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STCW 95Basic First Aid
STCW 95Basic First Aid: References
• STCW95: Section A-VI, Table A-VI/1-3
• American Heart Association, Heartsaver AED
• Ship Captain’s Medical Guide, 1999, MCA
STCW 95STCW-95
• Elementary First Aid: Table A-VI/1-3
– Immediate Care. Required training for all seafarers
• Medical First Aid: Table A-VI/4-1
– “The first responder” required after 8/98• Person in Charge:Table A-VI/4-2
– At least one per ship• Medical Care Onboard:Table A-II/2
– Master Chief Mate.
STCW 95Course Objectives• Define potential scene hazards, biohazards
and methods to protect rescuers.• Demonstrate adult, single rescuer CPR and
airway management.• Introduction to the use of the AED.• Response to bleeding, shock and burn
emergencies.• Introduction to moving a patient.
STCW 95What are you required to do?
Take immediate action upon encountering an accident or medical emergency.
• Keep yourself safe!
• Assess for injury or illness
• Treat appropriately
STCW 95
What are you required to do?– Proper patient positioning – Control the airway – Protect the spine – Maintain vital functions– CPR and AED– Control of hemorrhage and application of bandages – Immobilize when you suspect a bone injury– Treat burns, both thermal and electrical– Define, recognize and provide basic treatment for
shock from any cause
STCW 95How will we be tested?• Written, CPR/First Aid
• Skills, evaluations after through instruction
STCW 95Basic First Aid• The first responder
makes a tremendous difference in patient outcome
• What you do in the first 5 minutes can either help or doom a patient
STCW 95Onboard Resources
Call for help early!
STCW 95
You are Responsible for Protecting:• Self
• Bystanders
• Patient
STCW 95
Protect Yourself First: Scene Hazards• HAZMATS
• Confined spaces
• Electrical hazards
• Bloodborne pathogens
• Airborne pathogens
STCW 95
First: Know what chemicals you are carrying!Do not enter a possibly contaminated / confined area unprotected!
Protect Yourself First: Scene Hazards
STCW 95
Fire Hazard– Most combustibles will emit toxic smoke– Protect yourself and others from exposure to
inhaled toxins
Protect Yourself First: Scene Hazards
STCW 95Biohazards / Infectious Diseases
STCW 95Biohazards / Infectious Diseases
1. Wash your hands
2. Wash your hands
3. Wash, Wash, Wash your hands
STCW 95Biohazards / Infectious Diseases
• Use barrier devices such as: gloves, gowns, masks.
• Wash hands after contact with a patient.
• Have current vaccinations including Hepatitis B vaccine.
Personal Protection: Bloodborne Pathogens
STCW 95Personal Protection-Gloves
• Required for all patent contact.• If its wet and its not yours you don’t want it!• Gloves have small holes in them that we
cannot see but they are there.• Change bloody gloves immediately!
STCW 95
Biohazards / Infectious DiseasesAirborne Pathogens; what can
you catch ?
• TB (HEPA Mask)
• Measles/Chicken Pox
• Meningitis
• Mono
• Upper respiratory infections including pneumonia
STCW 95
Personal Protection: Airborne Pathogens• Use masks/ BVM for
CPR/Rescue breathing.• Wear face mask in
presence of person with cough.
• Keep patients with productive cough in well-ventilated area.
Biohazards / Infectious Diseases
STCW 95Biohazards / Infectious DiseasesStock a Broad range
of Antibiotics
STCW 95Proper Waste Disposal
STCW 95Duty-to-Act• Legal obligation of certain
persons either by statute, treaty or function to provide care
• Shipboard: Duty as officer to care for crew
• Shoreside: Protection through Good Samaritan Act
STCW 95Good Samaritan Act• Provides protection from law suit in non-
employment situation
• Must meet three criteria:• Acted within scope of practice or training.• No compensation received.• Patient turned over to competent provider.
STCW 95Consent• Expressed Consent: Knowingly consents to
being treated.
• Implied Consent: Cannot consent but a reasonable person would assume that they would wish to be treated. (i.e.; unconscious or minor unable to legally consent.
• Abandonment: Termination of care without patient’s consent.
STCW 95"חוק "לא תעמוד על דם רעך. 28/9/98, נכנס לתוקף ב-1998חוק לא תעמוד על דם רעך, התשנ"ח–
א( חובה על אדם להושיט עזרה לאדם הנמצא לנגד עיניו, עקב אירוע (פתאומי, בסכנה חמורה ומיידית לחייו, לשלמות גופו או לבריאותו, כאשר
לאל-ידו להושיט את העזרה, מבלי להסתכן או לסכן את זולתו.)ב( המודיע לרשויות או המזעיק אדם אחר היכול להושיט את העזרה
הנדרשת, יראוהו כמי שהושיט עזרה לעניין חוק זה; בסעיף זה, "רשויות" - חוק זה הופך את החובה .משטרת ישראל, מגן דוד אדום ושירות הכבאות
המוסרית של עזרה לזולת לחובה הנובעת מחוק. העובר על הוראת החוק .קנסעונשו
תקף במקרה שמתקיימים:"לאדם הנמצא לנגד עיניו".•"עקב אירוע פתאומי".•"בסכנה חמורה ומיידית לחייו, לשלמות גופו או לבריאותו".•
*הזעקת עזרה חיצונית )מד"א, משטרה וכיו"ב( נחשבת כעזרה מספקת.
