1 BEFORE GIVING CARE B eing knowledgeable and skilled in providing first aid can help you to make your workplace, home and community a safer place to be. When a person is injured or becomes suddenly ill, your quick action can prevent the injury or illness from worsening, and it may even save the person’s life. Although every emergency situation is unique, understanding basic principles of giving first aid care will always serve you well. Preparing for Emergencies By definition, emergencies are unexpected situations that require immediate action. But by expecting the unexpected and taking general steps to prepare, you can increase the likelihood of a positive outcome should an emergency situation arise. By reading this manual and participating in an American Red Cross First Aid/CPR/AED course, you have taken an important first step in preparing for emergencies. You will learn the concepts and skills you need to recognize emergency situations and respond appropriately until advanced medical personnel arrive and take over. Once you have learned these concepts and skills, review and practice them regularly so that if you ever have to use them, you will be well prepared and have the confidence to respond. Make sure you have ready access to items that will make it easier to respond to an emergency, should one occur. Keep a first aid kit in your home and vehicle (Box 1-1), and know the location of the first aid kit and automated external defibrillator (AED) in your workplace. Download the American Red Cross First Aid app to your mobile device so that you always have a first aid reference at your fingertips. You can purchase first aid kits and supplies from the Red Cross store (redcross.org) or a local store. Whether you buy a first aid kit or assemble one yourself, make sure it has all of the items you may need. Check the kit regularly and replace any used or expired supplies. The Red Cross recommends that first aid kits include the following at a minimum: 2 pairs of latex-free gloves © 2011, 2016 The American National Red Cross. All rights reserved. (3 of each of the following sizes): 1 36” malleable radiolucent splint 1 unit antibiotic ointment, cream or wound gel h) antiseptic wipe packets (Continued ) Chapter 1 Before Giving Care | 3 | First Aid/CPR/AED Participant’s Manual Box 1-1. continued ■ 2 hydrocortisone ointment packets (approximately 1 gram each) ■ 2 packets of chewable aspirin (81 mg each) ■ 1 space blanket ■ 1 CPR breathing barrier (with one-way valve) ■ 1 pair of utility shears or scissors ■ Oral thermometer (nonmercury/nonglass) ■ Tweezers ■ First aid manual For a list of the recommended contents for a workplace first aid kit, see ANSI/ISEA Z308.1-2015— American National Standard for Minimum Requirements for Workplace First Aid Kits and Supplies. Keep a current list of emergency telephone numbers in your mobile phone, by the telephones in your home and workplace, and in your first aid kit. Most communities are served by the emergency telephone number 9-1-1. If your community does not operate on a 9-1-1 system, look up the numbers for the police department, fire department and emergency medical services (EMS) system. Also include the number for the national Poison Help hotline (1-800-222-1222) on your list. Teach everyone in your home how and when to use these numbers. A B Figure 1-1. A medical identification tag (A) or an application on your phone (B) can give responders important information about you in case you are not able to. Chapter 1 Before Giving Care | 4 | First Aid/CPR/AED Participant’s Manual © 2011, 2016 The American National Red Cross. All rights reserved. Take steps to make it easier for EMS personnel and others to help you should an emergency occur: ■ Make sure your house or apartment number is ■ If you have a chronic medical condition such as large, easy to read and well lit at night. Numerals diabetes, epilepsy or allergies, consider wearing are easier to read than spelled-out numbers. a medical identification tag to alert responders to the presence of the condition in case you are ■ Keep relevant medical information, such as a not able to. You can also create a digital medical list of the medications that each family member identification tag in your mobile phone that takes, in an accessible place (for example, can be accessed without unlocking the phone on the refrigerator door and in your wallet or (Figure 1-1). In addition to information about mobile phone). chronic medical conditions, blood type and so on, you can enter contact information for the person you would want contacted on your behalf in case of an emergency. In a life-threatening emergency, every second counts. By preparing for emergencies, you can help ensure that care begins as soon as possible—for yourself, a family member, a co-worker or a member of your community. Understanding Your Role in the EMS System The emergency medical services (EMS) system is a network of professionals linked together to provide the best care for people in all types of emergencies (Box 1-2). As a member of the community, you play a major role in helping the EMS system to work effectively. Your role in the EMS system includes four basic steps: 1. Recognizing that an emergency exists. 2. Deciding to take action. 3. Activating the EMS system. 