Responding to Emergencies
Class Notes

Introduction. The objective of the American Red Cross First Aid ---Responding to Emergencies course is to train people to respond appropriately to emergency situations encountered in daily living. This course can help you to recognize emergency situations and provide care until EMS arrive on the scene.
 
In an emergency situation there are many issues that may arise. As a Citizen Responder, your greatest concern should be for your own safety. You may consider the most effective way you can be of help (calling 911, rescue breathing, etc.), the mechanism of the injury, the possibility of contracting diseases, and the presence of other bystanders to whom you may assist.
 
When assisting at an emergency scene you may be called upon to do many things. Helping at the scene does not necessarily mean providing direct care to the patient. You may be needed to keep the scene safe (warning traffic), get professional help, or give care to the patient.
Remember that a crowd of bystanders at an accident site does not necessarily mean that someone is helping the victims. Deciding to help is not always an easy decision, and sometimes it is not easy to decide how to help. There are many things you can do to help besides providing first aid.
 
Communication is a very important aspect of helping the victim. Use tender loving care, words of encouragement, and open body language to reassure the victim. It is essential to establish a good rapport and BE HONEST. (Tell the victim: "I'll do the best I can.") Do not panic or you will hinder more than help the situation.
 
There are four Emergency Action Principles (EPA's) to follow in the case of an emergency. (1) Survey the scene. Is the scene safe? (2) Do a primary survey. Check the victim's Level of Consciousness, Airway, Breathing, and Circulation. (3) Call EMS. Send someone to call an ambulance. (4) Do a secondary survey. Interview the victim, check vital signs, and perform a head to toe survey.
 
 
 
 
Body Systems; Anatomy . The body is a complex creation containing many intricately designed systems. For a greater understanding of the systems of the body we recommend that you look at the following sites: spine, elbow, ankle, hip, knee, and interactive knee.
Checking the Victim 1&2 - Lab. When performing a primary survey, assess the level of consciousness, airway, breathing, and circulation. This sequence can be easily remembered as the ABC's of your primary survey. If the victim is found to be unresponsive, have someone immediately call 911 and activate EMS. If you cannot assess the ABC's in the position that the victim is found in, roll them onto their back stabilizing the head and spine. Check the airway to see if any injury has occurred there. Assess breathing by looking for the chest to rise and fall, listening for breath sounds, and by feeling for breath on your cheek.
 
 
 
 
 
Respiratory Emergencies. Airway and breathing are assessed during the primary survey. There are many causes for respiratory emergencies (i.e. choking; heart attack or heart disease; lung disease; asthma; injury to the chest or lungs; allergic reactions to food, drugs, insect bites or stings; drowning or near-drowning. electrocution; poisoning; or shock. Three common causes of emergency distress include asthma, hyperventilation, and anaphylactic shock.
 
Asthma is a condition that causes the narrowing of the airway passages(bronchoconstriction). It can be triggered by emotional, physical, or environmental (i.e. allergens) situations.
 
Hyperventilation is another sort of respiratory distress. This rapid breathing causes inadequate exchange of oxygen and carbon dioxide in the lungs and often leads to the victim feeling weak or dizzy. Hyperventilation is often caused by emotional stress. As a citizen responder you can often provide care by calming the victim.
 
Anaphlactic shock (anaphylaxis) is a life threatening emergency caused by a severe allergic reaction. It results in the swelling of the air passages and highly restricted breathing. The signs and symptoms of such a reaction are characterized by a skin rash (hives); tightness of the chest and throat; swelling of the face, neck, and tongue. EMS must immediately be activated in this sort of an emergency. If the victim has had such a reaction before they may have epinephrine (Epi pen) to administer to themselves. Keep them calm and still until EMS arrives.
 
 
Cardiac Emergencies. The circulatory system works in conjunction with the respiratory system to provide oxygen throughout the body. As a general rule, arteries carry oxygen rich blood away from the heart to the body, and veins transport oxygen-poor blood from the body back to the heart. The pulmonary arteries and veins do the exact opposite. The pulmonary arteries carry oxygen-poor blood from the heart to the lungs, and the pulmonary veins transport oxygen-rich blood from the lungs to the heart. A heartbeat is a contraction of the cardiac muscle of the heart that is controlled by electrical stimuli. The normal heart rate for an adult is 60-100 beats per minute.
 
A heart attack (myocardial infarction) is a common cardiovascular emergency. This condition can be caused by the narrowing or blockage of the arteries that supply blood to the heart muscle. Often the signs and symptoms of this condition include radiating pain; pressure, squeezing, or tightness of the chest. The risk of heart disease and heart attacks is greatly increased by smoking (2x's), high BP, high cholesterol level, diet high in fat, and lack of exercise. When you combine these factors the risk of heart attack increases exponentially. To find out your own risk profile, go to AHA.
Bleeding and Shock. Blood has three major functions in the body. It contains antibodies that protect from disease, maintains constant body temperature, and transports oxygen, nutrients, and wastes. There are three sorts of blood vessels - arteries, veins, and capillaries. When a victim displays external bleeding, one or more type of vessel can be injured.
 
