete the test. Check answers using the answer sheet Students must have 80% correct to pass the test Student who fail may be remediated and given a second opportunity to pass the test. Students who do not pass the second attempt must retake the course After-course responsibilities:  Instructor completes student checklist and keeps a copy on file for min. of 2 years.61  Instructor completes online classroom records through instructor dashboard so students will receive certification cards. 62 63 ProFirstAid Basic CourseLayrescuer Adult CPR/AED and First Aid 64 ProFirstAid Basic Course Instructor Activities: Course Introduction: Videos for ProFirstAid Basic Course are available at: www.basic.profirstaid.com and on the ProFirstAid Instructor DVD Key Points: Use ProFirstAid Basic Skill Sheets for Skill sessions from appendix A  The goal of the ProFirstAid Basic Layrescuer program is to help the student gain the knowledge and skills necessary to manage a medical emergency and to provide layrescuer level CPR until more advanced help is available.  The techniques you will practice today will cover adult skills in 1 person CPR, conscious choking, unconscious choking, AED, and First Aid.  The course will combine short video segments, skill practice and demonstration on manikins, and teaching sessions. There will be a written test at the end. Make sure to pay attention to the key points in each of our activities.   Are there any questions before we begin? (briefly answer any questions) Five Fears: Show video: Five Fears Key Points:  Five Fears: Most people don’t get involved in performing first aid or CPR because of fear. Don’t let fear stop you. You will give the best possible care for the patient by doing something rather than nothing. We can break down almost all fears into five categories. Don’t let these fears stop you.  Fear of Disease: The Solution: Universal precautions. Always use personal protective equipment. In other words, gloves and a face shield. If you don’t have it available, you can perform hands only CPR.  Fear of Lawsuits: The Solution: Good Samaritan Laws protect you from legal liability 65 when you act in good faith and do not have a duty to act.  Fear of Uncertainty: The Solution: Emphasis is placed on the role of CPR, not merely on the number sequences. Even if numbers are forgotten, remember to push hard and push fast. The key is to circulate blood with oxygen to the brain until advanced medical care is available.  Fear of Hurting a Patient: The Solution: Patients who are clinically dead can only be helped, not made worse with resuscitation efforts.  Fear of Unsafe Scene: The Solution: Never enter an unsafe scene! Rescuers are no use to patients if they become patients themselves. A dead rescuer is no rescuer. Basic Physiology and CPR Philosophy: ProNote: The Chain of Survival AED Key Points:     Early Activation of EMS Early CPR Early Defibrillation Early Advanced Care Providing CPR early after a person collapses keeps a person from going into biological death. At the moment a per- The earlier these steps take place in an emerson’s heart stops and breathing stops, gency, the better the chance of a patient’s survival. the condition is called clinical death. A person has about 4-6 minutes of oxygen in the blood and body tissues. After 10 minutes of no breathing and no circulation, the body goes into biological death. Brain cells have died. It is rare to revive a person after biological death has occurred. CPR helps extend this time before biological death occurs, by getting circulating oxygen. CPR is not intended to restart the heart. Advanced care is needed to get the heart back into a regular rhythm.  Basic Anatomy & Physiology The cardiovascular system comprises the heart, arteries, capillaries, and veins. a) Heart – consists of four chambers, about the size of your fist, located under the breastbone. Function of the heart is to pump the blood to the brain, lungs and body. b) Lungs – there are two lungs, functions to take in oxygen and release carbon dioxide. c) Brain – tells the rest of the body what to do and needs oxygen on a regular basis. Brain cells will begin to die in 4 to 6 minutes (without oxygen). d) Cells – all cells of the body consistently require oxygen to carry out normal functions. Carbon dioxide is produced as a waste product and must be eliminated from the body through the lungs.  66  The ProCPR Method Protect yourself Safety first! Make sure the scene is safe. Do not enter an unsafe scene! If it is unsafe, stay at a safe distance and activate EMS (call 911). Prepare and apply appropriate personal protective equipment Respond Is the scene safe or can the scene be made safe for the rescuer? Is there a true medical emergency? Observe signs and symptoms Shout to the patient first then tap and shout to determine the level of responsiveness. Ask what happened? Are there any life threatening conditions? Call If no response or a life threatening condition exists, activate EMS (call 911). Provide proper care Care for the patient based on present medical conditions. Relinquish care to the provider of the next level of care Show video: Cardiovascular Disease and Heart Attacks Key Points:  Cardiovascular Disease and Heart Attacks Cardiovascular disease is the number one killer in the United States. The Center for Disease Control reports that in the United States over 650,000 people die each year from cardiovascular disease. Controllable risk factors:  cigarette smoking  high blood pressure  obesity  lack of exercise  high blood cholesterol levels  uncontrolled diabetes  high fat diet  high stress 67 Uncontrollable risk factors  Race  Heredity  Sex  Age  Heart Attack Signs and Symptoms may include  Chest discomfort/pressure, tightness, may radiate to jaw and arms.  Nausea  Sweating  Shortness of breath  Denial  Feeling of weakness Treatment: Recognize the signs and symptoms of a heart attack, activate EMS, have patient remain in a position of comfort, offer 1 adult dose aspirin, and keep the patient calm and quiet. Show video: Stroke Key Points: 68  Much like a heart attack, a stroke is a blockage of a vessel. However, blocked vessel is in the brain. The more time that the stroke is let go, the more damage occurs to brain tissue.  Signs & Symptoms  Numbness or weakness of the face, arm or leg, especially on one side of the body  Confusion  Trouble speaking or understanding  Trouble seeing in one or both eyes  Trouble walking  Dizziness  Loss of balance or coordination  Severe headache with no known cause Treatment: Recognize stroke signs and symptoms, activate EMS, check and correct ABC. Give nothing by mouth. Keep patient calm and reassure. Place patient in recovery position if the patient is unconscious, breathing effectively, and there is no suspected head neck or back injury. Show video: How to Reduce Your Risk Show video: Glove Removal and Disposal Key Points: Before treating patients you need to know how to use personal protective equipment properly to prevent contact with potentially infectious body fluids.  Treat all body fluids as potentially infectious because bloodborne pathogens, HIV, HBV, and HBC, can be present when blood is not visible to the eye.  Using personal Protective Equipment 1. Putting Gloves on: Always use disposable gloves when providing first aid care. If you have a latex allergy use a latex alternative such as nitrile or vinyl. Before providing care, make sure the gloves are not ripped or damaged. You may need to remove rings or other jewelry that may rip the gloves. 2. Removing Gloves: Remember to use skin to skin and glove to glove. Pinch the outside wrist of the other gloved hand. Pull the glove off turning the glove inside-out as you remove it. Hold it in the gloved hand. Use the bare hand to reach inside the other glove at the wrist to turn it inside out trapping the other glove inside. Dispose of gloves properly. If you did it correctly, the outside of either glove never touched your exposed skin. 3. Use a Rescue Mask or Face Shield: If you have to provide rescue ventilations, use a rescue mask or face shield that has a one way valve. To prevent exposure, avoid giving direct mouth to mouth ventilations.  The Chain of Survival Key Points:  The earlier these steps take place in an emergency, the better the chance of a patient’s survival. 69      Activating EMS – Call 911  Send someone to call 911 and tell them to come back. The caller should give dispatch the patient’s location, what happened, how many people are injured, and what is being done.  70 Early Recognition and Activation of EMS Early CPR Early Defibrillation Early Advanced Care If alone and no one is available PHONE FIRST for adults and get the AED. Return to start CPR and use the AED.  CARE FIRST for children and infants by providing about 5 cycles or 2 minutes of CPR before activating the emergency response number.  CARE FIRST for all age patients of hypoxic (asphyxial) arrest (ei., drowning, injury, drug overdose). Show video: Adult CPR Key Points:  The purpose of CPR is to circulate blood with oxygen in it to the brain and vital organs. Your focus should be on consistent smooth compressions at a rate of at least 100 per minute, pressing hard and fast.  Order of skills:  Check the scene  Check responsiveness and normal breathing  Activate EMS  Give 30 chest Compressions at a rate of at least 100 compressions per minute.  Open Airway using head tilt chin lift  Give 2 Breaths lasting 1 second each. Watch for chest rise and fall.  Continue cycles of 30 compressions to 2 breaths until an AED arrives, advanced medical personnel take over, the patient shows signs of life, the scene becomes unsafe, or you are too exhausted to continue.  ProNotes:  Infant is under 1 year old  Child is 1 to onset of puberty. Approx 12-14 years old.  Adult is onset of puberty and older.  Breaths: Watch for chest rise. Breaths should last 1 second each. When chest rises or resistance is felt, stop the breath.  Compressions: Push hard and push fast, and come up fully allowing the heart to refill. Compressions for all ages should be given at a rate of at least 100 per minute. DepthAdult– at least 2” Child & InfantAt least 1/3 the depth of the chest.  If you are unable or Hand placement for compressions: unwilling to give Adult— Place heel of hand of the dominant hand on breaths, at least the center of the chest between the nipples. The give compressions. second hand should be placed on top. Compression only CPR has been found to be effective. . One Rescuer CPR Skill Session  Direct students to the area where the manikins are ready. Arrange students 71           72 in groups as needed. Make sure students have the proper supplies. Gloves, practice face shields, manikin cleaning supplies, lungs, etc… There should be no more than 3 students per manikin. Tell students you will start with the adult manikin and adult scenario. Provide copies of the evaluator skill sheets for each student to use in class. Tell students you are going to direct them through the entire rescue breathing scenario, step by step. If you have more than 1 person per manikin, tell the other students to help coach and assist their partners with the skills as the scenario is presented. Lead the first set of students, as a group, through the scenario. Provide positive corrective feedback as necessary. Then allow the first set of students to practice on their own. Instructors should roam through the groups giving positive corrective feedback as necessary. After you have watched all of the students perform the skill correctly, check off their skills on the student checklist. If you have more than 1 person per manikin, disinfect the manikins and lead the next group of students through the scenario. Provide positive corrective feedback as necessary. Then allow the second student to practice on his or her own. Instructors should roam through the groups giving positive corrective feedback as necessary. After you have watched all of the students perform the skill correctly, check off their skills on the student skill sheet. Emphasize CAB: Circulation, Airway, Breathing  C– means that the rescuer will start compressions when there is no normal breathing or signs of life.  A– means that the patient’s airway is opened using a head tilt chin lift. The airway should be clear and free of any obstructions.  B– means that the rescuer will give breaths if the patient is not breathing. Breaths should last 1 second each and make the chest rise. At any time the air does not go in and make the chest rise, the rescuer should reposition the head and try again. Compressions: Consistent and smooth at a rate of at least 100 per minute, pressing hard and fast. Keep elbows locked and pivot at the waist. Press all the way down and come all the way back up without lifting off the chest. Lead students together through the Adult CPR scenario. Use the ProFirstAid Basic Adult CPR skill sheet. Make sure all students have satisfactorily passed the Adult CPR skills. ProNote:  An AED should include a kit containing gloves, face shield, a cloth to dry the chest, and a battery powered beard trimmer or shaver. Show video: Adult AED Key Points:                It is rare for children and infants to need an AED. The majority of cardiac problems in children are caused from breathing difficulties. CPR and effective rescue breaths are most important. AED use for a child or infant is considered ages 1month-8 years old. Use pediatric pads if available. If not, use a regular AED designed for adults. AED stands for Automated External Defibrillator AEDs are designed to shock the heart to stop chaotic rhythms, usually ventricular fibrillation, in order for the heart to restart under a normal rhythm. The AED analyzes the heart’s rhythm, advises whether a shock is advised and then powers up. The operator then pushes a button that will deliver the shock. Each minute the defibrillation is delayed the chance of survival is reduced by 10 percent. After 10 minutes few people are resuscitated. Early defibrillation within the first 5-6 minutes increases survival rates from just CPR alone to greater than 50%. Rescuers should begin chest compressions as soon as possible, and use the AED as soon as it is available and ready. If you are giving CPR to a child or infant, and the available AED does not have child pads or a way to deliver a smaller dose, use a regular AED with adult pads. You may need to place one pad on the front and one pad on the back. Bare the chest. Dry it off if it is wet. If there is excessive hair you may need to shave it off. Turn the machine on first. Place one pad on the patients upper right chest just below the collarbone and above the nipple. Place the other pad on the patients lower left ribs below the armpit. **Make sure to follow the directions shown on the pads for the AED pad placement. Manufactures will vary. Make sure pads are pressed down firmly. Do not try to lift up and adjust pads or they will not stick. Attach electrode cables now if not preconnected. Follow the directions the AED gives. Make sure to shout, “Stand Clear” before pushing the shock button. The normal cycle is 1 shock, 2 minutes of CPR, 1 shock, 2 minutes of CPR, etc. The AED should be kept still while in operation. It is not designed for movement, such as in a vehicle. 73       AED Considerations: Remove a patient from standing water, such as a puddle, before AED use. Rain, snow, or a wet surface is not a concern. Patient should be removed from a metal surface if possible. Slightly adjust pad placement so as not to directly cover the area if the patient has an obvious bump or scar for a pacemaker. Remove medication patches found on the patient’s chest with a gloved hand. Never remove the pads from the patient or turn off the AED. AED Skill Session            74 Direct students to the area where the manikins are ready. Arrange students in groups as needed. Make sure students have the proper supplies. Gloves, practice face shields, manikin cleaning supplies, lungs, etc… There should be no more than 3 students per manikin. Tell students you will start with the adult manikin and adult scenario. Provide copies of the evaluator skill sheets for each student to use in class. Tell students you are going to direct them through the entire skill scenario, step by step. If you have more than 1 person per manikin, tell the other students to help coach and assist their partners with the skills as the scenario is presented. Lead the first set of students, as a group, through the scenario. Provide positive corrective feedback as necessary. Then allow the first set of students to practice on their own. Instructors should roam through the groups giving positive corrective feedback as necessary. After you have watched all of the students perform the skill correctly, check off their skills on the student checklist. If you have more than 1 person per manikin, disinfect the manikins and lead the next group of students through the scenario. Provide positive corrective feedback as necessary. Then allow the second student to practice on his or her own. Instructors should roam through the groups giving positive corrective feedback as necessary. After you have watched all of the students perform the skill correctly, check off their skills on the student skill sheet. Practice with AED trainer/simulator: never use a real AED for practice Emphasize turning on the AED first and following the directions it gives. Lead students together through the Adult AED scenario. Use the ProFirstAid Basic Adult AED skill sheet. Current guidelines recommend AED with pediatric pads for infants and children. If no pediatric pads are available, adult pads can be used. Show video: Adult Conscious Choking Key Points:  Conscious Choking is when a victim cannot breath, cough or speak.  Look into the persons face and Ask, “Are you choking?”  If not able to breath, cough or speak, Activate EMS Adult  The rescuer should stand behind the victim and place one foot in-between the victims feet and the other foot behind in order to have a firm stance in case the victim becomes unconscious. In the case of a child, the rescuer may need to kneel down to get into the proper position  Administer abdominal thrusts until the object comes out or the patient becomes unconscious  Special Circumstances: If the patient is pregnant or too large to reach around, give chest thrusts. Conscious Choking Skill Session        Arrange students in groups as needed. Tell students you will start the adult conscious choking scenario. The rescuer should use the manikin to practice. Provide copies of the evaluator skill sheets for each student to use in class. Tell students you will direct them through the skill scenario, step by step. REMIND STUDENTS: If using partners rather than manikin to practice, DO NOT ACTUALLY GIVE THRUSTS TO EACH OTHER. Lead the students, as a group, through the scenario. Provide positive corrective feedback as necessary. Then allow the students to practice on their own. Instructors should roam through the groups giving positive corrective feedback as necessary. After you have watched all of the students perform the skill correctly, check off their skills on the student skill sheet. Use the following Infant CPR skill sheet: 75 Show video: Adult Unconscious Choking ProNote: Unconscious choking looks just like CPR with one added step, check the mouth. If you see an object sweep it out. Key Points: -Unconscious Choking  Unconscious  No signs of life. Absent breathing  Attempted rescue breaths will not go in Treatment:  If a conscious choking victim becomes unconscious, carefully lower person to the ground  Activate EMS  Give 30 chest Compressions at a rate of at least 100 compressions per minute.  Check the mouth for a foreign body. If something is seen sweep it out with a finger.  Open Airway using head tilt chin lift  Attempt a Breath  If first breath does not make the chest rise, reposition head and reattempt a breath. If first breath still does not make the chest rise, assume there is a foreign body airway obstruction.  Repeat 30 chest compressions, checking the mouth, and breathing attempts  After first breath goes in and makes the chest rise, give the second breath  If still not breathing normally and not moving, continue cycles of 30 chest compressions and 2 breaths. Unconscious Choking Skill Session  76 Direct students to the area where the manikins are ready. Arrange students in groups as needed. Make sure students have the proper supplies. Gloves,       practice face shields, manikin cleaning supplies, lungs, etc… There should be no more than 3 students per manikin. Tell students you will start with the adult manikin and adult scenario. Provide copies of the evaluator skill sheets for each student to use in class. Tell students you are going to direct them through the entire skill scenario, step by step. If you have more than 1 person per manikin, tell the other students to help coach and assist their partners with the skills as the scenario is presented. Lead the first set of students, as a group, through the scenario. Provide positive corrective feedback as necessary. Then allow the first set of students to practice on their own. Instructors should roam through the groups giving positive corrective feedback as necessary. After you have watched all of the students perform the skill correctly, check off their skills on the student checklist. If you have more than 1 person per manikin, disinfect the manikins and lead the next group of students through the scenario. Provide positive corrective feedback as necessary. Then allow the second student to practice on his or her own. Instructors should roam through the groups giving positive corrective feedback as necessary. After you have watched all of the students perform the skill correctly, check off their skills on the student checklist. 77 Show video: Arterial Bleeding Key Points: 78  Bleeding  For all bleeding, remember to use personal protective equipment.  Capillary bleeding is usually minor unless other injuries exists. Venous bleeding may be severe and potentially life threatening if a large cut and large blood loss exists. Arterial bleeding should always be considered severe and life threatening.  Treatment: Activate EMS if severe bleeding is present, use direct pressure at the site of the wound using an absorbent pad or gauze. Do not take off what you have applied. Add more gauze or padding if necessary. Watch for signs of shock and monitor ABC.  You may consider using a pressure bandage by wrapping a roller gauze or elastic bandage around the wound to maintain bleeding control.  If appears contaminated, irrigate with sterile or clean water. If wound is minor, wash and apply an antibiotic ointment, then bandage.  Nose Bleeds (Epistaxis)  Treatment: Pinch nose, tilt the head forward, and apply a cold pack to bridge of nose.  Evisceration (Disembowlment)  Treatment: Activate EMS, cover with sterile or clean moist dressing. Do not attempt to push bowl or organs back into place. Keep patient warm, care for shock, check and correct ABC.  Amputation  Treatment: Activate EMS, control bleeding with direct pressure, immobilize partial amputation with bulky dressing. If amputated part can be found wrap in clean or sterile dressing and place in plastic bag. Put bag in container of ice and water. Care for shock, check and correct ABC. Do not soak amputated part in water or allow it to freeze by putting it directly on ice. If teeth are knocked out, avoid handling by the root end, rinse with water, and store in milk. Bleeding Control Skill Session Direct students to the area where the supplies are ready. Arrange students in groups as needed. Make sure students have the proper supplies: gauze pads, roller bandage, gloves.  Provide copies of the evaluator skill sheets for each student to use in class.  Allow the students to practice on their own. Instructors should roam through the groups giving positive corrective feedback as necessary.  After you have watched all of the students perform the skill correctly, check off their skills on the student checklist.  79 Show video: Shock Key Points: Manage Shock  Shock is the body’s inability to circulate blood with oxygen to the brain and vital organs.  Signs & Symptoms: restlessness, anxiety, dizziness, confusion, cool moist skin, delayed capillary refill time, and weakness.  Treatment: Recognize, Activate EMS, keep calm, Nothing to eat or drink, maintain body heat, raise the legs if no spinal injury or fracture of the legs. Monitor ABC. Show video: Secondary Survey Key Points: Perform Ongoing Assessments  Check for and correct conditions which may not be immediately life threatening but may become so if not corrected.  SAMPLE (if time permits) get a sample history and do a “Head to Toe Survey” Symptoms Allergies Medications Past Medical History Last meal eaten Events leading up to need for help Look from head to toe for: Deformities Contusions Abrasions Penetrations Burns Tenderness 80 Lacerations Swelling  Head to Toe exam Head – soft spots, blood, look at the eyes, blood or loose teeth in the mouth, blood or fluid from nose or ears, bruising of the eyes and behind the ears Neck – bleeding, jugular vein distention, tracheal deviation, open wounds Chest – blood, accessory muscle breathing, broken ribs, or open wounds Abdomen – bleeding, abdominal evisceration, guarding, tenderness, bruising Pelvis – bleeding, unstable Legs – bleeding, bruising, deformity, open wounds, distal sensation and movement Arms – bleeding, bruising, deformity, open wounds, distal sensation and movement 81 Show video: Head, Neck, and Back Injuries Key Points:  Suspect Spinal Injuries in:  Motor Vehicle accidents  Pedestrian-vehicle collisions  Falls  Blunt trauma  Diving accidents  Any trauma leaving the patient unresponsive  Severe head injuries  Obvious bruising and injury to the neck  Treatment: Activate EMS, do not move the patient unless life threatening danger arises, maintain spinal stabilization, check and correct ABC. Show video: Musculoskeletal Injuries Key Points: 82 ProNote: Ice should not be placed directly on bare skin. Crepits- Crackling or grating feeling or sound under the skin.  Muscle & Bone Injuries  Consider the mechanism that caused the injury.  Look for deformity, open wounds, tenderness, swelling, discoloration, bruising, crepitus, and loss of movement.  Tell patient not to move the body part.  Cover any open wounds with dry clean dressings, but do not apply pressure over possible fracture.  General splinting is contraindicated in Current Guidelines. Stabilize fractures in the position found. Splinting may be appropriate if there will be an extended time for EMS response, EMS is not available, or an individual will be transporting the patient to a hospital.  Treatment: Activate EMS if necessary, manually stabilize the affected body part, do not attempt to straighten, use ice to minimize swelling. Show video: Burns Key Points:  Burns First Degree  Pain  Red Skin  Swelling  Second Degree  Pain  Blistering  White or Red Skin  Body fluids leaking from the burn site  Third Degree  Minimal pain at the burn site  Multicolored skin, black, white, gray, and red  Severe body fluid loss  Treatment: Cool burn with water, cover with dry sterile dressing (for chemical burns, flush with water for 15-20 minutes). For 1st and 2nd degree burns, activate EMS if severe conditions exist. For 3rd degree burns, electrical burns, and chemical burns activate EMS immediately. Care for shock, check and correct ABC.  For electrical burns look for an entrance and exit wound.  Show video: Eye injuries Key Points:  Eye Injuries  Burns – stop the burning, cool, and bandage both eyes  Chemical – flush with warm water for 15-20 minutes and bandage both eyes 83   Penetrating Trauma – Do not remove. Bandage the object into place, and cover both eyes. Treatment: Activate EMS if severe conditions exist. Seek professional medical treatment for all forms of eye injuries. Show video: Heat and Cold Emergencies Key Points:  84 Heat Related Emergencies  Heat Cramps  Faintness, dizziness  Exhaustion  Possible nausea and vomiting  Stiff boardlike abdomen  Normal mental status  Severe muscle cramps/pain  Sweating  Treatment: Get patient out of the hot environment, cool the patient, remove tight clothing, and give water if tolerated.  Heat Exhaustion  Moist and clammy skin, sweating  Pale  Weak, dizzy or faint  Headache  Nausea and vomiting  Treatment: Get patient out of the hot environment, remove clothing as necessary, gently cool the patient, give water if tolerated. If patient does not improve or becomes unconscious, activate EMS, check and correct ABC.  Heat Stroke  Life-threatening  Dry or wet skin, usually red  Very high body temperature  Coma or near coma  Treatment: Activate EMS immediately, get patient out of the hot environment, check and correct ABC, remove clothing as necessary, gently cool the patient, give nothing to drink or eat.  Cold Related Emergencies  Factors that affect onset  Weather severity  Age  Pre-existing medical condition  Alcohol or drug consumption  Clothing  Hypothermia signs and symptoms  Shivering (Usually in the early stages)  Feeling of numbness  Slow breathing  Slow pulse  Slurred speech  Decreased levels of consciousness  Hard, cold, painless body parts  Death  Treatment: Get patient out of cold environment. Gently rewarm by removing wet clothing and covering patient with a dry blanket. If patient does not improve, shows decreased level of consciousness or becomes unconscious, activate EMS.  Frost-Bite  Waxy looking, blistered, discolored, numb, swollen extremities (usually fingers and toes) after prolonged exposure to cold.  Black blisters may occur in severe cases.  Treatment: Seek immediate professional medical help. Do not rub the affected area. Do not rewarm area if chance of refreezing exists. Rewarm with warm or room temperature water, not hot. Show video: Allergic Reactions Show Video: Snake Bites \ Key Points:  Allergic Reactions  Allergic reaction can happen because of drugs, poisons, plants, inhalation, foods, or insect stings. 85  Signs and symptoms         Altered level of consciousness Hallucinations Burning sensation in the chest and throat Excessive sweating Difficulty breathing Nausea and vomiting Severe abdominal cramping Rashes/Hives Breathing Diffculty  If you see any signs of severe breathing difficulty, treat them as life threatening no matter the cause.  Signs & Symptoms  Shortness of breath or wheezing  Leaning forward to breath  Unable to make noise or speak  Blue lips and fingernails (Cyanosis)  Moist skin  Rapid, shallow breathing   Treatment for Allergic Reactions and Breathing Difficulties: Activate EMS and keep patient calm. Place in position of comfort. Ask about allergies, asthma, COPD or other medical conditions. Look for obvious bites and stings. If the patient has a prescribed inhaler or Epipen, assist patient to utilize the device. Check and correct ABC. Show video: Poison Control Key Points:  86 Poisoning  The most important thing you can do for poisonings is prevent them.  Signs & Symptoms  Altered level of consciousness  Hallucinations  Burning sensation in the chest and throat  Headache  Excessive sweating  Burns/stains around the mouth     Difficulty breathing Nausea and vomiting Severe abdominal cramping Treatment: Activate EMS, Check and correct ABC, and call Poison Control Services: 1-800-222-1222. Follow directions. Chest & Head Injuries Key Points:  Signs and Symptoms  Bruising around the eyes and behind the ears  Irregular or abnormal breathing patterns  Altered mental status (Most common sign of head injuries)  Slow or changing pulse  Blood or fluid draining from the nose or ears  Bruises, cuts, and swelling on the scalp  Dents or depressions in the skull  Headache  Penetrating injury  Nausea and vomiting  Visual disturbances  Treatment: Recognize life threatening conditions and activate EMS. Manually stabilize the head and spine. Check and correct ABC. Abdominal Emergencies Key Points: It is difficult to know what the exact problem may be with abdominal emergencies. Such emergencies may include but are not limited to: Internal bleeding, tubular pregnancy, appendicitis, bowl obstruction, organ damage, etc.  Signs and symptoms  Pain and tenderness  Rigidity  Nausea and vomiting  Bruising of the external abdomen  Treatment: Recognize life threatening emergencies and activate EMS. Care for shock, check and correct ABC.  87 Show video: Diabetes Key Points:  Diabetic Emergencies  Signs & Symptoms  Altered level of consciousness  Personality changes  Irritability  Weakness  Dizziness  Coma  Unusual breathing  Cool, clammy skin  Seizures or shakiness  Treatment: Give sugar if conscious. If unconscious or condition does not improve, activate EMS, check and correct ABC. Show video: Seizures Key Points:  88 Seizures  Signs & Symptoms  Altered level of consciousness  Uncontrollable shaking  Treatment: Activate EMS if the reason for the seizure is unknown or it lasts for more than 5 minutes. Protect patient from further harm, place nothing in the mouth, and do not try to restrain the patient. After seizure ends, open the airway, check and correct ABC, and consider moving patient into the recovery position if patient is unconscious and breathing. Moving Patients Key Points:  In general a rescuer should never move a patient unless it is necessary to provide care or there is a direct danger to the patients life. Remember to protect the patient’s head, neck and back.  Recovery Position  Helps keep airway open  Allows fluid to drain from mouth  Prevents aspiration  Extend victim’s arm closest to you above victim’s head  Place vicim’s leg farthest from you, over his other leg.  Support head and neck  Place victim’s arm farthest from you across his chest  Roll victim towards you  Position victims top leg so the knee acts as a prop for the body  Place victim’s hand under chin to keep airway open  Rescue Moves  Clothing Drag Grasp the shirt near the shoulders. Lift up and walk backwards dragging the patient.  Blanket Drag Place the patient on blanket or sheet. Grasp at head end, lift up and walk backwards dragging the patient.  Extremity drag If necessary simply drag by holding forearms and pulling. Use ProFirstAid Basic Final Test and answer sheets in Appendix D Administer Written Test     Allow students ample time to complete the test. Check answers using the answer sheet Students must have 80% correct to pass the test Student who fail may be remediated and given a second opportunity to pass the test. Students who do not pass the second attempt must retake the course After-course responsibilities:  Instructor completes student checklist and keeps a copy on file for min. of 2 years.  Instructor completes online classroom records through instructor dashboard so 89 students will receive certification cards. 90 ProCPR Basic CourseLayrescuer Adult CPR/AED 91 ProCPR Basic Course Instructor Activities: Course Introduction: Key Points: Videos for ProCPR Basic Course are available at: www.adult.procpr.org and on the ProFirstAid Instructor DVD Use ProCPR Basic Skill Sheets for Skill sessions from appendix A  The goal of the ProCPR Basic Layrescuer program is to help the student gain the knowledge and skills necessary to manage a medical emergency and to provide layrescuer level CPR until more advanced help is available.  The techniques you will practice today will cover adult skills in 1 person CPR, conscious choking, unconscious choking, and AED.  The course will combine short video segments, skill practice and demonstration on manikins, and teaching sessions. There will be a written test at the end. Make sure to pay attention to the key points in each of our activities.  