STCW 95
Heartsaver AEDHeartsaver AEDfor the Lay Rescuer andfor the Lay Rescuer and
First ResponderFirst Responder
©1998 American Heart Association1998 American Heart Association
STCW 95Extent of the Problem• 1.1 million heart attacks
• 480,000 deaths due tocoronary heart disease
• 250,000 prehospital cardiac arrests
In Israel:
• 25,000 heart attacks a year
• 7,000 deaths a year due to coronary heart disease
STCW 95Heart Attack• Heart Attack
(Myocardial Infarction)– Blockage of blood flow.– Results in death of
heart muscle.
• Presentations:– Sudden death.– Massive chest pain.– Mild chest discomfort.
STCW 95Stroke: CVABlockage of a cerebral artery
Symptoms:• Dizziness, headache• One sided paralysis• Slurred speech• Unconsciousness, coma• Seizures
STCW 95
“The first symptom of a heart attack is denial”!
STCW 95
Heart Attack & Stroke: Risk Factors• Hypertension (high BP)• Smoking• Obesity
STCW 95
• Excessive alcohol intake
• Diabetes
Heart Attack & Stroke: Risk Factors
STCW 95
• Lack of exercise• High fat diet
Heart Attack & Stroke: Risk Factors
STCW 95
• Age
• Gender
• Family history
• Race
Heart Attack & Stroke: Risk Factors
STCW 95Heart RhythmSinus Rhythm is normal electrical conduction in the
heart
VF is a frequent initial rhythm in sudden
cardiac arrest
VF is a quivering of the heart with no blood
flowDefibrillation is the only effective treatment for VF
STCW 95Other Heart Arrhythmias
Ventricular tachycardia
)shockable(
Asystole
)not shockable(
STCW 95Time and AEDs• Approximately 50%
survival after 5 minutes
• Survival reduced by 7% to 10% each minute
• Rapid defibrillation is the key
• CPR helps extend survival time
minutes
0
20
40
60
80
100
1 3 6 10
Survival
STCW 95Basic Life Support: CPR• If neck injury suspected:
– jaw thrust
STCW 95
CPR IN THREE SIMPLE STEPS • CALL Check the victim for unresponsiveness. If
there is no response, Call 911 and return to the victim. In most locations the emergency dispatcher can assist you with CPR instructions.
STCW 95
CPR IN THREE SIMPLE STEPS cont.
• BLOW Tilt the head back and listen for breathing. If not breathing normally, pinch nose and cover the mouth with yours and blow until you see the chest rise. Give 2 breaths. Each breath should take 1 second.
STCW 95CPR IN THREE SIMPLE STEPS
cont.• •PUMP If the victim is still not breathing normally,
coughing or moving, begin chest compressions. Push down on the chest 11/2 to 2 inches 30 times right between the nipples. Pump at the rate of 100/minute, faster than once per second.
STCW 95
CPR IN THREE SIMPLE STEPS cont.
• CONTINUE WITH 2 BREATHS AND 30 PUMPS UNTIL HELP ARRIVES NOTE: This ratio is the same for one-person & two-person CPR. In two-person CPR the person pumping the chest stops while the other gives mouth-to-mouth breathing.
STCW 95Basic Life Support: CPRIf pulse & breathing are
restored– but patient remains
unresponsive
Place in the recovery position.
STCW 95Basic Life Support: CPRWhen can CPR be
discontinued?– Physically exhausted – Patient revived– Relieved by trained rescuers– Unsafe to continue
STCW 95When Can CPR be Discontinued?
STCW 95
Basic Life Support: Obstructed Airway
STCW 95Assessing the Patient
Chief Complaint• Nature of the illness
• A statement in the patients own words as to “what's wrong.”
• Ask the patient what they think is wrong they may know.
STCW 95
STCW 95
Medical Alert Tags Patients Medications
STCW 95Adult Assessment• Form a general impression
– does the patient look sick?
• What is the mental status?– are they awake? Do they respond when you call their
name? shake them or pinch them?
• Can they speak?• are they breathing well or labored?
– Can they complete a sentence without stopping or are they gasping?
• What is their general color– is the skin warm and pink or pale, cold, wet?– Look around the face and mouth.
STCW 95Assess the Pulse
STCW 95Assess the Respirations
STCW 95Bleeding• Types of bleeding:
– Arterial: bright red, spurting: usually most serious– Venous: dark red, steady flow– Capillary: oozing
• Signs of internal bleeding– bruising– fractured ribs or bruises on the chest or abdomen– vomiting or coughing up blood
STCW 95
Usually looks worse than what it actually is.
