Responding to Emergencies: Comprehensive First Aid/CPR/AED Complement your training with the resources you’ll need that will keep you knowledgeable, confident, and ready to respond. From our mobile apps to the Red Cross store with best-in-class products, ensure you have the tools to quickly assist during emergency situations. Help is in your hand with mobile apps Red Cross apps provide you with the information to help you be prepared—whether it’s everyday safety tools, tips and preparedness information or what actions to take during a natural disaster or first aid emergency. • The Emergency App covers 35 severe weather and emergency alerts. • The First Aid App gives you instant help for the most common first aid emergencies. Go to redcross.org/emergencyapps to learn more. Get equipped at the Red Cross Store You’ll find the products you need to be prepared for any emergency: • First aid kits and refills • CPR keychains and lifeguard rescue tubes • First Aid and other reference guides • Emergency preparedness kits and products You’ll also find apparel and even gift ideas for the family, friends and neighbors who want to be ready and prepared. Plus, a portion of proceeds from the sale of all store products helps to fund the lifesaving mission of the American Red Cross. Shop at redcrossstore.org/classproducts. Access your digital certificate anytime, anywhere The American Red Cross makes certification fast, simple and easy. With Red Cross Digital Certificates you get anytime, anywhere access to your certificates; plus print, share, and download wherever and whenever you like. Each certificate includes a unique ID and a QR code which meets employment requirements and allows employers to easily confirm your certificate is valid. Learn more about how to access your digital certificate at redcross.org/myclasscert. Responding to Emergencies: Comprehensive First Aid/CPR/AED This textbook is part of the American Red Cross Responding to Emergencies: Comprehensive First Aid/CPR/AED program. Visit redcross.org to learn more about this program. The emergency care procedures outlined in this textbook reflect the standard of knowledge and accepted emergency practices in the United States at the time this textbook was published. It is the reader’s responsibility to stay informed of changes in emergency care procedures. The materials in this program, including all content, graphics, images, logos and downloadable electronic materials (as applicable), are copyrighted by, and the exclusive property of, The American National Red Cross (“Red Cross”). Unless otherwise indicated in writing by the Red Cross, the Red Cross grants you (the “Recipient”) the limited right to receive and use the materials only in conjunction with teaching, preparing to teach, or participating in a Red Cross course by individuals or entities expressly authorized by the Red Cross, subject to the following restrictions: ■■ The Recipient is prohibited from creating new versions of the materials, electronic or otherwise. ■■ The Recipient is prohibited from revising, altering, adapting or modifying the materials, which includes removing, altering or covering any copyright notices, Red Cross marks, logos or other proprietary notices placed or embedded in the materials. ■■ The Recipient is prohibited from creating any derivative works incorporating, in part or in whole, the content of the materials. ■■ The Recipient is prohibited from downloading the materials, or any part of the materials, and putting them on the Recipient’s own website or other third-party website without advance written permission of the Red Cross. ■■ The Recipient is prohibited from removing these Terms and Conditions in otherwise-permitted copies, and is likewise prohibited from making any additional representations or warranties relating to the materials. 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Published by The StayWell Company, LLC Printed in the United States of America ISBN: 978-1-58480-684-4 Acknowledgments The Responding to Emergencies: Comprehensive First Aid/CPR/AED textbook was developed through the dedication of both employees and volunteers. Their commitment to excellence made this textbook possible. The emergency care steps outlined in this textbook are consistent with the 2015 International Consensus on CPR and Emergency Cardiovascular Care (ECC) Science With Treatment Recommendations and the 2015 American Heart Association and American Red Cross Guidelines Update for First Aid. American Red Cross Scientific Advisory Council Guidance for the Responding to Emergencies: Comprehensive First Aid/CPR/AED program was provided by members of the American Red Cross Scientific Advisory Council. The Council is a panel of nationally recognized experts drawn from a wide variety of scientific, medical and academic disciplines. The Council provides authoritative guidance on first aid, CPR, emergency treatments, rescue practices, emergency preparedness, aquatics, disaster health, nursing, education and training. For more information on the Scientific Advisory Council, visit redcross.org/science. Dedication This textbook is dedicated to the thousands of employees and volunteers of the American Red Cross who contribute their time and talent to supporting and teaching lifesaving skills worldwide, and to the thousands of course participants who have decided to be prepared to take action when an emergency strikes. Table of Contents About This Course . . . . . . . . . . . . . . . . . . . . . . x PART ONE Introduction / 1 PART FIVE Medical Emergencies / 254 CHAPTER 1 If Not You … Who? . . . . . . . . . . 2 CHAPTER 15 Sudden Illnesses . . . . . . . . . 255 CHAPTER 2 Responding to an Emergency . . . . . . . . . . . . . 15 CHAPTER 16 Poisoning . . . . . . . . . . . . . . . . 276 CHAPTER 3 Before Giving Care . . . . . . . . 25 PART TWO Assessment / 40 CHAPTER 4 The Human Body . . . . . . . . . . 41 CHAPTER 5 Checking the Person . . . . . . . 62 CHAPTER 17 Bites and Stings . . . . . . . . . . 297 CHAPTER 18 Substance Abuse and Misuse . . . . . . . . . . . . . . 317 CHAPTER 19 Heat-Related Illnesses and Cold-Related Emergencies . . . . . . . . . . . . . 335 PART SIX Special Situations / 352 PART THREE Life-Threatening Emergencies / 78 CHAPTER 20 Water-Related Emergencies . . . . . . . . . . . . . 353 CHAPTER 6 Cardiac Emergencies . . . . . . 79 CHAPTER 21 Pediatric, Older Adult and Special Situations . . . . 364 CHAPTER 7 Breathing Emergencies . . . 111 CHAPTER 8 Bleeding . . . . . . . . . . . . . . . . . 139 CHAPTER 9 Shock . . . . . . . . . . . . . . . . . . . 152 PART FOUR Injuries / 158 CHAPTER 22 Emergency Childbirth . . . . . 384 CHAPTER 23 Disaster, Remote and Wilderness Emergencies . . . . . . . . . . . . . 398 CHAPTER 10 Soft Tissue Injuries . . . . . . . 159 Answers to Ready to Respond? Questions and Answers to Study Questions . . . . . . . . . . . . . . . 421 CHAPTER 11 Musculoskeletal Injuries . . . 185 Glossary �������� . . . . . . . . . . . . . . . . . . . . . . . 441 CHAPTER 12 Injuries to the Extremities . . . . . . . . . . . . . . . 200 Sources �������� . . . . . . . . . . . . . . . . . . . . . . . 452 CHAPTER 13 Injuries to the Head, Neck or Spine . . . . . . . . . . . . 226 APPENDIX Photography Credits . . . . . . . . . . . . . . . . 455 Index �������������� . . . . . . . . . . . . . . . . . . . . . . . 456 CHAPTER 14 Injuries to the Chest, Abdomen and Pelvis . . . . . . 242 Responding to Emergencies | iv | Table of Contents Detailed Table of Contents About This Course . . . . . . . . . . . . . . . . . . . . . . x PART ONE Introduction / 1 PART TWO Assessment / 40 CHAPTER 1 If Not You … Who?, 2 CHAPTER 4 The Human Body, 41 Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Key Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Types of Emergencies . . . . . . . . . . . . . . . . . . . . . . 4 Your Role in an Emergency . . . . . . . . . . . . . . . . . . 4 Preparing for an Emergency . . . . . . . . . . . . . . . . . 6 Incident Stress . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Ready to Respond? . . . . . . . . . . . . . . . . . . . . . . 13 Study Questions . . . . . . . . . . . . . . . . . . . . . . . . 14 Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Key Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Anatomical Terms . . . . . . . . . . . . . . . . . . . . . . . . 43 Body Systems . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Interrelationships of Body Systems . . . . . . . . . 59 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Ready to Respond? . . . . . . . . . . . . . . . . . . . . . . 59 Study Questions . . . . . . . . . . . . . . . . . . . . . . . . 60 CHAPTER 5 Checking the Person, 62 CHAPTER 2 Responding to an Emergency, 15 Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Key Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Checking for Life-Threatening Conditions . . . . . . . . . . . . . . . . . . . . . . . . . 63 Checking a Responsive Person . . . . . . . . . . . . 66 Interviewing the Person . . . . . . . . . . . . . . . . . . . 69 Checking the Person from Head to Toe . . . . . 69 Checking for Shock . . . . . . . . . . . . . . . . . . . . . . 71 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Ready to Respond? . . . . . . . . . . . . . . . . . . . . . . 71 Study Questions . . . . . . . . . . . . . . . . . . . . . . . . 72 Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Key Term . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Taking Action: The Emergency Action Steps . 16 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Ready to Respond? . . . . . . . . . . . . . . . . . . . . . . 23 Study Questions . . . . . . . . . . . . . . . . . . . . . . . . 24 CHAPTER 3 Before Giving Care, 25 Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Key Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Preventing Disease Transmission . . . . . . . . . . . 27 Legal Considerations . . . . . . . . . . . . . . . . . . . . 32 Reaching and Moving a Person . . . . . . . . . . . . 34 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Ready to Respond? . . . . . . . . . . . . . . . . . . . . . . 37 Study Questions . . . . . . . . . . . . . . . . . . . . . . . . 