Are there any questions before we begin? (briefly answer any questions) Five Fears: Show video: Five Fears Key Points:  92 Five Fears: Most people don’t get involved in performing first aid or CPR because of fear. Don’t let fear stop you. You will give the best possible care for the patient by doing something rather than nothing. We can break down almost all fears into five categories. Don’t let these fears stop you.  Fear of Disease: The Solution: Universal precautions. Always use personal protective equipment. In other words, gloves and a face shield. If you don’t have it available, you can perform hands only CPR.  Fear of Lawsuits: The Solution: Good Samaritan Laws protect you from legal liability when you act in good faith and do not have a duty to act.  Fear of Uncertainty: The Solution: Emphasis is placed on the role of CPR, not merely on the number sequences. Even if numbers are forgotten, remember to push hard and push fast. The key is to circulate blood with oxygen to the brain until advanced medical care is available.  Fear of Hurting a Patient: The Solution: Patients who are clinically dead can only be helped, not made worse with resuscitation efforts.  Fear of Unsafe Scene: The Solution: Never enter an unsafe scene! Rescuers are no use to patients if they become patients themselves. A dead rescuer is no rescuer. Basic Physiology and CPR Philosophy: ProNote: The Chain of Survival AED Key Points:     Early Activation of EMS Early CPR Early Defibrillation Early Advanced Care Providing CPR early after a person collapses keeps a person from going into biological death. At the moment a per- The earlier these steps take place in an emerson’s heart stops and breathing stops, gency, the better the chance of a patient’s survival. the condition is called clinical death. A person has about 4-6 minutes of oxygen in the blood and body tissues. After 10 minutes of no breathing and no circulation, the body goes into biological death. Brain cells have died. It is rare to revive a person after biological death has occurred. CPR helps extend this time before biological death occurs, by getting circulating oxygen. CPR is not intended to restart the heart. Advanced care is needed to get the heart back into a regular rhythm.  Basic Anatomy & Physiology The cardiovascular system comprises the heart, arteries, capillaries, and veins. a) Heart – consists of four chambers, about the size of your fist, located under the breastbone. Function of the heart is to pump the blood to the brain, lungs and body. b) Lungs – there are two lungs, functions to take in oxygen and release carbon dioxide. c) Brain – tells the rest of the body what to do and needs oxygen on a regular basis. Brain cells will begin to die in 4 to 6 minutes (without oxygen). d) Cells – all cells of the body consistently require oxygen to carry out normal functions. Carbon dioxide is produced as a waste product and must be eliminated from the body through the lungs.  93  The ProCPR Method Protect yourself Safety first! Make sure the scene is safe. Do not enter an unsafe scene! If it is unsafe, stay at a safe distance and activate EMS (call 911). Prepare and apply appropriate personal protective equipment Respond Is the scene safe or can the scene be made safe for the rescuer? Is there a true medical emergency? Observe signs and symptoms Shout to the patient first then tap and shout to determine the level of responsiveness. Ask what happened? Are there any life threatening conditions? Call If no response or a life threatening condition exists, activate EMS (call 911). Provide proper care Care for the patient based on present medical conditions. Relinquish care to the provider of the next level of care Show video: Cardiovascular Disease and Heart Attacks Key Points:  Cardiovascular Disease and Heart Attacks Cardiovascular disease is the number one killer in the United States. The Center for Disease Control reports that in the United States over 650,000 people die each year from cardiovascular disease. Controllable risk factors:  cigarette smoking  high blood pressure  obesity  lack of exercise  high blood cholesterol levels  uncontrolled diabetes  high fat diet  high stress 94 Uncontrollable risk factors  Race  Heredity  Sex  Age  Heart Attack Signs and Symptoms may include  Chest discomfort/pressure, tightness, may radiate to jaw and arms.  Nausea  Sweating  Shortness of breath  Denial  Feeling of weakness Treatment: Recognize the signs and symptoms of a heart attack, activate EMS, have patient remain in a position of comfort, offer 1 adult dose aspirin, and keep the patient calm and quiet. Show video: Stroke Key Points:  Much like a heart attack, a stroke is a blockage of a vessel. However, blocked vessel is in the brain. The more time that the stroke is let go, the more damage occurs to brain tissue.  Signs & Symptoms  Numbness or weakness of the face, arm or leg, especially on one side of the body  Confusion  Trouble speaking or understanding  Trouble seeing in one or both eyes  Trouble walking  Dizziness  Loss of balance or coordination  Severe headache with no known cause Treatment: Recognize stroke signs and symptoms, activate EMS, check and correct ABC. Give nothing by mouth. Keep patient calm and reassure. Place patient in recovery position if the patient is unconscious, breathing effectively, and there is no suspected head neck or back injury. 95 Show video: How to Reduce Your Risk Show video: Glove Removal and Disposal Key Points: Before treating patients you need to know how to use personal protective equipment properly to prevent contact with potentially infectious body fluids.  Treat all body fluids as potentially infectious because bloodborne pathogens, HIV, HBV, and HBC, can be present when blood is not visible to the eye.  Using personal Protective Equipment 1. Putting Gloves on: Always use disposable gloves when providing first aid care. If you have a latex allergy use a latex alternative such as nitrile or vinyl. Before providing care, make sure the gloves are not ripped or damaged. You may need to remove rings or other jewelry that may rip the gloves. 2. Removing Gloves: Remember to use skin to skin and glove to glove. Pinch the outside wrist of the other gloved hand. Pull the glove off turning the glove inside-out as you remove it. Hold it in the gloved hand. Use the bare hand to reach inside the other glove at the wrist to turn it inside out trapping the other glove inside. Dispose of gloves properly. If you did it correctly, the outside of either glove never touched your exposed skin. 3. Use a Rescue Mask or Face Shield: If you have to provide rescue ventilations, use a rescue mask or face shield that has a one way valve. To prevent exposure, avoid giving direct mouth to mouth ventilations.  The Chain of Survival Key Points:  96 The earlier these steps take place in an emergency, the better the chance of a patient’s survival.      Early Recognition and Activation of EMS Early CPR Early Defibrillation Early Advanced Care Activating EMS – Call 911  Send someone to call 911 and tell them to come back. The caller should give dispatch the patient’s location, what happened, how many people are injured, and what is being done.  If alone and no one is available PHONE FIRST for adults and get the AED. Return to start CPR and use the AED.  CARE FIRST for children and infants by providing about 5 cycles or 2 minutes of CPR before activating the emergency response number.  CARE FIRST for all age patients of hypoxic (asphyxial) arrest (ei., drowning, injury, drug overdose). 97 Show video: Adult CPR Key Points:  The purpose of CPR is to circulate blood with oxygen in it to the brain and vital organs. Your focus should be on consistent smooth compressions at a rate of at least 100 per minute, pressing hard and fast.  Order of skills:  Check the scene  Check responsiveness and normal breathing  Activate EMS  Give 30 chest Compressions at a rate of at least 100 compressions per minute.  Open Airway using head tilt chin lift  Give 2 Breaths lasting 1 second each. Watch for chest rise and fall.  Continue cycles of 30 compressions to 2 breaths until an AED arrives, advanced medical personnel take over, the patient shows signs of life, the scene becomes unsafe, or you are too exhausted to continue.  ProNotes:  Infant is under 1 year old  Child is 1 to onset of puberty. Approx 12-14 years old.  Adult is onset of puberty and older.  Breaths: Watch for chest rise. Breaths should last 1 second each. When chest rises or resistance is felt, stop the breath.  Compressions: Push hard and push fast, and come up fully allowing the heart to refill. Compressions for all ages should be given at a rate of at least 100 per minute. DepthAdult– at least 2” Child & InfantAt least 1/3 the depth of the chest.  If you are unable or Hand placement for compressions: unwilling to give Adult— Place heel of hand of the dominant hand on breaths, at least the center of the chest between the nipples. The give compressions. second hand should be placed on top. Compression only CPR has been found to be effective. . One Rescuer CPR Skill Session  98 Direct students to the area where the manikins are ready. Arrange students           in groups as needed. Make sure students have the proper supplies. Gloves, practice face shields, manikin cleaning supplies, lungs, etc… There should be no more than 3 students per manikin. Tell students you will start with the adult manikin and adult scenario. Provide copies of the evaluator skill sheets for each student to use in class. Tell students you are going to direct them through the entire rescue breathing scenario, step by step. If you have more than 1 person per manikin, tell the other students to help coach and assist their partners with the skills as the scenario is presented. Lead the first set of students, as a group, through the scenario. Provide positive corrective feedback as necessary. Then allow the first set of students to practice on their own. Instructors should roam through the groups giving positive corrective feedback as necessary. After you have watched all of the students perform the skill correctly, check off their skills on the student checklist. If you have more than 1 person per manikin, disinfect the manikins and lead the next group of students through the scenario. Provide positive corrective feedback as necessary. Then allow the second student to practice on his or her own. Instructors should roam through the groups giving positive corrective feedback as necessary. After you have watched all of the students perform the skill correctly, check off their skills on the student skill sheet. Emphasize CAB: Circulation, Airway, Breathing  C– means that the rescuer will start compressions when there is no normal breathing or signs of life.  A– means that the patient’s airway is opened using a head tilt chin lift. The airway should be clear and free of any obstructions.  B– means that the rescuer will give breaths if the patient is not breathing. Breaths should last 1 second each and make the chest rise. At any time the air does not go in and make the chest rise, the rescuer should reposition the head and try again. Compressions: Consistent and smooth at a rate of at least 100 per minute, pressing hard and fast. Keep elbows locked and pivot at the waist. Press all the way down and come all the way back up without lifting off the chest. Lead students together through the Adult CPR scenario. Use the ProFirstAid Basic Adult CPR skill sheet. Make sure all students have satisfactorily passed the Adult CPR skills. 99 ProNote:  An AED should include a kit containing gloves, face shield, a cloth to dry the chest, and a battery powered beard trimmer or shaver. Show video: Adult AED Key Points:               100  It is rare for children and infants to need an AED. The majority of cardiac problems in children are caused from breathing difficulties. CPR and effective rescue breaths are most important. AED use for a child or infant is considered ages 1month-8 years old. Use pediatric pads if available. If not, use a regular AED designed for adults. AED stands for Automated External Defibrillator AEDs are designed to shock the heart to stop chaotic rhythms, usually ventricular fibrillation, in order for the heart to restart under a normal rhythm. The AED analyzes the heart’s rhythm, advises whether a shock is advised and then powers up. The operator then pushes a button that will deliver the shock. Each minute the defibrillation is delayed the chance of survival is reduced by 10 percent. After 10 minutes few people are resuscitated. Early defibrillation within the first 5-6 minutes increases survival rates from just CPR alone to greater than 50%. Rescuers should begin chest compressions as soon as possible, and use the AED as soon as it is available and ready. If you are giving CPR to a child or infant, and the available AED does not have child pads or a way to deliver a smaller dose, use a regular AED with adult pads. You may need to place one pad on the front and one pad on the back. Bare the chest. Dry it off if it is wet. If there is excessive hair you may need to shave it off. Turn the machine on first. Place one pad on the patients upper right chest just below the collarbone and above the nipple. Place the other pad on the patients lower left ribs below the armpit. **Make sure to follow the directions shown on the pads for the AED pad placement. Manufactures will vary. Make sure pads are pressed down firmly. Do not try to lift up and adjust pads or they will not stick. Attach electrode cables now if not preconnected. Follow the directions the AED gives. Make sure to shout, “Stand Clear” before pushing the shock button. The normal cycle is 1 shock, 2 minutes of CPR, 1 shock, 2 minutes of CPR, etc. The AED should be kept still while in operation. It is not designed for movement, such as in a vehicle.       AED Considerations: Remove a patient from standing water, such as a puddle, before AED use. Rain, snow, or a wet surface is not a concern. Patient should be removed from a metal surface if possible. Slightly adjust pad placement so as not to directly cover the area if the patient has an obvious bump or scar for a pacemaker. Remove medication patches found on the patient’s chest with a gloved hand. Never remove the pads from the patient or turn off the AED. AED Skill Session            Direct students to the area where the manikins are ready. Arrange students in groups as needed. Make sure students have the proper supplies. Gloves, practice face shields, manikin cleaning supplies, lungs, etc… There should be no more than 3 students per manikin. Tell students you will start with the adult manikin and adult scenario. Provide copies of the evaluator skill sheets for each student to use in class. Tell students you are going to direct them through the entire skill scenario, step by step. If you have more than 1 person per manikin, tell the other students to help coach and assist their partners with the skills as the scenario is presented. Lead the first set of students, as a group, through the scenario. Provide positive corrective feedback as necessary. Then allow the first set of students to practice on their own. Instructors should roam through the groups giving positive corrective feedback as necessary. After you have watched all of the students perform the skill correctly, check off their skills on the student checklist. If you have more than 1 person per manikin, disinfect the manikins and lead the next group of students through the scenario. Provide positive corrective feedback as necessary. Then allow the second student to practice on his or her own. Instructors should roam through the groups giving positive corrective feedback as necessary. After you have watched all of the students perform the skill correctly, check off their skills on the student skill sheet. Practice with AED trainer/simulator: never use a real AED for practice Emphasize turning on the AED first and following the directions it gives. Lead students together through the Adult AED scenario. Use the ProFirstAid Basic Adult AED skill sheet. Current guidelines recommend AED with pediatric pads for infants and children. If no pediatric pads are available, adult pads can be used. 101 Show video: Adult Conscious Choking Key Points:  Conscious Choking is when a victim cannot breath, cough or speak.  Look into the persons face and Ask, “Are you choking?”  If not able to breath, cough or speak, Activate EMS Adult  The rescuer should stand behind the victim and place one foot in-between the victims feet and the other foot behind in order to have a firm stance in case the victim becomes unconscious. In the case of a child, the rescuer may need to kneel down to get into the proper position  Administer abdominal thrusts until the object comes out or the patient becomes unconscious  Special Circumstances: If the patient is pregnant or too large to reach around, give chest thrusts. Conscious Choking Skill Session        102 Arrange students in groups as needed. Tell students you will start the adult conscious choking scenario. The rescuer should use the manikin to practice. Provide copies of the evaluator skill sheets for each student to use in class. Tell students you will direct them through the skill scenario, step by step. REMIND STUDENTS: If using partners rather than manikin to practice, DO NOT ACTUALLY GIVE THRUSTS TO EACH OTHER. Lead the students, as a group, through the scenario. Provide positive corrective feedback as necessary. Then allow the students to practice on their own. Instructors should roam through the groups giving positive corrective feedback as necessary. After you have watched all of the students perform the skill correctly, check off their skills on the student skill sheet. Use the following Infant CPR skill sheet: Show video: Adult Unconscious Choking ProNote: Unconscious choking looks just like CPR with one added step, check the mouth. If you see an object sweep it out. Key Points: -Unconscious Choking  Unconscious  No signs of life. Absent breathing  Attempted rescue breaths will not go in Treatment:  If a conscious choking victim becomes unconscious, carefully lower person to the ground  Activate EMS  Give 30 chest Compressions at a rate of at least 100 compressions per minute.  Check the mouth for a foreign body. If something is seen sweep it out with a finger.  Open Airway using head tilt chin lift  Attempt a Breath  If first breath does not make the chest rise, reposition head and reattempt a breath. If first breath still does not make the chest rise, assume there is a foreign body airway obstruction.  Repeat 30 chest compressions, checking the mouth, and breathing attempts  After first breath goes in and makes the chest rise, give the second breath  If still not breathing normally and not moving, continue cycles of 30 chest compressions and 2 breaths. Unconscious Choking Skill Session  Direct students to the area where the manikins are ready. Arrange students in groups as needed. Make sure students have the proper supplies. Gloves, 103       104 practice face shields, manikin cleaning supplies, lungs, etc… There should be no more than 3 students per manikin. Tell students you will start with the adult manikin and adult scenario. Provide copies of the evaluator skill sheets for each student to use in class. Tell students you are going to direct them through the entire skill scenario, step by step. If you have more than 1 person per manikin, tell the other students to help coach and assist their partners with the skills as the scenario is presented. Lead the first set of students, as a group, through the scenario. Provide positive corrective feedback as necessary. Then allow the first set of students to practice on their own. Instructors should roam through the groups giving positive corrective feedback as necessary. After you have watched all of the students perform the skill correctly, check off their skills on the student checklist. If you have more than 1 person per manikin, disinfect the manikins and lead the next group of students through the scenario. Provide positive corrective feedback as necessary. Then allow the second student to practice on his or her own. Instructors should roam through the groups giving positive corrective feedback as necessary. After you have watched all of the students perform the skill correctly, check off their skills on the student checklist. Show video: Arterial Bleeding Key Points:  Bleeding  For all bleeding, remember to use personal protective equipment.  Capillary bleeding is usually minor unless other injuries exists. Venous bleeding may be severe and potentially life threatening if a large cut and large blood loss exists. Arterial bleeding should always be considered severe and life threatening.  Treatment: Activate EMS if severe bleeding is present, use direct pressure at the site of the wound using an absorbent pad or gauze. Do not take off what you have applied. Add more gauze or padding if necessary. Watch for signs of shock and monitor ABC.  You may consider using a pressure bandage by wrapping a roller gauze or elastic bandage around the wound to maintain bleeding control.  If appears contaminated, irrigate with sterile or clean water. If wound is minor, wash and apply an antibiotic ointment, then bandage.  Nose Bleeds (Epistaxis)  Treatment: Pinch nose, tilt the head forward, and apply a cold pack to bridge of nose.  Evisceration (Disembowlment)  Treatment: Activate EMS, cover with sterile or clean moist dressing. Do not attempt to push bowl or organs back into place. Keep patient warm, care for shock, check and correct ABC.  Amputation  Treatment: Activate EMS, control bleeding with direct pressure, immobilize partial amputation with bulky dressing. If amputated part can be found wrap in clean or sterile dressing and place in plastic bag. Put bag in container of ice and water. Care for shock, check and correct ABC. Do not soak amputated part in water or allow it to freeze by putting it directly on ice. If teeth are knocked out, avoid handling by the root end, rinse with water, and store in milk. 105 Show video: Shock Key Points: Manage Shock  Shock is the body’s inability to circulate blood with oxygen to the brain and vital organs.  Signs & Symptoms: restlessness, anxiety, dizziness, confusion, cool moist skin, delayed capillary refill time, and weakness.  Treatment: Recognize, Activate EMS, keep calm, Nothing to eat or drink, maintain body heat, raise the legs if no spinal injury or fracture of the legs. Monitor ABC. Key Points: Perform Ongoing Assessments  Check for and correct conditions which may not be immediately life threatening but may become so if not corrected.  106 SAMPLE (if time permits) get a sample history and do a “Head to Toe Survey” Symptoms Allergies Medications Past Medical History Last meal eaten Events leading up to need for help Look from head to toe for: Deformities Contusions Abrasions Penetrations Burns Tenderness Moving Patients Key Points:  In general a rescuer should never move a patient unless it is necessary to provide care or there is a direct danger to the patients life. Remember to protect the patient’s head, neck and back.  Recovery Position  Helps keep airway open  Allows fluid to drain from mouth  Prevents aspiration  Extend victim’s arm closest to you above victim’s head  Place vicim’s leg farthest from you, over his other leg.  Support head and neck  Place victim’s arm farthest from you across his chest  Roll victim towards you  Position victims top leg so the knee acts as a prop for the body  Place victim’s hand under chin to keep airway open  Rescue Moves  Clothing Drag Grasp the shirt near the shoulders. Lift up and walk backwards dragging the patient.  Blanket Drag Place the patient on blanket or sheet. Grasp at head end, lift up and walk backwards dragging the patient.  Extremity drag If necessary simply drag by holding forearms and pulling. Use ProCPR Basic Final Test and answer sheets in Appendix D Administer Written Test     Allow students ample time to complete the test. Check answers using the answer sheet Students must have 80% correct to pass the test Student who fail may be remediated and given a second opportunity to pass the test. Students who do not pass the second attempt must retake the course After-course responsibilities:  Instructor completes student checklist and keeps a copy on file for min. of 2 years.  Instructor completes online classroom records through instructor dashboard so 107 students will receive certification cards. 108 ProFirstAid Advanced CourseHealthcare Provider Adult, Child, Infant CPR/AED and First Aid 109 ProFirstAid Advanced Instructor Activities: Course Introduction: Videos for the ProFirstAid Advanced Course are available online at: www.advanced.profirstaid.com and on the ProCPR Instructor DVD for the CPR/AED topics and on the ProFirstAid Instructor DVD for the First Aid topics Key Points:  The goal of the ProFirstAid Advanced healthcare provider program is to help the student gain the knowledge and skills necessary to provide basic life support in a medical emergency until more advanced help is available.  The techniques you will practice today will cover adult, child, and infant skills in rescue breathing, 1 person CPR, 2 person CPR, conscious choking, unconscious choking, AED, bag valve mask usage, and First Aid.  The course will combine short video segments, skill practice and demonstration on manikins, and teaching sessions. There will be a written test at the end. Make sure to pay attention to the key points in each of our activities.  Are there any questions before we begin? (briefly answer any questions) ProFirstAid Advanced combines Healthcare Provider CPR/AED skills with First Aid. For the Healthcare Provider CPR/AED portion, use the ProCPR Instructor activities starting with the Five Fears on page 12 through page 28 and Spinal Injury on page 30. For the First Aid portion, use the ProFirstAid Instructor activities starting on page 46 through page 57. For Skills Sessions Use ProFirstAid Advanced Skills Cover Sheet from Appendix A. Use all of the ProCPR Skill Sheets from Appendix A. Use the Bleeding Control scenario from the ProFirstAid Skill Sheet from appendix A. Use ProFirstAid Advanced Final Test and answer sheets in Appendix D Administer Written Test     Allow students ample time to complete the test. Check answers using the answer sheet Students must have 80% correct to pass the test Student who fail may be remediated and given a second opportunity to pass the test. Students who do not pass the second attempt must retake the course After-course responsibilities: 110  Instructor completes student checklist and keeps a copy on file for min. of 2 years.  Instructor completes online classroom records through instructor dashboard so students will receive certification cards. 111 Appendix A     112 Skill Evaluation Checklists and Skill Sheets Skill sheets are meant to be used as a tool for the instructor/evaluator to evaluate the skills of participants. The instructor/evaluator may need to add more to the prompt or correct the participant if he or she does an incorrect skill. For example, the evaluator says, “The patient is not breathing.” The evaluator should not just stare at the participant until something happens. Rather, the evaluator may need to say, “What would you do next?” The object is to get the participant to think critically. The evaluator should be thinking, “Did the participant accomplish the goal of the scenario?” rather than the particular details with each individual skill. As participants perform skills the evaluator should watch for any errors and provide positive correction right away so the participant can practice the skill correctly. Instructors/evaluators should allow and direct practice as needed for individuals. The instructor/evaluator must complete the skill checklist for each participant as skills are assessed. The instructor/evaluator needs to keep a copy on file of the completed checklist for each student for a minimum of 2 years. 113 Skill Evaluation Checklist 1-888-406-7487 support@procpr.org Skill Evaluator Signature: (Sign inside of box) Registry #________________ Fax or email completed form to: Fax: 810-592-5007 Email: support@procpr.org Required Skill Scenarios Rescue Breathing Adult or Child CPR Infant CPR AED Adult or Child Conscious Choking Infant Conscious Choking Adult or Child Unconscious Choking Infant Unconscious Choking Adult 2 rescuer CPR Infant 2 rescuer CPR Individual Skills –May be assessed while performed during skill scenarios. Assessing the scene for safety Using personal protective equipment: Gloves Face Shield/Rescue Mask Bag Valve Mask Assessing patient responsiveness Checking for a pulse: Adult and Child– Carotid Artery Infant– Brachial Artery Giving Compressions: Adult- 2 hands on the center of the chest between the nipples. Child– 1 or 2 hands on the center of the chest between the nipples. Infant– 2 fingers on the center of the chest just below the nipples. 2 Rescuer Infant- 2 thumbs hands encircling chest technique Opening the Airway using a head tilt chin lift Giving rescue breaths: Adult and Child– Covering mouth Infant– Covering mouth and nose Removing a foreign object 114 For Instructors: Passed Written Test 80% Participant Names– (Please Print) Date:______________ 115 Skill Sheets ProCPR: Healthcare Provider Adult, Child, Infant CPR/AED Required Skill Scenarios Individual Skills Adult or Child Rescue Breathing Assessing the scene for safety Adult or Child CPR Using personal protective equipment: Gloves Face Shield Rescue Mask Bag Valve Mask Infant CPR AED Adult or Child Conscious Choking Infant Conscious Choking Adult or Child Unconscious Choking Infant Unconscious Choking Adult 2 rescuer CPR Infant 2 rescuer CPR Assessing patient responsiveness Checking for a pulse: Adult and Child– Carotid Artery Infant– Brachial Artery Giving Compressions: Adult- 2 hands on the center of the chest between the nipples. Child– 1 or 2 hands on the center of the chest between the nipples. Infant– 2 fingers on the center of the chest just below the nipples. 2 Rescuer Infant- 2 thumbs hands encircling chest technique Opening the Airway using a head tilt chin lift Checking for breathing Giving rescue breaths: Adult and Child– Covering mouth Infant– Covering mouth and nose Removing a foreign object Adult Rescue Breathing Check Scene: 1 Check for safety, apply gloves and prepare face shield. Scenario: Check Person: 2 Check for responsiveness by holding head still, tapping and shouting. Look at chest and face to determine no normal breathing. A man fell into a pond and was just pulled out of the water as you arrive. He appears to be unconscious. What would you do? Call 911: 3 If unresponsive or a life-threatening condition exists, send someone to call 911 and get an AED if available. Required Equipment: Adult Manikin Check Pulse: 4 Place fingers in valley between neck muscle and wind pipe. Check the pulse for no more than 10 seconds. Open Airway: 5 If there is a pulse but no breathing, begin Rescue Breathing. Open Airway using a head tilt chin lift technique. Look in the mouth for any obstructions. Rescue Breathing: 6 Give 1 breath every 5 seconds. Each breath should last 1 second and make the chest rise and fall. Reassess circulation every two minutes. NOTE: If unsure a pulse exists, start CPR. Don’t waste more critical time searching for a pulse. When to stop: If the patient shows signs of life Trained personnel or EMS take over The scene becomes unsafe An AED is ready to use The rescuer is too exhausted to continue Follows 2010 ECC/ILCOR and American Heart Association Guidelines Child Rescue Breathing Check Scene: 1 Check for safety, apply gloves and prepare face shield. Scenario: Check Person: 2 Check for responsiveness by holding head still, tapping and shouting. Look at chest and face to determine no normal breathing. Call 911: 3 At the pool, an 8 year old, who appears to be unconscious, is pulled from the water. What would you do? NOTE: Child age for rescue breathing and CPR is age 1 to puberty (aprrox. 12-14 years old) If unresponsive or a life-threatening condition exists, send someone to call 911 and get an AED if available. Required Equipment: Adult Manikin Check Pulse: 4 Place fingers in valley between neck muscle and wind pipe. Check the pulse for no more than 10 seconds. Open Airway: 5 If there is a pulse but no breathing, begin Rescue Breathing. Open Airway using a head tilt chin lift technique. Look in the mouth for any obstructions Rescue Breathing: 6 Give 1 breath every 3 seconds. Each breath should last 1 second and make the chest rise and fall. Reassess circulation every two minutes. NOTE: If unsure a pulse exists, start CPR. Don’t waste more critical time searching for a pulse. When to stop: If the patient shows signs of life Trained personnel or EMS take over The scene becomes unsafe An AED is ready to use The rescuer is too exhausted to continue Follows 2010 ECC/ILCOR and American Heart Association Guidelines Infant Rescue Breathing Check Scene: 1 Check for safety, apply gloves and prepare face shield. Scenario: Check Person: 2 Check for responsiveness by holding head still, tapping and shouting. Look at chest and face to determine no normal breathing. Call 911: 3 At the pool, an 9 month old, who appears to be unconscious, is pulled from the water. What would you do? NOTE: Infant age for rescue breathing and CPR is less than 1 year old. If unresponsive or a life-threatening condition exists, send someone to call 911 and get an AED if available. Required Equipment: Infant Manikin Check Pulse: 4 Place fingers on the inside upper arm to check the brachial pulse. Check the pulse for no more than 10 seconds. Open Airway: 5 6 If there is a pulse but no breathing, begin Rescue Breathing. Open Airway using a head tilt chin lift technique. Look in the mouth for any obstructions Rescue Breathing: Note: Cover infant’s mouth and nose. Give 1 breath every 3 seconds. Each breath should last 1 second and make the chest rise and fall. Reassess circulation every two minutes. NOTE: If unsure a pulse exists, start CPR. Don’t waste more critical time searching for a pulse. When to stop: If the patient shows signs of life Trained personnel or EMS take over The scene becomes unsafe The rescuer is too exhausted to continue Follows 2010 ECC/ILCOR and American Heart Association Guidelines Adult CPR Check Scene: 1 Check for safety, apply gloves and prepare face shield. Scenario: Check Person: 2 Check for responsiveness by holding head still, tapping and shouting. Look at chest and face to determine no normal breathing. You are walking in the park when you see a man lying on the ground. What would you do? Call 911: 3 If unresponsive or a life-threatening condition exists, send someone to call 911 and get an AED if available. Required Equipment: Adult Manikin Check Pulse: 4 Place fingers in valley between neck muscle and wind pipe. Check the pulse for no more than 10 seconds. 30 Compressions: 5 If no pulse and no normal breathing, begin CPR. Use 2 hands, give 30 chest compressions, at a rate of at least 100/minute, and at least 2” deep. Open Airway: 6 Open Airway using a head tilt chin lift technique. Look in the mouth for any obstructions. Give 2 Breaths: 7 Give 2 breaths lasting 1 second each making sure the chest rises and falls with each breath. Continue CPR: 8 Give cycles of 30 chest compressions, followed by 2 breaths. When to stop: If the patient shows signs of life Trained personnel or EMS take over The scene becomes unsafe An AED is ready to use The rescuer is too exhausted to continue Follows 2010 ECC/ILCOR and American Heart Association Guidelines Child CPR Check Scene: 1 Check for safety, apply gloves and prepare face shield. Scenario: Check Person: 2 Check for responsiveness by holding head still, tapping and shouting. Look at chest and face to determine no normal breathing. An 8 year old was riding a bike and was struck by a vehicle. The child appears to be unconscious and is lying on the road. What would you do? Call 911: 3 If unresponsive or a life-threatening condition exists, send someone to call 911 and get an AED if available. Required Equipment: Adult/Child Manikin Check Pulse: 4 Place fingers in valley between neck muscle and wind pipe. Check the pulse for no more than 10 seconds. 