24
Emergency
Medical Care
24
Objectives (1 of 2)
• Describe the steps needed to provide
infection control for victims and for fire
fighters.
• Describe the steps needed to perform
cardiopulmonary resuscitation (CPR) on
adult, child, and infant victims.
• Describe the steps used to manage
shock.
2
24
Objectives (2 of 2)
• Explain the steps needed to control
external bleeding.
• Discuss triage at a mass-casualty
incident.
• Describe how to assure safety at
emergency medical services incidents.
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24
Introduction
• Basic knowledge of emergency medical
care skills is important.
• The skills and knowledge covered in
this chapter are not meant to replace
formal courses.
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24
Infection Control
• Understanding of the most common
infectious disease is important so that you
can protect yourself from unnecessary
exposure.
–
–
–
–
–
AIDS
HBV
HCV
Tuberculosis
SARS
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24
Universal Precautions
•
•
•
•
•
Always wear gloves.
Always wear protective eyewear.
Wash your hands.
Place needles in “sharps” container.
Use a protective barrier if a victim needs
resuscitation.
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24
Immunizations
• Certain immunizations are required for
emergency medical care providers.
– Tetanus
– Hepatitis B
• Medical director will determine the
appropriate immunizations.
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24
Airway
• Airway care and rescue breathing are
two important lifesaving skills.
• The skills of CPR are as easy as A, B, C
– “A” is airway
– “B” is breathing
– “C” is circulation
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24
Anatomy and Function of the
Respiratory System (1 of 4)
• The respiratory
system
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24
Anatomy and Function of the
Respiratory System (2 of 4)
• Anatomy of the
respiratory system
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24
Anatomy and Function of the
Respiratory System (3 of 4)
• The exchange of
gases occurs in the
alveoli of the lungs
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24
Anatomy and Function of the
Respiratory System (4 of 4)
• Normal mechanical act
of breathing.
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24
“A” Is for Airway
• An injured or ill person may not be able
to protect the airway.
• You must take steps to check the
condition of the victim’s airway.
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24
Check for Responsiveness
• Ask the victim “Are
you okay?”
• If no response,
gently shake the
victim’s shoulder.
• Repeat your
question.
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24
Correct the Blocked Airway
• Open airway with head
tilt-chin lift or jaw thrust.
• Check for fluids, foreign
bodies, and dentures.
• Perform a finger sweep.
• Maintain the airway.
• Place victim in recovery
position.
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24
“B” Is for Breathing
• After correcting victim’s airway, you
should check and correct victim’s
breathing.
• Look for signs of normal and abnormal
respirations.
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24
Signs of Adequate Breathing
• Look:
– for rise and fall of chest
• Listen:
– for sounds of air passing into or out of
victim’s nose and mouth
• Feel:
– air moving on the side of your face
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24
Signs of Inadequate Breathing
•
•
•
•
•
•
Noisy respirations
Wheezing
Gurgling
Rapid or gasping respirations
Victim’s skin pale or blue
Respiratory arrest
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24
Causes of Respiratory Arrest
•
•
•
•
•
Heart attack (most common)
Mechanical blockage or obstruction
Vomitus
Foreign objects
Illness or disease such as heart attack or
severe stroke
• Drug overdose/poisoning
• Severe loss of blood
• Electrocution
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24
Check for the Presence of
Breathing
• Look for the rising and
falling of the victim's
chest.
• Listen for the sound of
air moving in and out of
the victim’s nose and
mouth.
• Feel for the movement
of air on the side of your
face and ear.
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24
Correct the Breathing
• You must rescue
breathe for a victim
who is not
breathing.
• Pinch nose and
blow into victim’s
mouth for 2
seconds.
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24
Rescue Breathing
• Mouth-to-mask
– Uses a mask that fits over the victim’s face with a
one way valve and rescuer mouth piece
• Mouth-to-barrier
– Uses a protective barrier that covers the victim’s
face
• Mouth-to-mouth
– Rescuer does not use protective barrier or mask.
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Rescue Breathing for Children
• A child is between the age of one and
eight.
• The steps for determining
responsiveness, correcting airway, and
breathing are the same as an adult.
• The rate is 12 rescue breaths per
minute.
