OFFICE OF THE STATE FIRE MARSHALfvccfireacademy.yolasite.com/resources/FFIIMODB-EMC.pdf · lower jaw and your thumbs on either side of the lower lip. Push the jaw forward as you tilt

OFFICE OF THE STATE FIRE MARSHAL

EMERGENCY MEDICAL CARE

OBJECTIVES

� 2-8 (2-3)

� Authority having jurisdiction (AHJ) must retain proof of completion of objectives satisfying objectives listed on the following slides. The required practical completion may be indicated on the practical key that remains in the fd training jacket of the individual.

OBJECTIVES

� The objectives may be accomplished by completing courses hosted by:

� American Red Cross: Basic First Aid

� American Red Cross: First Responder

� American Heart Association: CPR ONLY

� IDPH (1 of following): EMT-B, EMT-D, EMT-I, EMT-P

� National Safety Council: Basic First Aid

OBJECTIVES

� 2-8.1 Identify the principles of infection control and universal blood and body fluid precautions as prescribed for public safety officers.

� 2-8.2 Identify the use, decontamination, disinfection, and disposal of personal protective equipment used for protection from infection.

OBJECTIVES

� 2-8.3 Identify the following procedures as defined in the American Heart Association or American Red Cross CPR manuals:

� 2-8.3.1 Adult single-rescuer CPR

� 2-8.3.2 Child single-rescuer CPR

� 2-8.3.3 Infant single-rescuer CPR

� 2-8.3.4 Adult two-rescuer CPR

OBJECTIVES

� 2-8.3.5 Management of an obstructed airway in a conscious adult.

� 2-8.3.6 Management of an obstructed airway in an unconscious adult.

� 2-8.3.7 Management of an obstructed airway in a conscious child.

� 2-8.3.8 Management of an obstructed airway an unconscious child

� 2-3.3.9 Management of an obstructed airway in a conscious infant.

� 2-3.3.10 Management of an obstructed airway in an unconscious infant.

OBJECTIVES

� 2-8.4 Identify a primary survey for life-threatening injuries.

� 2-8.5 Identify the characteristics of three types of external bleeding.

� 2-8.6 Identify three procedures for controlling external bleeding.

� 2-8.7 Identify signs and symptoms of traumatic shock.

OBJECTIVES

� 2-8.8 Identify the emergency medical care for a victim of traumatic shock.

� 2-8.9 Identify the characteristics of thermal burns according to degree and severity.

� 2-8.10 Identify the emergency medical care of thermal burns according to degree and severity.

OBJECTIVES

� 2-8.11 Identify the signs and symptoms of ingested poisons and drug overdose.

� 2-8.12 Identify the method of contacting the poison control center that serves the department.

� 2-8.13 Identify the emergency medical care for victims of ingested poisons and drug overdoses.

OBJECTIVES

� 2-8.14 Identify the signs and symptoms of a fracture.

� 2-8.15 Identify the emergency medical care for a fracture.

� 2-8.16 Identify the use of a resuscitation mask in the performance of single and two-rescuer CPR.

� IFSTA Fire Service First Responder 1st ed.

� Delmar, Firefighter’s Handbook, copyright 2000, Chap 22

INFECTION CONTROL

� Four basic ways to spread infection

� Direct contact: handshake or fluid contact with an infected person.

� Indirect contact: contact with an object handled by an infected person.

� Droplet infection: inhaling droplets discharged by coughing/sneezing of an infected person.

� Sexual contact: transmission through close sexual contact.

INFECTION CONTROL

� Exercise extreme care around patients with

� A fever of unknown origin

� Diarrhea

� Draining wounds

� Bleeding wounds

� Jaundice

� Dialysis treatment in progress

� A rash

� Known history of communicable diseases

INFECTION CONTROL

� Precautions� Use an airway and pocket mask when

administering artificial respiration or CPR.

� Wear exam gloves on all EMS calls.

� Take extra care to avoid needle sticks. Do not pick up needles. Identify needles to paramedics and allow them to handle needles.