4. Giving care until EMS personnel take over. Recognizing that an Emergency Exists Sometimes it will be obvious that an emergency exists—for example, a scream or cry for help, a noxious or unusual odor, or the sight of someone bleeding severely or lying motionless on the ground are all clear indications that immediate action is needed. But other times, the signs of an emergency may be more subtle, such as a slight change in a person’s normal appearance or behavior, or an unusual silence. Your eyes, ears, nose and even your gut instincts can alert you that an emergency situation exists (Box 1-3). © 2011, 2016 The American National Red Cross. All rights reserved. Deciding to Take Action Once you recognize an emergency situation, you must decide to take action. In an emergency, deciding to act is not always as simple as it sounds. Some people are slow to act in an emergency because they panic, are not exactly sure what to do or think someone else will take action. But in an emergency situation, your decision to take action could make the difference between life and death for the person who needs help. Your decision to act in an emergency should be guided by your own values and by your knowledge of the risks that may be present. However, even if you decide not to give care, you should at least call 9-1-1 or the designated emergency number to get emergency medical help to the scene. Chapter 1 Before Giving Care | 5 | First Aid/CPR/AED Participant’s Manual Box 1-2. The Emergency Medical Services (EMS) System The EMS system is a network of professionals linked together to provide the best care for people in all emergencies. The system begins when someone sees an emergency and decides to take action by calling 9-1-1 or the designated emergency number. This action allows the EMS dispatcher to take down information about the emergency and provide it to the trained EMS professionals who will respond to the scene. Many EMS dispatchers are also trained to provide first aid and CPR instructions over the phone to assist the lay responder until the professional responders arrive. EMS professionals have advanced training that allows them to provide medical care outside of the hospital setting. EMS professionals have different roles and responsibilities, based on their level of training: Emergency medical responders (EMRs), such as police officers, fire fighters, ski patrol personnel, park rangers and athletic trainers, are trained in some of the most time-sensitive lifesaving measures, such as using an AED or an epinephrine auto injector. (Unlike lay responders, EMRs have a legal duty to act in an emergency.) ■ Emergency medical technicians (EMTs) are qualified to provide more comprehensive basic life support care at the scene of an emergency, in addition to performing the duties of an EMR. ■ Advanced EMTs (AEMTs) are EMTs who have received additional training that qualifies them to perform certain advanced life support skills and administer some medications at the scene of an emergency. ■ Paramedics are trained to give the highest level of advanced medical care at the scene of an emergency, including the administration of medications and advanced airway support. © 2011, 2016 The American National Red Cross. All rights reserved. ■ Once on the scene, these professionals will take over the care of the person, including transportation to a hospital or other facility for the best medical care if needed. Chapter 1 Before Giving Care | 6 | First Aid/CPR/AED Participant’s Manual Box 1-3. Signs of an Emergency Unusual Sounds Unusual Odors ■ Screaming, moaning, yelling or calls for help ■ Sudden, loud noises such as breaking glass, crashing metal or screeching tires ■ A change in the sound made by machinery or equipment ■ Unusual silence ■ A foul or unusually strong chemical odor ■ The smell of smoke ■ The smell of gas ■ An unrecognizable odor ■ An inappropriate odor (e.g., a sickly sweet odor on a person’s breath) © 2011, 2016 The American National Red Cross. All rights reserved. Unusual Sights ■ A stopped vehicle on the roadside or a car that has run off of the road Unusual Behaviors ■ Downed electrical wires ■ Confusion in a person who is normally alert ■ Sparks, smoke or fire ■ Unusual drowsiness ■ A person who suddenly collapses or is lying motionless ■ ■ Signs or symptoms of illness or injury, such as profuse sweating for no apparent reason or an uncharacteristic skin color Personality or mood changes (e.g., agitation in a person who is normally calm, irritability in a person who is normally pleasant) Many different fears and concerns can cause a person to hesitate to respond in an emergency. Understanding these fears and concerns can help you to overcome them: ■ Being uncertain that an emergency actually ■ Being afraid of giving the wrong care or exists. Sometimes people hesitate to take action inadvertently causing the person more because they are not sure that the situation is harm. Getting trained in first aid can give you a real emergency and do not want to waste the the confidence, knowledge and skills you need time of the EMS personnel. If you are not sure to respond appropriately to an emergency. If what to do, err on the side of caution and call you are not sure what to do, call 9-1-1 or the 9-1-1 or the designated emergency number. designated emergency number and follow the EMS dispatcher’s instructions. The worst thing to Chapter 1 Before Giving Care | 7 | First Aid/CPR/AED Participant’s Manual do is nothing. Chapter 1 Before Giving Care | 8 | First Aid/CPR/AED Participant’s Manual ■ Assuming that the situation is already under control. Although there may be a crowd of people around the injured or ill person, it is possible that no one has taken action. If no one is giving care or directing the actions of bystanders, you can take the lead. If someone else is already giving care, confirm that someone has called 9-1-1 or the designated emergency number and ask how you can be of help. ■ Squeamishness related to unpleasant sights, sounds or smells. Many people