37 Skill Sheets 5-1: Checking a Responsive Person . . . . . . . . 74 5-2: Checking a Person Who Appears to Be Unresponsive . . . . . . . . . . . . . . . . . . 76 Skill Sheet 3-1: Removing Disposable Latex-Free Gloves . . . . . . . . . . . . . . . . . . . 39 Responding to Emergencies | v | Detailed Table of Contents PART THREE Life-Threatening Emergencies / 78 CHAPTER 6 Cardiac Emergencies, 79 CHAPTER 8 Bleeding, 139 Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Key Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Cardiovascular Disease . . . . . . . . . . . . . . . . . . 81 Heart Attack . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Angina Pectoris . . . . . . . . . . . . . . . . . . . . . . . . . 84 Cardiac Arrest . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 CPR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 AED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Ready to Respond? . . . . . . . . . . . . . . . . . . . . . . 99 Study Questions . . . . . . . . . . . . . . . . . . . . . . . 100 Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140 Key Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 The Blood and Blood Vessels . . . . . . . . . . . . 141 When Severe Bleeding Occurs . . . . . . . . . . . 142 External Bleeding . . . . . . . . . . . . . . . . . . . . . . . 142 Internal Bleeding . . . . . . . . . . . . . . . . . . . . . . . 147 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148 Ready to Respond? . . . . . . . . . . . . . . . . . . . . . 148 Study Questions . . . . . . . . . . . . . . . . . . . . . . . 149 Skill Sheets 6-1: Giving CPR to an Adult . . . . . . . . . . . . . 103 6-2: Giving CPR to a Child . . . . . . . . . . . . . . 105 6-3: Giving CPR to an Infant . . . . . . . . . . . . . 107 6-4: Using an AED . . . . . . . . . . . . . . . . . . . . . 109 CHAPTER 7 Breathing Emergencies, 111 Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 Key Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 The Breathing Process . . . . . . . . . . . . . . . . . . 113 Respiratory Distress and Respiratory Arrest . . 114 Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 Choking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 Ready to Respond? . . . . . . . . . . . . . . . . . . . . . 128 Study Questions . . . . . . . . . . . . . . . . . . . . . . . 129 Skill Sheets 8-1: Using Direct Pressure to Control External Bleeding . . . . . . . . . . . . . . . . . . 150 8-2: Using a Commercial Tourniquet . . . . . . . 151 CHAPTER 9 Shock, 152 Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 Key Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 Shock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 Ready to Respond? . . . . . . . . . . . . . . . . . . . . . 156 Study Questions . . . . . . . . . . . . . . . . . . . . . . . 157 Skill Sheets 7-1: Assisting with an Asthma Inhaler . . . . . . 131 7-2: Caring for an Adult Who Is Choking . . . 133 7-3: Caring for a Child Who Is Choking . . . . 135 7-4: Caring for an Infant Who Is Choking . . . 137 Responding to Emergencies | vi | Detailed Table of Contents PART FOUR Injuries / 158 CHAPTER 10 Soft Tissue Injuries, 159 CHAPTER 13 Injuries to the Head, Neck or Spine, 226 Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160 Key Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 The Soft Tissues . . . . . . . . . . . . . . . . . . . . . . . 161 Wounds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 Burns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180 Ready to Respond? . . . . . . . . . . . . . . . . . . . . . 180 Study Questions . . . . . . . . . . . . . . . . . . . . . . . 181 Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227 Key Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 227 Recognizing Serious Head, Neck and Spinal Injuries . . . . . . . . . . . . . . . . . . 228 Specific Injuries . . . . . . . . . . . . . . . . . . . . . . . . 233 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239 Ready to Respond? . . . . . . . . . . . . . . . . . . . . . 239 Study Questions . . . . . . . . . . . . . . . . . . . . . . . 240 CHAPTER 11 Musculoskeletal Injuries, 185 CHAPTER 14 Injuries to the Chest, Abdomen and Pelvis, 242 Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186 Key Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 186 The Musculoskeletal System . . . . . . . . . . . . . 187 Injuries to the Musculoskeletal System . . . . . 190 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197 Ready to Respond? . . . . . . . . . . . . . . . . . . . . . 197 Study Questions . . . . . . . . . . . . . . . . . . . . . . . 198 Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243 Key Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 243 Chest Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . 244 Abdominal Injuries . . . . . . . . . . . . . . . . . . . . . . 247 Pelvic Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . 250 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252 Ready to Respond? . . . . . . . . . . . . . . . . . . . . . 252 Study Questions . . . . . . . . . . . . . . . . . . . . . . . 253 CHAPTER 12 Injuries to the Extremities, 200 Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201 Key Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 201 Immobilizing Serious Extremity Injuries . . . . . 202 Upper Extremity Injuries . . . . . . . . . . . . . . . . . 205 Lower Extremity Injuries . . . . . . . . . . . . . . . . . . 210 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215 Ready to Respond? . . . . . . . . . . . . . . . . . . . . . 215 Study Questions . . . . . . . . . . . . . . . . . . . . . . . 216 Skill Sheets 12-1: Applying a Sling and Binder . . . . . . . . 218 12-2: Applying a Rigid Splint . . . . . . . . . . . . . 220 12-3: Applying an Anatomic Splint . . . . . . . . 222 12-4: Applying a Soft Splint . . . . . . . . . . . . . . 224 Responding to Emergencies | vii | Detailed Table of Contents PART FIVE Medical Emergencies / 254 CHAPTER 15 Sudden Illnesses, 255 CHAPTER 18 Substance Abuse and Misuse, 317 Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . 256 Key Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 256 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 257 Sudden Illnesses . . . . . . . . . . . . . . . . . . . . . . . 257 Specific Sudden Illnesses . . . . . . . . . . . . . . . 259 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 272 Ready to Respond? . . . . . . . . . . . . . . . . . . . . . 272 Study Questions . . . . . . . . . . . . . . . . . . . . . . . 273 Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . 318 Key Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 318 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 319 Forms of Substance Abuse and Misuse . . . . 319 Abused and Misused Substances . . . . . . . . . 320 Signs and Symptoms of Substance Abuse and Misuse . . . . . . . . . . . . . . . . . . 329 Care for Substance Abuse and Misuse . . . . 330 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 332 Ready to Respond? . . . . . . . . . . . . . . . . . . . . . 332 Study Questions . . . . . . . . . . . . . . . . . . . . . . . 333 CHAPTER 16 Poisoning, 276 Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277 Key Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 277 Poisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 278 Types of Poisoning . . . . . . . . . . . . . . . . . . . . . . 281 Anaphylaxis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 288 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291 Ready to Respond? . . . . . . . . . . . . . . . . . . . . . 291 Study Questions . . . . . . . . . . . . . . . . . . . . . . . 292 Skill Sheet 16-1: Administering an Epinephrine Auto-Injector . . . . . . . . . . . . . . . . . . . . . 294 CHAPTER 19 Heat-Related Illnesses and Cold-Related Emergencies, 335 Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . 336 Key Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 336 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 337 How Body Temperature Is Controlled . . . . . . 337 Types of Heat-Related Illnesses . . . . . . . . . . . 340 Cold-Related Emergencies . . . . . . . . . . . . . . 344 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349 Ready to Respond? . . . . . . . . . . . . . . . . . . . . . 349 Study Questions . . . . . . . . . . . . . . . . . . . . . . . 350 CHAPTER 17 Bites and Stings, 297 Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . 298 Key Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 298 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 298 Insect Stings . . . . . . . . . . . . . . . . . . . . . . . . . . 298 Tick Bites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299 Mosquito Bites . . . . . . . . . . . . . . . . . . . . . . . . . 303 Spider Bites and Scorpion Stings . . . . . . . . . 305 Venomous Snakebites . . . . . . . . . . . . . . . . . . . 307 Marine-Life Stings . . . . . . . . . . . . . . . . . . . . . . 308 Domestic and Wild Animal Bites . . . . . . . . . . 310 Human Bites . . . . . . . . . . . . . . . . . . . . . . . . . . . 311 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 314 Ready to Respond? . . . . . . . . . . . . . . . . . . . . . 314 Study Questions . . . . . . . . . . . . . . . . . . . . . . . 315 Responding to Emergencies | viii | Detailed Table of Contents PART SIX Special Situations / 352 CHAPTER 20 Water-Related Emergencies, 353 CHAPTER 23 Disaster, Remote and Wilderness Emergencies, 398 Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . 354 Key Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 354 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 354 Water-Related Emergencies . . . . . . . . . . . . . 354 Taking Action in a Water-Related Emergency . . . . . . . . . . . . . . . . . . . . . . . . 357 Moving an Unresponsive Person to Dry Land . . . . . . . . . . . . . . . . . . . . . . . 360 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361 Ready to Respond? . . . . . . . . . . . . . . . . . . . . . 362 Study Questions . . . . . . . . . . . . . . . . . . . . . . . 363 Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . 399 Key Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 399 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 399 Disaster, Remote and Wilderness Emergencies . . . . . . . . . . . . . . . . . . . . . . 400 Taking Action Using Modified CHECK—CALL—CARE . . . . . . . . . . . . 402 Difficult Decisions . . . . . . . . . . . . . . . . . . . . . . 411 Protection from the Environment . . . . . . . . . . 412 Preparing for Emergencies . . . . . . . . . . . . . . . 414 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 418 Ready to Respond? . . . . . . . . . . . . . . . . . . . . . 418 Study Questions . . . . . . . . . . . . . . . . . . . . . . . 419 CHAPTER 21 Pediatric, Older Adult and Special Situations, 364 APPENDIX Answers to Ready to Respond? Questions and Answers to Study Questions, 421 Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365 Key Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 366 Children and Infants . . . . . . . . . . . . . . . . . . . . 366 Older Adults . . . . . . . . . . . . . . . . . . . . . . . . . . . 374 People with Disabilities . . . . . . . . . . . . . . . . . . 377 Language Barriers . . . . . . . . . . . . . . . . . . . . . . 380 Crime Scenes and Hostile Situations . . . . . . 380 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 381 Ready to Respond? . . . . . . . . . . . . . . . . . . . . . 381 Study Questions . . . . . . . . . . . . . . . . . . . . . . . 382 Glossary, 441 Sources, 452 Photography Credits, 455 Index, 456 CHAPTER 22 Emergency Childbirth, 384 Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . 385 Key Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 385 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 386 Pregnancy and the Birth Process . . . . . . . . . 386 Assisting with Delivery . . . . . . . . . . . . . . . . . . 388 Caring for the Newborn and Mother . . . . . . . 391 Special Considerations . . . . . . . . . . . . . . . . . . 392 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 395 Ready to Respond? . . . . . . . . . . . . . . . . . . . . . 395 Study Questions . . . . . . . . . . . . . . . . . . . . . . . 396 Responding to Emergencies | ix | Detailed Table of Contents ABOUT THIS COURSE People need to know what to do in an emergency before medical help arrives. It is, after all, trained lay responders such as yourself who are most likely to be on the scene of an emergency first. This course will prepare you to make appropriate decisions regarding first aid care, and equip you to act on your decisions, whether at home, at your workplace or in the community. The first critical step in any emergency depends on the presence of someone who is willing to act and take appropriate action. After completing this course, you should be able to: ■■ Recognize when an emergency has occurred. ■■ Follow the emergency action steps: CHECK—CALL—CARE. ■■ Give care for an injury or sudden illness until emergency medical services (EMS) personnel arrive. How You Will Learn Course content is presented in various ways. The textbook, which will be assigned reading, contains the information that will be discussed in class, as well as visual support to illustrate the key skills and concepts you will be learning. In addition, you will view videos demonstrating how to correctly perform specific skills in preparation for skill practice sessions. Participating in all class activities will increase your confidence in your ability to respond to a variety of emergencies. The course design allows you to frequently evaluate your progress in terms of skills competency, knowledge and decision making. Certain chapters in the textbook include directions for skill practice sessions that are designed to help you learn specific first aid skills. Some of the practice sessions require practice on a manikin. Others give you the opportunity to practice with another person. This will give you a sense of what it would be like to care for a real person in an emergency situation and help reduce any concerns or fears you may have about giving care. Your ability to perform specific skills competently will be checked by your instructor during the practice sessions. Your ability to make appropriate decisions when faced with an emergency will be enhanced as you participate in the class activities. Periodically, you will be given situations in the form of scenarios that provide you the opportunity to apply the knowledge and skills you have learned. These scenarios also provide an opportunity to discuss with your instructor the many different situations that you may encounter in any emergency. Requirements for American Red Cross Certification By taking this course, you will be eligible for American Red Cross certification in Responding to Emergencies: Comprehensive First Aid/CPR/AED. Red Cross certification means that on a particular date an instructor verified that a participant demonstrated competency in all required skills taught in the course. Competency is defined as being able to demonstrate correct decision making, sequence care steps properly, and proficiently complete all required skills without any coaching or assistance from the instructor or another participant. Responding to Emergencies | x | About This Course To obtain certification, you must: ■■ Attend and participate in all class sessions. {{ Note: If a participant must miss a session, the instructor should assign the appropriate make-up work to cover the course material missed during the participant’s absence. ■■ Participate in all skill sessions. ■■ Demonstrate competency in all required skills and scenarios. ■■ Pass each section of the written exam with a score of 80 percent or better. If this course is taught at a college or university, there may be additional academic requirements, such as graded quizzes and other assignments, in order to pass this course. Your instructor will explain these requirements to you. How to Use This Textbook 16 This textbook has been designed to facilitate your learning and understanding of the knowledge and skills required to effectively respond to emergency situations. The following pages graphically point out the features of this textbook so that you may use them to your best advantage. POISON ING Learn and Respond c Every chapter opens with a brief scenario that presents an event involving some aspect of the chapter content. The scenario in Learn and Respond will be used to answer the application questions at the end of the chapter, entitled Ready to Respond? Responding to Emergencies | Y ou stop by your cou sin’s house to drop off some things for party later that even a family ing. Your cousin answ ers the door and expl that they are in the ains middle of cleaning the bathroom. Afte you to drop the thin r directing gs you’ve brought in the kitchen, your upstairs to finish. cousin heads back That’s when you hea r a cry out, “Oh no! cousin’s 3-year-old Sophia!” Sophia is daughter, and whe your n you run up to see cousin is wiping som what’s wrong, your ething from Sophia’s mou th and looking distr is seated next to essed. Sophia the cleaning supp lies that were left on the floor. Learn and Respon d xi | About This Course Objectives c OBJ ECT IVE S After reading this ■ At the beginning of each chapter is a bulleted list of objectives. Each item describes something you should know or be able to do after reading the chapter and participating in class activities. Read this list carefully, and refer back to it as you read the chapter. These objectives form the basis for the testing and assessment that will determine your mastery of the material. A list of key terms with their definitions also appears at the beginning of each chapter. You need to know these key terms and their meanings to understand the material in the chapters. These key terms are printed in boldface italics the first time they are explained in the chapter and also appear, defined, in the Glossary, located in the back of the textbook. Additional glossary terms appear in boldface within the chapter content. ____ Using your ition. age c. Pressure band e. Arteries d. Internal bleeding f. Veins y pressure on gloved hand to appl ____ Bleeding that can be seen com of bloo ____ The escape place ____ A tight band a wound the wound to cont ing from a wound d from an artery, d around an arm g. Tourniquet vein or capillary insid or leg to constrict rol bleeding e the body blood vessels in orde r to stop blood flow to to the heart all parts of the body that carry blood from the cells for distribution to d to the capillaries d to control bleeding sure on the woun ly to maintain pres snug ied appl A bandage ____ Blood vessels transport bloo ____ Vessels that ____ and 2. List two signs to 3. Describe how symptoms of seve re, life-threatenin control severe, life-t and 4. List five signs ■ KEY TER MS 26 | Before Giving Care b Study Questions correct defin each term with the b. Direct pressure Identify two ways Responding to Emer gencies | Study Questions a. External bleeding ld be able to: that must be pres ent for disease trans mission to occur. in which a pathogen can enter the body . Describe how to minimize the risk of disease transmiss involves visible bloo ion when giving care d. in a situation that ■ Describe the diffe rence between cons ent and implied cons ent. ■ Describe the purp ose of Good Sam aritan laws. ■ List three situations in which moving a person is necessary . ■ List seven limitations you should be awar e of before you attem ■ pt to move someone. Describe five ways to move a person. After reading this chapter and com pleting the class activities, you shou ■ ld be able to: Demonstrate how to remove disposab le latex-free glove s. ■ Abandonment: Ending the care of an injured or ill pers or without ensuring on without obtaining that someone with that person’s cons equal or greater train ent ing will continue Consent: Permissio care. n to receive emergen or nonverbally. cy care granted by a competent adult either verbally Direct contact tran smission: Mode of transmission of touching infected path blood or other pote ntially infectious mate ogens that occurs through directly chemicals, drugs or toxins. rials (OPI M), or othe r agents such as Disease transmis sion: The passage of a disease from one person to anot Implied consent: her. Legal concept that assumes