First Responders

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First Responders

• Langley City Fire Rescue Service

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Patient Assessment

• Scene assessment
• Primary survey
• Secondary Survey
• Reporting of data

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Scene Assessment

• Make a quick assessment of the overall situation
  at an accident scene. Concentrate on the big big
  picture.
• Consider three things
• Environment
• Hazards
• Mechanism of injury
• Look for anything that may threaten your safety
  and the safety of others, such as downed power
  lines, falling rocks, traffic, fire, smoke, etc.
• Do not move a casualty unless he or she is in
  immediate danger, If you must move the casualty,
  do so as quickly as possible.

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Mechanism Of Injury

• The mechanism of injury can alert you to the
  possibility that certain types of injuries may be
  present. For example, fractured bones are usually
  associated with falls and motor vehicle
  accidents, burns with fires, and soft tissue
  injuries with gunshot wounds.
• Remember, however, that for every obvious injury,
  there may be a number of hidden ones.

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Primary Survey

• The primary survey is conducted once dangers at
  the scene have been neutralized. It is the first
  step in the physical assessment and consists of
  the following
• Check of level of consciousness (LOC) as you
  approach the patient.
• Check of DABC (Delicate spine, Airway, Breathing,
  and Circulation)
• Rapid body survey (RBS) for external blood loss
  and deformities
• While conducting the primary survey, you may
  discover life- threatening emergencies such as
  obstructed airways, respiratory difficulties,
  external bleeding, and obvious shock. Treat these
  problems immediately.
• For your protection, wear disposable gloves
  whenever you might be handling blood, body
  fluids, or secretions.

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Perform A Primary Survey

• To perform a primary survey, you must be able to
  do the following
• Assess level of consciousness (LOC) using the
  AVPU method.
• Manage a delicate spine.
• Open and maintain the airway.
• Clear obstructions from the patients mouth.
• Open the airway.
• Correctly use an oral airway for unconscious.
• Suction the mouth cavity if required.
• Place unconscious patients and patients with
  compromised airways in the recovery position and
  monitor breathing.
• Continued

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• Assess and manage the patients breathing.
• Determine when a patient is not breathing
  adequately.
• Use a pocket mask to ventilate patients with
  inadequate breathing.
• Ventilate an infant using a pocket mask,
  connected to oxygen, and mouth-to-mask
  ventilation's.
• Use the bag-valve-mask-oxygen reservoir unit to
  ventilate patients with inadequate breathing.
• Assess and manage the patients circulation.
• Perform a rapid body survey (RBS).
• Perform a rapid body survey.
• Give oxygen at high flow (10 L/min) with a
  standard face mask.
• Describe the pathophysiology of hypoxic drive and
  the management of a COPD patient.

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Assess Level of Consciousness (LOC)

• Check for LOC as you approach the patient.
• The A,V,P,U method is a short and simple way to
  assess the LOC
• A - patient is Alert
• V - patient responds to Verbal stimuli
• P - patient responds to Pain
• (Use a trapezoidal squeeze to administer a
  painful stimulus.)
• U - patient is Unresponsive to verbal and painful
  stimuli
• A change in the level of consciousness is the
  first sign of a brain injury or other serious
  medical conditions.

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Manage A Delicate Spine

• Always assume that the patient has a neck or
  spine injury(delicate spine). You may rule it out
  after considering the mechanism of injury, bur
  always check for a delicate spine if the patient
  must be moved.
• If you suspect that the patient has a delicate
  spine, do the following
• Approach the patient from the head.
• Tell the patient, If you can hear me, dont
  move.
• Stabilize the head in the position found.
• Do not move the patient unless absolutely
  necessary to maintain an an open airway.
• When using the various grips remember to use the
  principles of STABLE to UNSTABLE

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Open and Maintain The Airway

• Airway management involves three things
• Opening the airway
• Maintaining the open airway
• Helping the patient breathe effectively
  (ventilation)
• Look, listen, and feel for the movement of air at
  the mouth and/ or nose. After an injury, a
  patients airway may become closed or blocked by
  teeth, the tongue, or foreign objects. check for
  5 seconds
• Continued

