Chapter 7Before Providing Care and

Victim Assessment

Bloodborne PathogensBacteria and viruses present in blood and body

fluids that can cause disease in humans.

Bacteria and viruses MOST COMMON forms of pathogens

Found almost everywhere in our environment.

Bacteria vs. VirusesBACTERIA

Live can live outside of the body Commonly do NOT depend on other organisms of

lifeAntibiotics and other medications often are used

to treat the infection

VIRUSESDepend on other organisms to liveOnce viruses are in the body, they are difficult to

killPrevention is CRITICAL

Hepatitis B

Liver infection caused by the hepatitis B virus.

Severe or even fatal can be in body for up to 6 months before symptoms appear.

Prevention: Hepatitis B vaccine (3 doses)

Primarily spread through direct or indirect contact with infected blood or other body fluids

Hepatitis C

Liver disease caused by the hepatitis C virus

Most common chronic bloodborne infection in US

No vaccine against hepatitis C and NO treatment available to prevent infection after exposure

Leading cause of liver transplants

Primarily spread through direct or indirect contact with infected blood or other body fluids

HIV

Virus that causes acquired immunodeficiency syndrome (AIDS)

Weakens the body’s immune system

People with AIDS eventually develop life-threatening infections and can die from these infections.

Currently NO vaccine against HIV

Primarily spread through direct or indirect contact with infected blood or other body fluids

How Pathogens SpreadFor any disease to be spread, ALL four of the following conditions must be met:

1. A pathogen is present

2. A sufficient quantity of the pathogen is present to cause disease

3. A person is susceptible to the pathogen

4. The pathogen passes through the correct entry site (eyes, mouth other mucous membranes; non-intact skin or skin pierced by needle sticks, human bites, cuts, abrasions and other means)

How infections occur

Entry Site

SusceptibleQuantity

Present

Direct ContactOccurs when infected blood or body fluid from one person enters another person’s body at a correct entry site.

Example: *Infected blood splashing in the eye

*Directly touching the body fluids of an infected person and that infected blood or other body fluid enters the body through a correct entry site

Indirect ContactOccurs when a person touches an object that contains the blood or other body fluid of an infected person and matter enters the body through a correct entry site.

Example: *Soiled dressings: when a person picks up blood-soaked bandages with bare hands and the pathogens enter through a break in the skin on the hand.

*Equipment and work surfaces that are contaminated

Droplet TransmissionOccurs when a person inhales droplets from an infected person’s cough or sneeze

Example: Flu

Vector-Borne Transmission Occurs when the body’s skin is penetrated by an infectious source, such as an animal or insect bite or sting

Example: *Malaria*West Nile Virus

Risk of TransmissionVery low but should be very cautious

Neddlestick or cut exposure30% chance if unvaccinated person for Hep B

(depending on several factors)

Risk of hep c is about 2%

Risk of HIV infected blood less than 1%

 

OSHA Occupational Safety and Health Administration  “issue regulations about on-the-job exposure to bloodborne pathogens”

Exposure Control Plan Written program outlining the protective measures that employers will take to eliminate or minimize employee exposure incidents.

Standard PrecautionsPersonal protective equipment (PPE)

Good hand hygiene

Engineering controls

Work practice controls

Proper equipment cleaning

Spill clean-up procedures

Personal protective equipment (PPE)

Breathing barriers Non-latex disposable gloves Gowns Masks Shields Protective eyewear

Guidelines for using PPE to prevent infection:Avoid contact w blood and other body fluidsUse CPR breathing barriers when giving

ventilationsWear disposable gloves when providing care

Disposable Gloves

Gown

Mask Protective Eyewear

Bleeding control with spurting blood

Yes Yes Yes Yes

Bleeding control with minimal bleeding

Yes NO NO NO

Emergency childbirth Yes Yes Yes Yes

Oral/nasal suctioning; manually clearing airway

No No No, unless splashing is likely

No, unless splashing is likely

Handling and cleaning contaminated equipment and clothing

Yes No, unless soiling is likely

No NO

Recommended Protective Equipment against Hep B, Hep C, and HIV transmission in prehospital settings

Good hand hygiene Most effective measure to prevent the spread of infection Wash hands frequently (for at least 15 seconds)

