First Aid Settings and Practice

1. First AidSettings and Practice Agoura Hills DRT March 16, 2011 Bill Novik

2. First Aid Settings • Movies in the Park • Concerts in the Park • Relay for Life • The Great Race • The Big One • Little Ones (personal incidents)

3. General Operating Procedures • Incident command structure – IC • Sign-in and –out, report if leaving/returning area • Work in teams • PPE – Personal Protective Equipment • Perform only to level of (CERT) training • CERT level 1, First responder – level 3 • Water (ice), soap, sugar • Supplies – canopies, chairs, cots, backboard, two medical kits, soap, towels, ice, “grab-and-go” bag, radios (HAM or FRS), AED(?) • How to become more involved in DRT – jump in, be self-starting, you’re not far behind anyone

4. Typical Incidents • Lost children • Requests for OTC drugs • Bee stings • Sprains / Strains / Breaks • Scrapes / Scratches • Heat Exposure • Diabetes • Shock / Hypoperfusion • Heart Attack

5. General First Aid Protocol • Introduce self and level of training • Obtain permission to treat • under age 18 • Record name of victim (or gender and age) and injury • Do at least a quick, overall, visual head-to-toe assessment • Get information about nature and cause of injury (SAMPLE)

6. General First Aid Protocol • Tell the victim what you observe, what you will do, and what you are doing • Get assistance if serious injury (immediate-RPM) or are uncomfortable • Call for professional responders if needed (probably through IC) • Keep track of time for important events • Write a report for major incidents (w/i 24 hours) • Recommend professional follow-up if appropriate

7. Bee Stings • Remove stinger quickly • Scrape with edge of credit card, tweezers or fingernail • Tweezers • Do not squeeze the venom sac • Wash with soap and water • Apply ice (not directly to skin) • Ask about known allergic reactions • If unknown, have person stay at first-aid or with someone who can help • can develop an allergy even if immune before

8. Sprains / Strains / Breaks • Signs and Symptoms • Severe fall or collision • Slow capillary refill in child or infant • No pulse below injury • Loss of sensation • Inability to move without pain or discomfort • Painful, swollen, deformed • Action • RICE: Rest, Immobilize, Cold (20 minute cycle), Elevate • Immobilize / Splint • Soft – blanket, towel, pillow, sling • Rigid – board, metal strip, cardboard • Anatomic - arm to chest, leg to leg, digit to digit

9. Sprains / Strains / Breaks • Action: Splint • Do not splint if professionals responding • Splint only if can be done without causing more pain or discomfort • Splint injury in position you find it • Splint injured area and joints above and below injury • Check for proper circulation and sensation before and after splinting • Elevate splinted part if possible • Extra half tie to hold the tie (surgeon’s knot)

10. Scrapes / Scratches • Minor bleeding usually stops within 10 minutes • Blood loss • More than 2 pints – trouble • One liter – deep trouble • Action • Follow BSI (body substance isolation) precautions • Controlling bleeding more important than washing • Direct pressure (white on white on red) • Elevate injured area above level of heart, if not painful • Pressure points • Brachial artery – upper arm • Femoral artery – inner thigh • Monitor ABC (check for cause of injury or for other injuries)

11. Bandaging Tips • Start at narrower point working toward thicker part • Wrap at an angle • Leave a flap to fold over after first wrap and wrap two times to anchor • Half twist over wound to add pressure • Tie off with bow over wound for more pressure • Tie off tips • a) Pull free end of bandage under limb for tie • b) Tear end of bandage down middle for tie

12. Heat Exposure • Signs and Symptoms • Cool, moist, pale, ashen skin (red in early stages) • Headache Nausea • Dizziness and weakness Exhaustion • Signs and Symptoms – Serious Heat Exposure • Change in level of consciousness • Vomiting Sweating stops • Rapid, weak pulse Rapid, shallow breathing • Red, hot, dry or moist skin High temperature

13. Heat Exposure • Action • Check ABC • Summon advanced aid for serious heat exposure • Lie down in cool/shady spot with legs elevated • Loosen/remove clothing • Cool packs to body (wrist, ankles, armpits, groin) • Fan victim • Small amounts of water to conscious victim (sip every 3-4 minutes) • Prepare to do CPR if later stage heat-related illness

14. Diabetes • Signs and Symptoms • Change in level of consciousness • Dizziness, drowsiness, confusion • Irregular breathing • Rapid or weak pulse • Feeling and looking ill • Flushed, hot, dry skin • Sweet breath odor • Restless, agitated • Action • If conscious and can take food or fluids, give sugar • Candy, fruit juice, non-diet soda, table sugar or sugar water • If not better in five minutes after sugar, summon advanced aid

15. Shock / Hypoperfusion Inability for circulatory system to provide oxygen • Signs and Symptoms • Restless/irritable • Pale, ashen, cool, moist skin • Rapid breathing (>30 breaths/minute) • Rapid (100-200 beats/min), weak pulse (drop in blood pressure) • Excessive thirst • Changes in level of consciousness • Nausea • Action • Monitor ABC and treat • Rest comfortably, reassure victim • Keep from getting chilled or overheated • Control bleeding • Elevate legs 12 inches (but do no further harm) • No food or drink • Immediately call for advanced care as cannot be fixed by first aid alone

16. Heart Attack • Signs and Symptoms • Persistent chest pain/discomfort • Mild discomfort to unbearable crushing sensation • Chest pressure, squeezing, tightness, aching, constricting, heavy • Center of chest or spread to shoulder, arm, neck, or jaw • Lasts longer than ten minutes • Difficulty breathing (rapid breathing) • Pulse may be fast or slow • Skin may be pale, ashen, bluish, moist • Action • Convince victim to stop and rest • Obtain information from victim • When pain started What brought it on • Does anything lessen pain What does it feel like • Where does it hurt • Comfort victim Call for care • Assist with prescribed medications Monitor vital signs • Prepare to give CPR if heart stops beating

17. Practice • Scenario – Great Race but paramedics/ambulance not at scene (no band-aid situations) • Treat everyone and everything as real as possible • Select an Incident Commander • Become aware of available supplies • Use supplies – do it real • Reuse previously used supplies if available • Don’t activate cold packs, pour water, or cut clothing • Put supplies back – in good condition • Interact (talk) with victim. Some will give you more information if you talk with them or ask questions • Victims will give you feedback / guidance • If something is truly real, indicate so by saying “real, real, real” or by repeatedly tapping head. Shout out!