feel faint or nauseated when confronted with upsetting sights, sounds or smells, such as blood, vomit or a traumatic injury. You may have to turn away for a moment and take a few deep breaths to regain your composure before you can give care. If you still are unable to give care, you can volunteer to help in other ways, such as by calling 9-1-1 or the designated emergency number and bringing necessary equipment and supplies to the scene. ■ Fear of catching a disease. In today’s world, the fear of contracting a communicable disease while giving care to another person is a real one. However, although it is possible for diseases to be transmitted in a first aid situation, it is extremely unlikely that you will catch a disease this way. Taking additional precautions, such as putting on latex-free disposable gloves and using a CPR breathing barrier, can reduce your risk even further. ■ Fear of being sued. Sometimes people hesitate to get involved because they are worried about liability. In fact, lawsuits against lay responders (nonprofessionals who give care in an emergency situation) are highly unusual and rarely successful. The majority of states and the District of Columbia have Good Samaritan laws that protect people against claims of negligence when they give emergency care in good faith without accepting anything in return (Box 1-4). Box 1-4. Good Samaritan Laws If a lay responder’s actions were grossly negligent or reckless, or if the responder abandoned the person after starting care, Good Samaritan laws may not protect the responder. For more information about your state’s Good Samaritan laws, conduct an Internet search or contact a legal professional. ■ Ask a responsive person (or the parent or guardian of a minor) for permission to help (consent) before giving care. ■ Check the person for life-threatening conditions before giving further care. ■ Call 9-1-1 or the designated emergency number. ■ Continue to give care until more highly trained personnel take over. Chapter 1 Before Giving Care | 9 | First Aid/CPR/AED Participant’s Manual © 2011, 2016 The American National Red Cross. All rights reserved. Good Samaritan laws, which protect the responder from financial liability, were developed to encourage people to help others in emergency situations. They assume a responder will do his or her best to save a life or prevent further injury. Good Samaritan laws require the responder to use common sense and a reasonable level of skill and to give only the type of emergency care for which he or she is trained. Good Samaritan laws usually protect responders who act the way a “reasonable and prudent person” would act if that person were in the same situation. For example, a reasonable and prudent person would: ■ Move a person only if the person’s life were in danger. Activating the EMS System In a life-threatening emergency, activating the EMS system is an important thing for you to do. Activating the EMS system (Box 1-5) will send emergency medical help on its way as fast as possible. The sooner emergency personnel arrive, the better the chance for a positive outcome. At times you may be unsure if advanced medical personnel are needed. You will have to use your best judgment—based on the situation, your assessment of the injured or ill person, and information gained from this course and other training you may have received—to make the decision to call. When in doubt, make the call. Box 1-5. When to Activate the EMS System Call 9-1-1 or the designated emergency number for any of the following emergency situations and conditions. Emergency Situations ■ An injured or ill person who needs medical attention and cannot be moved ■ Fire or explosion ■ Downed electrical wires ■ ■ Swiftly moving or rapidly rising flood waters Drowning ■ Presence of poisonous gas ■ Serious motor-vehicle collision © 2011, 2016 The American National Red Cross. All rights reserved. Emergency Conditions ■ Unresponsiveness or an altered level of consciousness (LOC), such as drowsiness or confusion ■ Breathing problems (trouble breathing or no breathing) ■ Chest pain, discomfort or pressure lasting more than a few minutes that goes away and comes back or that radiates to the shoulder, arm, neck, jaw, stomach or back ■ ■ Severe external bleeding (bleeding that spurts or gushes steadily from a wound) ■ Vomiting blood or passing blood ■ Severe (critical) burns ■ Suspected poisoning that appears to be life threatening ■ Seizures ■ Signs or symptoms of stroke (e.g., drooping of the face on one side; sudden weakness on one side of the body; sudden slurred speech or difficulty speaking; or a sudden, severe headache) ■ Suspected or obvious injuries to the head, neck or spine ■ Suspected or obvious broken bone Persistent abdominal pain or pressure Chapter 1 Before Giving Care | 10 | First Aid/CPR/AED Participant’s Manual Most people in the United States call 9-1-1 for help in emergencies. But in some areas of the United States and in many workplaces, you many need to dial a designated emergency number instead. If you live or work in an area where 9-1-1 is not the number you should call in an emergency, make sure you know what the designated emergency number is. Phone carriers are required to connect 9-1-1 calls made from a mobile phone, even if the phone does not have an active service plan. In most areas, you cannot text 9-1-1. You must call! Unless you have confirmed that the 9-1-1 call center in your area supports texting, you should always call. Giving Care Until EMS Personnel Take Over First aid care can be the difference between life and death. Often it makes the difference between complete recovery and permanent