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Rescue Breathing for Infants
• An infant is under one year of age.
• Must be gentle when checking
responsiveness
• Blow gently into the infant’s mouth and
nose.
• The rescue rate is 20 breaths per
minute.
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24
Foreign Body Airway
Obstruction (1 of 2)
• Causes
– Tongue
– Injury
– Swelling
– Object
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24
Foreign Body Airway
Obstruction (2 of 2)
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24
Partial Airway Obstruction
•
•
•
•
The victim can cough or gag.
The victim may be able to speak.
Encourage the victim to cough.
Monitor victim carefully while awaiting
transport.
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24
Complete Airway Obstruction
• The victim is unable to breathe in or out.
• The victim cannot talk.
• Victim will lose consciousness in 3 to 4
minutes.
• Treat with the Heimlich maneuver.
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24
Management of Foreign Body
Airway Obstructions (1 of 3)
• In a conscious adult:
– Use Heimlich maneuver.
• In an unconscious adult:
– Use abdominal thrusts.
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24
Management of Foreign Body
Airway Obstructions (2 of 3)
• In a conscious or unconscious child:
– Steps are similar to adult
– Exceptions
• Only perform finger sweep if object is seen.
• If you are alone, attempt removal of foreign
body for 1 minute before activating EMS.
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Management of Foreign Body
Airway Obstructions (3 of 3)
• In a conscious infant:
– Airway structures are small and more
easily injured.
– Use combination of back blows and chest
thrusts.
• In an unconscious infant:
– Use same sequence of back blows and
chest thrusts.
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24
Gastric Distension
• Occurs when air is forced into stomach
instead of lungs
• Increases chance of victim vomiting
• Preventable by breathing slowly
• Better to prevent then to cure results
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24
Dental Appliances
• Do not remove firmly attached
appliances.
• Loose appliances may occlude airway.
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24
Airway Management in a Vehicle
• Use jaw-thrust technique if victim is
lying on the seat or floor.
• Stabilize victim’s cervical spine.
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Anatomy and Function of the
Circulatory System (1 of 5)
• Consists of heart,
blood vessels, and
blood
• Heart consists of
four chambers.
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24
Anatomy and Function of the
Circulatory System (2 of 5)
• Four major arteries are
– Brachial
– Carotid
– Radial
– Femoral
• Pulse is the pressure wave generated
by pumping action of heart.
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24
Anatomy and Function of the
Circulatory System (3 of 5)
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24
Anatomy and Function of the
Circulatory System (4 of 5)
• Capillaries are the smallest pipes in
system.
• Veins carry blood back to heart.
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Anatomy and Function of the
Circulatory System (5 of 5)
• Blood has several
components.
–
–
–
–
Plasma
Red blood cells
White blood cells
Platelets
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24
Cardiac Arrest (1 of 2)
• Occurs when heart stops contracting
• Without supply of blood, cells will die
because they cannot get oxygen or
nutrients.
• As cells die, organ damage occurs.
• Brain damage occurs within 4 to 6
minutes.
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Cardiac Arrest (2 of 2)
• Causes can be:
–
–
–
–
–
–
Diseased blood vessel or heart
Respiratory arrest, if untreated
Medical emergencies
Drowning
Suffocation
Trauma and shock due to blood loss
• Regardless of cause, initial treatment is the
same: CPR.
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24
Components of CPR
• Check victim for pulse.
• If there is no pulse, begin external chest
compressions.
– By depressing victim’s sternum, you can
change the pressure in the chest and force
enough blood through the system to
sustain life for a short period of time.
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24
Cardiac Chain of Survival
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24
When to Start CPR
• When to start
– Start on all nonbreathing, pulseless victims, unless
they are obviously dead.
• Exceptions
–
–
–
–
–
Valid DNR
Decapitation
Rigor mortis
Tissue decomposition
Dependant lividity
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24
When to Stop CPR
• Discontinue if circulation and ventilation
is restored.
• Reliable criteria for death are
recognized.
• You are too exhausted, or
environmental hazards endanger your
safety or others.
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External Cardiac Compression
in an Adult
• Victim is unconscious and not breathing.
– Check and correct airway.
– Check and correct breathing.
– Check circulation by feeling carotid artery.
• Victim must be on a firm surface.
