Kampala Police 2010-11
FIRST AIDER
ToT
Purpose of this course
• In Uganda, Police are often the frontline
for trauma care
Police can make a difference
• Without an ambulance or specialized
medical equipment you can save lives
• Goal is to empower cadets with
knowledge to save lives
Police can make a difference
• Stress that you do not need to be a doctor, have
an ambulance or other equipment to save lives!
Course Objectives
• Increase your medical knowledge
• Learn the highest-yield first aid
techniques that save lives
• Demonstrate proficiency in performing
and teaching these skills
Course Outline
•
•
•
•
•
•
Safety
Anatomy
DR. ABCs & High-yield first aid
Common medical and injury scenarios
Skills station
Post test
ROLES AND
RESPONSIBILITY OF THE
FIRST AIDER
Qualities of the First Responder:
• Observant.
• Resourceful.
– Use materials available at the time, improvise and implement
necessary ones.
• Dexterous (skillfully and cleverly done).
• Humanitarian.
– Able to work beyond social, tribal and religious boundaries.
• Perseverance.
– Able to work without giving up until qualified help arrives.
• Sympathetic.
• Explicit.
– Be clear with your instructions to the casualty and or bystanders.
Responsibilities of the First
Responder:
•
•
•
•
•
Safety
Scene management
Patient Assessment
Patient Care
Patient Transport
Anatomy
Respiratory System
Inhalation
Air Flows Into Lungs
Exhalation Air Flows Out of Lungs
•Away from the Heart
•High Pressure
•Back to the Heart
•Low Pressure
Arterial
Capillary
Venous
Carotid Pulse (find yours)
Femoral Pulse (find yours)
Radial Pulse (find yours)
Nervous System
Spinal Column
Scene Management and Safety
Personal Safety is #1
•Universal precautions
Infectious Diseases
What diseases can you contract from exposure
to blood and body fluids?
•HIV
•Hepatitis B and C
•Others?
What are the chances of contracting HIV from a
needlestick from an HIV infected victim?
What should you do if you are exposed to bodily
fluids?
•You cannot get cancer from blood/fluid contact
with a victim
Scene Safety: Assess the scene
Scene Safety: Secure the scene
•Turn off ignition & secure brake
•Use patrol car to protect the scene
Scene Safety: Secure the scene
•Protect the bystanders
Scene Safety: Assess Casualties
Scene Management: Get help
High-Yield First Aid
Casualty Management
& Initial Assessment
Don’t Panic, use ABCs
D
R
.
anger
•Personal and scene safety
esponse
•“Are you alright?”
A
B
C
irway
reathing
irculation
How does a road traffic
accident or any other trauma
kill a person?
A
irway
Airway Assessment
ABCs for All Victims
A
irway
• Without an open airway, a patient
can die within seconds
A
ABCs for All Victims
irway
Check if patient is conscious: “Are you ok?”
Victim Does NOT Respond
Open the Airway
-Clear nose and mouth
-Lift Chin
Victim Responds
A
irway
Without chin lift, jaw thrust
With chin lift, jaw thrust
Adrian et al, Anesthesiology June 1999 - Volume 90 - Issue 6 - pp 1617-1623
B
reathing
Breathing Assessment
B
ABCs for All Victims
reathing
Look
Listen
Feel
If patient not breathing, keep airway open & transport ASAP!
Adequate Breathing:
Normal Rates
 Adults 12-20/min.
 Children 15-30/min.
 Infant 25-50/min.
C
Circulation Assessment
C
ABCs for All Victims
irculation
•If bleeding:
•Apply pressure
•Elevate wound
•Wrap with bandage
Arterial
Capillary
Venous
C
irculation
Methods for bleeding control
Pressure, Pressure
& more Pressure!!!
Severe Bleeding
• A bleeding patient can lose all of their
blood in ONE MINUTE and die
• DIRECT PRESSURE is best
• DO NOT USE TOURNIQUETS
•Unless amputation AND unable
to control bleeding with pressure
alone
•A tourniquet WILL cause
irreversible damage and
possibly kill the limb
Artery Compression Technique
Artery Compression Technique
Carotid Pulse
Femoral Pulse
Radial Pulse
Infants: Check brachial pulse.
Don’t Panic, recall ABCs
A
B
C
irway
reathing
irculation
BASIC LIFE SUPPORT,
CPR & Rescue Breathing
What have you been
taught and what do you
teach about CPR and
rescue breathing?
B
reathing
Old Teaching:
• If patient not breathing, classic teaching
has been to give rescue breaths
Trauma 1st Responder Teaching
• If not breathing make sure airway open,
no breaths, and transport ASAP
Swenson et al. NEJM, July 2010
C
irculation
Current Teaching:
• If victim does not have a pulse, start chest
compressions at 100 per minute
Trauma 1st Responder Teaching
• If no pulse transport ASAP (after ABCs)
• DO NOT DELAY TRANSPORT FOR CPR
C
irculation
Trauma 1st Responder Teaching
• If no pulse and not breathing transport
ASAP (after ABCs)
• CPR and rescue breathing will not hurt as
long as it does not delay transport!
• 30 chest compressions : 2 breaths
Lifting and Moving
Victims
Transport Key Points
• Secure victim in car
• Drive at a reasonable speed
– Will not likely make a difference in
transport time
• If unconscious use the recovery
position
Recovery Position: if unconscious
Emergency Move
Blanket Drag
Emergency Move – Clothes Drag
Emergency Move - Back Pack Carry
Emergency Move – Direct Carry
Body Roll
Take positions to log roll patient.