Arterial bleeding is often rapid and profuse. The blood often spurts from the wound with each pulse of the heart. This is the most extensive type of bleeding to control. Venous bleeding tends to flow at a steady rate from the wound. Capillary bleeding oozes from the wound.
 
To control bleeding, cover the wound with gauze or some other sterile covering, apply direct pressure with your hand, and elevate the injured area to slow bleeding and allow for clotting to occur. Apply a pressure bandage to maintain pressure on the injury. If bleeding is not controlled, find the pressure point (Brachial-arm/Femoral-leg) on specific arteries of the body. After you apply any sort of gauze to a wound, do not remove it. Simply, add extra gauze on top of the initial pieces. Removal of the gauze will disrupt the clotting process of the wound.
 
Internal bleeding is the escape of blood from arteries, veins, or capillaries into spaces within the body. It may not be directly visible and may take time for the signals to appear. These signals include discoloration of the skin; tissues that are tender, swollen, or hard; anxiety or restlessness; rapid breathing; skin that is cool, moist, pale, or blue; nausea and vomiting, excessive thirst, and declining level of consciousness.
 
Shock (hypoperfusion) is a life-threatening condition in which the circulatory system fails to circulate oxygen-rich blood to all parts of the body. Signs of shock include: restlessness, rapid/weak pulse, rapid breathing, nausea and vomiting, drowsiness or loss of consciousness. With shock, the skin may appear pale, bluish, cool, or moist. This occurs because the body shunts the blood away from the periphery in order to supply the core tissues(heart, lung, brain).
 
For someone in shock, do no further harm - attempt to make the victim as comfortable as possible, monitor their ABC's, help maintain normal body temperature, comfort the victim and care for any specific injuries.
Introduction to CPR - CPR is a method of artificial breathing and circulation that provides a means of circulating oxygenated blood throughout the body. CPR is a combination of chest compressions and ventilations that work to keep the body tissues viable. In this course you will have the opportunity to certify for adult, child and infant CPR. When preforming CPR as a citizen responder, it is highly recommended that you use a pocket face mask or other barrier device as protection against infectious diseases. You can do CPR by your self or with a partner. The normal rate of compressions varies depending on whether you have a partner or not.
 
To do CPR on an adult, the rate of compressions for one person CPR is 15 compressions to 2 ventilations. The location of compressions can be found by running your ring- finger up the lowest rib of the victim to the xyphoid process, placing your middle and index fingers beside your ring finger, and then placing the heel of the other hand immediately beside the index finger. The sternum is then depressed approximately 1.5-2 inches with each compression. If you are doing two-person CPR with another rescuer, the rate of compressions to ventilations is 5 compressions to 2 ventilations.
 
To perform CPR on a child, find the location of compressions in the same place as on an adult patient (run your ring- finger up the lowest rib of the victim to the xyphoid process, place your middle and index fingers beside your ring finger, and then placing the heel of the opposite hand directly beside your index finger.) On a child, place the heel of only one hand on that location. Do compress the sternum only 1-1.5 inches at a rate of 100 compressions per minute. Do CPR at a rate of 1 ventilation to five compressions.
 
To perform CPR on an infant, the hand placement is different. To find the location for compressions, place your pinky finger on an imaginary line drawn between the baby's nipples. Place your ring finger and middle finger directly beside your pinky on the middle of the sternum. Lift up your pinky finger, leaving the other two fingers in place. This is how you do compressions on an infant. Depress the sternum approximately 0.5-1 inches at a rate of 100 compressions per minute. The rate of CPR for an infant is 5 compressions to one ventilation. Note that the ventilations are adequate when they make the chest rise and fall. For an infant this is merely a puff of air.
Injuries. Injury is the leading cause of death and disability for people ages 1-44 years old. Motor vehicle collisions are the most common cause of injury related deaths, followed by falls, poisonings,drownings, and fire-related incidents.
 
Five forms of energy cause damage to the body: mechanical, heat, electrical, chemical, and radiation. Mechanical energy causes the majority of all injuries. The others combine to account for only 25%. The two basic types of injuries are soft tissue injuries and musculoskeletal injury. Direct force at the site of impact can cause bruises, fractures, and cuts. Indirect forces cause injury away from the site of impact causing damage to the muscles, bones, joints, and internal organs. Twisting forces can cause fracture and joint injuries. Contracting forces can cause muscle injuries.
 
Age, gender, and environmental conditions all affect the injury rate. Injuries are the highest among people under the age of 45. Specifically, older adults and people between the ages of 15 and 24 have the highest rate of deaths from injury. Males are at a greater risk than females and suffer fatal injuries 2.5 times more than females. The usage of alcohol is a contributing factor in almost half of all fatally injured drivers.
 
A serious injury may include some of the following: severe bleeding, excruciating pain, deformity, swelling, discoloration, and inability of the victim to move.
Soft Tissue Injuries. Soft tissues include the layers of skin, fat, and muscle. The skin is comprised of three layers - the epidermis, dermis, and subcutaneous layers. The epidermis is a superficial layer that mainly provides a barrier to bacteria , prevents water loss, and protects the deeper layers. The dermis is directly below the epidermis and contains nerves, sweat glands, oil glands, and blood vessels. The subcutaneous layer contains a lot of fatty tissue that pads and protects the body.
 