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• Before taking steps to open the airway, make sure
  you have ruled out a delicate spine or protected
  the neck. The technique you use will depend on
  whether or not the mechanism of injury indicates
  a delicate spine.
• To manage the airway, you must be able to do the
  following
• Clear obstructions from the patient's mouth.
• Open the airway.
• Correctly use an oral airway for unconscious
  patients.
• Suction the mouth cavity if required.
• Place unconscious patients and patients with
  compromised airway in the recovery position and
  monitor breathing.

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Clear Obstructions From The Patients Mouth And
Throat.

• Make sure your patients airway is clear before
  trying to open it. Remove foreign materials such
  as broken teeth, vomitus, fluid and mucus before
  attempting any further treatment. Use a
  crossed-over finger technique to open the
  patient's mouth, and do a visual check.

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Crossed-over Finger Technique
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Opening The Airway

• Open the airway after clearing foreign materials
  form the mouth. The tongue can easily act as a
  lid, closing down onto the back of the throat and
  making breathing impossible. To open your
  patients airway, you must lift the tongue up and
  off the back of the throat.
• NO NECK INJURY
• Use the Head-Tilt/Chin-Lift Method
• Do not use this procedure on any patient with
  neck or spinal injuries.
• NECK INJURY SUSPECTED
• Use the jaw thrust or modified jaw thrust
• If you suspect a neck injury, take care not to
  move the neck.

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Head-Tilt/Chin-Lift
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Modified Jaw Thrust Method
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Oral Airways

• Once the airway passage is clear and open, you
  must keep it open, especially if the patient is
  unconscious and cannot do it himself or herself.
  The oral airway (oropharyngeal airway), a hard
  plastic tube, is the ideal tool for this.
  Inserted correctly, it prevents the tongue from
  falling back and blocking the airway.

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Oral Airways For Unconscious Patients
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Moving Patients

• A general principle for First Responders is that
  patients should be cared for in the position
  found. This principle is based on the assumption
  that certain conditions or injuries (such as a
  neck fracture in an unconscious patient) can be
  hidden so that it is missed during initial
  assessment, and unnecessary movement may make the
  situation worse. However, there are three
  situations in which you, the First Responder,
  will have to move the patient
• Repositioning the patient to manage immediate
  ABCs.
• Moving patients as quickly as possible out of
  hazardous areas.
• Rescuing and transporting patients.

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Repositioning The Patients To Manage Immediate
ABCs

• Many patients are found in unusual or difficult
  positions. It may be necessary to move them in
  order to effectively assess or manage their
  ABCs.
• If you must move a patient, follow these
  principles
• Moves are best done with the help of two or more
  people.
• Although managing the ABCs is always a priority,
  try to minimize movement during urgent
  repositioning.
• Movement of the neck and spine is potentially
  more dangerous than moving an extremity.
• In an awake patient, increased pain with movement
  should limit your repositioning.

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Positioning The Patient

• In most cases, positioning of the patient is
  determined by patient comfort. If possible, the
  patient should be left in the position found.
  However, if moving the patient results in better
  patient care, consider the following options
• Semi-sitting
• Shortness of breath obese patients chest pain.
• Supine
• Suspected neck injuries patient with no radial
  pulse hip fractures.
• 3/4 Prone or Recovery Position
• All unconscious patients with no neck injury.
• All patients with airway problems that cannot be
  controlled by suctioning.

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Suction

• Suctioning the mouth cavity is another procedure
  used to keep the airway clear. Secretions and
  other debris are removed by applying negative
  pressure through a hollow tube. If you do not
  remove the debris, you may force it into the
  patients lungs during ventilation.