Methods to control bleeding:– direct pressure– elevation– pressure dressing– pressure point– Tourniquet
Do not remove a dressing - reinforce
Bleeding
STCW 95Bleeding : Direct Pressure
STCW 95Bleeding: Elevation and Direct
Pressure
STCW 95Bleeding: Pressure Points
Pressure Points - Compress the artery over the bone to stop bleeding.
STCW 95TourniquetApply pad over
artery - proximal to injury
Wrap with wide material, apply
leverage: “windlass”
Tie down lever & secure tails
STCW 95PuncturesHarbor bacteria & are prone
to infection• Soap and water• Use irrigation and soaking• Peroxide is useful
– Careful monitoring after injury for signs of infection
STCW 95
Lacerations: Rough Jagged Edges
STCW 95Abrasion: Scraping the top layers of skin
STCW 95Shock
Loss of circulating blood volume– present in all injuries– inadequate tissue perfusion
STCW 95ShockSymptoms: • Rapid pulse • Pulse may be weak ("thready") • Rapid breathing • Anxiety, nervousness • Cool skin • Weakness, excessive tiredness • Pale skin, bluish skin ( cyanosis) • Sweating, moist skin • Low blood pressure
STCW 95Shock
Treatment• Give Oxygen• Reduce body’s workload• Keep patient warm & calm• Treat or manage
underlying cause
STCW 95Burns: Thermal
First degree: reddened skin (e.g, sunburn), painful– Cool with water
STCW 95Burns: Thermal Second degree; blistering of
deeper layers of skin- painful– Cool with water, dry sterile
dressing– Do not break blisters
STCW 95Burns: Thermal Third degree: black charred,
or hard white skin– Cool with water, dry
sterile dressing – All layers of skin &
underlying tissue are burned
– May not be painful
STCW 95BurnsBurns
– Often a very serious injury
– Any significant burn requires evacuation
STCW 95Burns: treatmentStop the burning process- cool the area with tepid
water
Assess the burn
May give pain relief immediately
Apply sterile dry non adherent dressing
Always treat for shock
Monitor for infection
Don’t:•Use ice•Break blisters•Use butter or other home remedies
STCW 95Patients palm is equal to 1% of
their Body Surface
STCW 95Burns: Thermal Other considerations:
– Burns to face & neck: airway & vision compromise
– Circumferential burns: impaired circulation
– Patients are prone to Infection– Patients lose fluids - Hypovolemia– Patients lose heat - Hypothermia
STCW 95Burns: Electrical • Turn off power
• Check ABC’s– anticipate cardiac arrest– access AED
• Consider spinal protection when moving patient
STCW 95Burns: Chemical
Liquid chemical - flush with water
Dry chemicals (lime)- brush away before flushing
Chemical burns to the eyes– flush for at least 20 minutes after
burning stops– avoid contaminating non-
affected eye
STCW 95SplintingNever restrict blood flow
Check for color, motion and sensitivity to affected limb )CMS( – before/after
Immobilization prevents further damage
Combine with elevation and application of ice
Maintain position of function
STCW 95Splinting
• When splinting a broken bone- the splint should extend to immobilize also the joint above and below
• When splinting a joint- the splint should extend to immobilize also the bone above and below
STCW 95Splinting
STCW 95Sling and Swathe
• Useful for upper arm, shoulder or collarbone
• May also help in elbow fx. / dislocation
• Not required for ALL upper extremity injuries!!
STCW 95Open bone injuries1. Apply a sterile dressing over the bone ends2. Try to splint in a neutral position3. Do not bring ends of the bone back under the
skin unless advised to do so by the doctor
STCW 95Proper Splinting?
STCW 95Moving a Patient
General Rule: Do not move patient until skilled help arrives
• Exceptions:– Area unsafe to patient– Area unsafe to rescuer
STCW 95Moving a Patient: Blanket Roll
Place a half-rolled blanket alongside the casualty
STCW 95Moving a Patient: Blanket Roll
Roll the casualty gently onto his side: The attendant closest to the head, or a 3rd attendant,
must support the casualty’s head
STCW 95Moving a Patient: Blanket Roll
Roll the casualty gently over
STCW 95Moving a Patient: Blanket Roll
Prepare the blanket for lifting the casualty by rolling the edges tightly
STCW 95Moving a Patient: Blanket Roll
Lifting the casualty: Tension to all side of the blanket & traction applied to the head
STCW 95Moving a Patient: Backboard
STCW 95Moving a Patient: Two-Man Carry
STCW 95
2-man drag through narrow space
Moving a Patient: Two-Man Carry
STCW 95Moving a Patient: One-Man Carry
One-man drag through narrow space
STCW 95Moving a Patient: One Man Drag
STCW 95Summary• Be safe: don’t become another victim• Remember to call for help• ABC’s of first aid