30 Compressions: 5 If no pulse and no normal breathing, begin CPR. Use 1 or 2 hands, give 30 chest compressions, at a rate of at least 100/minute, and at least 1/3 the depth of the chest. Open Airway: 6 Open Airway using a head tilt chin lift technique. Look in the mouth for any obstructions. Give 2 Breaths: 7 Give 2 breaths lasting 1 second each making sure the chest rises and falls with each breath. Continue CPR: 8 Give cycles of 30 chest compressions, followed by 2 breaths. When to stop: If the patient shows signs of life Trained personnel or EMS take over The scene becomes unsafe An AED is ready to use The rescuer is too exhausted to continue Follows 2010 ECC/ILCOR and American Heart Association Guidelines Infant CPR Check Scene: 1 Check for safety, apply gloves and prepare face shield. Scenario: Check Person: 2 Check for responsiveness by holding head still, tapping and shouting. Look at chest and face to determine no normal breathing A neighbor knocks on your door and asks for help. She states her 6 month old baby is not waking up. You find the baby lying in a crib. Call 911: 3 If unresponsive or a life-threatening condition exists, send someone to call 911 and get an AED if available. Required Equipment: Infant Manikin Check Pulse: 4 Place fingers on the inside upper arm to check the brachial pulse. Check the pulse for no more than 10 seconds. 30 Compressions: 5 If no pulse and no normal breathing, begin CPR. Use 2 fingers, give 30 chest compressions, at a rate of at least 100/minute, and at least 1/3 the depth of the chest. Open Airway: 6 Open Airway using a head tilt chin lift technique. Look in the mouth for any obstructions. Give 2 Breaths: 7 Give 2 breaths lasting 1 second each making sure the chest rises and falls with each breath. Continue CPR: 8 Give cycles of 30 chest compressions, followed by 2 breaths. Note: Cover infant’s mouth and nose. When to stop: If the patient shows signs of life Trained personnel or EMS take over The scene becomes unsafe An AED is ready to use The rescuer is too exhausted to continue Follows 2010 ECC/ILCOR and American Heart Association Guidelines AED Power on the AED: 1 Check to make sure it is safe to use the AED. Unsafe conditions include, victim in water, on metal surface, flammable gas... Bare the Chest: 2 Follow directions of AED. Dry any wet areas on chest, remove any patches, shave hair if needed. Apply Pads: 3 Peel off backing and place pads as the picture on the pads shows. Press down firmly to assure pads are securely affixed. Scenario: You are performing CPR on a person when an AED arrives and is ready to use. What will you do? Note: For victims 8 years old and younger, or under 55 lbs, use child pads. If victim is over 8 or 55 pounds, use adult pads. Adult pads can be used if no child sized pads are available. Make sure the pads do not touch. Plug in Connector: 4 Follow AED directions. Some AED models have pre-connected electrodes and will sense when pads are secure. Required Equipment: Adult/Child Manikin and AED Trainer Stand Clear: 5 Don’t touch the victim while the AED is analyzing or charging. Push Shock Button: 6 7 Shout, “Clear,” and make sure no one is touching patient. 30 Compressions: Give 5 cycles of 30 chest compressions, at a rate of at least 100 compressions/minute, followed with 2 breaths. After 2 Minutes: 8 The AED will reanalyze. If AED says, “No shock advised,” continue CPR if no signs of life. Follow AED prompts. Note: Don’t wait. Begin compressions immediately after the shock is delivered. When to stop: If the patient shows signs of life Trained personnel or EMS take over The scene becomes unsafe The rescuer is too exhausted to continue Follows 2010 ECC/ILCOR and American Heart Association Guidelines Adult or Child Conscious Choking Check Person: 1 2 Ask, “Are you choking?” If the person cannot cough, speak or breath, he or she is choking and needs your help. Scenario: Call 911: You are eating a picnic lunch at the park when a person stands up and grasps his throat. What would you do? Send someone to call 911. If no one is available to call, provide care first. Stand Behind: 3 Place your foot between the person’s feet and place your other foot firmly on the ground beside you. Note: You will need to kneel down for a child in order to give effective abdominal thrusts. Required Equipment: Adult Manikin Position Hands: 4 Find the navel. Tucking in the thumb, place the thumb side of the fist against the abdomen, just above the navel. Give Thrusts: 5 Grasp the back of your fist, give inward -upward abdominal thrusts until object is out or person goes unconscious. When to stop: The object comes out The scene becomes unsafe The person becomes unconscious (Call 911 and perform unconscious choking technique in this case) Follows 2010 ECC/ILCOR and American Heart Association Guidelines Infant Conscious Choking Check Baby: 1 If the baby cannot cough, cry or breath, he is choking and needs your help. Call 911: 2 Scenario: You are feeding a baby lunch when he begins to turn blue and cannot cry, cough or breath. What would you do? Send someone to call 911. If no one is available to call, provide care first. Position Baby: 3 Support the baby’s face with your hand on the jaw and the baby’s body along your forearm. Place the baby face down. Required Equipment: Infant Manikin Give 5 Back Blows: 4 Holding the baby’s head lower then the feet, give 5 back blows between the shoulder blades. Turn Baby Over: 5 Hold the back of the head. Sandwich the baby between your forearms and turn him over. Give 5 Chest Thrusts: 6 Place fingers on the sternum in the center of the chest and give 5 thrusts. Repeat Steps 3 to 5: 7 Keep giving 5 back blows and 5 chest thrusts until the object comes out or baby goes unconscious. When to stop: The object comes out The baby becomes unconscious (Call 911 and perform unconscious choking technique in this case) Follows 2010 ECC/ILCOR and American Heart Association Guidelines Adult Unconscious Choking Position Person: 1 Lower person safely to the ground. Scenario: 2 Call 911: If 911 has not been called, send someone to call 911 and get an AED if available. You are eating in your favorite restaurant when a man starts choking. You perform abdominal thrusts and he goes unconscious. 30 Compressions: 3 Using 2 hands, give 30 chest compressions, at a rate of at least 100 compressions per minute, followed by object check. Required Equipment: Adult Manikin Check for Object: 4 Open Airway using a head tilt chin lift technique. Look in the mouth for any obstructions. If object is seen, do a finger sweep to remove it. Give a Breath: 5 Open airway and Give a breath. Even if no object is seen, attempt a breath. If air goes in give a second breath. Reposition, Reattempt: 6 If air does not go in, reposition and reattempt a breath. If air still does not go in, continue compressions. 30 Compressions: 7 Using 2 hands, give 30 chest compressions, at a rate of at least 100 compressions per minute, followed by object check. When to stop: If the patient shows signs of life Trained personnel or EMS take over The scene becomes unsafe The rescuer is too exhausted to continue Check for Object: 8 Note: After breaths go in, check pulse, and If object is seen, do a finger sweep to remove it. Repeat steps 5-8 until air goes in and makes chest rise. continue CPR if the person shows no signs of life. If there is breathing and pulse, monitor Airway, Breathing, and Circulation until EMS arrives. Follows 2010 ECC/ILCOR and American Heart Association Guidelines Child Unconscious Choking Position Person: 1 Lower person safely to the ground. Scenario: 2 Call 911: If 911 has not been called, send someone to call 911 and get an AED if available. You are eating in your favorite restaurant when a child starts choking. You perform abdominal thrusts and she goes unconscious. 30 Compressions: 3 Use 1 or 2 hands, give 30 chest compressions, at a rate of at least 100/minute, and at least 1/3 the depth of the chest. Required Equipment: Adult/Child Manikin Check for Object: 4 Open Airway using a head tilt chin lift technique. Look in the mouth for any obstructions. If object is seen, do a finger sweep to remove it. Give a Breath: 5 Open airway and Give a breath. Even if no object is seen, attempt a breath. If air goes in give a second breath. Reposition, Reattempt: 6 If air does not go in, reposition and reattempt a breath. If air still does not go in, continue compressions. 30 Compressions: 7 Use 1 or 2 hands, give 30 chest compressions, at a rate of at least 100/minute, and at least 1/3 the depth of the chest. When to stop: If the patient shows signs of life Trained personnel or EMS take over The scene becomes unsafe The rescuer is too exhausted to continue Check for Object: 8 If object is seen, do a finger sweep to remove it. Repeat steps 5-8 until air goes in and makes chest rise. Note: After breaths go in, check pulse, and continue CPR if the person shows no signs of life. If there is breathing and pulse, monitor Airway, Breathing, and Circulation until EMS arrives. Follows 2010 ECC/ILCOR and American Heart Association Guidelines Infant Unconscious Choking Position Person: 1 Lay the infant down, supine, on a flat surface. Scenario: 2 Call 911: If 911 has not been called, send someone to call 911 and get an AED if available. You enter a baby’s room and notice that several marbles are scattered around the baby on the floor. The baby is conscious and choking. You perform back blows and chest thrusts. The baby goes unconscious. What will you do next? 30 Compressions: 3 Use 2 fingers, give 30 chest compressions, at a rate of at least 100/minute, and at least 1/3 the depth of the chest. Required Equipment: Infant Manikin Check for Object: 4 Open Airway using a head tilt chin lift technique. Look in the mouth for any obstructions. If object is seen, do a finger sweep to remove it. Give a Breath: 5 Open airway and Give a breath. Even if no object is seen, attempt a breath. If air goes in give a second breath. Reposition, Reattempt: 6 If air does not go in, reposition and reattempt a breath. If air still does not go in, continue compressions. 30 Compressions: 7 Use 2 fingers, give 30 chest compressions, at a rate of at least 100/minute, and at least 1/3 the depth of the chest. When to stop: If the patient shows signs of life Trained personnel or EMS take over The scene becomes unsafe The rescuer is too exhausted to continue Check for Object: 8 If object is seen, do a finger sweep to remove it. Repeat steps 5-8 until air goes in and makes chest rise. Note: After breaths go in, check pulse, and continue CPR if the person shows no signs of life. If there is breathing and pulse, monitor Airway, Breathing, and Circulation until EMS arrives. Follows 2010 ECC/ILCOR and American Heart Association Guidelines Adult 2 Person CPR Check Scene: 1 Check for safety, apply gloves and prepare face shield. Scenario: Check Person: 2 Check for responsiveness by holding head still, tapping and shouting. You and a coworker are called to the park for a emergency. You see a man lying on the ground. What would you do? Call 911: 3 If unresponsive and no normal breathing, send someone to call 911 and get an AED if available. Required Equipment: Adult Manikin and Bag Valve Mask Check Pulse: 4 Place fingers in valley between neck muscle and wind pipe. Check the pulse for no more than 10 seconds. 30 Compressions: 5 Second rescuer will give 30 chest compressions using 2 hands in the center of the chest. Open Airway: 6 Note: Use the Bag Valve Mask to give breaths for this skill scenario. First rescuer will open Airway using a head tilt chin lift technique. Look in the mouth for any obstructions. When to stop: Give 2 Breaths: 7 If no breathing, using the bag valve mask, first rescuer gives 2 breaths lasting 1 second each making sure the chest rises and falls with each breath. If the patient shows signs of life Trained personnel or EMS take over The scene becomes unsafe An AED is ready to use The rescuer is too exhausted to continue Continue and Switch: 8 Continue cycles of 30:2. Every 2 minutes, compressor calls for switch. At end of 30 compressions, person at head ends with 2 breaths, moves, and starts compressions. Note: The switch should take no more than 10 seconds. The purpose of 2 person CPR is to keep the compressor fresh in order to provide the best consistent compressions. Follows 2010 ECC/ILCOR and American Heart Association Guidelines Child 2 Person CPR Check Scene: 1 Check for safety, apply gloves and prepare face shield. Scenario: Check Person: 2 Check for responsiveness by holding head still, tapping and shouting. You and a coworker are called to a bike vs. car accident. And 8 year old child appears to be unconscious and is lying on the road. What would you do? Call 911: 3 If unresponsive and no normal breathing, send someone to call 911 and get an AED if available. Required Equipment: Adult/Child Manikin and Bag Valve Mask Check Pulse: 4 Place fingers in valley between neck muscle and wind pipe. Check the pulse for no more than 10 seconds. 15 Compressions: 5 Second rescuer will give 15 chest compressions using 1 or 2 hands in the center of the chest. Open Airway: 6 Note: Use the Bag Valve Mask to give breaths for this skill scenario. First rescuer will open Airway using a head tilt chin lift technique. Look in the mouth for any obstructions. When to stop: Give 2 Breaths: 7 If no breathing, using the bag valve mask, first rescuer gives 2 breaths lasting 1 second each making sure the chest rises and falls with each breath. If the patient shows signs of life Trained personnel or EMS take over The scene becomes unsafe An AED is ready to use The rescuer is too exhausted to continue Continue and Switch: 8 Continue cycles of 15:2. Every 2 minutes, compressor calls for switch. At end of 15 compressions, person at head ends with 2 breaths, moves, and starts compressions. Note: The switch should take no more than 10 seconds. The purpose of 2 person CPR is to keep the compressor fresh in order to provide the best consistent compressions. Follows 2010 ECC/ILCOR and American Heart Association Guidelines Infant 2 Person CPR Check Scene: 1 Check for safety, apply gloves and prepare face shield. Scenario: Check Person: 2 Check for responsiveness by holding head still, tapping and shouting. You and another healthcare worker respond to a first aid call for a baby. When you arrive the baby is blue and does not appear to be moving. What will you do? Call 911: 3 If unresponsive and no normal breathing, send someone to call 911 and get an AED if available. Required Equipment: Infant Manikin and Rescue Mask Check Pulse: 4 Place fingers on the brachial artery on the inside of the upper arm. Check the pulse for no more than 10 seconds. 15 Compressions: 5 Second rescuer will give 15 chest compressions using the 2 thumbs hands encircling chest technique. Open Airway: 6 Note: Use the Bag Valve Mask to give breaths for this skill scenario. First rescuer will open Airway using a head tilt chin lift technique. Look in the mouth for any obstructions. When to stop: Give 2 Breaths: 7 If no breathing, using the bag valve mask, first rescuer gives 2 breaths lasting 1 second each making sure the chest rises and falls with each breath. If the patient shows signs of life Trained personnel or EMS take over The scene becomes unsafe An AED is ready to use The rescuer is too exhausted to continue Continue and Switch: 8 Continue cycles of 15:2. Every 2 minutes, compressor calls for switch. At end of 15 compressions, person at head ends with 2 breaths, moves, and starts compressions. Note: The switch should take no more than 10 seconds. The purpose of 2 person CPR is to keep the compressor fresh in order to provide the best consistent compressions. Follows 2010 ECC/ILCOR and American Heart Association Guidelines 132 133 Skill Evaluation Checklist Participant Names– (Please Print) 1-888-406-7487 support@procpr.org Skill Evaluator Signature: (Sign inside of box) Registry #________________ Fax or email completed form to: Fax: 810-592-5007 Email: support@procpr.org Required Skill Scenarios Adult or Child CPR Infant CPR AED Adult or Child Conscious Choking Infant Conscious Choking Adult or Child Unconscious Choking Infant Unconscious Choking Bleeding Control Individual Skills –May be assessed while performed during skill scenarios. Assessing the scene for safety Using personal protective equipment: Gloves Face Shield/Rescue Mask Assessing patient responsiveness Giving Compressions: Adult- 2 hands on the center of the chest between the nipples. Child– 1 or 2 hands on the center of the chest between the nipples. Infant– 2 fingers on the center of the chest just below the nipples. Opening the Airway using a head tilt chin lift Giving rescue breaths: Adult and Child– Covering mouth Infant– Covering mouth and nose Removing a foreign object For Instructors: Passed Written Test 80% Date:______________ 135 Skill Sheets ProFirstAid: Layrescuer Adult, Child, Infant CPR/AED and First Aid Required Skill Scenarios Individual Skills Adult or Child CPR Assessing the scene for safety Infant CPR AED Using personal protective equipment: Gloves Face Shield Adult or Child Conscious Choking Assessing patient responsiveness Infant Conscious Choking Giving Compressions: Adult- 2 hands on the center of the chest between the nipples. Child– 1 or 2 hands on the center of the chest between the nipples. Infant– 2 fingers on the center of the chest just below the nipples. Adult or Child Unconscious Choking Infant Unconscious Choking Bleeding Control Opening the Airway using a head tilt chin lift Giving rescue breaths: Adult and Child– Covering mouth Infant– Covering mouth and nose Removing a foreign object Adult CPR Check Scene: 1 Check for safety, apply gloves and prepare face shield. Scenario: Check Person: 2 Check for responsiveness by holding head still, tapping and shouting. Look at chest and face to determine no normal breathing. You are walking in the park when you see a man lying on the ground. What would you do? Call 911: 3 If unresponsive or a life-threatening condition exists, send someone to call 911 and get an AED if available. Required Equipment: Adult Manikin 30 Compressions: 4 Use 2 hands, give 30 chest compressions, at a rate of at least 100 compressions/minute, at least 2” deep. Open Airway: 5 Open Airway using a head tilt chin lift technique. Look in the mouth for any obstructions. Give 2 Breaths: 6 Give 2 breaths lasting 1 second each making sure the chest rises and falls with each breath. Continue CPR: 7 Give cycles of 30 chest compressions, followed by 2 breaths. When to stop: If the patient shows signs of life Trained personnel or EMS take over The scene becomes unsafe An AED is ready to use The rescuer is too exhausted to continue Follows 2010 ECC/ILCOR and American Heart Association Guidelines Child CPR Check Scene: 1 Check for safety, apply gloves and prepare face shield. Scenario: Check Person: 2 Check for responsiveness by holding head still, tapping and shouting. Look at chest and face to determine no normal breathing. At the pool, an 8 year old, who appears to be unconscious, is pulled from the water. What would you do? Call 911: 3 If unresponsive or a life-threatening condition exists, send someone to call 911 and get an AED if available. Required Equipment: Adult/Child Manikin 30 Compressions: 4 Use 1 or 2 hands, give 30 chest compressions, at a rate of at least 100/minute, and at least 1/3 the depth of the chest. Open Airway: 5 Open Airway using a head tilt chin lift technique. Look in the mouth for any obstructions. Give 2 Breaths: 6 Give 2 breaths lasting 1 second each making sure the chest rises and falls with each breath. Continue CPR: 7 Give cycles of 30 chest compressions, followed by 2 breaths. When to stop: If the patient shows signs of life Trained personnel or EMS take over The scene becomes unsafe An AED is ready to use The rescuer is too exhausted to continue Follows 2010 ECC/ILCOR and American Heart Association Guidelines Infant CPR Check Scene: 1 Check for safety, apply gloves and prepare face shield. Scenario: Check Person: 2 Check for responsiveness by holding head still, tapping and shouting. Look at chest and face to determine no normal breathing A neighbor knocks on your door and asks for help. She states her 6 month old baby is not waking up. You find the baby lying in a crib. Call 911: 3 If unresponsive or a life-threatening condition exists, send someone to call 911 and get an AED if available. Required Equipment: Infant Manikin 30 Compressions: 4 Use 2 fingers, give 30 chest compressions, at a rate of at least 100/minute, and at least 1/3 the depth of the chest. Open Airway: 5 Open Airway using a head tilt chin lift technique. Look in the mouth for any obstructions. Give 2 Breaths: 6 Give 2 breaths lasting 1 second each making sure the chest rises and falls with each breath. Note: Cover infant’s mouth and nose. Continue CPR: 7 Give cycles of 30 chest compressions, followed by 2 breaths. When to stop: If the patient shows signs of life Trained personnel or EMS take over The scene becomes unsafe An AED is ready to use The rescuer is too exhausted to continue Follows 2010 ECC/ILCOR and American Heart Association Guidelines AED Power on the AED: 1 Check to make sure it is safe to use the AED. Unsafe conditions include, victim in water, on metal surface, flammable gas... Scenario: Bare the Chest: 2 Follow directions of AED. Dry any wet areas on chest, remove any patches, shave hair if needed. You are performing CPR on a person when an AED arrives and is ready to use. What will you do? Apply Pads: 3 Peel off backing and place pads as the picture on the pads shows. Press down firmly to assure pads are securely affixed. Plug in Connector: 4 Follow AED directions. Some AED models have pre-connected electrodes and will sense when pads are secure. Note: For victims 8 years old and younger, or under 55 lbs, use child pads. If victim is over 8 or 55 pounds, use adult pads. Adult pads can be used if no child sized pads are available. Make sure the pads do not touch. Required Equipment: Adult/Child Manikin and AED Trainer Stand Clear: 5 Don’t touch the victim while the AED is analyzing or charging. Push Shock Button: 6 Shout, “Clear,” and make sure no one is touching patient. Give Compressions: 7 Give 5 cycles of 30 chest compressions, at a rate of at least 100 compressions/minute, followed with 2 breaths. After 2 Minutes: 8 The AED will reanalyze. If AED says, “No shock advised,” continue CPR if no signs of life. Follow AED prompts. Note: Don’t wait. Begin compressions immediately after the shock is delivered. When to stop: If the patient shows signs of life Trained personnel or EMS take over The scene becomes unsafe The rescuer is too exhausted to continue Follows 2010 ECC/ILCOR and American Heart Association Guidelines Adult or Child Conscious Choking 1 Check Person: Ask, “Are you choking?” If the person cannot cough, speak or breath, he or she is choking and needs your help. Call 911: 2 Send someone to call 911. If no one is available to call, provide care first. Stand Behind: 3 Place your foot between the person’s feet and place your other foot firmly on the ground beside you. Scenario: You are eating a picnic lunch at the park when a person stands up and grasps his throat. What would you do? Note: You will need to kneel down for a child in order to give effective abdominal thrusts. Required Equipment: Adult/Child Manikin Position Hands: 4 Find the navel. Tucking in the thumb, place the thumb side of the fist against the abdomen, just above the navel. Give Thrusts: 5 Grasp the back of your fist, give inward -upward abdominal thrusts until object is out or person goes unconscious. When to stop: The object comes out The scene becomes unsafe The person becomes unconscious (Call 911 and perform unconscious choking technique in this case) Follows 2010 ECC/ILCOR and American Heart Association Guidelines Infant Conscious Choking Check Baby: 1 If the baby cannot cough, cry or breath, he is choking and needs your help. Call 911: 2 Scenario: You are feeding a baby lunch when he begins to turn blue and cannot cry, cough or breath. What would you do? Send someone to call 911. If no one is available to call, provide care first. Position Baby: 3 Support the baby’s face with your hand on the jaw and the baby’s body along your forearm. Place the baby face down. Required Equipment: Infant Manikin Give 5 Back Blows: 4 Holding the baby’s head lower then the feet, give 5 back blows between the shoulder blades. Turn Baby Over: 5 Hold the back of the head. Sandwich the baby between your forearms and turn him over. Give 5 Chest Thrusts: 6 Place fingers on the sternum in the center of the chest and give 5 thrusts. Repeat Steps 3 to 5: 7 Keep giving 5 back blows and 5 chest thrusts until the object comes out or baby goes unconscious. When to stop: The object comes out The baby becomes unconscious (Call 911 and perform unconscious choking technique in this case) Follows 2010 ECC/ILCOR and American Heart Association Guidelines Adult Unconscious Choking Position Person: 1 Lower person safely to the ground. Scenario: Call 911: 2 If 911 has not been called, send someone to call 911 and get an AED if available. You are eating in your favorite restaurant when a man starts choking. You perform abdominal thrusts and he goes unconscious. 30 Compressions: 3 Using 2 hands, give 30 chest compressions, at a rate of at least 100 compressions per minute, followed by object check. Required Equipment: Adult Manikin Check for Object: 4 Open Airway using a head tilt chin lift technique. Look in the mouth for any obstructions. If object is seen, do a finger sweep to remove it. Give a Breath: 5 Open airway and Give a breath. Even if no object is seen, attempt a breath. If air goes in give a second breath. Reposition, Reattempt: 6 If air does not go in, reposition and reattempt a breath. If air still does not go in, continue compressions. 30 Compressions: 7 Using 2 hands, give 30 chest compressions, at a rate of at least 100 compressions per minute, followed by object check. When to stop: If the patient shows signs of life Trained personnel or EMS take over The scene becomes unsafe The rescuer is too exhausted to continue Check for Object: 8 If object is seen, do a finger sweep to remove it. Repeat steps 5-8 until air goes in and makes chest rise. Note: After breaths go in, continue CPR if the person shows no signs of life. If there is breathing and movement, monitor Airway, Breathing, and Circulation until EMS arrives. Follows 2010 ECC/ILCOR and American Heart Association Guidelines Child Unconscious Choking Position Person: 1 Lower person safely to the ground. Scenario: Call 911: 2 If 911 has not been called, send someone to call 911 and get an AED if available. You are eating in your favorite restaurant when a child starts choking. You perform abdominal thrusts and she goes unconscious. 30 Compressions: 3 Use 1 or 2 hands, give 30 chest compressions, at a rate of at least 100/minute, and at least 1/3 the depth of the chest. Required Equipment: Adult/Child Manikin Check for Object: 4 Open Airway using a head tilt chin lift technique. Look in the mouth for any obstructions. If object is seen, do a finger sweep to remove it. Give a Breath: 5 Open airway and Give a breath. Even if no object is seen, attempt a breath. If air goes in give a second breath. Reposition, Reattempt: 6 If air does not go in, reposition and reattempt a breath. If air still does not go in, continue compressions. 30 Compressions: 7 Use 1 or 2 hands, give 30 chest compressions, at a rate of at least 100/minute, and at least 1/3 the depth of the chest. Check for Object: 8 If object is seen, do a finger sweep to remove it. Repeat steps 5-8 until air goes in and makes chest rise. When to stop: If the patient shows signs of life Trained personnel or EMS take over The scene becomes unsafe The rescuer is too exhausted to continue Note: After breaths go in, continue CPR if the person shows no signs of life. If there is breathing and movement, monitor Airway, Breathing, and Circulation until EMS arrives. Follows 2010 ECC/ILCOR and American Heart Association Guidelines Infant Unconscious Choking Position Person: 1 Lay the infant down, supine, on a flat surface. Scenario: Call 911: 2 If 911 has not been called, send someone to call 911 and get an AED if available. 30 Compressions: 3 You enter a baby’s room and notice that several marbles are scattered around the baby on the floor. The baby is conscious and choking. You perform back blows and chest thrusts. The baby goes unconscious. What will you do next? Use 2 fingers, give 30 chest compressions, at a rate of at least 100/minute, and at least 1/3 the depth of the chest. Required Equipment: Infant Manikin Check for Object: 4 Open Airway using a head tilt chin lift technique. Look in the mouth for any obstructions. If object is seen, do a finger sweep to remove it. Give a Breath: 5 Open airway and Give a breath. Even if no object is seen, attempt a breath. If air goes in give a second breath. Reposition, Reattempt: 6 If air does not go in, reposition and reattempt a breath. If air still does not go in, continue compressions. 30 Compressions: 7 Use 2 fingers, give 30 chest compressions, at a rate of at least 100/minute, and at least 1/3 the depth of the chest. When to stop: If the patient shows signs of life Trained personnel or EMS take over The scene becomes unsafe The rescuer is too exhausted to continue Check for Object: 8 If object is seen, do a finger sweep to remove it. Repeat steps 5-8 until air goes in and makes chest rise. Note: After breaths go in, continue CPR if the person shows no signs of life. If there is breathing and movement, monitor Airway, Breathing, and Circulation until EMS arrives. Follows 2010 ECC/ILCOR and American Heart Association Guidelines Bleeding Control Check Person: 1 Ask, “I’m trained in first aid, can I help you?” Scenario: 2 Call 911: You are working outside when a coworker cuts his forearm and blood is spurting out. What will you do? Send someone to call 911 Direct Pressure: 3 Required Equipment: Gauze pads, roller gauze, gloves Apply gloves. Use gauze or other barrier to apply direct pressure to site of wound. Elevate if no fracture is suspected. Pressure Bandage: 4 Apply more dressings if needed and a pressure bandage. Recheck: 5 Check for capillary refill, skin color, and skin temperature to make sure the bandage is not too tight. Loosen if necessary. Note: Monitor for signs of shock. If person show confusion, dizziness, bluish or grayish skin color, lay the person down and elevate the legs. Follows 2010 ECC/ILCOR and American Heart Association Guidelines Skill Evaluation Checklist 1-888-406-7487 support@procpr.org Skill Evaluator Signature: (Sign inside of box) Registry #________________ Fax or email completed form to: Fax: 810-592-5007 Email: support@procpr.org Required Skill Scenarios Adult CPR AED Adult Conscious Choking Adult Unconscious Choking Bleeding Control Individual Skills –May be assessed while performed during skill scenarios. Assessing the scene for safety Using personal protective equipment: Gloves Face Shield/Rescue Mask Assessing patient responsiveness Giving Compressions: Adult- 2 hands on the center of the chest between the nipples. Opening the Airway using a head tilt chin lift Giving rescue breaths: Adult– Covering mouth Removing a foreign object For Instructors: Passed Written Test 80% Participant Names– (Please Print) Date:______________ 149 Skill Sheets ProFirstAid Basic: Layrescuer Adult CPR/AED and First Aid Required Skill Scenarios Individual Skills Adult CPR Assessing the scene for safety AED Using personal protective equipment: Gloves Face Shield Adult Conscious Choking Adult Unconscious Choking Bleeding Control Assessing patient responsiveness and breathing Giving Compressions: Adult- 2 hands on the center of the chest between the nipples. Opening the Airway using a head tilt chin lift Giving rescue breaths Removing a foreign object Adult CPR Check Scene: 1 Check for safety, apply gloves and prepare face shield. Scenario: Check Person: 2 Check for responsiveness by holding head still, tapping and shouting. Look at chest and face to determine no normal breathing. You are walking in the park when you see a man lying on the ground. What would you do? Call 911: 3 If unresponsive or a life-threatening condition exists, send someone to call 911 and get an AED if available. Required Equipment: Adult Manikin 30 Compressions: 4 Use 2 hands, give 30 chest compressions, at a rate of at least 100 compressions/minute, at least 2” deep. Open Airway: 5 Open Airway using a head tilt chin lift technique. Look in the mouth for any obstructions. Give 2 Breaths: 6 Give 2 breaths lasting 1 second each making sure the chest rises and falls with each breath. Continue CPR: 7 Give cycles of 30 chest compressions, followed by 2 breaths. When to stop: If the patient shows signs of life Trained personnel or EMS take over The scene becomes unsafe An AED is ready to use The rescuer is too exhausted to continue Follows 2010 ECC/ILCOR and American Heart Association Guidelines AED Power on the AED: 1 Check to make sure it is safe to use the AED. Unsafe conditions include, victim in water, on metal surface, flammable gas... Scenario: Bare the Chest: 2 Follow directions of AED. Dry any wet areas on chest, remove any patches, shave hair if needed. You are performing CPR on a person when an AED arrives and is ready to use. What will you do? Apply Pads: 3 Peel off backing and place pads as the picture on the pads shows. Press down firmly to assure pads are securely affixed. Plug in Connector: 4 Follow AED directions. Some AED models have pre-connected electrodes and will sense when pads are secure. Note: For victims 8 years old and younger, or under 55 lbs, use child pads. If victim is over 8 or 55 pounds, use adult pads. Adult pads can be used if no child sized pads are available. Make sure the pads do not touch. Required Equipment: Adult/Child Manikin and AED Trainer Stand Clear: 5 Don’t touch the victim while the AED is analyzing or charging. Push Shock Button: 6 Shout, “Clear,” and make sure no one is touching patient. Give Compressions: 7 Give 5 cycles of 30 chest compressions, at a rate of at least 100 compressions/minute, followed with 2 breaths. After 2 Minutes: 8 The AED will reanalyze. If AED says, “No shock advised,” continue CPR if no signs of life. Follow AED prompts. Note: Don’t wait. Begin compressions immediately after the shock is delivered. When to stop: If the patient shows signs of life Trained personnel or EMS take over The scene becomes unsafe The rescuer is too exhausted to continue Follows 2010 ECC/ILCOR and American Heart Association Guidelines Adult or Child Conscious Choking 1 Check Person: Ask, “Are you choking?” If the person cannot cough, speak or breath, he or she is choking and needs your help. Call 911: 2 Send someone to call 911. If no one is available to call, provide care first. Stand Behind: 3 Place your foot between the person’s feet and place your other foot firmly on the ground beside you. Scenario: You are eating a picnic lunch at the park when a person stands up and grasps his throat. What would you do? Note: You will need to kneel down for a child in order to give effective abdominal thrusts. Required Equipment: Adult/Child Manikin Position Hands: 4 Find the navel. Tucking in the thumb, place the thumb side of the fist against the abdomen, just above the navel. Give Thrusts: 5 Grasp the back of your fist, give inward -upward abdominal thrusts until object is out or person goes unconscious. When to stop: The object comes out The scene becomes unsafe The person becomes unconscious (Call 911 and perform unconscious choking technique in this case) Follows 2010 ECC/ILCOR and American Heart Association Guidelines Adult Unconscious Choking Position Person: 1 Lower person safely to the ground. Scenario: Call 911: 2 If 911 has not been called, send someone to call 911 and get an AED if available. You are eating in your favorite restaurant when a man starts choking. You perform abdominal thrusts and he goes unconscious. 