a person if they were able or old enough to would consent to do so. receive emergency care Indirect contact transmission: Mod e of transmission touches objects that of pathogens that have the blood or occurs when a pers other potentially infec person, and that on infected blood or tious mate rials OPIM enters the body through a corre (OPI M) of an infected OPI M: Other pote ct entry site. ntially infectious mate rials such as body fluids (other than Personal protectiv blood). e equipment (PPE responder from direc ): The equipment and supplies that tly contacting infec help prevent the ted materials; inclu protective eyewear. des gloves, gowns, masks, shields and Standard precauti ons: Safety meas ures giving care to injure d or ill persons; assu taken to prevent exposure to bloo d and OPIM when sweat) are potentiall mes that all body fluids, secretions y infective. and excretions (exce pt Key Terms c 1. Match chapter, you shou List four conditions g external bleeding hreatening external symptoms of seve . At the end of each chapter is a series of study questions designed to test your retention and understanding of the chapter content and key terms. Completing these questions will help you determine how well you understand the material and also help you prepare for the final written exam. The answers to Study Questions are located in the Appendix of this textbook. bleeding. re internal bleeding . er question 5. nd on scenario to answ are standing arou A few spectators h flies several feet, game is in progress. grip on the bat, whic morning baseball e the leg was ball, he loses his wher curve The usual Saturday skin a at The g leg. swin Milo takes a nd, clutching his the sidelines. As s drops to the grou on the thigh. Chri hitting Chris hard begins to swell. ly becomes red and struck immediate has? s Chri suspect bleeding do you 5. What type of Use the following For question 6, circle the letter of the corre deep 6. A child has a do first? cut on their arm. a. Have someone call 9-1-1 or the designated er. emergency numb Answers are liste ct answer. The child’s face b. Apply a hemosta dressing to the wound. d in the Appendi tic is moist and very c. Place a cold pack on the affected arm. pale. What would you d. Apply pressure at the closest pressure point. x. gencies | Responding to Emer 149 | Bleeding Responding to Emergencies | xii | About This Course wit rs sh pause CPR until the ons should hover zing, the responde e the AED is analy taking over compressi ons as soon as the responder who is to stand clear. Whil ly start compressi t compressions. The h roles every they can immediate take over giving ches onders then switc on’s chest so that advised. The resp just above the pers was k ioned shoc no posit s hand ered or that rs every 2 minutes. a shock was deliv rhythm, which occu AED prompts that zes the person’s heart time the AED analy Summary cardiac arrest are Heart attack and k and our communities. toms of a heart attac r health threat to the signs and symp cies present a majo t. If a person ning to recognize Cardiac emergen prevent cardiac arres help emergencies. Lear iac and card tions Survival mon the two com the risk of complica Cardiac Chain of ce the redu when and can rs ly cies occu diate rgen val responding imme toms of cardiac eme test chance of survi iac arrest, the grea the signs and symp experiences card learning to recognize ly as possible. By e. happens as rapid renc you can make a diffe how to give care, PON D? REA DY TO RES ed to respond to what you have learn scenario, and use Getz in the opening Think back to Mr. these questions: Mr. Getz’s collapse? lerosis have led to his collapse? g have prevented 1. Could atherosc stopping and restin t pain, how might experienced ches had Getz Mr. If 2. cardiac arrest? may be suffering Getz Mr. her rtant to know whet 3. Why is it impo not sustain his life? why will CPR alone in cardiac arrest, 4. If Mr. Getz is Table 6-2. continued b Ready to Respond? Special Situatio n Solution The person has a tracheostomy or “stoma,” a surgically created opening in the front of the neck that opens into the trachea (windpipe ) to form an alternate route for breathing when the upper airway is blocked or dam aged. This feature includes application questions to challenge you to apply the information you have learned in the chapter and build a solution. The questions are based on the Learn and Respond scenario that appears at the beginning of the chapter. Answers to these questions can be found in the Appendix of this textbook. Use mouth-to-stom a breathing instead. Expose the person’s neck dow n to the breastbo ne and remove anything covering the stoma (e.g., a filter or stoma cover). Wipe away any secretions from the stoma. Make a complete seal over the pers on’s stoma or tracheostomy tube with your mouth and 1 second to make blow in for the chest rise. ■ If the chest does not rise, the trach eostomy tube may be bloc ked. Remove the inner tube and try rescue brea ths again. ■ gencies | Responding to Emer 99 ies | Cardiac Emergenc What If…? c This feature appears throughout each chapter and offers answers to some of the questions that participants may have as they learn about how to react in an emergency, especially regarding unexpected situations that may arise as you give care and information on how to deal with them. m by calling ting the EMS syste 9-1-1 emergency or the designated What if… I am givin g chest compressions to a person in card iac arrest and I hear In the adult popu a rib crack? lation, particularly among older adul a complication of ts, rib and sternal CPR. (breastbone) fract hear a cracking soun Making sure you use proper hand ures can be placement can minim d and begin to feel ize this risk. If you your hand position crepitus (grinding ) while compressing do and correct it as needed. Try to also the chest, reassess CPR—namely, savin remember that the g a life—outweigh potential benefits the unpleasantne a life-threatening of ss of a broken rib, injury. which in most case s is not What if… During CPR I lose count of the number of or less than the reco chest compressions mmended 30 com I am performing and pressions? do more While 30 compres sions is the recomme and 32 chest com nded amount, perfo pressions in anot rmin g 28 chest compressions her cycle is not goin Rather, what is impo in one cycle g to hurt the pers rtant are the ches on’s chances of surv t compression rate be between 100 ival. and 120 compres and depth, which, sions per minute for an adult, shou any interruptions. and at least 2 inch ld es deep, while minim izing Giving CPR to a Child Giving CPR to a child is very simil ar to giving CPR tilting the head to to an adult. However, a slightly past-neu in a child, you open tral position, rathe than compressing the airway by r than to a past-neu the chest to a dept tral position (see h of to a depth of abou Table 6-1). Rather t 2 inches for a child at least 2 inches as you would for an adult, you com . Also, for a small one hand, instead press the chest child you may only of two. The rate of need to give com chest compressions 100 and 120 com pressions with for a child is the same pressions per minu te. as it is for an adult —between number. Activa itself. situation resolves takes over or the a life or make EMS arrives and help that can save Giving care until nder can provide below for an a trained lay respo The EMS System es of an emergency, anent disability. See perm and ery In the first few minut ency. en a complete recov nding to an emerg respo in als the difference betwe ssion played by profe overview of the roles ■ ■ Responding to Emer gencies | The EM S System If you hear or feel air escaping from the person’s mouth or nose, the person is a partial neck breather (i.e., there is still a conn ection between the trach ea and the upper airway, and although the pers on breathes main ly through the stoma, they are also able to breathe some extent throu to gh the mouth and nose). Seal the person’s mou th and nose with your hand or a tight-fitting mask so that air does not escape out of the mouth or nose when you give rescue breaths into the stom a. 93 | Cardiac Emergenc ies er vices Dispatch rgency Medical Ser work in emergency tchers (EMDs), y medical dispa ly determines known as emergenc , an EMD receives the call and quick EMS call takers, also dialed services (EMS) gency medical rs. When 9-1-1 is ospital communications cente then dispatches the appropriate emer of training in preh levels and nized d recog medical what help is neede e the four nationally advanced emergency , includ nnel icians perso techn al provide medic personnel. EMS d EMDs and can nders, emergency traine respo are al tchers medic of dispa care: emergency nnel arrive. increasing number An perso . EMS edics until param technicians and how to perform CPR, to help, including instructions on how Eme der ical Respon gency medical spital care is the emer care to of training for preho to give emergency ally recognized levels d and skills needed a more highly traine The first of four nation basic knowledge ed to give care until ). EMRs have the e ill. They are certifi responder. responder (EMR first becom have called be who to d or g used people who are injure This level of trainin s. arrive EMT— as an professional—such Emergency Med nician ical Tech Emergency Med cation of training. Their certifi next highest level is initially (EMTs) have the the responder who cal technicians over the care from ort. Emergency medi training. EMTs take patient for transp ely 150 hours of and preparing the izing involves approximat stabil on scene, and work at the emergency an Medical Technici cy , which training than EMTs Ts) receive more and perform some technicians (AEM ving medications gency medical d number of lifesa Advanced emer IVs, administer a limite insert to them allows of care procedures. This level advanced airway . EMT-Intermediate used to be called Advanced Emergen b Sidebars Feature articles called sidebars enhance the information presented in the main body of the textbook. They present historical and current information and events that relate to the content of the chapter. Paramedic g more in-depth trainin Paramedics have health