disability. This manual and the American Red Cross First Aid/ CPR/AED courses provide you with the confidence, knowledge and skills you need to give care to a person in an emergency medical situation. In general, you should give the appropriate care to an injured or ill person until: ■ Another trained responder or EMS personnel take over. ■ You are too exhausted to continue. ■ The scene becomes unsafe. Obtaining Consent to Help ■ State your name. ■ State the type and level of training that you have (such as training in first aid or CPR). ■ Explain what you think is wrong. ■ Explain what you plan to do. ■ Ask if you may help. With this information, an ill or injured person can grant his or her consent for care. Someone who is unresponsive, confused or mentally impaired may not be able to grant consent. In these cases, the law assumes the person would give consent if he or she were able to do so. This is called implied consent. Implied consent also applies when a minor needs emergency medical assistance and the minor’s parent or guardian is not present. Chapter 1 Before Giving Care | 11 | First Aid/CPR/AED Participant’s Manual © 2011, 2016 The American National Red Cross. All rights reserved. Before giving first aid care, you must obtain consent (permission) from the injured or ill person (or the person’s parent or guardian if the person is a minor) (Figure 1-2). To obtain consent: Figure 1-2. Obtain consent before giving care. An injured or ill person may refuse care, even if he or she desperately needs it. A parent or guardian also may refuse care for a minor in his or her care. You must honor the person’s wishes. Explain to the person why you believe care is necessary, but do not touch or give care to the person if care was refused. If you believe the person’s condition is life threatening, call EMS personnel to evaluate the situation. If the person gives consent initially but then withdraws it, stop giving care and call for EMS personnel if you have not already done so. If you do not speak the same language as the injured or ill person, obtaining consent may be challenging. Find out if someone else at the scene can serve as a translator. If a translator is not available, do your best to communicate with the person by using gestures and facial expressions. When you call 9-1-1 or the designated emergency number, explain that you are having difficulty communicating with the person, and tell the dispatcher which language you believe the person speaks. The dispatcher may have someone available who can help with communication. © 2011, 2016 The American National Red Cross. All rights reserved. Lowering the Risk for Infection Giving first aid care is a hands-on activity. Providing this care can put you in close contact with another person’s body fluids (such as saliva, mucus, vomit or blood), which may contain pathogens (harmful microorganisms that can cause disease). Pathogens can be spread from person to person through direct or indirect contact. In direct transmission, the pathogen is passed from one person to another through close physical contact. In indirect transmission, the pathogen is spread by way of a contaminated surface or object. Some pathogens that you could be exposed to when providing first aid care pose particular risk because of their long-term effects on your health if you become infected (Box 1-6). ■ Bloodborne pathogens are spread when transmitted and are not spread by casual blood from an infected person enters the contact. Remember, for infection to occur, bloodstream of a person who is not infected. an infected person’s blood must enter your Bloodborne illnesses that are of particular bloodstream. This could happen through direct concern include human immunodeficiency or indirect contact with an infected person’s virus (HIV) infection and hepatitis B, C and D. blood if it comes in contact with your eyes, the Fortunately, although bloodborne pathogens mucous membranes that line your mouth and can cause serious illnesses, they are not easily nose, or an area of broken skin on your body. Chapter 1 Before Giving Care | 12 | First Aid/CPR/AED Participant’s Manual breathes, coughs or sneezes. Infection spreads when a person who is not infected inhales respiratory droplets containing the pathogens. Examples of airborne illnesses include tuberculosis and influenza. You could also become infected if you stick yourself with a contaminated needle (a “needlestick injury”) or cut yourself with broken glass that has been contaminated with blood. ■ Airborne pathogens are pathogens that are expelled into the air when an infected person Box 1-6. Bloodborne and Airborne Illnesses Although the risk of catching a disease when giving first aid care is very low, whenever you give care, there is the potential to be exposed to an infectious disease. Of particular concern are diseases that are not easily treated and can have long-term effects on your health, should you become infected. Using personal protective equipment (PPE) reduces your risk for catching an infectious disease significantly. Bloodborne Illnesses ■ ■ HIV is a virus that invades and destroys the cells that help us to fight off infections. A person who is infected with HIV may look and feel healthy for many years. However, during this time, the virus is breaking down the person’s immune system. Eventually, a person who is infected with HIV may develop acquired immunodeficiency syndrome (AIDS). A person with AIDS is unable to fight off infections that a healthy person would be able to resist or control. The person dies from one of these infections. Although medications have been developed to help slow the progression of