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First Aid for the First Responder.
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First Aid for the First Responder As a firefighter, you are already a part of a proud tradition. Members of the fire service have always stood at the ready to save lives and to protect property. You will receive training that will enable you to assess patients and provide first aid in the challenging out-of-hospital environment. You will still be a firefighter, but you will also become a competent and valuable part of the Emergency Medical Services ( EMS ) system.
Roles and Responsibilities Your ultimate responsibility will be to provide excellent patient care. To fulfill this responsibility, there are a number of different duties you must perform.
Roles and Responsibilities cont. • Assuring personal safety- remember that you cannot carry out your responsibilities of caring for a patient if you yourself are injured. Keeping yourself safe is your first responsibility. • Assuring the safety of the patient, or other firefighters and emergency care providers, and of bystanders at all times. • Performing patient assessments in order to determine what care is necessary. These are the top three responsibilities of the first responder
Roles and Responsibilities cont. • Lifting and moving the patients in a fashion that is safe for the patient and minimizes the risk of related injuries to yourself and the crew. • Providing for the safe transport of the patient or the smooth transition of patient care to those who will transport him. • Providing complete, accurate, and appropriate documentation of your patient as required by your department. • Respecting the patient as another human at all times. • Acting as a patient advocate – this means that you must at all times speak up for the patients rights and needs and do what you can to assure his well being.
Bloodborne pathogens The federal government established standards ( title 29 Code of Federal Regulation 1910-1030) in 1991 under the authority of the Occupational Safety and Health Administration ( OSHA ) regarding the exposure of emergency care workers to bloodborne pathogens. Infectious diseases are those that spread from person to person. They are called pathogens. These microorganisms include bacteria and viruses. The Federal Government has developed guidelines aimed at preventing the spread of disease through contact with blood and body fluids. These safeguards involve a form of infection control known as body substance isolation( BSI ). Handwashing is a simple measure that can be of great help in guarding against the spread of disease.BSI precautions involves the use of personal protective equipment( PPE ). This includes gloves, masks, goggles, and-when appropriate-gowns for protection against exposures.
PPE Gloves- should be worn on every EMS call where there is a possibility of the exposure to blood. Vinyl or latex specifically for patient care settings are the type most commonly used. Eye protection- to be used in cases where there is a possibility that blood could come into contact with the eyes. In these cases, wear goggles or glasses with side protectors designed to prevent such contact. Masks- are designed to prevent blood and body fluids from coming into contact with the mouth and nose. Gowns- should be of the single-use, disposable to provide a barrier to blood and body fluids and should be worn whenever possible.
Cleaning and disinfection of equipment Any equipment designed for single use should be disposed of properly after each use. Materials contaminated with blood or body fluids, such as gloves, gauze, or bandages should be disposed in a red bag or container marked with a biohazard seal. Needles and other sharp objects should be disposed in a puncture proof container, sometimes called a “sharps” container. Once placed in the appropriate container, dispose of according to your departments guidelines for hazardous waste. Non-disposable equipment used during a call, that may have come into contact with blood or body fluids must receive cleaning, disinfection, or sterilization. Cleaning-refers to the washing of an object with soap and water. Disinfection-includes cleaning, but also involves use of disinfectant to kill many of the microorganisms that may be on objects. Sterilization- is the use of chemical or physical methods to kill all microorganisms on an object.
Every time you respond to a call, you will be faced with some aspect of medical/legal issues. The issue may be as simple as making sure that the patient will accept help or as complex as a terminally ill patient who refuse care.
Legal aspects cont. You are governed by many medical, legal, and ethical guidelines. This collective set of regulations and considerations may be referred to as a scope of practice because it defines the scope, or extent and limits that you may perform.
Legal aspects cont. Before you treat any patient you must first obtain consent to treat that patient. Most of the time the patient or their families will have called for your assistance and will readily accept it.
Legal aspects cont. Consent can be either expressed or implied. • Expressed consent- the consent given by adults who are of legal age and mentally competent to make a rational decision in regard to their medical well-being. • Implied consent- in the case of an unconscious patient, consent may be assumed. The law states that rational patients would consent to treatment if they were conscious. In this situation, the law allows EMS personnel to provide treatment, at least until the patient becomes conscious and able to make rational decisions.
Consent cont. Children and mentally incompetent adults are not legally allowed to provide consent or to refuse medical care and transportation. For these patients, their parents and legal guardians have the legal authority to give consent. In life-threatening incidents, when a parent or guardian is not present, care may be given based on implied consent.