are considered allied than AEMTs and also perform more professionals. They other prehospital any than dures invasive proce paramedics also give care provider. Some as part unity-based care nonemergency comm unity paramedicine and comm of state and local care programs. health ated mobile integr encies | Responding to Emerg 5 Two of the most comm on categories of food poisoning typically poisoning are bacte occurs when bacte rial and chemical ria grow on food that cooked, which releas food poisoning. Bacte is allowed to stand es toxins into the rial food at room temperature food. Foods most and dairy or dairylikely to cause bacte based foods. Chem after being rial food poisoning ical food poisoning such as fruit juices are meats, fish typically occurs when or sauerkraut, are stored in containers foods with high acid metal pans. Anoth lined with zinc, cadm er primary source content, of ium or copper or chemical food poiso that supply drinking in enameled ning is lead, which and cooking water is sometimes found . Mercury, a heavy shellfish, such as in metal, can also be shark and swordfish, a source of food poiso older pipes are a major dietar from other dietary y source of mercu ning. Fish and items and contact ry. However, mercu with mercury metal ry can also come or its compounds Two of the most comm (e.g., a mercury therm on causes of food ometer). raw eggs) and Esche poisoning are Salm onella bacteria (most richia coli (E. coli) (most often found The deadliest type often found in poultry and in raw meats and of food poisoning unpasteurized milk is botulism, which home canning. See and is caused by a bacte Smart Moves: Preve rial toxin usually assoc juices). nting Food Poiso ning to learn how iated with to avoid foodborne illnesses. | If Not You … Who? SMART MOVES PREVENTING FOO D POI SON ING By following the steps Clean, Separate, Cook illnesses from occur and Chill, you can ring. reduc Clean Wash hands thoro ughly with soap and runnin (for 20 seconds) g water before and after preparing or handl ing food; between handling raw and cooked foods ; and whenever handl food preparation ing surfaces, dishes and utensils. ■ Smart Moves Prevention Boxes c Applicable chapters include a boxed feature that outlines recommended preventive measures to avoid the injuries and/or illnesses discussed in the chapter. Wash all surfaces and utensils after each use. Wash fruits and veget ables, but not meat, poultry or eggs. ■ ■ Use separate cuttin g boards—one for produce and one for raw meat, poultry, seafood and eggs—as well as separate plates and utensils for cooked and raw foods. ■ Cook ■ ■ Use a food therm ometer to make sure food is cooked to the prope r temperature (see www. foodsafety.gov for more details). Clean the thermometer after each use. Keep food hot after cooking, at a tempe rature of at least 140° F (60° C). ■ Keep meat, poultr y, seafood and eggs separate from other food in your grocery cart, when bagging and later at home in the refrig erator. Follow microwave directions to cook food thoroughly (to 165° F, or 74° C). If the instructions say to let food sit after microwaving, do so as it cook more completely. allows the food to Chill ■ Refrigerate perish able foods within 2 hours. Make sure your refrig erator and freeze r are at the right temperature : between 40° F (4° and 32° F (0° C) C) and at 0° F (−18° C) or below, respectively . ■ Never thaw or marin ■ Know when to throw SOURCE: FoodS afety.gov: Keep food safe: Check your Accessed Decem steps. http:// ber 2016. Responding to Emerg encies | xiii foodborne Separate ■ ■ Responding to Emergencies | e the likelihood of | About This Course ate foods on the count www.foodsafety.go 282 | Poisoning er. food out. v/keep/basics/ind ex.html. b Tables or Child oking in an Adult al Situations: Ch Table 7-1. Speci Solution Special Situation wrap your large for you to The person is too thrusts. give abdominal arms around to The person is obvi be pregnant. The person is in ously pregnant or a wheelchair. You are alone and choking. known to l thrusts. instead of abdomina Give chest thrusts behind the ts, position yourself To give chest thrus l thrusts. Place mina abdo for d person as you woul center of the your fist against the the thumb side of fist with your ne. Then cover your person’s breastbo g a quick straight back, givin pull and hand r othe on’s chest. pers the into t inward thrus Give chest thrusts instead of abdomina Tables are included in many chapters. They summarize key concepts and information and may aid in studying. l thrusts. that ts in the same way Give abdominal thrus who is standing. It may on you would for a pers lchair. If l behind the whee to give be necessary to knee ult diffic it lchair make features of the whee chest thrusts instead. give abdominal thrusts, cy number designated emergen Call 9-1-1 or the ile phone. a GPS-enabled mob will using a landline or speak, the open line to able not are Even if you . Give yourself help send to er cause the dispatch just as if you s, hand your using abdominal thrusts, her person. minal thrusts to anot were giving abdo abdomen over and press your of a chair Alternatively, bend such as the back ct, obje firm p any against anything with a shar over bend not Do or a railing. and be careful you, hurt t migh edge or corner that ted. eleva is that a railing when leaning on gencies | Responding to Emer 126 gencies | Breathing Emer Skill Sheet 8-2 Using a Commercia l Tourniquet Note: Always follo w the manufacturer ’s instructions when applying a tourn iquet. 1. Skill Sheets c ▼ 2. At the end of certain chapters, Skill Sheets are available to give step-by-step directions for performing specific skills. Learning specific skills that you will need to give appropriate care for a person with an injury or sudden illness is an important part of this course. Photographs enhance each skill sheet. Place the tourniqu et around the limb , approximately 2 inches above the wound. Avoi d placing the tourniquet over a joint. Secure the tourniqu et tightly in plac e according to the manufacturer ’s instructions. ▼ 3. Tighten the tour niquet by twisting the rod until the flow of bright red blood stops. ▼ 4. Secure the rod in place using the clip or holder. ▼ 5. Note and record the time that you applied the tourniquet and give this information to EMS personnel when they arrive. ■ Once you apply a tourniquet, do not loosen or remove it. ■ Responding to Emer gencies | Responding to Emergencies | xiv 151 | Bleeding | About This Course Five Steps to Success: Study Tips While Using This Textbook You should complete the following five steps for each chapter to gain the most from this textbook while studying from it: 1. Read the chapter Objectives before reading the chapter. 2. As you read the chapter, keep the Objectives in mind. When you finish, go back and review them. 3. Review figures and illustrations. Read captions and labels. 4. Answer the Ready to Respond? questions at the end of each chapter. Check your answers with those in the Appendix. If you cannot answer or do not understand the answers given, ask your instructor to help you with concepts or questions with which you are having difficulty. 5. Answer the Study Questions at the end of each chapter. Answer as many questions as you can without referring to the chapter. Then review the information covering any questions you were unable to answer, and try them again. Check your responses to the questions with the answers in the Appendix. If you have not answered a question appropriately, reread that part of the chapter to ensure that you understand why the answer is correct. This exercise will help you gauge how much information you are retaining and which areas you need to review. If, after rereading that part of the chapter, you still do not understand, ask your instructor to help you. Responding to Emergencies | xv | About This Course PART ONE Introduction 1 2 3 If Not You … Who? Responding to an Emergency Before Giving Care 1 IF NOT YOU … WHO? Y ou and several friends are driving home after a softball game, when your lively game recap is suddenly interrupted by the sound of crashing metal. As you approach the intersection, you see a car that has swerved off the road and into a tree in an attempt to avoid another car that ran through the stop sign. You pull over a safe distance away from the crash and get out. As you approach the scene, you notice that the windshield is damaged. You can also see that the driver is motionless and bleeding from the forehead. Learn and Respond OBJECTIVES After reading this chapter, you should be able to: ■■ Describe two types of emergencies that require first aid. ■■ Describe your role in an emergency situation. ■■ Identify the most important action(s) you can take in an emergency. ■■ List six reasons that may prevent people from being willing to act in an emergency. ■■ Identify five ways bystanders can help at the scene of an emergency. ■■ Recognize the signs and symptoms of incident stress and when you may need help to cope. KEY TERMS Advanced emergency medical technician (AEMT): A person trained to give basic and limited advanced emergency medical care and transportation for critical and emergent patients who access the emergency medical services (EMS) system. Emergency: A situation requiring immediate action. Emergency medical dispatcher (EMD): A telecommunicator who has received special training to respond to a request for emergency medical services via 9-1-1 or a designated emergency number and to allocate appropriate resources to the scene of an emergency. Some EMDs are trained to provide prearrival medical instructions to a responder before emergency medical services (EMS) personnel arrive. Emergency medical responder (EMR): A person trained in emergency care who may be called on to give such care as a routine part of their job until more advanced emergency medical services (EMS) personnel take over. EMRs often are the first trained professionals to respond to emergencies; also called “first responders.” Emergency medical services (EMS) personnel: Trained and equipped community-based personnel who give emergency care for injured or ill persons and who are often dispatched through 9-1-1 or a