30 Compressions: 3 Using 2 hands, give 30 chest compressions, at a rate of at least 100 compressions per minute, followed by object check. Required Equipment: Adult Manikin Check for Object: 4 Open Airway using a head tilt chin lift technique. Look in the mouth for any obstructions. If object is seen, do a finger sweep to remove it. Give a Breath: 5 Open airway and Give a breath. Even if no object is seen, attempt a breath. If air goes in give a second breath. Reposition, Reattempt: 6 If air does not go in, reposition and reattempt a breath. If air still does not go in, continue compressions. 30 Compressions: 7 Using 2 hands, give 30 chest compressions, at a rate of at least 100 compressions per minute, followed by object check. When to stop: If the patient shows signs of life Trained personnel or EMS take over The scene becomes unsafe The rescuer is too exhausted to continue Check for Object: 8 If object is seen, do a finger sweep to remove it. Repeat steps 5-8 until air goes in and makes chest rise. Note: After breaths go in, continue CPR if the person shows no signs of life. If there is breathing and movement, monitor Airway, Breathing, and Circulation until EMS arrives. Follows 2010 ECC/ILCOR and American Heart Association Guidelines Bleeding Control Check Person: 1 Ask, “I’m trained in first aid, can I help you?” Scenario: 2 Call 911: You are working outside when a coworker cuts his forearm and blood is spurting out. What will you do? Send someone to call 911 Direct Pressure: 3 Required Equipment: Gauze pads, roller gauze, gloves Apply gloves. Use gauze or other barrier to apply direct pressure to site of wound. Elevate if no fracture is suspected. Pressure Bandage: 4 Apply more dressings if needed and a pressure bandage. Recheck: 5 Check for capillary refill, skin color, and skin temperature to make sure the bandage is not too tight. Loosen if necessary. Note: Monitor for signs of shock. If person show confusion, dizziness, bluish or grayish skin color, lay the person down and elevate the legs. Follows 2010 ECC/ILCOR and American Heart Association Guidelines Skill Evaluation Checklist Participant Names– (Please Print) 1-888-406-7487 support@procpr.org Skill Evaluator Signature: (Sign inside of box) Registry #________________ Fax or email completed form to: Fax: 810-592-5007 Email: support@procpr.org Required Skill Scenarios Adult CPR AED Adult Conscious Choking Adult Unconscious Choking Individual Skills –May be assessed while performed during skill scenarios. Assessing the scene for safety Using personal protective equipment: Gloves Face Shield/Rescue Mask Assessing patient responsiveness Giving Compressions: Adult- 2 hands on the center of the chest between the nipples. Opening the Airway using a head tilt chin lift Giving rescue breaths: Adult– Covering mouth Removing a foreign object For Instructors: Passed Written Test 80% Date:______________ 157 Skill Sheets ProCPR Basic: Layrescuer Adult CPR/AED Individual Skills Required Skill Scenarios Adult CPR Assessing the scene for safety AED Adult Conscious Choking Using personal protective equipment: Gloves Face Shield Adult Unconscious Choking Assessing patient responsiveness and breathing Giving Compressions: Adult- 2 hands on the center of the chest between the nipples. Opening the Airway using a head tilt chin lift Giving rescue breaths Removing a foreign object Adult CPR Check Scene: 1 Check for safety, apply gloves and prepare face shield. Scenario: Check Person: 2 Check for responsiveness by holding head still, tapping and shouting. Look at chest and face to determine no normal breathing. You are walking in the park when you see a man lying on the ground. What would you do? Call 911: 3 If unresponsive or a life-threatening condition exists, send someone to call 911 and get an AED if available. Required Equipment: Adult Manikin 30 Compressions: 4 Use 2 hands, give 30 chest compressions, at a rate of at least 100 compressions/minute, at least 2” deep. Open Airway: 5 Open Airway using a head tilt chin lift technique. Look in the mouth for any obstructions. Give 2 Breaths: 6 Give 2 breaths lasting 1 second each making sure the chest rises and falls with each breath. Continue CPR: 7 Give cycles of 30 chest compressions, followed by 2 breaths. When to stop: If the patient shows signs of life Trained personnel or EMS take over The scene becomes unsafe An AED is ready to use The rescuer is too exhausted to continue Follows 2010 ECC/ILCOR and American Heart Association Guidelines AED Power on the AED: 1 Check to make sure it is safe to use the AED. Unsafe conditions include, victim in water, on metal surface, flammable gas... Scenario: Bare the Chest: 2 Follow directions of AED. Dry any wet areas on chest, remove any patches, shave hair if needed. You are performing CPR on a person when an AED arrives and is ready to use. What will you do? Apply Pads: 3 Peel off backing and place pads as the picture on the pads shows. Press down firmly to assure pads are securely affixed. Plug in Connector: 4 Follow AED directions. Some AED models have pre-connected electrodes and will sense when pads are secure. Note: For victims 8 years old and younger, or under 55 lbs, use child pads. If victim is over 8 or 55 pounds, use adult pads. Adult pads can be used if no child sized pads are available. Make sure the pads do not touch. Required Equipment: Adult/Child Manikin and AED Trainer Stand Clear: 5 Don’t touch the victim while the AED is analyzing or charging. Push Shock Button: 6 Shout, “Clear,” and make sure no one is touching patient. Give Compressions: 7 Give 5 cycles of 30 chest compressions, at a rate of at least 100 compressions/minute, followed with 2 breaths. After 2 Minutes: 8 The AED will reanalyze. If AED says, “No shock advised,” continue CPR if no signs of life. Follow AED prompts. Note: Don’t wait. Begin compressions immediately after the shock is delivered. When to stop: If the patient shows signs of life Trained personnel or EMS take over The scene becomes unsafe The rescuer is too exhausted to continue Follows 2010 ECC/ILCOR and American Heart Association Guidelines Conscious Choking 1 Check Person: Ask, “Are you choking?” If the person cannot cough, speak or breath, he or she is choking and needs your help. Call 911: 2 Send someone to call 911. If no one is available to call, provide care first. Stand Behind: 3 Place your foot between the person’s feet and place your other foot firmly on the ground beside you. Scenario: You are eating a picnic lunch at the park when a person stands up and grasps his throat. What would you do? Note: You will need to kneel down for a child in order to give effective abdominal thrusts. Required Equipment: Adult/Child Manikin Position Hands: 4 Find the navel. Tucking in the thumb, place the thumb side of the fist against the abdomen, just above the navel. Give Thrusts: 5 Grasp the back of your fist, give inward -upward abdominal thrusts until object is out or person goes unconscious. When to stop: The object comes out The scene becomes unsafe The person becomes unconscious (Call 911 and perform unconscious choking technique in this case) Follows 2010 ECC/ILCOR and American Heart Association Guidelines Unconscious Choking 1 Position Person: Lower person safely to the ground. Scenario: 2 Call 911: If 911 has not been called, send someone to call 911 and get an AED if available. You are eating in your favorite restaurant when a man starts choking. You perform abdominal thrusts and he goes unconscious. 30 Compressions: 3 4 Using 2 hands, give 30 chest compressions, at a rate of at least 100 compressions per minute, followed by object check. Required Equipment: Adult Manikin Check for Object: Open Airway using a head tilt chin lift technique. Look in the mouth for any obstructions. If object is seen, do a finger sweep to remove it. Give a Breath: 5 Open airway and Give a breath. Even if no object is seen, attempt a breath. If air goes in give a second breath. Reposition, Reattempt: 6 If air does not go in, reposition and reattempt a breath. If air still does not go in, continue compressions. 30 Compressions: 7 Using 2 hands, give 30 chest compressions, at a rate of at least 100 compressions per minute, followed by object check. When to stop: If the patient shows signs of life Trained personnel or EMS take over The scene becomes unsafe The rescuer is too exhausted to continue Check for Object: 8 If object is seen, do a finger sweep to remove it. Repeat steps 5-8 until air goes in and makes chest rise. Note: After breaths go in, continue CPR if the person shows no signs of life. If there is breathing and movement, monitor Airway, Breathing, and Circulation until EMS arrives. Follows 2010 ECC/ILCOR and American Heart Association Guidelines 163 Skill Evaluation Checklist Participant Names– (Please Print) 1-888-406-7487 support@procpr.org Skill Evaluator Signature: (Sign inside of box) Registry #________________ Fax or email completed form to: Fax: 810-592-5007 Email: support@procpr.org Required Skill Scenarios Adult or Child Rescue Breathing Adult or Child CPR Infant CPR AED Adult or Child Conscious Choking Infant Conscious Choking Adult or Child Unconscious Choking Infant Unconscious Choking Adult 2 rescuer CPR Infant 2 rescuer CPR Bleeding Control Individual Skills –May be assessed while performed during skill scenarios. Assessing the scene for safety Using personal protective equipment: Gloves Face Shield/Rescue Mask Bag Valve Mask Assessing patient responsiveness Checking for a pulse: Adult and Child– Carotid Artery Infant– Brachial Artery Giving Compressions: Adult- 2 hands on the center of the chest between the nipples. Child– 1 or 2 hands on the center of the chest between the nipples. Infant– 2 fingers on the center of the chest just below the nipples. 2 Rescuer Infant- 2 thumbs hands encircling chest technique Opening the Airway using a head tilt chin lift Giving rescue breaths: Adult and Child– Covering mouth Infant– Covering mouth and nose Removing a foreign object For Instructors: Passed Written Test 80% Date:______________ 165 ProFirstAid Advanced CourseHealthcare Provider Adult, Child, Infant CPR/AED and First Aid Use All ProCPR Skill Sheets and One ProFirstAid Skill Sheet, Bleeding Control Required Skill Scenarios Individual Skills Adult or Child Rescue Breathing Assessing the scene for safety Adult or Child CPR Using personal protective equipment: Gloves Face Shield Rescue Mask Bag Valve Mask Infant CPR AED Adult or Child Conscious Choking Infant Conscious Choking Adult or Child Unconscious Choking Infant Unconscious Choking Adult 2 rescuer CPR Infant 2 rescuer CPR Bleeding Control Assessing patient responsiveness Checking for a pulse: Adult and Child– Carotid Artery Infant– Brachial Artery Giving Compressions: Adult- 2 hands on the center of the chest between the nipples. Child– 1 or 2 hands on the center of the chest between the nipples. Infant– 2 fingers on the center of the chest just below the nipples. 2 Rescuer Infant- 2 thumbs hands encircling chest technique Opening the Airway using a head tilt chin lift Checking for breathing Giving rescue breaths: Adult and Child– Covering mouth Infant– Covering mouth and nose Removing a foreign object Appendix B- 168 Blended Course Information and Skill Evaluator Training Facts 169 Who needs the “Blended Course?” 1. Individuals who are getting certified for the first time 2. Individuals who have been informed by their company or licensing administration that they must have a hands-on skill evaluation What is the “Blended Course?” All training and written testing is completed online at www.procpr.org or www.profirstaid.com. Skills are then practiced and evaluated in-person by a registered ProTrainings Instructor/Skill Evaluator. How Can I become a Skill Evaluator? Bridge from another program or get trained by ProTrainings: Current certified CPR instructors can complete the application and upload, fax, or email a copy of their instructor credentials to become a skill evaluator. If not currently certified as an instructor you will need to complete the online skill evaluator training and a live video conference for the hands-on portion. The amount of training time is dependant upon the participant’s skills and training experience. You will need the following in order to complete the video conference: 1. A computer with a high speed internet connection. (Please verify that you have the minimum requirements for GoToMeeting HD Faces before scheduling your training. If your work facility does not have these minimum requirements, often someone's home, library or community center may be available as an alternative to conduct the training.)  Administrative rights in order to use GoToMeeting HD Faces on the computer  Unrestricted Internet high-speed broadband connection with a sustained 1 Mbps bandwidth or higher  Speakers and microphone – built-in or separate, or a computer headset.  A high definition webcam. (We can supply the webcam if you do not have one.) 2. An uninterrupted block of time for a live video-conference. 3. CPR manikins and training equipment required for the course you are completing. (Please see our pricelist for what we have available.) ProTrainings LLC, 5005 Plainfield Ave NE Suite B, Grand Rapids, MI 49525 1-888-406-7487 support@protrainings.com How Do the ProTrainings Blended Courses Work? Register at www.procpr.org or www.profirstaid.com Online Training Pass online test with 80% or better A currently certified CPR Instructor from another recognized agency can register as a new skill evaluator and submits instructor credentials via fax, email, or upload. The instructor may then complete the student’s skill evaluation. The instructor can pay the fee to become publicly listed. However, no payment is required to simply be registered as a skill evaluator. Download form: http://downloads.protrainings.com/skillevalapp.pdf Purchase certificate Print temporary certificate and skill evaluation checklist If skill evaluator is registered, he or she conduct’s the student’s skill evaluation Individuals who are not currently certified CPR instructors can be trained to become an instructor or skill evaluator by starting at www.proskilleval.com. He or she will register and must complete the blended skill evaluator/instructor training, including a hands-on session, before conducting a student’s skill evaluation. If skill evaluator is not registered, he or she completes registration process prior to administering evaluation ProTrainings, LLC verifies credentials or trains evaluator Newly registered evaluator conducts skill evaluation. Skill evaluator uses online dashboard or faxes checklist to ProTrainings, LLC Certification is complete. Skill evaluation verification is attached to student’s record. Certification card is mailed to student and is available to print. ProTrainings, LLC., 5005 Plainfield Ave NE Suite B, Grand Rapids, MI 49525 1-888-406-7487 support@protrainings.com www.protrainings.com ProTrainings, LLC. Skill Evaluator/Instructor Application and Agreement Fax or email completed form to ProTrainings, LLC. Fax: 810-592-5007 Email: support@protrainings.com ProTrainings LLC, 5005 Plainfield Ave NE Suite B, Grand Rapids, MI 49525 Personal Information: First Name___________________________ Middle Initial ______ Last Name______________________________ Home Address______________________________________________________________ PO Box___________ City___________________________________________________ State_________ Zip_____________________ Home Phone______________________________________ Cell Phone_________________________________ Email_________________________________________________ Company Information: (Complete only if becoming a skill evaluator for a company or employer) Organization___________________________________________ Title__________________________________ Street Address______________________________________________________________ PO Box___________ City___________________________________________________ State__________ Zip____________________ Work Phone_____________________________________ Fax_________________________________________ Please check the correct boxes: Training: I have a current CPR instructor certification– Fax or email a copy of the front and back of your certification with this application. After certification is verified a ProTrainings registry # will be issued. I do not have a current CPR instructor certification– Call or email to schedule Skill Evaluator training. The training is completed through a blended program of online training and a live personal video conference for skills assessment. Equipment: Skill evaluators must own or have access to the required equipment to perform skill evaluations I have the following required equipment available to perform skill evaluations: Adult Manikin Infant Manikin AED Trainer Bag Valve Mask I do not have all of the required equipment. I need to purchase the following equipment: Adult Manikin **ProTrainings has high quality training equipment in stock available to Infant Manikin purchase at discounted prices. For a complete pricelist, please call or email. AED Trainer Bag Valve Mask Availability: I would like my information posted on www.blendedcpr.com so ProTrainings students in my area can be directed to me for skill evaluations. The cost is a $49.95 one time charge. Please send check, call to charge to a credit card, or register and pay online at www.blendedcpr.com. I will charge students $________ to perform a skill evaluation (Average is $20. ProTrainings allows a maximum of $50) I will not charge for skill evaluations. (This is the normal choice for one who is already being paid by an employer and will only provide skill evaluations for other employees) I do not want my information made public. I agree to abide by the evaluator/instructor agreement as established by ProTrainings LLC. _______________________________ Evaluator/Instructor Applicant’s Signature _____________________________ Printed Name ProTrainings LLC, 5005 Plainfield Ave NE Suite B, Grand Rapids, MI 49525 (888) 406-7487 _____________ Date support@protrainings.com ProTrainings LLC Skill Evaluator/Instructor Agreement As a ProTrainings Evaluator/Instructor, I agree to:  Follow all the current policies, regulations and procedures of ProTrainings related to the conduct and administration of skill evaluations          Maintain updated contact information and regular communication with ProTrainings Assist ProTrainings in resolving issues that may arise with participants Accept evaluation of responsibilities by ProTrainings staff Maintain a safe environment and proper equipment necessary for skill evaluations Provide honest and fair skill evaluations for participants Conduct the complete evaluation requirements for each participant and provide appropriate information to participants for the completion of their certification. Recognize that ProTrainings materials are copyrighted and may be reproduced only with the permission of ProTrainings Recognize that this Agreement remains in effect as long as the evaluator’s requirements for authorization are maintained with ProTrainings I acknowledge that failure to follow agreements, policies, regulations and procedures related to the conduct and administration of ProTrainings may result in the immediate revocation of registration, terminating the ability to evaluate skills for participants to receive certification from ProTrainings. No Evaluator shall:  Authorize the use of the name, logo, endorsement, services, or property of ProTrainings , without the express permission of ProTrainings .     Charge any fees or seek financial gain for services relating to ProTrainings above the skill evaluation fee. Disclose any confidential information that is available solely as a result of the affiliation with ProTrainings to any person not authorized to receive such information. Operate in any manner that is contrary to the best interest of ProTrainings . Operate against the best interests of ProTrainings where a conflict exists. If the interests of any organization in which he or she has a financial interest or with which he or she is affiliated conflicts, the Instructor shall disclose such conflict to ProTrainings as soon as he or she becomes aware of it. ProTrainings is committed to providing the following for evaluators:  Technical support and open communication       Training, course curriculum and access to training materials Information and materials needed to properly evaluate skills and assist participants through the process of obtaining their certifications Maintain Evaluator and participant records Provide timely updates and information to Evaluators Provide a quality assurance program Assure that students receive their certification card who properly register online and successfully complete skill evaluation. As a condition for using the ProTrainings , LLC Web based training and internet-based information products herein and/or maintaining an information access account, you expressly accept, without limitation or modification, the following conditions, terms, and notices: The information included on the ProTrainings , LLC web based education is provided on an "as is," "as available" basis. 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ProTrainings, LLC., 5005 Plainfield Ave NE Suite B, Grand Rapids, MI 49525 (888) 406-7487 support@protrainings.com ProTrainings, LLC Skill Evaluator Training Facts Description: The ProTrainings, LLC Skill Evaluator training is designed to prepare individuals to conduct hands-on skill evaluations for students who complete the blended course online for ProCPR and ProFirstAid courses. Purpose: ProTrainings, LLC skill evaluator certification provides individuals with the skills, tools, and knowledge to successfully evaluate student’s CPR and First Aid skills. Upon successful completion, Evaluators can mark students passed according to their level of training. Course Design: Prerequisite:  Must have a current ProTrainings, LLC student/provider level certificate or equivalent that is equal to the skill level of desired skill evaluator certificate. Skill Evaluator Training: Individuals begin training at www.proskilleval.com  Total time: 4-8 hours  Includes a blended combination of online training, live skills demonstration, practice teaching and skill assessment. The time for the online portion is dependent on the level of certification desired and individual student needs.  Skill Evaluator Bridge– Submit a current equivalent CPR/FirstAid instructor certification from a recognized organization to be bridged to be a ProTrainings, LLC Instructor. Instructors should complete the ProTrainings student/ provider level training for the equivalent instructor level of certification. Certificate Awarded: There are three levels of ProTrainings, LLC certified Skill Evaluators:  ProCPR Skill Evaluator–Can evaluate skills for ProCPR, ProFirstAid Advanced, ProFirstAid, and ProFirstAid Basic, ProCPR Basic  ProFirstAid Skill Evaluator-Can evaluate skills for ProFirstAid and ProFirstAid Basic, ProCPR Basic  ProFirstAid Basic Evaluator– Can evaluate skills for ProFirstAid Basic, ProCPR Basic Each skill evaluator certificate is valid for 2 years. Skill Evaluators must complete a minimum of 2 skill evaluations before expiration date and complete all updates as required in order to renew the certification. Also one can submit a current equivalent instructor certification from another recognized organization for skill evaluator certificate renewal. ProTrainings, LLC Blended Courses Blended Course (Active for a 2 year period): An individual completes cognitive training and testing online by watching video segments, completing activities, and passing a written test. A hands-on skills session for skills practice and evaluation by a registered ProTrainings, LLC Instructor or Skill Evaluator is required to complete the certification process. Certification Accredited 2 Year Certification ProCPR: Healthcare Provider Adult/Child/& Infant CPR/AED 2 year certification Format Training URL Blended Online training, testing, & required hands-on skill evaluation Skill Eval Length: 45 min www.procpr.org ProFirstAid Advanced Online training, testing, Healthcare Provider Adult/Child/ & & required hands-on Infant CPR/AED & First Aid skill evaluation Skill Eval Length: 45 min www.advanced.profirstaid.com 2 year certification ProFirstAid: Adult/Child/ & Infant CPR/AED & First Aid 2 year certification Online training, testing, & required hands-on skill evaluation Skill Eval Length: 30 min www.profirstaid.com ProFirstAid Basic: Adult CPR/AED & First Aid 2 year certification Online training, testing, & required hands-on skill evaluation Skill Eval Length: 20 min www.basic.profirstaid.com ProCPR Basic: Adult CPR/AED 2 year certification Online training, testing, & required hands-on skill evaluation Skill Eval Length: 15 min www.adult.procpr.org Skill Evaluator Materials Skill evaluators will need the following materials:  Skill Sheets for the appropriate certification level  Student Checklists for the appropriate certification level  Required manikins and equipment for the appropriate certification level 176 Appendix C- Quality Assurance Quality assurance is a top priority for ProTrainings, LLC. In order to ensure quality training programs that comply with the most current training standards, a ProTrainings Review Committee exists. The ProTrainings Review Committee is made up of experienced ProTrainings, LLC staff members and other training professionals. Primary responsibilities include:  Evaluating and endorsing Instructor Trainers  Ensuring medical and educational integrity of ProTrainings programs  Curriculum writing  Assuring compliance with the most current training requirements and standards  Following up allegations of serious quality assurance problems  Ensuring customer satisfaction  Monitoring Instructors/Evaluators  Making certain that Instructors/Evaluators comply with published guidelines and administrative aspects of ProTrainings, LLC programs Some of the tools used to carry out quality assurance for Instructor/Evaluators are:  Weekly email video reminders to keep Instructor/Evaluator skills fresh  Student course evaluations  Periodic Instructor/Evaluator training updates  Electronic record keeping and data tracking  Easily accessible published training and student materials ProTrainings Course Evaluation Your feedback is important as it helps us to improve the quality of our training programs. Please rate the following statements: Date Course Completed:___________ Instructor/Skill Evaluator Name___________________________ Organization of the activity:  I am satisfied with the training I received.  I am satisfied with how the course was organized. Effectiveness of the Instructor/Skill Evaluator:  The instructor presented the information clearly.  The instructor helped me to learn the information.  The instructor presented the information professionally. My questions were answered appropriately.  Quality of Teaching Methods:  I am satisfied with the length and quantity of the training videos.  I feel the training videos were high quality.    I feel the testing accurately reflected the training received. I am satisfied with all of the training materials used. I am satisfied with the training format. Effectiveness of Skills Practice and Evaluation:  I was able to complete my skill practice and evaluation in a timely manner.  The instructor/skill evaluator had all the necessary equipment and it was in good order.  I received appropriate feedback from the instructor/skill evaluator.  The instructor/skill evaluator was professional and fair. Strongly Disagree Disagree Neutral Agree Strongly Agree 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 Please Share Any Additional Comments: ProTrainings, LLC., 5005 Plainfield Ave NE Suite B, Grand Rapids, MI 49525 Phone: 1-888-406-7487 Fax: 810-592-5007 Email: support@protrainings.com 180 Appendix D- Written Tests 181 182 ProCPR Written Test ANSWER KEY Location of ProCPR training material Video: Student Manual: Instructor Manual: 1) A Five Fears pg 2 pg 12-13 2) B Adult CPR pg 10-13 pg 20-21 3) A Adult CPR pg 10-13 pg 20-21 4) D Adult CPR pg 10-13 pg 20-21 5) A Infant CPR pg 10-13 pg 20-21 6) B Infant CPR 2 person pg 20-21 pg 25-28 7) C Adult CPR 2 person pg 20-21 pg 25-28 8) B Child rescue breathing pg 20-21 pg 17-19 9) D Child CPR pg 10-13 pg 20-21 10) C Adult Rescue Breathing pg 20-21 pg 17-19 11) C Adult AED pg 14-16 pg 22-23 12) C Adult Conscious Choking pg 17 pg 24 13) B Adult Unconscious Choking pg 18-19 pg 25-26 14) C Child Conscious Choking pg 17 pg 24 15) C Child Unconscious Choking pg 18-19 pg 25-26 16) D Infant Conscious Choking pg 17 pg 24 17) D Infant Unconscious Choking pg 18-19 pg 25-26 18) C Adult Bag Valve Mask pg 22 pg 27 19) C Adult Bag Valve Mask pg 22 pg 27 20) D Heart Attacks pg 5-6 pg 14-15 183 184 ProCPR Written Test Answer Sheet ProCPR Written Test Answer Sheet Name:______________________ Date:________ Name:______________________ Date:________ 1. _______ 1. _______ 2. _______ 2. _______ 3. _______ 3. _______ 4. _______ 4. _______ 5. _______ 5. _______ 6. _______ 6. _______ 7. _______ 7. _______ 8. _______ 8. _______ 9. _______ 9. _______ 10. _______ 10. _______ 11. _______ 11. _______ 12. _______ 12. _______ 13. _______ 13. _______ 14. _______ 14. _______ 15. _______ 15. _______ 16. _______ 16. _______ 17. _______ 17. _______ 18. _______ 18. _______ 19. _______ 19. _______ 20. _______ 20. _______ 185 186 ProCPR (Healthcare Provider Adult, Child, Infant CPR/AED and First Aid) Test Please do not write on the test. Select the best answer for each question. Write the letter of your choice on the answer sheet. Question 1 You are driving down the road when the car in front of you hits a pedestrian. As you slam on the brakes and your car comes to a stop, you see a man lying in the middle of the road about 30 feet away in front of the car that hit him. Other people are staring and trying to see what happened. What should you do? a. Make sure the scene is safe, ensure personal protection, check the patient for responsiveness, then call 911 b. Stay away because you might get some kind of disease from the man if he's c. Let somebody else help because you don't want to take a chance on doing something wrong and hurting the man d. Drive on by because you don't want to get sued for doing anything incorrectly Question 2 You are on the scene of a car vs. pedestrian accident, and all traffic is now stopped. There do not appear to be any other obvious dangers. You check the person for responsiveness and look at the chest for movement. The person does not respond or appear to be breathing normally. You now send a bystander to call 911. What is your next action? a. Give two breaths immediately b. Check for a pulse c. Open the victim's airway, and then look, listen, and feel for d. Start chest compressions Question 3 You are on the scene of a car vs. pedestrian accident and all traffic is now stopped. The scene is safe. You have checked for responsiveness, did not see normal breathing, and called 911. You check for a carotid pulse on one side of the neck and you do not feel it. What is your next action? a. Start chest compressions b. Check for a pulse on the radial artery c. Check for a carotid pulse on the other side of the d. Check for a pulse on the brachial artery Question 4 Your patient is not breathing normally and you do not feel a pulse. How would you perform CPR? a. Start CPR by giving 30 compressions to 1 breath at a rate of 100 compressions per minute b. Start CPR by giving 15 compressions to 2 breaths at a rate of 100 per minute c. Start CPR by giving 15 compressions to 1 breath at a rate of 100 per minute d. Start CPR by giving 30 compressions to 2 breaths at a rate of at least 100 compressions per minute Question 5 A neighbor knocks on your door and asks for help. She states that her 6 month old baby is not responsive. You find the baby lying face up in the crib. The scene is safe. You tap the baby's feet and rub the chest to check for responsiveness. There is no response and the baby does not appear to be breathing normally. You send the mom to call 911. You check the pulse on the brachial artery and do not feel a pulse. What is your next action? a. Start CPR by giving 30 compressions to 2 breaths at a rate of at least 100 compressions per minute using 2 fingers on the center of the chest b. Start CPR by giving 15 compressions to 2 breaths at a rate of 100 per minute using 2 fingers on the center of the chest c. Open the airway and give 2 breaths before starting compressions d. Look, listen, and feel for breathing to make sure that the baby is not breathing before starting CPR Question 6 You have been been performing CPR by yourself on an infant for a few minutes. A neighbor arrives and says she knows 2 person CPR. What will you do? a. Have the second rescuer take over breaths. You will give 30 compressions using the 2 thumbs hands encircling chest technique and she will give 2 breaths b. Have the second rescuer take over compressions. She will give 15 compressions using the 2 thumbs hands encircling chest technique and you will give 2 breaths. c. Tell the second rescuer to wait until you get tired. When you are exhausted, tell her to take over d. Tell her that she can't legally help you unless she has a current CPR certification Question 7 You are performing CPR compressions and a coworker is giving breaths for an adult patient. What will you do after about 5 cycles of 30 compressions to 2 breaths or when you feel tired? a. Tell your coworker that you will need to switch soon. Have the second rescuer continue breaths while you continue compressions for 5 more cycles before switching positions. b. Tell your coworker take over compressions immediately. You will give some breaths after your coworker finishes 30 compressions. c. Call for a switch and complete your 30 compressions. Your coworker will finish with 2 breaths, move into position, and give 30 chest compressions. After the 30 compressions, you will give 2 breaths. d. Tell your coworker to take over CPR while you rest for a few cycles of 30 compressions to 2 breaths Question 8 You are walking in a park when you see an 8-year-old child lying face up near a swing. There is no one around to help you, you do not have a cell phone, the scene is safe, and the child is unresponsive and does not appear to be breathing normally. What is your next action? a. Leave the child to go call 911 immediately. After calling 911, come back and perform CPR b. Give care for 2 minutes before going to call 911 c. Yell for help very loudly until somebody hears you. d. Give care until somebody shows up to help you, no matter how long it takes. Then, send the person to call 911 Question 9 You are performing rescue breathing on the child. After 2 minutes, you stop to check the pulse and do not feel a pulse. What should you do now? a. Continue rescue breathing by giving 1 breath every 3 seconds b. Double check the breathing and pulse for another 10 to 15 seconds c. Place the child in the