Wounds are classified as either open or closed. Tissue damage that occurs beneath the surface of the skin, but leaves the surface of the skin intact is called a closed wounds. Most closed wounds do not require medical attention. Apply direct pressure, elevation, and cold to decrease any bleeding in that area. Be aware of possible serious internal injuries to bones, muscles, or organs.

Open wounds break the skin and result in various amounts of bleeding. There are four common types of open wounds: abrasions(scrapes), lacerations (cuts), avulsions (skin torn away), and punctures. A major open wound is one with severe bleeding, deep destruction of tissue, or a deeply embedded or impaled object. Do not waste time washing the wound. Apply a sterile dressing, immediately apply direct pressure and elevation. If the bleeding does not stop, find the indirect pressure point on an artery supplying blood to the injured limb, and apply pressure to that point. If an object is impaled in a victim, DO NOT REMOVE it. By removing the object you can cause more damage to the surrounding tissues. Apply a bulky dressing to stabilize the impaled object and control bleeding.

 
Musculoskeletal Injuries. The musculoskeletal system is comprised of the bones, joints, tendons, ligaments, cartilage, and muscle of the body. A musculoskeletal injury is often very painful but rarely life-threatening. If it is not cared for properly there can be serious consequences including permanent disability.
 
There are over 200 hundred bones that make up the human skeleton. These are formed from dense connective tissues, provide support for the body, and protect the internal organs. Bones articulate at joints. These joints are supported by ligaments (which connect bone to bone), and tendons (that connect muscle to bone). There are over 600 different muscles, most of which attach to bone. Muscles are soft tissues, but they have the ability to contract and relax allowing for all body movements.
 
Musculoskeletal injuries are caused by three general mechanisms: direct force, indirect force, and twisting force. These forces cause four basic types of injuries: fractures (a break in the bone classified as open or closed), dislocations (displacement or separation of a bone from its normal position), sprains (the partial or complete tearing of ligaments and other connective tissue at a joint), or strains ( the stretching and tearing of muscle or tendon fibers).
 
Signs of a serious musculoskeletal injury often include significant deformity, an inability to move or use the affected body part, protruding bone fragments, a grating sound, snap, or pop heard by the victim, or a mechanism of injury that might suggest severe injury. Less severe injuries are often signaled by pain, swelling, slight deformity, discoloration of the skin, and limited use of the body part.
 
In order to care for a musculoskeletal injury, first assess the victim. If there is a possibility that the person has suffered trauma to the spinal column DO NOT MOVE the patient. If there does not appear to be head or neck trauma, you can elevate the injured extremity. To begin care of the victim, first check for a distal pulse, sensory and motor functions. Manually stabilize the extremity using in-line stabilization, and then use a board of some sort to immobilize the area. If a bone is broken, you must immobilize the joint above and below the break. If a joint is injured, secure above and below the joint. Splint the extremity in the position found - DO NOT ATTEMPT TO REALIGN THE BONE. Be sure to pad the splint well, and be careful not to impede circulation. Always check the pulse, motor and sensory function again after you apply a splint.

Musculoskeletal Injuries -- Head to Pelvis. In America, nearly 80,000 victims are permanently disabled a year as a result of head and spine trauma. Motor vehicle collisions account for over half of these injuries. Other such injuries are caused through falls, sports and recreational accidents, and violent acts of assault. Prompt recognition and care of a spine or head injuries can prevent further damage to the tissue. With head, neck, and back injuries, it is imperative that you consider the mechanism of injury. If a person is found unconscious, has suffered blunt force trauma to the head or trunk region, has suffered at penetrating force to the head or trunk, is involved in a serious automobile accident (star on windshield or no seat-belt), is thrown from motor vehicle, or if the person's helmet is damaged - IMMEDIATELY STABILIZE the head and neck with in-line stabilization.

Some signs of severe head or spine injury include: a change in level of consciousness (is the victim oriented to person, place and time?), severe pressure or pain in head, neck or back, tingling or loss of sensation, loss of movement, cerebral spinal fluid from ears or nose (clear fluid), nausea/vomiting, persistent headache, loss of balance, and bruising around head and eyes (battle signs).

While waiting for the arrival of EMS, stabilize the head, manage the airway, monitor level of consciousness, control any severe bleeding, and prevent shock. Because damage to the spinal cord is often irreversible, it is important that you keep a severely injured person from moving. Keep the victim as still as possible. Remember that one of your biggest jobs as a Citizen Responder is to help calm the victim and keep their condition from worsening until the Emergency Medical Services arrive on scene. There are certain situations when you do not want to move the victim's head at all. If the victim's head is severely angled, he complains of pain, pressure, or muscle spasms on initial movement of the head, or if you feel resistance when attempting to move the head -- do not move the head. Just support it in the position found. Maintain the airway, control bleeding with direct pressure, and prevent shock.

 Injuries to the Chest, Abdomen, and Pelvis. Injuries to the chest, abdomen, and pelvis are very common in motor vehicle accidents and many common injuries. These injuries are either closed or open wounds that span from crush injuries to puncture wounds and can be either closed or open. With closed wounds, there is an internal injury that there is no open pathway from the injury to the outside. These can range from bruises to severe internal bleeding, internal punctures, the rupture of internal organs, etc. When you arrive on the scene of an accident and a patient is not bleeding, you cannot assume that they are not severely injured. The possibility of closed soft tissue injuries must always be considered when there is bruising, swelling, deformity, and a mechanism of injury including blunt trauma.