HIV infection, currently there is no cure. Airborne Illnesses ■ Tuberculosis is a bacterial infection of the lungs that is spread through the air from one person to another. Although tuberculosis primarily affects the lungs, it can also affect the bones, brain, kidneys and other organs. If not treated, tuberculosis can be fatal. Treatment is complex and involves taking many different medications over an extended period of time. Limiting Your Exposure to Pathogens There are two main steps you can take to limit your exposure to pathogens and your risk for contracting a communicable disease while giving first aid care: use personal protective equipment (PPE) and wash your hands after giving care. Chapter 1 Before Giving Care | 13 | First Aid/CPR/AED Participant’s Manual © 2011, 2016 The American National Red Cross. All rights reserved. Hepatitis is inflammation of the liver, an organ that performs many vital functions for the body. There are many different types and causes of hepatitis. Hepatitis B, hepatitis C and hepatitis D are caused by infection with bloodborne viruses. Chronic infection with the viruses that cause hepatitis B, C or D can lead to liver failure, liver cancer and other serious conditions. Personal Protective Equipment Personal protective equipment (PPE) is equipment used to prevent pathogens from contaminating your skin, mucous membranes or clothing. Articles of PPE that are commonly used when giving first aid care include latex-free disposable gloves and CPR breathing barriers. Face masks and protective eyewear are other types of PPE that may be used in a first aid situation. Safety First! Be prepared by having a first aid kit handy and adequately stocked with PPE. You can also carry a keychain kit containing a pair of latex-free disposable gloves and a breathing barrier so that you always have this equipment readily available. Latex-Free Disposable Gloves Disposable gloves are meant to be worn once and then discarded. Never clean or reuse disposable gloves. Disposable gloves should fit properly and be free of rips or tears. Wear latex-free disposable gloves: ■ When providing care, especially whenever there is a possibility that you will come in contact with a person’s blood or other potentially infectious materials. ■ When there is a break in the skin on your own hands (cover any cuts, scrapes or sores before putting on the gloves). ■ When you must handle items or surfaces soiled with blood or other potentially infectious materials. © 2011, 2016 The American National Red Cross. All rights reserved. When you are wearing gloves, try to limit how much you touch other surfaces with your gloved hands. Pathogens from your soiled gloves can transfer to other items or surfaces that you touch, putting the next person who handles the item or touches the surface at risk for infection. If possible, remove soiled gloves and replace them with a clean pair before touching other surfaces or equipment in your first aid kit. When you are finished providing care, remove your gloves using proper technique to avoid contaminating your own skin (Skill Sheet 1-1), dispose of the gloves properly and wash your hands. When multiple people are in need of care, remove your gloves, wash your hands and replace your gloves with a clean pair before assisting the next person. Safety First! Because many people are allergic to latex, the American Red Cross recommends the use of latex-free disposable gloves. Nitrile gloves are preferred over other types of latex-free disposable gloves, such as those made of vinyl. Chapter 1 Before Giving Care | 14 | First Aid/CPR/AED Participant’s Manual CPR Breathing Barriers CPR breathing barriers are used to protect you from contact with saliva and other body fluids, such as blood, as you give rescue breaths. Breathing barriers also protect you from breathing the air that the person exhales. The most basic and portable type of breathing barrier is a face shield, a flat piece of thin plastic that you place over the person’s face, with the opening over the person’s mouth. The opening contains a filter or a valve that protects you from coming into contact with the person’s body fluids and exhaled air. A pocket mask is a transparent, flexible device that creates a tight seal over the person’s nose and mouth to allow you to give rescue breaths without making mouth-to-mouth contact or inhaling exhaled air. Breathing barriers sized specifically for children and infants are available. Always use equipment that is sized appropriately for the injured or ill person. Hand Washing Wash your hands thoroughly with soap and warm running water when you have finished giving care, even if you wore disposable gloves. Wash for a minimum of 20 seconds and make sure to cover all surfaces of both hands: your wrists, the palms and backs of your hands, in between your fingers and underneath your fingernails. Safety First! Alcohol-based hand sanitizers may not be as effective if your hands are visibly soiled with dirt or body fluids. In addition, although using an alcohol-based hand sanitizer properly will reduce the number of pathogens on your hands, it may not eliminate all pathogens. For these reasons, always wash your hands with soap and water as soon as you can, even if you used an alcohol-based hand sanitizer! Chapter 1 Before Giving Care | 15 | First Aid/CPR/AED Participant’s Manual © 2011, 2016 The American National Red Cross. All rights reserved. If soap and water are not available, you may use an alcohol-based hand sanitizer to decontaminate your hands. When using an alcohol-based hand sanitizer, use the amount of product recommended by the manufacturer. Rub it thoroughly over