recovery position d. 30 chest compressions by placing the heel of one hand directly on the center of the chest Question 10 You have an adult who was just pulled out of a pool after drowning. You have checked the scene for safety, checked for responsiveness, did not see normal breathing, and called 911. What will indicate that you need to perform rescue breathing at a rate of 1 breath every 5 seconds? a. The person begins to move and gag b. You check for breathing and find no breathing c. You check the pulse. The victim is not breathing but has a pulse. d. You check the pulse and find no pulse Question 11 You are helping a victim of sudden cardiac arrest and a bystander approaches with an AED. What would prevent you, the rescuer, from using an AED? a. Bystander says not to use the AED because the patient does not want to be revived b. The AED looks confusing and is not the one you were certified with c. The victim is lying in a puddle of water and you are unable to move the victim at this time d. You are afraid that the AED might shock the patient Question 12 You are at a restaurant with a friend when you see a commotion at the next table. A person is standing at the side of his table and looks panicked. He is gagging and leaning over with his hands on the table. He does not appear to be coughing or speaking. The scene is safe and you move toward the person. What is the first thing you should do? a. Slap the person on the back 10 times and then call 911 b. Lay the person on the floor and begin doing CPR compressions on the chest c. Ask the person if he is choking and wait to see if he is able to respond verbally d. Assume the person is having a heart attack and call 911 Question 13 While you are performing abdominal thrusts on a conscious adult who appears to be choking, he suddenly becomes limp and unconscious. You help him to the ground and protect his head. The next steps in order of care would be: a. Call 911, open the airway and check for breathing. If no breathing, attempt two breaths. If breaths do not go in, reposition the head and try again. If the air still does not go in, give 30 chest compressions. b. Call 911, do a blind finger sweep, and give breaths. If the breaths do not go in, immediately begin doing chest compressions. c. Begin compressions for at least 2 minutes and, if still needed, call 911 d. Call 911 and begin chest compressions Question 14 Your child is having a birthday party and some of the kids want to see who can fit the most grapes in their mouth at one time. One of the 8-year-old children begins choking on a grape. After some forceful coughing, she becomes silent with some gagging sounds but cannot move air in and out by herself. What would your next action be? a. Begin chest thrusts and continue until the object comes out b. Look in the mouth. If you see the object, sweep it out with your smallest finger c. Ask the child if she is okay. If she is unable to speak or breathe, begin abdominal thrusts until the object comes out or she becomes unconscious. d. Simply assure the child she is okay, call 911, and wait for help to arrive Question 15 You are performing abdominal thrusts on a conscious child. She suddenly becomes unconscious and you lower her to the ground. You call 911 and give 30 chest compressions. You check the mouth and don't see any obvious object that could be swept clear. You open the airway and attempt a rescue breath . No air will go in. What steps of action come next? a. Perform a finger sweep inside the mouth to remove the object b. Start rescue breathing, 1 breath every 3 seconds, until the air finally starts to go in c. Reposition the airway and try another breath. d. Provide continuous chest compressions until help arrives Question 16 You hear someone pounding on your door. You open the door and find your neighbor panicked and holding her 6-month-old boy. The baby is awake but turning blue around the mouth and nose, looks sleepy, and does not appear to be breathing. The parent says that the child was playing with older children and may have placed a marble in his mouth. What should you do next? a. Take the child and begin CPR compressions while holding him in your arms. If the object does not come out, give back blows and chest thrusts. b. Take the child and attempt two rescue breaths. If they don't go in, try two more rescue breaths. c. Send someone to call 911. Look in the child's mouth. If you see an object, remove it. Try CPR for two minutes followed with a finger sweep. d. Send someone to call 911. Position the baby on your arm with his head down and begin 5 back blows/back slaps followed by 5 chest thrusts. Question 17 A choking infant becomes unconscious. You send someone to call 911 and lay the baby down. You look in his mouth for an object and do not see anything in the back of his throat. Choose the correct series of next steps to help this infant. a. Attempt rescue breaths until you see the chest rise and fall b. Attempt two breaths. If air does not go in, reposition the airway and try again. If the air still does not go in, begin 30 chest compressions. c. Perform back blows and chest thrusts until the ambulance arrives d. Begin chest compressions Question 18 You and a coworker are performing 2-person CPR on an adult victim, and you are about to give breaths with a bag valve mask. The single most important thing to remember when using a bag valve mask is: a. Oxygen is always used with a bag valve mask(BVM) b. The mask must be an exact size and fit the patient perfectly in order to provide adequate ventilation c. Bag valve mask use should be effective and cause good chest rise and fall d. Bag valve mask seal is performed with the C 3 method Question 19 As you attempt to give breaths to your patient using a bag valve mask, air is coming out of the sides of the mask and the chest is not rising. You know you need to get a better mask seal. A helpful method for getting the bag valve mask to seal on a patient's face is to: a. Use all your force to hold the mask onto the patient's face b. Push the mask down onto the patient's face with both hands and squeeze the bag somehow c. Use the C - E method of sealing the mask to the patient's face and pull the patient's face into the mask d. Apply an adhesive to the bottom of the face mask and then seal it to the patient's face Question 20 You are called to help a 48-year-old male who has shortness of breath, is sweating, and has pressure across the top of his chest. He says that he has been feeling this way for the last hour. He has no history of heart problems and is not taking any medications. What do you suspect is wrong, and what should you do next? a. Stroke. Lay the person down and call 911. Monitor his airway, breathing, and circulation b. Indigestion. Give the person some antacid and check to see how he feels in 15 minutes c. No medical problem. Tell the person to rest and see if he feels better in about half an hour d. Heart attack. Call 911, assist him to the position of comfort, offer him a non-coated aspirin, and monitor 191 ProFirstAid Written Test ANSWER KEY 1) A 2) A 3) C 4) B 5) C 6) A 7) D 8) D 9) C 10) D 11) B 12) B 13) D 14) C 15) B 16) A 17) A 18) A 19) C 20) D 21) D 22) B 23) D 24) B 25) B 26) B 27) A 28) D 29) C 30) C 31) D 32) A 33) C 34) B 192 35) C ProFirstAid Written Test Answer Sheet ProFirstAid Written Test Answer Sheet Name:______________________ Date:________ Name:______________________ Date:________ 1. _______ 1. _______ 2. _______ 2. _______ 3. _______ 3. _______ 4. _______ 4. _______ 5. _______ 5. _______ 6. _______ 6. _______ 7. _______ 7. _______ 8. _______ 8. _______ 9. _______ 9. _______ 10. _______ 10. _______ 11. _______ 11. _______ 12. _______ 12. _______ 13. _______ 13. _______ 14. _______ 14. _______ 15. _______ 15. _______ 16. _______ 16. _______ 17. _______ 17. _______ 18. _______ 18. _______ 19. _______ 19. _______ 20. _______ 20. _______ 21. _______ 21. _______ 22. _______ 22. _______ 23. _______ 23. _______ 24. _______ 24. _______ 25. _______ 25. _______ 26. _______ 26. _______ 27. _______ 27. _______ 28. _______ 28. _______ 29. _______ 29. _______ 30. _______ 30. _______ 31. _______ 31. _______ 32. _______ 32. _______ 33. _______ 33. _______ 34. _______ 34. _______ 35. _______ 35. _______ 193 194 ProFirstAid (Layrescuer Adult, Child, Infant CPR/AED and First Aid) Test Please do not write on the test. Select the best answer for each question. Write the letter of your choice on the answer sheet. Question 1 What is one of the five fears that prevents people from performing CPR? a. The fear of doing CPR incorrectly and hurting the patient b. The fear that a reward will not be given c. The fear of the unknown d. The fear that people in cardiac arrest are better off left alone Question 2 You are walking in the park when you hear somebody scream. As you look in the direction of the sound, you see a person lying on the ground about 30 feet away. What is the first thing you should do? a. Stop and check the scene for safety b. Stay away because you might get sued if you try to help c. Quickly go to the injured person to see what is wrong d. Tap and shout to see if the person is responsive Question 3 There is a man lying on the ground and the scene is safe. You have approached, put on your personal protective equipment, and are kneeling beside him. What should you do now? a. Be careful not to touch the person because of contagious diseases b. Call 911 c. Tap and shout to check for responsiveness d. Open the airway Question 4 You have checked the man for responsiveness by tapping and shouting, he is unresponsive, and does not appear to be breathing normally. What should you do next? a. Be very careful not to move any part of his body because you might hurt him b. Send someone to call 911 c. Open the airway d. Give two breaths Question 5 You have checked the man for responsiveness by tapping and shouting, he is unresponsive, and not breathing normally. A bystander is calling 911. What is your next action? a. Place him in the recovery position b. Wait for EMS to arrive c. Give Chest Compressions d. Give two breaths Question 6 You gave 30 chest compressions. What is your next action? a. Give two breaths b. Wait for EMS to arrive c. Do a finger sweep d. Look, listen, and feel for breathing Question 7 You have just given 30 chest compressions followed by 2 breaths to an unresponsive man. What is your next action? a. Give two breaths b. Wait for EMS to arrive c. Reposition the airway d. Give 30 chest compressions Question 8 How will you perform CPR on an unresponsive man with no signs of life? a. Give 30 chest compressions at a rate of 80 per minute, followed by 1 breath b. Give 30 chest compressions at a rate of 80 per minute, followed by 2 breaths c. Give 30 chest compressions at a rate of at least 100 per minute, followed by 1 breath d. Give 30 chest compressions at a rate of at least 100 per minute, followed by 2 breaths Question 9 You are kneeling at the side of an unresponsive man who does not appear to be breathing normally. You have called 911. You do not have personal protective equipment available and do not feel comfortable giving breaths.How will you perform effective CPR? a. Give breaths anyway. Without breaths CPR is totally ineffective. b. Use a piece of paper towel over the mouth to protect yourself c. Give hands-only (compression-only) CPR d. Wait for EMS personnel to arrive Question 10 What is the preferred method for performing 1-rescuer CPR on an infant? a. Use the heel of one hand to give chest compressions 1/3 to 1/2 the depth of the chest b. Use two hands to give chest compressions 1/3 to 1/2 the depth of the chest c. Use the "2 thumbs, hands encircling the chest" technique d. Use two fingers of one hand to give chest compressions at least 1/3 the depth of the chest Question 11 What is the preferred method for performing 1-rescuer CPR on a child? a. Always use two hands to give chest compressions 1/3 to 1/2 the depth of the chest b. Use the heel of one hand to give chest compressions at least 1/3 the depth of the chest c. Use the heel of one hand to give chest compressions at least 2 1/2 inches deep d. Use the heel of one hand to give chest compressions as deep as you can Question 12 You are eating lunch in a restaurant and a woman suddenly drops to the floor behind you. The scene is safe, so you approach and check for responsiveness. She is unresponsive and not breathing normally. You call 911. Next, you give 30 compressions, check the mouth for an object, and attempt a breath . The breath does not go in and the chest does not rise. What is your next action? a. b. c. d. Give abdominal thrusts Reposition the head and reattempt a breath Perform a finger sweep Give 30 chest compressions at a rate of 100 per minute Question 13 After you reposition the head of the unresponsive woman and attempt another breath , the breath still will not go in, and the chest will not rise. What is your next action? a. b. c. d. Give abdominal thrusts Reposition the head and reattempt 2 breaths Perform a finger sweep Give 30 chest compressions at a rate of at least 100 per minute Question 14 Video: Adult Unconscious Choking You just gave 30 chest compressions to the unconscious, choking woman. What is your next action? a. Give abdominal thrusts b. Immediately attempt 2 breaths c. Perform a finger sweep if you see an object in the mouth d. Give another set of 30 chest compressions at a rate of 100 per minute Question 15 Video: Adult Unconscious Choking You performed a finger sweep for the unconscious, choking woman, and pulled an object out of her mouth. What is your next action? a. Give abdominal thrusts b. Attempt a breath. If it goes in, give a second breath c. Place the person in the recovery position d. Give another set of 30 chest compressions at a rate of 100 per minute Question 16 Video: Adult Conscious Choking As you are eating in a restaurant, your friend stands up and cannot cough, speak or breathe. What is your next action? a. Call 911, stand behind the person, and give abdominal thrusts b. Call 911 and give 30 chest thrusts c. Encourage the person to try harder to cough d. Lay the victim down and give 30 chest compressions Question 17 Video: Conscious Infant Choking You believe an infant is choking because he is conscious but not breathing, coughing, or moving air. You should: a. Give 5 back blows followed by 5 chest thrusts and repeat until the object comes out or the baby becomes unconscious b. Give abdominal thrusts and repeat until the object comes out or the baby becomes unconscious c. Try to sweep the object out of the mouth with your pinky finger d. Give continuous back slaps until the object comes out Question 18 Video: Unconscious Infant Choking (skip unconscious child choking) You tried to give the first breath to an unconscious choking infant, but the air did not go in. You repositioned the head and reattempted another breath . The air still did not go in or make the chest rise. What should you do next? a. Give 30 chest compressions using 2 fingers in the center of the chest b. Call 911, keep him comfortable, and monitor airway, breathing, and circulation until help arrives c. Perform a finger sweep to get the object out d. Give 5 back blows followed by 5 chest thrusts Question 19 Video: Unconscious Infant Choking (skip unconscious child choking) You just finished doing 30 chest compressions on an unconscious choking infant. What should you do next? a. Give another 30 chest compressions using 2 fingers in the center of the chest b. Immediately perform a finger sweep using your index finger c. Check the airway and perform a finger sweep if there is an object d. Give 5 back blows followed by 5 chest thrusts Question 20 A coworker has a severe headache, slurred speech, and weakness on the left side of her body. What medical emergency do you suspect? a. Seizure b. Diabetic emergency c. Heart attack d. Stroke Question 21 A 48-year-old male is experiencing shortness of breath, sweating, and crushing pain in his chest. He states that he has not been feeling well for the past hour. What medical emergency do you suspect? a. b. c. d. Stroke Flu Diabetic emergency Heart attack Question 22 A fellow employee was struck in the nose by a wrench. Blood is on the tool and the floor. How should you protect yourself to properly clean up the blood? a. Use a sterile gauze to wipe off the tool and the floor b. Wear proper personal protective equipment c. Just be careful not to touch the fluids with your hands d. Call for a professional cleaning service Question 23 While performing CPR at your job, blood gets in your mouth. What should you do next? a. Report the incident to your supervisor and go to the doctor after your shift is over b. Rinse out your mouth with water for a minimum of 20 minutes c. Rinse out your mouth with mouthwash, which will kill all the germs d. Decontaminate, report the incident, and do not delay medical evaluation Question 24 A man cut his forearm and is bleeding severely. Blood is spurting out of the wound with each heartbeat. What should you do? a. Apply a pressure bandage immediately b. Use direct pressure on the wound and apply a pressure bandage c. Lower the wound below the level of the heart, then wrap a pressure bandage around it d. Apply a tourniquet as soon as possible Question 25 You have applied direct pressure and a pressure bandage to a man who cut his forearm and was bleeding severely. He is pale, has moist skin, feels dizzy, and is acting confused. What medical emergency do you suspect, and how should you treat the victim? a. Heart attack: keep him calm until the ambulance arrives b. Shock: elevate the legs and keep him warm c. Diabetic emergency: give him something sweet to eat d. Stroke: monitor his airway, breathing, and circulation Question 26 You have a victim that is unconscious and breathing without any obvious injuries that need immediate treatment. You have called 911. How would you begin a secondary survey to find fractures, bleeding, and other injuries that are not obvious on initial inspection? a. Start with the arms to find problems with muscle control b. Start at the head, making sure the airway is open c. Start at the legs, making sure there is movement d. Start at the chest, making sure no ribs are broken Question 27 A coworker fell down to the ground and used his arm to stop the fall. He tried using his hand to stand up and noticed severe pain in his right wrist. There is swelling, and he is unable to move his wrist, so you suspect a fracture. How should you treat this injury? a. Check for serious illness or injury that may have caused the fall. Stabilize the injured part to avoid movement. b. Make sure there is not a compound fracture by pressing on the injured area. If there is a great deal of pain, apply a splint. c. Tell the coworker to hold onto the wrist tightly while you assist him to the nearest place for medical treatment d. Apply a splint immediately. Straighten any deformed areas before applying the splint. Question 28 A person fell from a 10-foot ladder onto a sidewalk. The person is unresponsive. You suspect a potential head, neck, or back injury. What should be your first actions? a. Call 911 and check for other potential fractures in the ribs, arms, and legs b. Send someone to call 911 and use something to splint the neck area c. Splint the spine, check for fractures, and call 911 d. Minimize movement, call 911, and check airway, breathing, and circulation (signs of life) Question 29 You notice a man having what appears to be a seizure. What should you do to help this person? a. Call 911 and hold the man down to stop him from convulsing b. Shove a stick, comb or wallet into the man's mouth so he doesn't swallow his tongue c. Call 911 and protect the person from injury d. Send someone to call 911 and get the man's mouth open any way you can Question 30 Choose the one item listed that you would NOT give to a person who is experiencing a diabetic emergency? a. Glucose gel b. Sugar c. Insulin d. Juice Question 31 A three-inch-long, toothpick-sized piece of wood is stuck in a coworker's right eye. How would you treat the injury? a. Pack gauze tightly around the wood so it cannot move. Then, use roller gauze to wrap both eyes to apply pressure. b. Loosely wrap gauze around the injured eye c. Place an eye pad over the injured eye and tape it down snugly d. Place a cup over the object in the injured eye and cover both eyes Question 32 A person ate a candy bar containing peanuts about 15 minutes ago and has the following symptoms: difficulty breathing, blotchy skin, and swelling around the lips. What do you suspect? a. An allergic reaction b. A diabetic reaction c. A stroke d. Choking Question 33 A coworker was working for several hours outside where the temperature was 42 degrees Fahrenheit. He is shivering, confused, and dressed inappropriately for the temperature. What do you believe this person is suffering from? a. Stroke b. Hyperthermia c. Hypothermia d. Heart problems Question 34 A 48-year-old male was working on a construction site on a very hot and humid day. He staggers to your vehicle and tells you that he is dizzy, his legs are cramping, and he feels sick. He is sweating, and his skin feels hot and wet. What would you suspect? a. Heart attack b. Heat exhaustion c. Heat stroke d. Diabetic emergency Question 35 Which of the following is the appropriate treatment for a person with a suspected second-degree (blister) burn on her forearm? a. Wrap the burned area snugly with a roller gauze to cover it b. Cool the burn by holding ice directly on the skin c. Cool the burn by applying cool water d. Smear large amounts of butter or olive oil all over the burn 201 ProFirstAid Basic Written Test ANSWER KEY 1) A 2) A 3) C 4) B 5) C 6) A 7) D 8) D 9) C 10) B 11) D 12) C 13) B 14) A 15) D 16) D 17) B 18) D 19) B 20) B 21) B 22) A 23) D 24) C 25) C 26) D 27) A 28) C 29) B 30) C 202 203 204 ProFirstAid Basic Written Test Answer Sheet ProFirstAid Basic Written Test Answer Sheet Name:______________________ Date:________ Name:______________________ Date:________ 1. _______ 1. _______ 2. _______ 2. _______ 3. _______ 3. _______ 4. _______ 4. _______ 5. _______ 5. _______ 6. _______ 6. _______ 7. _______ 7. _______ 8. _______ 8. _______ 9. _______ 9. _______ 10. _______ 10. _______ 11. _______ 11. _______ 12. _______ 12. _______ 13. _______ 13. _______ 14. _______ 14. _______ 15. _______ 15. _______ 16. _______ 16. _______ 17. _______ 17. _______ 18. _______ 18. _______ 19. _______ 19. _______ 20. _______ 20. _______ 21. _______ 21. _______ 22. _______ 22. _______ 23. _______ 23. _______ 24. _______ 24. _______ 25. _______ 25. _______ 26. _______ 26. _______ 27. _______ 27. _______ 28. _______ 28. _______ 29. _______ 29. _______ 30. _______ 30. _______ 205 ProFirstAid Basic (Adult CPR/AED and First Aid) Test Please do not write on the test. Select the best answer for each question. Write the letter of your choice on the answer sheet. Question 1 What is one of the five fears that prevents people from performing CPR? a. The fear of doing CPR incorrectly and hurting the patient b. The fear that a reward will not be given c. The fear of the unknown d. The fear that people in cardiac arrest are better off left alone Question 2 You are walking in the park when you hear somebody scream. As you look in the direction of the sound, you see a person lying on the ground about 30 feet away. What is the first thing you should do? a. Stop and check the scene for safety b. Stay away because you might get sued if you try to help c. Quickly go to the injured person to see what is wrong d. Tap and shout to see if the person is responsive Question 3 There is a man lying on the ground and the scene is safe. You have approached, put on your personal protective equipment, and are kneeling beside him. What should you do now? a. Be careful not to touch the person because of contagious diseases b. Call 911 c. Tap and shout to check for responsiveness d. Open the airway Question 4 You have checked the man for responsiveness by tapping and shouting, and he is unresponsive. As you look at the face and chest, he does not appear to be breathing normally. What should you do next? a. Be very careful not to move any part of his body because you might hurt him b. Send someone to call 911 c. Open the airway d. Give two breaths Question 5 A bystander is calling 911. What is your next action? a. Place him in the recovery position b. Wait for EMS to arrive c. Start Chest Compressions d. Give two breaths Question 6 You gave 30 chest compressions to an unresponsive man. What is your next action? a. Open the airway and give two breaths b. Wait for EMS to arrive c. Do a finger sweep d. Look, listen, and feel for breathing 207 Question 7 You have just given 30 chest compressions followed by 2 breaths to an unresponsive man. What is your next action? a. Give two more breaths b. Wait for EMS to arrive c. Reposition the airway d. Give 30 chest compressions Question 8 How will you perform CPR on an unresponsive man with no signs of life? a. Give 30 chest compressions at a rate of 80 per minute, followed by 1 breath b. Give 30 chest compressions at a rate of 80 per minute, followed by 2 breaths c. Give 30 chest compressions at a rate of at least 100 per minute, followed by 1 breath d. Give 30 chest compressions at a rate of at least 100 per minute, followed by 2 breaths Question 9 You are kneeling at the side of an unresponsive man who does not appear to be breathing normally. You have called 911. You do not have personal protective equipment available and do not feel comfortable giving breaths. How will you perform effective CPR? a. Give breaths anyway. Without breaths CPR is totally ineffective. b. Use a piece of paper towel over the mouth to protect yourself c. Give hands-only (compression-only) CPR d. Wait for EMS personnel to arrive Question 10 You are eating lunch in a restaurant and a woman suddenly drops to the floor behind you. The scene is safe, so you approach and check for responsiveness. She is unresponsive and not breathing normally. You call 911. Next, you give 30 compressions, check the mouth for an object, and attempt a breaths. The breath does not go in, and the chest does not rise. What is your next action? a. b. c. d. Give abdominal thrusts Reposition the head and reattempt a breath Perform a finger sweep Give 30 chest compressions at a rate of 100 per minute Question 11 After you reposition the head of the unresponsive woman and attempt another breath , the breath still will not go in, and the chest will not rise. What is your next action? a. b. c. d. Give abdominal thrusts Reposition the head and reattempt 2 breaths Perform a finger sweep Give 30 chest compressions at a rate of at least 100 per minute Question 12 You just gave 30 chest compressions to the unconscious, choking woman. What is your next action? a. Give abdominal thrusts b. Immediately attempt 2 breaths c. Perform a finger sweep if you see an object in the mouth d. Give another set of 30 chest compressions at a rate of 100 per minute 208 Question 13 You performed a finger sweep for the unconscious, choking woman, and pulled an object out of her mouth. What is your next action? a. Give abdominal thrusts b. Attempt 2 breaths c. Place the person in the recovery position d. Give another set of 30 chest compressions at a rate of 100 per minute Question 14 As you are eating in a restaurant, your friend stands up and cannot cough, speak or breathe. What is your next action? a. Call 911, stand behind the person, and give abdominal thrusts b. Call 911 and give 30 chest thrusts c. Encourage the person to try harder to cough d. Lay the victim down and give 30 chest compressions Question 15 A coworker has a severe headache, slurred speech, and weakness on the left side of her body. What medical emergency do you suspect? a. Seizure b. Diabetic emergency c. Heart attack d. Stroke Question 16 A 48-year-old male is experiencing shortness of breath, sweating, and crushing pain in his chest. He states that he has not been feeling well for the past hour. What medical emergency do you suspect? a. Stroke b. Flu c. Diabetic emergency d. Heart attack Question 17 A fellow employee was struck in the nose by a wrench. Blood is on the tool and the floor. How should you protect yourself to properly clean up the blood? a. Use a sterile gauze to wipe off the tool and the floor b. Wear proper personal protective equipment c. Just be careful not to touch the fluids with your hands. d. Call for a professional cleaning service Question 18 While performing CPR at your job, blood gets in your mouth. What should you do next? a. Report the incident to your supervisor and go to the doctor after your shift is over b. Rinse out your mouth with water for a minimum of 20 minutes c. Rinse out your mouth with mouthwash, which will kill all the germs d. Decontaminate, report the incident, and do not delay medical evaluation Question 19 A man cut his forearm and is bleeding severely. Blood is spurting out of the wound with each heartbeat. What should you do? a. Apply a pressure bandage immediately b. Use direct pressure on the wound and apply a pressure bandage c. Lower the wound below the level of the heart, then wrap a pressure bandage around it d. Apply a tourniquet as soon as possible 209 Question 20 You have applied direct pressure and a pressure bandage to a man who cut his forearm and was bleeding severely. He is pale, has moist skin, feels dizzy, and is acting confused. What medical emergency do you suspect, and how should you treat the victim? a. Heart attack: keep him calm until the ambulance arrives b. Shock: elevate the legs and keep him warm c. Diabetic emergency: give him something sweet to eat d. Stroke: monitor his airway, breathing, and circulation Question 21 You have a victim that is unconscious and breathing without any obvious injuries that need immediate treatment. You have called 911. How would you begin a secondary survey to find fractures, bleeding, and other injuries that are not obvious on initial inspection? a. Start with the arms to find problems with muscle control b. Start at the head, making sure the airway is open c. Start at the legs, making sure there is movement d. Start at the chest, making sure no ribs are broken Question 22 A coworker fell down to the ground and used his arm to stop the fall. He tried using his hand to stand up and noticed severe pain in his right wrist. There is swelling, and he is unable to move his wrist, so you suspect a fracture. How should you treat this injury? a. Check for serious illness or injury that may have caused the fall. Stabilize the injured part to avoid movement. b. Make sure there is not a compound fracture by pressing on the injured area. If there is a great deal of pain, apply a splint. c. Tell the coworker to hold onto the wrist tightly while you assist him to the nearest place for medical treatment d. Apply a splint immediately. Straighten any deformed areas before applying the splint. Question 23 A person fell from a 10-foot ladder onto a sidewalk. The person is unresponsive. You suspect a potential head, neck, or back injury. What should be your first actions? a. Call 911 and check for other potential fractures in the ribs, arms, and legs b. Send someone to call 911 and use something to splint the neck area c. Splint the spine, check for fractures, and call 911 d. Minimize movement, call 911, and check airway, breathing, and circulation (signs of life) Question 24 You notice a man having what appears to be a seizure. What should you do to help this person? a. Call 911 and hold the man down to stop him from convulsing b. Shove a stick, comb or wallet into the man's mouth so he doesn't swallow his tongue c. Call 911 and protect the person from injury. After the seizure stops, check airway, breathing, and circulation (signs of life). d. Send someone to call 911 and get the man's mouth open any way you can Question 25 Choose the one item listed that you would not give to a person who is experiencing a diabetic emergency? a. Glucose gel b. Sugar 210 c. Insulin d. Juice Question 26 A three-inch-long, toothpick-sized piece of wood is stuck in a coworker's right eye. How would you treat the injury? a. Pack gauze tightly around the wood so it cannot move. Then, use roller gauze to wrap both eyes to apply pressure. b. Loosely wrap gauze around the injured eye c. Place an eye pad over the injured eye and tape it down snugly d. Place a cup over the object in the injured eye and cover both eyes Question 27 A person ate a candy bar containing peanuts about 15 minutes ago and has the following symptoms: difficulty breathing, blotchy skin, and swelling around the lips. What do you suspect? a. An allergic reaction b. A diabetic reaction c. A stroke d. Choking Question 28 A coworker was working for several hours outside where the temperature was 42 degrees Fahrenheit. He is shivering, confused, and dressed inappropriately for the temperature. What do you believe this person is suffering from? a. Stroke b. Hyperthermia c. Hypothermia d. Heart problems Question 29 A 48-year-old male was working on a construction site on a very hot and humid day. He staggers to your vehicle and tells you that he is dizzy, his legs are cramping, and he feels sick. He is sweating, and his skin feels hot and wet. What would you suspect? a. Heart attack b. Heat exhaustion c. Heat stroke d. Diabetic emergency Question 30 Which of the following is the appropriate treatment for a person with a suspected second-degree (blister) burn on her forearm? a. Wrap the burned area snugly with a roller gauze to cover it b. Cool the burn by holding ice directly on the skin c. Cool the burn by applying cool water d. Smear large amounts of butter or olive oil all over the burn 211 212 ProCPR Basic Written Test ANSWER KEY 1) A 2) A 3) C 4) B 5) C 6) A 7) D 8) D 9) C 10) B 11) D 12) C 13) B 14) A 15) D 16) D 213 214 ProCPR Basic Written Test Answer Sheet ProCPR Basic Written Test Answer Sheet Name:______________________ Date:________ Name:______________________ Date:________ 1. _______ 1. _______ 2. _______ 2. _______ 3. _______ 3. _______ 4. _______ 4. _______ 5. _______ 5. _______ 6. _______ 6. _______ 7. _______ 7. _______ 8. _______ 8. _______ 9. _______ 9. _______ 10. _______ 10. _______ 11. _______ 11. _______ 12. _______ 12. _______ 13. _______ 13. _______ 14. _______ 14. _______ 15. _______ 15. _______ 16. _______ 16. _______ 215 216 ProCPR Basic (Layrescuer Adult CPR/AED) Test Please do not write on the test. Select the best answer for each question. Write the letter of your choice on the answer sheet. Question 1 What is one of the five fears that prevents people from performing CPR? a. The fear of doing CPR incorrectly and hurting the patient b. The fear that a reward will not be given c. The fear of the unknown d. The fear that people in cardiac arrest are better off left alone Question 2 You are walking in the park when you hear somebody scream. As you look in the direction of the sound, you see a person lying on the ground about 30 feet away. What is the first thing you should do? a. Stop and check the scene for safety b. Stay away because you might get sued if you try to help c. Quickly go to the injured person to see what is wrong d. Tap and shout to see if the person is responsive Question 3 There is a man lying on the ground and the scene is safe. You have approached, put on your personal protective equipment, and are kneeling beside him. What should you do now? a. Be careful not to touch the person because of contagious diseases b. Call 911 c. Tap and shout to check for responsiveness d. Open the airway Question 4 You have checked the man for responsiveness by tapping and shouting, and he is unresponsive. As you look at the face and chest, he does not appear to be breathing normally. What should you do