� Avoid direct skin and mucous membrane contact with blood and body fluids of an AIDS patient. Wash your hands thoroughly afterwards with soap and water as soon as possible.

INFECTION CONTROL

� Clean blood spills with a solution of chlorine bleach and water. Use ¼-cup bleach per gallon of water.

� Place clothes or linen soiled by blood or body fluids in a plastic bag marked “blood contaminated.” Launder the items per department regulations.

INFECTION CONTROL

� Basic procedures for infection control

� Keep your hands and equipment clean.

� Keep inoculations up to date.

� Keep your hands away from your face: avoid introduction of germs through the mucous membranes.

� Avoid touching open skin lesions or any draining wounds.

INFECTION CONTROL

� Use exam gloves on all EMS calls.

� Wash hands thoroughly with soap after each patient contact. Clean your fingernails.

� Wear a disposable mask around infectious patients.

� Use an airway and pocket mask when performing CPR.

INFECTION CONTROL

� Clean your equipment after each use.

� Place soiled linens in plastic bags for disposal or sterilization.

� Bag contaminated items.

USE, DECONTAMINATION, DISINFECTION, & DISPOSAL OF PPE

� The above objective will be accomplished using the specific PPE equipment designated for protection from infection by the AHJ in accordance with practices of AHJ.

CPR

� Airway

� Modified Jaw Thrust: used for trauma victims

� Kneel beside patient’s head

� Place your hands on both sides of the patient’s head and hold the head in such a way that the neck remains in a fixed, neutral position without being extended.

� Place your fingers behind the angle of the lower jaw on each side of the patient’s head.

� Move the jaw forward with your fingers, taking care not to tilt the head back or move it to either side.

CPR

� Head-tilt chin-lift

� Kneel beside patient’s head.

� Place one hand on the patient’s forehead and press back firmly with your palm.

� Grasp the patient’s chin with the fingertips of your other hand and lift up and forward until the teeth are nearly closed.

CPR

� Jaw-thrust

� Kneel above the patient’s head.

� Place your hands on both sides of the patient’s head with your fingers behind the angles of the lower jaw and your thumbs on either side of the lower lip.

� Push the jaw forward as you tilt the head backwards.

� Open the lower lips with your thumbs.

CPR

� Face-down

� Kneel at the patient’s side.

� Grasp the patient’s farthest shoulder with one hand and the farthest hip with the other.

� Roll the patient gently toward you until they are resting on the side nearest you.

CPR

Look, listen and feel for up to 10

seconds, before deciding that

breathing is absent.

� Breathing� Lean over the patient’s head

with your ear within an inch of the victim’s mouth and nose.

� Look to see whether the chest rises or falls.

� Listen for air movement at the nose and mouth.

� Feel for air movement on your check or ear.

CPR

� Circulation� Feel carotid pulse on near side of

patient for 5-10 seconds with index and middle fingers.

� Severe bleeding� Quick visual of the patient and/or

surrounding area.

CPR

� Removal of Airway Obstruction� Conscious Adult

� Stand behind the standing or sitting patient and wrap your arms around the patient’s waist.

� Make a fist with one hand and place the thumb side of your fist against the patient’s abdomen, slightly above the navel and well below the xiphoid process.

� Grasp the fist with your other hand and press the fist into the patient’s abdomen 6 to 10 times with quick, inward and upward thrusts.

� Each thrust should be distinct and delivered with the intent of relieving the airway obstruction.

CPR

� Unconscious Adult� Either kneel at the patient’s side or straddle

the patient’s body so that you are facing his/her head.

� Place the heel of one of your hands on the patient’s abdomen, slightly above the navel and well below the xiphoid process.

� With your other hand, press the heel of that hand into the patient’s abdomen with 6 to 10 sharp, forward thrusts.

� Move back to the patient’s head, and hook your thumb over the patient’s teeth and pull the jaw up.

� Look into the patient’s mouth. If you see a foreign object, carefully pull in out.