When a patient refuses care, several conditions must be fulfilled. • The patient must be mentally competent and oriented. • The patient must be fully informed. • The patient must sign a “release” form, aka an AMA(against medical advice).
It will only be a matter of time before you come upon a patient who has a do not resuscitate(DNR)order. This is a legal document, usually signed by the patient and his physician, which states that the patient has a terminal illness and does not wish to prolong life through resuscitation efforts.
More legal aspects. There are more legal aspects that you should know before hand. If a legal situation arises that could possibly involve you or your department, certain things need to be found. These are; was there negligence, was there a duty to act, was the patients confidentiality violated, and was the patient abandoned.
negligence Negligence is the finding of failure to act properly at a situation in which there was a duty to act, needed care as would reasonably be expected of the first responder was not provided, and harm was caused to the patient as a result.
Duty to act Duty to act is an obligation to provide care to a patient.
confidentiality Confidentiality is the obligation not reveal information obtained about a patient except to other health care professionals involved in the patients care, or under subpoena, or in a court of law, or when the patient has signed a release of confidentiality.
abandonment Abandonment is when the first responder leaves the patient after care has been initiated and before the patient has been transferred to someone with equal or greater medical training.
Good Samaritan Laws have been developed in all states to provide immunity to individuals trying to help people in emergencies
Special Situations A patient may wear a medical identification device. This device is worn to alert the first responder that the patient has a particular medical condition. Examples of these conditions are: • Heart conditions • Allergies • Diabetes • Epilepsy
Special Situations cont. You may also respond to a call to find that a patient is an organ donor. An organ donor is a patient who has a completed legal document that allows for donation of organs and tissues in the event of their death.
Crime scenes A crime scene is identified as the location where a crime has been committed or any place that evidence relating to a crime may be found. Once police have made the scene safe, the priority of the first responder is to provide patient care. While providing patient care you should take care to preserve evidence, but first you need to know what evidence is.
Examples of evidence at a crime scene • The condition of the scene • The patient • Fingerprints and footprints • Microscopic evidence Remember that your first priority is patient care. But you should also remember what you touch and minimize your impact on the scene. You should work with the police on any crime scene, you may be needed to provide a statement about your actions or observations at the scene
Vital signs are outward signs of what is going on inside the human body. They include pulse; respirations; skin color, temperature, and condition; pupils;and blood pressure.
Pulse The pumping action of the heart is normally rhythmic, causing blood to move through the arteries in waves-not smoothly and continuously at the same pressure like water flowing through a pipe. A finger tip held over an artery where it lies close to the surface can be felt as a “beat.” this is what is called the pulse. The pulse rate is the number of beats per minute. Pulse rates vary among individuals depending on the their age, physical condition, degree of exercise just completed, medications and other substances being taken, blood loss, stress, and body temperature.
Pulse cont. The normal rate for an adult at rest is between 60 and 100 beats per minute. Any pulse rate above 100 beats per minute is a rapid pulse. A rapid pulse is called tachycardia. Any pulse below 60 beats per minute is a slow pulse. A slow pulse is called bradycardia. Two factors determine pulse quality: rhythm and force. Pulse rhythm reflects regularity, while pulse force refers to the pressure of the pulse wave. Pulse rate and quality can be determined at a number of points throughout the body. You should initially find a radial pulse in patients 1 year of age and older. In an infant less than 1 year of age you should find the brachial pulse. If you are not able to measure the radial or brachial pulse, you should find the carotid pulse. Count the pulsations for 30 seconds and multiply by 2 to determine the beats per minute.
Respiration The act of breathing is called respiration. A single breath is considered to be the complete process of breathing in( inspiration or inhalation ) followed by breathing out( expiration or exhalation ). The respiratory rate is the number of breaths a patient takes in in one minute. The rate of respiration is classified as normal, rapid, or slow. A normal respiration rate for an adult at rest is between 12 and 20 breaths per minute. However, if you have an adult patient maintaining a rate above 24( rapid ) or below 8( slow ), you must administer high concentration oxygen and be prepared to assist with ventilations. Respiratory quality, the quality of a patients breathing, may fall into any of four categories: normal, shallow, labored, or noisy. Respiratory rhythm is not important in most of the conscious patients you will see. If you observe irregular respirations in an unconscious patient you should report and document. To record respiratory rate, start counting respirations as soon as you have determined the pulse rate. Count the number of breaths taken by the patient during 30 seconds and multiply by 2 to obtain the respiratory rate. Be sure to keep in mind that brain cells will start to die off after 4 to 6 minutes without oxygen, from the time of the accident or illness. So, the faster you can assess the patients respirations the better the chance for a full recovery of the patient.