next? a. Be very careful not to move any part of his body because you might hurt him b. Send someone to call 911 c. Open the airway d. Give two breaths Question 5 A bystander is calling 911. What is your next action? a. Place him in the recovery position b. Wait for EMS to arrive c. Start Chest Compressions d. Give two breaths Question 6 You gave 30 chest compressions to an unresponsive man. What is your next action? a. Open the airway and give two breaths b. Wait for EMS to arrive c. Do a finger sweep d. Look, listen, and feel for breathing 217 Question 7 You have just given 30 chest compressions followed by 2 breaths to an unresponsive man. What is your next action? a. Give two more breaths b. Wait for EMS to arrive c. Reposition the airway d. Give 30 chest compressions Question 8 How will you perform CPR on an unresponsive man with no signs of life? a. Give 30 chest compressions at a rate of 80 per minute, followed by 1 breath b. Give 30 chest compressions at a rate of 80 per minute, followed by 2 breaths c. Give 30 chest compressions at a rate of at least 100 per minute, followed by 1 breath d. Give 30 chest compressions at a rate of at least 100 per minute, followed by 2 breaths Question 9 You are kneeling at the side of an unresponsive man who does not appear to be breathing normally. You have called 911. You do not have personal protective equipment available and do not feel comfortable giving breaths. How will you perform effective CPR? a. Give breaths anyway. Without breaths CPR is totally ineffective. b. Use a piece of paper towel over the mouth to protect yourself c. Give hands-only (compression-only) CPR d. Wait for EMS personnel to arrive Question 10 You are eating lunch in a restaurant and a woman suddenly drops to the floor behind you. The scene is safe, so you approach and check for responsiveness. She is unresponsive and not breathing normally. You call 911. Next, you give 30 compressions, check the mouth for an object, and attempt a breaths. The breath does not go in, and the chest does not rise. What is your next action? a. b. c. d. Give abdominal thrusts Reposition the head and reattempt a breath Perform a finger sweep Give 30 chest compressions at a rate of 100 per minute Question 11 After you reposition the head of the unresponsive woman and attempt another breath , the breath still will not go in, and the chest will not rise. What is your next action? a. b. c. d. Give abdominal thrusts Reposition the head and reattempt 2 breaths Perform a finger sweep Give 30 chest compressions at a rate of at least 100 per minute Question 12 You just gave 30 chest compressions to the unconscious, choking woman. What is your next action? a. Give abdominal thrusts b. Immediately attempt 2 breaths c. Perform a finger sweep if you see an object in the mouth d. Give another set of 30 chest compressions at a rate of 100 per minute 218 Question 13 You performed a finger sweep for the unconscious, choking woman, and pulled an object out of her mouth. What is your next action? a. Give abdominal thrusts b. Attempt 2 breaths c. Place the person in the recovery position d. Give another set of 30 chest compressions at a rate of 100 per minute Question 14 As you are eating in a restaurant, your friend stands up and cannot cough, speak or breathe. What is your next action? a. Call 911, stand behind the person, and give abdominal thrusts b. Call 911 and give 30 chest thrusts c. Encourage the person to try harder to cough d. Lay the victim down and give 30 chest compressions Question 15 A coworker has a severe headache, slurred speech, and weakness on the left side of her body. What medical emergency do you suspect? a. Seizure b. Diabetic emergency c. Heart attack d. Stroke Question 16 A 48-year-old male is experiencing shortness of breath, sweating, and crushing pain in his chest. He states that he has not been feeling well for the past hour. What medical emergency do you suspect? a. Stroke b. Flu c. Diabetic emergency d. Heart attack 219 220 ProFirstAid Advanced Written Test ANSWER KEY 1) A 36) C 2) A 37) A 3) C 38) C 4) B 39) B 5) C 40) C 6) D 7) A 8) D 9) C 10) D 11) B 12) B 13) D 14) C 15) B 16) A 17) A 18) A 19) C 20) D 21) D 22) B 23) D 24) B 25) B 26) B 27) A 28) D 29) C 30) C 31) D 32) A 33) C 34) B 35) C 221 222 ProFirstAid Advanced Written Test Answer Sheet ProFirstAid Advanced Written Test Answer Sheet Name:______________________ Date:________ Name:______________________ Date:________ 1. _______ 36. _______ 1. _______ 36. _______ 2. _______ 37. _______ 2. _______ 37. _______ 3. _______ 38. _______ 3. _______ 38. _______ 4. _______ 39. _______ 4. _______ 39. _______ 5. _______ 40. _______ 5. _______ 40. _______ 6. _______ 6. _______ 7. _______ 7. _______ 8. _______ 8. _______ 9. _______ 9. _______ 10. _______ 10. _______ 11. _______ 11. _______ 12. _______ 12. _______ 13. _______ 13. _______ 14. _______ 14. _______ 15. _______ 15. _______ 16. _______ 16. _______ 17. _______ 17. _______ 18. _______ 18. _______ 19. _______ 19. _______ 20. _______ 20. _______ 21. _______ 21. _______ 22. _______ 22. _______ 23. _______ 23. _______ 24. _______ 24. _______ 25. _______ 25. _______ 26. _______ 26. _______ 27. _______ 27. _______ 28. _______ 28. _______ 29. _______ 29. _______ 30. _______ 30. _______ 31. _______ 31. _______ 32. _______ 32. _______ 33. _______ 33. _______ 34. _______ 34. _______ 35. _______ 35. _______ 223 ProFirstAid Advanced (Healthcare Provider Adult, Child, Infant CPR/AED and First Aid) Test Please do not write on the test. Select the best answer for each question. Write the letter of your choice on the answer sheet. Question 1 What is one of the five fears that prevents people from performing CPR? a. The fear of doing CPR incorrectly and hurting the patient b. The fear that a reward will not be given c. The fear of the unknown d. The fear that people in cardiac arrest are better off left alone Question 2 You are walking in the park when you hear somebody scream. As you look in the direction of the sound, you see a person lying on the ground about 30 feet away. What is the first thing you should do? a. Stop and check the scene for safety b. Stay away because you might get sued if you try to help c. Quickly go to the injured person to see what is wrong d. Tap and shout to see if the person is responsive Question 3 There is a man lying on the ground and the scene is safe. You have approached, put on your personal protective equipment, and are kneeling beside him. What should you do now? a. Be careful not to touch the person because of contagious diseases b. Call 911 c. Tap and shout to check for responsiveness d. Open the airway Question 4 You have checked the man for responsiveness by tapping and shouting, and he is unresponsive, and does not appear to be breathing normally. What should you do next? a. Be very careful not to move any part of his body because you might hurt him b. Send someone to call 911 c. Open the airway d. Give two breaths Question 5 You have checked the man for responsiveness by tapping and shouting, and he is unresponsive, and does not appear to be breathing normally. A bystander is calling 911. What is your next action? a. Place him in the recovery position b. Wait for EMS to arrive c. Check for a carotid pulse d. Give two breaths Question 6 You find an unresponsive man has no pulse. What is your next action? a. Give two breaths b. Wait for EMS to arrive c. Do a finger sweep d. Give 30 chest compressions 225 Question 7 You have just given 30 chest compressions to an unresponsive man with no pulse. What is your next action? a. Open the airway and give two breaths b. Wait for EMS to arrive c. Reposition the airway and look for an object d. Give 30 chest compressions at a rate of 100 per minute, then 2 breaths Question 8 How will you perform CPR for an adult with no pulse? a. Give 30 chest compressions at a rate of 80 per minute, compressing 2 inches deep, followed by 1 breath b. Give 30 chest compressions at a rate of 80 per minute, compressing 2 inches deep, followed by 2 breaths c. Give 30 chest compressions at a rate of at least 100 per minute,compressing at least 2 inches deep, followed by 1 breath d. Give 30 chest compressions at a rate of at least 100 per minute, compressing at least 2 inches deep, followed by 2 breaths Question 9 You are kneeling at the side of an unresponsive man who does not appear to be breathing normally. You have called 911. You do not have personal protective equipment available and do not feel comfortable giving breaths.How will you perform effective CPR? a. Give breaths anyway. Without breaths CPR is totally ineffective. b. Use a piece of paper towel over the mouth to protect yourself c. Give hands-only (compression-only) CPR d. Wait for EMS personnel to arrive Question 10 What is the preferred method for performing 1-rescuer CPR on an infant? a. Use the heel of one hand to give chest compressions 1/3 to 1/2 the depth of the chest b. Use two hands to give chest compressions 1/3 to 1/2 the depth of the chest c. Use the "2 thumbs, hands encircling the chest" technique d. Use two fingers of one hand to give chest compressions at least 1/3 the depth of the chest Question 11 What is the preferred method for performing 1-rescuer CPR on a child? a. Always use two hands to give chest compressions at least 1/3 the depth of the chest b. Use the heel of one hand to give chest compressions at least 1/3 the depth of the chest c. Use the heel of one hand to give chest compressions 2 inches deep d. Use the heel of one hand to give chest compressions as deep as you can Question 12 You are eating lunch in a restaurant and a woman suddenly drops to the floor behind you. The scene is safe, so you approach and check for responsiveness. She is unresponsive and not breathing normally. You call 911. Next, you give 30 compressions, check the mouth for an object, and attempt breaths. The first breath did not go in, and the chest did not rise. What is your next action? a. Give abdominal thrusts b. Reposition the head and reattempt a breath c. Perform a finger sweep d. Give 30 chest compressions at a rate of 100 per minute Question 13 After you reposition the head of the unresponsive woman and attempt a breath , the breath still will not go in, and the chest will not rise. What is your next action? a. Give abdominal thrusts b. Reposition the head and reattempt 2 breaths c. Perform a finger sweep d. Give 30 chest compressions at a rate of at least 100 per minute Question 14 You just gave 30 chest compressions to the unconscious, choking woman. What is your next action? a. Give abdominal thrusts b. Immediately attempt 2 breaths c. Perform a finger sweep if you see an object in the mouth d. Give another set of 30 chest compressions at a rate of 100 per minute Question 15 You performed a finger sweep for the unconscious, choking woman, and pulled an object out of her mouth. What is your next action? a. Give abdominal thrusts b. Attempt a breath. If it goes in, give a second breath c. Place the person in the recovery position d. Give another set of 30 chest compressions at a rate of 100 per minute Question 16 As you are eating in a restaurant, your friend stands up and cannot cough, speak or breathe. What is your next action? a. Call 911, stand behind the person, and give abdominal thrusts b. Call 911 and give 30 chest thrusts c. Encourage the person to try harder to cough d. Lay the victim down and give 30 chest compressions Question 17 You believe an infant is choking because he is conscious but not breathing, coughing, or moving air. You should: a. Give 5 back blows followed by 5 chest thrusts and repeat until the object comes out or the baby becomes unconscious b. Give abdominal thrusts and repeat until the object comes out or the baby becomes unconscious c. Try to sweep the object out of the mouth with your pinky finger d. Give continuous back slaps until the object comes out Question 18 Video: Unconscious Infant Choking (skip unconscious child choking) You tried to give the first breath to an unconscious choking infant, but the air did not go in. You repositioned the head and reattempted another breath . The air still did not go in or make the chest rise. What should you do next? a. Give 30 chest compressions using 2 fingers in the center of the chest b. Call 911, keep him comfortable, and monitor airway, breathing, and circulation until help arrives c. Perform a finger sweep to get the object out d. Give 5 back blows followed by 5 chest thrusts Question 19 You just finished doing 30 chest compressions on an unconscious choking infant. What should you do next? a. Give another 30 chest compressions using 2 fingers in the center of the chest b. Immediately perform a finger sweep using your index finger c. Check the airway and perform a finger sweep if there is an object d. Give 5 back blows followed by 5 chest thrusts Question 20 A coworker has a severe headache, slurred speech, and weakness on the left side of her body. What medical emergency do you suspect? a. Seizure b. Diabetic emergency c. Heart attack d. Stroke Question 21 A 48-year-old male is experiencing shortness of breath, sweating, and crushing pain in his chest. He states that he has not been feeling well for the past hour. What medical emergency do you suspect? a. Stroke b. Flu c. Diabetic emergency d. Heart attack Question 22 A fellow employee was struck in the nose by a wrench. Blood is on the tool and the floor. How should you protect yourself to properly clean up the blood? a. Use a sterile gauze to wipe off the tool and the floor b. Wear proper personal protective equipment c. Just be careful not to touch the fluids with your hands d. Call for a professional cleaning service Question 23 While performing CPR at your job, blood gets in your mouth. What should you do next? a. Report the incident to your supervisor and go to the doctor after your shift is over b. Rinse out your mouth with water for a minimum of 20 minutes c. Rinse out your mouth with mouthwash, which will kill all the germs d. Decontaminate, report the incident, and do not delay medical evaluation Question 24 A man cut his forearm and is bleeding severely. Blood is spurting out of the wound with each heartbeat. What should you do? a. Apply a pressure bandage immediately b. Use direct pressure on the wound and apply a pressure bandage c. Lower the wound below the level of the heart, then wrap a pressure bandage around it d. Apply a tourniquet as soon as possible Question 25 You have applied direct pressure and a pressure bandage to a man who cut his forearm and was bleeding severely. He is pale, has moist skin, feels dizzy, and is acting confused. What medical emergency do you suspect, and how should you treat the victim? a. Heart attack: keep him calm until the ambulance arrives b. Shock: elevate the legs and keep victim warm c. Diabetic emergency: give him something sweet to eat d. Stroke: monitor his airway, breathing, and circulation Question 26 You have a victim that is unconscious and breathing without any obvious injuries that need immediate treatment. You have called 911. How would you begin a secondary survey to find fractures, bleeding, and other injuries that are not obvious on initial inspection? a. Start with the arms to find problems with muscle control b. Start at the head, making sure the airway is open c. Start at the legs, making sure there is movement d. Start at the chest, making sure no ribs are broken Question 27 A coworker fell down to the ground and used his arm to stop the fall. He tried using his hand to stand up and noticed severe pain in his right wrist. There is swelling, and he is unable to move his wrist, so you suspect a fracture. How should you treat this injury? a. Check for serious illness or injury that may have caused the fall. Stabilize the injured part to avoid movement. b. Make sure there is not a compound fracture by pressing on the injured area. If there is a great deal of pain, apply a splint. c. Tell the coworker to hold onto the wrist tightly while you assist him to the nearest place for medical treatment d. Apply a splint immediately. Straighten any deformed areas before applying the splint. Question 28 A person fell from a 10-foot ladder onto a sidewalk. The person is unresponsive. You suspect a potential head, neck, or back injury. What should be your first actions? a. Call 911 and check for other potential fractures in the ribs, arms, and legs b. Send someone to call 911 and use something to splint the neck area c. Splint the spine, check for fractures, and call 911 d. Minimize movement, call 911, and check airway, breathing, and circulation (signs of life) Question 29 You notice a man having what appears to be a seizure. What should you do to help this person? a. Call 911 and hold the man down to stop him from convulsing b. Shove a stick, comb or wallet into the man's mouth so he doesn't swallow his tongue c. Call 911 and protect the person from injury d. Send someone to call 911 and get the man's mouth open any way you can Question 30 Choose the one item listed that you would NOT give to a person who is experiencing a diabetic emergency? a. Glucose gel b. Sugar c. Insulin d. Juice Question 31 A three-inch-long, toothpick-sized piece of wood is stuck in a coworker's right eye. How would you treat the injury? a. Pack gauze tightly around the wood so it cannot move. Then, use roller gauze to wrap both eyes to apply pressure. b. Loosely wrap gauze around the injured eye c. Place an eye pad over the injured eye and tape it down snugly d. Place a cup over the object in the injured eye and cover both eyes Question 32 A person ate a candy bar containing peanuts about 15 minutes ago and has the following symptoms: difficulty breathing, blotchy skin, and swelling around the lips. What do you suspect? a. An allergic reaction b. A diabetic reaction c. A stroke d. Choking Question 33 A coworker was working for several hours outside where the temperature was 42 degrees Fahrenheit. He is shivering, confused, and dressed inappropriately for the temperature. What do you believe this person is suffering from? a. Stroke b. Hyperthermia c. Hypothermia d. Heart problems Question 34 A 48-year-old male was working on a construction site on a very hot and humid day. He staggers to your vehicle and tells you that he is dizzy, his legs are cramping, and he feels sick. He is sweating, and his skin feels hot and wet. What would you suspect? a. Heart attack b. Heat exhaustion c. Heat stroke d. Diabetic emergency Question 35 Which of the following is the appropriate treatment for a person with a suspected second-degree (blister) burn on her forearm? a. Wrap the burned area snugly with a roller gauze to cover it b. Cool the burn by holding ice directly on the skin c. Cool the burn by applying cool water d. Smear large amounts of butter or olive oil all over the burn Question 36 You have an adult who was just pulled out of a pool after drowning. You have checked the scene for safety, checked for responsiveness, and called 911. What will indicate that you need to perform rescue breathing at a rate of 1 breath every 5 seconds instead of CPR? a. The person begins to move and gag b. You check for breathing and find no breathing c. You check the pulse. The victim is not breathing but has a pulse. d. You check the pulse and find no pulse Question 37 You are performing rescue breathing on a child. After 2 minutes, you stop to recheck the pulse. You feel a pulse but the child is still not breathing. What should you do now? a. Continue rescue breathing by giving 1 breath every 3 seconds b. Double check the breathing and pulse for another 10 to 15 seconds c. Continue rescue breathing by giving 1 breath every 5 seconds d. Give 30 chest compressions by placing the heel of one hand directly on the center of the chest Question 38 You and a coworker are performing 2-person CPR on an adult victim, and you are about to give breaths with a bag valve mask. The single most important thing to remember when using a bag valve mask is: a. Oxygen is always used with a bag valve mask(BVM) b. The mask must be an exact size and fit the person in order to provide adequate ventilation c. Bag valve mask use should be effective and cause good chest rise and fall d. Bag valve mask seal is performed with the C 3 method Question 39 You have been been performing CPR by yourself on an infant for a few minutes. A neighbor arrives and says she knows 2 person CPR. What will you do? a. Have the second rescuer take over breaths. You will give 30 compressions using the 2 thumbs hands encircling chest technique and she will give 2 breaths. b. Have the second rescuer take over compressions. She will give 15 compressions using the 2 thumbs hands encircling chest technique and you will give 2 breaths. c. Tell the second rescuer to wait until you get tired. When you are exhausted, tell her to take over. d. Tell her that she can't legally help you unless she has a current CPR certification Question 40 You are performing CPR compressions and a coworker is giving breaths for an adult patient. What will you do after about 5 cycles of 30 compressions to 2 breaths or when you feel tired? a. Tell your coworker that you will need to switch soon. Have the second rescuer continue breaths while you continue compressions for 5 more cycles before switching positions. b. Have your coworker take over compressions immediately. You will give 2 breaths after your coworker finishes 30 compressions. c. Call for a switch and complete your 30 compressions. Your coworker will finish with 2 breaths, move into position, and give 30 chest compressions. After the 30 compressions, you will give 2 breaths. d. Tell your coworker to take over CPR while you rest for a few cycles of 30 compressions to 2 breaths Appendix E- Sample Certification Cards Front Back JIM SMITH 01 Jan 2011 01 Jan 2013 129083355777 JODY MARVIN 1000 JODYMARVIN MARVIN JODY # 1000 1000 JODY MARVIN 1000 JIM SMITH 01 Jan 2011 01 Jan 2013 129083355777 JIM SMITH 01 Jan 2011 01 Jan 2013 129083355777 233 Front Back JIM SMITH 01 Jan 2011 01 Jan 2013 129083355777 JODY MARVIN 1000 ProBloodborne SAMPLE Course Certification Card Participants will complete the training and testing online. After successfully passing the written test, the participant will be issued a certification card valid for 1 year. JIM SMITH 01 Jan 2011 01 Jan 2012 100% Online Cognitive Training SAMPLE Course Certification Card Participants will complete the training and testing online. After successfully passing the written test, the participant will be issued a certification card valid for 2 year. JIM SMITH 234 01 Jan 2011 01 Jan 2013 129083355799 100% online card only states cognitive evaluation. 100% online card only has one signature line. Appendix F- Equipment Decontamination and Participant Safety Manikin Decontamination & Participant Safety There has never been a documented case of a CPR manikin transmitting a bacterial, fungal, or viral disease. In order to prevent the possibility of an infectious disease being spread from manikin use, manikins need to be cleaned and disinfected properly. The following are the evaluator’s responsibilities in regard to manikin decontamination:  Inspect manikins before each use: Look for cracks or tears on the face that could inhibit cleaning or may injure a participant. Do not use manikins with cracks or tears on the face.  Personal Protective Equipment: Participants should use their own practice face shield or rescue mask and wear gloves when performing skills.  Decontaminate manikins during use: After every participant’s use, the face and inside mouth should be wiped briskly. Manikins with individual use lungs should be changed between each participant. Use a clean absorbent material wetted down with a solution of household chlorine bleach and water (1 part bleach to 10 parts water solution). A solution of 70% alcohol (isopropanol or ethanol) will also work well. Let the surface stay wet for about 1 minute before wiping off with a clean dry cloth or letting it air-dry.  Decontaminate manikins after each session or day: All manikins used should be thoroughly cleaned after each session or day of use. Remember to clean manikins in a well ventilated area and use safety goggles and gloves when cleaning manikins. Completely disassemble according to manufacturer’s directions and scrub the parts with warm soapy water, rinse, and decontaminate by soaking in a bleach solution for 10 minutes. Make sure to scrub manikin parts vigorously as this is just as important as using a bleach solution. Rinse with fresh water, dry, and reassemble. Make sure to replace the disposable lungs and airway passages with new parts.  Participant Safety: Individuals that take the course may have a wide range of physical limitations: hearing disabilities, legally blind, lack of full use of limbs, back troubles, etc. A blended participant will be familiar with the required skills after completing the web-based content. However, evaluators should use the skill sheets to brief individuals on the required skills. Some adaptations may be made as long as the objective of the skill can be successfully met. If the objective cannot be safely met respectfully explain that certification cannot be given. Do not compromise the safety of the participant or the evaluator. 235 236 Appendix G-ProBloodborne Course -Bloodborne for Body Art Course 237 ProBloodborne Course Facts OSHA Standard 29 CFR 1910.1030 and Infection Control Description: ProBloodborne includes the following Bloodborne Pathogens and Infection Control training:  Basic Terms related to BloodBorne Pathogens  How bloodborne pathogens and infectious disease are spread  Healthcare Professional’s responsibilities to avoid spreading BBP and infectious disease  HIV and Aids, including symptoms and prevention  Hepatitis B, including symptoms, prevention, and vaccine  Hepatitis C, including symptoms and prevention  Other infectious concerns  How to reduce risks of exposure including appropriate engineering controls, work practices, personal protective equipment, and safe injection practices.  Information on the types, proper use, location, removal, handling, decontamination and disposal of personal protective equipment  Exposure control plans  Proper cleanup and decontamination procedures  Procedure to follow if an exposure incident occurs  An explanation of the signs and labels and/or color coding required for  hazardous disposal  An opportunity for interactive questions and answers is available with the training organization via email, chat, and phone support. Purpose: This course is intended for people who need OSHA compliant Bloodborne Pathogens and infection control training, according to OSHA 29 CFR 1910.1030 standard, as part of their job requirement because they may face occupational exposure to Bloodborne Pathogens and infectious disease. People who need this certification include healthcare providers, daycare providers, home care workers, teachers, and general workplace employees. Course Design: Traditional Classroom:  ProBloodborne Training: 2 Hours  After the participant has passed the written test with a minimum of 80% correct, he or she will receive a certification card valid for 1 year. Online: www.probloodborne.com  All cognitive learning and testing is to be completed online at the participant’s own pace. After the participant has passed the written test with a minimum of 80% cor238 rect, he or she will receive a certification card valid for 1 year. ProBloodborne Instructor Activities When you see the camera symbol it is time to show the video. The video titles will be highlighted in red. When you see the teacher symbol it is time to teach key points. Yellow highlighted text is information the instructor needs to know. Green highlighted text is information the instructor needs to say. Make sure to state the key points to the students in each section. The key points are the most important things the students need to know after each activity. In short, the color coding system is as follows: Red= Stop and show the video to the students Yellow= Slow down and review the information before proceeding Green= Go present the information to the students (See end of instructor activities for complete OSHA 29CFR 1910.1030 standard) Videos for the ProBloodborne Course are available online at www.probloodborne.com and on the ProBloodborne Instructor DVD Key Points:  The goal of the ProBloodborne course is to help the student gain the knowledge and skills necessary to prevent the transmission of bloodborne pathogens.  The course will combine short video segments and discussion. There will be a written test at the end. Make sure to pay attention to the key points in each of our activities.  Are there any questions before we begin? (briefly answer any questions. Show video: Introduction to Bloodborne Pathogens Key Points: Bloodborne Pathogens are microorganisms (such as viruses) that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV), hepatitis C (HCV) and human immunodeficiency virus (HIV). Infectious Disease is a disease that enters into the body through various routes, that is caused by microorganisms such as a bacteria, fungus, or virus. Infectious diseases 239 can range from mild to life-threatening. video: How Bloodborne Pathogens Spread Key Points: The Chain of Infection For disease to be spread, it requires that all of the following conditions be present:  An adequate number of pathogens, or disease-causing organisms.  A reservoir or source that allows the pathogen to survive and multiply (e.g., blood).  A mode of transmission from the source to the host.  An entrance through which the pathogen may enter the host.  A susceptible host (i.e., one who is not immune). Effective infection control strategies prevent disease transmission by interrupting one or more links in the chain of infection. The primary source of potential infection is blood and bodily fluids, especially those visibly contaminated with blood  cerebrospinal fluid (Brain)  synovial fluid (Joints)  pleural fluid (Lungs)  amniotic fluid (Uterus)  pericardial fluid (Heart)  peritoneal fluid (Abdomen)  semen  vaginal secretions  blood  any body fluid contaminated with blood  body fluids that cannot be recognized Modes of Transmission  Direct contact -occurs when microorganisms are transferred from one infected person directly to another person. For example, infected blood from on person enters a care giver’s body through an open cut.  Indirect contact- involves the transfer of an infectious agent through a contaminated object or person. For example, a caregiver doesn't wash hands in-between caring for someone with infected body fluids and other patients. For Example, Parenteral contact with a needle stick.  Airborne transmission– occurs when droplets or small particles contain infectious agents that remain effective over time and distance in the air. Tuberculosis is a common disease spread this way. Bloodborne pathogens are not typically spread this way. 240      Sexual contact is the primary mode of transmission for Bloodborne Pathogens, however the risk of exposure does exist while providing medical or first aid care The highest potential risk while providing care exists when a contaminated sharp object cuts or punctures the skin. (Parenteral examples: needle stick, illegal drug usage, cut from broken glass, bite) A medium potential risk exists when an infected body fluid gets into an open cut or mucous membrane (inside eyes, mouth, ears or nose) The lowest potential risk is when a contaminated object touches inflamed skin, acne, or skin abrasion Unlike some infectious diseases, Bloodborne Pathogens are NOT spread by:  Intact skin- is created as our first defense against disease. The CDC states that there is no known risk from exposure to intact skin  Casual contact- such as handshakes and hugging Show Video: HIV and Aids Key Points: HIV- attacks the body’s ability to protect itself against disease (autoimmune system) and may cause AIDS (Acquired Immune Deficiency Syndrome)  Approximately 1.1 million people in the US are living with HIV/AIDS. Approximately 50,000 people become infected with HIV each year. About 15,000 people every year in the USA die from AIDS.  Symptoms may or may not be present. You may be infected for years and not know it. Only a blood test can determine the infection, not symptoms:  Fever  Fatigue  Weight loss  Rash The HIV virus is fragile and may die within seconds outside the body. The amount of HIV present in the body fluid and the conditions will determine how long the virus lives.  HIV is primarily spread by sexual contact with an infected person or by sharing needles and/or syringes (primarily for drug injection). Babies may become infected before/during birth or through breast-feeding. Only a fraction of less than 1% of the people contract the virus from providing medical care.  HIV it is not spread by casual contact like handshakes, sharing food, door 241  knobs, sneezing, toilet seats, swimming pools, etc… There is no vaccination Show video: Hepatitus B Key Points: Hepatitis B Virus- reproduces in the liver causing inflammation and possibly cirrhosis or liver cancer.  Over 1.2 million people in the US have chronic HBV. About 38,000 people/ year become infected with HBV. Each year, about 3,000 people die as a result of liver disease caused by HBV. Infections have decreased since 1990 because of the HBV vaccine.  Symptoms may or may not be present. The older, the more apt to have symptoms. Only a blood test can determine the infection. Symptoms may include:  yellow skin (jaundice)  yellowing eyes  tiredness  loss of appetite, nausea  joint pain  abdominal discomfort      242 Up to 100 times easier to catch than HIV. HBV can live outside of body for at least 7 days and longer. 90% adults who contract hepatitis B clear the virus from their systems within a few months and develop immunity. About 10% become chronic--the virus stays in the blood, infecting liver cells damaging them over time. If exposed to the virus, infants and young children are most at risk from chronic infections, complications, and death. Further, in most children, the virus is a silent killer. It destroys the liver or induces liver cancer often over a period of 20 years or more. HBV is primarily spread by sexual contact with an infected person, sharing needles and/or syringes (primarily for drug injection), from an infected mother to her baby during birth, or sharps exposures on the job However, still like HIV it is not spread by casual contact like handshakes, sharing food, doorknobs, sneezing, toilet seats, swimming pools, etc… Key Points: HBV Vaccine– usually given in 3 doses  Hepatitis B vaccine is made from a part of the hepatitis B virus. It cannot cause H.B.V. infection.  Hepatitis B vaccines are among the safest vaccines we have. In studies, severe adverse events were not detected and local reactions were no greater in persons receiving hepatitis B vaccine than persons who received a placebo or another vaccine.  Booster doses of hepatitis B vaccine are not recommended. Immune memory remains indefinitely following immunization.  It is wise to have Immunity confirmed through antibody testing 1-2 months after the vaccine.  HBV vaccine is 80 to 95% effective in providing protection from Hepatitis B when the complete series of three doses of vaccine are administered.  The HBV vaccine must be offered free to employees who face occupational exposure to bloodborne pathogens. Employees who do not want the vaccine must complete a vaccine declination form. (  Occupationally exposed employees include those who:  Administer first aid  Provide medical aid to students  Assist in bathroom care  Work in medical or dental offices  Perform custodial duties involving the cleaning and decontamination of surfaces that may be contaminated with blood and or other potentially infections materials (OPIM).  