CPR

� Open the patient’s airway using the head-tilt, chin-lift method.

� Pinch the patient’s nose closed with the thumb and index finger of the hand that is on the forehead, as you maintain pressure on the forehead with the heel of the same hand.

� Open your mouth widely, take a deep breath, and blow into the patient’s mouth.

� Watch for the rise and fall of the patient’s chest.

� If unable to ventilate the patient’s lung, re-position head and try again.

� Repeat steps above until you can provide ventilation for the lungs.

CPR

3. PUMP

If the victim is still not breathing normally, coughing or moving, begin chest compressions. Pushdown on the chest 11/2 to 2 inches 15 times right between the nipples. Pump at the rate of 100/minute, faster than once per second

CPR

CPR

� Infants� Hold the infant face down so they straddle

your forearm.� Hold the head lower than the rest of the

body and support it by holding the jaw.� Rest your arm on your thigh and deliver

four sharp back blows between the infant’s shoulder blades.

� Place your free arm along the infant’s back so that their head and body are sandwiched between your arms and hands.

� Carefully turn the infant over and position them on your thighs so that the head is lower than the rest of the body.

CPR

� Imagine a line across the infant’s chest that intersects both nipples. Place three fingers on one hand just below this line where it intersects with the sternum.

� Life the finger closest to the nipple line and with the remaining two fingers, administer four chest thrusts.

� Look into infant’s mouth and remove obstruction, if possible.

� Repeat steps above if you cannot see obstruction

CPR

� CPR

� Airway

� Breathing

� Circulation

� Assess effectiveness of CPR

� Continue CPR

PRIMARY SURVEY

� Upon arrival on the scene of a call for medical assistance a rapid assessment of the scene must be made to deem the hazard zone safe for entry by rescuers. Safety of the first responder is of utmost importance.� Weapons

� Downed wires

� Leaking gasoline

� Hazardous materials

� Fire

� Confined Space

� Terrain

� Stability of vehicle or structure

PRIMARY SURVEY

� As the first responder approaches the patient, a quick visual survey should be performed to assist in determining how serious the patient’s condition is. (This assessment should be completed in 60 seconds). Assess visually when approaching patient:

� Is patient awake

� Does situation/environment pose threat of further harm to the patient

� The position of the patient.

� Any objects or people in the area of the patient that may have contributed to the injury or illness.

� Skin color of the patient (cyanotic, ashen, flushed)

PRIMARY SURVEY

� Upon reaching the patient, the first responder must conduct a primary survey of the patient’s basic signs of life and life-threatening injuries. Assess the following immediately:� Level of consciousness

� Is patient awake

� Can the patient talk

� Does patient respond appropriately

� Airway� Does patient have a patent (open) airway?

PRIMARY SURVEY

� Breathing� Is patient breathing?

� Assess the quality (short, rapid, deep, slow)

� Circulation� Does patient have a pulse?

� Assess the quality (full, thready, rapid, slow, regular, irregular)

� Major bleeding� Is there obvious major bleeding?

� If patient laying down or seated, check under patient for bleeding

� Control major bleeding immediately

CHARACTERISTICS OF EXTERNAL BLEEDING

� Arterial bleeding�� Blood spurts with the rhythm of the heartbeat.Blood spurts with the rhythm of the heartbeat.

�� Blood is bring red in color (rich in oxygen).Blood is bring red in color (rich in oxygen).

�� Blood loss is rapid and profuseBlood loss is rapid and profuse..

� Venous bleeding� Blood oozes from wound at even rate.

� Blood is dark red or bluish in color (CO2/waste)

� Bleeding can be profuse.

� Capillary bleeding�� Blood oozes slightly (abrasions, etc)Blood oozes slightly (abrasions, etc)

�� Color of blood varies from bright red to dark redColor of blood varies from bright red to dark red

�� Bleeding often stops by itself.Bleeding often stops by itself.

CHARACTERISTICS OF EXTERNAL BLEEDING

� The human body has natural system for controlling bleeding.� Clotting effective when bleeding is not too

serious.