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Assess And Manage The Patients Breathing

• A patient may be breathing on his or her own but
  not doing so adequately. Do not wait for
  respiratory arrest before ventilating the
  patient.(below 10, and over 30).
• To assess and manage the patients breathing, you
  must be able to do the following
• Determine when a patient is not breathing
  adequately.
• Use a pocket mask to ventilate patients with
  inadequate breathing.
• Ventilate an infant using pocket mask, connected
  oxygen, and mouth-to-mask ventilation's.
• Use the bag-valve-mask-oxygen reservoir unit to
  ventilate patients with inadequate breathing.

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Determine When A Patient Is Not Breathing
Adequately

• A patient is not breathing adequately if he or
  she has fewer than 10 respirations per minute
  and/ or shows some or all of the following signs
  of hypoxia (low oxygen level in the blood)
• agitation
• irritability
• drowsiness
• headache
• decreased level of consciousness
• rapid pulse
• labored breathing
• abdominal breathing
• bluish skin color
• irregular heartbeat

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BVM

• The bag-valve-mask-oxygen reservoir (BVM) unit
  allows you to ventilate a patient by moving
  enriched, oxygenated air into the lungs and
  removing carbon dioxide.
• The unit consists of the following
• oxygen reservoir
• a bag
• a non-return valve(to prevent rebirthing)
• an anesthetic-type mask of various sizes (the
  pocket mask may also be used with this unit)
• an inlet for oxygen delivery

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Circulation - Radial Pulse
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Circulation - Carotid Pulse
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Causes of Cardiac Arrest

• heart attack
• electric shock
• drowning
• asphyxiation
• sensitivity reaction

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Compression Rates

• One person adult CPR 15 compressions - 2
  ventilation
• Two person adult CPR 5 compressions - 1
  ventilation
• One person child CPR 5 compressions - 1
  ventilation
• Two person child CPR 5 compressions - 1
  ventilation
• One person infant CPR 5 compressions - 1
  ventilation

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Perform A Rapid Body Survey (RBS).

• The rapid body survey will help you to locate and
  expose injury sites, stabilize fractures, and
  control bleeding.
• You should be able to accomplish the following
• Perform a rapid body survey.
• Give oxygen at high flow (10 L/min) with a
  standard face mask.
• Describe the pathophysiology of hypoxic drive and
  the management of a COPD patient.

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Rapid Body Survey

• Check for bleeding, deformity, and your patients
  response to pain by systematically running your
  hands over and under the following
• head and neck
• chest and abdomen
• back
• lower extremities
• upper extremities
• You should take no more than 30 seconds to
  perform a rapid body survey. It should be
  interrupted only long enough to provide
  intervention for life-threatening injuries.

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Oxygen Flow Rates

• 5 Litres per minute
• COPD Patients (No Trauma)
• 10 Litres per minute
• All trauma patients
• Medical emergencies
• 15 Litres per minute
• Smoke and/ or gas inhalation
• Carbon monoxide poisoning

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Oxygen Delivery Masks

• Bag-Valve-Mask (BVM)
• Assist patients patients with inadequate
  respiration's.
• Hyperventilate unconscious patients with head
  injuries.
• Pocket Mask
• CPR-on-the-move.
• Infant ventilation's.
• when resuscitation from BVM does not create an
  effective seal.
• Non-Rebreather Mask
• Victims of smoke and/ or gas inhalation.
• Victims of carbon monoxide poisoning
• Full Face Mask
• Patients with adequate respiration's.

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Oxygen

• As a first responder, you should use a standard
  face mask to give oxygen at 10 L/min to
• All trauma patients
• All medical patients except those with a history
  of chronic obstructive pulmonary disease (COPD)
• Oxygen therapy for the non-traumatic COPD patient
  is 5 L/min through a standard adult oxygen mask.
  But at a 10 L/min flow for traumatic COPD
  patients.