designated emergency number. Emergency medical services (EMS) system: A network of professionals linked together to give the best care for people in all types of emergencies. Emergency medical technician (EMT): A person who gives basic emergency medical care and transportation for critical and emergent patients who access the EMS system. EMTs are typically authorized to function after completing local and state certification requirements; formerly referred to as EMT-Basic. First aid: The helping behaviors and initial care given for an acute injury or illness. Good Samaritan laws: Laws that protect people against claims of negligence when they give emergency care in good faith without accepting anything in return. Injury: Damage that occurs when the body is subjected to an external force, such as a blow, a fall, a collision, an electrical current or temperature extremes. Lay responder: A layperson who is not trained to provide first aid, but who recognizes an emergency and decides to act. (Continued) Responding to Emergencies | 3 | If Not You … Who? KEY TERMS continued Life-threatening emergency: An injury or illness that impairs a person’s ability to circulate oxygenated blood to all parts of the body and will likely cause death if not cared for immediately. Non-life-threatening emergency: A situation that does not have an immediate impact on a person’s ability to circulate oxygenated blood but still requires medical attention. Paramedic: An allied health professional whose primary focus is to give advanced emergency medical care for critical and emergency patients who access the EMS system. Paramedics may also give nonemergency, community-based care based on state and local community paramedicine or mobile integrated healthcare programs. Prehospital care: Emergency medical care given before a person arrives at a hospital or medical facility. Sudden illness: A physical condition requiring immediate medical attention. Trained lay responder: A layperson who is trained in basic emergency care (i.e., trained to give first aid), but who does not have special or advanced medical training, and is willing to act in an emergency. Introduction An emergency is a situation requiring immediate action. An emergency can happen at any place (on the road, in your home, where you work), to anyone (a friend, relative, stranger) and at any time. This text provides you with basic first aid information and skills so that you will be able to recognize and respond to any emergency appropriately by knowing how to give care to a person with an injury or sudden illness until more advanced care can be obtained. Your willingness to act and the care given may help save a life. Types of Emergencies There are two types of emergencies that require first aid: injury and sudden illness (usually referred to simply as illness). An injury is damage to the body from an external force, such as a broken bone from a fall. A sudden illness is a physical condition that requires immediate medical attention. Examples of sudden illness include a heart attack and a severe allergic reaction. Emergencies can be further categorized as life-threatening and non-life-threatening. A life-threatening emergency is an injury or illness that impairs a person’s ability to circulate oxygenated blood to all parts of the body and will likely cause death if not cared for immediately. A non-life-threatening emergency is a situation that does not have an immediate impact on a person’s ability to circulate oxygenated blood but still requires medical attention. You will learn more about caring for life-threatening and non-life-threatening emergencies as you progress through this text. Your Role in an Emergency The emergency medical services (EMS) system is a network of professionals linked together to give the best care for people in all types of emergencies. Think of the EMS system as a chain made up of several links. Each link depends on the others for success. Without the involvement of trained lay responders such as you, the EMS system cannot function effectively. As a trained lay responder, your primary role in an emergency includes: ■■ Recognizing that an emergency exists. ■■ Being willing to act. Responding to Emergencies | 4 | If Not You … Who? ■■ Activating the EMS system by calling 9-1-1 or the designated emergency number. ■■ Giving care until EMS arrives and takes over or the situation resolves itself. In the first few minutes of an emergency, a trained lay responder can provide help that can save a life or make the difference between a complete recovery and permanent disability. See The EMS System below for an overview of the roles played by professionals in responding to an emergency. The EMS System Emergency Medical Services Dispatcher EMS call takers, also known as emergency medical dispatchers (EMDs), work in emergency communications centers. When 9-1-1 is dialed, an EMD receives the call and quickly determines what help is needed and then dispatches the appropriate emergency medical services (EMS) personnel. EMS personnel include the four nationally recognized levels of training in prehospital care: emergency medical responders, emergency medical technicians, advanced emergency medical technicians and paramedics. An increasing number of dispatchers are trained EMDs and can provide instructions on how to help, including how to perform CPR, until EMS personnel arrive. Emergency Medical Responder The first of four nationally recognized levels of training for prehospital care is the emergency medical responder (EMR). EMRs have the basic knowledge and skills needed to give emergency care to people who are injured or who have become ill. They are certified to give care until a more highly trained professional—such as an EMT—arrives. This level of training used to be called first responder. Emergency Medical Technician Emergency medical technicians (EMTs) have the next highest level of training. Their certification involves approximately 150 hours of training. EMTs take over the care from the responder who is initially at the emergency scene, and work on stabilizing and preparing the patient for transport. Advanced Emergency Medical Technician Advanced emergency medical technicians (AEMTs) receive more training than EMTs, which allows them to insert IVs, administer a limited number of lifesaving medications and perform some advanced airway procedures. This level of care used to be called EMT-Intermediate. Paramedic Paramedics have more in-depth training than AEMTs and are considered allied health professionals. They also perform more invasive procedures than any other prehospital care provider. Some paramedics also give nonemergency community-based care as part of state and local community paramedicine and mobile integrated healthcare programs. Responding to Emergencies | 5 | If Not You … Who? Preparing for an Emergency 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 textbook and participating in this American Red Cross Responding to Emergencies (RTE) 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 or community setting. Download the American Red Cross First Aid app to your mobile device so that you always have a first aid reference at your fingertips. Box 1-1. First Aid Kits You can purchase first aid kits and supplies from the Red Cross store (http://www.redcrossstore. 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 disposable latex-free gloves ■■ Latex-free adhesive bandages (3 of each of the following sizes): {{ 1 × 3 inches {{ Large fingertip {{ ¾ × 3 inches {{ Knuckle ■■ 8 sterile gauze pads (2 × 2 inches) ■■ 8 sterile gauze pads (4 × 4 inches) ■■ 1 roll of adhesive cloth tape (2½ yards × 3⁄8 inch) ■■ 4 roller bandages (2 inches or 3 inches × 4 yards) ■■ 4 roller bandages (4 inches × 4 yards) ■■ 1 elastic bandage (3 inches or 4 inches × 5 yards) ■■ 3 or 4 triangular bandages (40 inches × 40 inches × 56 inches) ■■ 1 36-inch malleable radiolucent splint ■■ 1 unit antibiotic ointment, cream or wound gel ■■ 4 sealable plastic bags (1 quart) or 2 chemical cold packs ■■ 5 antiseptic wipe packets ■■ 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 (non-mercury/non-glass) ■■ 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. Responding to Emergencies | 6 | If Not You … Who? 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 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. Also include the numbers for the police department, fire department and the national Poison Help line (1-800-222-1222) on your list. Teach everyone in your home how and when to use these numbers. 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 large, easy to read and well lit at night. Numerals are easier to read than spelled-out numbers. ■■ Keep relevant medical information, such as a list of the medications that each family member takes, in an accessible place (for example, on the refrigerator door and in your wallet or mobile phone). ■■ If you have a chronic medical condition such as diabetes, epilepsy or allergies, consider wearing a medical identification tag to alert responders to the presence of the condition in case you are not able to (Figure 1-1, A). You can also create a digital medical identification tag in your mobile phone that can be accessed without unlocking the phone (Figure 1-1, B). In addition to information about 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. A B Figure 1-1, A–B. A medical identification tag, A, or an app on your phone, B, can give responders important information about you in case you are not able to. Photos: N-StyleID.com Recognizing an Emergency The ability to recognize that an emergency has occurred is the first step toward taking appropriate action. You may become aware of an emergency from certain indicators, including: ■■ Unusual sounds. ■■ Unusual odors. ■■ Unusual sights. ■■ Unusual appearance or behaviors. Box 1-2 provides examples for each of these indicators. See also Figure 1-2. Your own personal safety is a top priority. Always put your own safety first if you smell an unusual or very strong odor because many fumes are poisonous. An unusual odor on a person’s breath may also be a clue to an emergency situation. A person experiencing a diabetic emergency, for