• Must maintain proper hand placement
• Compressions must be rhythmic and
continuous.
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24
External Chest Compressions
on an Infant
• Victim is unconscious and not breathing.
– Check and correct airway.
– Check and correct breathing.
– Check circulation by feeling brachial pulse.
• If there is no pulse, begin chest
compressions.
• Compressions must be rhythmic and
continuous.
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24
External Chest Compressions
on a Child
• Victim is unconscious and not breathing.
– Check and correct airway.
– Check and correct breathing.
– Check circulation by feeling carotid pulse.
• If there is no pulse, begin chest
compressions.
• Compressions must be rhythmic and
continuous.
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One-Rescuer Adult CPR
• Establish level of consciousness.
• Call 9-1-1.
• Check for ABCs and correct as needed.
– Apply 15 compressions at a rate of 100 per
minute.
– Ratio between chest compressions and
breathing is 15 to 2.
– Chest compressions are 1 1/2" to 2".
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24
Two-Rescuer Adult CPR
• Establish level of consciousness.
• Call 9-1-1.
• Check for ABCs and correct as needed.
– Apply 15 compressions at a rate of 100 per
minute.
– Ratio between chest compressions and breathing
is 15 to 2.
– Chest compressions are 1 1/2" to 2".
• Second rescuer can do chest compressions
while first rescuer breathes for victim.
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One-Rescuer Infant CPR
• Establish level of consciousness.
• Call 9-1-1.
• Check for ABCs and correct as needed.
– Apply 5 compressions at a rate of 100 per
minute.
– Ratio between chest compressions and
breathing is 5 to 1.
– Chest compressions are 1/2" to 1".
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One-Rescuer Child CPR
• Establish level of consciousness.
• Call 9-1-1.
• Check for ABCs and correct as needed.
– Apply 5 compressions at a rate of 100 per
minute.
– Ratio between chest compressions and
breathing is 5 to 1.
– Chest compressions are 1" to 1 1/2".
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Signs of Effective CPR
• Second rescuer feels carotid pulse on
chest compressions.
• Victim’s pupils constrict on exposure to
light.
• Victim’s color improves (blue to pink).
• Independent breathing occurs.
• Independent heartbeat occurs.
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24
Complications of CPR
• Broken bones
• Vomiting
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24
Creating Sufficient Space for CPR
• To perform CPR
correctly, you need
3' to 4' of space on
all sides of victim.
• To make room:
– Rearrange furniture
– Drag victim into area
that has more room
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CPR Training
• Fire fighters should successfully
complete a CPR course through a
recognized agency.
• Fire fighters should regularly update
CPR skills through a recognized
recertification course.
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Legal Implications of CPR
• Living wills, advanced directives, and
DNR orders are legal documents
specifying victim’s wishes.
• Abandonment is discontinuing CPR
without the order of a licensed physician
or without turning the victim over to
someone as qualified as you.
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Shock
• Defined as failure of the circulatory
system
• Three primary causes of shock:
– Pump failure
– Pipe failure
– Fluid loss
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Pump Failure
• Cardiogenic shock occurs if the heart
cannot pump enough blood to supply
the needs of the body.
– Inadequate pumping of the heart can
cause blood to back up in the vessels of
the lungs, resulting in congestive heart
failure (CHF).
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Pipe Failure (1 of 2)
• Caused by the expansion (dilation) of
the capillaries
• Blood pools in the capillaries instead of
circulating throughout the system.
• Blood pressure falls and shock results.
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Pipe Failure (2 of 2)
• Three types of shock caused by
capillary expansion:
– Shock induced by fainting
– Anaphylactic shock
– Spinal shock
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Fluid Loss
• Blood loss (hemorrhage) shock
– Fluid loss by excessive bleeding through
wounds
• Average adult has 12 pints of blood.
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Signs and Symptoms of Shock
•
•
•
•
•
•
•
Confusion, restlessness, or anxiety
Cold, clammy, sweaty, pale skin
Rapid breathing and rapid weak pulse
Increased capillary refill time
Nausea and vomiting
Weakness or fainting
Thirst
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General Treatment for Shock
•
•
•
•
•
•
•
Position victim.
Maintain ABCs.
Treat cause of shock if possible.