all surfaces of your hands, including your nails and in between your fingers, until the product dries. Wash your hands with soap and water as soon as you have access to hand-washing facilities. Cleaning and Disinfecting Surfaces and Equipment Reusable equipment and surfaces that have been contaminated by blood or other potentially infectious materials need to be properly cleaned and disinfected before the equipment is put back into service or the area is reopened. Clean and disinfect surfaces and equipment as soon as possible after the incident occurs. Remember to wear appropriate PPE. © 2011, 2016 The American National Red Cross. All rights reserved. If blood or other potentially infectious materials have spilled on the floor or another surface, prevent others from accessing the area. If the spill contains a sharp object (e.g., shards of broken glass), do not pick the object up with your hands. Instead, use tongs, a disposable scoop and scraper, or two pieces of cardboard to remove and dispose of the object. Wipe up or absorb the spill using absorbent towels or a solidifier (a fluid-absorbing powder). After wiping up the spill, flood the area with a freshly mixed disinfectant solution of approximately 1½ cups of bleach to 1 gallon of water (1 part bleach to 9 parts water, or about a 10 percent solution). When using a bleach solution, always ensure good ventilation and wear gloves and eye protection. Let the bleach solution stand on the surface for at least 10 minutes. Then use clean absorbent materials (such as paper towels) to wipe up the disinfectant solution and dry the area. Dispose of all materials used to clean up the blood spill in a labeled biohazard container. If a biohazard container is not available, place the soiled materials in a sealable plastic bag or a plastic container with a lid, seal the container and dispose of it properly. Handling an Exposure Incident If another person’s blood or other potentially infectious material comes into contact with your eyes, the mucous membranes of your mouth or nose, or an opening or break in your skin, or if you experience a needlestick injury, then you have been involved in an exposure incident. In the event of an exposure incident, follow these steps immediately: ■ Decontaminate the exposed area. If your skin ■ Report the exposure incident to EMS personnel was exposed, wash the contaminated area or your healthcare provider. with soap and water. For splashes into your mouth or nose, flush the area with water. For ■ If the exposure incident occurred in a workplace splashes into the eyes, irrigate the eyes with setting, notify your supervisor and follow your water, saline or a sterile irrigant for 15 to company’s exposure control plan for reporting the 20 minutes. incident and receiving post-exposure follow-up care. Chapter 1 Before Giving Care | 16 | First Aid/CPR/AED Participant’s Manual Taking Action: The Emergency Action Steps In any emergency situation, there are three simple steps to take to guide your actions. If you ever feel nervous or confused, remember these three emergency action steps to get you back on track: 1. CHECK the scene and the person. 2. CALL 9-1-1 or the designated emergency number. 3. CARE for the person. Check First, check the scene. Then check the person. Check the Scene Before rushing to help an injured or ill person, conduct a scene size-up and form an initial impression. Try to answer these questions: Is the scene safe to enter? Check for hazards that could jeopardize your safety or the safety of bystanders, such as fire, downed electrical wires, spilled chemicals, an unstable building or traffic. Do not enter bodies of water unless you are specifically trained to perform in-water rescues (Box 1-7). Avoid entering confined areas with poor ventilation and places where natural gas, propane or other substances could explode. Do not enter the scene if there is evidence of criminal activity or the person is hostile or threatening suicide. If these or other dangers threaten, stay at a safe distance and call 9-1-1 or the designated emergency number immediately. Once professional responders make the scene safe, you can offer your assistance as appropriate. ■ What happened? Take note of anything that might tell you the cause of the emergency. If the person is unresponsive and there are no witnesses, your check of the scene may offer the only clues as to what happened. Use your senses to detect anything out of the ordinary, such as broken glass, a spilled bottle of medication or an unusual smell or sound. Keep in mind that the injured or ill person may not be exactly where he or she was when the injury or illness occurred—someone may have moved the person, or the person may have moved in an attempt to get help. ■ How many people are involved? Look carefully for more than one injured or ill person. A person who is moving or making noise or who has very visible injuries will likely attract your attention right away, but there may be a person who is silent and not moving or a person obscured by debris or wreckage that you do not notice at first. It also is easy to overlook a small child or an infant. In an emergency with more than one injured or ill person, you may need to prioritize care (in other words, decide who needs help first). Chapter 1 Before Giving Care | 17 | First Aid/CPR/AED Participant’s Manual © 2011, 2016 The American National Red Cross. All rights reserved. ■ Box 1-7. Reach or Throw, Don’t Go! Never go into water or onto ice in an attempt to rescue a person who is in trouble. Instead, get help from a trained responder, such as a lifeguard, to get the person out of the water as quickly and safely