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COPD Patients

• In normal people, the breathing reflex is
  triggered by high level of carbon dioxide (CO2)
  in the blood. Patients with emphysema, chronic
  bronchitis, and chronic asthma may have a
  condition know as Chronic Obstructive Pulmonary
  Disease (COPD). They retain CO2 and thus have a
  chronically high level of this gas. Their
  breathing reflex is triggered only when the
  oxygen level in their blood is low. This
  mechanism is known as hypoxic drive. By giving
  COPD patients oxygen, you may suppress their
  breathing reflex.
• Give the patient with COPD, 5 L/min through a
  standard adult oxygen mask. Closely monitor the
  patients respiratory rate, depth, and volume.
  Assist the patients ventilation's if necessary.

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Perform A Secondary Survey

• The purpose of a secondary survey is to identify
  problems that, while not immediately
  life-threatening, may threaten the patients
  survival if left undetected.
• The secondary survey consists of the
• Medical history (chief complaint and history of
  chief complaint)
• Vital signs (LOC, pulse, respiration's, and skin
  colour and temperature)
• Head-to-toe physical examination (if time
  permits)
• The information you gather here will be vital for
  the patients later care. You should be able to
  report it accurately and concisely to ambulance
  personnel when they arrive.

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Chief Complaint

• The chief complaint is what the patient says is
  wrong with him or her. Record and report it using
  the patients own words. This will help you avoid
  interpreting what was said, which may obscure or
  change the nature of the problem.
• Most chief complaints are characterized by pain
  or abnormal function. Find out what is bothering
  the patient most. For example, a victim of a
  motor vehicle accident may have an obvious leg
  fracture but his chief concern may be,I cant
  breath. This may help you discover an
  unsuspected chest injury.

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History Of The Chief Complaint

• The history of the chief complaint examines the
  chief complaint in greater detail. Get a
  description of the events that caused the chief
  complaint. If pain is the chief complaint, use
  the PQRST method to help you organize your
  questioning.
• Ask the following
• Position of the pain.
• Quality of the pain.
• Does the pain Radiate?.
• Severity of the pain.
• Timing of the pain.

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• P - Position
• Where is it located? Can you point to it?
• Q - Quality
• What does it feel like? Is it sharp, dull,
  throbbing, or crushing?
• R - Radiation
• Does it radiate anywhere? or Does it stay in one
  place or move around? Does anything relieve it?
  What makes it worse?
• S - Severity
• How would you rate the pain on a scale of 1 to 10
  
• (10 being the worst)?
• T - Timing
• When did it start? What brought it on? Have you
  had it before? How long does it last?

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Guidelines When Interviewing A Patient

• Allow the patient to answer in his or her own
  words.
• Avoid suggesting answers. (What provoked the
  pain? Not Does the pain come after exertion?)
• Use open-ended questions. Avoid asking questions
  that can be answered with yes or no.
• To pinpoint responses, give the patient
  alternatives. (Does the pain stay in one place or
  does it move around?)
• Reassure the patient frequently.

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Vital Signs

• Baseline vital signs are one of the most
  important aspects of patient assessment. They are
  taken after the primary survey and the medical
  history. Based on them, ambulance personnel and
  receiving hospital staff can tell whether or not
  the patients condition is deteriorating.

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• As a First Responder you should record the
  following
• LOC (using the AVPU method)
• Skin - colour, condition and temperature
• Pulse - rate, rhythm, and strength
• Respiration's - rate, rhythm, and volume
  (quality)
• Monitor the LOC, take the pulse, and count the
  respiration's every five minutes.
• Check whether the patients skin is
• cool or warm
• moist or dry
• pale or normal in colour
• condition

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Recording And Reporting Data

• Recording and reporting data is the last major
  component of the patient assessment model. Your
  report will help guide the ambulance personnel
  and hospital staff in treating the patient.
• Report your findings orally to responding
  ambulance personnel. Your oral report should
  include the following
• Mechanism of injury
• Chief complaint
• History of chief complaint
• LOC, pulse, respiration's, and skin colour and
  temperature
• Treatment given
• All relevant physical findings
• Follow up your oral report with a completed copy
  of the First Responder Report. (within 24 hours
  of the incident)

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Manage An Unconscious Medical Patient
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Assess And Manage Victims Of A Heart Attack
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Manage A Patient Experiencing A Heart Attack
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Assess and Manage Victims of Respiratory Emergency

• People experience difficulty breathing for many
  reasons. Some conditions that cause respiratory
  distress are
• Asthma - spasms occurring in the airways of
  the lungs, causing wheezes.
• Pneumonia - infection of the lungs.
• Bronchitis - inflammation of the bronchi in
  the lungs.
• Emphysema - a chronic decrease in the lungs
  ability to expel air due to cell damage
• If respiratory distress is not relived,
  respiratory failure and respiratory arrest may
  follow.