Engineering controls- objects used in the workplace that isolate or remove a hazard

Biohazard bags and labels Personal protective equipment Sharps disposal containers Self-sheathing needles Safer medical devices

Work practice controls- things done to help reduce the risk

Placing sharp items in puncture-resistant containers Avoiding splashing, spraying, and splattering of droplets of blood Removing and disposing of soiled clothing Cleaning and disinfecting all equipment Washing hands thoroughly with soap and warm water immediately Not eating or drinking, smoking, applying cosmetics or lip balm, handling contact

lenses, or touching the eyes, mouth or nose when in an area where exposure to infectious materials is possible

Isolating contaminated areas so other employees or people do not walk through and become exposed

Equipment cleaning and Spill-clean up procedures Always clean and disinfect the equipment and surfaces used Wear disposable gloves and other personal protective equipment

when cleaning up spills Clean up spills immediately or as soon as possible after the spill

occurs Dispose of the absorbent material used to collect the spill in a

labeled biohazard container Flood the area with fresh disinfectant solution of approximately 1

½ cups of liquid chlorine bleach to 1 gallon of water and allow to stand for about 10 minutes

Use appropriate material to absorb the solution, and dispose of it in a labeled biohazard container

Scrub soiled boots, leather shoes, and other leather goods, such as belts, with soap, a brush and hot water. If a uniform is worn to work, was and dry it according to the manufacture's instructions.

If you are exposed

Clean the contaminated area thoroughly with soap and water

If you are splashed with blood or other potentially infectious material around your mouth or nose, flus the area with water.

If your eyes are involved, irrigate them with clean water, saline for 20 minutes

Report the exposure incident

Document what happened (include time date)

Seek immediate follow-up care

General Procedures for injury or sudden illness on land

1. Size up the scene Move victim only if necessary for his or her safety

2. Perform a primary assessment Obtain consent if the victim is conscious.

3. Summon EMS, if needed

4. Perform secondary assessment, if no life-threatening conditions are found.

5. Provide care for the conditions found.

6. Report, advise, and release

Size up the Scene: Determine if the scene is safe for LGs, other rescuers, victim(s) and

bystanders• Use your senses to check hazards (gas leak or fire, look for things

explosion)

Determine what caused the injury or illness Determine the number of injured or ill victims Determine what additional help may be needed Put on the appropriate PPE

Moving a victimvictim on land move only:You are faced w immediate dangerYou need to get to other victims who have more serious injuries

or illnessesIt is necessary to provide appropriate care (stairs)

MovesNon-emergency moves

Walking assist: one or two responders conscious person who simply needs assistance

Two-person seat carry: requires a second responder. Conscious person no serious injury

MovesEmergency moves:

Clothes drag: conscious or unconscious person suspected of having a head, neck, or spinal injury

Pack-strap carry: conscious and unconscious

Ankle drag: (foot drag) to move a person who is too large to carry or move in any other way.

Perform an initial assessment:

to identify any Life-threatening conditions

Checking the victim for responsiveness A person who speaks is CONSCIOUS

Breathing and pulse

Scanning for severe bleeding

Continue sudden illness on landPerform Secondary assessment

To identify additional conditions Only do it if you know that there are no life-

threatening conditions To gather additional info about injuries or

conditions that may need care Not life-threatening but could be if not cared for

Summon EMS if any of the following conditions are found:

Unconsciousness or altered level of consciousness (LOC) “confusion or drowsiness”

Breathing problems (difficulty or no breathing) Any victim recovered from underwater who may have inhaled water Chest pain, discomfort, or pressure lasting more than a few minutes

or goes away and comes back Persistent abdominal pain or pressure No pulse Severe external bleeding Vomiting blood or passing blood Severe (critical) burns Suspected poisoning Seizures in the water Seizures that last more than 5 minutes or cause injury Suspected or obvious injuries to head, neck or spine Stroke Painful, swollen, deformed areas (broken bones) or open fracture Victim's physical condition is unclear or is worsening (allergic

reaction)

Open the Airway and check for breathing and Pulse

No more than 10 secondsPerform concurrently If able to speak, airway is functioning

Opening AirwayTo check breathing and give ventilations, you must manually tilt the head or thrust the jaw to move the tongue away from the back of the throat

Head-tilt/chin lift: used when the rescuer is positioned at the victim’s side

Jaw-thrust maneuver (with head extension): used when the rescuer is positioned above the victim’s head

Jaw-thrust maneuver (without head extension) used when the victim is suspected of having an injury to the head, neck or spine

Child, tilt the head slightly past the neutral position not as far as adultInfant, tilt head to neutral position

Checking for BreathingPosition your ear over the mouth and nose so

that you can hear and feel air as it escapes while you look for the chest to rise and fall.