as possible. Reaching and throwing assists are the safest assists for responders who are not professionally trained lifeguards to use to help a person who is in trouble in the water. When doing a reaching or throwing assist: ■ Talk to the person and let the person know help is coming. ■ Tell the person what he or she can do to help with the rescue, such as grasping a line or other floating device. Use gestures to communicate with the person if it is too noisy or if the person is too far away to hear. ■ Encourage the person to move toward safety by kicking his or her legs or stroking with his or her arms. Some people are able to reach safety by themselves with calm encouragement from a person on the deck or shore. © 2011, 2016 The American National Red Cross. All rights reserved. Reaching assist. To do a reaching assist, use any available object that will extend your reach and give the person something to grab onto (such as a pole, an oar or paddle, a branch or a towel). Extend the object to the person, tell him or her to hold on, and pull the person to safety. If no equipment is available and you are close enough, you may be able to perform a reaching assist by extending your arm to the person. You can also perform a reaching assist from a position within the water by extending an arm or a leg to the person, if you are already in the water and you have something secure to hold onto. ■ Throwing assist. A throwing assist involves throwing a floating object to the person so that he or she can grasp it and be pulled to safety. A floating object with a line attached (such as a ring buoy) is ideal for a throwing assist; however, a line or an object that floats (such as a life jacket or cooler) can also be used alone. Wading assist. A wading assist involves wading into the water and using a reaching assist to help pull the person to safety. Only use a wading assist in water that is less than chest deep. If a current or soft bottom makes wading dangerous, do not enter the water. For your own safety, wear a life jacket if one is available and take something to extend to the person, such as a ring buoy, branch, pole or paddle. What is your initial impression about the nature of the person’s illness or injury? Before you reach the person, try to form an initial impression about the person’s condition and what is wrong. For example, does the person seem alert, or confused or sleepy? Look at the person’s skin—does it appear to be its normal color, or does it seem pale, ashen (gray) or flushed? Is the person moving, or motionless? Does the person have any immediately identifiable injuries? Look for signs of a life-threatening illness or injury, such as loss of consciousness, trouble breathing or severe bleeding. If you see severe, lifethreatening bleeding, use the resources available to you to control the bleeding as soon as possible (see Chapter 6). Chapter 1 Before Giving Care | 18 | First Aid/CPR/AED Participant’s Manual ■ Is anyone else available to help? Take note of bystanders who can be of assistance. A bystander who was there when the emergency occurred or who knows the injured or ill person may be able to provide valuable information about the situation or the person. Bystanders can also assist in other ways, such as by calling 9-1-1 or the designated emergency number, waiting for EMS personnel and leading them to the site of the emergency, getting needed items (such as an AED and first aid kit), controlling crowds and reassuring the injured or ill person. Check the Person When you reach the person, you can conduct a more thorough check to determine what is wrong and what care is needed. If the person is awake and responsive, obtain consent and then begin to gather additional information about the nature of the person’s illness or injury. Chapter 2 provides more detail about how to check a person who is responsive. If the person appears to be unresponsive, shout, using the person’s name if you know it. If there is no response, tap the person’s shoulder (if the person is an adult or child) or the bottom of the person’s foot (if the person is an infant) and shout again while checking for normal breathing. Check for responsiveness and breathing for no more than 5 to 10 seconds. If the person does not respond to you in any way (such as by moving, opening his or her eyes, or moaning) and the person is not breathing or is only gasping, the person is unresponsive. If the person responds and is breathing normally, the person is responsive, but may not be fully awake. Give care according to the conditions that you find and your level of knowledge and training (see Chapter 2). Unresponsiveness, trouble breathing and severe bleeding are all signs of a life-threatening emergency. If your initial check of the person reveals these or any other life-threatening conditions (see Box 1-5), make sure that someone calls 9-1-1 or the designated emergency number right away. Also have someone bring an AED and a first aid kit, if these items are available. © 2011, 2016 The American National Red Cross. All rights reserved. Chapter 1 Before Giving Care | 19 | First Aid/CPR/AED Participant’s Manual Call If you decide it is necessary to summon EMS personnel (see Box 1-5), make the call quickly and return to the person. If possible, ask someone else to make the call so that you can begin giving care. The person making the call should be prepared to give the dispatcher the following information: ■ The location of the emergency (the address, or ■ The telephone number of the phone being used nearby intersections or landmarks if the address is not known) ■ A description of what happened ■ The nature of the emergency (e.g., whether police, fire or medical assistance is needed) ■ The number of injured or ill people What help, if any, has been given so far, and by whom The caller should stay on the phone until the dispatcher tells him or her it is all right to hang up. The dispatcher may need more information. Many dispatchers also are trained to give first aid and CPR instructions over the phone, which can be helpful if you are unsure of what to do or need to be reminded of the proper care steps. ■ If you are alone and there is no one to send to call 9-1-1 or the designated emergency number, you may need to decide whether to call first or give care first (Box 1-8). Call First situations are likely to be cardiac arrest. In cardiac arrest, the priority is getting help on the scene as soon as possible because early access to EMS personnel and an AED increases the person’s chances for survival. Care First situations include breathing emergencies and severe life-threatening bleeding. In these situations, there are immediate actions that you can take at the scene that may prevent the person’s condition from worsening. After you take these actions, call 9-1-1 or the designated emergency number to get advanced medical help on the way. Most of the time, you will call first and then give care. But if you are alone, you may have to decide whether to call first or care first. Any person about 12 years or older who is unresponsive. A child or an infant whom you witnessed suddenly collapse. © 2011, 2016 The American National Red Cross. All rights reserved. An unresponsive child or infant known to have heart problems. CARE First (give immediate care, then call 9-1-1 or the designated emergency number) for: An unresponsive infant or child younger than about 12 years whom you did not see collapse. A person who is experiencing a severe allergic reaction (anaphylaxis) and has an epinephrine auto injector. A person who has severe, life-threatening bleeding. Chapter 1 Before Giving Care | 20 | First Aid/CPR/AED Participant’s Manual Care The final emergency action step is to give care according to the conditions that you find and your level of knowledge and training. Follow these general guidelines: ■ Do no further harm. ■ Reassure the person by telling the person that ■ Monitor the person’s breathing and level of you will help and that EMS personnel have been consciousness. called (if appropriate). ■ Help the person rest in the most comfortable position. ■ Keep the person from getting chilled or overheated. ■ Give care consistent with your knowledge and training as needed, and continue to watch for changes in the person’s condition. If you must move the person, use one of the techniques described in Appendix A, Emergency Moves. If the person does not have a life-threatening illness or injury, you may decide to take the injured or ill person to a medical facility yourself instead of calling for EMS personnel. Never transport a person yourself if the Chapter 1 Before Giving Care | 21 | First Aid/CPR/AED Participant’s Manual © 2011, 2016 The American National Red Cross. All rights reserved. Generally speaking, you should avoid moving an injured or ill person to give care. Unnecessary movement can cause additional injury and pain and may complicate the person’s recovery. However, under the following three conditions, it would be appropriate to move an injured or ill person: ■ You must move the person to protect him ■ You must move the person to reach another person or her from immediate danger (such as fire, who may have a more serious injury or illness. flood or poisonous gas). However, you should only attempt this if you can reach the person ■ You must move the person to give proper care. and remove him or her from the area without For example, it may be necessary to move a endangering yourself. person who needs CPR onto a hard, flat surface. person has or may develop a life-threatening condition, if you are unsure of the nature of the injury or illness, or if the trip may aggravate the injury or cause additional injury. If you decide it is safe to transport the person yourself, be sure you know the quickest route to the nearest medical facility capable of handling emergency care. Ask someone to come with you to help keep the person comfortable and monitor the person for changes in condition so that you can focus on driving. Remember to obey traffic laws. No one will benefit if you are involved in a motor-vehicle collision or get a speeding ticket on your way to the medical facility. © 2011, 2016 The American National Red Cross. All rights reserved. Discourage an injured or ill person from driving him- or herself to the hospital. An injury may restrict movement, or the person may become faint. The sudden onset of pain may be distracting. Any of these conditions can make driving dangerous for the person, passengers, other drivers and pedestrians. Chapter 1 Before Giving Care | 22 | First Aid/CPR/AED Participant’s Manual Skill Sheet 1-1 Removing Latex-Free Disposable Gloves 2. Pull the glove toward your fingertips, turning it inside out as you pull it off your hand. 3. Hold the glove in the palm of your other (still-gloved) hand. 4. Carefully slip two fingers under the wrist of the other glove. Avoid touching the outside of the glove. 6. Dispose of the gloves properly and wash your hands. Chapter 1 Before Giving Care | 23 | First Aid/CPR/AED Participant’s Manual © 2011, 2016 The American National Red Cross. All rights reserved. 5. Pull the glove toward your fingertips, turning it inside out as you pull it off your hand. The other glove is now contained inside.
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