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Signs and Symptoms of Respiratory Distress

• Laboured, Noisy Breathing
• Irregular Rate, Rhythm, and depth of breathing
• Unusual Pulse Rate and Character
• Flaring Nostrils
• Pursed Lips
• Numbness or Tingling in Hands ands And Feet
• Blue or Grey Lips, Skin, or Nail Beds
• Confusion, Hallucinations
• Desire to Lean Forward

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Manage A Patient Experiencing A Respiratory
Emergency
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Assess and Manage Stroke Victims

• Strokes are sudden brain damage caused by blocked
  or ruptured arteries. A severe stroke may cause
  death less severe one may impair certain bodily
  functions. Because each of the two hemispheres in
  the brain controls the opposite side if the body,
  damage in one hemisphere causes weakness or
  paralysis in the opposite side of the body.

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Signs and Symptoms of a Stroke

• Change in level of mental ability
• Decreased consciousness
• Change in personality
• Trouble understanding speech
• Convulsions
• Severe headache
• Loss of vision, or dimness
• Pupils unequal in size

• Drooping mouth, eyelids
• Inability to speak
• Respiratory distress
• Loss of bladder or bowel control
• Nausea and/ or vomiting
• Paralysis or weakness on one or both sides of the
  body(face, arm, or leg)
• Rapid, strong pulse

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Manage a Patient Experiencing a Stroke

• Do the following
• Maintain an open airway and provide O2 .
• Keep the patient at rest.
• Turn an unconscious patient 3/4 prone onto the
  affected side.
• Place a conscious patient in the position with
  head and shoulders slightly elevated to relieve
  pressure on the brain.
• Continued

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• Protect the patient from injury when being lifted
  or moved or during convulsions.
• Do not allow the patient to become overheated.
• Do not give the patient anything by mouth.

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Assess and Manage Patients With Seizures

• A seizure is a sudden change in sensation,
  behavior, muscle activity, or level of
  consciousness. It is not a disease but a symptom
  of an underlying problem.
• The most common cause of seizure is epilepsy.
  Epileptic have recurrent seizures, but the cause
  is not always known. Focal seizures begin with
  convulsive movements in one part of the body.
  Generalized seizures may begin suddenly and
  spread rapidly.
• Continued

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• Other causes of seizures are
• head trauma
• infection and high fever
• tumors
• hypoglycemia (too little sugar or too much
  insulin)
• stroke
• poisoning

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Signs and Symptoms of a Generalized Seizure

• The patient has sudden loss of consciousness and
  collapses.
• The patients body stiffens.
• Convulsions occur, jerking all parts of the body.
• Breathing is laboured.
• There is frothing at the mouth.
• After convulsions, the patient's body relaxes
  completely.
• The patient becomes conscious, but is very tired
  and confused.

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Manage A Patient Experiencing A Seizure

• Place the patient on the floor or ground if the
  patient is not already down.
• Check the patients ABCs. Intervene if necessary
  to maintain an open airway or to ventilate the
  patient. If an oral airway is not tolerated, do
  not force any other objects between the patients
  teeth while the seizure is going on.
• Administer high flow O2 at 10 L/ min.
• Loosen tight clothing.
• Do not hold the patient during the convulsions.
• Protect the patient from injury and from
  onlookers. Remove any potentially harmful
  objects.
• After the seizure, turn the patient on his or her
  side (3/4/ prone recovery position).
• If the seizure resulted from high fever, cool the
  patient by removing excess clothing.