Be sure to note the mechanism of the injury, and keep a high index of suspicion about your patient's condition. Look for such indications as a deflated air bag, deformed steering wheel, or hard fall that may be indicative of severe internal injury. Even though the body's exterior may remain intact,strong detrimental forces can to internal structures. Solid organs such as the liver and spleen contain considerable amounts of blood. When they are injured by blunt force they may bleed severely on the interior of the body and cause shock. Hollow organs such as the stomach, bladder, and intestines can leak their contents into the body's cavities can cause severe infection and tissue damage.

As with injuries to other parts of the body, the chest, abdomen, and pelvis all exhibit signs of their injury. As a Citizen Responder, you may notice deformities to the area that would indicate underlying broken bones, contusions (bruises), abrasions, penetrations or punctures, burns, lacerations, tenderness, and swelling. Indications of a serious chest injury include difficulty breathing, severe pain, and coughing up blood. Contusions are common signs of internal injury. This is merely the medical term for bruising, and it refers to a condition where the epidermis remains intact, but the cells and blood vessels underneath are damaged. When you see large contusions forming over vital organs you can assume that there is internal damage. Treat for shock, manage any external blood loss, and keep the patient calm until the arrival of EMS. Puncture wounds often seriously injure underlying tissues. NEVER remove an embedded object from a patient unless the airway is obstructed and rescue breathing is needed.

When the chest is punctured or the subject of a crush injury, it is very possible that the patient have a collapsed lung. This injury will obviously compromise their breathing, and you must be alert for respiratory arrest. There is also a chance that the victim may have a sucking chest wound. This is often the result of a penetrating injury where the there is a distinctive sucking noise from the chest. If you encounter a sucking chest wound, cover it with an airtight dressing (plastic wrap) and leave one corner untaped. As with all other chest wounds assist the victim to be in a position of comfort and control any major bleeding.

Common signs of an abdominal injury include nausea, vomiting, severe thirst, a very rigid abdomen, or protruding organs. In dealing with injuries to the abdomen it is possible that an open abdominal wound may be encountered. An eviseration is a wound where some of the intestine or abdominal organs are protruding through the skin. It is important to remember that you absolutely must never reinsert any parts that may be outside of the body. Cover the wound with a saline--moistened sterile bandage and cover with plastic wrap. Be aware of spinal injuries, and position the patient on their back. Treat the patient for shock and activate EMS.

Pelvic injuries are often very painful, especially if they entail injury to the genitalia. If there is an open wound, control bleeding with direct pressure. The femoral arteries are the biggest suppliers of oxygenated blood to the lower extremities. They are the pressure points for major bleeding in the groin. Care for a pelvic injury by minimizing the movement of the victim and summon EMS personnel immediately.

For all burns that you may encounter, stop the burning in the area using water or saline, remove any burning clothing from the patient and cover the wounds with dry sterile bandages. Remember that your personal safety is the most important thing. Never enter a accident scene that is dangerous to you.

*Injuries to the extremities are quite common and vary in the degree of severity. Signal of injury include: pain, tenderness, swelling, discoloration of the skin, deformity, inability to use the limb, loss of sensation, cool to touch, and severe external bleeding. Care for such an injury involves the immobilization of the area. You must immobilize a joint on the bones above and below the joint. If a long bone is injured, be sure the the victim cannot move the joint above or below the injury. This can be accomplished simply by the application of a sling and a swathe or a splint applied to the region. Ice often is helpful to reduce pain and swelling. EMS should be called for severe injury to weight-bearing bones (femur)

Sudden Illnesses. At anytime, you may encounter a person having a medical emergency. This category includes diabetic emergencies, strokes, heart attacks, seizures, poisoning, and more. A change in level of consciousness, dizziness, nausea, vomiting, difficulty breathing, abnormal pulse or skin temperature are all indicators of a medical emergency.

Fainting is a common sudden illness characterized by partial or complete loss of consciousness. Fainting is caused by a temporary reduction of blood flow to the brain and is actually classified as a type of shock. The victim will often exhibit signs of shock --- dizziness, sweating, nausea, and cool, moist, pale skin. When adequate blood flow is returned to the brain, the patient's level of consciousness usually improves. Fainting does not harm the patient, but the cause of the fainting, and injuries associated with fainting can hurt the patient. Position a person who feels faint, or who has fainted, on a the ground. Elevate their legs to help increase blood flow to the brain and core. Check and manage the victim's Airway, Breathing, and Circulation. Loosen any restrictive clothing and look for medic alert tags.

Diabetes mellitus is a very common cause of medical emergency. Diabetes is brought about by decreased insulin production or by the inability of the body's cells to use insulin properly. The most common diabetic emergency is hypoglycemia (low blood sugar). This can occur when the patient takes too much insulin, skips a meal, over exercises, or vomits a meal emptying the stomach of its sugar source. When the blood sugar is reduced it directly affects the brain causing an altered level of consciousness and can eventually lead to unconsciousness (diabetic coma) if not properly cared for. The onset of hypoglycemia is very quick and is characterized by abnormal behavior and pale, cool, moist skin.