Maintain body temperature.
Do not allow victim to eat or drink anything.
Assist with other treatments.
Arrange for prompt transport to a medical
facility.
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Treatment for Shock Caused
by Pump Failure (1 of 2)
• Keep victim lying down, unless
breathing is easier in a sitting position.
• Maintain ABCs.
• Maintain body temperature.
• Do not allow victim to eat or drink.
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Treatment for Shock Caused
by Pump Failure (2 of 2)
• Keep victim quiet and do any necessary
moving for him or her.
• Provide reassurance.
• Arrange transport to a medical facility.
• Provide high-flow oxygen.
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Treatment for Shock Caused
by Pipe Failure
• Examine victim for injuries.
• Keep victim lying down, with legs
elevated.
• Maintain ABCs.
• Maintain body temperature.
• Provide reassurance.
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Treatment for Anaphylactic Shock
• Keep victim lying down, and elevate legs.
• Maintain ABCs.
– Airway may swell in victims experiencing
anaphylactic shock.
• Maintain body temperature.
• Provide reassurance.
• Arrange for transport to a medical facility.
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Treatment for Shock Caused
by Fluid Loss (1 of 2)
• Control bleeding.
• Keep victim lying down, and elevate
legs.
• Maintain ABCs.
• Maintain body temperature.
• Do not allow victim to eat or drink.
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Treatment for Shock Caused
by Fluid Loss (2 of 2)
• Provide reassurance.
• Arrange transport to a medical facility.
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Treatment for Shock Caused
by Internal Blood Loss (1 of 2)
•
•
•
•
•
Keep victim lying down, elevate legs.
Maintain ABCs.
Maintain body temperature.
Do not allow victim to eat or drink.
Provide reassurance.
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Treatment for Shock Caused
by Internal Blood Loss (2 of 2)
• Keep victim quiet and do any necessary
moving for him or her.
• Provide high-flow oxygen.
• Monitor vital signs.
• Arrange transport to a medical facility.
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Bleeding (1 of 2)
• Three types of
external blood loss:
– Capillary
– Arterial
– Venous
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Bleeding (2 of 2)
• To control bleeding:
– Use direct pressure.
– Elevate.
– Use pressure points.
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Wounds
• Wounds are injuries caused by any
physical means that leads to damage of
a body part.
• Two kinds of wounds:
– Open (skin is disrupted)
– Closed (skin remains intact)
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Principles of Wound Treatment
(1 of 2)
• Minor bruises need no treatment.
• Open-wound treatment
– Control bleeding.
– Prevent further contamination of wound.
– Immobilize injured part.
– Stabilize impaled object.
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Principles of Wound Treatment
(2 of 2)
• Apply dressing and
bandages as
needed.
– Do not apply
dressings too
tightly—may cut off
circulation.
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Mass-Casualty Incidents
• Any calls involving multiple victims or that
place a great demand on available equipment
and personnel
• Triage
– Sorting of two or more victims ranked in level of
severity
– Triage should be done with color coding.
– Transportation Sector Officer decides the order in
which victims are transported.
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Violent Situations
• Safety of you and your team is primary
concern.
• Evaluate scene for potential violence
upon arrival.
• Law enforcement must secure scene.
• You may need to wait for scene to be
safe before beginning treatment.
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Behavioral Emergencies
• Most people with mental problems are
not violent.
• Look for indicators that may be
associated with violence.
– Past history
– Posture
– Vocal activity
– Physical activity
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Summary (1 of 3)
• Body substance isolation prevents
spread of disease.
• The steps for performing CPR involve:
– Determining responsiveness
– Checking and correcting the airway
– Checking and correcting breathing
– Checking and correcting circulation
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Summary (2 of 3)
• The steps for performing CPR and
relieving an airway in adults, children,
and infants are similar, but modifications
must be made for children and infants.
• Bleeding can be controlled by using:
– Direct pressure
– Elevation
– Pressure points
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Summary (3 of 3)
• Fire fighters must be able to recognize the
signs of shock and treat a victim suffering
from shock appropriately.
• Your safety, the safety of other rescuers, the
safety of victims, and safety of bystanders are
all critical.
• Triage is used at mass-casualty incidents to
provide the best treatment to large numbers
of victims.
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