example, may have a sweet breath odor that can be mistaken for the smell of alcohol. You will learn about diabetic emergencies in Chapter 15. It may also be difficult to tell if someone’s appearance or behavior is unusual, particularly if it is a stranger. If you see someone collapse to the floor, they obviously require your immediate attention. You will not know if your help is needed until you check the scene and approach the person. The person may merely have slipped and may not need your immediate help. On the other hand, the person may be unresponsive and need immediate medical assistance. Responding to Emergencies | 7 | If Not You … Who? Box 1-2. Signs of an Emergency Unusual Sounds Unusual Odors ■■ Screaming, moaning, yelling or calls for help ■■ A foul or unusually strong chemical odor ■■ Sudden, loud noises such as breaking glass, crashing metal or screeching tires ■■ The smell of smoke ■■ The smell of gas A change in the sound(s) made by machinery or equipment ■■ An unrecognizable odor ■■ An inappropriate odor (e.g., a sickly sweet odor on a person’s breath) ■■ ■■ The sound of an explosion or falling ladder ■■ Unusual silence Unusual Appearance or Behaviors Unusual Sights ■■ Unresponsiveness ■■ Confusion, drowsiness or unusual behavior ■■ Personality or mood changes (e.g., agitation in a person who is normally calm or irritability in a person who is normally pleasant) ■■ A stopped vehicle on the roadside or a car that has run off the road ■■ Downed electrical wires ■■ Sparks, smoke or fire ■■ Trouble breathing ■■ A person who collapses or is lying motionless ■■ Sudden collapse, slip or fall ■■ Signs or symptoms of injury or illness, such as profuse sweating for no apparent reason or an uncharacteristic skin color ■■ Clutching the chest or throat ■■ A person doubled over in pain ■■ Slurred, confused or hesitant speech ■■ Sweating for no apparent reason ■■ Uncharacteristic skin color ■■ Inability to move a body part ■■ Spilled medication or an empty medication container ■■ An overturned pot in the kitchen Responding to Emergencies | 8 | If Not You … Who? 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 and be willing to act 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. Willingness to Act Sometimes people recognize an emergency but are reluctant to act. People have various reasons for hesitating or not acting. Common reasons people give for not acting include: ■■ Being uncertain that an emergency actually exists. ■■ Being afraid of giving the wrong care or inadvertently causing the person more harm. ■■ Assuming that the situation is already under control. ■■ Squeamishness related to unpleasant sights, sounds or smells. ■■ Fear of catching a disease. ■■ Fear of being sued. Figure 1-2. Unusual sounds, sights or behaviors are some of the indicators of an emergency. Responding to Emergencies | 9 | If Not You … Who? 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 exists. Sometimes people hesitate to take action because they are not sure that the situation is a real emergency and do not want to waste the time of the EMS personnel. If you are not sure what to do, err on the side of caution and call 9-1-1 or the designated emergency number. ■■ Being afraid of giving the wrong care or inadvertently causing the person more harm. Getting trained in first aid can give you the confidence, knowledge and skills you need to respond appropriately to an emergency. If you are not sure what to do, call 9-1-1 or the designated emergency number and follow the EMS dispatcher’s instructions. The worst thing to do is nothing. ■■ ■■ 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 (Figure 1-3). 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. 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 disposable latex-free 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. For more information on Good Samaritan laws, see Chapter 3. Squeamishness related to unpleasant sights, sounds or smells. Many people feel faint or nauseated when confronted with upsetting sights, sounds or smells, such as Figure 1-3. A bystander can help you respond to an emergency in many ways. Responding to Emergencies | 10 | If Not You … Who? What if… I really don’t know what is wrong with the person I am trying to help, or how serious their injury is? Lay responders decide not to act for many reasons; fear of not knowing what to do or of doing something wrong is normally at the top of the list. Rest assured, however, that regardless of your knowledge and skill level, you can always help by taking one simple but important step in an emergency: calling 9-1-1 or the designated emergency number. After that, if you are uncomfortable with actually performing any emergency care, providing comfort and reassurance and controlling the scene would be the next best things you can do. What if… I mistakenly call 9-1-1 or the designated emergency number from a landline phone? In either case if you were to dial 9-1-1 accidentally—do not hang up! Instead, explain to the call taker what happened. In the case of a call coming in on an E9-1-1 line, if you were to hang up before speaking with the call taker, it would trigger an automatic call back. If the dispatcher was unable to reach anyone, appropriate personnel would be sent to investigate the situation, potentially tying up valuable resources. What if… I only have a mobile phone at home, and not a landline? Will I still have access to 9-1-1? Yes. Throughout the United States, mobile phones can access the 9-1-1 system as long there is a wireless signal. Most wireless public safety answering points (PSAPs) have the ability to locate the phone’s location, but this can take some time so it is critical to tell the call taker your exact location to speed up the response. Finally, if you do need to call 9-1-1, remember not to hang up until you are sure the dispatcher has all of the information necessary to send help to exactly where it is needed. Your willingness 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 if it is warranted. Activating the EMS System Calling 9-1-1 or the designated emergency number is the most important action you and other trained lay responders can take in an emergency. Early arrival of EMS personnel increases the person’s chances of surviving a life-threatening emergency. Remember, some facilities, such as hotels, office and university buildings and some stores, require you to dial a 9 or some other number to get an outside line before you dial 9-1-1 (e.g., 9-9-1-1). There are also a few areas that still are without access to a 9-1-1 system and use either a 7- or 10-digit emergency number instead. Becoming familiar with your local system is important so you are ready when an emergency occurs. When you dial 9-1-1 or the designated emergency number, your call will normally be answered by a 9-1-1 call taker. It is important to stay calm and listen to the call taker’s questions. The most important information you can share with the call taker is the location of the emergency so that public safety resources can be dispatched while other information is gathered and any prearrival instructions can be given. Based on the nature of the emergency, you may be transferred by the call taker to an EMD or a dispatcher, if appropriate. The EMD will ask you a series of questions in order to ensure that the most appropriate response is sent to the location of the emergency. You should not hang up until directed by the EMD. Once EMS personnel are on the way, the EMD may stay on the line and give you prearrival instructions to assist you with lifesaving techniques until EMS personnel take over (Figure 1-4). Responding to Emergencies | 11 | If Not You … Who? Figure 1-4. Many EMDs give prearrival instructions for what to do before EMS personnel arrive. Giving Care Until Help Arrives There are many actions you, other trained lay responders or bystanders can take before EMS personnel arrive. Always follow the prearrival instructions provided by the EMD. These instructions may range from taking actions that make the scene safer and more accessible to EMS personnel (e.g., confining household pets, turning on extra lights, gathering the person’s medications) to giving care. You will learn to give more advanced care for an injured or ill person as you progress through this course. In general, you should give appropriate care to an injured or ill person until one or more of the following occurs: ■■ ■■ Another trained responder or EMS personnel take over. You are alone and you need to call 9-1-1 or the designated emergency number after giving initial care in a Care First situation (see Box 2-3 in Chapter 2). ■■ You are too exhausted to continue. ■■ The scene becomes unsafe. ■■ The person you are helping is awake and alert and asks you to stop giving care. Incident Stress After responding to an emergency involving a serious injury, illness or death, it is not unusual to experience acute stress. Sometimes, people who have given first aid or performed CPR in these situations feel that they are unable to cope with the stress. This feeling is known as incident stress. If not appropriately managed, this acute stress may lead to a serious condition called post-traumatic stress disorder. Responding to Emergencies | 12 | If Not You … Who? Signs and Symptoms of Incident Stress Reactions Some effects may appear right away, whereas others may take longer to develop. Signs and symptoms of incident stress include: ■■ Anxiousness and inability to sleep. ■■ Depression. ■■ Nightmares. ■■ Anger. ■■ Restlessness and other problems. ■■ Nausea. ■■ Confusion. ■■ Change in interactions with others. ■■ Lower attention span. ■■ Increased or decreased eating. ■■ Poor concentration. ■■ Uncharacteristic, excessive humor or silence. ■■ Denial. ■■ Unusual behavior. ■■ Guilt. ■■ Difficulty performing one’s job. Coping with Incident Stress Incident stress may require professional help to prevent post-traumatic stress from developing. Other things that you may do to help reduce stress include using relaxation techniques, eating a balanced diet, avoiding alcohol and drugs, getting enough rest, and participating in some type of physical exercise or activity. If you recognize these