The second type is hyperglycemia, or high blood sugar. This usually has a slower onset and is characterized by warm, red, dry skin, thirst, nausea, vomiting, abdominal pain, and fruity-smelling breath. Although a hyperglycemic victim has too much blood sugar, their condition is not as immediately detrimental as hypoglycemia. For this reason, it is recommended that sugar be given to any patient who is suspected to be having a diabetic emergency.

You must be very careful when assessing a person for diabetes. The altered mental status that quickly arises with hypoglycemia can be misleading and appear that the victim is drunk. Look for medic tags and ask the person and any associated person if they have a medical condition such as diabetes. Give the victim sugar in the form of fruit juice, candy, non diet soft drinks. If the patient's condition is caused by low sugar, the candy will help very quickly, and if the patient has hyperglycemia, the excess sugar will do no further harm. If the patient is unconscious at anytime, do not put anything into their mouth, monitor ABC's, and call EMS immediately.

**Sudden Illnesses Cont. When the normal activity of the brain is interrupted by injury, disease, fever, or infection, the normal electrical activity becomes irregular and can cause a sudden loss of body control. This is known as a seizure. A seizure is usually preceded by a visual hallucination, a strange sound, taste, or smell, or a feeling of impending doom. These warning signs are known as an aura. Seizures range in severity from mild black-outs to uncontrolled muscular contractions that may last for minutes. A chronic seizure disorder commonly controlled with medication is known as epilepsy.

If you are on the scene of a person having a seizure, absolutely DO NOT try to restrain them. Protect the person from injury, remove nearby objects (furniture, etc), and try to protect the head. Do not hold any part of the patient down, and never place anything in their mouth. When the seizure is over, position the patient on their side to allow for drainage of any fluids that might cause obstruct the airway and endanger the patient further. In caring for the patient after the seizure, realize that they may be very embarrassed. It is possible, in this lapse of mental control, for them to loose control of bodily functions as well as speech, etc.

When the person stops seizing, they will be drowsy and disoriented. Be reassuring and comforting while you do a secondary survey and look for any injuries. It is necessary for you to call EMS if the seizure lasts for longer than a couple of minutes. When the seizure is happening, the person is not getting adequate oxygen. If they seize for an extended period of time, there can be devastating effects. Likewise, if the person seizes repeatedly, they are in the same dangerous position. EMS should also be activated if the person is severely injured, if you are uncertain about the cause of the seizure, if the victim is pregnant, a known diabetic, an infant/child, or if the victim fails to regain consciousness.

A stroke is a condition of altered function caused when an artery in the brain is blocked or ruptured, causing the necessary supply of oxygenated blood to be disrupted or causing bleeding in the brain. Known also as a cerebrovascular accident, a stroke causes irreparable damage to the tissues of the brain. A stroke is, more or less, a heart attack of the brain that is most commonly caused by a blood clot that lodges in an artery of the brain and prevents adequate passage of oxygenated blood to the cells. When the blood flow is reduced to the brain, a patient may have a transient ischemic attack (TIA). This is a mini-stroke and often a warning sign.

A stroke victim will appear or feel ill. They make exhibit some of the following signs: sudden weakness/numbness generally to one side of the body (face, hands, legs). They may have difficulty speaking, blurred vision, severe headache, dizziness, confusion, loss of consciousness, or ringing in the ears. In short, you can suspect a stroke 90% of the time if the patient exhibits facial palsy (droopy, paralyzed, or asymetrical appearance of the face), arm weakness (difficulty lifting extremity or squeezing hand), or trouble speaking.

As with other sudden-onset illnesses, you must primarily care for the ABC's, immediately activate EMS, position patient to one side to allow for drainage of fluid and vomit from the mouth ( keep the airway clear). There is now a newly found clot-busting drug that can help an individual experiencing a stroke if the medication is administered fast enough. It is essential that a stroke patient go to the hospital immediately. For more information on STROKES and to evaluate your personal risk level look at this site.

Poisoning is a sudden illness that is brought about by external substances entering the body. Over two million poisonings occur annually in the US. Although some of these cases are murders and suicide attempts, most are accidental incidents often involving young children. A poison is any substance that can harm the body sometimes even seriously enough to create a medical emergency. We often think of poisons as being synthesized substances that have been ingested. It is possible that this may be the case, but living organisms also produce substances that are poisonous to humans. These are known as toxins and can be equally as deadly as store-bought chemicals.

Poisons are classified into four types depending on the way they enter the body: ingested, injected, inhaled, or absorbed. Ingested poisons, poisons that are swallowed, can include many household/industrial chemicals, medications, plant materials, etc. Inhaled poisons enter the body upon inspiration through the forms of vapors, gases, and sprays. Absorbed poisons are taken into the body through unbroken skin and may or may not visibly damage the skin. Many are corrosives or irritating substances that can injure the skin, enter the blood stream, and then cause widespread damage to the tissues of the body. Many common insecticides and agricultural chemicals are absorbed poisons. Injected poisons are those that are inserted through the skin. These may include illicit drugs and venom injected by snake bites or insect stingers. Signs of poisoning include: nausea, vomiting, abdomen/chest pain, burns around the mouth, difficulty breathing, altered mental status, and seizures.