Leader at head directs.
Transport Key Points
• Secure victim in car
• Drive at a reasonable speed
– Will not likely make a difference in
transport time
• If unconscious use the recovery
position
Special Injury
Considerations
Soft-Tissue Injuries
Impaled Object
Impaled Object
Internal Bleeding
Abdominal Evisceration
Burns
Burns
Burns
Burn Care
• Stop the burning process with water
• Remove smoldering clothing & jewelry
• ABCs
• Cover burn with dry, sterile dressing
• NO ointments/creams
• Don’t break blisters
• Seek medical attention
Musculoskeletal
Injuries
Types of Musculoskeletal Injuries
Fractures
SAFETY
ABC Initial Assessment
Patient talking &
Bleeding Controlled
Patient unable to talk or
Bleeding Uncontrolled
• Move the limb as little as
possible
• Use cardboard, cotton, and
tape or cloth ties keep limb
clean, still, and stable
Take to hospital
immediately!!!
Fractures
• Splint ONLY AFTER ABCs
• Do NOT delay transport for splinting in a
patient who is unconscious or has
uncontrolled bleeding
Improvised Splints
Making cardboard splint
Splint for Injured Forearm
Injuries to the
Head and Spine
Nervous System
Spinal Column
Mechanisms of Spinal Injury
Transport:
Possible spine injury
• If possible, get others to
help, and maintain
control of the neck, do
not need special collar
• Transport victim onto
carrier by log-rolling
Secure patient and transport.
Skull Fractures and Concussions
• What do you teach about managing these
conditions?
Common
Medical Emergencies
Heart Attack
CHOKING
• ABCs !!! (check mouth if unconscious)
• If ABLE to speak or cough, then not
complete obstruction
– Encourage coughing
– Heimlich if failed
• If UNABLE to speak/cough attempt then
Heimlich
CHOKING: Heimlich Maneuver
Position yourself behind patient.
Place thumb-side of fist in middle of abdomen,
between navel and rib cage.
Heimlich Maneuver
Infant choking - conscious
Deliver 5 chest thrusts.
Infant choking - Unconscious
Perform tongue-jaw lift & remove
visible objects.
Drowning
What do you teach
about managing a
drowning victim?
Diabetes
 High Blood Sugar
 Need insulin
If too much medication can have low
blood sugar
If too little medication, high blood sugar
Can cause fits, loss of consciousness or
confusion
STROKE
Stroke: Signs & Symptoms
 Altered mental status
 Slurred speech or difficulty speaking
 Facial droop
 Unequal pupil
 Unable to move half of body
 Difficulty swallowing
(Continued)
Fits (Seizures)
Not Contagious!
SAFETY
ABCs
Put patient in recovery
position ASAP
Transport ASAP
Make sure victim is clear of
obstacles that could cause injury
Shock & Fainting
What do you teach
about fainting?
What about shock?
Snake Bites
Coin coverage and blackstones are ineffective
One review in Gulu, 108 snake bite patients, none received
antivenom, all survived
Do not cut and suck
Immobilization, cleaning of limb and immediate transport
are key (Below the heart, light compression wrap)
Gabon Viper
Puff Adder
Common Causes of Allergic Reactions
Insect Stings
Plants
Foods
Medications
Four Routes of Poisoning
INHALATION
INJECTION
INGESTION
ABSORPTION
Acid – Intentional Burns
Acid Burns
• ABCs !!!
• Rinse well with water
– Even if no pain
• Acids and bases can cause damage
without causing pain
Obstetrics and
Gynecology
Anatomy
Uterus
Cervix
Pubic Bone
Vagina
Perineum
Anatomy
Placenta
Umbilical Cord
Amniotic Sac
Multiple-Casualty
Incidents
Tasks for Mass Casualty
Extrication
Transportation
 Triage
 Supply
 Staging
 Command
 Treatment
Mass Casualty: STEP 1
Triage officer announces that all
patients that can walk should get up
and walk to a designated area for
eventual secondary triage.
Color coding
© Lou Romig MD, 2006. Used with permission.
Mass Casualty: STEP 2
• If no breathing and no pulse, leave
alone
• If no breathing but has pulse, evaluate
ABCs and consider for immediate
transportation
• If breathing and has pulse, also
evaluate ABC and prepare for transport
© Lou Romig MD, 2006. Used with permission.
Death
• Do not decide if a patient is dead at the
scene!
• This must be done at a health facility!
• Live patients have been transported to
the morgue
QUICK REVIEW
Police can make a difference
• Without an ambulance or specialized
medical equipment you can save lives
• Goal is to empower cadets with
knowledge to save lives
Police can make a difference
• You do not need to be a doctor, have an
ambulance or other equipment to save lives!
Personal Safety is #1
•Universal precautions
Don’t Panic, recall ABCs
A
B
C
irway
reathing
irculation
A
irway
Chin lift & jaw thrust
Adrian et al, Anesthesiology June 1999 - Volume 90 - Issue 6 - pp 1617-1623
B
ABCs for All Victims
reathing
Look
Listen
Feel
If patient not breathing, transport ASAP!
C
irculation
Pressure, Pressure
& more Pressure!!!
CPR
• If no pulse and not breathing trauma victim
transport ASAP (after ABCs)
• CPR and rescue breathing will not hurt as
long as it does not delay transport!
• 30 chest compressions : 2 breaths
Transport Key Points
• Secure victim in car
• Drive at a reasonable speed
– Will not likely make a difference in
transport time
• If unconscious use the recovery
position