Agonal gasps, isolated or infrequent gasping (this is NOT breathing) assume he/she is not breathing

Checking for a pulseIf you do not find a pulse with your fingertips in

the arteries near the skin, within 10 seconds do not waste time.

Adult and child: feel for carotid pulse “place two fingers in the middle of the victim’s throat and then slide them into the groove of the neck closest to you.”

Infant: feel for brachial pulse on the inside of the upper arm between elbow and shoulder

Give 2 ventilations Victims of cardiac arrest (witnessed sudden collapse),

IMMEDIATELY begin CPR chest compressions.

Other situations drowning or another respiratory event, giving ventilations before beginning CPR is important because victims of hypoxia (deprived of oxygen) likely to experience respiratory emergencies.

Adults: unconscious and not breathing as a result of drowning, hypoxia or another respiratory problem, give the victim 2 ventilations before compressions. If unconscious and no pulse begin compressions

Child or infant: unconscious and not breathing give 2 ventilations. Only skip if you witness a sudden collapse

Scan for severe BleedingDo a quick visual scan of the victim for severe

bleeding. Head to toe scan

Additional LGs should assist by controlling the bleeding

Recovery PositionLeave the victim in a face-up position and

maintain an open airway if he/she unconscious but breathing (especially suspected spinal)

High arm endangered spine (H.A.IN.E.S):keep the airway open and clear even if a spinal injury. You are alone and have to leave victim to call for help, you cannot maintain an open and clear airway because of the fluids or vomit.

Perform secondary assessment

Victim does NOT have any life-threatening conditions, to identify any additional problems

Provide Care for the Conditions Found

Always treat life-threatening situations FIRST.

Care should be continued until EMS personnel take over

Report, Advise, and Release

Once care is given, be sure to complete incident report forms, advise the victim on next steps and release the victim to appropriate parties.

One Age does NOT fit allPurpose of the skills in this manual

Anyone approx. 12 years of age or older is an ADULT

Anyone age 1 year to about 12 years is a child

An infant is anyone younger than 1 year

AED anyone 1 to 8 years of age less than 55 pounds is an child

Call first or care firstIf alone:

Call first for : (cardiac emergencies)

Any adult or child about 12 years of age or older who is unconscious

A child or an infant who you witnessed suddenly collapseAn unconscious child or infant known to have heart

problems.Care First (proved 2 minutes of care) for: (breathing

emergencies)

An unconscious child (younger than 12 years of age) who you did not see collapse

Any victim of a nonfatal drowning

Adult Child Infant1. Tap the victims shoulder and shout, “Are you okay.”

Tap on foot

2. If no, response (Unconscious) summons EMS

3. Check for signs of life (movement and NORMAL breathing)a. If victim face down, roll victim onto back, while supporting head.b. Tilt head back and lift the chin to open airway.Look for movement and look, listen and feel for normal breathing for NO more than 10 seconds.

Head tilt not as dramatic

Very little to no head tilt

4. If no movement or breathing, give two rescue breaths with resuscitation mask. Each breath should last about 1 second and make the chest clearly rise.

5. If chest clearly rises, check for pulse, CAROTID ARTERY, for no more than 10 seconds.a. One hand on the victim’s forehead, take other hand and place two fingers on the front of the neck. Then, slide the fingers down into the groove at the side of neck.

One hand on infant’s forehead, use other hand to find the brachial pulse on the inside of the upper arm, between the infant’s elbow and shoulder

6. Quickly scan the victim for severe bleeding.

7. Care for conditions found.a. If there is movement, breathing, and pulse, place victim in H.A.IN.E.S. recovery position (if spinal is suspected) continue to monitor ABCs (airway, breathing, circulation)