Often the scene itself is the best indicator of what poisoning may have occurred. Follow these steps: **survey the scene, remove the victim from the source of the poison (remember not to become contaminated), do a primary survey, care for life-threatening conditions until EMS arrives, and follow any advice given to you by a Poison Control Center (PCC). The majority of poisonings happen within the home so stay alert to clues of the cause of the sickness. Preventing poisoning is the best thing to do. Keep products in their original containers, dispose of out-of-date products, use proper safety precautions, use symbols to identify poisonous substances, and KEEP all household chemicals and medication OUT OF THE REACH OF CHILDREN. To find the nearest Poison Control Center.

Sudden Illness: Substance Misuse and Abuse. As a Citizen Responder, you may encounter many situations involving a patients use or abuse of alcohol or other substances. Although alcohol is a legal substance, it must not be forgotten that it is still a drug that affects the central nervous system and causes an altered mental status. Substance misuse and abuse are forms of poisoning and should be treated in much the same manner. When mind altering substances are involved, as with other medical emergencies (diabetic), it is possible for the patient to be aggressive and uncooperative when you try to help them. Provide what care you can only if you feel that you are not in danger. For care, follow the steps detailed above (**) for general poisoning conditions. If the patient becomes combative at anytime, withdraw immediately from the scene.

A drug is classified as any chemical, natural or synthetic, that affects the functions of the body or mind when taken into the body or applied to the surface. When a drug is misused, it is either used for unintended purposes or used for appropriate purposes but in the wrong dosage. Excessive or persistent use of a drug without regard the medical implications is considered drug/substance abuse. If someone abuses drugs for a long period of time, they may become dependent on the drug. There are intertwined physical and psychological affects of drug dependence. After an extended period of use, the body requires the drug and likewise, there is a strong habitual attachment of the mind. After repeated exposures to a drug, the body becomes tolerant to its effects and requires larger doses. If one drug is combined with another, there may be a synergistic effect, something that cannot be achieved by either drug alone and multiplies the effects of both. Many of these factors, physical and psychological dependence, tolerance, and compulsive drug use, all combine to make an addiction.

There are several categories of drugs that are necessary to mention here. Stimulants affect the nervous system to excite the user. Also known as 'uppers', stimulants directly affect the CNS, increase mental and physical activity, suppress appetite, and prevent fatigue. They increase the pulse and breathing rates, dilate the pupils, cause warm, flushed, and often sweaty skin. Examples include caffeine, amphetamines, and cocaine. Hallucinogens are substances that cause changes in mood, sensation, thought, emotion, and self-awareness. These drugs are known to excite the user, and distort the user's perception of time and space. they increase the pulse, dilate the pupils, and affect the patient so that she does not have an accurate concept of real time. Examples of hallucinogens are as follows: LSD, PCP, STP, and mushrooms.

Depressants (downers) directly affect the CNS to create a relaxed state of consciousness. These include alcohol, barbiturates, Valium, and methaqualudes. Narcotics are drugs capable of producing an intense state of relaxation. These are often used to relieve pain and to quiet coughing. Many drugs are legitimately used for these purposes, but they are also abused. They affect the nervous system and change many of the normal activities of the body to create a feeling of well-being and sleepiness. Most narcotics are found in pill form, but heroin, a commonly abused narcotic is injectable. Substances such as opium, morphine, and heroin all fit into this category decreasing the heart rate and respirations, constricting the pupils, and having a potentially synergistic effect with alcohol. Examples include: codeine, demerol, morphine, and opium.

Alcohol is the most widely abused and misused depressant. It affects the body by creating a relaxed feeling, decreases motor skills, and creates a false sense of warmth. Abuse of this drug leads to cirrhosis of the liver, memory loss and apathy as well as possible physical and psychological dependence. An alcoholic patient may not be under the influence of alcohol, but rather they may be in withdrawal from alcohol. This can cause a severe reaction when the patient has not had a drink, is too sick to drink, or has suddenly decided to quit drinking. A major symptom complex of withdrawal is delirium tremens (DT's) where the patient may experience seizures. This is a condition characterized by sweating, trembling, anxiety, and hallucinations. There is a high fatality rate associated with DT's.

Marijuana (cannabis) also known as pot, grass, weed, reefer, ganja, tea, and dope is the most widely used illicit drug in the United States. This is a nonhallucinogenic, mind altering substance that creates a feeling of elation, distorts perceptions, and impairs judgment. It effects the body by increasing the pulse, causing visibly red eyes, throat irritation, and increased appetite. Marijuana can be smoked or made into food, but either way it contains the active ingredient THC. Smoking one joint is the equivalent of smoking one pack of cigarettes in terms of tar. It contains carcinogenic substances in high concentrations and highly affects the perceptions of the body.