� Platelets in blood combine with proteins to form clot.

� Clots close the wounds and stop bleeding.

� Profuse bleeding washes away clots and requires external efforts to stop it.

CONTROLLING EXTERNAL BLEEDING

� Direct pressure� Place a sterile dressing over the wound (controls

most bleeding) (can use clean cloth, handkerchief or sanitary napkin)

� Apply pressure directly over wound using fingers or heel of hand.

� Maintain pressure three to five minutes.

� If injury is arm or leg, elevate it. EXCEPT:

� Fractures

� Embedded object

� Possible spinal cord injury


� When bleeding is under control, apply a pressure bandage over the wound.

� Apply a universal dressing over original dressing firmly and securely.

� Check for proper circulation and adjust as needed to provide blood flow below wound. (Do not remove dressing once in place.)


� Pressure Points (compress artery supply area)� Temporal

� Maxillary

� Carotid

� Brachial

� Radial

� Femoral

� Popliteal

� Tibial

� Pedal

� DO NOT apply at a fracture site.

� Use ONLY when direct pressure/elevation fail to stop bleeding.


� Tourniquet (USE ONLY WHEN ALL ELSE FAILS)� Apply a pad over the artery to be compressed

� Arm: brachial artery

� Leg: femoral artery

� Feet: tibial and pedal arteries

� Lower leg: popliteal artery

� Place a folded or rolled cloth pad on the artery at that point.

� Use a wide, flat material such as a cravat or handkerchief.

� Wrap a tourniquet twice around the extremity and tie a half knot. Never remove once applied.

� Place a stick, pencil or similar object on top of the half knot. Tie the ends of the tourniquet in a square knot above the tourniquet.

� Twist the stick just enough to stop the bleeding.

� Tie the ends of the tourniquet in place.

� Mark TK and the time applied on the patient’s forehead.

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SIGNS AND SYMPTOMS OF TRAUMATIC SHOCK

� Restlessness or anxiety: often prelude to other signs

� Extreme thirst

� Nausea or vomiting: may accompany thirst

� Dull, vacant looking eyes: dilated pupils

� Cold/clammy skin: blood vessels near the skin surface constrict

� Pale or cyanotic face


�� Rapid, shallow breathing: Rapid, shallow breathing:

possibly labored, irregular or possibly labored, irregular or

gasping, patient requires more gasping, patient requires more

oxygen.oxygen.

�� Weak, rapid pulse: heart pumps Weak, rapid pulse: heart pumps

faster to circulate oxygen.faster to circulate oxygen.

�� Falling blood pressure; relatively Falling blood pressure; relatively

late sign indicates circulatory late sign indicates circulatory

system is collapsing. Blood system is collapsing. Blood

pressure may fall gradually or pressure may fall gradually or

drop suddenly.drop suddenly.


� Level of consciousness: patient may be sleepy, disorientated or unconscious.

� It is important to monitor vital signs frequently.

� Signs of shock may be delayed for an hour or more. Do not wait for blood pressure to fall before treating.

� Pay particular attention to elderly, they do not withstand shock as well as others.

� Watch children carefully, they do not exhibit signs until deep in shock. Treat shock signs in a child as an emergency.

� Different types of shock exhibit different signs.

� Neurogenic (Nervous System) shock has warm, dry skin.


� Anaphylactic shock causes hives, swelling of face and hands and is life-threatening


EMC FOR A VICTIM OF TRAUMATIC SHOCK

� Shock cannot be reversed, but proper treatment can keep it from worsening.� Establish an airway; always the first step.� Administer oxygen� Prevent loss of body heat� Avoid rough handling of patient� Do not give patient food or drink� Monitor vital signs and level of consciousness

frequently� Arrange for immediate transportation to a

medical facility.

� Treat the cause(s) of shock

� Control bleeding/splint fractures as necessary

� Position patient to reduce stress to vital systems; lying down with legs elevated

EMC FOR A VICTIM OF TRAUMATIC SHOCK

THERMAL BURNS

� The severity of a burn is classified by both the depth of the burn and the amount of tissue destroyed.