Respiratory quality Normal – means that the chest or abdomen moves an average depth with each breath and the patient is not using their accessory muscles. Shallow – occurs when there is only slight movement of the chest or abdomen. This especially serious in the unconscious patient. Labored – can be recognized by signs such as an increase in the work of breathing , the use of accessory muscles, nasal flaring, and retractions above the collarbones or between the ribs, especially in infants and children. Noisy – is obstructed breathing. Sounds to be concerned with are snoring, wheezing, gurgling, and crowing. A patient with snoring respirations needs to have their airway opened. Wheezing may respond to prescribed inhalers or medications. Gurgling sounds usually mean that you need to suction the patients airway. Crowing(a noisy, harsh sound when breathing in ) may not respond to any treatment you give.
Skin The color, temperature, and condition of the skin can provide valuable information about your patients circulation.the best places to assess skin color in adults are the nail beds, inside the cheek, and inside of the lower eyelids. In infants and children, the best places to look are the palms of the hands and the soles of the feet. In patients with dark skin you can check the lips and nail beds. The normal color in any of these places should be pink. Abnormal colors include pale, cyanotic( blue-gray ), flushed( red ), and jaundiced( yellow ).
Skin cont. To determine skin temperature feel the patients skin with the back of your hand. A good place to do this is the patients forehead. Note if the skin feels normal( warm ), hot, cool, or cold. At the same time notice the skins condition, is it dry( normal ), moist, or clammy( both cool and moist ). Also look for goose pimples, which are often associated with chills.
Pupils The pupil is the black center of the eye. One of the things that can cause it to change is the amount of light entering the eye. When the environment is dim the pupil will dilate( get larger ) to allow more light in. when there is a lot of light the pupil will constrict( get smaller ). To check the pupil for reactivity you would shine a light into the patients eyes. You will need to look for three things: size, equality, and reactivity. Both pupils are normally the same size, and when light is shined into them they react by constricting.
Blood pressure Each time the ventricle ( lower chamber ) of the left side of the heart contracts, it forces blood out into the circulatory system. This force of blood against the walls of the blood vessels is called blood pressure. The pressure created during contraction is called the systolic blood pressure. When the heart relaxes, the pressure remaining in the blood vessels is called the diastolic blood pressure. These pressures vary, just like with the pulse, from person to person, depending on their lifestyle and medical history.
Blood pressure cont. To measure blood pressure, you would use a sphygmomanometer cuff ( blood pressure cuff ) with gauge. Position yourself at the patients side and place the cuff around the patients upper arm, the cuff should cover two-thirds of the upper arm. Take care as to not put the cuff on the patients arm if you suspect an injury to that arm. The center of the bladder inside of the cuff needs to be centered over the brachial artery, the major artery in arm. There are two common ways to measure the blood pressure with a blood pressure cuff; auscultation and palpation. Auscultation requires using a stethoscope to listen for characteristic sounds. Palpation of the blood pressure requires using you fingers to feel the pulse as it starts when pressure is released from the cuff. Palpation is not as accurate as auscultation.
Blood pressure ( auscultation ) To measure the blood pressure using the auscultation method, you would, after putting the cuff on the patients arm , put the stethoscope on the patients arm above the brachial artery. Begin inflating the cuff to a point 30mm above the point that you last heard pulse sounds. Begin to slowly deflate the cuff by releasing the air in the bladder, at a rate of 5 to 10 mm per second. Listen for the sounds of the pulse to obtain the systolic reading. Continue deflating the cuff until you no longer hear the pulse sounds, at the point that you last hear pulse sounds will be your diastolic reading. Record the measurement and the time at which it was taken.
Blood pressure ( palpation ) To measure the blood pressure using the palpation method , you would first out the blood pressure cuff on the patients arm just as you would for auscultation. Next, you will need to find the radial pulse. After finding the radial pulse, begin inflating the blood pressure cuff to a point 30 mm above where you last feel the pulse. Then slowly begin deflating the cuff, noting the point where the radial pulse returns.
SAMPLE history When you obtain a patients medical history, you are gathering information that will help shape your subsequent assessment and treatment. The most effective way of taking a patients history is to use the SAMPLE format. The elements of the SAMPLE history are as follows: Signs/Symptoms Allergies Medications being taken Pertinent past history Last oral intake Events leading up to the illness or injury
Signs/Symptoms Signs are objective findings that you can see, hear, feel, or smell without having to question the patient Symptoms are subjective findings. You can’t observe them; you only know about them because the patient tells you