Drugs in General. When you are dealing with a person who is under the influence of a mind altering substance be sure that the scene is safe. It may be hard to detect their influence, so look for bottles, syringes, pills, drug paraphernelia, etc. Ask the victim and talk to people on the scene. Check the mouth for pills and breath odors that might be an indicator. Here are 6 Danger Signs that can be considered EMERGENCY INDICATORS of the victim's status: 1) Unconsciousness - if the person cannot wake up or is awakened and then goes right back out. 2) Breathing difficulty-weak, shallow breathing, or cyanosis (blueness) around the lips, in the mouth, eye lids, or nail beds. 3) Fever -- above 100 degrees. 4)Abnormal Pulse rate -- above 100 or below 60 beats per minute. Or if the rhythm is not regular. 5) Vomiting while decreased level of consciousness. 6) Convulsions or Seizures. If the person is experiencing any of these or combinations there of, EMS should be activated. General Care includes management of the ABC's, provide comfort and TLC, check responsiveness and level of consciousness, treat for shock, watch for vomiting, and position the patient on their side. Remain with the victim to prevent self injury, and if you are not sure of the substance that has been ingested consider calling a Poison Control Center for advice. Try to keep the victim awake and conscious.

It is important to remember that many medical emergencies ( diabetes, epilepsy, etc) present symptoms similar to the signs of drug overdose. Do not make the mistake of jumping to conclusions about the person. Do not assume that the stuporous, slurry-speeched person is under the affect of drugs.

 

Heat Related Emergencies. The body is a machine that operates with only 25% efficiency. It generates heat as a result of constant internal chemical processes. Some of this metabolic heat is needed to maintain normal body temperature (Av. 98.6 degrees F.), and some of it is lost to the environment. If the body is unable to regulate the amount of body heat given off, then an abnormally high body temperature (hyperthermia) results. Heat, sun exposure, and humidity often cause this potentially fatal situation. When the body gets too hot, excessive heat is removed by blood vessels in the skin dilating. Sweating is also a mechanism that the body uses to cool itself. In a humid environment, evaporation of perspiration is much slower. Since evaporative heat loss is thus reduced, then the moist heat can have dramatic effects on the body in a short amount of time. Hot humid environments tire people quickly forcing them to stop frequently. Thus, they avoid overexertion. Hot dry weather conditions often deceive people. They continue to work and remain exposed to the sun and heat for long periods of time - far beyond their body's tolerance.

There are two types of heat emergencies. Heat exhaustion occurs when a victim is exposed to excessive heat for a prolonged period of time. The victim will appear pale and will have moist, cool, clammy skin. The individual perspires heavily and will drink lots of liquids, but their excessive sweating leads to a deficiency of salt in the body. This deficiency then causes heat cramps that involve painful muscular spasms. The best thing to do for such a patient is to move them from the heat to a cool, shaded area. Have them drink water and eat something to replenish the lost salts. Place cool, moist cloths over any spasming muscle to reduce the pain.

If the person's skin appears to be hot and dry/moist this is an indication that the body's temperature-regulating mechanisms have failed. The body can no longer rid the body of its excess heat, and the person is essentially baking. This is a more severe form of heat emergency known as heat stroke. When the skin is hot, it is a true emergency. The victim will be breathing rapidly. They will have a full, rapid pulse, little to no perspiration, dilated pupils, and possibly an altered mental status. Immediately remove the patient from the hot environment. Remove excess clothing, and apply cool packs to the neck, groin, and underarms. Sponge the skin with wet towels and fan them aggressively.

Note that young children and the elderly are at a much greater risk of heat and cold related injuries. Their heat regulating mechanisms are not as developed or as adequate as ours. When cooling an over-heated infant or child, start with lukewarm water and gradually decrease the temperature.

Cold Related Emergencies.In a cold environment, the body can loose heat even faster than it is generated. The body adjusts for this by constricting the blood vessels in the periphery, shutting down perspiration, and increasing muscular activity (shivering) and the rate of metabolism. When the cooling affects the entire body, a condition called hypothermia (low body temp.) results. Over time the body will not be able to maintain an adequate core temperature possibly resulting in a fatality. Signs of hypothermia include: shivering (or lack thereof in the late stages), vague, slow, slurred speech, incoherence, numbness, apathy, and decreased level of consciousness and motor function. To care for hypothermia, call EMS and rewarm the victim. Remove all wet clothing. Place the victim in dry blankets in a warm environment, and give warm fluids (nonalcoholic) to an alert patient. You must gradually rewarm the person; if you rewarm them too quickly, cardiac problems may arise. The person may be in denial, but listen to the symptoms(not the victim) in this case.

Localized cold injuries, also known as frostbite, affect only a specific portion of the body. This occurs in varying degrees and must be recognized by progressive symptoms. First, exposed skin reddens (light-skinned individual) or blanches (darker-skinned individual), and then it takes on a gray/white blotchy appearance. The exposed skin becomes numb because of reduced circulation, and then, as the freezing process continues, all sensation is lost and the skin becomes dead white. To care for a localized cold injury, first get the victim into a warm environment. Do not rewarm a limb that is going to refreeze. Rewarm the area. Do not rub or massage, and do not re-expose the limb to the cold. If the limb is frozen, await for EMS to immediately transport the victim to a hospital. At this point, there are ice crystals at the capillary level. Do Not rub the area as this will further damage the tissues. Do not let the person walk on the affected limb.