signs or symptoms in yourself or another responder, it is important to seek help from a trained mental healthcare professional. Summary An emergency can happen at any place, to anyone and at any time. The EMS system is a network of community resources and medical personnel that give emergency care to injured or ill persons. However, the EMS system cannot function properly without the actions of a trained lay responder like you. By learning to recognize an emergency and, more importantly, being willing to act (calling 9-1-1 or the designated emergency number and giving care), you can help save the life of a person with an injury or sudden illness. Once you have taken care of the injured or ill person, remember to also consider your own feelings about the emergency situation and take signs and symptoms of incident stress seriously if any are present. In the following chapters, you will learn how to manage different kinds of emergencies. You will learn emergency action steps that you can apply to any emergency situation, and how to give care in both life-threatening and non-life-threatening situations. READY TO RESPOND? Think back to the car crash in the opening scenario, and use what you have learned to respond to these questions: 1. What immediate steps could you and your friends who were first on the scene at the car crash take? 2. As you approach the car and the injured person, you begin to feel faint and nauseated, and are not sure you can proceed any further. How can you still help? Responding to Emergencies | 13 | If Not You … Who? Study Questions 1. In each of the following three scenarios, circle the indicators of a potential emergency. a. I was fixing sandwiches and talking with my next-door neighbor, Mrs. Roberts, who had come by to borrow a book. My 3-yearold, Jenny, was in her room playing with some puzzles. As Mrs. Roberts got up to leave, I heard a loud thump and a shriek from upstairs. b. I was on the bus headed for work. A man from the back of the bus came down the aisle, and I noticed that he was moving unsteadily. It was cold in the bus, but I noticed he was sweating and looked very pale. “I don’t know where I am,” I heard him mumble to himself. c. On my way into the grocery store from the parking lot, I heard the loud screech of tires and the crash of metal. I saw that a car had struck a telephone pole, causing the telephone pole to lean at an odd angle. Wires were hanging down from the pole onto the street. It was very frightening. 2. List the six common fears or concerns that prevent people from taking action at the scene of an emergency. 3. How can a trained lay responder overcome any one of these fears or concerns listed in question 2? 4. Match each item with the correct phrase. a. First aid c. Emergency e. EMS system b. Lay responder d. Sudden illness f. Common fears and concerns ____ A situation requiring immediate action ____ A  network of community resources and medical personnel that gives emergency care to a person with an injury or sudden illness ____ Immediate care given to a person with an injury or sudden illness until more advanced care can be obtained ____ A physical condition, such as a heart attack, requiring immediate medical attention ____ A  layperson (someone who does not have special or advanced medical training or skill) who recognizes an emergency and is willing to act ____ Reasons for not acting or for hesitating to act in an emergency situation 5. Identify five ways bystanders can help at the scene of an emergency. Answers are listed in the Appendix. Responding to Emergencies | 14 | If Not You … Who? 2 RESPONDING TO AN EMERGENCY A s you arrive at your friend’s house one Saturday morning, you are surprised that your friend is not in his usual spot—in the driveway tinkering with the antique car he is currently restoring. It’s a little chilly today, though, and you hear music coming from the garage, so you figure your friend is in the garage. When you open the garage door to say hello, you are not prepared to find your friend lying on the floor apparently unresponsive. You need to do something, but what? Learn and Respond OBJECTIVES After reading this chapter, you should be able to: ■■ Identify and describe the three emergency action steps: CHECK—CALL—CARE. ■■ Explain when and how to call 9-1-1 or the designated emergency number. KEY TERM Emergency action steps: Three basic steps you should take in any emergency: CHECK—CALL—CARE. Introduction An emergency scene can be overwhelming. It poses questions that demand immediate answers. What should I do first? Where can I get help? What can I do to help the injured or ill person? By learning how to check an emergency scene and prioritize your actions, you will be able to respond effectively in any emergency situation. 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 Photo: Jonathan L. Epstein, MEMS Responding to Emergencies | 16 | Responding to an Emergency 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? ■■ What is your initial impression about the nature of the person’s injury or illness? ■■ What happened? ■■ How many people are involved? ■■ Is anyone else available to help? ■■ 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 2-1). 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. Box 2-1. 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 they 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. 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. Encourage the person to move toward safety by kicking their legs or stroking with their arms. Some people are able to reach safety by themselves with calm encouragement from a person on the deck or shore. Throwing assist. A throwing assist involves throwing a floating object to the person so that they 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 be used instead. ■■ 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 them 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 Responding to Emergencies | 17 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. | Responding to an Emergency ■■ 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 they were 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 is also 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). ■■ What is your initial impression about the nature of the person’s injury or illness? 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 injury or illness, such as unresponsiveness, trouble breathing or severe bleeding. If you see severe, life-threatening bleeding, use the resources available to you to control the bleeding as soon as possible (see Chapter 8). ■■ 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. What if… I am trying to help out an injured neighbor, but the family dog starts acting aggressively towards me when I enter the house? Should I try to enter anyway? An aggressive animal is complex and unpredictable, and the potential consequences of being attacked by such an animal can be serious. You should not risk becoming injured yourself, complicating the emergency further. Instead of continuing into the house, immediately call 9-1-1 or the designated emergency number from a safe place, and explain that you need to report an emergency and that there is an aggressive animal blocking your access to the injured person. The dispatcher will make sure that the appropriate resources are dispatched to the scene to handle the full situation safely and appropriately. The same would be true if you encountered downed power lines, falling rocks, fire, smoke or the like. What if… I am helping on the scene of a car crash in which a downed power line has fallen on someone’s car and is touching the ground? Should I help the person exit the car? No! The person should stay in the car. When a person is in the vehicle, they are not a part of the electricity’s path to the ground; therefore, the car is the safest place to be under the circumstances. Have the person wait in the car until public safety professionals or qualified electrical workers turn the power off. At the same time, you should stay in a safe location while waiting for help to arrive. Electricity can spread out through the ground in a circle from any downed line, making more than just the vehicle electrically charged. 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 alert, obtain consent (you will learn about consent in Chapter 3) and then begin to gather additional information about the nature of the person’s injury or illness. Chapter 5 provides more detail about how to check a person who is responsive. Responding to Emergencies | 18 | Responding to an Emergency 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 their 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. 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 2-2), 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. Call If you decide it is necessary to summon EMS personnel (see Box 2-2), 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 nearby intersections or landmarks if the address is not known) ■■ A description of what happened ■■ The number of injured or ill people ■■ The nature of the emergency (e.g., whether police, fire or medical assistance is needed) ■■ What help, if any, has been given so far, and by whom ■■ The telephone number of the phone being used ■■ Responding to Emergencies | 19 | Responding to an Emergency Box 2-2. 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 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 ■■ Persistent abdominal pain or pressure ■■ 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 a 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 PHOTO: Hammonds/Shutterstock.com The caller should stay on the phone until the dispatcher tells the caller it is all right to hang up. The dispatcher may need more information. Many dispatchers are also 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 2-3). 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. Responding to Emergencies | 20 | Responding to an Emergency Box 2-3. Call First or Care First? Most of the time, you will call first and then give care. But if you are alone, you must decide whether to call first or care first. I...
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