� First Degree Burns

� Second Degree Burns

� Third Degree Burns

THERMAL BURNS

� First Degree Burns:

� Damage superficial layers of the skin

� Moderate sunburn or scald

� Produce redness and pain

� Usually heal within one week

THERMAL BURNS� Second Degree Burns

� Penetrate deeper into skin

� Blistering and swelling

� Extremely painful, nerve endings irritated

� Deep second degree burns less painful; nerve endings are damaged

� skin

� Most second degree burns heal within 2-3 weeks

� Most often caused by boiling liquids

� First and second degree burns are known as partial thickness burns.

THERMAL BURNS

� Third Degree Burns:

� Full thickness burns, through the full thickness of skin and perhaps into the fatty and muscle tissues.

� Skin is pale and dry; possibly charred and leathery with “burned” smell.

� Usually not painful, nerve endings destroyed.

� Rapid and significant body fluid loss due to damaged skin, hypovolemic shock.

� Damaged skin cannot heal itself; skin contracture and grafting necessary.

RULES OF NINES

� Adults� Head (9%)

� Chest (9%)

� Upper back (9%)

� Abdomen (9%)

� Lower back (9%)

� Each arm (9% each x 2 = 18%)

� Front of each leg (9% each x 2 = 18%)

� Back of each leg (9% each x 2 = 18%)

� Groin (1%)

� Total for all: 100%

RULES OF NINES

� Children� Front of head (9%)

� Back of head (9%)

� Front of torso (9%)

� Back of torso (9%)

� Each arm (9% each x 2 = 18%)

� Each leg (9% each x 2 = 18%)

� Total for all 100%

OTHER DERTERMINING FACTORS TO SEVERITY OF BURNS

� Minor burns

� First degree burns on less than 20% of body surface.

� Second degree burns on less than 15% of body surface.

� Third degree burns on less than 2% of body surface.


� Moderate burns

� Second degree burns involving 15 to 30% of body surface

� Third degree burns involving 2 to 10% of body surface.


� Critical (severe) burns� Respiratory injury

� Face, psychologically damaging

� Hands and feet, swelling may cut off circulation

� Genitalia and buttocks prone to early infection

� Fractures or major soft tissue injury.

� Electrical and deep acid burns.

� Burn patients with underlying medical problems, heart condition or diabetes, etc.

� Very young children, lower resistance to infection

� Elderly patients over 60 with underlying medical conditions and lower resistance.

OTHER DERTERMINING FACTORS TO SEVERITY OF

BURNS

EMC OF THERMAL BURNS

� General

� STOP THE BURNING PROCESS

� Maintain the ABC’s

� Help relieve the pain

� Treat for shock

� Aid in the prevention of infection


� Thermal

� Extinguish any clothing on fire

� Check for signs of respiratory involvement� Burns around face

� Patient who has been unconscious in a burning area

� Patient who has been exposed to smoke or hot gases

� Signed nasal hair

� Sooty sputum

� Hoarseness

� Cyanosis

� Administer oxygen


� Take patient’s vital signs� 5 minute intervals

� Watch for increasing pulse rate

� Watch for signs of shock

� Cover burns with dry sterile dressing (except eyes or eyelids use sterile moist dressing)


� Chemical burns� Water soluble

� Flush area with large amounts of water

� Remove contaminated clothing

� Continue flushing for at least 15 minutes

� Prevent personal injury by avoiding skin or clothing contact

� After flushing is complete, apply dry sterile dressing


� Chemical burns

� Dry (non-soluble)