 

Emergency Childbirth. The birthing process includes three main stages and a recovery stage. The first stage begins with the first contraction and ends when the cervix is fully dilated. Stage two begins when the top of the baby's head emerges and ends when the baby is born. The third stage begins when the baby is born and ends with the delivery of the afterbirth (placenta, umbilical cord, etc.). This will normally happen within 30 minutes following the birth of the baby. After this is the recovery phase including uterine contractions to control bleeding. If you massage the lower abdomen of the mother, you will help to stop the bleeding as well.

 
In assessing labor, there are a few key questions that you need to consider:
  • Has EMS been called?
  • Is there any bloody discharge? (This is a sign of a mucous plug that falls out as the cervix begins dilating at the onset of labor. )
  • Has the patient's "water" broken? (This is the rupturing of the amniotic sac that surrounds and protects the infant.)
  • How far apart are the contractions? If they are 2-5 minutes apart, the baby is moving from the uterus into the birth canal.
  • Does the mother have an urge to bear down or push (as though having a bowel movement)? If so, absolutely do not allow the mother to go to the restroom. This is a sign of the infant's eminent birth.
  • Lastly, is the baby's head crowning?
  • In evaluating the status of a pregnant woman in labor, these questions will help you to know how soon she is likely to give birth.

Delivery is a very emotional event for all involved. Your most important role is to provide emotional support for the mother. It may be important also to position the mother so that she is most comfortable for delivery.

If you are present for a birth, it is important to have, at a bare minimum, clean towels and sheets, a plastic bag (for the placenta), and latex gloves. A bulb syringe and gauze pads are also important. When the infant emerges, support the head. Do not pull, but gently guide the baby as it moves through the cervix. Have a clean towel present to 'catch' the baby when it is born. After birth, clear the baby's airway, and help to maintain a normal body temperature by covering the baby in blankets. You may lay the baby on the mother's abdomen. Place a sanitary napkin or towel over the mother's vagina and massage the uterus to control the bleeding. Note the time of the birth.

There are several complications that may arise during pregnancy. A prolapsed cord is a condition that occurs when a loop of the umbilical cord protrudes from the vagina while the baby is still in the birth canal. As the baby moves through the canal, it will compress the umbilical cord. This will cut off its blood supply, oxygen, and nutrients it needs for survival. If this happens, raise the mother's buttocks with pillows and have her pull her knees to her chest. A breech birth occurs when the infant's buttocks or feet present first. Or, the mother could have multiple births in which she will deliver more than one child. In this case, assist with the delivery of the other babies, and be sure to note the time of birth of each. If the mother is bleeding just treat for shock by keeping her warm (see shock above).

Reaching the Victim. For different patients, it is important to consider their special needs. Children, adolescents, the elderly, and people with disabilities sometimes require different care.

Children are often shy and frightened by strangers. Begin your assessment for injuries at the toe, instead of the head, and go up. Use appropriate language so that they can understand you. Bend down so that you are at their eye level, and talk to the child as well as their parents.

The Elderly are a growing population in the United States. In 1950, the average life span was 49 yrs. In 1996, the average life expectancy was 75 yrs. These individuals are often on medications, and they are more likely to have special conditions such as diabetes and high blood pressure. Also, as they get older, the aged have declining body functions. They are often cold, and they can become hypothermic in a room that feels just a bit chilly to us. This is especially an issue if an elderly person falls and is on a cold floor for an extended period of time. The elderly have slower reflexes, their eyesight and hearing are failing, and they have unsteady balance. This makes them at a great risk for falling and hence fracturing bones. Also, there are many factors that lead to increased confusion and increased risk of falling -- head injury, insufficient oxygen, stroke, and improper medication are some such factors. Due to their decreased capabilities, the elderly tend not to eat or drink enough. This leads to dehydration and malnutrition.

People with disabilities are also a special needs group. In evaluation of any injuries or situations, just use common sense. Remember that they are capable until proven otherwise.

***When Help is Delayed. When Help is delayed, there are a few basic steps to follow.
  • Check: the scene for dangers, the victim for injury, and the area for resources.
  • Call for help: by staying where you are and signaling for help, sending someone or leaving the victim to get help, transporting the victim to help, or caring for the victim yourself until they have recovered enough to travel on their own.
  • Use Distress Signals: smoke, mirrors, and whistles. If you go somewhere, mark the path so that you can find your way back. If you are leaving the victim alone in order to get help, leave a note that tells your route, time of departure, and anticipated time to return. Be sure that the victim has shelter and water. Place the victim in the recovery position ( on side) if they are unconscious.
  • Provide Care: Monitor the patient's condition, creatively splint any broken limbs, control major bleeding, treat for shock, and maintain in-line stabilization of the head, neck, and back. Keep the patient as warm as possible.
  • Prepare: If you are going on a trip, the best thing that you can do is prepare and prevent dangerous situations. Know the local geography, watch the weather and prepare appropriately, and avoid hazardous conditions. Practice wilderness skills-- have a compass, good equipment, proper clothing, and a first aid kit. Let others know your route, plan, destination, and estimated time of arrival.

 

Healthy Living. Eating properly, exercising, and paying attention to your body are all essential for healthy living. Here are some web sites of interest:

 

 

 

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