Handle Regulated medical waste Show Video: Hepatitus C Key Points: Hepatitis C Virus- reproduces in the liver causing inflammation and possibly cirrhosis or liver cancer.  3.2 million people are infected in the USA with about 17,000 new cases each year. Deaths from chronic disease each year are about 12,000. 243       About 80% of exposed people develop a chronic infection. 20% are able to clear the virus by naturally building immunity. Symptoms are not a reliable way to detect HCV. A blood test is needed. Symptoms may look the same as HBV. Unlike HIV or HBV, HCV is spread primarily through parenteral contact:  Illegal injection drug use  Transfusion or transplant from infected donor  Tattoos Occupational exposure to blood mostly through needle sticks It is also spread through:  Birth to HCV-infected mother  Multiple sex partners There is no cure or vaccination Watch Video: Skin Diseases and Disorders Key Points: Skin Diseases, Disorders, and Conditions– Persons with boils, infected wounds, open sores, abrasions, or weeping dermatological lesions should avoid working where there is a likelihood they could contaminate healthcare supplies, body art equipment, or working surfaces. Worker’s skin should be free of rash or infection. Healthcare workers, tattoo artists, and caregivers should cover any sores with bandages to avoid the potential spread of disease. Skin Anatomy– Skin is the largest organ of the body. Contains blood vessels, sensory receptors, nerves, and sweat glands. It is made up of the Epidermis and the dermis. Varies in thickness from 1.5 to 4 mm or more. Skin is the first line of defense against infection.  Epidermis- The thick outer layer of tissue  Dermis– Strong, flexible second layer of connective tissue. The dermis is filled with blood vessels. Unclean tattooing or body art is a high risk activity for bloodborne pathogens because it involves multiple punctures of the skin to instill pigment into the dermis.  Hypodermis– Just below the skin, it is the fatty layer, also called the subcutaneous layer.  Commonly spread skin diseases: Bacteria:  MRSA- (methicillin-resistant Staphylococcus aureus) infection can look like an ordinary skin wound, boil, or infected sore. People contract MRSA by touching infected mucous mem244 branes, skin, or contaminated objects. Virus:  Herpes Simplex– Generally found on the face, scalp, arms, neck and upper chest. Small round blisters when broken can secrete a clear or yellowish fluid. People contract herpes by touching infected saliva, mucous membranes, or skin. Fungus:  Athlete’s Foot, Jock Itch, and Ringworm– Causes red, patchy, flaky, itchy areas. It is contagious and is easily spread from one person to another. Spreads when infected area on another person or contaminated surfaces (showers) are touched. Affected areas need to be kept clean and dry.  Some people with the following conditions are more prone to skin disorders. Healing may be adversely affected by receiving tattoos or body art:  History of Hepatitis B or Hepatitis C  HIV/AIDS  Diabetes  History of hemophilia or any other blood disorder/ disease  History of skin diseases or skin lesions  History of allergies or adverse reactions to pigments, dyes, latex, etc.  Immune disorders Show Video: How to Reduce Your Risk Key Points: Standard Precautions  Treat all body fluids from every person as potentially infectious  Follow the recommendations in the employer’s Bloodborne Pathogens Exposure Control Plan Bloodborne Pathogens Exposure Control PlanElements that must be included:  Determination of employee exposure  Implementation of various methods of exposure control, including:  Universal precautions  Engineering and work practice controls  Personal protective equipment  Housekeeping  Hepatitis B vaccination 245  Post-exposure evaluation and follow-up Communication of hazards to employees and training Recordkeeping Procedures for evaluating circumstances surrounding exposure incidents  Implementation methods for these elements    Controlling exposures- The fundamental method of protecting workers is controlling hazards. Hierarchy of controls: The control methods at the top of the list have a higher potential to be more effective than those at the bottom:  Elimination– get rid of the hazard  Substitution– replace hazard with a safer method  Engineering controls– use devices such as self sheathing needles and sharps containers to block or eliminate risk  Work Practice and Administrative controls– follow policies and procedures to eliminate risk  Personal protective equipment Show Video: Work Practice Controls Key Points: Work Practice, Engineering and Administrative Controls  Follow all training, legal requirements, policies and procedures related to infection control at your facility  Example Work Practice Controls  Do not eat, drink, smoke, apply cosmetics or handle contact lenses in areas where there is the possibility of exposure to BBP.  When emptying trash containers, do not use your hands to compress the trash in the bag. Lift and carry the trash bag away from your body Use Personal Protective Equipment- (PPE must be provided by your employer)  Gloves– use when the potential exists of touching blood, body fluids, or contaminated items.  CPR Shields and Eye Protection– use when patient care is likely to generate splashes or secretions of blood/body fluids.  Gowns– use when the potential exists of contact with blood/body fluids on clothing or exposed skin.  Masks and Respirators– Use to protect from potential airborne infectious diseases. 246 Know where PPE is at your workplace Know what PPE is available and how to use it Make sure first-aid kits and emergency supplies include disposable gloves and CPR face shields or rescue masks  If laundering items rather than disposing, follow your facility’s procedures for handling laundry: General Laundry procedures:  Wear PPE  Keep contaminated laundry separate from other laundry  Bag potentially contaminated laundry where it is used  Use leak-proof bags for wet laundry  Transport in properly labeled bags    Show Video: Regulated Waste Key Points: Hazardous Disposal  Definition: Liquid or semi-liquid blood or other potentially infectious materials (OPIM). Contaminated items that would release blood or other potentially infectious materials in a liquid or semi-liquid state if compressed  Dispose of in a properly labeled biohazard container: either a red bag or container labeled in orange or orange-red with the Bio-Hazard symbol.  Properly labeled and bundled waste needs to be handled according to your facility’s disposal procedures. Do not dispose in normal trash. Show Video: Body Fluid Cleanup Key Points: Cleanup Procedures  Use a solution of 1 part household bleach to 10 parts water or ¼ cup bleach to a gallon of water.  Other commercial disinfectants registered with the EPA as effective against 247 HIV/HBV may be used. Check the label.   Use Personal Protective Equipment. If a Body Fluid Spill Kit is available, use according to manufacture’s directions 1. First, put on Personal Protective Equipment 2. Remove visible material with absorbent towels 3. If any sharp object or broken glass is visible, remove with tongs or dust pan and place in a ridged sealable container. Never use bare hands. 4. Spray disinfectant liberally on contaminated area and let stand for up to 10 minutes 5. Once the area has been disinfected, dry area with absorbent towels and dispose of towels in trash Show Video: Glove Removal Key Points: Glove Removal  Remember, only skin touches skin and glove touches glove  Grip one glove near the cuff and peel it down until it comes off inside out. Cup it in the palm of your gloved hand  Place two fingers of your bare hand inside the cuff of the remaining glove  Peel that glove down so that it also comes off inside out and over the first glove.  Properly dispose of the gloves. Watch Video: Hand Washing Key Points: Hand Hygiene  Hand Hygiene is the most important infection control technique.  Disinfect your hands whenever they are visibly dirty or contaminated and...  Before:  having contact with patients  putting on gloves 248    inserting any invasive device manipulating an invasive device After: having contact with a patient’s skin having contact with bodily fluids or excretions, non-intact skin, wound dressings, contaminated items  having contact with inanimate objects near a patient  removing gloves How to Practice Proper Hand Hygiene:  Alcohol-Based Hand Rubs (foam and gel) kill more effectively and more quickly than handwashing with soap and water. They are also less damaging to the skin. It is preferred method unless hands are visibly dirty.  Apply to palm of one hand (the amount used depends on specific hand rub product).  Rub hands together, covering all surfaces, focusing in particular on the fingertips and fingernails, until dry. Use enough rub to require at least 15 seconds to dry.  Soap and Water  Wet hands with water.  Apply soap.  Rub hands together for at least 15 seconds, covering all surfaces, focusing on fingertips and fingernails.  Rinse under running water and dry with disposable towel.  Use the towel to turn off the faucet.   Hospital Associated Infections Key Points: Hospital Associated Infections  To avoid the spread of bloodborne pathogens and infectious diseases, healthcare professionals have an ethical and professional responsibility to adhere to scientifically accepted or evidence based practices and principles of infection control and to monitor the performance of those for whom the professional is responsible.  Multiple organizations publish best practices for infection control. Some states, such as New York, include a legal responsibility to adhere to infection control practices.  Nosocomial infections are those that originate or occur in a hospital or hospital-like setting. In American hospitals alone, healthcare-associated infections account for an estimated 1.7 million infections and 99,000 associated deaths each year. 249  Some of the common nosocomial infections are urinary tract infections, respiratory pneumonia, surgical site wound infections, bacteremia, gastrointestinal and skin infections.  According to the CDC, the most common pathogens that cause nosocomial infections are Staphylococcus aureus, Pseudomonas aeruginosa, and E. coli.  MRSA- methicillin-resistant Staphylococcus aureus. It is a strain of staph that's resistant to the broad-spectrum antibiotics commonly used to treat it. MRSA can be fatal.  Pseudomonas aeruginosa– pathogens that are highly resistant to antibiotics. Because antibiotics are usually non-effective, it can lead to more serious infections: septicemia, urinary tract infections, pneumonia, chronic lung infections, endocarditis, dermatitis, and osteochondritis.  E. Coli– typically causes severe stomach cramps, diarrhea (often bloody), and vomiting. Some E. coli strains can be life threatening.  Exposure Prevention is the primary strategy for reducing occupational exposure Watch Video: Safe Injection Practices Key Points: 250 Safe injection practices  The Needlestick Prevention Act requires appropriate, commercially available, and effective safer medical devices designed to eliminate or minimize occupational exposure  Needles and other sharps must be discarded in rigid, leak-proof, puncture resistance containers  Do not bend, shear, break or recap needles. If you must recap, use onehanded method.  Use aseptic technique to avoid contamination of sterile injection equipment.  Do not administer medications from a syringe to multiple patients, even if the needle or cannula on the syringe is changed. Needles, cannulae and syringes are sterile, single-use items; they should not be reused for another patient nor to access a medication or solution that might be used for a subsequent patient.  Use fluid infusion and administration sets (i.e., intravenous bags, tubing and connectors) for one patient only and dispose appropriately after use. Consider a syringe or needle/cannula contaminated once it has been used to enter or connect to a patient's intravenous infusion bag or administration set.  Use single-dose vials for parenteral medications whenever possible.  Do not administer medications from single-dose vials or ampules to multiple patients or combine leftover contents for later use. If multidose vials must be used, both the needle or cannula and syringe used to access the multidose vial must be sterile.  Do not keep multidose vials in the immediate patient treatment area and store in accordance with the manufacturer's recommendations; discard if sterility is compromised or questionable.  Do not use bags or bottles of intravenous solution as a common source of supply for multiple patients.  Infection control practices for special lumbar puncture procedures: Wear a surgical mask when placing a catheter or injecting material into the spinal canal or subdural space (i.e., during myelograms, lumbar puncture and spinal or epidural anesthesia.)  Show Video: Exposure Incident and Reporting Key Points: Exposure Incident and Reporting An exposure incident is defined as a specific mucous membrane, broken skin, or puncture contact with blood or OPIM that results from the performance of an employee's duties.  If you think you’ve been exposed, decontaminate, report to supervisor, and seek medical treatment. An immediate confidential post exposure medical evaluation, prophylactic treatment, and follow-up needs to be conducted by a physician.  Complete forms as soon as possible after incident. Don’t delay medical treatment to fill out paperwork. Complete an Exposure Incident Report including the following:  A description of how the exposure occurred  Time, date, and place  All people involved including source individual, exposed person(s), and first aid providers  Forms and continued follow-up action will proceed according to employer’s policies and procedures.  251 Administer Written Test     (Located at the end of the instructor activities section.) Allow students ample time to complete the test. Check answers using the answer sheet Students must have 80% correct to pass the test Student who fail may be remediated and given a second opportunity to pass the test. Students who do not pass the second attempt must retake the course. After-course responsibilities:  Instructor completes student checklist and keeps a copy on file for min. of 1 year.  Instructor completes online classroom records through instructor dashboard so students will receive certification cards. References: Centers for Disease Control and Prevention. Estimates of Healthcare-Associated Infections. http://www.cdc.gov/hai/. 2011 Centers for Disease Control and Prevention. Injection Safety Information for Providers. http://www.cdc.gov/ncidod/dhqp/ ps_providerInfo.html Centers for Disease Control and Prevention. Guideline for Hand Hygiene in Healthcare Settings - 2011. http://www.cdc.gov/handhygiene/ Centers for Disease Control and Prevention. NIOSH safety and health topic: Body Art. http://www.cdc.gov/niosh/topics/body_art/ default.html Special Notes: Sample HBV Vaccine Declination I understand that due to my occupational exposure to blood or other potentially infectious materials I may be at risk of acquiring hepatitis B virus (HBV) infection. I have been given the opportunity to be vaccinated with hepatitis B vaccine, at no charge to myself. However, I decline hepatitis B vaccination at this time. I understand that by declining this vaccine, I continue to be at risk of acquiring hepatitis B, a serious disease. If in the future I continue to have occupational exposure to blood or other potentially infectious materials and I want to be vaccinated with hepatitis B vaccine, I can receive the vaccination series at no charge to me. New York State Infection Control Outline Element I The Professional’s responsibility to adhere to scientifically accepted principles and practices of infection control and to monitor the performance of those for who the professional is responsible.  Covered under topic “How Are Bloodborne Pathogens and Infectious Disease are Spread”, Subheading Healthcare Professionals Element II The modes and mechanisms of transmission of pathogenic organisms in the healthcare setting and strategies for prevention and control.  Covered under topic “Definition” 252  Covered under topic “How Are Bloodborne Pathogens and Infectious Disease are Spread”  Covered under topic “HIV, HBV, HCV, and Other Concerns” Element III The use of engineering and work practice controls to reduce the opportunity for patient and healthcare worker contact with potentially infectious material  Covered under topic “How to Reduce Your Risk” Element IV Selection and use of barriers and/or personal protective equipment for preventing patient and healthcare worker contact with potentially infectious material.  Covered under topic “How to Reduce Your Risk” Subheading Use Personal Protective Equipment Element V The creation and maintenance of a safe environment for patient care through application of infection control principles and practices for cleaning, disinfection, and sterilization.  Covered under topic “How to Reduce Your Risk”  Covered under topic “Hazardous Disposal”  Covered under topic “Cleanup Procedures” Element VI The prevention and management of infectious or communicable disease in healthcare workers  Covered under topic “How Are Bloodborne Pathogens and Infectious Disease are Spread”, Subheading Healthcare Professionals 253 Retreived from http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10051 Complete 29 CFR 1910.1030 OSHA Bloodborne Pathogens Standard 1910.1030(a) Scope and Application. This section applies to all occupational exposure to blood or other potentially infectious materials as defined by paragraph (b) of this section. 1910.1030(b) Definitions. For purposes of this section, the following shall apply: Assistant Secretary means the Assistant Secretary of Labor for Occupational Safety and Health, or designated representative. Blood means human blood, human blood components, and products made from human blood. Bloodborne Pathogens means pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV) and human immunodeficiency virus (HIV). Clinical Laboratory means a workplace where diagnostic or other screening procedures are performed on blood or other potentially infectious materials. Contaminated means the presence or the reasonably anticipated presence of blood or other potentially infectious materials on an item or surface. Contaminated Laundry means laundry which has been soiled with blood or other potentially infectious materials or may contain sharps. Contaminated Sharps means any contaminated object that can penetrate the skin including, but not limited to, needles, scalpels, broken glass, broken capillary tubes, and exposed ends of dental wires. Decontamination means the use of physical or chemical means to remove, inactivate, or destroy bloodborne pathogens on a surface or item to the point where they are no longer capable of transmitting infectious particles and the surface or item is rendered safe for handling, use, or disposal. Director means the Director of the National Institute for Occupational Safety and Health, U.S. Department of Health and Human Services, or designated representative. Engineering Controls means controls (e.g., sharps disposal containers, self-sheathing needles, safer medical devices, such as sharps with engineered sharps injury protections and needleless systems) that isolate or remove the bloodborne pathogens hazard from the workplace. Exposure Incident means a specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee's duties. Handwashing Facilities means a facility providing an adequate supply of running potable water, soap and single use towels or hot air drying machines. Licensed Healthcare Professional is a person whose legally permitted scope of practice allows him or her to independently perform the activities required by paragraph (f) Hepatitis B Vaccination and Post-exposure Evaluation and Follow-up. HBV means hepatitis B virus. HIV means human immunodeficiency virus. Needleless systems means a device that does not use needles for: (1) The collection of bodily fluids or withdrawal of body fluids after initial venous or arterial access is established; (2) The administration of medication or fluids; or (3) Any other procedure involving the potential for occupational exposure to bloodborne pathogens due to percutaneous injuries from contaminated sharps. Occupational Exposure means reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee's duties. Other Potentially Infectious Materials means (1) The following human body fluids: semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids; (2) Any unfixed tissue or organ (other than intact skin) from a human (living or dead); and (3) HIV-containing cell or tissue cultures, organ cultures, and HIV- or HBV-containing culture medium or other solutions; and blood, organs, or other tissues from experimental animals infected with HIV or HBV. Parenteral means piercing mucous membranes or the skin barrier through such events as needlesticks, human bites, cuts, and abrasions. Personal Protective Equipment is specialized clothing or equipment worn by an employee for protection against a hazard. Gen254work clothes (e.g., uniforms, pants, shirts or blouses) not intended to function as protection against a hazard are not considered eral to be personal protective equipment. Production Facility means a facility engaged in industrial-scale, large-volume or high concentration production of HIV or HBV. Regulated Waste means liquid or semi-liquid blood or other potentially infectious materials; contaminated items that would release blood or other potentially infectious materials in a liquid or semi-liquid state if compressed; items that are caked with dried blood or other potentially infectious materials and are capable of releasing these materials during handling; contaminated sharps; and pathological and microbiological wastes containing blood or other potentially infectious materials. Research Laboratory means a laboratory producing or using research-laboratory-scale amounts of HIV or HBV. Research laboratories may produce high concentrations of HIV or HBV but not in the volume found in production facilities. Sharps with engineered sharps injury protections means a nonneedle sharp or a needle device used for withdrawing body fluids, accessing a vein or artery, or administering medications or other fluids, with a built-in safety feature or mechanism that effectively reduces the risk of an exposure incident. Source Individual means any individual, living or dead, whose blood or other potentially infectious materials may be a source of occupational exposure to the employee. Examples include, but are not limited to, hospital and clinic patients; clients in institutions for the developmentally disabled; trauma victims; clients of drug and alcohol treatment facilities; residents of hospices and nursing homes; human remains; and individuals who donate or sell blood or blood components. Sterilize means the use of a physical or chemical procedure to destroy all microbial life including highly resistant bacterial endospores. Universal Precautions is an approach to infection control. According to the concept of Universal Precautions, all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens. Work Practice Controls means controls that reduce the likelihood of exposure by altering the manner in which a task is performed (e.g., prohibiting recapping of needles by a two-handed technique). 1910.1030(c) Exposure Control -1910.1030(c)(1) Exposure Control Plan. 1910.1030(c)(1)(i) Each employer having an employee(s) with occupational exposure as defined by paragraph (b) of this section shall establish a written Exposure Control Plan designed to eliminate or minimize employee exposure. 1910.1030(c)(1)(ii) The Exposure Control Plan shall contain at least the following elements: 1910.1030(c)(1)(ii)(A) The exposure determination required by paragraph (c)(2), 1910.1030(c)(1)(ii)(B) The schedule and method of implementation for paragraphs (d) Methods of Compliance, (e) HIV and HBV Research Laboratories and Production Facilities, (f) Hepatitis B Vaccination and Post-Exposure Evaluation and Follow-up, (g) Communication of Hazards to Employees, and (h) Recordkeeping, of this standard, and 1910.1030(c)(1)(ii)(C) The procedure for the evaluation of circumstances surrounding exposure incidents as required by paragraph (f)(3)(i) of this standard. 1910.1030(c)(1)(iii) Each employer shall ensure that a copy of the Exposure Control Plan is accessible to employees in accordance with 29 CFR 1910.1020(e). 1910.1030(c)(1)(iv) The Exposure Control Plan shall be reviewed and updated at least annually and whenever necessary to reflect new or modified tasks and procedures which affect occupational exposure and to reflect new or revised employee positions with occupational exposure. The review and update of such plans shall also: 1910.1030(c)(1)(iv)(A) Reflect changes in technology that eliminate or reduce exposure to bloodborne pathogens; and 1910.1030(c)(1)(iv)(B) Document annually consideration and implementation of appropriate commercially available and effective safer medical devices designed to eliminate or minimize occupational exposure. 1910.1030(c)(1)(v) An employer, who is required to establish an Exposure Control Plan shall solicit input from non-managerial employees responsible for direct patient care who are potentially exposed to injuries from contaminated sharps in the identification, evaluation, and selection of effective engineering and work practice controls and shall document the solicitation in the Exposure Control Plan. 1910.1030(c)(1)(vi) The Exposure Control Plan shall be made available to the Assistant Secretary and the Director upon request for examination and copying. 1910.1030(c)(2) Exposure Determination. 1910.1030(c)(2)(i) Each employer who has an employee(s) with occupational exposure as defined by paragraph (b) of this section shall prepare an exposure determination. This exposure determination shall contain the following: 1910.1030(c)(2)(i)(A) 255 A list of all job classifications in which all employees in those job classifications have occupational exposure; 1910.1030(c)(2)(i)(B) A list of job classifications in which some employees have occupational exposure, and 1910.1030(c)(2)(i)(C) A list of all tasks and procedures or groups of closely related task and procedures in which occupational exposure occurs and that are performed by employees in job classifications listed in accordance with the provisions of paragraph (c)(2)(i)(B) of this standard. 1910.1030(c)(2)(ii) This exposure determination shall be made without regard to the use of personal protective equipment. 1910.1030(d) Methods of Compliance -1910.1030(d)(1) General. Universal precautions shall be observed to prevent contact with blood or other potentially infectious materials. Under circumstances in which differentiation between body fluid types is difficult or impossible, all body fluids shall be considered potentially infectious materials. 1910.1030(d)(2) Engineering and Work Practice Controls. 1910.1030(d)(2)(i) Engineering and work practice controls shall be used to eliminate or minimize employee exposure. Where occupational exposure remains after institution of these controls, personal protective equipment shall also be used. 1910.1030(d)(2)(ii) Engineering controls shall be examined and maintained or replaced on a regular schedule to ensure their effectiveness. 1910.1030(d)(2)(iii) Employers shall provide handwashing facilities which are readily accessible to employees. 1910.1030(d)(2)(iv) When provision of handwashing facilities is not feasible, the employer shall provide either an appropriate antiseptic hand cleanser in conjunction with clean cloth/paper towels or antiseptic towelettes. When antiseptic hand cleansers or towelettes are used, hands shall be washed with soap and running water as soon as feasible. 1910.1030(d)(2)(v) Employers shall ensure that employees wash their hands immediately or as soon as feasible after removal of gloves or other personal protective equipment. 1910.1030(d)(2)(vi) Employers shall ensure that employees wash hands and any other skin with soap and water, or flush mucous membranes with water immediately or as soon as feasible following contact of such body areas with blood or other potentially infectious materials. 1910.1030(d)(2)(vii) Contaminated needles and other contaminated sharps shall not be bent, recapped, or removed except as noted in paragraphs (d) (2)(vii)(A) and (d)(2)(vii)(B) below. Shearing or breaking of contaminated needles is prohibited. 1910.1030(d)(2)(vii)(A) Contaminated needles and other contaminated sharps shall not be bent, recapped or removed unless the employer can demonstrate that no alternative is feasible or that such action is required by a specific medical or dental procedure. 1910.1030(d)(2)(vii)(B) Such bending, recapping or needle removal must be accomplished through the use of a mechanical device or a one-handed technique. 1910.1030(d)(2)(viii) Immediately or as soon as possible after use, contaminated reusable sharps shall be placed in appropriate containers until properly reprocessed. These containers shall be: 1910.1030(d)(2)(viii)(A) Puncture resistant; 1910.1030(d)(2)(viii)(B) Labeled or color-coded in accordance with this standard; 1910.1030(d)(2)(viii)(C) Leakproof on the sides and bottom; and 1910.1030(d)(2)(viii)(D) In accordance with the requirements set forth in paragraph (d)(4)(ii)(E) for reusable sharps. 1910.1030(d)(2)(ix) Eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses are prohibited in work areas where there is a reasonable likelihood of occupational exposure. 1910.1030(d)(2)(x) Food and drink shall not be kept in refrigerators, freezers, shelves, cabinets or on countertops or benchtops where blood or other potentially infectious materials are present. 1910.1030(d)(2)(xi) All procedures involving blood or other potentially infectious materials shall be performed in such a manner as to minimize splashing, spraying, spattering, and generation of droplets of these substances. 1910.1030(d)(2)(xii) Mouth pipetting/suctioning of blood or other potentially infectious materials is prohibited. 1910.1030(d)(2)(xiii) Specimens of blood or other potentially infectious materials shall be placed in a container which prevents leakage during collection, handling, processing, storage, transport, or shipping. 1910.1030(d)(2)(xiii)(A) The container for storage, transport, or shipping shall be labeled or color-coded according to paragraph (g)(1)(i) and closed prior to being stored, transported, or shipped. When a facility utilizes Universal Precautions in the handling of all specimens, the labeling/ color-coding of specimens is not necessary provided containers are recognizable as containing specimens. This exemption only 256 while such specimens/containers remain within the facility. Labeling or color-coding in accordance with paragraph (g)(1)(i) is applies required when such specimens/containers leave the facility. 1910.1030(d)(2)(xiii)(B) If outside contamination of the primary container occurs, the primary container shall be placed within a second container which prevents leakage during handling, processing, storage, transport, or shipping and is labeled or color-coded according to the requirements of this standard. 1910.1030(d)(2)(xiii)(C) If the specimen could puncture the primary container, the primary container shall be placed within a secondary container which is puncture-resistant in addition to the above characteristics. 1910.1030(d)(2)(xiv) Equipment which may become contaminated with blood or other potentially infectious materials shall be examined prior to servicing or shipping and shall be decontaminated as necessary, unless the employer can demonstrate that decontamination of such equipment or portions of such equipment is not feasible. 1910.1030(d)(2)(xiv)(A) A readily observable label in accordance with paragraph (g)(1)(i)(H) shall be attached to the equipment stating which portions remain contaminated. 1910.1030(d)(2)(xiv)(B) The employer shall ensure that this information is conveyed to all affected employees, the servicing representative, and/or the manufacturer, as appropriate, prior to handling, servicing, or shipping so that appropriate precautions will be taken. 1910.1030(d)(3) Personal Protective Equipment -1910.1030(d)(3)(i) Provision. When there is occupational exposure, the employer shall provide, at no cost to the employee, appropriate personal protective equipment such as, but not limited to, gloves, gowns, laboratory coats, face shields or masks and eye protection, and mouthpieces, resuscitation bags, pocket masks, or other ventilation devices. Personal protective equipment will be considered "appropriate" only if it does not permit blood or other potentially infectious materials to pass through to or reach the employee's work clothes, street clothes, undergarments, skin, eyes, mouth, or other mucous membranes under normal conditions of use and for the duration of time which the protective equipment will be used. 1910.1030(d)(3)(ii) Use. The employer shall ensure that the employee uses appropriate personal protective equipment unless the employer shows that the employee temporarily and briefly declined to use personal protective equipment when, under rare and extraordinary circumstances, it was the employee's professional judgment that in the specific instance its use would have prevented the delivery of health care or public safety services or would have posed an increased hazard to the safety of the worker or co-worker. When the employee makes this judgement, the circumstances shall be investigated and documented in order to determine whether changes can be instituted to prevent such occurrences in the future. 1910.1030(d)(3)(iii) Accessibility. The employer shall ensure that appropriate personal protective equipment in the appropriate sizes is readily accessible at the worksite or is issued to employees. Hypoallergenic gloves, glove liners, powderless gloves, or other similar alternatives shall be readily accessible to those employees who are allergic to the gloves normally provided. 1910.1030(d)(3)(iv) Cleaning, Laundering, and Disposal. The employer shall clean, launder, and dispose of personal protective equipment required by paragraphs (d) and (e) of this standard, at no cost to the employee. 1910.1030(d)(3)(v) Repair and Replacement. The employer shall repair or replace personal protective equipment as needed to maintain its effectiveness, at no cost to the employee. 1910.1030(d)(3)(vi) If a garment(s) is penetrated by blood or other potentially infectious materials, the garment(s) shall be removed immediately or as soon as feasible. 1910.1030(d)(3)(vii) All personal protective equipment shall be removed prior to leaving the work area. 1910.1030(d)(3)(viii) When personal protective equipment is removed it shall be placed in an appropriately designated area or container for storage, washing, decontamination or disposal. 1910.1030(d)(3)(ix) Gloves. Gloves shall be worn when it can be reasonably anticipated that the employee may have hand contact with blood, other potentially infectious materials, mucous membranes, and non-intact skin; when performing vascular access procedures except as specified in paragraph (d)(3)(ix)(D); and when handling or touching contaminated items or surfaces. 1910.1030(d)(3)(ix)(A) Disposable (single use) gloves such as surgical or examination gloves, shall be replaced as soon as practical when contaminated or as soon as feasible if they are torn, punctured, or when their ability to function as a barrier is compromised. 