� Dry lime

� Brush from clothing and skin

� Flush with LARGE quantity of water

� Phenol

� Place patient under running water

� Wash affected area with alcohol or oil

� Chemical burns to eyes

� Flush the eyes for at least 20 minutes

� Cover eyes with sterile moist dressing

INGESTED POISIONS AND DRUG OVERDOSE

� Nausea and/or vomiting

� Diarrhea

� Drowsiness or unconsciousness

� Cramps or severe abdominal pain

� Abnormal breathing

� Abnormal or irregular pulse rate

� Convulsions

� Burns or stains around the victim’s mouth

� Unusual breath odors or odors on the victim’s clothing

� Sweating

� Dilated or constricted pupils

� Excessive salivation or foaming at the mouth

INGESTED POISIONS AND DRUG OVERDOSE

� Drug Overdoses� Many drug users take combinations of drugs to

heighten effect. This can lead to life-threatening physical and behavioral systems injuries.

� Emergency intervention is more effective with orally taken drugs, because there is a short time before absorption into the blood stream.

� Injected or inhaled drugs are absorbed and take effect almost immediately.

� Street names of drugs are important to know in determining appropriate treatment.

CONTACING POISON CONTROL CENTERS

� Poison Control Centers or hospitals are available for diagnosis and treatment 24 hrs per day.

� Record the local/regional Poison Control Center or hospital telephone number in easily accessible locations.

� If you suspect poisoning, contact the Poison Control Center immediately.

EMC FOR INJESTED POISONS AND DRUG OVERDOSES

� Perform initial assessment (ABC’s)

� Contact nearest Poison Control Center or hospital with essential information (ask bystanders, search victim (be alert for needles) and immediate area.

� Perform basic life support as necessary and transport to hospital immediately.

� Administer first aid as directed by Poison Control Center or hospital

� Speak to patient in a soothing voice and try to reduce anxiety and/or apprehension.

� Call for police assistance immediately with agitated, combative or violent patients.

FRACTURE

� A fracture is a break in the continuity of bone and is usually accompanied by a muscular spasm in the area of the fracture.

FRACTURE

� Two classifications of fractures:� Closed or simple: overlying skin is

intact.

� Open or compound: there is a wound over the fracture site. Bone ends may or may not protrude.

� Significant bleeding may occur with either type.

� Open fractures are more serious: risk of contamination and infection.

FRACTURE

� Signs and Symptoms of Fractures� Deformity:extremity angled unnaturally.

� Pain, tenderness and soreness at site of fracture.

� Crepitus, grating sound when injured extremity is moved.

� Swelling and discoloration; may or may not be immediate.

� Loss of function; extraordinary pain with movement of injured extremity.

� Exposed bone fragments are definite sign of fracture.

EMC OF FRACTURE

� Sling and swathe� Ask patient to place injured arm in comfortable position

across the chest.

� If patient cannot hold arm in place, have partner or another individual hold it.

� Slip a triangular bandage between the injured extremity and the patient’s side opposite the injury with one point of the bandage extending beneath the elbow on the injured side.

� Bring the bottom edge of the bandage up and over the forearm and tie it to the other end of the bandage to one side of the patient’s neck.

� Tie or pin the pointed edge of the sling at the elbow to form a cradle for the patient’s elbow.

� Put another triangular bandage around the patient’s chest and injured arm over sling.

� Bring the swathe ends together under the arm on the uninjured side and puts padding beneath the arm to protect the patient’s armpit.

EMC OF FRACTURE

� Pillow Splint: The best way to immobilize an injured foot is splinting it with a pillow by molding the pillow around the foot and typing (or safety pinning) it.

� Mold the pillow around the injured extremity

� Fasten in place with safety pins or cravats

EMC OF FRACTURE

� Rigid splints: Inflexible splint to provide stability to the injured limb.

� One individual grasps the extremity above and below the fracture site and applies gentle traction.

� Attach the splint to the injured extremity.

� Wrap the limb and splint in self-adhering bandages (should be tight enough to hold splint, but not so tight as to cut off circulation.)

Documents

OFFICE OF THE STATE FIRE MARSHALfvccfireacademy.yolasite.com/resources/FFIIMODB-EMC.pdf · lower jaw and your thumbs on either side of the lower lip. Push the jaw forward as you tilt