1910.1030(d)(3)(ix)(B) Disposable (single use) gloves shall not be washed or decontaminated for re-use. 1910.1030(d)(3)(ix)(C) Utility gloves may be decontaminated for re-use if the integrity of the glove is not compromised. However, they must be discarded if they are cracked, peeling, torn, punctured, or exhibit other signs of deterioration or when their ability to function as a barrier is compromised. 1910.1030(d)(3)(ix)(D) If an employer in a volunteer blood donation center judges that routine gloving for all phlebotomies is not necessary then the employer shall: 1910.1030(d)(3)(ix)(D)(1) Periodically reevaluate this policy; 1910.1030(d)(3)(ix)(D)(2) 257 Make gloves available to all employees who wish to use them for phlebotomy; 1910.1030(d)(3)(ix)(D)(3) Not discourage the use of gloves for phlebotomy; and 1910.1030(d)(3)(ix)(D)(4) Require that gloves be used for phlebotomy in the following circumstances: 1910.1030(d)(3)(ix)(D)(4)(i) When the employee has cuts, scratches, or other breaks in his or her skin; 1910.1030(d)(3)(ix)(D)(4)(ii) When the employee judges that hand contamination with blood may occur, for example, when performing phlebotomy on an uncooperative source individual; and 1910.1030(d)(3)(ix)(D)(4)(iii) When the employee is receiving training in phlebotomy. 1910.1030(d)(3)(x) Masks, Eye Protection, and Face Shields. Masks in combination with eye protection devices, such as goggles or glasses with solid side shields, or chin-length face shields, shall be worn whenever splashes, spray, spatter, or droplets of blood or other potentially infectious materials may be generated and eye, nose, or mouth contamination can be reasonably anticipated. 1910.1030(d)(3)(xi) Gowns, Aprons, and Other Protective Body Clothing. Appropriate protective clothing such as, but not limited to, gowns, aprons, lab coats, clinic jackets, or similar outer garments shall be worn in occupational exposure situations. The type and characteristics will depend upon the task and degree of exposure anticipated. 1910.1030(d)(3)(xii) Surgical caps or hoods and/or shoe covers or boots shall be worn in instances when gross contamination can reasonably be anticipated (e.g., autopsies, orthopaedic surgery). 1910.1030(d)(4) Housekeeping -1910.1030(d)(4)(i) General. Employers shall ensure that the worksite is maintained in a clean and sanitary condition. The employer shall determine and implement an appropriate written schedule for cleaning and method of decontamination based upon the location within the facility, type of surface to be cleaned, type of soil present, and tasks or procedures being performed in the area. 1910.1030(d)(4)(ii) All equipment and environmental and working surfaces shall be cleaned and decontaminated after contact with blood or other potentially infectious materials. 1910.1030(d)(4)(ii)(A) Contaminated work surfaces shall be decontaminated with an appropriate disinfectant after completion of procedures; immediately or as soon as feasible when surfaces are overtly contaminated or after any spill of blood or other potentially infectious materials; and at the end of the work shift if the surface may have become contaminated since the last cleaning. 1910.1030(d)(4)(ii)(B) Protective coverings, such as plastic wrap, aluminum foil, or imperviously-backed absorbent paper used to cover equipment and environmental surfaces, shall be removed and replaced as soon as feasible when they become overtly contaminated or at the end of the workshift if they may have become contaminated during the shift. 1910.1030(d)(4)(ii)(C) All bins, pails, cans, and similar receptacles intended for reuse which have a reasonable likelihood for becoming contaminated with blood or other potentially infectious materials shall be inspected and decontaminated on a regularly scheduled basis and cleaned and decontaminated immediately or as soon as feasible upon visible contamination. 1910.1030(d)(4)(ii)(D) Broken glassware which may be contaminated shall not be picked up directly with the hands. It shall be cleaned up using mechanical means, such as a brush and dust pan, tongs, or forceps. 1910.1030(d)(4)(ii)(E) Reusable sharps that are contaminated with blood or other potentially infectious materials shall not be stored or processed in a manner that requires employees to reach by hand into the containers where these sharps have been placed. 1910.1030(d)(4)(iii) Regulated Waste -1910.1030(d)(4)(iii)(A) Contaminated Sharps Discarding and Containment. 1910.1030(d)(4)(iii)(A)(1) Contaminated sharps shall be discarded immediately or as soon as feasible in containers that are: 1910.1030(d)(4)(iii)(A)(1)(i) Closable; 1910.1030(d)(4)(iii)(A)(1)(ii) Puncture resistant; 1910.1030(d)(4)(iii)(A)(1)(iii) Leakproof on sides and bottom; and 1910.1030(d)(4)(iii)(A)(1)(iv) Labeled or color-coded in accordance with paragraph (g)(1)(i) of this standard. 1910.1030(d)(4)(iii)(A)(2) During use, containers for contaminated sharps shall be: 1910.1030(d)(4)(iii)(A)(2)(i) Easily accessible to personnel and located as close as is feasible to the immediate area where sharps are used or can be reasonably anticipated to be found (e.g., laundries); 1910.1030(d)(4)(iii)(A)(2)(ii) Maintained upright throughout use; and 258 1910.1030(d)(4)(iii)(A)(2)(iii) Replaced routinely and not be allowed to overfill. 1910.1030(d)(4)(iii)(A)(3) When moving containers of contaminated sharps from the area of use, the containers shall be: 1910.1030(d)(4)(iii)(A)(3)(i) Closed immediately prior to removal or replacement to prevent spillage or protrusion of contents during handling, storage, transport, or shipping; 1910.1030(d)(4)(iii)(A)(3)(ii) Placed in a secondary container if leakage is possible. The second container shall be: 1910.1030(d)(4)(iii)(A)(3)(ii)(A) Closable; 1910.1030(d)(4)(iii)(A)(3)(ii)(B) Constructed to contain all contents and prevent leakage during handling, storage, transport, or shipping; and 1910.1030(d)(4)(iii)(A)(3)(ii)(C) Labeled or color-coded according to paragraph (g)(1)(i) of this standard. 1910.1030(d)(4)(iii)(A)(4) Reusable containers shall not be opened, emptied, or cleaned manually or in any other manner which would expose employees to the risk of percutaneous injury. 1910.1030(d)(4)(iii)(B) Other Regulated Waste Containment -1910.1030(d)(4)(iii)(B)(1) Regulated waste shall be placed in containers which are: 1910.1030(d)(4)(iii)(B)(1)(i) Closable; 1910.1030(d)(4)(iii)(B)(1)(ii) Constructed to contain all contents and prevent leakage of fluids during handling, storage, transport or shipping; 1910.1030(d)(4)(iii)(B)(1)(iii) Labeled or color-coded in accordance with paragraph (g)(1)(i) this standard; and 1910.1030(d)(4)(iii)(B)(1)(iv) Closed prior to removal to prevent spillage or protrusion of contents during handling, storage, transport, or shipping. 1910.1030(d)(4)(iii)(B)(2) If outside contamination of the regulated waste container occurs, it shall be placed in a second container. The second container shall be: 1910.1030(d)(4)(iii)(B)(2)(i) Closable; 1910.1030(d)(4)(iii)(B)(2)(ii) Constructed to contain all contents and prevent leakage of fluids during handling, storage, transport or shipping; 1910.1030(d)(4)(iii)(B)(2)(iii) Labeled or color-coded in accordance with paragraph (g)(1)(i) of this standard; and 1910.1030(d)(4)(iii)(B)(2)(iv) Closed prior to removal to prevent spillage or protrusion of contents during handling, storage, transport, or shipping. 1910.1030(d)(4)(iii)(C) Disposal of all regulated waste shall be in accordance with applicable regulations of the United States, States and Territories, and political subdivisions of States and Territories. 1910.1030(d)(4)(iv) Laundry. 1910.1030(d)(4)(iv)(A) Contaminated laundry shall be handled as little as possible with a minimum of agitation. 1910.1030(d)(4)(iv)(A)(1) Contaminated laundry shall be bagged or containerized at the location where it was used and shall not be sorted or rinsed in the location of use. 1910.1030(d)(4)(iv)(A)(2) Contaminated laundry shall be placed and transported in bags or containers labeled or color-coded in accordance with paragraph (g)(1)(i) of this standard. When a facility utilizes Universal Precautions in the handling of all soiled laundry, alternative labeling or color-coding is sufficient if it permits all employees to recognize the containers as requiring compliance with Universal Precautions. 1910.1030(d)(4)(iv)(A)(3) Whenever contaminated laundry is wet and presents a reasonable likelihood of soak-through of or leakage from the bag or container, the laundry shall be placed and transported in bags or containers which prevent soak-through and/or leakage of fluids to the exterior. 1910.1030(d)(4)(iv)(B) The employer shall ensure that employees who have contact with contaminated laundry wear protective gloves and other appropriate personal protective equipment. 1910.1030(d)(4)(iv)(C) When a facility ships contaminated laundry off-site to a second facility which does not utilize Universal Precautions in the handling of all laundry, the facility generating the contaminated laundry must place such laundry in bags or containers which are labeled or color-coded in accordance with paragraph (g)(1)(i). 1910.1030(e) HIV and HBV Research Laboratories and Production Facilities. 1910.1030(e)(1) This paragraph applies to research laboratories and production facilities engaged in the culture, production, concentration, experimentation, and manipulation of HIV and HBV. It does not apply to clinical or diagnostic laboratories engaged solely in the analysis of 259 blood, tissues, or organs. These requirements apply in addition to the other requirements of the standard. 1910.1030(e)(2) Research laboratories and production facilities shall meet the following criteria: 1910.1030(e)(2)(i) Standard Microbiological Practices. All regulated waste shall either be incinerated or decontaminated by a method such as autoclaving known to effectively destroy bloodborne pathogens. 1910.1030(e)(2)(ii) Special Practices. 1910.1030(e)(2)(ii)(A) Laboratory doors shall be kept closed when work involving HIV or HBV is in progress. 1910.1030(e)(2)(ii)(B) Contaminated materials that are to be decontaminated at a site away from the work area shall be placed in a durable, leakproof, labeled or color-coded container that is closed before being removed from the work area. 1910.1030(e)(2)(ii)(C) Access to the work area shall be limited to authorized persons. Written policies and procedures shall be established whereby only persons who have been advised of the potential biohazard, who meet any specific entry requirements, and who comply with all entry and exit procedures shall be allowed to enter the work areas and animal rooms. 1910.1030(e)(2)(ii)(D) When other potentially infectious materials or infected animals are present in the work area or containment module, a hazard warning sign incorporating the universal biohazard symbol shall be posted on all access doors. The hazard warning sign shall comply with paragraph (g)(1)(ii) of this standard. 1910.1030(e)(2)(ii)(E) All activities involving other potentially infectious materials shall be conducted in biological safety cabinets or other physicalcontainment devices within the containment module. No work with these other potentially infectious materials shall be conducted on the open bench. 1910.1030(e)(2)(ii)(F) Laboratory coats, gowns, smocks, uniforms, or other appropriate protective clothing shall be used in the work area and animal rooms. Protective clothing shall not be worn outside of the work area and shall be decontaminated before being laundered. 1910.1030(e)(2)(ii)(G) Special care shall be taken to avoid skin contact with other potentially infectious materials. Gloves shall be worn when handling infected animals and when making hand contact with other potentially infectious materials is unavoidable. 1910.1030(e)(2)(ii)(H) Before disposal all waste from work areas and from animal rooms shall either be incinerated or decontaminated by a method such as autoclaving known to effectively destroy bloodborne pathogens. 1910.1030(e)(2)(ii)(I) Vacuum lines shall be protected with liquid disinfectant traps and high-efficiency particulate air (HEPA) filters or filters of equivalent or superior efficiency and which are checked routinely and maintained or replaced as necessary. 1910.1030(e)(2)(ii)(J) Hypodermic needles and syringes shall be used only for parenteral injection and aspiration of fluids from laboratory animals and diaphragm bottles. Only needle-locking syringes or disposable syringe-needle units (i.e., the needle is integral to the syringe) shall be used for the injection or aspiration of other potentially infectious materials. Extreme caution shall be used when handling needles and syringes. A needle shall not be bent, sheared, replaced in the sheath or guard, or removed from the syringe following use. The needle and syringe shall be promptly placed in a puncture-resistant container and autoclaved or decontaminated before reuse or disposal. 1910.1030(e)(2)(ii)(K) All spills shall be immediately contained and cleaned up by appropriate professional staff or others properly trained and equipped to work with potentially concentrated infectious materials. 1910.1030(e)(2)(ii)(L) A spill or accident that results in an exposure incident shall be immediately reported to the laboratory director or other responsible person. 1910.1030(e)(2)(ii)(M) A biosafety manual shall be prepared or adopted and periodically reviewed and updated at least annually or more often if necessary. Personnel shall be advised of potential hazards, shall be required to read instructions on practices and procedures, and shall be required to follow them. 1910.1030(e)(2)(iii) Containment Equipment. 1910.1030(e)(2)(iii)(A) Certified biological safety cabinets (Class I, II, or III) or other appropriate combinations of personal protection or physical containment devices, such as special protective clothing, respirators, centrifuge safety cups, sealed centrifuge rotors, and containment caging for animals, shall be used for all activities with other potentially infectious materials that pose a threat of exposure to droplets, splashes, spills, or aerosols. 1910.1030(e)(2)(iii)(B) Biological safety cabinets shall be certified when installed, whenever they are moved and at least annually. 1910.1030(e)(3) HIV and HBV research laboratories shall meet the following criteria: 1910.1030(e)(3)(i) Each laboratory shall contain a facility for hand washing and an eye wash facility which is readily available within the work area. 1910.1030(e)(3)(ii) An autoclave for decontamination of regulated waste shall be available. 1910.1030(e)(4) HIV and HBV production facilities shall meet the following criteria: 260 1910.1030(e)(4)(i) The work areas shall be separated from areas that are open to unrestricted traffic flow within the building. Passage through two sets of doors shall be the basic requirement for entry into the work area from access corridors or other contiguous areas. Physical separation of the high-containment work area from access corridors or other areas or activities may also be provided by a double-doored clothes-change room (showers may be included), airlock, or other access facility that requires passing through two sets of doors before entering the work area. 1910.1030(e)(4)(ii) The surfaces of doors, walls, floors and ceilings in the work area shall be water resistant so that they can be easily cleaned. Penetrations in these surfaces shall be sealed or capable of being sealed to facilitate decontamination. 1910.1030(e)(4)(iii) Each work area shall contain a sink for washing hands and a readily available eye wash facility. The sink shall be foot, elbow, or automatically operated and shall be located near the exit door of the work area. 1910.1030(e)(4)(iv) Access doors to the work area or containment module shall be self-closing. 1910.1030(e)(4)(v) An autoclave for decontamination of regulated waste shall be available within or as near as possible to the work area. 1910.1030(e)(4)(vi) A ducted exhaust-air ventilation system shall be provided. This system shall create directional airflow that draws air into the work area through the entry area. The exhaust air shall not be recirculated to any other area of the building, shall be discharged to the outside, and shall be dispersed away from occupied areas and air intakes. The proper direction of the airflow shall be verified (i.e., into the work area). 1910.1030(e)(5) Training Requirements. Additional training requirements for employees in HIV and HBV research laboratories and HIV and HBV production facilities are specified in paragraph (g)(2)(ix). 1910.1030(f) Hepatitis B Vaccination and Post-exposure Evaluation and Follow-up -1910.1030(f)(1) General. 1910.1030(f)(1)(i) The employer shall make available the hepatitis B vaccine and vaccination series to all employees who have occupational exposure, and post-exposure evaluation and follow-up to all employees who have had an exposure incident. 1910.1030(f)(1)(ii) The employer shall ensure that all medical evaluations and procedures including the hepatitis B vaccine and vaccination series and post-exposure evaluation and follow-up, including prophylaxis, are: 1910.1030(f)(1)(ii)(A) Made available at no cost to the employee; 1910.1030(f)(1)(ii)(B) Made available to the employee at a reasonable time and place; 1910.1030(f)(1)(ii)(C) Performed by or under the supervision of a licensed physician or by or under the supervision of another licensed healthcare professional; and 1910.1030(f)(1)(ii)(D) Provided according to recommendations of the U.S. Public Health Service current at the time these evaluations and procedures take place, except as specified by this paragraph (f). 1910.1030(f)(1)(iii) The employer shall ensure that all laboratory tests are conducted by an accredited laboratory at no cost to the employee. 1910.1030(f)(2) Hepatitis B Vaccination. 1910.1030(f)(2)(i) Hepatitis B vaccination shall be made available after the employee has received the training required in paragraph (g)(2)(vii)(I) and within 10 working days of initial assignment to all employees who have occupational exposure unless the employee has previously received the complete hepatitis B vaccination series, antibody testing has revealed that the employee is immune, or the vaccine is contraindicated for medical reasons. 1910.1030(f)(2)(ii) The employer shall not make participation in a prescreening program a prerequisite for receiving hepatitis B vaccination. 1910.1030(f)(2)(iii) If the employee initially declines hepatitis B vaccination but at a later date while still covered under the standard decides to accept the vaccination, the employer shall make available hepatitis B vaccination at that time. 1910.1030(f)(2)(iv) The employer shall assure that employees who decline to accept hepatitis B vaccination offered by the employer sign the statement in Appendix A. 1910.1030(f)(2)(v) If a routine booster dose(s) of hepatitis B vaccine is recommended by the U.S. Public Health Service at a future date, such booster dose(s) shall be made available in accordance with section (f)(1)(ii). 1910.1030(f)(3) Post-exposure Evaluation and Follow-up. Following a report of an exposure incident, the employer shall make immediately available to the exposed employee a confidential medical evaluation and follow-up, including at least the following elements: 1910.1030(f)(3)(i) Documentation of the route(s) of exposure, and the circumstances under which the exposure incident occurred; 1910.1030(f)(3)(ii) Identification and documentation of the source individual, unless the employer can establish that identification is infeasible or prohibited by state or local law; 261 1910.1030(f)(3)(ii)(A) The source individual's blood shall be tested as soon as feasible and after consent is obtained in order to determine HBV and HIV infectivity. If consent is not obtained, the employer shall establish that legally required consent cannot be obtained. When the source individual's consent is not required by law, the source individual's blood, if available, shall be tested and the results documented. 1910.1030(f)(3)(ii)(B) When the source individual is already known to be infected with HBV or HIV, testing for the source individual's known HBV or HIV status need not be repeated. 1910.1030(f)(3)(ii)(C) Results of the source individual's testing shall be made available to the exposed employee, and the employee shall be informed of applicable laws and regulations concerning disclosure of the identity and infectious status of the source individual. 1910.1030(f)(3)(iii) Collection and testing of blood for HBV and HIV serological status; 1910.1030(f)(3)(iii)(A) The exposed employee's blood shall be collected as soon as feasible and tested after consent is obtained. 1910.1030(f)(3)(iii)(B) If the employee consents to baseline blood collection, but does not give consent at that time for HIV serologic testing, the sample shall be preserved for at least 90 days. If, within 90 days of the exposure incident, the employee elects to have the baseline sample tested, such testing shall be done as soon as feasible. 1910.1030(f)(3)(iv) Post-exposure prophylaxis, when medically indicated, as recommended by the U.S. Public Health Service; 1910.1030(f)(3)(v) Counseling; and 1910.1030(f)(3)(vi) Evaluation of reported illnesses. 1910.1030(f)(4) Information Provided to the Healthcare Professional. 1910.1030(f)(4)(i) The employer shall ensure that the healthcare professional responsible for the employee's Hepatitis B vaccination is provided a copy of this regulation. 1910.1030(f)(4)(ii) The employer shall ensure that the healthcare professional evaluating an employee after an exposure incident is provided the following information: 1910.1030(f)(4)(ii)(A) A copy of this regulation; 1910.1030(f)(4)(ii)(B) A description of the exposed employee's duties as they relate to the exposure incident; 1910.1030(f)(4)(ii)(C) Documentation of the route(s) of exposure and circumstances under which exposure occurred; 1910.1030(f)(4)(ii)(D) Results of the source individual's blood testing, if available; and 1910.1030(f)(4)(ii)(E) All medical records relevant to the appropriate treatment of the employee including vaccination status which are the employer's responsibility to maintain. 1910.1030(f)(5) Healthcare Professional's Written Opinion. The employer shall obtain and provide the employee with a copy of the evaluating healthcare professional's written opinion within 15 days of the completion of the evaluation. 1910.1030(f)(5)(i) The healthcare professional's written opinion for Hepatitis B vaccination shall be limited to whether Hepatitis B vaccination is indicated for an employee, and if the employee has received such vaccination. 1910.1030(f)(5)(ii) The healthcare professional's written opinion for post-exposure evaluation and follow-up shall be limited to the following information: 1910.1030(f)(5)(ii)(A) That the employee has been informed of the results of the evaluation; and 1910.1030(f)(5)(ii)(B) That the employee has been told about any medical conditions resulting from exposure to blood or other potentially infectious materials which require further evaluation or treatment. 1910.1030(f)(5)(iii) All other findings or diagnoses shall remain confidential and shall not be included in the written report. 1910.1030(f)(6) Medical Recordkeeping. Medical records required by this standard shall be maintained in accordance with paragraph (h)(1) of this section. 1910.1030(g) Communication of Hazards to Employees -1910.1030(g)(1) Labels and Signs -1910.1030(g)(1)(i) Labels. 1910.1030(g)(1)(i)(A) Warning labels shall be affixed to containers of regulated waste, refrigerators and freezers containing blood or other potentially infectious 262 material; and other containers used to store, transport or ship blood or other potentially infectious materials, except as provided in paragraph (g)(1)(i)(E), (F) and (G). 1910.1030(g)(1)(i)(B) Labels required by this section shall include the following legend: 1910.1030(g)(1)(i)(C) These labels shall be fluorescent orange or orange-red or predominantly so, with lettering and symbols in a contrasting color. 1910.1030(g)(1)(i)(D) Labels shall be affixed as close as feasible to the container by string, wire, adhesive, or other method that prevents their loss or unintentional removal. 1910.1030(g)(1)(i)(E) Red bags or red containers may be substituted for labels. 1910.1030(g)(1)(i)(F) Containers of blood, blood components, or blood products that are labeled as to their contents and have been released for transfusion or other clinical use are exempted from the labeling requirements of paragraph (g). 1910.1030(g)(1)(i)(G) Individual containers of blood or other potentially infectious materials that are placed in a labeled container during storage, transport, shipment or disposal are exempted from the labeling requirement. 1910.1030(g)(1)(i)(H) Labels required for contaminated equipment shall be in accordance with this paragraph and shall also state which portions of the equipment remain contaminated. 1910.1030(g)(1)(i)(I) Regulated waste that has been decontaminated need not be labeled or color-coded. 1910.1030(g)(1)(ii) Signs. 1910.1030(g)(1)(ii)(A) The employer shall post signs at the entrance to work areas specified in paragraph (e), HIV and HBV Research Laboratory and Production Facilities, which shall bear the following legend: (Name of the Infectious Agent) (Special requirements for entering the area) (Name, telephone number of the laboratory director or other responsible person.) 1910.1030(g)(1)(ii)(B) These signs shall be fluorescent orange-red or predominantly so, with lettering and symbols in a contrasting color. 1910.1030(g)(2) Information and Training. 1910.1030(g)(2)(i) The employer shall train each employee with occupational exposure in accordance with the requirements of this section. Such training must be provided at no cost to the employee and during working hours. The employer shall institute a training program and ensure employee participation in the program. 1910.1030(g)(2)(ii) Training shall be provided as follows: 1910.1030(g)(2)(ii)(A) 263 At the time of initial assignment to tasks where occupational exposure may take place; 1910.1030(g)(2)(ii)(B) At least annually thereafter. 1910.1030(g)(2)(iii) [Reserved] 1910.1030(g)(2)(iv) Annual training for all employees shall be provided within one year of their previous training. 1910.1030(g)(2)(v) Employers shall provide additional training when changes such as modification of tasks or procedures or institution of new tasks or procedures affect the employee's occupational exposure. The additional training may be limited to addressing the new exposures created. 1910.1030(g)(2)(vi) Material appropriate in content and vocabulary to educational level, literacy, and language of employees shall be used. 1910.1030(g)(2)(vii) The training program shall contain at a minimum the following elements: 1910.1030(g)(2)(vii)(A) An accessible copy of the regulatory text of this standard and an explanation of its contents; 1910.1030(g)(2)(vii)(B) A general explanation of the epidemiology and symptoms of bloodborne diseases; 1910.1030(g)(2)(vii)(C) An explanation of the modes of transmission of bloodborne pathogens; 1910.1030(g)(2)(vii)(D) An explanation of the employer's exposure control plan and the means by which the employee can obtain a copy of the written plan; 1910.1030(g)(2)(vii)(E) An explanation of the appropriate methods for recognizing tasks and other activities that may involve exposure to blood and other potentially infectious materials; 1910.1030(g)(2)(vii)(F) An explanation of the use and limitations of methods that will prevent or reduce exposure including appropriate engineering controls, work practices, and personal protective equipment; 1910.1030(g)(2)(vii)(G) Information on the types, proper use, location, removal, handling, decontamination and disposal of personal protective equipment; 1910.1030(g)(2)(vii)(H) An explanation of the basis for selection of personal protective equipment; 1910.1030(g)(2)(vii)(I) Information on the hepatitis B vaccine, including information on its efficacy, safety, method of administration, the benefits of being vaccinated, and that the vaccine and vaccination will be offered free of charge; 1910.1030(g)(2)(vii)(J) Information on the appropriate actions to take and persons to contact in an emergency involving blood or other potentially infectious materials; 1910.1030(g)(2)(vii)(K) An explanation of the procedure to follow if an exposure incident occurs, including the method of reporting the incident and the medical follow-up that will be made available; 1910.1030(g)(2)(vii)(L) Information on the post-exposure evaluation and follow-up that the employer is required to provide for the employee following an exposure incident; 1910.1030(g)(2)(vii)(M) An explanation of the signs and labels and/or color coding required by paragraph (g)(1); and 1910.1030(g)(2)(vii)(N) An opportunity for interactive questions and answers with the person conducting the training session. 1910.1030(g)(2)(viii) The person conducting the training shall be knowledgeable in the subject matter covered by the elements contained in the training program as it relates to the workplace that the training will address. 1910.1030(g)(2)(ix) Additional Initial Training for Employees in HIV and HBV Laboratories and Production Facilities. Employees in HIV or HBV research laboratories and HIV or HBV production facilities shall receive the following initial training in addition to the above training requirements. 1910.1030(g)(2)(ix)(A) The employer shall assure that employees demonstrate proficiency in standard microbiological practices and techniques and in the practices and operations specific to the facility before being allowed to work with HIV or HBV. 1910.1030(g)(2)(ix)(B) The employer shall assure that employees have prior experience in the handling of human pathogens or tissue cultures before working with HIV or HBV. 1910.1030(g)(2)(ix)(C) The employer shall provide a training program to employees who have no prior experience in handling human pathogens. Initial work activities shall not include the handling of infectious agents. A progression of work activities shall be assigned as techniques are learned and proficiency is developed. The employer shall assure that employees participate in work activities involving infectious agents only after proficiency has been demonstrated. 1910.1030(h) Recordkeeping -1910.1030(h)(1) Medical Records. 264 1910.1030(h)(1)(i) The employer shall establish and maintain an accurate record for each employee with occupational exposure, in accordance with 29 CFR 1910.1020. 1910.1030(h)(1)(ii) This record shall include: 1910.1030(h)(1)(ii)(A) The name and social security number of the employee; 1910.1030(h)(1)(ii)(B) A copy of the employee's hepatitis B vaccination status including the dates of all the hepatitis B vaccinations and any medical records relative to the employee's ability to receive vaccination as required by paragraph (f)(2); 1910.1030(h)(1)(ii)(C) A copy of all results of examinations, medical testing, and follow-up procedures as required by paragraph (f)(3); 1910.1030(h)(1)(ii)(D) The employer's copy of the healthcare professional's written opinion as required by paragraph (f)(5); and 1910.1030(h)(1)(ii)(E) A copy of the information provided to the healthcare professional as required by paragraphs (f)(4)(ii)(B)(C) and (D). 1910.1030(h)(1)(iii) Confidentiality. The employer shall ensure that employee medical records required by paragraph (h)(1) are: 1910.1030(h)(1)(iii)(A) Kept confidential; and 1910.1030(h)(1)(iii)(B) Not disclosed or reported without the employee's express written consent to any person within or outside the workplace except as required by this section or as may be required by law. 1910.1030(h)(1)(iv) The employer shall maintain the records required by paragraph (h) for at least the duration of employment plus 30 years in accordance with 29 CFR 1910.1020. 1910.1030(h)(2) Training Records. 1910.1030(h)(2)(i) Training records shall include the following information: 1910.1030(h)(2)(i)(A) The dates of the training sessions; 1910.1030(h)(2)(i)(B) The contents or a summary of the training sessions; 1910.1030(h)(2)(i)(C) The names and qualifications of persons conducting the training; and 1910.1030(h)(2)(i)(D) The names and job titles of all persons attending the training sessions. 1910.1030(h)(2)(ii) Training records shall be maintained for 3 years from the date on which the training occurred. 1910.1030(h)(3) Availability. 1910.1030(h)(3)(i) The employer shall ensure that all records required to be maintained by this section shall be made available upon request to the Assistant Secretary and the Director for examination and copying. 1910.1030(h)(3)(ii) Employee training records required by this paragraph shall be provided upon request for examination and copying to employees, to employee representatives, to the Director, and to the Assistant Secretary. 1910.1030(h)(3)(iii) Employee medical records required by this paragraph shall be provided upon request for examination and copying to the subject employee, to anyone having written consent of the subject employee, to the Director, and to the Assistant Secretary in accordance with 29 CFR 1910.1020. 1910.1030(h)(4) Transfer of Records. 1910.1030(h)(4)(i) The employer shall comply with the requirements involving transfer of records set forth in 29 CFR 1910.1020(h). 1910.1030(h)(4)(ii) If the employer ceases to do business and there is no successor employer to receive and retain the records for the prescribed period, the employer shall notify the Director, at least three months prior to their disposal and transmit them to the Director, if required by the Director to do so, within that three month period. 1910.1030(h)(5) Sharps injury log. 1910.1030(h)(5)(i) The employer shall establish and maintain a sharps injury log for the recording of percutaneous injuries from contaminated sharps. The information in the sharps injury log shall be recorded and maintained in such manner as to protect the confidentiality of the injured employee. The sharps injury log shall contain, at a minimum: 1910.1030(h)(5)(i)(A) The type and brand of device involved in the incident, 1910.1030(h)(5)(i)(B) The department or work area where the exposure incident occurred, and 1910.1030(h)(5)(i)(C) 265 An explanation of how the incident occurred. 1910.1030(h)(5)(ii) The requirement to establish and maintain a sharps injury log shall apply to any employer who is required to maintain a log of occupational injuries and illnesses under 29 CFR 1904. 1910.1030(h)(5)(iii) The sharps injury log shall be maintained for the period required by 29 CFR 1904.6. 1910.1030(i) Dates -1910.1030(i)(1) Effective Date. The standard shall become effective on March 6, 1992. 1910.1030(i)(2) The Exposure Control Plan required by paragraph (c) of this section shall be completed on or before May 5, 1992. 1910.1030(i)(3) Paragraph (g)(2) Information and Training and (h) Recordkeeping shall take effect on or before June 4, 1992. 1910.1030(i)(4) Paragraphs (d)(2) Engineering and Work Practice Controls, (d)(3) Personal Protective Equipment, (d)(4) Housekeeping, (e) HIV and HBV Research Laboratories and Production Facilities, (f) Hepatitis B Vaccination and Post-Exposure Evaluation and Follow-up, and (g)(1) Labels and Signs, shall take effect July 6, 1992. [56 FR 64004, Dec. 06, 1991, as amended at 57 FR 12717, April 13, 1992; 57 FR 29206, July 1, 1992; 61 FR 5507, Feb. 13, 1996; 66 FR 5325 Jan., 18, 2001; 71 FR 16672 and 16673, April 3, 2006; 73 FR 75586, Dec. 12, 2008] 266 ProBloodborne Written Test ANSWER KEY 1) B 2) D 3) A 4) C 5) D 6) A 7) D 8) B 9) A 10) B 267

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